Template Information
Home visit checklists are used by healthcare professionals when conducting house calls to assess the medical condition of patients and provide patient care. this digital home visit checklist covers the patient’s immobility, nutrition, home environment, other people, medications, examination, safety, spiritual health, and other services needed (inhomesss).
Category: general
Template Questions
- Impairments/immobility
- Advanced activities of daily living (select all that apply)
- Activities of daily living (select all that apply)
- Any issues with balance and gait (select all that apply)
- Eating habits
- Variety and quality of food
- Nutrition
- Freezer
- Nutritional status
- Obesity
- Malnutrition
- Other
- Fluid intake
- Alcohol presence/use
- Swallowing difficulty
- Oral health
- Neighborhood
- Exterior of home
- Interior of home (select all that apply)
- Other people
- Prescription drugs
- Nonprescription drugs
- Dietary supplements
- Medications organized
- Medication compliance
- Medication discrepancy
- Multiple prescribers
- Allergies to medications
- Written instructions
- Weight
- Examination
- Examination
- Examination
- Examination
- Focused examination
- Safety
- Spiritual includes cultural and ethnic influences
- e.g. fire, police, emergency medical services, home health, social services, meals on wheels, hospice, transportation, legal, equipment, health benefit advisor
- Comments/Recommendations
- Conducted by: Name & Signature