/depts/,/depts/uwmf/,/depts/uwmf/patient-resources/,/depts/uwmf/patient-resources/social-guide/,/depts/uwmf/patient-resources/social-guide/manual/,/depts/uwmf/patient-resources/social-guide/manual/population-specific/,/depts/uwmf/patient-resources/social-guide/manual/population-specific/transplant/,/depts/uwmf/patient-resources/social-guide/manual/population-specific/transplant/heart-transplant/,/depts/uwmf/patient-resources/social-guide/manual/population-specific/transplant/heart-transplant/pre-heart-transplant/,/depts/uwmf/patient-resources/social-guide/manual/population-specific/transplant/heart-transplant/pre-heart-transplant/pre-heart-transplant-vad-evaluation/,/depts/uwmf/patient-resources/social-guide/manual/population-specific/transplant/heart-transplant/pre-heart-transplant/pre-heart-transplant-vad-evaluation/transplant-vad/,

/depts/uwmf/patient-resources/social-guide/manual/population-specific/transplant/heart-transplant/pre-heart-transplant/pre-heart-transplant-vad-evaluation/transplant-vad/

201412356

page

100

UWHC,

Patient Services,

Social Work Services Quick Guide,Social Work Manual,Population Specific,Transplant,Heart Transplant,Pre-Heart Transplant,Pre-Heart Transplant VAD Evaluation

Pre-Heart Transplant/Lung Transplant/VAD Assessments: A Guide for Clinicians

Pre-Heart Transplant/Lung Transplant/VAD Assessments: A Guide for Clinicians - Social Work Services Quick Guide, Social Work Manual, Population Specific, Transplant, Heart Transplant, Pre-Heart Transplant, Pre-Heart Transplant VAD Evaluation

Focus

Patient Prefers to be Called

Information Provided By

Concerns Identified by Team

Primary Medical Issues

History of illness/referral for transplant/VAD (ventricular assist device, a pump that assists their heart function)

Type of Surgery

Description of Family System/Emergency Contacts

Care-giving Status

Who would you like involved in planning your care?

Current ADL Equipment/Home Services?

Plan for Post-Transplant Assistance

Housing

Abuse/Neglect

Education

Advanced Directives/Guardianship

Religion/Spirituality

Cultural Issues

Financial Resources

Veteran’s Status

Recent Changes in Relationships/Other Current Stressors

Mental Health History

Adaptation/Reaction to Illness

Stress Reduction Techniques/Tools

Adherence

Substance Abuse History

Legal Issues

Prior Personal Experiences with Transplant/VAD

Expectations for Transplant/VAD

Family/Patient Concerns about Transplant/VAD?

Other

Information Provided

Impression/Summary

Recommendations/Plans/Goals (Choose One)

 

After the Assessment

After you have completed the assessment, please type into a HealthLink note using the appropriate SmartText.

Heart Transplant: The heart transplant coordinators can be reached at 2-8915.

Lung Transplant: The lung coordinators can be reached at 5-5658.

VAD: The VAD coordinator can be reached at 2-0773.