Volunteer Documentation Log VOLUNTEER DOCUMENTATION LOG Patient's Name Volunteer Name* Volunteer Email* Date of visit*MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Time In:* : AM PM Time Out:* : 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 describe 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 describe 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.
