{"id":625,"date":"2000-08-02T12:00:00","date_gmt":"2000-08-02T12:00:00","guid":{"rendered":"https:\/\/care-givers.com\/articles\/carerecipient-profile-for-all-caregivers\/"},"modified":"2021-06-29T20:22:40","modified_gmt":"2021-06-29T20:22:40","slug":"carerecipient-profile-for-all-caregivers","status":"publish","type":"post","link":"https:\/\/care-givers.com\/articles\/carerecipient-profile-for-all-caregivers\/","title":{"rendered":"Carerecipient Profile For All Caregivers:"},"content":{"rendered":"
\n\n\n
Name of Care Recipient: _____________________<\/p>\n

Please call me: ___________________<\/p>\n

My Day Begins at: _______________<\/p>\n

The tasks I need help with are as follows:<\/p>\n

____________________________________________________________________________<\/p>\n

____________________________________________________________________________<\/p>\n

____________________________________________________________________________<\/p>\n

____________________________________________________________________________<\/p>\n

____________________________________________________________________________<\/p>\n

____________________________________________________________________________<\/p>\n

The best time of the day for me is: _________________________________________________________<\/p>\n

The most difficult time of the day for me is: _______________________________________<\/p>\n

I usally end my day around: ____________________________________________________<\/p>\n

The following are tasks I need help with:<\/p>\n

___________________________________________________________________________<\/p>\n

___________________________________________________________________________<\/p>\n

___________________________________________________________________________<\/p>\n

___________________________________________________________________________<\/p>\n

Meals:<\/p>\n

Breakfast:<\/p>\n

___________________________________________________________________________<\/p>\n

___________________________________________________________________________<\/p>\n

___________________________________________________________________________<\/p>\n

Lunch:<\/p>\n

___________________________________________________________________________<\/p>\n

___________________________________________________________________________<\/p>\n

___________________________________________________________________________<\/p>\n

Dinner:<\/p>\n

___________________________________________________________________________<\/p>\n

__________________________________________________________________________<\/p>\n

___________________________________________________________________________<\/p>\n

In between snacks:<\/p>\n

___________________________________________________________________________<\/p>\n

___________________________________________________________________________<\/p>\n

___________________________________________________________________________<\/p>\n

My favorite beverage is:___________________________________________________________<\/p>\n

I like my coffee or tea prepared: ______________________________________________________<\/p>\n

I also enjoy: __________________________________________________________________<\/p>\n

Special dietary needs:<\/p>\n

__________________________________________________________________________<\/p>\n

___________________________________________________________________________<\/p>\n

___________________________________________________________________________<\/p>\n

Special utensils :________________________________________________________________<\/p>\n

Foods I am allergic or sensitive to are:<\/p>\n

___________________________________________________________________________<\/p>\n

___________________________________________________________________________<\/p>\n

Foods I don’t like are:<\/p>\n

___________________________________________________________________________<\/p>\n

___________________________________________________________________________<\/p>\n

My favorite food preferences are:<\/p>\n

___________________________________________________________________________<\/p>\n

___________________________________________________________________________<\/p>\n

___________________________________________________________________________<\/p>\n

I enjoy eating my meals served in (room): _____________________________________________________<\/p>\n

I enjoy my caregiver eating with me: Yes __________ No _ _____<\/p>\n

My favorite restaurants (and you may order out from them) are:<\/p>\n

Name: ___________________________Address: _______________________________________<\/p>\n

Name: ___________________________Address: _______________________________________<\/p>\n

Name: ___________________________Address: _______________________________________<\/p>\n

Name: ___________________________Address: _______________________________________<\/p>\n

For list of family, personal contacts, physicians and other professionals, please read our
\nemergency information list.<\/p>\n

Things I need help with\u00a0(please describe):<\/p>\n

Keeping Clean and presentable: ______________________________________________________<\/p>\n

Toileting: ____________________________________________________________________<\/p>\n

Bathing: _____________________________________________________________________<\/p>\n

Waling: _____________________________________________________________________<\/p>\n

