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Open the tracker
It works right in your phone's browser — no app, no download, no account.
Why I made it
The form I needed while I was still standing in the office
Intake never happens at a convenient time. You're exhausted, scared, and someone is asking you nine questions at once while handing you a clipboard — and somehow you're also supposed to remember every phone number, every medication, every insurance detail, and what you just handed over to a stranger to hold onto your kid's things.
I did this over and over, at different facilities, at different levels of care, and every single time I was rebuilding the same information from scratch — digging through my phone for the pediatrician's number, guessing at the insurance group number, trying to remember if I wrote down the charge nurse's name or just heard it once in a hallway.
I wanted one form I could pull up on my phone in the parking lot before I even walked in, and keep updating for as long as my child was there — who's on the care team, when they'd call, what was going in, what I left behind, and what changed on every update after that.
This is that form. It lives in your browser, not in a filing cabinet, and you can start a new one for every placement without losing the last one.
Intake moves fast
You don't get to slow it down
Nobody hands you a packet that has everything in it. You get a name here, a number there, a signature line you sign without fully reading because there are four more forms behind it. Somewhere in the middle of that, you're also supposed to be the person who remembers what medications your child takes and what insurance authorization number the last call gave you.
And it doesn't stop after intake day. Care teams change. Nurses rotate. Someone calls with an update and you scramble for a pen. A month in, you're trying to remember what was actually said on that first call versus what you're remembering now.
This tracker can't make intake slower or gentler. What it can do is hold the pieces so you're not also carrying them in your head.
Nine sections, one form
Everything you'd otherwise be digging for
Placement BasicsFacility name, address, admission date, and expected level of care — in one place, not a photo of a sign in the lobby.
Care Team ContactsEvery name, role, and number for the psychiatrist, nurse, therapist, social worker, and case manager.
Communication PlanWhen the team will call you, when your child can call, visiting hours, and who to ask for.
Medications Going InWhat your child was taking on admission — dose, frequency, and prescriber, ready to hand over.
Insurance & AuthorizationCompany, member ID, group number, and the prior-authorization contact and reference number.
Items Left With Your ChildWhat you sent in and when — useful at discharge, and at the next placement.
Visit & Update LogA running log for every call and every change — the living part of this document.
Emergency & Legal ContactsParents, guardians, custody notes, and who is authorized to make decisions.
Not a one-time form
Save one entry per placement
Name each entry after the facility, and the tracker keeps it separate from any others — one for this placement, one for the next, without overwriting what came before. Update it every time something changes, and open it right back up the next time you need it, on your phone or on your computer.
Quick tip
Fill it in while you wait
You don't have to finish it all at once
Open the tracker in the waiting room, on the drive, or the night before, and fill in what you already know — your own contacts, current medications, insurance information. Leave the rest blank and add it as intake happens. Nothing has to be perfect or complete before you start.
If you're already using the Medication, Visit & Diagnosis Tracking Toolkit, keep both open together — this tracker is for one placement in real time, the Toolkit is your full ongoing history.
How it works
Name it, fill it in, save it
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Name the placement
Name the entry after the facility so it's easy to tell apart from any others later.
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Fill in what you know
Contacts, meds, insurance, whatever you have — leave the rest for later.
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Save, update, repeat
Save the entry, add to the log as things change, and start a new entry for the next placement.
Questions
Before you begin
Is this medical, legal, or insurance advice?
No. This is an organizational tool for keeping track of what your child's care team and insurer tell you — it is not medical, legal, or insurance advice. Always confirm details directly with the facility, your child's prescriber, and your insurer.
Where is my information stored?
Everything you type stays in your own device's browser storage — nothing is sent to a server. Use "Download Backup" to save a copy of an entry as a file you control, and to move it to another device.
Can I track more than one placement?
Yes — that's the point. Name each entry after the facility and switch between saved entries using the dropdown in the toolbar. Starting a new entry never erases the others.
Can I print it or save it as a PDF?
Yes. Use "Print / Save PDF" in the toolbar for a paper or PDF copy to hand to a new provider or keep in a binder.
Free to use
You shouldn't have to rebuild this from memory every time
Open the tracker, name this placement, and start filling in whatever you already know — you can add the rest as intake happens.
This form may end up holding sensitive personal, medical, or insurance information. It stores everything locally in your own browser and does not send data to a server. Save or share exported copies only with people you trust and through secure methods when possible. This tracker is an organizational tool; it is not medical, legal, or insurance advice.