CARING NURSES, INC.
SOC HHRG
Patient: HOFFMAN, TAMARA- MR# 900009172
Chart: 1 Episode: 1
Patient Care Assistant: daughter is assisting with care.
Visit Date: 04/18/2024
Problems:
Pedal edema, CHF, HTN, DVT on warfarin, Lupus, Multiple ulcers on both legs

Tests
CLOX:
pass

04/18/2024
OASIS-D
Joan Leyderos
Assessor
(M0030) Start of Care Date:
04/18/2024

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

(M1033) Therapies the patient receives at home: (Mark all that apply.).
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:
0 - Very rarely or never has bowel incontinence

(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).
1 - Grooming utensils must be placed within reach before able to complete grooming activities.

(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).
2 - Able to bathe in shower or tub with the intermittent assistance of another person:
(a) for intermittent supervision or encouragement or reminders, OR
(b) to get in and out of the shower or tub, OR
(c) for washing difficult to reach areas.

(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.
NA - No injectable medications prescribed.

Home Health Certification and Plan of Care
04/18/2024
Skilled Nursing Jeanne Javinar
Case Manager
Added by: Alexia 04/18/24 02:32 PM
Joan Leyderos
Added by: Ron 04/18/24 01:40 PM
1Week1
04/18/24 - 04/19/24
1
2Week4
04/20/24 - 05/17/24
8
1Week5
05/18/24 - 06/16/24
5
PRN
04/18/24 - 06/16/24
2
Primary Care Physician DR. LEO CAPOBIANCO
PECOS Enrolled
Physician Scheduled Visit 04/30/2024: DR. DAVID ENG
10/28/2024: DR. RAMANATHAN VEERAPPAN
Reported to: Ron 04/18/2024 01:40 PM
Printed By/Date/Time: 07/06/2025 04:54 PM