South Carolina Volunteer Form

Location of Service:
Home VisitAssisted Living FacilitySkilled Nursing FacilityHospitalHospice House

Type of Activity:
VisitPhone CallBereavementRefused VisitOther

Service Provided During Visit:
Music/Art/Pet TherapyRead to PatientCompanionshipEmotional SupportRespite for CaregiverFood PreperationHousehold ChoresLife ReviewPresence at bedsideBereavement SupportFuneral/Memorial ServiceRun ErrandsOther

Administrative Facilities:
Answer PhoneFiling/CopyingSpecial EventsOther