Patient Participation Forms
The following forms are tools for patients, family members, and caregivers to use to prepare for health care encounters, to fully participate in their visits, and to keep track of important information during hospitalization.
Please print the appropriate form, fill in the information, and share with your providers. Use the back of each for additional notes and keep a copy for your own personal health record.
Please Note: We have moved all of our patient education resources (and others!) to our new companion website at www.EngagedPatients.org. The new website is membership-based and it is free to join. The membership offers free access to all of our materials, including the comprehensive Empowered Patient Hospital Guide. This is to make it easier and more efficient for you to find the appropriate tools and to allow us to track the numbers of downloads so we can assess which resources are most helpful to our visitors. Clicking on a link below will take you directly to that resource on the Engaged Patients website. Thank you!
Patient and Family Rounding Daily Summary
True patient and family centered rounding is dependent on educating families about the purpose and the goals of daily rounds and to offer them the opportunity to participate in a meaningful way. This form assists families in feeling prepared before, during and after rounds and in sharing their observations, questions and concerns using a tool that is similar to the ones used by providers.
Free Download – Patient and Family Rounding Daily Summary
Preparing For a Health Care Visit
With a limited amount of time available to patients during the typical office visit, it is important to prepare ahead of time by listing your symptoms, questions, and concerns. Taking the time to organize your thoughts will help you make the most of your time with your care provider.
Free Download – Preparing For a Health Care Visit Form
Outpatient Visit Summary
One way that patients and their advocates can participate during an office visit is to keep track of the details in a format that provides an organized summary of the visit. A summary allows patients to refer back to the events of the visit, to confirm any instructions that were given, and to be sure they follow up on recommendations and goals before their next visit.
Free Download – Outpatient Visit Summary Form
Inpatient Information Sheet
It can be especially challenging for family members and advocates to stay organized during a hospitalization – especially if several people are taking shifts. An inpatient information sheet kept at the bedside will ensure that everyone helping with the patient’s needs have important information about the patient and his or her limitations, questions, and expectations their fingertips.
Free Download – Inpatient Information Sheet
Inpatient Daily Progress Sheet
One of the most important steps you can take toward being an empowered patient is to keep your own record of your hospital care. Hospitals keep a detailed record of your treatment to function as a safety and communication tool. Keeping your own daily progress sheet will provide a starting point for asking questions and successful consulting with your care team. The Daily Progress Sheet is brief and organized and will also assist family members and advocates in keeping other friends and family updated on the patient’s progress.
Free Download – Inpatient Daily Progress Sheet