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Getting Started

 

List of Patient Needs

Personal Care
Bathing/Grooming: _______________________________________________________
Feeding: _______________________________________________________
Dressing: _______________________________________________________
Toileting: _______________________________________________________
Exercise/Physical Therapy: _______________________________________________________
Other: _______________________________________________________
 
Daily Activities/Maintaining the Household
Shopping: _______________________________________________________
Cleaning: _______________________________________________________
Cooking: _______________________________________________________
Laundry: _______________________________________________________
Going to Appointments: _______________________________________________________
Doing/Taking Patient to Do Errands: _______________________________________________________
Other: _______________________________________________________
 
Participating in Medical/Nursing Care at Home
Administering Medications: _______________________________________________________
Performing Medical Procedures (e.g. changing dressings): _______________________________________________________
Communicating with the Health Care Team: _______________________________________________________
Symptom Management (e.g. pain, breathlessness): _______________________________________________________
Other: _______________________________________________________
  _______________________________________________________
Supervision
Visiting: _______________________________________________________
Providing Emotional Support: _______________________________________________________
Providing Companionship: _______________________________________________________
Checking on the Patient: _______________________________________________________
Other:  _______________________________________________________
     
Organizing Home Care  
Visiting Nurse: _______________________________________________________
Home Care: _______________________________________________________
Hospice Home Care: _______________________________________________________
Physical Therapy: _______________________________________________________
Ordering Equipment: _______________________________________________________
Other: _______________________________________________________
 
Organizing Medical Care  
Keeping Track of Appointments: _______________________________________________________
Picking Up Prescriptions: _______________________________________________________
Transportation to Appointments: _______________________________________________________
Acting as a Health Care Proxy: _______________________________________________________
Dealing with Emergency Hospital Visits: _______________________________________________________
Managing Deliveries of Supplies/Equipment: _______________________________________________________
Other: _______________________________________________________
 
Managing Finances  
Handling Insurance: _______________________________________________________
Maintaining Bank Account: _______________________________________________________
Collecting Social Security Benefits: _______________________________________________________
Paying Bills: _______________________________________________________
Paying for Items Not Covered by Insurance: _______________________________________________________
Will & Estate Planning: _______________________________________________________
Other: _______________________________________________________
_______________________________________________________
Other  

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