Volunteer Documentation Log VOLUNTEER DOCUMENTATION LOG Patient's Name Volunteer Name* Volunteer Email* Date of visit*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Time In:* : HH MM AM PM Time Out:* : HH MM AM PM SERVICES PROVIDED(check all appropriate descriptions)ROUTINE DIRECT PATIENT CARE Reading/Letter Writing Companion to Patient Support to Family Members Assist with Meals Caregiver Companionship Child Care to Relieve Caregiver Bereavement Personal Visit Support at Time of Death Shopping/Errands Outing with Patient Caregiver Respite Telephone Reassurance Bereavement Support Group Other If you selected "Other", please describeTotal Miles Round TripTotal Hours (Include Drive Time)ROUTINE ADMINISTRATIVE Clerical Coordination/Support of Special Functions Marketing Assistance Condolence Letters/Cards Bereavement Telephone Follow-Up Participation on Board/Committee Other If you selected "Other", please describeADDITIONAL COMMENTSSignature*To sign, please type full name here (ie: John Smith) **By signing, I certify that answers given herein are true and accurate to the best of my knowledge. I understand that the visitation of any Treasure Valley Hospice Client requires documentation. I recognize that I am responsible for documenting my time volunteered either at a clients home, or time spent running errands or time spent volunteering in the Treasure Valley Hospice office or at events.
