CARING NURSES, INC.
PDGM HHRG
Patient: SHAW, WALLACE - MR# 900002019
Chart: 2 Episode: 10
Patient Care Assistant: LIVE ALONE
05/04/2025 - 07/02/2025
Home Health 60-Day Episode
Problems:
Left Foot plantar wound, Skin CA, DM DIET CONTROL, HTN, BPH, GEN ANXIETY, DEPRESSION, MALAISE, MORBID OBESITY, HYPOTHYRODISM, HLD

05/04/2025 - 06/02/2025
30-Day Service Period
Mary Olson
Assessor
(M0030) Start of Care Date:
11/11/2023

(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
05/04/2025
Skilled Nursing Mary Olson
Case Manager
Added by: Veltra 04/30/25 10:36 AM
Veltra Metts-Cannon
Added by: 04/30/25 10:36 AM
Veltra Metts-Cannon
Added by: MJ 05/15/25 11:37 AM
Mary Olson
Added by: Veltra 06/10/25 11:18 AM
1Week9
05/04/25 - 07/02/25
9
Primary Care Physician DR. STANLEY KIDIAVAYI
Not PECOS Enrolled
Reported to: Veltra 04/30/2025
Printed By/Date/Time: 07/06/2025 07:01 PM