Interdisciplinary Group Meeting Note (Hospice IDG)

Patient: [name, DOB, hospice ID]

Location: [home / facility type]

Primary Caregiver/Contact: [name, relationship]

Meeting Date: [date] Time: [start-stop or duration]

Modality: [in-person / phone / video]

Level of Care: [routine / continuous / GIP / respite]

Hospice Diagnosis: [primary terminal diagnosis]

Attendance

• RN (Case Manager): [name] — Facilitator
• MD/Medical Director: [name]
• Social Work: [name]
• Spiritual Care: [name]
• Aide: [name]
• Scribe: [name]
• Others present: [names and roles if applicable]
• Absent with input reviewed: [discipline, note source/date if applicable]

Interval Summary & Clinical Status

[Since last IDG on [date] / Since SOC/recertification / Ad hoc IDG triggered by: [reason]]

[Interval narrative summarizing functional trajectory, top symptoms and control status, significant medication or treatment changes, caregiver capacity, and any setting transitions or hospitalizations] (3–6 sentences; use attribution language such as "Caregiver reports…", "RN observed…")

Active Symptom Trends:

• [Symptom]: [trend since last IDG], [current management], [response/effectiveness]
• [Symptom]: [trend], [interventions], [effectiveness]
• [Additional active symptoms as relevant]

(Include only symptoms actively addressed; for symptoms not evaluated, state "Not assessed this interval")

Goals: [Updated patient/family goals and priorities] / "Goals unchanged since last review." (Note decision-maker or code status changes if applicable; document how patient/caregiver was engaged regarding plan changes if not present)

Plan of Care Review & Revisions

(Organize by active problem in descending priority)

Problem: [problem name]

• Status/Trend: [brief supporting evidence]
• Goal: [patient-centered goal]
• Interventions: [by discipline, including visit frequency changes as applicable]
• Medication/DME/Supply Changes: [change, indication, order status: ordered / pending / implemented]
• Monitoring/Contingency: [parameters for escalation, when to call MD/on-call]

Problem: [additional problem as needed]

• Status/Trend: [evidence]
• Goal: [patient-centered goal]
• Interventions: [by discipline as applicable]
• Medication/DME/Supply Changes: [if applicable]
• Monitoring/Contingency: [if applicable]

(For stable items requiring no change: "Constipation management: stable on current regimen; continue.")

(If no revisions needed: "Plan of care reviewed; no revisions indicated at this time.")

Follow-Up & Next Review

• [Task] — [Owner] — [Due date/timeframe]
• [Task] — [Owner] — [Due date/timeframe]

Next scheduled IDG review date: [date]

Triggers for earlier review: [uncontrolled symptoms / hospitalization / caregiver breakdown / rapid decline / change in goals / safety concerns]

Authentication

Author/Recording Clinician: [name, credentials] — [signature/date/time]

MD/Medical Director Co-signature: [signature/date/time] (if required by policy)