CARING NURSES, INC.
SOC HHRG
Patient: APPLETON HULTZ, KELLIE- MR# 900010873
Chart: 1 Episode: 1
Patient Care Assistant: patient lives with the sister, but it's bedbound
Visit Date: 02/06/2026
Problems:
Migraine, HTN, DM2, Hypothyroidism, Bipolar disorder, Anxiety

Tests
CLOX:
fail

02/06/2026
OASIS-D
Mary Gurrola
Assessor
(M0030) Start of Care Date:
02/06/2026

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

(M1033) Therapies the patient receives at home: (Mark all that apply.).
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

(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?
1 - When walking more than 20 feet, climbing stairs

(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).
1 - Grooming utensils must be placed within reach before able to complete grooming activities.

(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:
1 - Able to dress upper body without assistance if clothing is laid out or handed to the patient.

(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).
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.
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.
1 - Able to transfer with minimal human assistance or with use of an assistive device.

(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.
2 - Requires use of a two-handed device (e.g., walker or crutches) to walk alone on a level surface and/or requires human supervision or assistance to negotiate stairs or steps or uneven surfaces.

(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.
3 - Unable to take injectable medication unless administered by another person.

Home Health Certification and Plan of Care
02/06/2026
Skilled Nursing Mary Gurrola
Added by: Ron 02/06/26 12:56 PM
1Week1
02/06/26 - 02/06/26
1
2Week1
02/07/26 - 02/13/26
2
1Week8
02/14/26 - 04/06/26
8
Physical Therapy
1/WK x 1WK for eval, safety transfer, and hep. 		Conrad Chi
Added by: Ron 02/06/26 01:35 PM
Eval
02/06/26 - 04/06/26
1
Primary Care Physician DR. MARIA JILL ALFONSO
PECOS Enrolled
Reported to: Ron 02/06/2026 12:56 PM
Printed By/Date/Time: 02/07/2026 03:47 AM