CARING NURSES, INC.
SOC HHRG
Patient: SMITH, MARY- MR# 900008161
Chart: 4 Episode: 1
Patient Care Assistant: Mother
Visit Date: 03/25/2026
Problems:
AFIB, MS, Wounds, Hypothyroidism, Foley Catheter, PANCOLITIS, Colitis

Tests
CLOX:
pass Mother did test

03/25/2026
OASIS-D
Mary Olson
Assessor
(M0030) Start of Care Date:
03/25/2026

(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?
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:
2 - Patient requires a urinary catheter (i.e., external, indwelling, intermittent, suprapubic) [ Go to M1620 ]

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

Home Health Certification and Plan of Care
03/25/2026
Skilled Nursing Mary Olson
Added by: Veltra 03/26/26 11:46 AM
2Week10
03/25/26 - 05/23/26
20
PRN
03/26/26 - 05/23/26
2
Primary Care Physician DR. YUK KI CHOI
PECOS Enrolled
Physician Scheduled Visit 06/15/2023: DR. LORING JACOBS
10/21/2024: DR. WITOLD IGLIKOWSKI
03/16/2025: DR. YUK KI CHOI
Reported to: Veltra 03/26/2026 11:46 AM
Printed By/Date/Time: 04/06/2026 09:06 AM