Palliative Patient Symptom Assessment (ESAS-r)

Personal health information on this form is collected by Health PEI for the purposes of your care and for other purposes permitted by the Health Information Act, including the planning and management of health services. Your information will be collected, used and disclosed only as permitted by law. For more information, visit www.healthpei.ca/yourprivacy or contact Peter Howatt, Manager, Provincial Palliative Care Centre, 902-368-4781.