When a healthcare professional conducts a home visit to assess the medical condition of a patient and provide patient care, they need to make sure that they leave no stone unturned when it comes to collecting information regarding the patient's health as well as building a kind, trusting relationship and ensuring they are residing in a safe and secure environment.

It requires technical skills, good judgement, and relationship building skills. 

By conducting the visit with a clear, comprehensive checklist in hand, a healthcare professional can make sure they are gathering all necessary information to make an accurate evaluation and free up time to focus on building a trusting relationship with the patient. 

This checklist will enable you to quickly and easily evaluate the patients:

  • Impairments and immobility
  • Nutrition
  • Relationship with other people
  • Medication
  • Physical condition
  • Home environment
  • Home safety

Let's get started. 

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Record basic details

Introduce yourself

Introduce yourself to the patient! 

In addition to your name, state your institution and describe the reason you are there. 

Remember to always be polite and friendly. Listen carefully and don't interrupt them. Developing a positive interpersonal relationship is essential to working well together and helping them achieve their goals 


Determine if there is indication of cognitive impairment

This can be a difficult thing to determine early on, so just focus on the word "indication" and take some notes in the section below to describe your observations regarding the patients cognitive ability. 

Determine if there is any sensory impairment

Observe the patient and your interactions with them to determine if they have any sensory impairments.

Of course, you can also politely ask them

Select the impairments below

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
    No impairments

Determine if the patient has any issues with balance

A good method to test the patience's balance is the Romberg Test. 

The test is performed as follows:

  1. The patient is asked to remove their shoes and stand with their two feet together. The arms are held next to the body or crossed in front of the body.
  2. The clinician asks the patient to first stand quietly with eyes open, and subsequently with eyes closed. The patient tries to maintain their balance. 
  3. The Romberg test is scored by counting the seconds the patient is able to stand with eyes closed.

For safety, it is essential that the observer stand close to the patient to prevent potential injury if the patient were to fall.


Determine eating habits

Ask the patient about what they eat on a day to day basis. 

Find out the following and enter the information in the text form field below.

  • 1
    What a regular day of eating looks like
  • 2
    Times of day that they eat

Inspect pantry and refrigerator

Inspect the patient's refrigerator and pantry

Note dow their contents in the section below. Be sure to describe any items that you think warrant concern. 

Determine alcohol presence/use

Recording the presence of alcohol is an important step when conducting a home visit. Does it look like they are a heavy drinker? Be sure to note down the type and quantity of alcohol you identify in the home.

State any nutritional concerns

Use this section to summarize your thoughts when it comes to the patient's diet and eating habits. Is there any cause for concern?

Relationship with other people:

Determine if the patient has a caregiver

Ask the patient if they currently have a caregiver looking after them.

Record details of the caregiver

Determine if there are other individuals offering support

Does the patient have any family members or friends that are currently offering support for them at home?

If so, note down their names and relation in the section below.


Determine if the patient is on any prescription drugs

Ask the patient if they are currently on any prescription drugs. If they are state their names in the section below. 

Determine if the patient is taking any non-prescription drugs

Does the patient take over the counter medication like paracetamol and ibuprofen?

If they do, how often do they take these medications?

Note down any details regarding the patient's usage of non-prescription drugs in the section below. 

Ensure all medication is well-organized and labeled properly

Check that all of the patient's medication is well organized, stored and labeled properly.

Ensure that medication is out of reach for children. This is particularly important if the patient has family or friends with children that visit regularly.  

Determine if the patient is taking any dietary supplements

Ask the patient if they are currently taking any dietary supplements. 

Determine if the patient has any allergies to medications

Ask the patient if they are allergic to any medication. If they are, state the names of the medication.  

Physical examination:

Learn the patient's weight and height

Ask the patient their height and current weight. Record the details below.

Learn the patient's blood pressure

Take the patient's blood pressure and record the result below 

Describe their general physical condition

Use the section below to describe the patient's general physical condition.

Home environment:

Evaluate condition of the home (interior)

Evaluate the condition of the home inside and select all that apply from the list of keywords below.

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    Neat and tidy
  • 3
    Pets present
  • 4
    Working internet
  • 5
  • 6
  • 7
  • 8

Evaluate conditions of the neighborhood

Get a feel for the neighborhood and describe its conditions in the section below.

Is it a suitable environment for the patient?

Inspect exterior of home for safety and security

Walk around and inspect the exterior of the home, looking out for any potential safety or security risks. 

Home safety:

Ensure the patient has access to emergency services

It is essential that the patient has the ability to contact emergency services at all times. 

If the patient's physical condition is very poor and there is a risk that they would be unable to access a telephone if they were to fall or hurt themselves, the appropriate measures should be taken.

Home health patients should have individualized emergency response plans to address the emergencies they are most likely to experience, and the appropriate response. This document should list emergency contacts including telephone numbers, and be located in an obvious and readily accessible location (e.g. close to a telephone)

Ensure stairs, carpets and electrical cords are hazard-free

Inspect areas of the home where tripping, slipping and other hazards are potentially present.

The most common areas that should be inspected carefully and cleared of any hazards are:

  • 1
  • 2
  • 3
    Electrical cords
  • 4
  • 5
    Tables, chairs and other furniture

Determine if any adaptations to the home are needed

If there are any adaptations that you have determined as being necessary for the patient (e.g. handrails on the stairs, in the bathroom), note them down in the section below so they can be addressed after the visit

Ensure a telephone is available at all times

Before concluding the visit, make sure that the patient has access to a working telephone at all times.

The importance of this cannot be overstated.

In addition to a mobile phone, there should be a home phone fixed in a familiar, easy to reach location.


Add any comments/recommendations

As a final step, note down any final comments and/or recommendations you have on the patient's status and how you think their care should be managed in the future. 


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