Climbing Steps: ________________________________________________________________<\/p>\n

Getting in and out of bed: __________________________________________________________<\/p>\n

Housework: ___________________________________________________________________<\/p>\n

Making and receiving phone calls: ____________________________________________________<\/p>\n

Walking: ___________________________________________________________________<\/p>\n

Taking medications: _____________________________________________________________<\/p>\n

Transportation: __________________________________________________________________<\/p>\n

Shopping ____________________________________________________________________<\/p>\n

Eating: ______________________________________________________________________<\/p>\n

Cooking: ____________________________________________________________________<\/p>\n

I am most comfortable wearing: ______________________________________________________<\/p>\n

__________________________________________________________________________<\/p>\n

Going out to an appointment I like to wear:<\/p>\n

___________________________________________________________________________<\/p>\n

___________________________________________________________________________<\/p>\n

Going out on an errand I like to wear:<\/p>\n

___________________________________________________________________________<\/p>\n

While in my home I like to wear:<\/p>\n

___________________________________________________________________________<\/p>\n

Going to church or temple I like to wear:<\/p>\n

___________________________________________________________________________<\/p>\n

___________________________________________________________________________<\/p>\n

Special appliances, health care items, or aids I use:<\/p>\n

Wig: ____________________ Makeup: ___________________ Cane: ________________<\/p>\n

Walker: ____________________Wheelchair: ___________________ Mobile chair: _____<\/p>\n

Eyeglasses: ____________________Incontinence pads \/ adult diapers: _____________<\/p>\n

Hearing Aid: ___________________ Dentures: ______________Oxygen: ____________<\/p>\n

Commode: ____________________ Walker: _________________________________<\/p>\n

Special shoes, socks, etc.:_______________________________________________<\/p>\n

Other:_________________________________________________________________<\/p>\n

_<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Crafts and hobbies<\/td>\n.<\/td>\n<\/tr>\n
Television Programs<\/td>\n.<\/td>\n<\/tr>\n
Radio Programs<\/td>\n.<\/td>\n<\/tr>\n
Music<\/td>\n.<\/td>\n<\/tr>\n
Exercise<\/td>\n.<\/td>\n<\/tr>\n
Musical Instruments
\nplayed<\/td>\n		.<\/td>\n<\/tr>\n
Languages spoken<\/td>\n.<\/td>\n<\/tr>\n
Favorite topics for
\nconversations<\/td>\n		.<\/td>\n<\/tr>\n
Meaningful life
\nexperiences<\/td>\n		.<\/td>\n<\/tr>\n
Travel experiences<\/td>\n.<\/td>\n<\/tr>\n
Memorable childhood
\nexperiences<\/td>\n		.<\/td>\n<\/tr>\n
Marriage<\/td>\n.<\/td>\n<\/tr>\n
Family<\/td>\n.<\/td>\n<\/tr>\n
Religous & Spiritual
\nbackground<\/td>\n		.<\/td>\n<\/tr>\n
Accomplishments<\/td>\n.<\/td>\n<\/tr>\n
Other interests<\/td>\n.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

