Clemens Health | Old-home to new-home service handoff
Updated 2026-10-05 | (651) 354-1196

Complete with the person and responsible contacts. Keep precise addresses and entry details in the agreed private record, not in public messages.

Move status
Which move date is proposed or confirmed?
Illustrative entry: Proposed move next month; access date awaiting confirmation.
Your notes: ________________________________________

Setting review
Who is reviewing the new living arrangement?
Illustrative entry: Case manager has requested the relevant housing details.
Your notes: ________________________________________

Final visit
What is confirmed at the old address?
Illustrative entry: Provider to confirm final afternoon visit.
Your notes: ________________________________________

First visit
What is confirmed at the new address?
Illustrative entry: New-area staffing check open; no start date promised.
Your notes: ________________________________________

Gap and interim plan
Which interval lacks confirmed help, and who will review it?
Illustrative entry: Move-day routine support not assigned; coordinator to discuss options.
Your notes: ________________________________________

Routine change
What will work differently after the move?
Illustrative entry: Laundry location and community travel route will change.
Your notes: ________________________________________

Revision owner
Who updates everyone when a date changes?
Illustrative entry: Chosen coordinator sends the revised schedule and records responses.
Your notes: ________________________________________

Illustrative example
A person moving across town wants to keep the same IHS provider. The existing afternoon worker cannot travel to the new address at the old time. The team records continued provider interest separately from an unconfirmed schedule. They review a different visit time with the person and identify the move-day interval that still needs a plan. The first visit is marked confirmed only when the address, worker and time are agreed. The person's preferred community activity remains a separate travel-planning question.

Next step
Arrange one coordination conversation about the move's unresolved dependencies, with the person, case manager and relevant provider contact.

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.