Home Visit and Community Outreach Record
What was found, what was done, what comes next — one sheet per visit, for the nurse or community health worker
What it is
A home-visit record: reason, household members and their health, the patient's condition and medicines, home environment (falls, hygiene, food, heating), social needs, actions taken, referrals and the next visit — plus the monthly outreach summary.
Where to use it
Community nurses and health workers; filed in the patient record; summarised monthly. Evidence for: PHC Standard 7 — community and outreach; Standard 6 — continuity. Evidence for: PHC Standard 7 — community and outreach; Standard 6 — continuity. Evidence for: PHC Standard 7 — community and outreach; Standard 6 — continuity. Evidence for: PHC Standard 7 — community and outreach; Standard 6 — continuity.
Translate and adapt
English master edition. Georgian and other translations are added as they are clinically reviewed. Any facility may translate, add its logo and adapt wording to local practice — keeping the ASF block, the source attribution and the licence line on the sheet. Clinical thresholds and drug doses must be confirmed against national protocols before use.
The same code is printed on the tool itself. Scan it in any facility to reach this page.
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