Getting to Know You

We want to understand how to support YOU in the way that works best. Your answers will help us provide care that's tailored to your unique needs and preferences.

Who This Person Is

Understanding their identity, values, and what defines them as an individual.

What are the most important things to know about this person — their history, personality, and what makes them unique?

What are this person's core values and beliefs that should guide their care?

What does a "good day" look like for this person?

Risk Identification

4. What potential risks have you identified for this client? (Select all that apply)

Fall Risk Medication Mismanagement Malnutrition / Dehydration Social Isolation Cognitive Decline / Memory Loss Skin Integrity Issues Financial Exploitation Risk Wandering / Elopement Risk

5. Describe any specific concerns or risks not listed above:

6. What is the severity level of identified risks?

Recommended Interventions

7. What interventions would help improve the client's quality of life? (Select all that apply)

Personal Care Assistance Medication Management Physical Therapy / Exercise Social Activities & Engagement Cognitive Stimulation Activities Nutritional Support & Meal Prep Transportation Services Companionship & Emotional Support

8. Describe specific intervention strategies you recommend:

9. How frequently should these interventions be implemented?

Strategies for Improvement

10. What long-term strategies would help maintain or improve quality of life?

11. What support does the family/caregivers need to implement these strategies?

12. What are the key goals for the next 30-60-90 days?

30-Day Goals

60-Day Goals

90-Day Goals

13. Additional Comments or Recommendations

Your thoughtful responses will help us create a truly personalized care plan.

Getting to Know You

Who This Person Is

Quality of Life Assessment

Risk Identification

Recommended Interventions

Strategies for Improvement