Clemens Health | Daily routine discussion sheet
Updated 2026-10-05 | (651) 354-1196

Download this editable worksheet, add your notes, and bring it to the relevant planning conversation. Leave unknown details blank and identify who can confirm them.

Routine and purpose
Which part of the day are we discussing, and why does it matter to the person?
Your notes: ________________________________________

What already works
What does the person do now, including any tools or reminders they choose?
Your notes: ________________________________________

Help requested
At which point is assistance wanted, and what should the worker ask before helping?
Your notes: ________________________________________

Preferences
What pace, words, privacy or choices should the team respect?
Your notes: ________________________________________

Change to discuss
What varies on difficult days, and who should review the plan?
Your notes: ________________________________________

Illustrative example
An adult wants to leave for a community activity on time. They choose their clothes and pack their bag, but ask for a reminder to check the activity time. The planning question is how that reminder fits their support plan, not whether someone should take over the whole morning.

Next step
Bring one completed routine to your case manager and prospective IHS provider. Confirm the agreed tasks and schedule before treating this discussion sheet as a working arrangement.

This is an optional discussion worksheet, not an official assessment, authorization, service plan, or emergency plan. Keep completed copies private and share through an agreed channel.