Patient Health Profile

Keeping track of personal health information is key to getting the right care. The patient health profile is a simple form that allows patients or caregivers to keep track of important health information.

 

What information can and should be added to the patient health profile?

  • Notable health changes that occur while a patient is at home
  • Doctor or hospital visits
  • Surgical procedures and any related complications
  • Medications
  • Immunizations, like the flu vaccine or tetanus shot
  • Special needs, such as blood sugar checks and seizure precautions
  • Information that could aid staff in helping a patient with activities like bathing, dressing, swallowing or shopping
  • Patient’s doctor's contact information (name and phone number)
  • Insurance information
  • Pharmacy phone number
  • Advance directives, a set of written instructions that specifies what actions are acceptable relative to a patient’s health if they are no longer able to make decisions due to illness or incapacity

Fill out a patient health profile:

Download and print form