Caregiver Medical Alert Checklist

This worksheet is educational only. It is not medical advice, emergency advice, fall-risk assessment, or a guarantee that any device or provider will respond in a specific way. Confirm details directly with providers and qualified professionals.

1. Senior profile
- Name:
- Primary home address:
- Lives alone / with family / assisted living / other:
- Main caregiver:
- Backup caregiver:

2. Home and mobility notes
- Mostly home-based or often outside the home:
- Stairs or high-risk areas:
- Bathroom/shower concerns:
- Outdoor/garage/porch concerns:
- Wearable preference: pendant / wrist / wall button / mobile device:
- Fall detection should be discussed: yes / no / unsure:

3. Emergency contact handoff
- Primary emergency contact:
- Backup emergency contact:
- Nearby neighbor/building contact:
- Doctor/care-team contact:
- Access instructions:

4. Provider questions
- What happens when the button is pressed?
- Is monitoring 24/7?
- Is fall detection included or optional?
- Does the device work outside the home?
- What network/connection does it use?
- Battery life:
- Setup fee:
- Monthly fee:
- Equipment fee:
- Cancellation terms:
- Return policy:

5. Family decision notes
- Will the senior actually wear/use this?
- Who will test it monthly?
- Who updates contact information?
- What would make this system a bad fit?