CARING NURSES, INC.
PDGM HHRG
Patient: LOPEZ, DIANA - MR# 900010000
Chart: 2 Episode: 2
Patient Care Assistant: lives alone
06/28/2025 - 08/26/2025
Home Health 60-Day Episode
Problems:
PAIN IN LEFT HIP, DISPLACED INTERTROCHANTERIC FRACTURE OF LEFT FEMUR, HLD, CHRONIC PAIN, CONSTIPATION

06/28/2025 - 07/27/2025
30-Day Service Period
Jennifer Negrete
Assessor
(M0030) Start of Care Date:
04/29/2025

(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
06/28/2025
Skilled Nursing Jennifer Negrete
Case Manager
Added by: Elsie 06/30/25 01:29 PM
Joshua Clark
Added by: Veltra 07/02/25 04:10 PM
QO/Week X 9Weeks
06/28/25 - 08/26/25
5
Physical Therapy
With fracture left femur, P.T. to continue for strengthening, gait training and HEPApproved for 1/WK X 3WKS
Conrad Chi
Added by: Ron 06/30/25 03:09 PM
Eval
06/28/25 - 08/26/25
1
Primary Care Physician DR. AMIT PAREKH
Not PECOS Enrolled
Reported to: Elsie 06/30/2025
Printed By/Date/Time: 07/06/2025 07:02 PM