Home Health Aide Visit Documentation Checklist [FREE PDF]
Home health aides and supervisors use this checklist for visit documentation per CMS Conditions of Participation 42 CFR 484 home health agency requirements and state home health aide scope of practice.
- Industry: Healthcare / Home Health
- Frequency: Per Visit
- Estimated Time: 10-15 minutes
- Role: Home Health Aide
- Total Items: 8
- Compliance: CMS 42 CFR Part 484, State Home Health Regulations
Patient Assessment & Vital Signs
Document patient condition and vital sign measurements.
- Have vital signs been taken and documented per the care plan?
- Are any changes in patient condition noted and reported to the supervisor?
- Has skin integrity been assessed for signs of breakdown or pressure injury?
- Patient assessment notes
Care Plan Task Completion
Verify completion of assigned care plan tasks.
- Were assigned ADL tasks (bathing, grooming, dressing) completed per care plan?
- Were medication reminders provided as authorized in the care plan?
- Was the home environment assessed for safety hazards during the visit?
- Care plan task notes
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Why Use This Home Health Aide Visit Documentation Checklist [FREE PDF]?
This home health aide visit documentation checklist [free pdf] helps healthcare / home health teams maintain compliance and operational excellence. Designed for home health aide professionals, this checklist covers 8 critical inspection points across 2 sections. Recommended frequency: per visit.
Ensures compliance with CMS 42 CFR Part 484, State Home Health Regulations. Regulatory-aligned for audit readiness and inspection documentation.
Frequently Asked Questions
What does the Home Health Aide Visit Documentation Checklist [FREE PDF] cover?
This checklist covers 8 inspection items across 2 sections: Patient Assessment & Vital Signs, Care Plan Task Completion. It is designed for healthcare / home health operations and compliance.
How often should this checklist be completed?
This checklist should be completed per visit. Each completion takes approximately 10-15 minutes.
Who should use this Home Health Aide Visit Documentation Checklist [FREE PDF]?
This checklist is designed for Home Health Aide professionals in the healthcare / home health industry. It can be used for self-assessments, team audits, and regulatory compliance documentation.
Can I download this checklist as a PDF?
Yes, this checklist is available as a free PDF download. You can also use it digitally in the POPProbe mobile app for real-time data capture, photo documentation, and automatic reporting.