| Admission Form | PT Evaluation | OT Evaluation | ||
|---|---|---|---|---|
| Admission Form | #getStartofCare.M1100_PTNT_LVG_STUTN# | |||
| M1700 Cognitive Functioning | |
#getPTEvaluation.F34# | #getOTEvaluation.F38# | |
| M2102d Assistance for Procedures & Treatments |
|
#getPTEvaluation.F240# | #getOTEvaluation.F240# | |
| Careplan |
|
#getsocVBP.V_or_M# | #getptVBP.V_or_M# | #getotVBP.V_or_M# |
| GG0100A Prior Function - Self Care | #getStartofCare.F82# | #getPTEvaluation.F138# | #getOTEvaluation.F138# | |
| GG0100B Prior Function - Indoor Mobility (Ambulation) | #getStartofCare.F83# | #getPTEvaluation.F139# | #getOTEvaluation.F139# | |
| Unhealed wounds | ||||
| Current Goals |
|
|
|
|
| Recommended Goals |
|
improvement in ambulation |
|
|
| Patient Safety | ||||
| Behavioral | ||||
| Case Management | ||||
| Total Visits |
|
|
|
|
| Recommended Visits | 1st 30 days HIPPS : #getrecommvisits1.F297# 1st 30 days Recommended: #getrecommvisits1.Total_Skilled# 1st 30 days LUPA : #getrecommvisits1.LUPA# 2nd 30 days HIPPS : #getrecommvisits2.F300# 2nd 30 days Recommended: #getrecommvisits2.Total_Skilled# 2nd 30 days LUPA : #getrecommvisits2.LUPA# |
| Start of Care | |
|---|---|
| Mental Status | #getStartofCare.F34# |
| Mobility | #getStartofCare.F81# |
| Incontinence—Urine | #getStartofCare.F139# |
| Incontinence—Bowel | #getStartofCare.F140# |
| Unintentional weight loss of 10 or more lbs in the last 12 months |
|
| Start of Care | |
|---|---|
| Mental Status | #getStartofCare.F34# |
| 2 or more falls – or any fall with an injury – in the past 12 months |
|
| Mobility | #getStartofCare.F81# |
| Incontinence—Urine | #getStartofCare.F139# |
| Incontinence—Bowel | #getStartofCare.F140# |
| Vision | #getStartofCare.F223# |
| Orthostatic Blood Pressure | |
| Home Safety Issues |
| Start of Care | |
|---|---|
| 2 or more falls – or any fall with an injury – in the past 12 months |
|
| Unintentional weight loss of a total of 10 pounds or more in the past 12 months |
|
| Multiple hospitalizations (2 or more) in the past 6 months | #IIf(findNoCase('Multiple hospitalizations (2 or more) in the past 6 months', getStartofCare.F143,0), DE("YES"), DE("NO"))# |
| Multiple emergency department visits (2 or more) in the past 6 months |
|
| Decline in mental, emotional, or behavioral status in the past 3 months |
|
| Reported or observed history of difficulty complying with any medical instructions (for example, medications, diet, exercise) in the past 3 months |
|
| Currently taking 5 or more medications |
|
| Currently reports exhaustion |
|
| #DateFormat(Visit_Date,"mm/dd/yyyy")# | ||||
|---|---|---|---|---|
| #getvitalwounds.Description# | #Value_Sum# | #getvitalwounds.WoundType# | #getvitalwounds.Reading1# |