CARING NURSES, INC.
SOC HHRG
Patient: MESSMAN , JEFFREY- MR# 900010644
Chart: 1 Episode: 1
Patient Care Assistant: LIVE ALONE
Visit Date: 10/27/2025
Problems:
RIGHT FOOT OSTEOMYELITIS, STATUS POST AMPUTATION OF THE FIRST AND SECOND TOE ON THE RIGHT, MID CHEST PERM CATH DOUBLE LUMEN, IV ANTIBIOTICS X 6WKS,, LEGALLY BLIND, CKD, DM/INSULIN, DEXCOM MACHINE BS READING

Tests
CLOX:
fail UNABLE BLIND

10/27/2025
OASIS-D
Beverly Coplin
Assessor
(M0030) Start of Care Date:
10/27/2025

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

(M1033) Therapies the patient receives at home: (Mark all that apply.).
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:
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).
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).
4 - Unable to use the shower or tub, but able to bathe self independently with or without the use of devices at the sink, in chair, or on commode.

(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.
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.
3 - Able to walk only with the supervision or assistance of another person at all times.

(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
10/27/2025
Skilled Nursing Gamaliel Digan
Case Manager
Added by: Veltra 10/28/25 11:15 AM
Beverly Coplin
Added by: Veltra 10/28/25 10:02 AM
2Week1
10/27/25 - 10/31/25
2
1Week8
11/01/25 - 12/25/25
8
PRN
10/27/25 - 12/25/25
2
Primary Care Physician DR. RONALD HEDGER
PECOS Enrolled
Physician Scheduled Visit 10/23/2025: DR. OGANES SHILGEVORKYAN
Reported to: Veltra 10/28/2025 10:02 AM
Printed By/Date/Time: 11/09/2025 06:13 AM