2026 Tuck in phone call log

VOLUNTEER TUCK IN CALL LOG
Hospicare
Patient Name*
Date of call*

MonthDayYear
Date
Time of call*
Made contactLeft message (see script below)Unable to leave a message
If contact was made, spoke with (full name please) blanks*. Please fill in N/A if you did not speak to anyone.
Script for voicemail: "This is (your name), a volunteer from Hospicare and a member of your care team. I am making our weekly phone call to make sure you have the medication and supplies you need to get through the weekend. If you do have any needs or are having pain or unmanaged symptoms, please call Hospicare at 607-272-0212. Thank you. Goodbye."
Script when contact is made: Hello, my name is ____________, and I am calling from Hospicare. May I please speak with (patient or primary caregiver's name)?
1. I am calling on behalf of your team to make sure you have everything you need before the weekend. Are you (or is the patient) having pain or discomfort today?*

NoYesNot applicable, no contact made
if yes document response:
2.. Are there any medications or supplies you need to get through the weekend?*

NoYesNot applicable, no contact made
If yes, what do you need?
3. Do you have any physical needs, concerns, or any other symptoms that you(the patient) are experiencing that you would like to talk to your primary nurse about before the weekend?*

NoYesNot applicable, no contact made
If yes document response
5. Would you like a phone call from the Social Worker or Chaplain before the weekend?*

NoYesNot applicable, no contact made
If yes document response
6. Do you have any other concerns as we head into the weekend?*

NoYesNot applicable, no contact made
If yes document response
Wrap up phone call with, as an example: Thank you for talking with me today. Please remember if you have any questions or problems this weekend, you can call the main phone number and speak to our on-call nurse.
At completion of call:*

No concerns to report or no contact madeSpoke directly to the nurse regarding concerns and/or requestsLeft voicemail or email for Primary Nurse regarding concerns and/or requestsSpoke directly to Social Worker or Chaplain about request to speak to themLeft voicemail or email for Social Worker or Chaplain regarding concerns and/or requests
By checking this box and typing my name below, I am electronically signing my name.
By checking this box and typing my name below, I am electronically signing my name.
Printed name of volunteer*
Should be Empty: