#ind#

0% progress

progress

0%

Neurological

checked /> Aphasia checked /> Breath Sounds not Clear checked /> Hallucinations checked /> Headaches checked /> Long Term Memory Limits 10 - 14 seconds'>checked /> PT <> 10 - 14 seconds 22 - 45 seconds'>checked /> PTT <> 22 - 45 seconds checked /> Pupils fixed checked /> Short Term Memory Limits checked /> Sputum not Clear, Scant, Watery checked /> Stupor checked /> Tremors, Handgrip Weakness checked /> Asymptomatic checked /> Other

Home Safety

checked /> Unsafe Stairs and/or Doorways checked /> Rugs, Cords and/or Furniture causing Safety Risk checked /> Inadequate Heating and/or Cooling checked /> Unsafe Appliances checked /> Inadequate Sanitation and/or Plumbing checked /> Inadequate Refrigeration checked /> Presence of Insects and/or Rodents checked /> Inadequate Smoke Detectors checked /> O2 in use without precautions checked /> Home has no hazards checked /> Other

Musculo-Skeletel

checked /> Abnormal Gait and Station checked /> Limited Range of Motion checked /> Limited Muscle Strength checked /> Impaired Coordination checked /> Multiple Falls in the last 6 months checked /> Weakness checked /> Asymptomatic checked /> Other

Home Health Aide Indicators

checked /> Light Housekeeping Needed checked /> Light Meal Prep Needed checked /> Shopping Needed checked /> Errands Needed checked /> Companionship Needed checked /> Caregiver Respite Needed checked /> Emotional Support Needed checked /> Other

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