CARING NURSES, INC.
SOC HHRG
Patient: SANDOVAL, PAULINE - MR# 900010830
Chart: 2 Episode: 1
Patient Care Assistant:
Visit Date: 01/25/2026
Problems:
ACUTE ON CHRONIC SYSTOLIC HF EF 30-35%,, HYPOTENSION, SLIP AND FALL, AKI ON CDK3,, HTN, HLD, T2DM W HYPERGLYCEMIA,, NORMCYTIC ANEMIA,, THROMBOCYTOPENIA,, HYPOALBUMINEMIA,, OBSESITY CLASS 1,, S/P RECENT R HOLICOLECTOMY, CHOLECYSTITIS S/P RECENT CHOLECYSTOSTOMY

Tests
CLOX:
fail

01/25/2026
OASIS-D
Jonai Palmore
Assessor
(M0030) Start of Care Date:
01/25/2026

(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:
4 - On a daily basis

(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).
5 - Unable to use the shower or tub, but able to participate in bathing self in bed, at the sink, in bedside chair, or on commode, with the assistance or supervision of another person throughout the bath.

(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.
3 - Unable to transfer self and is unable to bear weight or pivot when transferred by another person.

(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
01/25/2026
Skilled Nursing Jonai Palmore
Added by: Veltra 01/25/26 05:03 PM
Rea Sayas
Added by: Veltra 01/26/26 07:03 PM
2Week2
01/25/26 - 02/06/26
4
1Week7
02/07/26 - 03/25/26
7
Physical Therapy
CONSULT SAFETY, TRANSFER, HEP 1 WK 1 		Annie Copeland
Added by: Danielle 01/26/26 09:34 AM
Home Health Aide
ADL SAFETY 		Blanca Luz Mendizabal
Added by: Ron 01/26/26 03:10 PM
1Week4
01/25/26 - 02/20/26
4
Primary Care Physician DR. JASMINE JOU
PECOS Enrolled
Physician Scheduled Visit 01/24/2026: DR. GEORGE CHEN
Reported to: Veltra 01/25/2026 05:03 PM
Printed By/Date/Time: 02/07/2026 03:46 AM