WORKSHEETS

Figure 1-1 Personal Medical Fact Sheet 

The foundational document in a Family Healthcare Playbook. This worksheet provides an overview of your loved one’s medical history and includes critical healthcare information including your loved one’s emergency contacts; preferred urgent care, emergency room, and hospital; doctors’ names; current allergies and medications; a medical history timeline, which includes previous surgeries. It is also a place to keep copies of health insurance and identification cards. A part of a Family Healthcare Playbook, this worksheet serves as the single source of truth (SSOT) for your loved one’s medical information. 

Figure 1-2 Electronic Medical Record (EMR) Logins Worksheet 

A tool for managing your loved one’s electronic medical record login information. 

Figure 2-1  The Personal Legal and Financial Information Fact Sheet 

This worksheet includes places to record legal and financial contact information and account information.

Figure 4-1 Care Notes Worksheet  

A tool for documenting all medical interactions and activities related to your loved one’s care. This worksheet can be used to take notes and document activities as part of your loved one’s hospital stay as well as exams or consultations with doctors or specialists in a clinic setting. 

Figure 6-1 Home Caregiver Interview Questions Worksheet 

A list of suggested questions to use when interviewing a potential third- party in-home care nurse or paid caregiver. The worksheet includes spaces to record the responses. 

Figure 6-2 Daily Medications and Vital Signs Worksheet 

A daily tracking tool designed for documenting your loved one’s medications, vital signs and other critical health readings, and daily activities.