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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Cut inspection time by 50% Uncover more issues and solve them 4x faster Select from over 4000 expert-proofed templates Home Visit Checklist Impairments/immobility Any indication of cognitive impairment? Yes No Advanced activities of daily living (select all that apply) Select Employment/volunteering Reading Music Socialization Hobbies Other Activities of daily living (select all that apply) Select Employment/volunteering Reading Music Socialization Hobbies Other Any issues with balance and gait (select all that apply) Select Employment/volunteering Reading Music Socialization Hobbies Other Sensory impairments (select all that apply) Hearing Vision Smell Taste Tactile Nutrition Variety and quality of food Home Environment Interior of home (select all that apply) Select Employment/volunteering Reading Music Socialization Hobbies Other Other people Is there a caregiver? Yes No Advanced directives? Yes No Power of attorney? Yes No Safety Access to emergency services Yes No Alternative power source if needed Yes No Adaptations to home needed Yes No Telephone availability Yes No Tables, chairs, and other furniture Yes No Fire and smoke detectors Yes No Fire extinguishers Yes No Gas or electric range Yes No Heating/air-conditioning Yes No Services e.g. fire, police, emergency medical services, home health, social services, meals on wheels, hospice, transportation, legal, equipment, health benefit advisor Completion Conducted by: Name & Signature