Volunteer Patient Visit Record


homenursing homehospitalphone visitother


BedWheelchairRecliningChairOther


agitatedalertasleepawakecomfortableconfusedrelaxedrestlesstalkativeshort of breathother


bereavementcosmetologyerrands & shopperfriendly visitormassage therapistpersonal historian/patient life storiesseamstress/quilterrespite (caregiver relief)singer/instrumentalistvisiting dogveterans to veterans11th hour vigilpersonal carespiritual careother


agitatedalertasleepawakecomfortableconfusedrelaxedrestlesstalkativeshort of breathother

Did the patient complain of pain? yesno

If yes, please tell what actions you took:
patient took medicationpatient refused medicationnotified the caregivernotified employee at LSHother

Visit Time:




in-service trainingcommunity eventvolunteer lunchvolunteer meetingoffice assistantbereavementsewingother