Healthcare Forms

We have created healthcare forms to help you track your medications, appointments, healthcare information, and more. Because we feel passionate about helping you help yourself, we have provided these forms free for your convenience. Each page will provide you a link to the PDF version of the form which you can print and include in your healthcare binder to maintain your personal health records (this will tell you the how's and why's of keeping your medical records).

While we haven't yet mastered creating forms which you can actually fill in on your computer and save directly (we are working on it!), they can at least provide you with a (free) start to creating your own healthcare binder.

The old saying "you can lead a horse to water but you can't make him drink" came to mind as we created these forms. While we are providing you with the tools that you need, in this case, the forms themselves, they are useless unless you decide to use them! And, they are only "useful" if you keep the information up to date!!!

While the technology exists to create an identification card that can carry all your health history including medications, hospitalizations, health conditions and allergies, a "universal" system has not yet been established. Until a system is in place, it is up to you to do as much as you can to have this information available and up to date for your healthcare team! Remember, you are the chief executive officer (CEO) of your healthcare team!

Whether you decide to use the healthcare forms we have provided, or to create your own is not as important as - yes, write it down!

Please note, you must have Adobe® Reader® on your computer to view these healthcare forms. If you do not have this software, and would like a free copy of it, please click

now.

Medication Flowsheet

Vitamins/Herbal Supplements/Over-the-Counter Medications

Appointment Calendar

Doctor Appointment Worksheet

HIPAA Release Form

Hospital Checklist Form


The following sites will add further to your information:

• Caring Connections also provides state-by-state examples of Advanced Directives.
• From the New York Online Access to Health, is a site which lists state-by-state Advance Directives, and some legal information in general and by state.
• Information from the American Bar Association about the "Consumer's Tool Kit for Health Care Advance Planning".
• The US Living Will Registry provides an online repository for advance directives, which can be accessed by hospitals and healthcare providers, for a fee. It also has state-by-state forms. At the top right of the page is a link for "Online Offer", which allows you to see if there is a discounted or free registry in participating states (you have to enter your zip code to check this. Check the bottom left column for this information).
• This site provides caregiving resources including tips and tools, agencies and organizations, healthcare information, depression in caregivers, medical ID's and more.
• Information about Canada's Advanced Directives from Dalhousie University.
• For a small fee, MegaDox will provide an Advance Health Care Directive, based on province or territory.

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