Intro
Primary Language
Narative
Your Health
Care Preferences
Variation
Characteristics
Family & Home
Money and Resources
Stress
Safety & Civics

Welcome to the Humanistic Charting Questionnaire

Introduction

Let’s learn a bit about who you are, the person we have the pleasure and privilege of taking care of:

Hello, welcome to the Humanistic Charting Questionnaire. Every patient is so much more than the medical information found in their electronic medical record. You are an individual, you are a person.

With that in mind, we want to improve our process of providing care to every patient by tailoring that care to the person we are working with. Rather than taking care of a patient or disease, we want to take care of you.

Knowing information about a patient’s life outside of the hospital is just as important as the labs, medications, past medical history, allergies, etc. This tool is designed to empower you to provide this information to your health care team, enabling the team to make your care process more effective. This tool gives you the power and control to present important information about yourself to your health care team.

Working with our patients, four critical areas were identified that only patients could provide information on. Information they felt every medical professional working with them should know. This tool is designed to take you through those four important areas and, as you feel comfortable, writing down that information.

Please understand, this is not a requirement for you to complete. That being said, our goal is to provide you the best care we can. The more information we have about you, your preferences, your life, etc., the more personalized and effective care we can provide. Thank you for taking part in this.

Unique Participant Identifiers



Part 1: Your Story

In this section, we want to learn a bit about you and your life. Who or what is important to you; what you would like us to call you; what your favorite food is; hobbies that you enjoy; etc.?

Below you can see an example that one of the patients who helped create this tool provided:

Hi, my name is John Doe, my pronouns are he/him/his, and my mother makes some amazing spaghetti meatballs and sausage. I have a large family and the most important people to me are my wife Sandra and my sister. I love going to the park with my wife and spending time with our cats, Spumoni and Cecilia. The thing I value most is that I am not judged by my mental health condition, I am so much more than that. In my free time I love to write, but it is something I really only enjoy when I am inspired. I also like to make movies, especially documentaries. I am a simple man, but very happy with everything I have.

This is a short paragraph one of our patients (John Doe is not their real name) was able to put together. We realize how complicated writing a paragraph like this can be, for that reason, under the guidance of our patients we created two options.

Option A: If you feel comfortable writing the paragraph yourself, select YES.

Option B: If you do not feel comfortable writing the paragraph yourself, select NO.This will take you to an electronic survey that based on a few short answers will create a short paragraph for you.In order to make this story your own, you will be able to edit the paragraph however you want.

Part 2: Your Health

By pressing on the + button, you are able to add more answers to the questions. You can also remove answers by pressing the x button.

Is there anything that you have been wanting to speak with your doctor about? (i.e., Insurance change, recent fall/injury, question about preventive care, vaccines, etc.)

By pressing on the + button, you are able to add more answers to the questions. You can also remove answers by pressing the x button.

Part 3: Care Preferences

This section was designed to inform your health care team how they can best work with you. Every person has a preferred way of communicating, learning, and interacting . The main goal of every health care team is to keep you healthy. If there is any way to improve the care being provided, it is important to make that effort!

* Visual learners will typically retain more information when they can see something that graphically depicts what they are trying to learn. The best way to learn are through visual aids whenever possible. (Info provided to provider in one-pager based on answer)
* Auditory learners will retain more information when they hear something. The best way to learn something is to hear it over and over. (Info provided to provider in one-pager based on answer)
* Physical learners will retain information when they use the hands-on approach – like labs and demonstration or using the tools. (Info provided to provider in one-pager based on answer)

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In case you have not heard this term before, here is a link to a video that talks a bit more about this: https://www.youtube.com/watch?v=MERUHyT3yFk

Part 4: Variation


Important things to know about your life outside of the hospital!

Our life outside of the hospital can strongly impact our health. Information about your current reality, your past, and your community/environment could be important information for your health care team to know about. With this information, the care you receive can be tailored to be more effective and meet your individual needs. Below are a few areas for you to write about your life and help guide the care that is being provided.

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Part 5: Personal Characteristics

Part 6: Family and Home

Part 7: Money and Resources

Part 8: Stress, Safety, & Civics


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