ADULT BELONGINGS INVENTORY - Items Allowed On The Unit - Discharge Acknowledgement

Sep 12, 2026

Upload by Rhys

Adult belongings inventory form for documenting a patient’s property on the unit, including items allowed, counts allowed, and optional or other permitted belongings. The form captures patient identifiers and the date, lists hygiene and clothing categories, and records whether items are stored in safe or in the belongings room. It also includes search outcomes, acknowledgement that the inventory is complete, staff and patient signatures, and a discharge section confirming all belongings were returned.

LanguageEnglish

CategoryForms

FormatPDF

Pages2

Reading Time1 min

AccessFree to download

ADULT BELONGINGS INVENTORY

Items Allowed On The Unit

Hygiene Items Allowed On The Unit

Other/Optional Items Allowed On The Unit

Other Items Stored In Belongings Room

Items Stored In Safe / Belongings Room

Search Outcomes And Handling Notes

Acknowledgement And Signatures

Complete At Discharge

| ADULT BELONGINGS INVENTORY | | | | | --- | --- | --- | --- | | PATIENT NAME: PATIENT ID: DATE: | | | | | PATIENT PROPERTY | \# Allowed | \# Brought | Comment | | Duffel Bag or Suitcase | 1 | | | | CLOTHING ITEMS ALLOWED ON THE UNIT | | | | | Belt | 2 | | | | Bra | 3 | | | | Jacket | 1 | | | | Pajamas/Robe | 2 | | | | Pants (jeans, slacks, sweats, leggings) | 5 | | | | Shirts (T-shirt, button shirt, blouse, sweatshirt) | 5 | | | | Shoes (tennis, flip flops, flat soles, slippers) | 4 | | | | Shorts or Skirt (1" above knee) | 5 | | | | Socks | 7 | | | | Sweaters/Pullovers | 2 | | | | Undershirts ( tank tops, Camisole) | 5 | | | | Underwear | 7 | | | | HYGIENE ITEMS ALLOWED ON THE UNIT | | | | | Cardboard nail files (NO METAL) | 3 | | | | Dentures/Cream/Tablets | 1 ea. | | | | Deodorant | 2 ea. | | | | Disposable Razors | 1 pk. | | | | Glasses/Contact Case/Eye Solution | 1 ea. | | | | Hair accessories (Ties, Scrunchy, Clip or Barrettes) | 5 | | | | Hairbrush/Comb | 1 ea. | | | | Lotion | 1 ea. | | | | Make-up: Foundation, powder, blush, eyeshadow, eye liner, mascara | 1 ea. | | | | Nail Clipper /Tweezers | 1 ea. | | | | Shampoo, Conditioner, Body Wash | 1 ea. | | | | OTHER/OPTIONAL ITEMS ALLOWED ON THE UNIT | | | | | Books/Magazines/Puzzle books (NO PORN) | 4 | | | | Colored Pencils or Crayons (optional) | 24pk | | | | Envelopes/Stamps | | | | | Hat, Gloves (NO DRUG/GANG/ETOH LOGO) | 1 ea. | | | | Notebook paper/Journal | 1 | | | | Spiritual Items (ROSARY, BIBLE, Etc.) | | | | | Sunglasses (OUTDOOR USE ONLY) | 1 | | | | OTHER ITEMS | | | Stored in Belongings Room | | | | | | | | | | | | ADULT BELONGINGS INVENTORY | | | --- | --- | | ITEMS STORED IN SAFE | ITEMS STORED IN BELONGINGS ROOM | | Identification card(s) Qty:
| \# Of Bags Date: | | Insurance Card(s) Qty:
| \# Of Bags Date: | | Items NOT Required or Encouraged: | \# Of Bags Date: | | Cash Amount:
| \# Of Bags Date: | | Debit/Credit Card(s) Qty:
| | | Gift Card(s) Qty:
| | | | Bags Searched | | | Bags not searched | | Cell Phone Charger Keys
| | | | --- | --- | --- | | Wallet
| | | | | | | | PATIENT BELONGINGS OVER ALLOWABLE LIMIT OR NOT ALLOWED ON THE UNIT ARE PLACED IN STORAGE, AND WILL BE RETURNED AT DISCHARGE | | | | RX MEDICATIONS AND OTC SUPPLEMENTS ARE INVENTORIED SEPARATELY BY NURSE | | | | Any Illegal Substances/Contraband found during search will be confiscated | | | | I have received a copy of this inventory and agree that this is a complete list of my belongings | | | | ACKNOWLEDGEMENT OF COMPLETE BELONGINGS INVENTORY:
Print Staff Name
Print Patient Name | | / /
Staff Signature Date
/ / Time
Patient Signature Date Time | | COMPLETE THIS SECTION AT DISCHARGE: (Do not complete if Admitting to Rehab) | | | | All belongings listed were returned to me at discharge:
Print Patient Name
Staff Witness Name | | / /
Patient Signature Date
/ / Time
Staff Signature Date Time | Miscellaneous Items: TURQUOISE LODGE HOSPITAL Patient Label Here 5400 Gibson Blvd SE Albuquerque, New Mexico 87108 (505) 841-8978 FAX: (505) 383-1109 Rev: 10/15; 07/17; 2/18, 5/19, 10/19, 8/20 8/22

FAQs

What information does the adult belongings inventory collect at the start?

It records patient name, patient ID, and date, then lists clothing items, hygiene items, and other allowed or optional belongings with allowed counts.

How are items handled that are over the allowable limit or not allowed?

The form states that items placed over the allowable limit or not allowed on the unit are stored and will be returned at discharge.

What does the discharge section require?

It requires completion at discharge to confirm all listed belongings were returned, including patient name, staff witness name, and the required patient and staff signatures with dates and times.

Sep 12, 2026

Upload by Rhys