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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 Sections list below.
  • Collaborative Care Notebook (Word Document 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 (PDF Document 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: 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.

Sections of the Utah Care Notebook, English and Español

Other Sample Care Notebooks

  • Care Notebook (Word Document 2.7 MB)
    Track your child's care, health, and other information in this care notebook with pages from 10 different states. The Word document can be modified by you.
  • Care Notebook (UT Dept. of Health) (PDF Document 467 KB)
    For families to track your child's care, health, and other information; with pages from 10 different states. Word document may be edited.
  • 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

  • Tracking Medical Bills (Word Document 125 KB)
    This form, developed for Tennessee's Family Information Notebook, provides a way to track bills including dates, insurance company, who paid, and more. For a PDF version and other forms, see the Care Notebook page.
  • Weekly Medication Diary (PDF Document 99 KB)
  • Portable Medical Summary (PDF Document 70 KB)
    A 2-page form to keep track of medical information including diagnoses, medications, equipment, hospitalizations, and insurance.
  • Focus Sheet (Word Document 27 KB)
    This form helps parents decide what they want to focus on during the appointment with the doctor and includes places for questions (behavior problems, family needs, etc.); places for things to bring (lab results, reason for visit, etc.); and places to write thing to remember after the appointment (next visit, treatment plan, etc.).
For more forms, see the Forms for Education and Planning for Emergencies pages.

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