Elimination Chart Weekly Tracker

A 4-page printable Word weekly log for caregivers to record toileting assistance and what they observed.

For USA non-medical home care agency owners and supervisors. Plus 1 agency instructions page to remove before use.

What's included

1. Page 1: client, week, usual pattern from the care plan, codes, and the daily log
2. Page 2: daily log continued
3. Page 3: weekly summary counts and changes reported to the Agency
4. Page 4: supervisor review and Agency Use Only follow-up
5. Agency instructions page, to remove before use

Add your logo and name

1. Open the Word file and replace the Your Logo Here box with your logo.
2. Replace Agency Name in the letterhead; the body says "the Agency," so no other name edits are needed.
3. Replace the Street Address, City, State ZIP line and the Phone, Email, Website line with your details.
4. Set the letterhead text to black, delete the instructions page, and save.

Customizable template, not legal advice; check your state's requirements. Not a license to operate, not HIPAA software, and no medical claims. Records observations only, not assessments. Store securely with limited access.