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(609) 906-1179
(732) 860-9993
(732) 860-9994
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Contact
Home
About
Services
Skilled Services
Wound & Post-Surgical Care
Medication Management
Chronic Disease & Diabetes Management
Vital Signs & Health Monitoring
Specialized Medical Care
Catheter & Colostomy Care
Feeding Tube Management
Hospice & Respite Care
Non-Skilled Services
Live-in, Live-out, Hourly Care
Personal Care (Hygiene, Dressing, Grooming)
Meal Prep & Feeding Support
Housekeeping & Laundry
Companionship & Family Respite
Blog
Careers
Career Opportunities
Client Forms
Current Employees
Timesheet
Trainings
Service Areas
Contact
Schedule Appointment
Companion Plan of Care
Client Name
Date
MM slash DD slash YYYY
Emergency Contact
Emergency Contact Info
Scheduled hours/days per week
Daily Activity
Diet
Fluids
Encourage
Regular
Diabetic
Encourage
DASH
Low Fat
Other
Frequency
Other (Please Specify)
Meal Prep
Breakfast
Lunch
Dinner
Prepare and Supervise
Frequency
Medications
Remind medications
Elimination
Remind Toilet
Light Housekeeping
Bedroom
Bathroom
Kitchen
Make Bed
AM
NOON
PM
Linen Change
AM
NOON
PM
Shopping
AM
NOON
PM
Social activities as per client’s request (i.e., card games, board games, movies, reading, conversation & socialization etc.
Nursing or Medical Dx
Special Observations and Precautions to Report
Change in Mental Status
Dizziness or Seizures
Chest Pain, SOB, Weight Gain or Swollen Ankles
Falls/ Injuries/ Bruising/Skin Breakdown
Other
Other (Please Specify)
Short Term Goals
Client will remain safe
ADLs will be met by client
Will Maintain diet
Will be able to independently transfer
Will be able to ambulate independently
Personal Care needs will be met by client
Will receive Emotional Support
Other
Other (Please Specify)
Long Term Goals
Will maintain maximum level of independence
Will remain independent at home
Will maintain strength & physical activity
Will be free from falls and injuries
Discharge Plan
Ongoing companion care
Independent management by client and family
Other
Notes
Other (Please Specify)
Notes (Please Specify)
Please note: If at any time you are performing any task not noted on this plan of care, or performing any physical care for this client, you must call the nursing supervisor immediately.
RN Name
RN Signature
Date
MM slash DD slash YYYY
Companion Name
Date
MM slash DD slash YYYY
Companion Signature
Date
MM slash DD slash YYYY
Client/Authorized Rep Name
Client/Authorized Rep Signature
Date
MM slash DD slash YYYY
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