CARING NURSES, INC.
SOC HHRG
Patient: WATANABE, THOMAS- MR# 900009964
Chart: 1 Episode: 1
Patient Care Assistant: LIVE ALONE
Visit Date: 01/22/2025
Problems:
2.4 CM RIGHT PERIRECTAL ABSCESS, EXTERNAL HEMORRHOIDS,, COLITIS VS PROCITIS,, ANEMIA, HTN, MICROCYTIC ANEMIA 2/2 IRON DEFICIENCY, VITAMIN B12 DEFICIENCY, WOUND CARE DAILY

Tests
CLOX:
pass

01/22/2025
OASIS-D
Mary Olson
Assessor
(M0030) Start of Care Date:
01/22/2025

(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?
0 - Patient is not short of breath

(M1610) Urinary Incontinence or Urinary Catheter Presence:
0 - No incontinence or catheter (includes anuria or ostomy for urinary drainage) [ Go to M1620 ]

(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).
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:
1 - Able to dress upper body without assistance if clothing is laid out or handed to the patient.

(M1820) Current Ability to Dress Lower Body safely (with or without dressing aids) including undergarments, slacks, socks or nylons, shoes:
1 - Able to dress lower body without assistance if clothing and shoes are laid out or handed to the patient.

(M1830) Bathing: Current ability to wash entire body safely. Excludes grooming (washing face, washing hands, and shampooing hair).
1 - With the use of devices, is able to bathe self in shower or tub independently, including getting in and out of the tub/shower.

(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.
1 - With the use of a one-handed device (e.g. cane, single crutch, hemi-walker), able to independently walk on even and uneven surfaces and negotiate stairs with or without railings.

(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
01/22/2025
Skilled Nursing Mary Olson
Added by: Veltra 01/22/25 01:45 PM
3Week1
01/22/25 - 01/24/25
3
6Week1
01/25/25 - 01/31/25
6
5Week1
02/01/25 - 02/07/25
5
1Week1
02/08/25 - 02/14/25
1
Primary Care Physician DR. STANLEY KIDIAVAYI
PECOS Enrolled
Physician Scheduled Visit 01/20/2025: DR. PINAK SHAH
Reported to: Veltra 01/22/2025 01:45 PM
Printed By/Date/Time: 07/06/2025 04:46 PM