HD Helpful Forms
Caregiver Daily Instructions-Page 2


Things For Caretakers To Remember
Index Page
Download Word Documents
Personal Emergency Information
Medication & OTC Form
Personal Health History
Caregiver Daily Instructions-Page 1
Caregiver Daily Instructions-Page 2
Caregiver Daily Instructions-Page 3
Instructions-Appointment Schedule
Instructions-Daily Hygiene Schedule
Instructions-Daily Meal & Snack Schedule
Instructions-Daily TV Schedule
Instructions-Household Appliances
Appointments & Follow Up List
Letter to Doctor-Medications
Top 3 Things To Discuss With Doctor
Question List To Give To Doctor(s)
Picture Cards
For "Absent Friends"

Index Page



Favorite Setting

Is there a favorite spot in the house they would prefer being in during different times of the day?  A special chair?  Are there areas that should be avoided?  Why?





Nap time:





Favorite Places/Places they like to go

Do they like to take a walk daily?  Have coffee with a neighbor? Go to the movies?  Indicate where the caretaker may take them in your absence.




Entertainment Preferred

Describe what they enjoy doing the most in their daily routine.  Do they like having a book or newspaper read to them?  Listen to a favorite tape, radio or TV station?  Are there games they enjoy playing alone or with someone?




Are there daily or weekly schedules of outings?  Do they enjoy being taken to a nearby park? Will someone be taking them to a movie, etc..



Habits & Hygiene


Personal Habits

Describe any personal traits the caretaker should be aware of: for example if the person hates bathing, changing clothes, changes clothes frequently, or has any compulsive tendencies




Grooming (see Daily Schedules below)

Indicate how much assistance is required and normal daily schedule for each.


Dental Care



Hair Care


Personal Care


Other/Additional Details


Cleanliness and Neatness

Indicate personal habits, areas of difficulty, special needs for protective clothing etc.




Describe any special needs that should be considered.  What is their level of urgency, i.e. should they be taken immediately to a restroom when they indicate they need to relieve themselves?  Are they incontinent?  If yes, what special things need to be considered?





Do they need assistance?  Prefer shower or tub?  Any special equipment, like a tub chair required?  Do they have any preference for soaps or shampoos?  Do they like to linger or get it over with quickly?  What is their level of modesty, what might embarrass them?


-> Caregiver Daily Instructions-Page 3