Compassion Line Report
This form is to be filled out on the same day and completed for every report. If caller did not provide the information requested, just enter "Not Answered" or "N/A".
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Chaplain ID or Advocate Telephone Number *
Chaplain or Advocate Name *
Date of Call *
MM
/
DD
/
YYYY
Time of Call
Time
:
Callers First Name or Initials Only? *
Caller Gender *
Age *
Borough/County/State *
Religion *
What was the callers need? *
Required
What was the outcome? *
Does Caller want Follow-Up Call? *
Callers Name and Phone Number? *
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