Utah Family Voices

Utah Family Voices

Family’s Coordinating Care

Utah Care Notebook

In caring for a child with special health care needs, families get information and paperwork from many sources.  The Utah 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 it in your own binder or download separate forms by clicking items on the list below.

Collaborative Care Notebook: Word Version
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 Version
From Utah Family Voices, this Care Notebook in PDF format incorporates forms from many other states.  Use selected pages or the entire Notebook.

Tips on Setting Up Your Care Notebook
PDF Document
Step 1: Gather information you already have.
Gather up any health information about your children you already have.  This may include reports from recent doctor’s visits, a summary of a recent hospital stay, the year’s school plan, test results or informational pamphlets.

Step 2: Look through the pages of the Utah Care Notebook. Which of these pages could help you keep track of information about your child’s health or care?  Print off the entire Notebook or choose the pages you like.  Print copies of any that you think you will use.

Step 3: Decide which information about your child is most  important to keep in the Utah Care Notebook. What information do you look up often?  What information do people caring for your child need?  Consider storing other information in a file drawer or box where you can find it if needed.

Step 4: Put the Utah Care Notebook together. Everyone has a different way of organizing information.  The only important thing is to make it easy for you to find again.  Here are some suggestions for supplies used to create a Care Notebook: 3-ring notebook or large accordion envelope – hold papers securely; tabbed dividers – create your own information sections; pocket dividers – store reports; and plastic pages – store business cards and photographs.

Sections of the Utah Care Notebook, English and Español

Pages to keep track of Appointments & Care / Paginas para Mantener las Citas y el Cuidado

Appointment Log ( 43 KB) / Registro de las Citas ( 139 KB)

Diet Tracking ( 26 KB) / Formulario de Dieta ( 70 KB)

Equipment ( 95 KB) / Equipos o Articulos ( 72 KB)

Growth Tracking Form ( 36 KB) / Formulario para Mantener Su Crecimiento ( 153 KB)

Hospital Stay Tracking Form ( 29 KB) / Formulario de Estadia en el Hospital ( 70 KB)

Lab Work and Tests ( 35 KB) / El Laboratorio Trabajo Pruebas Procedimientos ( 135 KB)

Medical Bill Communication Log ( 42 KB) / Libro de Comunicacion de Fracturas Medicas ( 114 KB)

Medical Surgical Highlights ( 35 KB) / Los Momentos Culminantes Quirurgicos Medicos ( 117 KB)

Medications ( 32 KB) / Medicaciones ( 103 KB)

Notes ( 19 KB) / Notas ( 30 KB)

Supplies ( 53 KB) / Provisiones ( 104 KB)

Pages to create a care summary: Abilities & Special Care Needs / Las páginas para crear un resumen del cuidado: Las Habilidades y las Necesidades del Cuidado Especial

Activities of Daily Living ( 23 KB) / Las Actividades Diarias ( 91 KB)

Care Schedule ( 46 KB) / Horario del Cuidado ( 127 KB)

Communication ( 20 KB) / Comunicacion ( 90 KB)

Coping/Stress Tolerance ( 23 KB) / Sobrellevar Tolerar el Estres ( 91 KB)

Mobility ( 18 KB) / Mobilidad ( 89 KB)

Nutrition ( 18 KB) / Nutricion ( 89 KB)

Respiratory ( 20 KB) / Respiratorio ( 87 KB)

Rest/Sleep ( 23 KB) / Dormir Reposar ( 87 KB)

Social/Play ( 31 KB) / Social Juego ( 92 KB)

Transitions ( 35 KB) / Transiciones ( 94 KB)

Pages to create a Care Team & Resource List / Paginas para crear un Equipo Y Lista De Recursos

Child Care ( 51 KB) / Cuidado De Ninos ( 96 KB)

Early Intervention ( 94 KB)

School Contacts ( 75 KB)

Family Information ( 114 KB) / Informacion Familiar ( 88 KB)

Family Support Resources ( 72 KB) / Recursos de Apoyo Familiar ( 91 KB)

Home Care Providers ( 47 KB) / Cuidado en la Casa ( 63 KB)

Insurance ( 48 KB) / Fuentes de Ayuda Economica S ( 61 KB)

Medical Dental Providers ( 99 KB) / Medico Dental ( 120 KB)

Pharmacy ( 60 KB) / Farmacia ( 96 KB)

Recreation ( 348 KB) / Oportunidades de Recreacion ( 101 KB)

Respite Care ( 56 KB) / Cuidado De Descanso Respite ( 56 KB)

Association for Utah Community Health (AUCH) / Contactos de la Escuela ( 109 KB)

Special Transportation ( 55 KB) / Transportacion Especial ( 63 KB)

Therapists ( 45 KB) / Terapistas ( 63 KB)

Other Sample Care Notebooks

Care Notebook ( 2.7 MB)
Track your child’s care, health, and other information in this care notebook with pages from 10 different states.

Care Notebook ( 467 KB)
Track your child’s care, health, and other information in this care notebook with pages from 10 different states, PDF version.

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.