Home Visit and Telehealth Technology Checklist – Example


The Home Visit Checklist is used upon enrollment of a member in the telehealth program. The checklist helps ensure the participant is set up correctly with the telescale and has the necessary information to participate meaningfully in the program. Telehealth or disease management nurses can use the checklist to guide their interaction with the client, ensuring consistency among staff who conduct home visits. The checklist includes information on infrastructure needed for telehealth equipment, safety precautions around equipment use, transmission of data, and competency assessment for patients around device use.


Appropriate for telehealth staff or providers conducting home visits for the program.

Helpful Tips

  • Provide contact information to patients to use if they need technical support or need assistance after-hours.
  • Restate that the telemonitoring program is not an emergency response service and to call 911 in case of a medical emergency.
  • Provide educational handouts and technology support handouts as needed after reviewing program information and equipment use.

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