Free Nursing Home Assessment Documentation

Streamline resident evaluations with the Nursing Home Assessment Documentation Template from Template.net. This editable and customizable template facilitates thorough assessments of residents' needs and conditions, aiding in personalized care planning. Editable in our Ai Editor Tool, it's crucial for ensuring accurate, comprehensive documentation, supporting optimal care delivery, and enhancing resident well-being in your nursing home.

Name:
Date of Birth:
Gender:
Address:
Admission Date:
Physician:

Physical Health Assessment
Vital Signs:	Blood Pressure: Heart Rate: Respiratory Rate: Temperature:
Mobility Status:
Skin Integrity:
Nutrition Status:
Activities of Daily Living (ADLs):

Mental Health Assessment
Cognitive Function:
Mood and Affect:
Behavioral Observations:

Safety Assessment
Fall Risk:
Environmental Safety:
Emergency Preparedness:

Free Nursing Home Assessment Documentation

Resident Information

Next of Kin/Contact Person

Assessment Details

Care Plan

Follow-Up Plan

Signature Section

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Name of Next of Kin/Contact Person:
Relationship:
Contact Information:

Medication Management
Current Medications:
Allergies:

Social and Emotional Assessment
Social Support System:
Emotional Well-being:

Regular Follow-Up Assessments:
Consultations with Specialists:
Family Meetings: