Home Care (Spitex) Intake Form
Comprehensive Spitex and home care patient intake form for Swiss home nursing organisations. Collect care needs, household situation, medication plan, emergency contacts, health insurance details, and carer preferences under Swiss KVG and nFADP.
About this template
The Home Care (Spitex) Intake Form is designed for Swiss home nursing and community care organisations (Spitex). It collects the comprehensive patient information required to plan safe, appropriate, and KVG-compliant home care services. The form covers care needs assessment, household and living situation, medication management, emergency contacts, health insurance details, and individual carer preferences.
KVG and nFADP compliance
Home care services in Switzerland are regulated under KVG (Krankenpflegegesetz / loi sur l'assurance-maladie) and must be prescribed by a physician for insurance reimbursement. Patient health data collected during intake is sensitive personal data under the nFADP and must be handled with appropriate security measures, retained for the legally required period, and shared only on a need-to-know basis within the care team.
What this form collects
- Patient full name, address, date of birth, and contact details
- Referring physician and care coordinator details
- Primary care needs and diagnoses
- Household situation (living alone, with family, in assisted living)
- Current medications and allergy information
- Emergency contacts (minimum two)
- Health insurance provider and policy number
- Preferred care schedule and carer gender preference
- Special requirements (language, cultural, mobility aids)
- Patient or guardian consent signature
How to use this template
Use this template
Click 'Use template' to create a copy in your dashboard.
Add your organisation branding
Customise the title and description to reflect your Spitex organisation's name and service area.
Send to family or referrer
Share the form with the patient's family member or the referring hospital discharge team to complete before the first home visit.
Review and assign a care team
Your care coordinator reviews the completed intake form and assigns the appropriate nursing and care staff.
Archive in your care management system
Export the completed form to your electronic care record system and retain per KVG documentation requirements.
Home Care (Spitex) in Switzerland: A Complete Guide
Spitex (Spitalexterne Hilfe und Pflege) is the Swiss system of home-based nursing and personal care. Spitex organisations operate in every Swiss commune and provide medical, nursing, and domestic support to individuals who need assistance to remain in their own homes. Services range from wound care and medication management to personal hygiene assistance and household support.
Who is eligible for Spitex services?
Spitex services are available to anyone who needs nursing or personal care in their home, regardless of age. Common recipients include elderly individuals who need support to live independently, people recovering from surgery or acute illness, individuals with chronic conditions requiring regular nursing care, and people with disabilities. A physician's prescription is required for KVG-reimbursed nursing services. Social support (Haushilfe) may be covered by supplementary social assistance or cantonal subsidies.
What does KVG cover for home care?
Under KVG, basic home nursing services (Krankenpflege zu Hause) prescribed by a physician are covered by mandatory basic health insurance. Covered services include nursing assessments, wound care, medication management and administration, monitoring of vital signs, and catheter or stoma care. Each visit is billed per hour or per intervention. The patient pays their standard deductible (Franchise) and 10% co-payment. Personal care and household assistance are typically not covered by KVG and must be financed by the patient, cantonal subsidies, or supplementary insurance.
What is the Spitex intake assessment?
The Spitex intake process typically begins with an initial home visit by a qualified nurse who assesses the patient's physical, functional, and social needs. The nurse uses a standardised assessment tool (such as RAI-HC or a cantonal equivalent) to determine the level and type of care required, document the living environment and safety considerations, and develop an individualised care plan. The digital intake form completed before this visit enables the nurse to prepare for the assessment and reduces the time spent on administrative data collection during the visit itself.
How does Spitex protect patient data?
Spitex organisations are healthcare providers and are therefore subject to the nFADP (revised Federal Act on Data Protection). Patient health data is sensitive personal data and must be processed with appropriate technical and organisational measures. Care records must be retained for a minimum of 10 years. Data may only be shared within the care team on a need-to-know basis and with other providers (e.g. hospital, GP) with the patient's consent or a legal basis. Digital intake forms must be processed on adequately secured platforms.
Frequently asked questions
How do I request Spitex services in Switzerland?
Contact your local Spitex organisation directly or ask your GP, hospital discharge team, or social worker to make a referral. Your physician will issue a prescription (Verordnung) for any KVG-covered nursing services. The Spitex care coordinator will then arrange an initial assessment visit to determine your care needs and develop a care plan.
Can I choose my Spitex carer?
Most Spitex organisations will try to accommodate preferences for a consistent carer where possible. You may indicate preferences such as carer gender, language spoken, or specific skills in the intake form. However, staff availability and scheduling constraints mean that total consistency cannot always be guaranteed.