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Free Inventory Patient Personal Property Form - PDF Form Download

Inventory Patient Personal Property Form Overall rating: ☆☆☆☆☆ 0 based on 0 reviews
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Inventory Patient Personal Property Form is an essential document required during admittance of a patient/resident in a hospital or other health care institution. The inventory is classified into categories like valuables like jewelry, cash, credit and/or debit cards, etc. and Personal Effects are patient’s belongings required during day-to-day tasking.


However, the nurse or the administrator admitting the patient must return the valuables or offer to store them in a security vault after describing them properly. Patients are allowed to keep personal effects upon inventorying them in this form. However, the intention of preparing the Inventory Patient Personal Property Form is to minimize inventory and subsequent loss. The patient and the nurse must sign this personal property form in acknowledgement of the contents mentioned in it. Please file this form safely and the hospital may choose to handover a copy of the same to the patient or patient’s relative for record purpose. However, hospitals or other health care service providers do not accept responsibility of safekeeping of any item not listed in this Inventory Patient Personal Property Form.


Inventory Patient Personal Property Form

Steps To Prepare the Inventory Patient Personal Property Form

  • Enter the last and first name of the patient.
  • Then mention the room number in which the patient is admitted.
  • Enter the admission number of the patient. This number is the identifier of the patient in the hospital records.
  • Enter the date of preparing the Inventory Patient Personal Property Form.

Items Retained By Resident

  • Please mark all items in the possession of the patient. However, clothing is not allowed. List items like Bathrobe, Bed Jacket, Belt, Bra, Coat, Dress, Girdle, Gloves, Hat/Cap, Housecoat/Robe, Jacket, Necktie, Nightgown, Pajamas, Panties, Scarf, Shirt, Slacks/Trousers, Slip, Slippers, Socks, Stockings, Suit coat, Sweater, Undershirt, and Undershorts. Please specify other personal belongings not listed descriptively in the space provided for the same.
  • Then list other items in the possession of the patient/resident like Bible, Brush, Clock, Comb, Glasses, Keys, Luggage, Medals, Pen, Purse, Radio, Razor, Toilet Items, Watch, and Wallet. However, describe jewelry items in detail. You may choose to mention other items if any separately.
  • Mention prosthetics separately. Please provide details of Brace, Cane/Crutches, Dentures, Upper Dentures, Lower Dentures, Partial Dentures, Glasses, Walker, and Wheelchair as and when applicable.

Other Essentials

  • Enter the envelop receipt number of the valuables in case the resident/patient opts to keep them in security vault.
  • Select yes or no to state if clothing is placed in storage.
  • Please use the next line to mention all items added to the Inventory Patient Personal Property Form after the original inventory.
  • The resident/patient or any other responsible party like a relative of the resident must sign this Inventory Patient Personal Property Form. Initials of the person checking the items and the form are required in addition to the signature of the attending nurse.

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