Free printable
Caregiver Information Sheet: Free Printable
By Jason Su · Updated September 18, 2026
One page, written by whoever knows the routine best, so that anyone stepping in can do the job for a day. That includes a family member covering a shift, a paid aide on their first visit, or a neighbour helping in an emergency. Handoffs are where care goes wrong — not because people do not care, but because the things that matter were never written down.
Why one page is enough
Because a caregiver on their first visit cannot read a manual. They need to know what happens, when, and what to do if something goes wrong.
Keep it to one page, in plain language, with the emergency section at the top. Anything longer will not be read at the moment it is needed.
Where to start
Fill in the emergency section first. If you only ever complete one part, that is the part — a caregiver who knows who to call and where the paperwork is can handle almost anything else by asking.
Then do the routine. Then the preferences, which are the section that makes care feel like care rather than a checklist.
The sheet
Emergency — read this first
| Call this person first | Name: ______________ Phone: ______________ |
| Second contact | Name: ______________ Phone: ______________ |
| Doctor | Name: ______________ Phone: ______________ |
| Do not call | |
| Hospital preference | |
| Advance directive is kept | |
| Healthcare agent is | Name: ______________ Phone: ______________ |
| Insurance card is kept | |
| Medication list is kept |
- If there is a DNR or POLST order, its location is noted above — a caregiver must know where it is and what it says
- Emergency services: call 911 — do not drive the person yourself if it is serious
About the person
| Name they prefer | |
| Date of birth | |
| Address | |
| Conditions to know about | |
| Allergies | |
| Speaks / understands | |
| Hearing | [ ] Good ☐ Some difficulty ☐ Hearing aid(s) |
| Vision | [ ] Good ☐ Glasses ☐ Low vision |
| Mobility | [ ] Independent ☐ Walker ☐ Wheelchair ☐ Bed-bound |
| Fall risk | [ ] Low ☐ Some ☐ High — do not leave standing alone |
The daily routine
| Time | What happens |
|---|---|
| Morning | |
| Midday | |
| Afternoon | |
| Evening | |
| Night |
Medications
Give the caregiver the Medication Log alongside this sheet.
| How medications are given | [ ] Self ☐ Prompted ☐ Assisted ☐ Crushed in food |
| Where they are kept | |
| What to do if a dose is missed | |
| Pharmacy | Name: ______________ Phone: ______________ |
Food and drink
| Diet or restrictions | |
| Swallowing difficulty | [ ] No ☐ Yes — note what helps |
| Help needed at meals | [ ] None ☐ Cueing ☐ Cutting ☐ Full assistance |
| Favourite foods | |
| Foods to avoid | |
| Fluid intake to aim for |
Personal care
| Bathing | [ ] Independent ☐ Standby help ☐ Full help — days: ______ |
| Dressing | [ ] Independent ☐ Some help ☐ Full help |
| Toileting | [ ] Independent ☐ Prompted ☐ Pads ☐ Catheter |
| Mouth care | |
| Skin care |
What helps, and what does not
| Calms them | |
| Upsets them | |
| Best time of day | |
| How they ask for help | |
| What they like to do |
The house
| Pets (food, times, vet) | |
| Doors and locks | |
| Alarm code | |
| Wi-Fi | |
| Where the spare key is | |
| Anything a visitor should not touch |
How to use it
- Fill in the emergency block first. Give copies to every caregiver.
- Update it whenever anything changes — a new medication, a new aide, a fall. An out-of-date sheet is actively misleading.
- Keep a master copy in the emergency binder and a working copy where the care happens.
- Go through it with a new caregiver in person, at least once. A sheet handed over silently is a sheet that does not get read.
- Pair it with the Medication Log and the Medical Information Sheet — this sheet is the instruction manual; those two are the medical detail.
Frequently asked
Who should fill this in?
Whoever currently does the care, or the person themselves while they still can. If a family member has been covering most of it, they are the one with the knowledge — write it down before it lives only in their head.
Is it safe to have a caregiver’s sheet with medical details on it?
It is a necessary trade-off. Keep the full sheet in a protected place, and be deliberate about who receives a copy. What a caregiver genuinely needs on day one is the emergency section and the routine.
What if there are several caregivers?
Everyone gets the same sheet. Different information for different helpers is what produces contradictions — and contradictions in medication and mobility are the ones that cause harm.
Should a DNR be written on this sheet?
Note where the order is and who signed it — but the order itself is a clinical document and should be kept as its own original, in the location noted. A caregiver must know it exists and where it is.
What about someone with memory loss?
Then the “what helps, and what does not” section matters most, and the routine should be as consistent as possible between caregivers. See how to help your parents organize their paperwork for the wider setup around this stage.
How often should it be updated?
Whenever anything changes, and reread once a month. Care arrangements change faster than people expect, and the sheet is the first thing that goes out of date.
Next step
Fill in the emergency block today — the first name, the second name, the doctor, and where the advance directive is kept. Four lines, and they are the four lines a new caregiver needs most.
Then record where the sheet and the documents live using the free Checklist Builder, and read what to do if you are named as someone’s healthcare agent if you are the person who would be called.
This is a blank record sheet, not medical advice. Care needs, legal requirements, and DNR or POLST procedures differ by state and by person — please follow your care team’s instructions and talk with a licensed professional about your situation.