We’ve developed this handy patient profile form that you can use with doctors, care providers, other healthcare services, and family members. It gives a quick snapshot of your loved one’s desires, habits, favorite things, and, most importantly, medications.
To use the form, download it and print it, then fill it in and keep it on hand for appointments. You can even make multiple copies to share with other interested caregivers or doctors.
Let’s take a look at the important information contained in the Patient Profile Form.
- Personal Information: Make sure you enter the patient’s full legal name, address, phone, and birthdate clearly. The weight, height, and blood pressure range will be helpful for tracking any changes in the patient’s health.
- Ailments/Diagnosis: Here, you should list the major diagnoses the patient has. Many people will have comorbidity (meaning more than one diagnoses) but try to capture the most important and life affecting ones here so they can be tracked and disclosed to those who need the information most.
- Prescriptions: An updated list of meds, dosages, and orders for taking them is important to track for anyone who may be in a position to care for your loved one. This section is especially important to doctors and physicians who prescribe medications to help them avoid prescriptions that negatively impact other medications. This is also a good place to list allergies to medications!
- Patient’s Preferences: This is the section where you can share a bit about your loved one’s likes and dislikes. If the patient has memory impairments, these key favorites may help ground a memory or provide a path of communication from caregivers and family members. The favorites can be used as the basis for discussion, outings, reading/research, and remembering. Fond memory prompts also give physicians and home healthcare providers a way to connect with the patient in a meaningful way.
- Advocate Information: Finally, you’ll want to include all relevant contact information for the patient’s conservator or advocate, making it simple and quick to reach out to that person should the need arise.
If you have questions or need help, we are here to help care for those who wish to remain in their homes as long as possible. Call us today at 269-204-6537 to learn more.
Download Our Free Patient Profile Form
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