Sbar Communication Technique Worksheet For Patients And Advocates Page 2

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Complete both sides of the SBAR form before calling your health care provider.
A
A
A
ssessment
New symptoms I have noticed are
.
What has changed in my (the patient’s) condition is
.
(Examples: pain level, temperature, pulse, blood pressure, breathing, color of skin,
agitation, sweating, dizzy, lack of energy, swelling)
I (the patient) seem to be
.
(Examples: stable, unstable, getting worse, in serious trouble)
R
R
R
equest
I would like to talk about these possible actions:
.
(Examples: being seen by the provider, additional tests or monitoring, changes in
medication)
If a change is ordered:
When might I see improvement?
Who should I contact if there is no improvement?
When should I contact that person if there is no improvement?
How should I contact that person if there is no improvement?

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