Medical Home Health Aide Intake Form

Streamline Home Health Care with a Professional Intake Form

Finding the right home health aide starts with understanding your patient's unique needs. This Medical Home Health Aide Intake Form template helps healthcare providers, home care agencies, and senior care organizations gather essential information to match patients with appropriate caregivers and establish effective care plans.

Whether you're running a home healthcare agency or coordinating family care, this intake form collects everything you need in one organized submission—from personal care requirements and medication schedules to dietary needs and supervision levels. By gathering comprehensive patient information upfront, you can ensure care quality, reduce miscommunication, and create personalized care plans that truly support patient wellbeing.

Built for Home Healthcare Workflows

This template is designed specifically for home health agencies, senior care providers, rehabilitation services, and family caregivers coordinating professional care. Use it to:

• Assess care needs accurately with detailed questions about mobility, personal care, and daily living activities
• Document medication management requirements including reminders, administration needs, and pharmacy information
• Plan meal preparation based on dietary restrictions, preferences, and nutrition requirements
• Determine supervision levels to match patients with appropriately trained aides
• Capture emergency contacts and healthcare provider information for seamless coordination

The form flows naturally from basic patient information through detailed care needs, making it easy for family members or case managers to complete while ensuring nothing critical gets overlooked.

Automate Your Home Care Operations

Once you've captured intake information, use Stepper (stepper.io) to automate what comes next. Automatically route new patient submissions to your scheduling team, create care plan documents, send welcome packets to families, notify assigned caregivers, and update your CRM—all without manual data entry.

Connect this form to your existing healthcare tools, send intake data to your patient management system, trigger background checks for new aide assignments, and keep your entire team in sync. With Paperform's conditional logic, you can even route urgent care needs differently than routine requests, ensuring high-priority patients get immediate attention.

HIPAA Considerations and Data Security

While Paperform is not HIPAA compliant, this template provides a strong foundation for gathering home health information. For organizations requiring HIPAA compliance, we recommend using this template as a pre-screening tool or supplementing with additional security measures. Paperform offers SOC 2 Type II compliance, SSL encryption, and robust data security features suitable for many healthcare workflows.

Whether you're an established home health agency looking to digitize your intake process or a new provider building efficient care coordination systems, this template transforms a typically paper-heavy process into a streamlined digital experience that families appreciate and care teams can actually use.