Back to the Home Care Client Intake template

Home Care Client Intake checklist

Take every new home care client through referral, assessment, an agreed care plan, the start of services and a scheduled review.

Client referenceDate started

Work down the steps in order. Fields marked * must be filled in before moving to the next step.

  1. 1. Referral

    A new client has been referred.

    • Enter the Client name and Suburb.
    • Record Referral from (e.g. "GP", "hospital discharge team", "family", "self") and the Referral date.
    • Pick the Client contact and any Family or representative you will be speaking to.
    • Attach the Referral document if there is one.
    • Contact the client or their representative to arrange an assessment visit.
    Completed byDate

  2. 2. Assessment

    Home visit done and support needs recorded.

    • Visit the client and complete your organisation's own assessment.
    • Set the Assessment date and Assessed by.
    • Summarise the Support needs in plain words (e.g. "shopping weekly, help with showering three times a week").
    • Note anything staff should know before visiting in Home safety notes (pets, steps, parking, smoking).
    • Attach your completed Assessment form.
    Completed byDate

  3. 3. Care plan

    Plan agreed with the client and their family.

    • Write the plan from the assessment and attach it as Care plan.
    • Go through it with the client and anyone they want involved. Record who in Care plan agreed with.
    • Tick Service agreement signed once your service agreement is signed and filed.
    Completed byDate

  4. 4. Services started

    Visits scheduled and a coordinator assigned.

    • Name the Coordinator.
    • Set the Visit days (e.g. "Mon, Wed, Fri mornings") and the First visit date.
    • Set the Review due date, usually three months out or as your policy requires.
    • Brief the staff doing the visits, including the Home safety notes.
    • Call the client after the first visit to check it went well.
    Completed byDate

  5. 5. Review

    Scheduled review with the client.

    • Meet the client and anyone they want involved.
    • Record Reviewed by and the Review outcome.
    • If the plan changed, attach the new version as Care plan and note what changed on the record's Notes tab.
    Completed byDate