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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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Determine patient health with a home visit safety checklist

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.

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