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:
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Home Health Certification and Plan of Care |
05/04/2025
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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 |
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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
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