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Create Your Own Health Care Notebook

The major role of this notebook is to help individuals served by TCRC and/or their parents, caregivers or service providers maintain an ongoing record of the individual’s health care history and current medical status. Healthcare notebooks are valuable in providing medical personnel with vital information and helping individual’s and/or their families take an active role in their medical care.

These forms were gathered by Rainbow Connection Family Resource Center to assist families in creating health care notebooks for individuals. Please choose the forms that are appropriate for your needs.

There are many websites where you can download different forms and use for your notebook. These are two examples of many you can access online:

In addition to the forms, we have included fact sheets and checklists for you to use on a variety of topics.

01-02 Medical History Worksheet.pdf
03 Emergency Names and Numbers.doc
04 Medical Care Contact Information.doc
05 Medical Emergency Information.doc
06 Emergency Room Information.doc
07 Doctor’s appointments.doc
08 Surgeries and procedures.doc
09 Medical Appointment.doc
10 Notes From Doctors appointments.doc
11 Test Results.doc
12 Allergies.doc
13 Dental History.doc
14 Medication Information.doc
15 Consent Form.doc
16 Medical Power of Attorney.doc
17 Important People in My Life.doc
18 Health Review Checklist.doc
20 Aspiration pg 1.doc
21 Aspiration pg 2.doc
22 Bowel Impaction pg 1.doc
23 Bowel Impaction pg 2.doc
24 Diabetes pg 1.doc
25 Diabetes pg 2.doc
26 Epilepsy pg 1.doc
27 Epilepsy pg 2.doc
28 G-Tube pg 1.doc
29 G-Tube pg 2.doc
30 Osteoporosis pg 1.doc
31 Osteoporosis pg 2.doc
32 Staph Infection pg 1.doc
33 Staph Infection pg 2.doc
34 Weight Management pg 1.doc
35 Weight Management pg 2.doc
36 Planning for Individuals who are Severely Physically Handicapped.doc

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