Online Information Center

Worksheets and Checklists

Interactive forms to plan and prepare for various life events

Checklist for Communicating Clearly with Your Doctor

Source: IlluminAge Communication Partners

Description:

Planning ahead before going to your healthcare provider helps ensure a productive visit. Bring this form along to help you remember instructions. Includes advance directives information.


Checklist for Older Drivers

Source: IlluminAge Communication Partners

Description:

Points for seniors and families to consider; is it safe to continue driving? What alternative transportation is available?


Checklist for Reducing Your Risk of Falling

Source: IlluminAge Communication Partners

Description:

Steps for seniors and family caregivers to consider as part of a conscious effort to reduce the risk of falls.


Checklist for Selecting and Working with a Geriatric Care Manager

Source: IlluminAge Communication Partners

Description:

Form to use while deciding how you might use the services of a geriatric care manager; choosing a qualified individual; working effectively with the GCM you select.


Consumer's Toolkit for Health Care Advance Planning

Source: American Bar Association

Description:

Information and forms for making a health care advance directive (such as a living will or durable power of attorney for health care)


Funeral or Memorial Service Planner

Source: IlluminAge Communication Partners

Description:

Checklist covers type of service, arrangements to be made, content of service and participants.


Health Care Representative's Discussion Checklist

Source: IlluminAge Communication Partners

Description:

Worksheet lists questions you may want to ask if you are serving as a person's health care representative.


Home Repairs and Modifications Checklist

Source: IlluminAge Communication Partners

Description:

Check for ways to make your home safer and more functional. Includes checklist for hiring a contractor.


Home Safety Inspection Checklist

Source: IlluminAge Communication Partners

Description:

This three-part form includes checklist items that should be part of any home safety inspection, to prevent falls, other accidents and fire, and make your home more secure.


How To Pay and Plan for Alzheimer's Disease

Source: Alzheimers.gov

Description:

Video discusses the need to build a sound financial and legal plan.


Is It Time to Move? Retirement Housing Planning Sheet

Source: IlluminAge Communication Partners

Description:

Questions for seniors and family to ask when weighing the pros and cons of moving to a retirement community.


Medicare Authorization to Disclose Personal Health Information Form

Source: Medicare.gov

Description:

Form can be used for healthcare representatives, family caregivers


My Family Health Portrait

Source: U.S. Department of Health and Human Services

Description:

Online tool for families to use in compiling a health history.


Nursing Facility Move-In Checklist

Source: IlluminAge Communication Partners

Description:

Three-part form to help you or your loved one make a smooth transition to living and receiving care in a nursing facility.


Resident/Family Care Conference Worksheet

Source: IlluminAge Communication Partners

Description:

Form for organizing your notes before and during a nursing home care conference.


Sample Combined Advance Healthcare Directive Form

Source: IlluminAge Communication Partners

Description:

Form includes introduction to healthcare directives, appointing a healthcare representative, creating a personal values statement and more.


State-Specific Advance Directives Documents

Source: National Hospice and Palliative Care Organization

Description:

Caring Connections provides free advance directives and instructions for each state that can be opened as a PDF.


Worksheet for Evaluating a Nursing Facility

Source: IlluminAge Communication Partners

Description:

When choosing between long-term care facilities, use this checklist to compare the available choices.


Worksheet for Evaluating a Senior Living Community

Source: IlluminAge Communication Partners

Description:

Questions to ask when choosing between retirement communities, including facilities, terms and conditions, cost and services.


Worksheet for Hiring a Home Helper

Source: IlluminAge Communication Partners

Description:

Questions to ask when selecting a person to come into the home to help with personal care needs and household chores.


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