End of Life Assessment Template

Patient Information: [document full name, age, gender, relevant cultural or religious background if noted] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in full sentences.) Presenting Concerns: [describe current health status, terminal diagnosis, recent changes or deterioration, symptoms, and relevant concerns] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in full sentences.) Goals of Care: [outline patient's expressed goals, wishes for care, or what is most important to them at this stage] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in full sentences.) Medical History: [include relevant medical, surgical, and psychiatric history that impacts current care planning] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in full sentences.) Medications: [list current medications including dose and frequency, as well as any recent changes] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as list.) Symptoms: [detail presence, severity, and impact of symptoms such as pain, dyspnoea, nausea, agitation, etc.] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in full sentences.) Functional Status: [describe current mobility, level of independence, cognitive status, and ability to perform daily activities] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in full sentences.) Psychosocial and Emotional Needs: [include emotional wellbeing, fears, concerns, family dynamics, and support systems] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in full sentences.) Spiritual and Cultural Considerations: [describe any spiritual, cultural, or religious beliefs that may influence care preferences] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in full sentences.) Advance Care Planning: [note presence of advance care directives, resuscitation orders, substitute decision-makers or legal guardians] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in full sentences.) Environment and Supports: [describe current care environment (e.g. home, hospital, aged care), involved services and carers, and any gaps or needs] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in full sentences.) Clinical Summary and Recommendations: [provide overall clinical impression, key findings, and recommendations for ongoing care] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write in full sentences.) (Never come up with your own patient details, assessment, plan, interventions, evaluation, and plan for continuing care - use only the transcript, contextual notes or clinical note as a reference for the information include in your note. If any information related to a placeholder has not been explicitly mentioned in the transcript, contextual notes or clinical note, you must not state the information has not been explicitly mentioned in your output, just leave the relevant placeholder or omit the placeholder completely. Use as many lines, paragraphs or bullet points, depending on the format, as needed to capture all the relevant information from the transcript.)