Healthcare Priorities Checklist

My Healthcare Priorities
Dragonfly's Nook Healthcare Navigation Library
Empowerment through information.
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Recent Concerns & Current Needs

My Top Healthcare Goals

☐ Maintain independence at home
☐ Enhance quality of life
☐ Manage and reduce pain
☐ Regulate chronic conditions
☐ Prevent future health issues
☐ Clarify insurance coverage
☐ Locate primary provider
☐ Find specialist care
☐ Support mental wellbeing
☐ Weight management
☐ Quit nicotine use
☐ Increase physical activity
☐ Other

Medical Care I Need
☐ Primary care visit
☐ Specialist visit
☐ Dental services
☐ Vision services
☐ Hearing services
☐ Physical therapy
☐ Occupational therapy
☐ Speech therapy
☐ Mental health counseling
☐ Skilled home health
☐ Medical equipment
☐ Pharmacy assistance
☐ Routine vaccinations
☐ Screenings
☐ Other

Insurance & Benefit Support
☐ Medical transportation
☐ Dental plan
☐ Vision plan
☐ Hearing plan
☐ OTC benefits
☐ Grocery assistance
☐ Home health coverage
☐ Durable equipment
☐ Fitness programs
☐ Caregiver resources
☐ Case management
☐ Other

Key Concerns
☐ Bill payment
☐ Nutrition access
☐ Housing stability
☐ Transport needs
☐ Medication costs
☐ Caregiving stress
☐ Social isolation
☐ Cognition changes
☐ Fall prevention
☐ Emotional health
☐ Policy understanding
☐ Other

Existing Support System
☐ Family units
☐ Social circle
☐ Neighbors
☐ Faith community
☐ Private caregiver
☐ Home health agency
☐ Benefit manager
☐ Social worker
☐ Community groups
☐ Other

Additional Support Required

Provider Questions

Action Items

Take this healthcare checklist to your appointments for regular review. Your objectives may evolve as your journey progresses.

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