Client information

Client name

Add location
Changes in details

Have you changed your telephone number?

Has there been any changes to your emergency contacts and NOK?

Has there been a change in doctors etc.?

Are there any changes in accessing the property? (I.e key codes etc.)

Changes in health

Are there any changes in mobility?

Have there any changes in medication?

Please list current medication taken?

Are these changes recorded in the care plan?

Are there any changes in the client's skin integrity?

Add a photo if applicable?

Does the client have any pressure areas?

Add a photo if applicable?

Are there any changes in the capacity of the client's senses (eg eyesight, hearing) and communications skills?

Is the client fully continent? If not, please if urine incontinent or fecal or both. Are any incontinence products used?

Has the client had any falls since the last review?

General comments:

Food and drink

Does the client eat well?

Who prepares the client's food?




Meals on wheels etc

Does the client drink well?

Changes to the living environment?

General comments:


Does the service user use a hoist or bath lift? If yes, enter date of last service.

Any other equipment used? Please add details.

Further action?

Does the care plan continue to meet the needs of the service user?

Are all care plans and risk assessments up to date?

Any further action required?

Please detail if yes.

Client signature


Assessor signature


Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.