Age range classification | 0–1 Y, > 1–10 Y, 11–20 Y, > 20 Y |
Disease classification | Haematology/Oncology |
Neurology/Degenerative | |
Genetic/Metabolic | |
Cardiovascular | |
Gastroenterology | |
Nephrology | |
Congenital abnormalities | |
Immunological | |
Respiratory | |
Others (Neonatology, Transplantation) | |
Origin of referral Classification of patients Number of patients | Origin of referral for new patients (same hospital/other hospital) Curative/palliative/end-of-life patients Total patients followed-up per year |
Death | Place of death (home, hospital, other) Total number of deaths Duration of follow-up Frequencies of admission in hospital Mean average duration of admission Number of contacts with families post-death |
Objectives and needs | What objectives did you have? Which objectives did you achieve? Which objectives did you partially achieve? Why? What are your needs? Which objective(s) did you not achieve? Why? What are your objectives for next year? Did your team change during this year? |
Strengths and weaknesses | What are the strengths of your team? What are the weaknesses of your team? |
Needs assessment | What are the requests of the target group? What are the requests of the PLT? What are the requests of services/institutions/hospitals? |