Senior Care Medication Refill & Fall Risk Assessment Form

Managing medication for elderly residents in senior care facilities requires careful attention to multiple risk factors, drug interactions, and individual health conditions. This Senior Care Medication Refill & Fall Risk Assessment Form provides a comprehensive solution for facilities that need to coordinate prescription refills while actively monitoring for fall risks and potential medication-related complications.

Designed specifically for senior care facilities, assisted living communities, nursing homes, and geriatric healthcare providers, this template goes beyond simple refill requests. It combines medication management with critical safety assessments that are essential for elderly patients who often take multiple medications (polypharmacy) and face elevated fall risks.

The form captures essential resident information, current medication details, and prescription refill requests while simultaneously assessing fall risk factors such as dizziness, mobility issues, and medication side effects. Healthcare staff can flag concerns about drug interactions, request polypharmacy reviews from geriatric pharmacists, and schedule consultations when needed—all within a single streamlined workflow.

Paperform makes it easy to create professional, compliant forms that work seamlessly with your existing healthcare systems. With conditional logic, you can show relevant follow-up questions based on resident responses, ensuring thorough assessments without overwhelming staff with unnecessary fields. Connect your form to Stepper to automatically route urgent refill requests to appropriate staff, send notifications when fall risk assessments require immediate attention, or trigger pharmacist consultation scheduling workflows.

For facilities managing sensitive resident health information, Paperform's SOC 2 Type II compliance and secure data handling provide peace of mind, while the professional, easy-to-navigate form design ensures that busy healthcare staff can complete requests quickly and accurately. Whether you're a director of nursing, care coordinator, medication aide, or facility administrator, this template helps you maintain the highest standards of geriatric medication safety.