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Palliative Care Needs
1.
Name of your parish
2.
Name of your ministry within your parish
3.
Does this ministry support any of the following?
Hospital visits
Nursing home visits
Homebound visits
Caregivers
People suffering from specific illness (if yes, please list illness in comment section)
None of the above
Other (please specify)
4.
What does this ministry provide?
Bringing Holy Communion
Visiting and praying with person
Helping with meals
Helping with household chores
Transportation services
Support group for specific illness (please list illness in comment section)
Other (please specify)
5.
Within the definition of palliative Care, are there any other areas of need that are not currently being addressed by your parish or the Diocese?
6.
Are you aware of palliative medicine specialists/providers, or hospice or home care providers, in your area who follow the Catholic Church's teachings (even if they are not Catholic themselves)? If so, please tell us about them in the comment box.
Yes
No
Unsure
Other (please specify)
7.
How can the Diocese of Arlington help you in this mission?
Provide more informational resources and brochures
Offer training for those who visit the sick
Be a central point-of-contact for all parish liaisions related to palliative care ministries
Help parishes set up a "Lending Closet" for medical and other equipment.
Other (please specify)
8.
Optional: Please provide your contact information if you would like to stay informed about palliative care initiatives within the diocese.
Name
Company
Address
Address 2
City/Town
State/Province
ZIP/Postal Code
Country
Email Address
Phone Number
Current Progress,
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