Senior Emergency Kit Worksheets and Checklists

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​​​The Senior Emergency Kit​ features several worksheets that family caregivers can complete with the help of a senior loved one. This toolkit can be kept in an easy-to-reach location, such as a nightstand, to allow easy access to information.

emerg_card.gifChecklist of Things to Have in Your File
  • Keep these documents about your senior loved one in your information management tool file:
  • ​Contact Names and Numbers
  • Medication Tracker
  • Allergies and Conditions Worksheet
  • Doctor Visit Worksheet
  • Health Care Proxy
  • DNR (Do Not Resuscitate) Order
  • Advance Directives such as Living Will and Durable Power of Attorney
  • Insurance Policies
  • ​​Will and Testament
  • Copy of Medicare/Medicaid Card
  • Anatomical Gift/Organ Donation Card
  • Valuables Designation List
The toolkit is part of the Home Instead Senior Care® network’s Answering the CallSM program designed to help family caregivers be ready for a call when a senior loved one needs emergency assistance.

Important Contacts
It’s important that a family caregiver has easy access to the medical and business professionals that manage their senior’s affairs in the event of an emergency. List on the worksheet all of those individuals with whom your senior does business.​​​

Medications and Dosages
Tracking medications is one of the most important exercises that a family caregiver can do to help keep an older adult safe from medication accidents. This worksheet is a valuable resource to keep all of a senior’s medications and dosages up-to-date.

Allergies and Conditions
Your loved ones and any emergency workers who may assist your senior in a medical crisis should be aware of allergies or conditions that a senior is suffering from, including:
  • ​​Foods
  • Seasonal Allergies
  • Medications​
  • Heart Problems
  • Diabetes
  • Arthritis
  • Macular Degeneration

Allergies and Conditions Worksheet (PDF)

​​​Doctor Visit Worksheet

Doctor visits can be confusing for older adults. Take this doctor visit worksheet to an appointment so you can write down questions, answers, and what you need to do next.

Senior Emergency Wallet Card
Keep emergency information quickly available wherever your loved one goes. Information such as emergency contacts, medical data and a medical conditions list are easily available with this wallet card.

Explore these pages to learn more about:

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