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(609) 906-1179
(732) 860-9993
(732) 860-9994
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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
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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
HHA Plan of Care
Client Name
Date
MM slash DD slash YYYY
Emergency Contact
Scheduled hours/days per week
Daily Activity
Positioning
Up as tolerated
T & P every 2 hours
Bathing
Shower
Sponge
Bed Bath
Chair
Hair Care
Shampoo
Shower
Bed
Grooming
Oral Care
Denture Care
Brush Teeth
Rinse
Skin Care
Lotion
Nail/Foot care (do not cut)
Shave (electric only)
Dressing
Assist
Complete
Day
Evening
Ambulation
Walking (guard while ambulatory)
Cane
Walker
Wheelchair
ROM
Active
Passive
Elevate lower extremities
Transfer
Bed to Chair
Hoyer Lift
Pivot
Diet
Fluids
Encourage
Restrict
Regular
DASH
Low Fat
Diabetic
Other
Other (Please Specify)
Meal Prep
Breakfast
Lunch
Dinner
Feed
Cut
Supervise
Frequency
Meal Prep
Breakfast
Lunch
Dinner
Prepare and Supervise
Medications
Remind medications
Elimination
Toilet
Commode
Bed Pan
Measure I/O
Catheter
Light Housekeeping
Bedroom
Bathroom
Kitchen
Make Bed
AM
NOON
PM
Linen Change
AM
NOON
PM
Laundry
AM
NOON
PM
Shopping
AM
NOON
PM
Other Duties
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)
THE RN SUPERVISOR MUST BE CONTACTED FOR ANY CHANGE IN THE PATIENT STATUS
RN Name
Title
RN Signature
Date
MM slash DD slash YYYY
CHHA Name
Date
MM slash DD slash YYYY
CHHA 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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