/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/lung-transplant/,/depts/uwmf/patient-resources/social-guide/manual/population-specific/transplant/lung-transplant/assessments/,

/depts/uwmf/patient-resources/social-guide/manual/population-specific/transplant/lung-transplant/assessments/

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UWHC,

Patient Services,

UW Medical Foundation,Patient Resources,Social Work Services Quick Guide,Social Work Manual,Population Specific,Transplant,Lung Transplant

Assessments

Assessments - UW Medical Foundation, Patient Resources, Social Work Services Quick Guide, Social Work Manual, Population Specific, Transplant, Lung Transplant

Focus

Pre-Transplant Assessment

SmartText

Social Work Pre-lung Transplant Psychosocial Assessment

Patient Prefers to be Called:

Information Provided by:

Concerns Identified by Team:

Primary Medical Issues:

History of Illness/Referral for Transplant:

Description of Family System:

Support System/Emergency Contacts:

Caregiving Status:

Current Home Equipment:

Current Home Services:

Plan for Post-transplant Assistance:

Plan for 24 Hour Caregiver Post-Discharge:
Plan for Madison-area Housing Post-Discharge:
Payment Source for Housing:
Payment Source for Meals:

Housing:

Abuse/neglect:

Transportation:

Education/Learning:

Advance Directives/Guardianship:

Cultural Issues:

Religion/Spirituality:

Financial Resources

Income:
Insurance/Rx:
Veteran Status:

Other Current Stressors:

Mental Health:

Adaptation/Reaction to Illness:

Stress Reduction Techniques/Tools:

Adherence to Medical Plan:

Nicotine Use:

Alcohol Use:

Illicit Drug Use:

Legal Issues:

Prior Personal Experiences with Transplants:

Expectations for Transplant:

Patient/family Concerns about Transplant:

Other: Reviewed Risk of Depression, Anxiety, PTSD, Guilt Post Transplant.

INFORMATION PROVIDED

IMPRESSIONS

RECOMMENDATIONS

SUMMARY

Support:

Employment:

Nicotine Hx:

Yrs in School:

Insurance:

ETOH Hx:

Cultural:

Emotional:

Illicit Drug Hx:

Spiritual:

Compliance:

Other Concerns:

Recommendations:

Resources