Form from HIS OpenVistA

  1. 2/25/12 2/25/12 -
  2. 6/7/17 6/7/17 - Martin Dugas
Uploaded on:

June 7, 2017

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Creative Commons BY-NC 3.0
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  1. StudyEvent: HIS
    1. HIS
Anticipated discharge planning on admission
Assisted Living, Residential Care
Home (lives alone)
Home with parent(s)
Home w/Significant Other
Home w/Spouse
Home w/Family (children)
Home w/Friend (caretaker)
Dependent in ADLs
Independent in ADLs
Nursing Home (NH)
Rehabilitation, Rehabilitation therapy
Retirement Center/Assisted Living Facility
Requires Assistance with ADLs
Educational learning assessment
Is the patient/family motivated to learn?
Do You have any emotional/family/home concerns that need to be addressed during your hospitalization?
Do You have any physical or cognitive limitation that may alter care or limit your learning ability?
Reading preference
Collaborative Patient/Family Education record

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