CARING NURSES, INC.
PDGM HHRG
Patient: GOLDSBORO, JEROME - MR# 900008295
Chart: 2 Episode: 2
Patient Care Assistant: spouse
06/26/2024 - 08/24/2024
Home Health 60-Day Episode
Problems:
PRIMARY MALIGNANT NEOPLASM OF PROSTATE, IRON DEFICIENCY ANEMIA, ANEMIA DUE TO AND FOLLOWING CHEMOTHERAPY,, SECONDARY MALIGNANT NEOPLASM OF BONE, HTN

06/26/2024 - 07/25/2024
30-Day Service Period
Lillian West
Assessor
(M0030) Start of Care Date:
04/27/2024

(M1030) Therapies the patient receives at home: (Mark all that apply.)

(M1033) Risk for Hospitalization: Which of the following signs or symptoms characterize this patient as at risk for hospitalization? (Mark all that apply.)

(M1200) Vision (with corrective lenses if the patient usually wears them):

(M1242) Frequency of Pain Interfering with patient's activity or movement:

(M1400) When is the patient dyspneic or noticeably Short of Breath?

(M1610) Urinary Incontinence or Urinary Catheter Presence:

(M1620) Bowel Incontinence Frequency:

(M1630) Ostomy for Bowel Elimination: Does this patient have an ostomy for bowel elimination that (within the last 14 days): a) was related to an inpatient facility stay, or b) necessitated a change in medical or treatment regimen?
(M1800) Grooming: Current ability to tend safely to personal hygiene needs (specifically: washing face and hands, hair care, shaving or make up, teeth or denture care, or fingernail care).

(M1810) Current Ability to Dress Upper Body safely (with or without dressing aids) including undergarments, pullovers, front-opening shirts and blouses, managing zippers, buttons, and snaps:

(M1820) Current Ability to Dress Lower Body safely (with or without dressing aids) including undergarments, slacks, socks or nylons, shoes:

(M1830) Bathing: Current ability to wash entire body safely. Excludes grooming (washing face, washing hands, and shampooing hair).

(M1840) Toilet Transferring: Current ability to get to and from the toilet or bedside commode safely and transfer on and off toilet/commode.

(M1850) Transferring: Current ability to move safely from bed to chair, or ability to turn and position self in bed if patient is bedfast.

(M1860) Ambulation/Locomotion: Current ability to walk safely, once in a standing position, or use a wheelchair, once in a seated position, on a variety of surfaces.

(M2030) Management of Injectable Medications: Patient's current ability to prepare and take all prescribed injectable medications reliably and safely, including administration of correct dosage at the appropriate times/intervals. Excludes IV medications.

Home Health Certification and Plan of Care
06/26/2024
Skilled Nursing Lillian West
Case Manager
Added by: Ronald 06/26/24 05:23 AM
Leah Lamipeti
Added by: Teena 07/22/24 11:48 AM
1Week2
06/29/24 - 07/12/24
2
QO/Week X 5Weeks
07/20/24 - 08/23/24
3
1Week1
08/24/24 - 08/24/24
1
Home Health Aide Liduvina Chongson
Added by: 07/17/24 12:03 AM
1Week10
06/26/24 - 08/24/24
10
1Week2
06/29/24 - 07/12/24
2
1Week1
07/20/24 - 07/26/24
1
1Week10
06/26/24 - 08/24/24
10
1Week10
06/29/24 - 08/23/24
10
Primary Care Physician DR. CLARK JEAN
Not PECOS Enrolled
Reported to: Ronald 06/26/2024
Printed By/Date/Time: 09/19/2024 02:14 AM