FAMILY CONFERENCE

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FAMILY CONFERENCE								    

PURPOSE OF MEETING: 
(Mark those that apply)
[  ] Sharing Information
[  ] Goal Setting
[  ] End of Life Planning
[  ] Discharge Planning

PARTICIPANTS:

SURROGATE DECISION MAKER:

FAMILY/SOCIAL SUPPORT MEMBERS:

PATIENT/FAMILY/SOCIAL SUPPORT GOALS:

SUMMARY OF CONFERENCE DISCUSSION:

TRANSLATOR USED DURING SESSION?
[  ] Yes
[  ] No
-	TRANSLATION DETAILS: 


TOTAL TIME SPENT IN FAMILY CONFERENCE:

FOLLOW-UP:

FAMILY CONFERENCE

PURPOSE OF MEETING:
(Mark those that apply)
[ ] Sharing Information
[ ] Goal Setting
[ ] End of Life Planning
[ ] Discharge Planning

PARTICIPANTS:

SURROGATE DECISION MAKER:

FAMILY/SOCIAL SUPPORT MEMBERS:

PATIENT/FAMILY/SOCIAL SUPPORT GOALS:

SUMMARY OF CONFERENCE DISCUSSION:

TRANSLATOR USED DURING SESSION?
[ ] Yes
[ ] No
- TRANSLATION DETAILS:


TOTAL TIME SPENT IN FAMILY CONFERENCE:

FOLLOW-UP:

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0, 52 boilerplate words
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