Care Notebook

A Care Notebook is often used to help caregivers document and maintain their child’s care, services, providers, and anything else useful to the caring for their child.

Many medical professionals recommend that caregivers maintain a notebook (especially when the child has many appointments and needs). The caregiver is often asked to keep the notebook handy whenever possible.

MOM has put together a few templates to help get you started. Please feel free to download and use any that you think pertain to your child. Also, if you are interested in ALL files, you can download a zip file that contains them all. These files are all pdf’s.

Click on the file name to download/view the file(s)

File Name File Description
AllAboutMe.pdf All out your child- a great tool to share with anyone new in your child’s life.
AppointmentLog.pdf Date, time, type of appointment, who you saw, and reason for appointment
ChildcareAndRespiteProviders.pdf Name and contact details for people that can care for your child (friend, family, nurse, etc.)
DailyRoutineAndCareSchedule.pdf Time and description of daily activities (range of motion, bath, feeding, etc.)
DietAndNutrition.pdf Use this blank page to write about your child’s nutritional needs, method of obtaining nutrition (oral, tube, etc.) This form can be used in conjunction with the Enteral/Parenteral Nutrition Form. This is also a good place to document your child’s favorite foods, calorie requirements, food allergies, sensory issues, swallowing problems, texture requirements, thickening needs, etc.
DoctorsVisitSummary.pdf Keep multiple blank copies of this form in your Care Notebook to use for each appointment. Includes some suggestions for things to go into the appointment with to get the most out of each appointment as well as a way to document the appointment outcome.
EnteralParenteralNutritionForm.pdf Doctor details, feeding tube details, nutrition details and feeding schedule
EquipmentList.pdf Name, description, serial number, supplier, all information related to your medical equipment (big or small)
FamilyAndEmergencyContactList.pdf Child’s medical overview and contact details for parents, guardians, and in case of emergency contact
HomecareNursingAndServices.pdf Name, descrition of services and contact details for any home health providers (nursing, aids, therapist, etc.)
HospitalAndClinicsForm.pdf Primary Hospital details as well as a list of all other clinics and hospitals, doctor you see, and phone number.
InpatientHospitalJournal.pdf Keep multiple blank copies of this form in your Care Notebook to use for each inpatient hospital stay. We recommend documenting EVERYTHING, including discussions, concerns, medication administrations, therapy sessions, staff names and titles, tests performed and results, care concerns, excellence of service, and going home instructions.
InsuranceAndMedicalCoverageInformation.pdf Insurance details, contact numbers, policy numbers, preauths, etc.
MakeASchedule.pdf Blank calendar to help keep track of up comming appointments and activities
MedicalSuppliesAndSupplyCompany.pdf Name of product, reorder number, quanity allowed/covered, manufacturer
MedicationList.pdf A complete list of medications, strength, dosage, time administered, perscribing doctor and pharmacy
PharmacyContactList.pdf Name and contact details for all pharmacies used
PhysicianAndTherapistsContacts.pdf Name and any contact info for each doctor and/or therapist.
RespiratoryNotesForm.pdf Use this blank page to write about your child’s daily respiratory care routine, equipment needed, oxygen requirements, O2 saturations, and respiratory therapy routines including nebulizer treatments, vest and percussion therapies, and suctioning routines. If your child has a tracheostomy tube, describe his/her daily care routine in detail. Ventilator/BIPAP/CPAP patients should use the VENTILATOR/BIPAP/CPAP form in conjunction with this form. You may also use this form to list frequency of supply changes and cleanings.
SchoolAndCommunityBasedServices.pdf The name of any program, a contact person and program demographics
SeizureEventLog.pdf Date and time of seizure, duration, any interventions given and details on any calls placed
VentilatorBipapCpapForm.pdf Doctor, respiratory therapist and supplier contacts, machine details, settings, O2 goals, etc. ZIP file containing ALL of the files listed above.

After creating a care notebook (or select care pages) for your child, MOM recommends checking out Rescue Facts. They offer tools that help to alerting EMS or anyone entrusted with your child’s care to the existence of the care notebook and/or pages.

Note: The Seizure Event Logs were developed by Seizure