A Community of Exceptional Nurses
University of Medicine & Dentistry of New Jersey: Palliative Care Order Sheet
A palliative care order form completed by the attending physician.
Clinical Care Tools - Care Plan
University of Medicine and Dentistry of New Jersey
150 Bergen Street
Newark, New Jersey 07103-4300
Anne Mosenthal, M.D.
How the grantee used this instrument:
Filled out by attending palliative care physician, these orders become part of the
patients chart and include instructions for palliative care medication/infusions
and other care areas of the critical care patient.
clinical information, intensive care unit, ICU, advance care plan, care plan, protocols,
continuity of care, care coordination
To use this tool:
This tool was revised and used with permission from the Department of Pain and Palliative
Care, Beth Israel Medical Center, NY, NY. For information on obtaining copies of
the Palliative Care Order Sheet please go to
www.theuniversityhospital.com/palliative . Forms are at the bottom of the
Developed specifically for this project by the project team.
To view this tool:
Palliative Care Orders - 5 page PDF
(Viewing PDF files requires downloading and installation of the free
Adobe Acrobat Reader.)
Posted: July 2006
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Promoting Excellence in End-of-Life Care was a national program of the Robert Wood Johnson Foundation
dedicated to long-term changes in health care institutions to substantially improve
care for dying people and their families.
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