CARING NURSES, INC.
ROC HHRG
Patient: JERKINS, KENNETH- MR# 900007785
Chart: 1 Episode: 1
Patient Care Assistant: Patient lives alone.
Visit Date: 03/19/2023
Problems:
Acute Stroke, Hypertension, Hyperlipidemia

Tests
CLOX:
fail

03/19/2023
OASIS-D
Puneetpal Wander
Assessor
(M0030) Start of Care Date:
02/28/2023

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

(M1033) Therapies the patient receives at home: (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?
2 - With moderate exertion (e.g., while dressing, using commode or bedpan, walking distances less than 20 feet)

(M1610) Urinary Incontinence or Urinary Catheter Presence:
1 - Patient is incontinent

(M1620) Bowel Incontinence Frequency:
3 - Four to six times weekly

(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).
2 - Someone must assist the patient to groom self.

(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:
2 - Someone must help the patient put on upper body clothing.

(M1820) Current Ability to Dress Lower Body safely (with or without dressing aids) including undergarments, slacks, socks or nylons, shoes:
2 - Someone must help the patient put on undergarments, slacks, socks or nylons, and shoes.

(M1830) Bathing: Current ability to wash entire body safely. Excludes grooming (washing face, washing hands, and shampooing hair).
3 - Able to participate in bathing self in shower or tub, but requires presence of another person throughout the bath for assistance or supervision.

(M1840) Toilet Transferring: Current ability to get to and from the toilet or bedside commode safely and transfer on and off toilet/commode.
1 - When reminded, assisted, or supervised by another person, able to get to and from the toilet and transfer.

(M1850) Transferring: Current ability to move safely from bed to chair, or ability to turn and position self in bed if patient is bedfast.
1 - Able to transfer with minimal human assistance or with use of an assistive device.

(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.
2 - Requires use of a two-handed device (e.g., walker or crutches) to walk alone on a level surface and/or requires human supervision or assistance to negotiate stairs or steps or uneven 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.
2 - Able to take medication(s) at the correct times if given reminders by another person based on the frequency of the injection

ROC Verbal Orders for Modification
03/19/2023
Skilled Nursing
2Week1
03/19/23 - 03/24/23
2
1Week1
03/25/23 - 03/31/23
1
Physical Therapy Joshua Jung
Added by: Julia 03/21/23 04:12 PM
Social Work Carol Dennison
Added by: Julia 03/21/23 04:16 PM
1Week1
03/20/23 - 03/24/23
1
Primary Care Physician DR. SCOTT LAMPRECHT
Not PECOS Enrolled
Physician Scheduled Visit 02/27/2023: DR. BABAK MAHGEREFTEH
Reported to: MJ 03/20/2023 01:35 PM
Printed By/Date/Time: 09/19/2024 02:12 AM