Interdisciplinary Case Conference Note

Date/Time: [Date and start time of conference]

Patient: [Name and identifiers per local policy]

Conference Type: [routine IDT / discharge/transition / complex care / safety/risk / hospice-SNF plan-of-care review]

Reason for Conference: [One-line trigger for meeting]

Location/Modality: [in-person / virtual] (Note remote attendance if applicable.)

Author/Recorder: [Name, role, and service]

Attendance

• [Participant 1: Name — Discipline/Role — present / remote / absent-with-reason]
• [Participant 2: Name — Discipline/Role — Presence status]
• [Add additional participants as needed]

(Include external participants only when present. If expected disciplines were absent, note reason and whether follow-up outreach is planned.)

Patient/Caregiver Present: [Yes / No] — [If No: medically unable / declined / lacks capacity / staff coordination only] (If family/caregiver present, note relationship and whether patient consented to their participation.)

Discussion & Decisions

Synopsis: [Brief patient-centered summary] (2–4 sentences: why the case is complex, relevant clinical and social context, and what decision(s) the conference aimed to reach.)

[Issue 1]: [Problem or focus]

• Key facts: [Concise objective/contextual facts relevant to this issue]
• Decision: [Specific decision reached]
• Rationale: [Brief rationale]
• Contingency: [If X, then Y — include escalation triggers]

[Issue 2]: [Problem or focus]

• Key facts: [Facts]
• Decision: [Decision]
• Rationale: [Rationale]
• Contingency: [If X, then Y]

(Add additional issues as needed. Prioritize highest-risk or highest-urgency issues first.)

Goals of Care

[Stated goals and preferences] (Use patient's words if available; otherwise provide attributed summary.)

Code Status: [Full Code / DNR / DNI / Other / Undecided]

Surrogate Decision-Maker: [Name, relationship, and legal status if identified]

(Include only if goals of care were discussed. If not discussed, replace this subsection with: "Goals of care not addressed today.")

Discharge/Transition Planning

Target disposition: [Home with services / SNF / Inpatient rehab / Hospice / Other / Undecided — if undecided, note what is pending]

Estimated discharge date or readiness criteria: [Date or criteria]

Services and follow-up: [Services to arrange, follow-up appointments, responsible party for scheduling]

Medication transition: [Reconciliation status, access barriers, education needs]

(Include only if discharge or transition planning was on the agenda.)

Safety/Risk Mitigation

• Risk: [Falls / self-harm / elopement / medication error / other] — Mitigation: [Specific actions] — Monitoring: [What, how often, by whom] — Escalation triggers: [Specific thresholds] — Responsible party: [Name/role]
• [Add additional risks as needed]

(Include only if safety/risk issues were discussed. Avoid vague statements; specify concrete monitoring and escalation criteria.)

Action Items

Action	Owner	Due	Priority	Status
[Specific, testable task]	[Name, role]	[Date/time or "by discharge" / "within 48h"]	[high / routine]	[new / in progress / completed / deferred]
[Task]	[Name, role]	[Due]	[Priority]	[Status]
[Task]	[Name, role]	[Due]	[Priority]	[Status]

(Use imperative, testable tasks. Assign single accountable owner. For high-priority tasks, note whether owner acknowledged acceptance.)

Follow-up

Next Review: [Date/time of next conference or criteria that would trigger reconference]

Author Signature: [Standard EHR attestation with credentials]