Essential emergency information form for seniors
Senior emergency information form template
10 page caregiver emergency form designed for families who have a senior loved one in mind, for private caregivers, or home care companies. This form can also be used as a general assessment form for senior care providers..
What does this form cover?
It Includes all emergency and non emergency contact information needed, including senior’s name, address, phone number, blood type, disease/all those conditions, any allergies, medications, hygiene routines, mobility aids, regular Doctors, Specialists, home environment, Social workers and much more. This form also provides contact information for other family members, friends and neighbors.
Prepare ahead of time for any potential falls
Remember to post Emergency numbers – 911, police, fire department and local hospitals and house fire escape plan on the wall where the senior lives, and place in an obvious spot where anyone entering the home to provide care can see right away in plain view.
Before you download the single template have a look at our packages
If you plan to start a home care business for seniors this is an excellent guide + 24 senior care form templates
If you currently operate a home care business for seniors and are looking for the forms you need you will find this pack helpful for your business
Or do you plan to hire a caregiver for a senior loved one(s)? This guide will definitely help you throughout the process
This ‘digital’ guide book, will take you quickly through each necessary steps to find, screen, and employ quality caregivers.
The ‘Hire a private caregiver guide’ also includes 17 professional senior care form templates
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✔️ Senior care information form
✔️ Caregiver employment agreement (long form)
✔️ Caregiver employment contract (short form)
✔️ Pre-interview caregiver questionnaire
✔️ Caregiver interview questionnaire
✔️ Caregiver reference check questionnaire
✔️ Caregiver visit report
✔️ Senior housekeeping chart
✔️ Senior hygiene care chart
✔️ Senior care invoice
✔️ Looking for caregiver job post template
✔️ Tax receipt for senior care
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✔️ Senior home Safety checklist (private home/residence)