Create Your Own Health Care Notebook

The major role of this notebook is to help individuals served by TCRC and/or their parents, caregivers or service providers maintain an ongoing record of the individual's health care history and current medical status. Health care notebooks are valuable in providing medical personnel with vital information and helping individual's and/or their families take an active role in their medical care.

 

These forms were gathered by Rainbow Connection Family Resource Center to assist families in creating health care notebooks for individuals. Please choose the forms that are appropriate for your needs.

 

There are many websites where you can download different forms  and use for for your notebook. These are two examples of many you can access on the internet:

http://www.medicalhomeinfo.org/for_families/care_notebook

 

http://www.childdisabilityconnection.org/careNotebook.php

 

In addition to the forms, we have included fact sheets and checklists for you to use on a variety of topics.

 

 

Attachments:
Download this file (01-02  Medical History Worksheet.pdf)01-02 Medical History Worksheet.pdf[Medical History Worksheet]33 Kb
Download this file (03  Emergency Names and Numbers.doc)03 Emergency Names and Numbers.doc[Emergency Names and Numbers]25 Kb
Download this file (04  Medical Care Contact Information-.doc)04 Medical Care Contact Information-.doc[Medical Care Contact Information]25 Kb
Download this file (05  Medical Emergency Information.doc)05 Medical Emergency Information.doc[Medical Emergency Information]26 Kb
Download this file (06  Emergency Room Information.doc)06 Emergency Room Information.doc[Emergency Room Information]30 Kb
Download this file (07  Doctor's appointments.doc)07 Doctor's appointments.doc[Doctor's Appointments]29 Kb
Download this file (08  Surgeries and procedures -.doc)08 Surgeries and procedures -.doc[Surgeries and Procedures]36 Kb
Download this file (09  Medical Appointment.doc)09 Medical Appointment.doc[Medical Appointment]24 Kb
Download this file (10  Notes From Doctors appointments.doc)10 Notes From Doctors appointments.doc[Notes from Appointments]25 Kb
Download this file (11  Test Results.doc)11 Test Results.doc[Test Results]25 Kb
Download this file (12  Allergies.doc)12 Allergies.doc[Allergies]35 Kb
Download this file (13  Dental History.doc)13 Dental History.doc[Dental History]25 Kb
Download this file (14  Medication Information.doc)14 Medication Information.doc[Medication Information]34 Kb
Download this file (15  Consent Form.doc)15 Consent Form.doc[Consent Form]88 Kb
Download this file (16 Medical Power of  Attorney.doc)16 Medical Power of Attorney.doc[Medical Power of Attorney]21 Kb
Download this file (17 IMPORTANT PEOPLE IN MY LIFE.doc)17 IMPORTANT PEOPLE IN MY LIFE.doc[Important People in My Life]22 Kb
Download this file (18 Health Review Checklist.doc)18 Health Review Checklist.doc[Health Review Checklist]190 Kb
Download this file (20 Aspiration pg  1.doc)20 Aspiration pg 1.doc[Aspiration pg 1]46 Kb
Download this file (21 Aspiration pg 2.doc)21 Aspiration pg 2.doc[Aspiration pg 2]934 Kb
Download this file (22 Bowel Impaction pg 1.doc)22 Bowel Impaction pg 1.doc[Bowel Impaction pg 1]63 Kb
Download this file (23 Bowel Impaction pg 2.doc)23 Bowel Impaction pg 2.doc[Bowel Impaction pg 2]361 Kb
Download this file (24 Diabetes pg 1.doc)24 Diabetes pg 1.doc[Diabetes pg 1]52 Kb
Download this file (25 Diabetes pg 2.doc)25 Diabetes pg 2.doc[Diabetes pg 2]104 Kb
Download this file (26 Epilepsy pg 1.doc)26 Epilepsy pg 1.doc[Epilepsy pg 1]54 Kb
Download this file (27 Epilepsy pg 2.doc)27 Epilepsy pg 2.doc[Epilepsy pg 2]467 Kb
Download this file (28 G-Tube pg 1.doc)28 G-Tube pg 1.doc[G-Tube pg 1]59 Kb
Download this file (29 G-Tube pg 2.doc)29 G-Tube pg 2.doc[G-Tube pg 2]1476 Kb
Download this file (30 Osteoporosis pg 1.doc)30 Osteoporosis pg 1.doc[Osteoporosis pg 1]58 Kb
Download this file (31 Osteoporosis pg 2.doc)31 Osteoporosis pg 2.doc[Osteoporosis pg 2]108 Kb
Download this file (32 Stap Infection pg 1.doc)32 Stap Infection pg 1.doc[Staph Infection pg 1]191 Kb
Download this file (33 Staph Infection pg 2.doc)33 Staph Infection pg 2.doc[Staph Infection pg 2]66 Kb
Download this file (34 Weight Management pg 1.doc)34 Weight Management pg 1.doc[Weight Management pg 1]48 Kb
Download this file (35 Weight Management pg 2.doc)35 Weight Management pg 2.doc[Weight Management pg 2]208 Kb
Download this file (36 Planning for Individuals who are Severely Physically Handicapped.doc)36 Planning for Individuals who are Severely Physically Handicapped.doc[Planning for Individuals Who Are Severely Physically Handicapped]85 Kb