My Care and Daily Routines

My name:

In the event of my being called away or unavoidably delayed this form will give alternative carer information that I hope will be helpful.

The person I care for is ......

Likes to be known as ......

Things I do most days ------Early Morning:

Morning:

Lunchtime:

Afternoon:

Teatime:

Evening/Overnight: My Care and Daily Routines

Other People who share care for......

Eg. Care Manager, GP, Specialist nurse/s, OT, usual care workers etc.

Frequency of care worker support:

Other comments/concerns/things you should know:

Eg. Dietary, care needs, manual handling, equipment, personal likes/dislikes etc.

......

I keep any other information about ...... in/on......

This information was updated: ...... (insert date)

PLEASE UPDATE THIS REGULARLY TO RECORD ANY CHANGES AND KEEP IT WHERE THE PERSON YOU CARE FOR LIVES.