Caregiver & Elder Care Information Sheet

Personal information

Caregiver information

Medical information

Current medications

Daily living assistance

• Bathing / grooming
• Dressing
• Toileting
• Eating / meal prep
• Mobility / transfers
• Housekeeping
• Laundry
• Transportation
• Managing medications
• Money / bills

Preferences & routine

Doctors & appointments

Important documents on file

• Advance directive / living will
• Durable power of attorney
• Health care proxy
• Will / trust
• Insurance policies
• Medical records

Notes