Transition care plan template.xlsx

	A	B	C	D	E	F
1		Optimal Autonomy At Home LLC
2		Contact: 508-644-0050
3		Email: optimalautonomyinfo@gmail.com
4		Book a Consultation
5
6	Patient Name	Discharge Date	Primary Diagnosis	Hospital Contact	Case Manager Name	Home Care Agency Contact
7	[Enter Name]	[Enter Date]	[e.g., Hip Surgery]	[Phone/Email]	[Name & Contact]	[Agency Name & Contact]
8	Medications	Dosage	Time/Frequency	Notes
9	[e.g., Lisinopril]	10 mg	1x daily, AM	Take with food
10	Follow-Up Appointments	Provider Name	Date	Time	Location	Notes
11	Primary Care Visit	Dr. Smith	08/15/2025	10:00 AM	Clinic A	Bring medication list
12	Home Safety Adjustments	Completed? (Y/N)	Responsible Party	Notes
13	Install grab bars	Y	Family	Installed in bathroom
14	In-Home Care Tasks	Assigned To	Frequency	Notes
15	Bathing Assistance	Caregiver Jane	M/W/F	Supervised by nurse
16	Nutrition Plan	Dietary Restrictions	Meal Prep Notes	Assigned To
17	Heart-Healthy Diet	Low sodium	Meals delivered 3x/week	Home care agency
18	Emergency Contacts	Role	Phone Number	Notes
19	Daughter (Primary Contact)	Family	(555) 123-4567	Lives nearby
20	Mental/Emotional Support	Assigned Support	Notes
21	Weekly check-in	Caregiver / Family	Encourage light walks and hobbies
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100