VISITING NOTE

VISITING NOTE
OFFICE USE ONLY
DAY MARE ATTN HKM PA CHOICE PVT INSU RES VA SSBG T3 T3E VHSP
MON
TUES
WED
THUR
FRI
SAT
SUN
DAY DATE TIME IN TIME OUT TOTAL HOURS TYPE1 TYPE2 TYPE3 PT INITIAL STAFF INITIAL
MON 3/2
3/2		 9:00am
11:00am		 11:00am
1:00pm		 2
3		 HMK
ATTN		 J S
TUES
WED 3/9 3:00PM 6:00PM 3 ATTN
THUR
FRI
SAT
SUN
TYPES: ATTN/HMK/CHOICE/PA/RES/MEDICARE/T3/T3E/SSBG/CHSP/INSUR
DESCRIPTION M T W TH F SA SU DESCRIPTION M T W TH F SA SU
TUB/SHOWER ASSIST X REPOSITION BED/CHAIR PATIENT
BATHROOM CLEAN UP X MEDICATION REMINDERS
PERINEAL CARE x ASSIST TO BR, BSC, BED PAN
SKIN CARE/LOTION x CATH CARE,FOLEY/EXT
ORAL CARE/SHAVE X x INCONTINENT CARE
SHAMPOO/COMB X x PREP OF MEALS/SNACKS X
SAFETY PROCAUTIONS KITCEN CLEAN UP X
DRESS/UNDRESS X x BED MADE/ LINEN CHANGE
ASSIST WITH AMBULATION X CLIENT LAUNDRY DONE X
RANGE OF MOTION X MAINT. CLEAN EQUIP
TRANSFER ASSIST VACCUM/DUSTING X
A & D O N L Y
MECHANICAL LIFT OSTOMY CARE
OTHER RECORD INTAKE/OUTPUT
ASSIST FEEDING CHECK/ REINFORCE DRESSING