CARING NURSES, INC.
SOC HHRG
Patient: CAGE, DORIS- MR# 900003278
Chart: 3 Episode: 1
Patient Care Assistant: daughter is assisting with care.
Visit Date: 01/29/2026
Problems:
Acute on chronic hypoxic respiratory failure, COPD exacerbation, Pneumonia, Elevated BNP, CVA, HTN, Multiple falls, Stage pressure ulcer of sacrum

Tests
CLOX:
fail

01/29/2026
OASIS-D
Rea Sayas
Assessor
(M0030) Start of Care Date:
01/29/2026

(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)
2 - Unintentional weight loss of a total of 10 pounds or more 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?
3 - With minimal exertion (e.g., while eating, talking, or performing other ADLs) or with agitation

(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).
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.
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.
5 - Chairfast, unable to ambulate and is unable to wheel self.

(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
01/29/2026
Skilled Nursing Rea Sayas
Added by: Ron 01/29/26 10:36 AM
1Week1
01/29/26 - 01/30/26
1
2Week1
01/31/26 - 02/06/26
2
1Week8
02/07/26 - 03/29/26
8
PRN
01/29/26 - 03/29/26
2
Home Health Aide
1/WK X 4WKS 		April King
Added by: Ron 01/29/26 12:58 PM
1Week4
01/30/26 - 02/20/26
4
Primary Care Physician DR. ERIC WOLFSON
PECOS Enrolled
Physician Scheduled Visit 01/20/2026: DR. FARZIN FARHANG
Reported to: Ron 01/29/2026 10:36 AM
Printed By/Date/Time: 02/07/2026 03:46 AM