---
title: Remote Geriatric Assessment Form Template for Telehealth | Paperform
description: Comprehensive telehealth form for geriatric assessments including cognitive screening, fall history, medication review, and advance care planning. Perfect for elderly patient virtual visits.
url: "https://paperform.co/templates/remote-geriatric-assessment-form"
type: static
generatedAt: "2026-03-28T00:45:01.564Z"
---

[← Back to free form templates](/templates/)    ![Remote Geriatric Assessment Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/remote-geriatric-assessment-form.png)
    [Preview](https://_preview.paperform.co/ai-template/remote-geriatric-assessment-form) [Use this template for free](/create?ai-template=remote-geriatric-assessment-form)    [Healthcare & Medical Forms](/templates/category/healthcare/) [Healthcare](/templates/industry/healthcare/)[Telehealth](/templates/industry/telehealth/)[Senior Care](/templates/industry/senior-care/) [Physician](/templates/role/physician/)[Nurse](/templates/role/nurse/)[Healthcare Administrator](/templates/role/healthcare-admin/)[Caregiver](/templates/role/caregiver/)     About this free form template
### Streamline Remote Geriatric Care with Paperform's Telehealth Assessment Template

Providing comprehensive geriatric care through telehealth requires more than just a video call—it demands a structured, thorough assessment that captures cognitive function, physical safety, medication management, and future care planning. Our **Remote Geriatric Assessment Form** template gives healthcare providers, geriatric specialists, and telehealth clinics a professional, HIPAA-aware tool to conduct complete virtual assessments of elderly patients.

#### Why geriatric telehealth assessments matter

As the population ages and telehealth becomes standard practice, remote geriatric assessments bridge the gap between accessibility and quality care. These comprehensive evaluations help identify cognitive decline, fall risks, medication interactions, and care planning needs without requiring elderly patients to travel to appointments. For geriatricians, primary care physicians, nurse practitioners, and home health coordinators, a well-structured assessment form ensures no critical element is overlooked during virtual visits.

#### What this template includes

This geriatric assessment template covers the essential domains of elderly care:

 - **Patient demographics and contact information** to establish baseline records
 - **Cognitive screening tools** including orientation questions and memory assessments
 - **Comprehensive fall history** documenting previous falls, circumstances, and injuries
 - **Polypharmacy review** to identify medication lists, potential interactions, and adherence issues
 - **Functional status evaluation** assessing activities of daily living (ADLs) and instrumental ADLs
 - **Social determinants screening** to identify isolation, caregiver support, and living conditions
 - **Advance care planning discussions** documenting patient preferences and directive status
 - **Social services referral triggers** to connect patients with community resources

Each section uses conditional logic to reveal follow-up questions based on responses, creating a streamlined experience that adapts to each patient's unique situation while maintaining clinical thoroughness.

#### Built for healthcare workflows with Paperform

Paperform makes it easy for busy healthcare practices to implement structured telehealth assessments without IT support. The doc-style editor lets clinical staff customize questions, add practice branding, and adjust screening tools to match their protocols. Healthcare administrators can embed the form directly into patient portals or share secure links via email or SMS before scheduled telehealth appointments.

Once submitted, assessment data can flow automatically into your EHR system, trigger care coordinator alerts for high-risk findings, or populate clinical notes—all without manual data entry. Use **Stepper** (stepper.io) to build smart workflows that route urgent findings to the care team, schedule follow-up appointments based on assessment results, or automatically generate referrals to social services when screening indicates need.

#### Telehealth solutions for geriatric care teams

This template is purpose-built for:

 - **Geriatric medicine practices** conducting comprehensive geriatric assessments remotely
 - **Primary care physicians** providing age-focused preventive care via telehealth
 - **Nurse practitioners and physician assistants** managing elderly patient populations
 - **Home health agencies** coordinating care for homebound seniors
 - **Hospital discharge planners** assessing post-acute care needs virtually
 - **Memory care clinics** screening for cognitive impairment and dementia risk
 - **Geriatric care managers** conducting initial assessments for private clients
 - **Medicare Advantage programs** performing annual wellness visits remotely

#### Security, compliance, and professional credibility

Healthcare providers need forms they can trust. Paperform is **SOC 2 Type II compliant** and offers the security infrastructure required for handling sensitive patient information. While Paperform itself is not HIPAA compliant, it provides the technical safeguards and administrative controls that support secure telehealth workflows when used within your organization's HIPAA compliance framework.

Role-based permissions let you control which team members can access completed assessments, while conditional email notifications ensure the right specialists receive alerts for concerning findings. Custom success pages can provide patients with immediate next steps, educational resources, or caregiver support information based on their assessment results.

#### Enhance efficiency with integrated workflows

Connect your geriatric assessment form to your existing healthcare technology stack through Paperform's native integrations or **Stepper's** AI-native workflow automation. Send assessment data directly to your EHR, update patient records in Salesforce Health Cloud or HubSpot, log high-risk patients in care coordination spreadsheets, or trigger Slack notifications to care managers when assessments identify fall risks, medication concerns, or cognitive decline.

For practices managing multiple locations or care teams, Paperform's Agency+ plan supports multi-brand management with centralized billing and administration—perfect for health systems or telehealth networks serving diverse elderly populations across regions.

#### Mobile-friendly for patients and caregivers

Many elderly patients complete assessments with assistance from family caregivers or during video visits where the provider shares their screen. Paperform's responsive design ensures the assessment displays perfectly on tablets and smartphones, with large, readable text and simple navigation that accommodates users of all technical abilities.

The one-question-at-a-time Guided Mode can reduce cognitive load for patients with mild impairment, while the classic multi-page layout works well for comprehensive reviews during synchronous telehealth visits.

#### Start improving geriatric telehealth today

With over 500,000 teams worldwide trusting Paperform for professional forms and workflows, healthcare providers can confidently digitize their geriatric assessment process. This template provides the structure you need while remaining fully customizable to your practice's specific protocols, screening tools, and documentation requirements.

Whether you're expanding telehealth services, improving care coordination for elderly patients, or seeking more efficient ways to conduct comprehensive geriatric assessments remotely, this template—combined with Paperform's powerful automation capabilities through **Stepper**—gives you a complete solution that puts patient care first.
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