Promoting Excellence : PEACE: Palliative Care Clinic Referral Letter

University of Chicago PEACE: Palliative Care Clinic Referral Letter

A one-page letter to the physician of a patient who was seen at the Peace Palliative Care Clinic, summarizing the clinic evaluation and offering several recommendations.

Clinical Care Tools - Care Plan

Palliative Excellence in Alzheimer's Care Efforts (PEACE)
University of Chicago Medical Center
Section of Geriatrics (MC 6098)
5841 South Maryland Ave.
Chicago, IL 60637

Gavin W. Hougham, Research Director
[email protected]

Greg A. Sachs, Chief, Section of Geriatrics
[email protected]

How the grantee used this instrument:
This letter informed the patient's referring physician that their patient was seen at the clinic, who accompanied them, a list of recommendations for care, and the date of the next visit. Each letter is customized to the specifics of each patient.

symptom management, assessment

To use this tool:
You may adapt this letter for your own clinical use without additional permissions.

Adapted for the PEACE project by Deon Cox-Haley and Lisa Maillard.

To view this tool:
Left click on the download link to view the PDF document in your Web browser. Right-click on the download link to save the document to your computer.
pdf PDF 12 KB / 1 page (Viewing PDF files requires downloading and installation of the free Adobe Acrobat Reader.)

Posted August 2004

University of Chicago: PEACE overview page

# UCP11, type:care_plan

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. Visit for more resources.

Promoting Excellence logo and link to home page