Medical Neglect Risk Assessment for Vulnerable Adults

Basic Information

Client Name: Date of Assessment: Assessor Name:

Health and Medical Needs

Existing Medical Conditions: Current Medications: Are medical appointments regularly attended? Always Sometimes Rarely Never

Risk Factors

Risk Factor	Present?	Details
Lack of access to medical care	Yes No
Unmanaged chronic health conditions	Yes No
Medication mismanagement	Yes No
Cognitive or physical impairment	Yes No
Inadequate caregiver support	Yes No
Signs of untreated illness or injury	Yes No

Observations and Notes

Summary of Concerns: Recommended Actions: