Interactive Homecare Worker Progress Report

This interactive form is designed so that it can be used in home care scenarios, where internet access may not always be available.

Click here to download the file (650KB)

This interactive PDF form can be used with the free Adobe Reader.
Download the free Adobe Reader at

This interactive PDF form can be filled out when online – or offline.
This interactive PDF form can then be used submit the data you entered into an online database and can also be used to retrieve data from the same database.

When the interactive PDF form file opens, you can type your information into form fields.

To expose where the form fields are, click over this Highlight Fields tool
— ( this will reveal all the form fields with a light blue highlight )

What is nice about this interactive PDF form is that if you are not connected to the internet you can save and print this PDF.

When you are connected to the internet – you can upload and or retrieve data from an online database that this form is connected to.

When you click the Login button located in the top left corner, a dialog box will apear requesting a username and password.

Enter the username: “pdfpictures” and the password: “pdfpictures
(You will need to actually login to upload and / or retrieve a record.)

Here is the use case description of this form;

A homecare worker downloads the unfilled blank PDF file to their laptop or TabletPC.

The homecare worker visits the patient, renders the care and then fill out a form. Since they are at the patients home, they may or may not have internet access or wireless available.

This is the REASON this form is a PDF, as it can be saved with the data inside, and then LATER, when the caretaker has access, they can connect and upload – this may be when they visit the next patient or when they get back to the office (or an office admin person could do this for the homecare worker)

As long as they have a username and password (which provides the security part) any homecare worker can submit the information to a database using only Adobe Acrobat Reader (version 6 or later is required. )

The homecare worker can create a new patient record and they can update a patient record. They can type in the healthcard number and or name and hit retrieve and the form will fill itself out if there is already a record on file.

They can then update the record and submit it to the database.

In this way, the web based system that they have already can be extended to an offline situation using PDF. The PDF can be emailed and saved too. This will do away with faxing. the security is rock solid – you can’t log into the system with out username and passwords from either the PDF or the website. You can see the database records by clicking on the visit site button. Click on the listings to see how the information is updated.

Feel free to create a fictitious name and healthcare record number and try it out.

In this way – instead of a web page – everything is handled by thee interactive PDF form. They can still use a web page form – but the PDF can be filled out offline and later it can update the record or get that latest record that has been updated by someone else.

This form can be used as a dashboard to the entire system using the proper username and password

Enter this into the HCN field and then click the [REQUEST RECORD] button to see a sample record: 6492453475UZ

Below is the record after it has been retrieved and displayed inside the fields of this PDF form.

Here is the how the data displays on the web site.