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Nancy
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Aug 1

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Clock In
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8:43am...
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8:43am - 4:45pm
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Sign-off Activities
8:43am - 4:45pm
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8:43am - 4:45pm
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8:43am - 4:45pm
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Assigned Activities

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Housekeeping
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Lunch
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Bathing
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Mobility
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Vital Signs
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Medication Assistance

Notes

General notes & explanations for incomplete activities

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Would not eat lunch. She said s...

Observations

Changes in Nancy's condition

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Forgetting my name twice per...

Housekeeping

Was this activity completed?

Yes
No
Yes
No
Yes
No
ruby

Details

Yes
No
Yes
No

Housekeeping
Assist with light housekeeping to maintain a safe environment

Dishes

8am-noon

Dusting

8am-noon

Note: The duster is in the front closet

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Medicare estimates 45min for this activity.

Yes
No
Yes
No

Lunch

Was this activity completed?

Yes
No
Yes
No
Yes
No
ruby

Details

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Yes
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Prepare a nutritious lunch in line with dietary needs.

Lunch

noon-1pm

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Medicare estimates 1hr 20min for this activity.

Yes
No
Yes
No

Bathing

Was this activity completed?

Yes
No
Yes
No
Yes
No
ruby

Bathing Details

Yes
No
Yes
No

Bathing in a shower or tub as needed. If no bath or shower, give a sponge bath.

Assist into and out of shower.
8am-noon
Note: Nancy uses downstairs tub

Shampoo hair
8am-noon
Note: Nancy needs assistance opening shampoo bottle and lathering

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Medicare estimates 1hr 20min for this activity.

Yes
No
Yes
No

Mobility

Was this activity completed?

Yes
No
Yes
No
Yes
No
ruby

Details

Yes
No
Yes
No

Conduct 15 minutes of prescribed light stretching exercises to maintain mobility

Stretching

2-5pm

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Medicare estimates 1hr 20min for this activity.

Yes
No
Yes
No

Vital Signs

Was this activity completed?

Yes
No
Yes
No
Yes
No
ruby

Details

Yes
No
Yes
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Check and leave note with vital signs.

Blood pressure, pulse, temperature

2-5pm

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Medicare estimates 1hr 20min for this activity.

Yes
No
Yes
No

Medication Assistance

Was this activity completed?

Yes
No
Yes
No
Yes
No
ruby

Details

Yes
No
Yes
No

Help patients self-administer medication by:

  • Reminding them when to take it
  • Bringing the medication and any needed equipment
  • Demonstrating how to properly administer the medication, including the right person, dose, time, route, and documentation
  • Positioning the patient
  • Opening the container

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Medicare estimates 30min for this activity.

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No
Yes
No

Note

Observation