Printable care diary template

Seven pages, structured according to the six assessment modules – free and without registration.

Download the care diary template

The template is structured according to the six modules of the assessment – exactly the structure the Medical Service uses for its evaluation. That is the decisive difference from a blank notebook: your entries end up where they will be needed later.

Care diary template (PDF, 7 pages, 14 KB)

Page 1 explains the scoring from 0 to 3 points and the point thresholds of the care levels. After that, one page per module to fill in.

Download template

Free, without registration, without an email address.

What belongs in each line

Three details make a line useful:

And a score from 0 to 3 in the last column. Afterwards, enter the total for each module in the care level calculator.

When paper is no longer enough

Paper has two weaknesses that become obvious after two weeks: it does not calculate, and it stays in one place. If you provide care from a distance or take turns with siblings and a home care service, you end up writing in four different notebooks.

The digital care diary solves exactly that: everyone writes in the same record, the system calculates the module totals, and you print out a report for the appointment.

Frequently asked questions about the template

Is the template free?

Yes, without registration and without an email address. You download the PDF directly.

How is the template structured?

According to the six modules of the assessment – one page per module with the criteria and space for date, description and score. A template structured differently produces notes that nobody can assign to the modules.

Do I have to fill in everything every day?

No. Fill in what happened that day. What matters is that the days you record are complete – not that every line is full.

Paper or app?

Both are acceptable. Paper is available immediately; the app calculates the module totals and shows where your records are thin. Many people start on paper and switch when it goes on for longer.

How many weeks should I keep it?

Two to four weeks before the assessment appointment. Anything shorter looks like a snapshot; hardly anyone keeps it up for longer.

Note. This page explains the procedure in general terms and does not replace legal or care advice. Amounts and point values reflect the situation as of 2025 and are taken from the legal basis cited in each case. The binding decision is always made by your long-term care insurance fund (Pflegekasse). Free and independent advice is available from your local care support centre (Pflegestützpunkt) and from care counselling under § 7a SGB XI.

Prefer to go digital straight away?

Care-Assistant keeps the care diary digitally: entries in seconds, evaluation according to the six modules of the assessment, report as a PDF for the long-term care insurance fund and the Medical Service (MD).

€9.50 per month, cancel anytime. incl. 19% VAT