CARING NURSES, INC.
SOC HHRG
Patient: MILANEY, JUDITH- MR# 900010992
Chart: 1 Episode: 1
Patient Care Assistant: SPOUSE
Visit Date: 03/26/2026
Problems:
PNA WITH ORAL ABX X 7DAYS, COPD W/ O2, CHRONIC PAIN, HYPOTHYROID, Patients spouse currently admitted to hospital with PNA, pt. needs assist with adls

Tests
CLOX:

03/26/2026
OASIS-D
Kira Irenze
Assessor
(M0030) Start of Care Date:
03/26/2026

(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)
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

(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:
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).
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).
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.
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.
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.

Home Health Certification and Plan of Care
03/26/2026
Skilled Nursing Kira Irenze
Added by: Juliet 03/27/26 01:59 PM
1Week1
03/26/26 - 03/27/26
1
2Week1
03/28/26 - 04/03/26
2
1Week8
04/04/26 - 05/24/26
8
Home Health Aide Blanca Luz Mendizabal
Added by: Julia 03/27/26 03:13 PM
1Week4
03/28/26 - 04/24/26
4
Physical Therapy
HEP AND SAFETY WITH ADLS, EVAL ONLY 		Maria Consolo
Added by: Julia 03/27/26 03:13 PM
Primary Care Physician DR. CHRISTOPHER CHOI
PECOS Enrolled
Physician Scheduled Visit 04/01/2026: DR. CHRISTOPHER CHOI
03/18/2026: DR. SANDEEP VIJAY
Reported to: Juliet 03/27/2026 01:59 PM
Printed By/Date/Time: 04/06/2026 09:06 AM