I am involved in the following community programs:<\/p>\n

——————————————————————————————————————————-<\/p>\n

——————————————————————————————————————————-<\/p>\n

——————————————————————————————————————————-_<\/p>\n

My disposition:<\/p>\n

Caregivers enjoy caring for me because:<\/p>\n

________________________________________________________________<\/p>\n

________________________________________________________________<\/p>\n

Caregivers have difficulty with me because:<\/p>\n

________________________________________________________________________________________________<\/p>\n

________________________________________________________________________________________________<\/p>\n

 <\/p>\n\n\n\n\n\n\n\n\n
Name of medication or vitamin<\/td>\n,<\/td>\n<\/tr>\n
Form: liquid, tablet, capsule, injection, breathing treatment, bandage change, etc.<\/td>\n.<\/td>\n<\/tr>\n
Dosage<\/td>\n.<\/td>\n<\/tr>\n
Times given:<\/td>\n_____times per day at _____________________________________<\/td>\n<\/tr>\n
Taken with fluid, after food or before eating<\/td>\n,<\/td>\n<\/tr>\n
Special instructions<\/td>\n,<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n\n\n\n\n\n
Name of medication or vitamin<\/td>\n,<\/td>\n<\/tr>\n
Form: liquid, tablet, capsule, injection, breathing treatment, bandage change, etc.<\/td>\n.<\/td>\n<\/tr>\n
Dosage<\/td>\n.<\/td>\n<\/tr>\n
Times given:<\/td>\n_____times per day at _____________________________________<\/td>\n<\/tr>\n
Taken with fluid, after food or before eating<\/td>\n,<\/td>\n<\/tr>\n
Special instructions<\/td>\n,<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n\n\n\n\n\n
Name of medication or vitamin<\/td>\n,<\/td>\n<\/tr>\n
Form: liquid, tablet, capsule, injection, breathing treatment, bandage change, etc.<\/td>\n.<\/td>\n<\/tr>\n
Dosage<\/td>\n.<\/td>\n<\/tr>\n
Times given:<\/td>\n_____times per day at _____________________________________<\/td>\n<\/tr>\n
Taken with fluid, after food or before eating<\/td>\n,<\/td>\n<\/tr>\n
Special instructions<\/td>\n,<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n\n\n\n\n\n
Name of medication or vitamin<\/td>\n,<\/td>\n<\/tr>\n
Form: liquid, tablet, capsule, injection, breathing treatment, bandage change, etc.<\/td>\n.<\/td>\n<\/tr>\n
Dosage<\/td>\n.<\/td>\n<\/tr>\n
Times given:<\/td>\n_____times per day at _____________________________________<\/td>\n<\/tr>\n
Taken with fluid, after food or before eating<\/td>\n,<\/td>\n<\/tr>\n
Special instructions<\/td>\n,<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n\n\n\n\n\n
Name of medication or vitamin<\/td>\n,<\/td>\n<\/tr>\n
Form: liquid, tablet, capsule, injection, breathing treatment, bandage change, etc.<\/td>\n.<\/td>\n<\/tr>\n
Dosage<\/td>\n.<\/td>\n<\/tr>\n
Times given:<\/td>\n_____times per day at _____________________________________<\/td>\n<\/tr>\n
Taken with fluid, after food or before eating<\/td>\n,<\/td>\n<\/tr>\n
Special instructions<\/td>\n,<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>","protected":false},"excerpt":{"rendered":"

This profile gives the caregivers all of the needs, likes and dislikes of care recipients. This is a form every caregiver should use.<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[15],"tags":[],"ppma_author":[38],"class_list":["post-625","post","type-post","status-publish","format-standard","hentry","category-aging"],"authors":[{"term_id":38,"user_id":6,"is_guest":0,"slug":"gail-mitchell","display_name":"Gail Mitchell","avatar_url":"https:\/\/secure.gravatar.com\/avatar\/?s=96&d=mm&r=g","1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":""}],"_links":{"self":[{"href":"https:\/\/care-givers.com\/articles\/wp-json\/wp\/v2\/posts\/625","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/care-givers.com\/articles\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/care-givers.com\/articles\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/care-givers.com\/articles\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/care-givers.com\/articles\/wp-json\/wp\/v2\/comments?post=625"}],"version-history":[{"count":3,"href":"https:\/\/care-givers.com\/articles\/wp-json\/wp\/v2\/posts\/625\/revisions"}],"predecessor-version":[{"id":5179,"href":"https:\/\/care-givers.com\/articles\/wp-json\/wp\/v2\/posts\/625\/revisions\/5179"}],"wp:attachment":[{"href":"https:\/\/care-givers.com\/articles\/wp-json\/wp\/v2\/media?parent=625"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/care-givers.com\/articles\/wp-json\/wp\/v2\/categories?post=625"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/care-givers.com\/articles\/wp-json\/wp\/v2\/tags?post=625"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/care-givers.com\/articles\/wp-json\/wp\/v2\/ppma_author?post=625"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}