The Aged Care Assessment Form Template by WPForms is a great solution for onboarding new patients to your aged care facility.
It is completely customizable and designed to make the patient enrollment process as smooth as possible for both incoming residents and your team.
How Does the Aged Care Assessment Form Template Work?
The Aged Care Assessment Form Template requires the WPForms Pro License and the Signature Addon to cover all aspects of an individual’s needs and personal details. Here’s a brief look at what each field covers:
- Personal Information:
- Name: Capture the full name of the prospective resident.
- Date of Birth: Record the individual’s date of birth for age verification.
- Gender: Identify the gender of the person for personalized care.
- Phone: Keep a direct line of communication with the resident or their family.
- Email: For sending important updates and information about care plans.
- Address: Useful for understanding the resident’s previous living conditions.
- Health Information:
- General Health Status: Gain insights into the overall health and any chronic conditions.
- Medications: Track prescriptions and dosage for proper medical care.
- Allergies: Critical for avoiding allergic reactions and ensuring safe dietary and medication plans.
- Physician’s Name and Contact: Maintain a connection with the resident’s primary healthcare provider.
- Daily Living Evaluation:
- Mobility: Understand the level of assistance required for personal movement.
- Daily Activities: Assess capabilities in eating, bathing, dressing, and more for appropriate support.
- Assistive Devices: Note any tools the resident relies on, like walkers or hearing aids.
- Consent and Privacy:
- Checkbox: A section for residents to agree to the terms of care and privacy policies.
- Signature and Date: The resident or their legal guardian signs off on the information provided and consents to the terms.
Sign up with WPForms today and access the Aged Care Assessment Form Template. It is perfect for care facilities, charities, or any organization looking to offer top-notch care to the elderly.
