CARE Volunteer Advocates Center.

Complete your monthly activity report below.

Your Name

First Name

Last Name

Client's Name

First Name

Last Name

Date of Report

Today's date or the date of your report.

YYYY

Name of Client's Facility

Number of face-to-face contacts with your client this month

The VASIA statute requires that you visit your client in person at least one time each month.

Total time spent in-person with your client this month

Give your best estimate

Date of Last Face-to-Face Client Contact

YYYY

Date of Last Care Plan/Quarterly Meeting

YYYY

Number and brief description of other contacts made on behalf of your client

Ex. 2 telephone calls with nurse and 1 e-mail to CARE

Total time spent making contacts on behalf of your client

Estimate to the quarter hour

What would you estimate the quality of your Ward's care to be?

Describe how things are going with your client, including concerns.