CARING NURSES, INC.
SOC HHRG
Patient: OCHOA, MARIA- MR# 900010670
Chart: 1 Episode: 1
Patient Care Assistant: daughter is assisting with care.
Visit Date: 11/12/2025
Problems:
Pneumoperitoneum, Bowel obstruction, Cervical CA, Sepsis, Perforated sigmoid diverticulitis, Pelvic abscess, Colostomy

Tests
CLOX:
pass

11/12/2025
OASIS-D
Joan Leyderos
Assessor
(M0030) Start of Care Date:
11/12/2025

(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?
0 - Patient is not short of breath

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

(M1620) Bowel Incontinence Frequency:
NA - Patient has ostomy for bowel elimination

(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?
2 - The ostomy was related to an inpatient stay or did necessitate 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:
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.
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
11/12/2025
Skilled Nursing Joan Leyderos
Added by: Ron 11/12/25 01:20 PM
Mary Wagner
Added by: Ron 11/19/25 04:04 PM
3Week1
11/12/25 - 11/14/25
3
2Week4
11/15/25 - 12/12/25
8
3Week2
11/12/25 - 11/21/25
6
2Week3
11/22/25 - 12/12/25
6
Primary Care Physician DR. EVANGELINE DE GUZMAN-DELALUZ
PECOS Enrolled
Physician Scheduled Visit 11/07/2025: DR. MARY HOLSTEIN
Reported to: Ron 11/12/2025 01:20 PM
Printed By/Date/Time: 02/07/2026 03:47 AM