Awareness

HD Awareness Tri-fold Handout I Have Huntington's Disease card Info on HD For Temporary Caregivers Click here to download this document   CNA's First Shift Jim Pollard's excellent brochure providing an overview on an HD patient for Certified Nursing Assistants (CNA's) which can also be used to provide temporary caregivers at home, at day care centers, etc. Appointments Appointment Information                                      Use this form to keep track of your loved ones medical appointments* Appointment Information-Q&A's Therapy Calendar-Questions & Recommendations Weekly Rehab Calendar A form to help you and your loved one track his or her rehabilitation goals and successes* At Home Helpful Forms   Caregivers Document Organizer A form that will help you identify, locate, and organize the important documents your will need as a primary caregiver*   Caregivers Journal Some tips for setting up a notebook to keep track of your caregiving situation*   Caregivers Log Use copies of this form to monitor daily changes and help with communication among care providers working in shifts*   Caregiving Decision Questionaire A brief list of questions to help you set prioities and solve caregiving problems*   Continuing Care Questionnaire A list of questions to ask when you and your loved one visit a continuing care retirement community*   CPR-Everything You Wanted To Know (in PDF format) Cardiopulmonary Resuscitation (CPR) includes a group of procedures used when the heart stops beating.   Daily Caregiver Instruction form   Home Modification Checklist How to safety-proof a loved ones home*   Home Modifiction - Safety Checklist and Assessment Instrument Excellent links to home modifications and checklists from the National Resource Center on Supportive Housing and Home Modifications   In Case of Emergency Form    Personal Daily Care Instructions In depth instructions to leave for temporary caregivers.   Personal Records A form to help you keep track of your loved ones personal records and other important information*   Sample Filing System One possible method for setting up a home filing system. You should adopt a system that fits your needs and those of your family* Assessment-Checklists Driving Assessment Checklist Needs Assessment Worksheet (ADL) Medical Choosing the Right Doctor Consider these questions and steps as you and your loved one evaluate physicians*   Choosing A Rehabilitation Program A list of questions to consider as you and your loved one prepare to choose a rehabilitation program* Making a Personal Medical History Chart A sample chart to help you document your loved one's medical history Medical Appointments-Record Changes To Discuss With Your Doctor Use this form to keep track of your medical appointments. Personal Medical History form                                     A very indepth and personal report typically asked from new physicians. Medications My Medication & OTC list New Drug Checklist-Q&A's Weekly Medication Direction & Check Off Chart Individual Medication Weekly Chart-Check Off Keeping Track of Side Effects Form

Assisted Living-Questions To Ask

Social Services Q&A Checklist

Assisted Living:  Quality Of Life A checklist of questions dealing with socializing, meals, safety, and other issues to consider when you and your loved one visit an assisted living facility*

Assisted Living: Special Care Units If your loved one is considering a move to assisted living, you need to find out about any special care services offered by the facility*   Assisted Living: Costs And Contracts A list of financial questions to ask when you and your loved one visit an assisted living facility*   Assisted Living: Personal Care A checklist of personal and health care questions to ask when you and your loved one visit an assisted living facility*   Assisted Living-Questions To Ask WORD DOC  A checklist of personal and health care questions to ask when you and your loved one visit an assisted living facility.   Assisted Living: Special Care Units                          If your loved one is considering a move to assisted living, you need to find out about any special care services offered by the facility.   Nursing Home Checklist A list of basic questions to ask when you and your loved one visit a nursing home*   Social Service Checklist Use this form to keep a record of in-person and phone interviews with social service agencies*   Questions About Hospice Care A checklist of questions to ask as you try to find the right hospice service for your loved one*

Estate Planning

What Is Estate Planning Document

What Is A Conservatorship-Guardianship?

 

Do Not Resuscitate Order WORD DOC

 

Guidelines for Quality Care-Evaluating Quality of Care Checklist (in PDF format) Although there are no "report cards" or accepted national standards

yet available for judging quality end-of-life care, these are some questions you can ask to evaluate care. These can be used to help select providers and are also helpful if a loved one is dying and you are uncertain of the quality of care they are receiving. Use this checklist to talk to members of the health care team.

 

Health Care Surrogate

 

Making A Personal File in Word

 

Personal Record & Documentation Form 

Valuable Records Form

 

Where To Find My Papers Form

 

Net Worth Calculation Worksheet
A form to help you assess your loved ones financial situation*

 

Your Valuable Records
A form to help you keep track of all of your familys valuable records*

 

End of Life

 

Are You Grieving? A checklist of the physical, mental, and behavioral symptoms of grief*

Funeral Planning Checklist A list of all of the issues to consider when planning a funeral*

Funeral Planning Form As your loved one makes his or her funeral plans, use this form to record all of their wishes for final arrangements*

Funeral Planning: Personal Information A form to help you record important personal information for use in planning a funeral, informing friends and relatives, and writing an obituary*   *Source Family Care America one of the most trusted sources of information and resources for care-givers of the elderly, disabled, and chronically ill.  These forms are linked here for your convenience and use.