Keeping a care decision log

A care decision log records what was chosen, why it was chosen, and what happens next. It is especially useful when several relatives or professionals participate in a process over time. Keep it small enough to maintain and clear enough that a new participant can distinguish a decision from a suggestion.

Give each entry a specific decision

Write one decision per entry. “Find care” is a project. “Ask the receiving clinician for an evaluation before choosing a program” is a decision with a next action. Narrow entries make it possible to track completion without rewriting the entire family plan.

Identify who made the decision and what role they were acting in. The person receiving care, an involved clinician, a parent or representative, and a person arranging payment may have different responsibilities. Do not record a family consensus unless the participants actually agreed.

Preserve the basis without attaching everything

List the relevant recommendation, proposal, or provider answer and its date. The log can point to the original document rather than reproduce its entire contents. This keeps the source available while avoiding a second uncontrolled archive.

NIMH emphasizes discussion with the health care provider about treatment concerns and fit. Keep clinical reasons attributed to the actual professional. If the reason is practical availability or a personal preference, name it accurately. A scheduling preference should not be rewritten later as clinical necessity.

Use status words that describe evidence

Choose a small status set: proposed, chosen, arrangement pending, confirmed, completed, and revised. Define the difference. A person may choose an option while the appointment is still pending. A confirmed appointment may not yet have occurred.

Ask what evidence changes the status. It could be a written booking message, an acknowledgment from the receiving office, or a completed conversation reported by the person who attended. Record the evidence without claiming a treatment result from an administrative completion.

Include the condition that could change the decision

Write down material conditions such as a receiving assessment, an insurance answer, or a requested cost clarification. Name who follows up and by when. This prevents the family from treating a conditional choice as irreversible simply because it was written down.

If circumstances change, make a new entry referring to the earlier one. Do not erase the old reasoning. SAMHSA's treatment guidance discusses giving feedback when the fit is uncertain; a log should make that conversation easier, not make a person feel trapped by a previous choice.

Review open items before adding new ones

At a brief review, ask which decisions still lack arrangements and which tasks need reassignment. Stop tracking items that have been completed and retain the record privately. A log full of old reminders becomes harder to use at the next real decision.

Give the person receiving care an opportunity to correct their stated preferences. A relative's record is not proof that the person agreed with every detail. If accounts differ, label the disagreement and identify the next conversation needed instead of forcing a single narrative.

A decision review can be brief: read the open entries, verify whether their status has changed, and choose the next contact. Add a new entry only for a new choice. Administrative activity can stay in the task list.

Printable decision entry

Use this original format for one decision. Make as many copies as needed, but keep the latest open items together so the log remains a working record rather than a scrapbook.

• Decision question and entry date:
• Choice made and actual decision maker:
• Reasons, source documents, and personal priorities:
• Conditions or information still outstanding:
• Arrangement owner, next step, and follow-up date:
• Current status and evidence supporting that status:
• Revision link or date for reviewing the choice:

Before sharing an entry, remove information that the recipient does not need. Clinical instructions, financial details, and scheduling tasks may require different recipients. Keep the original records where their authorized owners can access them.

Use proposal comparison when choosing among services and the decision-record protocol when the process needs a common structure. The log does not decide treatment; it helps people carry an actual decision into a confirmed next step.