CASE CONFERENCE NOTE

Patient: [Name, date of birth, or ID]
Date: [Date]
Start and end time: [Times, and total minutes]
Conference type: [Team case conference, family care conference, discharge planning meeting, or planned review]
Format: [In person, video, phone, or a mix]
Chair: [Name, role]
Note written by: [Name, role]

ATTENDANCE
Present: [Each person's name, role, and organization, and how they joined]
Patient: [Present for all or part, or not present and why]
Family and supports: [Names and relationship, or none]
Interpreter: [Language and name, or not needed]
Invited, not present: [Name, role, and any written input sent]

CONSENT
Patient agreed to: [The conference, who took part, and what could be shared with them]
If the patient lacks capacity: [Who agreed for the patient, and on what authority]
Limits set by the patient: [Topics or copies the patient asked to keep from family or agencies, or none]

PURPOSE
Why now: [The trigger: repeated admissions, a discharge, a stalled plan, a new risk, or a family request]
Questions for today: [The decisions the team needs to reach]
Last conference: [Date, or first conference]

SITUATION BY DISCIPLINE
Physician or nurse practitioner: [Diagnoses, recent events, results, and current medicines]
Nursing: [Symptoms, self-care, monitoring, and what the nurse has seen at home or on the unit]
Pharmacy: [Medicine review findings: duplicates, interactions, adherence, cost]
Therapy: [Occupational, physical, or speech therapy findings and function]
Social work or case management: [Housing, income, caregiving, school or work, and services in place]
Other services: [Home care, housing, school, or other agencies, and who reported]

GOALS
Patient's goals: [What the patient wants, in their words]
Family's view: [Each person's hopes and worries, under their name]
Strengths and supports: [People, skills, and services already helping]
Advance care plan: [Wishes or decision-maker on file that bear on today's decisions, or none]

OPTIONS DISCUSSED
Option 1: [What it is, who raised it, benefits and risks]
Option 2: [What it is, who raised it, benefits and risks]
Option 3: [What it is, who raised it, benefits and risks, or none]

DECISIONS
Decision 1: [What was decided, and why]
Decision 2: [What was decided, and why]
Patient's response: [Agreed, agreed with changes, or declined, in their words]

ACTIONS
Action 1: [Task, owner, due date]
Action 2: [Task, owner, due date]
Action 3: [Task, owner, due date]
Patient and family tasks: [Task, who, due date]

DISAGREEMENTS
Points not agreed: [Who held which view, and their reasons]
How handled: [Compromise, a trial with a review date, the patient's decision respected, a second opinion, or an ethics consult]

FOLLOW-UP
Plan updated: [Care plan or treatment plan changed, and where it is kept]
Copies to: [Patient, family, team members, and agencies, as consent allows]
Next conference: [Date, time, format, and what would bring it forward]

Signed: [Name, role, date and time]