Are you sure you want to exit? Your progress will be lost.
Who are you caring for?
Which best describes their mobility?
How well are they maintaining their hygiene?
How are they managing their medications?
Does their living environment pose any safety concerns?
Fall risks, spoiled food, or other threats to wellbeing
Are they experiencing any memory loss?
Which best describes your loved one's social life?
Acknowledgment of Disclosures and Authorization
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington. Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services. APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid. We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour. APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment. You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints. Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights. APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.I agree that: A.I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information"). B.APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink. C.APFM may send all communications to me electronically via e-mail or by access to an APFM web site. D.If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records. E.This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year. F.You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
✔
I acknowledge and authorize
✔
I consent to the collection of my consumer health data.*
✔
I consent to the sharing of my consumer health data with qualified home care agencies.*
*If I am consenting on behalf of someone else, I have the proper authorization to do so. By clicking Get My Results, you agree to our Privacy Policy. You also consent to receive calls and texts, which may be autodialed, from us and our customer communities. Your consent is not a condition to using our service. Please visit our Terms of Use. for information about our privacy practices.
Mostly Independent
Your loved one may not require home care or assisted living services at this time. However, continue to monitor their condition for changes and consider occasional in-home care services for help as needed.
Remember, this assessment is not a substitute for professional advice.
Share a few details and we will match you to trusted home care in your area:
I think you are looking on how to create one on this site, for communication to loved ones, etc. I would like to know how also - I cannot find it anywhere on this site.
Depending on the purpose of the report requirements may be different. Normally general health while documenting recent decline would be a good place to start. Any activities and reactions to them should also be included.
A care report.????? What Doctor or agency requires this of you ? And since care indicates to me " the care given to a patient " it most likely means that you simply write down, A.]... what the caretaker does for the patient... noting else. Start with a.m. to p.m. care activities only, as in all things assisting the patient..... then , separately , B.}... State the financial support provided, WITHOUT DOLLAR AMOUNTS ...i.e.- you provide all patient food and medications, transportation, clothing....etc C.]... Then describe timing and details , provided thru assistance provided “ BY OTHERS ” [support personnel ], (without stating their names, addresses and such details), unless you have their permission. I would also not include details of the patient’s health information. That does not fall under the definition of the word “Care”... in my opinion.... Also, if this is an agency of some sort, they should provide a FORM with appropriate questions to be answered, rather than requiring you to be the free-style author of a daily life story...... Care given a patient is always charted on a form in hour increments...on easy overview forms... Freehand text style is short and confined to incidences....or progress-notes.... related to health condition. The word Care relates only to effort provided, not the condition that results from that care... I wish you well !!!
5/5/2015........ I could not find anything in AgingCare either... so I searched Google with these words: ... “home care of elderly charting format. “ ...This Question brought up as usual the 1st 3 ads for home care providers, as the 1st 3 listings on a google page are always advertising... But Item No. 4 brought up this: "graceworksathome" it is also an ad but was worth a look: When that site opens ...CLICK the Tab named RESOURCES , scroll down a bit to: SPECIFICALLY , WE ASSESS THE FOLLOWING : It has 8 points consisting of : Medical, Nutrition, Activities of Daily Living, Social/Emotional, Safety/Security, Financial management., all followed by more detail. If one is writing a free-hand assessment of one’s loved one’s condition to relate to someone by written means, these 8 points give all the info in more detail, that could be included in a one or two-page report, and still allows you to be careful about giving out info which is “none of their business” ...or such as other caregiver’s names or personal info , ...or the precise financial details .... I Do hope that helps a bit, and do wish you well !!!!
Forgot to say: that after typing in "Homecare of elderly charting format" ...the google choice page that appeared had a collumn on the right full of Charting examples used in the medical profession .... might be worth a look ...!!! ... again, wishing you well !!
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
And since care indicates to me " the care given to a patient " it most likely means
that you simply write down,
A.]... what the caretaker does for the patient... noting else. Start with a.m. to p.m. care activities only, as in all things assisting the patient..... then , separately ,
B.}... State the financial support provided, WITHOUT DOLLAR AMOUNTS ...i.e.- you provide all patient food and medications, transportation, clothing....etc C.]... Then describe timing and details , provided thru assistance provided “ BY OTHERS ” [support personnel ], (without stating their names, addresses and such details), unless you have their permission.
I would also not include details of the patient’s health information.
That does not fall under the definition of the word “Care”... in my opinion....
Also, if this is an agency of some sort, they should provide a FORM with appropriate questions to be answered, rather than requiring you to be the free-style author of a daily life story......
Care given a patient is always charted on a form in hour increments...on easy overview forms...
Freehand text style is short and confined to incidences....or progress-notes.... related to health condition.
The word Care relates only to effort provided, not the condition that results from that care...
I wish you well !!!
But Item No. 4 brought up this: "graceworksathome" it is also an ad but was worth a look:
When that site opens ...CLICK the Tab named RESOURCES , scroll down a bit to: SPECIFICALLY , WE ASSESS THE FOLLOWING : It has 8 points consisting of : Medical, Nutrition, Activities of Daily Living, Social/Emotional, Safety/Security, Financial management., all followed by more detail.
If one is writing a free-hand assessment of one’s loved one’s condition to relate to someone by written means, these 8 points give all the info in more detail, that could be included in a one or two-page report, and still allows you to be careful about giving out info which is “none of their business” ...or such as other caregiver’s names or personal info , ...or the precise financial details .... I Do hope that helps a bit, and do wish you well !!!!