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Huntington's Disease Caregiving

Helpful Forms-Download
Home
Index
What Is A Caregiver?
What Is An HD Caregiver?
Caregiving For A Spouse
Caregivers Bill of Rights
Cargiver~Knowledge
Helping Your Loved One
Your pHD Is Unique!
About Huntington's Disease
HD Articles of Interest
HD Guidebooks
Post Emergency Info
Early/ Early Intermediate Stages
Late Intermediate Stage
Swallowing Diagnostic
Speech & Language in HD
Swallowing Safety in HD
Early Advanced Stage
Swallowing/Diet
Swallowing Difficulties~Physician's Guide
Warning Signs of Swallowing Problems
Swallowing, Coughing, Choking & Pneumonia
Swallowing~Giving Medication
A Practical Guide: Nutrition and HD & Resources
Diet & Nutrition in HD
Nutrition and Huntington's Disease
Nutrition Information for the Care Giver
Texture & Consistency/Thining & Thickening Foods
Drinks/Shakes Recipes
Adaptive Equipment-Mealtime Help
Food Thickners
What Is A Feeding Tube?
When To Consider A Feeding Tube
Feeding Tube Decision in HD
Feeding Tube Resources
Advanced Stage
Late Stage Care
Commom Problems Encountered~Hospice Care
Temporary List of Resources
Personality Issues
Symptoms
Legal Issues
Disability Issues
At Home Care
Outside Care
Caregiver Tips
Caregiver Support
HD Facts
Helpful Forms-Download
Personal Articles/Stories
Miller Messages
HD Links
Fix It-R-Us?
How-To Tips
Have An HD Question?
Beautiful Memories
Caregiver's Chat Room
HD Caregiver Newsletter
Daily Humor & Health News
Dreams & Signs (Fun Stuff)
Share A Link
Send An HD Greeting Card
Location Map
Blank page
The following forms are all available on the HD Helpful Forms website
clix.to/HDHelpfulForms, but am copying them here for ease of finding. 
You can also find Word Documents on various articles on HD under the
HD Articles of Interest on this website. 
 
AWARENESS

HD Awareness Tri-fold Handout

I Have Huntington's Disease card

Info on HD For Temporary Caregivers

CNA First Shift handout

 
AT HOME HELPFUL FORMS

Appointment Information
Use this form to keep track of your loved ones medical appointments*

Caregivers Document Organizer
A form that will help you identify, locate, and organize the i
mportant documents your will need as a primary caregiver*
 
Caregivers Journal
Some tips for setting up a notebook to keep track of your
caregiving situation*
 
Use copies of this form to monitor daily changes and help with communication among care providers working in shifts*
 
Caregiving Decision Questionaire
A brief list of questions to help you set prioities and solve caregiving
problems*
 
Continuing Care Questionnaire
A list of questions to ask when you and your loved one visit
a continuing care retirement community*
 
(in PDF format) Cardiopulmonary
Resuscitation (CPR) includes a group of
procedures used when the heart stops beating.
 
 
HD Activities of Daily Living Rating Chart 4pgs This chart can be printed out and used to measure noticable changes to discuss with your physician.
 
Home Modification Checklist
How to safety-proof a loved ones home*
 
Assessment Instrument Excellent links to home modifications and checklists from the
National Resource Center on Supportive Housing and Home Modifications
 
 
In depth instructions to leave for temporary caregivers.
 
Personal Records
A form to help you keep track of your loved ones personal records
and other important information*
 
Sample Filing System
Listed below is one possible method for setting up a home filing
system. You should adopt a system that fits your needs and those of your family*
 
 

ASSESSMENT~CHECKLISTS

Driving Assessment Checklist

Needs Assessment Worksheet (ADL)

APPOINTMENTS

Appointment Information-Q&A's

Therapy Calendar-Questions & Recommendations

Weekly Rehab Calendar
A form to help you and your loved one track his or her
rehabilitation goals and successes*

MEDICAL

Choosing the Right Doctor
Consider the following questions and steps as you and your
loved one evaluate physicians*
 
Choosing A Rehabilitation Program
A list of questions to consider as you and your loved one
prepare to choose a rehabilitation program*

Making a Personal Medical History Chart
A sample chart to help you document your loved one's
medical history

Medical Appointments-Record Changes To Discuss With Your Doctor Use this form to keep track of your medical appointments.

Personal Medical History form

MEDICATIONS

My Medication & OTC list

New Drug Checklist-Q&A's

Weekly Medication Direction & Check Off Chart

Individual Medication Weekly Chart-Check Off

Keeping Track of Side Effects Form

 

 
OUTSIDE OF HOME

Assisted Living-Questions To Ask

Social Services Q&A Checklist

Assisted Living: Quality Of Life
A checklist of questions dealing with socializing, meals,
safety, and other issues to consider when you and your loved one visit an assisted living facility*
Assisted Living: Special Care Units
If your loved one is considering a move to assisted living,
you need to find out about any special care services offered by the facility*
 
Assisted Living: Costs And Contracts
A list of financial questions to ask when you and your loved
one visit an assisted living facility*
 
Assisted Living: Personal Care
A checklist of personal and health care questions to ask
when you and your loved one visit an assisted living facility*
 
Assisted Living-Questions To Ask WORD DOC  A checklist of personal and health care questions to ask when
you and your loved one visit an assisted living facility.
 
Assisted Living: Special Care Units If your loved one is considering a move to assisted living,
you need to find out about any special care services offered by the facility.
 
Nursing Home Checklist
A list of basic questions to ask when you and your
loved one visit a nursing home*
 
Social Service Checklist
Use this form to keep a record of in-person and phone interviews with
social service agencies*
 
Questions About Hospice Care
A checklist of questions to ask as you try to find the right
hospice service for your loved one*

ESTATE PLANNING

What Is Estate Planning Document

What Is A Conservatorship-Guardianship?

Advance Care Directives Checklist in PDF Format Partnership In Caring's simply checklist you can print out to help you in completing your advance directives.
 
 
Guidelines for Quality Care-Evaluating Quality of Care Checklist (in PDF format) Although there are no "report cards" or accepted national standards
yet available for judging quality end-of-life care, these are some questions you can ask to evaluate care. These can be used to help select providers and are also helpful if a loved one is dying and you are uncertain of the quality of care they are receiving. Use this checklist to talk to members of the health care team.
 
 
 
 
 
Net Worth Calculation Worksheet
A form to help you assess your loved ones financial situation*
 
Your Valuable Records
A form to help you keep track of all of your familys valuable records*
 
End of Life
 
Are You Grieving?
A checklist of the physical, mental, and behavioral symptoms of grief*
Funeral Planning Checklist
A list of all of the issues to consider when planning a funeral*
Funeral Planning Form
As your loved one makes his or her funeral plans, use this form
to record all of his or her wishes for final arrangements*
Funeral Planning: Personal Information
A form to help you record important personal information for use
in planning a funeral, informing friends and relatives, and writing an obituary*
 
*Source
From Family Care America, one of the most trusted sources of information and resources for caregivers of the elderly, disabled, and chronically ill.  These forms
are linked here for your convenience and use. www.familycareamerica.com