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Determine patient health with a home visit safety checklist

Home visit checklists are used by healthcare professionals when conducting house calls to assess the medical condition of patients and provide patient care. This digital home visit checklist covers the patient’s immobility, nutrition, home environment, other people, medications, examination, safety, spiritual health, and other services needed (INHOMESSS).
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Home Visit
Impairments/immobility
Any indication of cognitive impairment?
Advanced activities of daily living (select all that apply)
Specify other
Activities of daily living (select all that apply)
Any issues with balance and gait (select all that apply)
Sensory impairments (select all that apply)
Falls?
Nutrition
Eating habits
Variety and quality of food
Pantry
Refrigerator
Freezer
Nutritional status
Obesity
Malnutrition
Other
Fluid intake
Alcohol presence/use
Swallowing difficulty
Oral health
Home Environment
Neighborhood
Exterior of home
Interior of home (select all that apply)
Other people
Is there a caregiver?
Who?
Tasks of the caregiver
Hours of caregiving per day
Stress?
Coping?
Abuse?
Need for respite?
Physically or emotionally capable?
Social supports?
Advanced directives?
Power of attorney?
Who?
Financial resources
Patient attitude
Medications
Prescription drugs
Nonprescription drugs
Dietary supplements
Medications organized
Medication compliance
Medication discrepancy
Multiple prescribers
Allergies to medications
Written instructions
Examination
Weight
Weight loss?
Height
Blood pressure
Glucose
Urinalysis
Other
Mini-Mental State Examination
Depression screening
General physical condition
Focused examination
Safety
Access to emergency services
Alternative power source if needed
Adaptations to home needed
Telephone availability
Bathroom
Kitchen
Carpets
Lighting
Electrical cords
Stairs
Tables, chairs, and other furniture
Hot water heater
Fire and smoke detectors
Fire extinguishers
Emergency plans
Evacuation route
Gas or electric range
Heating/air-conditioning
Water source
Spiritual health
Spiritual includes cultural and ethnic influences
Services
e.g. fire, police, emergency medical services, home health, social services, meals on wheels, hospice, transportation, legal, equipment, health benefit advisor
Completion
Comments/Recommendations
Conducted by: Name & Signature
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A home visit checklist is a document that contains information about the patient, such as their medical history and current condition. It is also used to track the patient’s progress and provide care during their visits. The purpose of a home visit checklist is to ensure quality patient care by reducing paperwork and improving communication between doctors and patients. By having everything documented in one place, it becomes easy for both parties to understand the patient’s health status and make appropriate decisions based on that information.
Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.

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