Hospice Of Michigan Volunteer Documentation
Volunteer Information
Volunteer Name:
Submit Form To:
-- Please Make a Selection --
Alana Knoppow
Alison Wagner
Alpena Volunteers
Ann Thomas
Anne Schippers
Big Rapids Volunteers
Breanna Rodwell
Cadillac Volunteers
Danielle Locks or Jess Dailey
Gaylord Volunteers
Kathy Lietaert
Laura Hewson
Lauren Becker-Barkman
Ludington Volunteers
Macomb Volunteer
McKenna LeCouffe
Megan Cadle
Paige Heys
Ruth Moore-Lilly
Traverse City Volunteers
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Patient Information
Patient ID:
Patient Name:
Visit Information
Date:
Start Time:
End Time:
AM
PM
AM
PM
Notes:
Direct Duration:
Indirect Duration:
Hours
Minutes
Hours
Minutes
Travel Duration:
Total Miles:
Hours
Minutes
(Round Trip)
N500 Attempted Patient Visit
S100 COVID Screening and Temp Check
V201 Household Chores
V203 Volunteer Phone Contact
V204 Spiritual Support
V205 Group Activity
V206 Licensed Professional
V207 Grief Support
V208 Relief for Caregiver
V209 Companionship
V210 Office Support
V211 Community Outreach
V212 Education
V213 Fundraising
V214 Grief Support, Group
V215 Grief Support, phone contact
V217 My Stories Program
V218 Bedside Vigil
V219 Pet Visits
V220 Bereavement, Memorial/Funeral Visits
V221 Veteran To Veteran Visit
V222 Veteran Community Outreach
V223 Patient Music Visit
V224 Grief Support Event
V225 Support for Grief Department
V250 Compassionate Call
V260 Grief Support, Admin Phone Call
V270 Respite Visit in LTC Facility
V700 My Music Program Visit
V800 Virtual Spiritual Support
V801 Virtual Grief Support
V802 Virtual Companionship
V803 Virtual Pet Visit
V804 Virtual Vigil
V805 Virtual My Stories
V806 Virtual Veteran to Veteran
V807 Virtual Patient Music Visit
V808 Virtual Art Program
V809 Virtual Mailings Cards
V810 Remote Patient Support
V811 Intern Training
V812 Intern Documentation
Description:
This activity includes companionship visit for patient, family or significant other.