Online Information Center

Forms & Checklists

Checklist for Choosing a Home Health Agency

Source: IlluminAge Communication Partners

Description:

Questions to ask when selecting home health services. Covers licensure, fees, references.


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.


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.


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.


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.


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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