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Parent Information Worksheet

Organize essential contacts, medical information, legal document locations, and key support information in one binder-ready reference sheet.

Privacy-friendly: no account, no email, and no personal information submitted to this site.

Parent name

Primary contact

Date last updated

If you only fill out one caregiving document, make it this one. Use this worksheet to keep the most important information about an aging parent in one trusted place for emergencies, hospital visits, doctor appointments, family coordination, long-distance caregiving, and future planning.

Do not write Social Security numbers, full financial account numbers, passwords, or login codes on this worksheet.

Section 1

Emergency Snapshot

A helper should be able to understand the basics within 30 seconds.

Field	Information
Parent name
Preferred name
Date of birth
Home address
Phone number
Lives alone?	Yes No
Primary language
Emergency contact
Backup emergency contact
Neighbor or nearby helper
Pets in home
Special access instructions

Extra emergency notes:

Section 2

Medical Contacts

Provider	Name	Phone	Notes
Primary doctor
Specialist
Specialist
Specialist
Pharmacy
Home health provider
Physical therapy provider
Other provider
Other provider

Questions to ask at the next appointment:

Section 3

Medication Overview

This is not a full medication log. Use it to keep a quick overview.

Medication name	Purpose	Notes

Medication questions or concerns:

Section 4

Medical Information

Field	Notes
Allergies
Diagnoses
Medical equipment
Mobility concerns
Vision concerns
Hearing concerns
Recent hospitalizations
Other important medical notes

Recent changes to mention to a doctor:

Section 5

Legal And Planning Documents

This section is only for locating documents. It is not legal advice.

Document	Exists?	Location	Notes
Advance directive	Yes No Unsure
Health care proxy	Yes No Unsure
Health care power of attorney	Yes No Unsure
Financial power of attorney	Yes No Unsure
Will	Yes No Unsure
Trust	Yes No Unsure
Other document	Yes No Unsure
Other document	Yes No Unsure

Attorney or legal contact, if any:

Name

Phone

Notes:

Section 6

Insurance And Benefits

Use summary information only. Do not write full policy numbers or full account numbers here.

Coverage or benefit	Has it?	Contact or plan name	Notes
Medicare	Yes No Unsure
Medicaid	Yes No Unsure
Supplemental insurance	Yes No Unsure
Long-term care insurance	Yes No Unsure
VA benefits	Yes No Unsure
Other benefits	Yes No Unsure
Other benefits	Yes No Unsure

Benefits questions to follow up on:

Section 7

Key Helpers

Name	Relationship	Phone	What they help with

People who should be updated in an emergency:

Section 8

Caregiving Responsibilities

Task	Primary person	Backup person
Appointments
Transportation
Medications
Bills
Groceries
Home maintenance
Family updates
Emergency contact
Pet care
Other: ____________________
Other: ____________________

Notes about boundaries, availability, or backup plans:

Section 9

Home And Safety Notes

Topic	Notes
Stairs
Mobility concerns
Fall concerns
Driving concerns
Emergency alert system
Pets
Other safety notes

Home access notes:

Do not write alarm codes, safe combinations, passwords, or hidden-key locations here unless this worksheet will be stored very securely.

Section 10

Questions To Follow Up On

Use this space for unresolved concerns.

Examples:

Driving evaluation
Legal documents
Medication review
Home safety assessment

Questions:

Additional notes:

Final Page

Review Checklist

Before putting this worksheet away, check:

Information updated.
Contacts verified.
Medication list reviewed.
Legal document locations confirmed.
Caregiving responsibilities updated.
Emergency contacts confirmed.

Next review date

Who should keep a copy?

Where will this worksheet be stored?

Potential Companion Printables

Medication Tracker
Hospital Discharge Worksheet
Family Meeting Agenda
Caregiving Responsibility Worksheet
Assisted Living Tour Worksheet
Long-Distance Caregiver Checklist