CARING NURSES, INC.
SOC HHRG
Patient: SACKS, PAUL- MR# 900008624
Chart: 1 Episode: 1
Patient Care Assistant: Patient lives alone.
Visit Date: 11/08/2023
Problems:
Fall, Syncope, CAD, Heart failure, Cardiomyopathy, DM2 on insulin, Pacemaker, A Flutter, HFMEF, Hx of Hepatic CA, Hx of Prostate CA, Stage 2 Pressure ulcer of coccyx

Tests
CLOX:
fail

11/08/2023
OASIS-D
Dana Whiteside Luck
Assessor
(M0030) Start of Care Date:
11/08/2023

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

(M1033) Therapies the patient receives at home: (Mark all that apply.).
1 - History of falls (2 or more falls - or any fall with an injury - in the past 12 months)
2 - Unintentional weight loss of a total of 10 pounds or more in the past 12 months
3 - Multiple hospitalizations (2 or more) in the past 6 months
4 - Multiple emergency department visits (2 or more) in the past 6 months
5 - Decline in mental, emotional, or behavioral status in the past 3 months
6 - Reported or observed history of difficulty complying with any medical instructions (for example, medications, diet, exercise) in the past 3 months
7 - Currently taking 5 or more medications
8 - Currently reports exhaustion

(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:
2 - One to three 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?
0 - Patient does not have an ostomy for bowel elimination.
(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:
3 - Patient depends entirely upon another person to dress lower body.

(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.
2 - Unable to get to and from the toilet but is able to use a bedside commode (with or without assistance).

(M1850) Transferring: Current ability to move safely from bed to chair, or ability to turn and position self in bed if patient is bedfast.
2 - Able to bear weight and pivot during the transfer process but unable to transfer self.

(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.
3 - Unable to take injectable medication unless administered by another person.

Home Health Certification and Plan of Care
11/08/2023
Skilled Nursing Lillian West
Case Manager
Added by: Alexia 12/01/23 01:18 PM
Dana Whiteside Luck
Added by: Ron 11/09/23 01:32 PM
2Week1
11/08/23 - 11/10/23
2
1Week9
11/11/23 - 01/06/24
9
PRN
11/08/23 - 01/06/24
2
Home Health Aide
1/WK X 4WKS 		Liduvina Chongson
Added by: Julia 11/09/23 02:49 PM
1Week4
11/08/23 - 12/01/23
4
Primary Care Physician DR. STANLEY KIDIAVAYI
Not PECOS Enrolled
Physician Scheduled Visit 11/02/2023: DR. DAVID ENG
11/02/2023: DR. KARYN DODDY
Reported to: Ron 11/09/2023 01:32 PM
Printed By/Date/Time: 07/06/2025 05:08 PM