Personal Notes and Questions

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Personal Notes

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For Family and Friends

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More information for families and friends

of McLean patients can be found on our
website at www.mcleanhospital.org
2012 The McLean Hospital Corporation

When someone you care about is in the hospital,

it may be helpful to jot down reminders, questions
you want to ask, what you want to say to others,
information that could help the treatment team,
as well as your thoughts and feelings.

Information about your family

member/friend that could be helpful for
you to share with the treatment team.

The name of the case manager:

Recent changes in behavior, speech and functioning

(such as sleeping, eating, socializing, personal care, etc.):

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Case manager contact information:
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The name(s) of the doctor(s):
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The names of the nurses:
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The hospital unit and location:_________________________
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Past or recent trauma or abuse:

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Recent changes in physical health:
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Recent changes in relationships:
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Recent changes in and past use of alcohol or drug use:
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Family history of mental illness or misuse of alcohol
or drugs:

Current concerns for safety of patient and/or others: _

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History of self-harm or suicide threats or attempts:
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Patient strengths:
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Family expectations for treatment:

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The phone number to the nurses station:

Recent changes in ability and willingness to take

medication:

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The number of the patient telephone line:

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Tell your family member if youd like

to be involved as a partner in their
care. Ask him/her to sign a release
of information form so clinical staff
may share treatment and discharge
planning information with you.