CARING NURSES, INC.
SOC HHRG
Patient: DIPASQUALUCCI, JUDY- MR# 900009774
Chart: 2 Episode: 1
Patient Care Assistant:
Visit Date: 01/24/2026
Problems:
ACUTE HYPOXIC RESPIRATORY FAILURE,, ACUTE ON CHRONIC BRONCHITIS, SOB, PULMONARY EDEMA,, HFPEF,, PANCREATIC HEAD MASS,, HTN, DEMENTIA WITH AGITATION,

Tests
CLOX:
fail

01/24/2026
OASIS-D
Jonai Palmore
Assessor
(M0030) Start of Care Date:
01/24/2026

(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)
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:
3 - Four to six 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).
3 - Patient depends entirely upon someone else for grooming needs.

(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:
3 - Patient depends entirely upon another person to dress the upper body.

(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).
6 - Unable to participate effectively in bathing and is bathed totally by another person.

(M1840) Toilet Transferring: Current ability to get to and from the toilet or bedside commode safely and transfer on and off toilet/commode.
4 - Is totally dependent in toileting.

(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
01/24/2026
Skilled Nursing Jonai Palmore
Added by: Veltra 01/25/26 04:42 PM
2Week1
01/24/26 - 01/30/26
2
1Week8
01/31/26 - 03/24/26
8
2Week1
01/24/26 - 01/30/26
2
QO/Week X 7Weeks
02/07/26 - 03/24/26
4
Physical Therapy
CONSULT SAFETY, TRANSFER AND HEP 1 WK 1 		Joseph Tanaquin
Added by: Ron 01/27/26 01:27 PM
1Week3
01/24/26 - 02/13/26
3
Home Health Aide
ADL SAFETY 1 WK 4 		April King
Added by: Julia 02/03/26 07:34 PM
Liduvina Chongson
Added by: Ron 01/26/26 03:10 PM
1Week4
01/24/26 - 02/20/26
4
Social Work
1/30/26 new referral for MSW for community resources ,for PCA 		Karen Davis
Added by: Ron 01/30/26 04:42 PM
1Week1
02/21/26 - 02/27/26
1
Primary Care Physician DR. KRISTI ASANTE
PECOS Enrolled
Physician Scheduled Visit 01/13/2026: DR. DAVID ENG
Reported to: Veltra 01/25/2026 04:42 PM
Printed By/Date/Time: 02/07/2026 03:47 AM