CARING NURSES, INC.
SOC HHRG
Patient: FERGUSON, PAULINE- MR# 15003
Chart: 3 Episode: 1
Patient Care Assistant: patient lives in a assisted living.
Visit Date: 07/14/2026
Problems:
Hyponatremia, HTN, Hypothyroidism, Right facial paralysis, HX of colon CA, Ileostomy

Tests
CLOX:
fail

07/14/2026
OASIS-D
Alexis Balle
Assessor
(M0030) Start of Care Date:
07/14/2026

(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:
1 - Patient is incontinent

(M1620) Bowel Incontinence Frequency:
NA - Patient has ostomy for bowel elimination

(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?
1 - Patient's ostomy was not related to an inpatient stay and did not necessitate change in medical or treatment regimen.
(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:
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).
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.
2 - Unable to get to and from the toilet but is able to use a bedside commode (with or without assistance).

(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.
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
07/14/2026
Skilled Nursing Alexis Balle
Added by: Ron 07/15/26 02:30 PM
2Week1
07/14/26 - 07/17/26
2
1Week8
07/18/26 - 09/11/26
8
PRN
07/14/26 - 09/11/26
2
Home Health Aide
1/WK X 4WKS 		Marietta Salvani
Added by: Ron 07/15/26 03:25 PM
1Week4
07/16/26 - 08/07/26
4
Physical Therapy
1/WK X 1WK for eval, safety transfer, and hep. 		Maria Consolo
Added by: Ron 07/23/26 04:14 PM
Primary Care Physician DR. ANTONIO GUMINA
PECOS Enrolled
Physician Scheduled Visit 07/13/2026: DR. LISA HIGUCHI
Reported to: Ron 07/15/2026 02:30 PM
Printed By/Date/Time: 08/06/2026 12:37 PM