Collecting Information - Worksheet

Caring for an aging loved one can be very difficult, which is why you should gather as much of their information as possible, right away. Having information you need at your fingertips can help make the daily challenges a little easier.

In addition to the checklist on this page, you can download this Eldercare-worksheet, which will give you a simple document for recording important information.

Remember, this is just a start. Consider what other information is important for your situation. Then save the document, and make at least one printout that you can keep easily at hand.

Elder Care Checklist:

Personal Information

  • Birth Date
  • Name
  • Age
  • Birthday
  • Social Security Number
  • Diagnoses
  • Address
  • Phone Number
  • Height                                                 
  • Weight
  • Special Equipment / Devices
  • Allergies
  • Blood Type
  • Foods Not Allowed

Insurance and Medical Information

  • Medicare Number
    • Phone Number
  • Primary Insurance and Number
    • Phone Number
  • Supplemental Insurance and Number
    • Phone Number
    • Medical Care Providers
  • Doctor
    • Address
    • Phone Number
  • Specialty Doctor(s)
    • Address
    • Phone Number
    • Hospital Affiliation
    • Address
  • Other Health Care or In-Home Care Provider
    • Phone Number
  • Current Medications and Dosage

Legal and Financial Information

  • Location of important papers and documents
    • Will Power of Attorney
    • Durable Medical Power of Attorney
    • Birth Certificate
    • Divorce Decree
    • Property Deeds

Safe Deposit Box

  • Location of Key(s)

Other Documents

  • Sources of Income
  • Monthly Income
  • Social Security
  • Retirement / Pension

Bank Accounts

  • Name of Bank
  • Account Number
  • Checking
  • Savings
  • Address
  • Phone Number

Investments

  • Institution or Broker
  • Phone Number
  • Location of Account Statements
  • Stocks
  • Bonds
  • Annuities
  • CDs
  • Mutual Funds
  • IRA’s
  • Money Market
  • Other
  • Accountant/Broker/Financial Planner
  • Name
  • Address
  • Phone Number

Types of Insurance

  • Life
  • Disability
  • Long Term Care
  • ElderGap
  • Dental
  • Homeowners / Rental
  • Liability
  • Automobile

End of Life Information

  • Funeral Pre-Planning
  • Funeral / Burial / Cremation / Memorial Arrangements
  • Clergy
  • Florist
  • Music / Songs
  • Newspaper / Obituary
  • People to be Contacted