HoursDirectHospice.xlsx

Pine Tree Hospice

Client Services Record for Direct Care: Hospice Clients/Families

Welcome Volunteer…

Here by mistake? You can select a different form:

Our funding and our licensure depend on accurate records of your service

Please select electronic OR paper forms from the "Volunteer Menu" of the Pine Tree Hospice

You may navigate through this form with the Tab key or with your mouse,

entering information into any lavender area, and in any order

Please…

~ enter your name, then select the start date and the end date for this report (3 required fields)

~ record hours for service and travel in 1/4 hour increments, using decimals (ie 2.25)

~ include client initials only (a required field)

~ include dates and comments for direct care service

Note:

Totals recalculate after pressing the keyboard "Enter" key or the left mouse button

You can scroll down any time to the Submit and Erase buttons at the bottom of the form

You can clear data from your last entry by pressing the Erase button at the bottom of the form

You may have to reactivate your number pad by pressing the "Num Lock" key on your keyboard

Name:

Start Date:

Calendar

(click on the calendar icons)

End Date:

Calendar

Client Initials:

Hours

Date

Comments (client initials only, please)

Visit

Phone

Travel

Total

Calendar

Totals:

Total DIRECT CARE Hours for Hospice:

Another client or need more dates? Please submit this form, then fill in another one … thank you

Please let us know if this form was:

Anything else you would like us to know before you submit this form ?

Thank you, Pine Tree Hospice Volunteer … for all that you do !

Note: You can print this page and mail it or deliver it to the office instead of using e-mail

Please enter your name, the dates for this report, and your client's initials

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