Caregiver Notes

Caregiver notes to clients.

Client Information

Chose Client from Dropdown
MM slash DD slash YYYY

Client Vitals

Please fill in all that apply
example: 120/80
Body Temperature (Degrees)

Medication Reminders

Please Select
If other please explain

Memory Loss

Please Select
If changed please explain

Mood Behavior

Select One
If changed please explain

Transfers / Ambulation

Check all that apply
If changed please explain
Add a number for falls
Other examples

Bathing

Check all that apply
If changed please explain
Please explain bed sore
Please explain other bathing

Toileting

Check all that apply
If changed please explain
Please explain other toileting

Dressing

Check all that apply
If changed please explain

Meal Prep

Check all that apply
If changed please explain

Food Intake

If changed please explain

Fluid Intake

Example: Milk, Water, Ensure

Urine Output

Check all that apply
If changed please explain
Please explain other urine output

Bowel Movement

Check all that apply
If changed please explain

Housekeeping

Only 20% of full shift should be focused on client related housekeeping.

Daily Shift

Are you taking your 3 - 40 minute breaks?
Are you getting 8 hours uninterrupted sleep at night?
I've practised universal precautions?
Gloves, Masks, and hand washing

Have You Checked CHANGED?

If you have checked off "Changed" you MUST call the office immediately
MM slash DD slash YYYY