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Evaluation

Are you evaluating a patient's prognosis to determine if hospice care might be indicated?

Does the patient have a life-threatening condition?

Have the patient and/or family been informed of the seriousness of the patient's condition?

Is the disease documented as being progressive based on clinical and objective measures?

Has the patient had multiple emergency room visits or hospitalizations over the previous 6 months?

Karnofsky performance status (enter as a whole number from 0 to 100)

percent

Current body weight

Body weight 6 months ago

Was the weight loss unintentional and progressive?

Serum albumin

Patient or family's agreed upon treatment goals

Dependence in activities of daily living

Results

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