Sbar Communication Technique Worksheet For Patients And Advocates printable pdf download

Sbar Communication Technique Worksheet For Patients And Advocates

SBAR Communication Technique for

Patients and Advocates

This form is to help you talk with your healthcare provider when you notice a change in your

health that you believe needs medical attention. Gather all this information and complete

both sides before you call so you can quickly describe the problem. Healthcare providers are

used to getting information this way.

If this is an emergency, call 911.

ituation

I am

(state your name).

I am the

(relative, advocate, friend, Medical

Power of Attorney) for

(state the patient’s

name).

I am concerned about

ackground

My (the patient’s) diagnosis is

or unknown at this time.

My (the patient’s) physical limitations are

(Examples: hearing loss, difficulty walking, swallowing, poor vision)

My (the patient’s) mental limitations are

(Examples: dementia, head injury, unable to communicate)

I am (the patient is)

(Examples: on oxygen, receiving new medications, recovering from a procedure or

surgery, waiting for test results

)

Fill in the other side before calling.

Sbar Communication Technique Worksheet For Patients And Advocates