• Home Clinical Readiness Assessment Form

    Use this form to evaluate whether a home is properly prepared for a clinical care setup. Please answer all questions based on the current state of the home.
  • Accessibility: Is the main entrance easily accessible for patients and clinical staff (e.g., no major stairs, wide doorway)?*
  • Space Availability: Is there adequate space for clinical equipment and care activities?*
  • Electrical Outlets: Are there sufficient and safe electrical outlets available for medical equipment?*
  • Safety Hazards: Are there any visible safety hazards (e.g., loose rugs, exposed wires, clutter) in the care area?*
  • Privacy: Does the home offer adequate privacy for clinical care (e.g., separate room or screened area)?*
  • Support Availability: Is there a responsible person available to assist with care if needed?*
  • Home Environment Checklist: Check all that apply regarding the care area.
  • Clinical Supplies: Are all required clinical supplies and equipment present and in working order?*
  • Should be Empty:
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