Page 22 - Chatham-Kent Hospice
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4 Are there any upcoming events that you would like to recognize? (i.e. birthdays, anniversaries, etc) If so, how would you like to recognize them?
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5. Do you belong to any community groups/clubs? (i.e. Knights of Columbus, Book Clubs) ............................................................................................................................................................................................................. ............................................................................................................................................................................................................. ............................................................................................................................................................................................................. .............................................................................................................................................................................................................
6. Is there anything you are worried about? ............................................................................................................................................................................................................. ............................................................................................................................................................................................................. ............................................................................................................................................................................................................. .............................................................................................................................................................................................................
7. Is there anything else that you would like to share that will help us provide you with the best possible care?
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8. Are you a veteran? Yes No
9. Would you be open to a visit from our Spiritual Care Provider? Yes Not at this time
10. Would you be open to a visit from our Social Worker? Yes Not at this time
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