Welcome To Serene Care

Exceptional Homecare and Interfacing Families With

Information

1. Basic Information:

- What is the patient's full name?

What is the patient's date of birth?

Phone number

Street Address

Medical

2. Medical History:

What medications is the patient currently taking?

- Does the patient have any chronic medical conditions?

- Does the patient have any allergies or adverse reactions to specific medications?

- Has the patient recently been hospitalized or had any surgeries?

Activities

3. Activities of Daily Living (ADLs):

- Does the patient have any mobility issues or require assistance with walking or transferring?

- Does the patient require assistance with bathing, grooming, dressing, or toileting?

- Does the patient require assistance with medication management?

- Does the patient require assistance with meal preparation, eating, or managing nutrition?

Health Care

4. Health Care Needs:

- Does the patient require assistance with medical equipment, such as oxygen, nebulizers, or mobility aids?

- Does the patient have any specific health care needs, such as wound care, injections, or monitoring of vital signs?

- Is there a need for specialized care due to conditions like dementia, Alzheimer's, or Parkinson's disease?

Support

5. Social and Emotional Support:

- Are there any mental health concerns, such as anxiety, depression, or cognitive impairment?

- Does the patient experience social isolation or require companionship?

- Are there any specific cultural or religious preferences that should be considered?

Family

6. Family Support and Involvement:

- What level of involvement do family members or caregivers have in providing care?

- Are there family members or caregivers involved in the patient's care?

- Are there any specific preferences or requirements for family involvement?

Schedule

7. Schedule and Availability:

- Are there any specific scheduling considerations or restrictions?

- What are the preferred days and times for in-home care services?

- Is there a need for 24-hour care, overnight care, or live-in care?

Additional questions

Certainly! Here are additional questions related to transfers, transportation, falls, and the patient's
preferences:

Transfers

9. Transfers and Mobility:

- Does the patient use any mobility aids (e.g., walker, cane, and wheelchair) or require assistance with ambulation?

- Does the patient require assistance with transfers, such as getting in and out of bed, chairs, or the bathroom?

- Are there any specific techniques or equipment preferences for transfers, such as a Hoyer lift or a sliding board?

Transportation

10. Transportation:

- Are there any preferences or limitations regarding the use of public transportation or specialized transportation services?

- Are there any specific mobility requirements or equipment needed for transportation, such as a wheelchair-accessible vehicle?

- Does the patient need transportation assistance for medical appointments, grocery shopping, or other outings?

Prevention

11. Falls and Fall Prevention:

- Has the patient experienced any recent falls or have a history of falls?

- Are there any specific risk factors or concerns related to fall prevention that should be considered?

- Has any home modification or assistive equipment been recommended to prevent falls?

Personal

12. Personal Preferences and Interests:

- What activities or hobbies does the patient enjoy the most?

- Are there any specific cultural, religious, or recreational activities that are important to the patient?

- How does the patient prefer to spend their time during the day?

Company representative

These questions will help the company representative gather essential information about the patient's
mobility needs, transportation requirements, fall prevention measures, and personal preferences. By
understanding these aspects, the in-home care or in-home health provider can create a more tailored
and comprehensive care plan that caters to the patient's individual needs and preferences.

Additional

8. Additional Concerns or Questions:

- Are there any specific concerns, expectations, or questions regarding in-home care services?

- Is there anything else the representative should know to better understand the patient's needs and preferences?

Personalized care

Remember, this list serves as a guide, and the specific questions may vary based on the company's
protocols, the patient's condition, and the purpose of the consultation. The representative should
always approach the questions with sensitivity, respect, and a focus on.

Serene Care of Middle Tennessee

Enriching Lives with Serenity & Compassion Care