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Home > For Parents & Families > Caring for Children with Chronic Conditions > Managing and Coordinating Care > Care Notebook

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Care Notebook

Keeping Records

In caring for a child with special health care needs, families get information and paperwork from many sources. The care notebook is designed to help organize the information in a central place to assist both families and providers. You may download the complete notebook and compile in your own binder or download separate forms by clicking on the list below.

• Collaborative Care Notebook ( 9.8 MB)
  From Utah Family Voices, this care notebook incorporates forms from many other states. Use selected pages or the entire notebook. The Word version is easy to edit on your computer.
• Collaborative Care Notebook ( 467 KB)
  From Utah Family Voices, this care notebook in PDF format incorporates forms from many other states. Use selected pages or the entire notebook.

Utah Care Notebook

Tips on setting up your care notebook ( 105 KB)

Utah Care Notebook: Español

Al cuidar la salud de su niño con necesidades especiales, usted puede recibir copias e información de muchas fuentes. Un Cuaderno de registro le facilitara a organizarse mejor con la información más importante. Con un cuaderno de registros le será mucho más fácil para usted encontrar y compartir una porción de información con otros quienes son parte del equipo del cuidado de su niño.

Siga estos pasos para preparar el notebook (cuaderno deregistro) de su Niño ( 149 KB)

Completo Care Notebook ( 1.3 MB)

Sections of the Utah Care Notebook, English and Español

Pages to keep track of Appointments & Care / Paginas para Mantener las Citas y el Cuidado

• Appointment Log ( 43 KB) / Registro de las Citas ( 139 KB)
• Diet Tracking ( 26 KB) / Formulario de Dieta ( 70 KB)
• Equipment ( 95 KB) / Equipos o Articulos ( 72 KB)
• Growth Tracking Form ( 36 KB) / Formulario para Mantener Su Crecimiento ( 153 KB)
• Hospital Stay Tracking Form ( 29 KB) / Formulario de Estadia en el Hospital ( 70 KB)
• Lab Work and Tests ( 35 KB) / El Laboratorio Trabajo Pruebas Procedimientos ( 135 KB)
• Medical Bill Communication Log ( 42 KB) / Libro de Comunicacion de Fracturas Medicas ( 114 KB)
• Medical Surgical Highlights ( 35 KB) / Los Momentos Culminantes Quirurgicos Medicos ( 117 KB)
• Medications ( 32 KB) / Medicaciones ( 103 KB)
• Notes ( 19 KB) / Notas ( 30 KB)
• Supplies ( 53 KB) / Provisiones ( 104 KB)

Pages to create a care summary: Abilities & Special Care Needs / Las páginas para crear un resumen del cuidado: Las Habilidades y las Necesidades del Cuidado Especial

• Activities of Daily Living ( 23 KB) / Las Actividades Diarias ( 91 KB)
• Care Schedule ( 46 KB) / Horario del Cuidado ( 127 KB)
• Communication ( 20 KB) / Comunicacion ( 90 KB)
• Coping/Stress Tolerance ( 23 KB) / Sobrellevar Tolerar el Estres ( 91 KB)
• Mobility ( 18 KB) / Mobilidad ( 89 KB)
• Nutrition ( 18 KB) / Nutricion ( 89 KB)
• Respiratory ( 20 KB) / Respiratorio ( 87 KB)
• Rest/Sleep ( 23 KB) / Dormir Reposar ( 87 KB)
• Social/Play ( 31 KB) / Social Juego ( 92 KB)
• Transitions ( 35 KB) / Transiciones ( 94 KB)

Pages to create a Care Team & Resource List / Paginas para crear un Equipo Y Lista De Recursos

• Child Care ( 51 KB) / Cuidado De Ninos ( 96 KB)
• Early Intervention ( 94 KB)
• School Contacts ( 75 KB)
• Family Information ( 114 KB) / Informacion Familiar ( 88 KB)
• Family Support Resources ( 72 KB) / Recursos de Apoyo Familiar ( 91 KB)
• Home Care Providers ( 47 KB) / Cuidado en la Casa ( 63 KB)
• Insurance ( 48 KB) / Fuentes de Ayuda Economica S ( 61 KB)
• Medical Dental Providers ( 99 KB) / Medico Dental ( 120 KB)
• Pharmacy ( 60 KB) / Farmacia ( 96 KB)
• Recreation ( 348 KB) / Oportunidades de Recreacion ( 101 KB)
• Respite Care ( 56 KB) / Cuidado De Descanso Respite ( 56 KB)
• Association for Utah Community Health (AUCH) / Contactos de la Escuela ( 109 KB)
• Special Transportation ( 55 KB) / Transportacion Especial ( 63 KB)
• Therapists ( 45 KB) / Terapistas ( 63 KB)

Other Sample Care Notebooks

• Care Notebook ( 2.7 MB)
  Track your child's care, health, and other information in this care notebook with pages from 10 different states.
• Care Notebook ( 467 KB)
  Track your child's care, health, and other information in this care notebook with pages from 10 different states, PDF version.
• Building Your Care Notebook (AAP)
  The American Academy of Pediatrics provides a central place with links to several forms from many states. For families that are new to making care notebooks, we suggest you pick one form and try filling it out before downloading other forms.

Other Forms

For more forms, see the Forms page.

Authors

Author:

Gina Pola-Money, 6/2008

Reviewing Authors:

Barbara Ward RN BS, 11/2007 Juan Carlos Vasquez, 11/2007

Content Last Updated:

10/2009