TX HHS Form 2189. Palliative Care

TX HHS Form 2189: Palliative Care

This form is designed to assist in documenting palliative care and services necessary for a resident in a nursing facility. It should be used by the attending physician to identify expected outcomes on any resident who has been assessed and determined to be in need of end-of-life care. The form helps to ensure that the care and services provided meet standards of practice for nursing, dietary, social, and other services necessary for the resident's comfort and well-being.

The form requires information on expected outcomes such as weight loss, skin breakdown, dehydration, and placement of an indwelling catheter. It also asks about the resident's ability to move independently and potential need for frequent use of medications. The attending physician should identify areas where the resident's response to the disease process or end-of-life process may be unavoidable.

This form is essential for developing a comprehensive care plan that meets the needs of residents in nursing facilities who require end-of-life care. It ensures that all parties involved, including the nursing facility and hospice agency (if applicable), work together to provide coordinated care that prioritizes the resident's comfort and well-being.