Daily Care Log Template (Katie Beckett)
Tip: use your browser's Print or "Save as PDF" option to download this. 🖨️ Print Now
Daily Care Log Template (Katie Beckett)
From caidee.org · Tennessee TennCare resource
Use this template to document a typical day. Fill in 5-7 days of logs and submit with your application or appeal. Hour-by-hour specificity is what wins reviewers.
Child's Name: ____________________________
Date: ____________________________
| Time | Care Activity | Who Provided | Duration (min) |
|---|---|---|---|
| 6:00 AM | |||
| 7:00 AM | |||
| 8:00 AM | |||
| 9:00 AM | |||
| 10:00 AM | |||
| 11:00 AM | |||
| 12:00 PM | |||
| 1:00 PM | |||
| 2:00 PM | |||
| 3:00 PM | |||
| 4:00 PM | |||
| 5:00 PM | |||
| 6:00 PM | |||
| 7:00 PM | |||
| 8:00 PM | |||
| 9:00 PM | |||
| 10:00 PM | |||
| 11:00 PM | |||
| OVERNIGHT |
End of Day Summary
Total hours of direct care provided: _______
Number of caregivers involved: _______
Medications administered: _______
Skilled procedures performed (suctioning, G-tube, etc.): _______
Behavioral incidents requiring intervention: _______
Notes: _______________________________________________
Tip: do this for at least 5 days (including a weekend day). Patterns matter — reviewers look at consistency, not just one day.
caidee.org/downloads/daily-care-log · Updated for 2026 TennCare rules · Not legal advice — for navigation guidance only