A 12-page non-medical home care visit documentation pack for recording what happened on a shift.

For small non-medical home care agencies in the USA. You get one editable Microsoft Word file, plus 1 agency instructions page to remove before use.

What’s included

1. Cover and how to use
2. Client care snapshot and preferences
3. Daily visit: ADLs and personal care
4. Mobility, transfers, meals, and hydration
5. Medication reminder log (reminders only, not administration)
6. Household and IADL support
7. Companionship, engagement, and home safety
8. Weekly caregiver task grid
9. Shift handoff and communication log
10. Observation and change-from-baseline notes
11. Incident and near-miss report
12. Care goals checklist and sign-off
13. Agency instructions page, to remove before use

Add your logo and name

1. Open the Word file. On the cover, click the “Your Logo Here” box and insert your logo.
2. Replace the light-gray Agency Name line with your agency name.
3. Replace the address line and the phone, email, and website line with yours.
4. Delete the instructions page and save. Print it or fill it in Word to record each visit.

These are editable templates for your agency to adapt. They are not legal advice, not a license to operate, and not HIPAA software. Check them against your state rules and your own policies before you use them.