Home Visit written assessment record


I’m currently developing a project to introduce home visit for our new PD patients after they start doing Peritoneal Dialysis.

I’m currently working on a written assessment record sheet to provide a tool to the nurse when she’s doing home visit.

I plan to record things like the environment, storage of equipment and supplies, family support, technique and medication. There should also be a comment/recommendation box.

I was wondering if similar assessment tool for PD home visit were done and what are they recording ?

Thanks !

David P.