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ACCOMMODATE MEDICAL STAFFING AND HOME CARE: CAREGIVERS DAILY TASK FORMS
MUST BE SUBMITTED AT THE END OF EACH SHIFT TO VERIFY TASK WITH SCHEDULED TIME FOR ALL CLIENTS. EACH CLIENT WILL REQUIRE A TASK FORMS FOR EACH SHIFT. IF AN ELECTRON FORM IS NOT COMPLETE A PAPER TASK FORMS MUST BE COMPLETE AND EMAILED PER POLICY. FOR ISSUES CALL 404.984.6212
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* Indicates required question
CLIENT FIRST AND LAST NAME
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Your answer
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MM
/
DD
/
YYYY
CHECK ALL TASK COMPLETE FOR TODAY BASED OFF THE CARE PLAN IN THE HOME
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bathing (tub/shower/bed)
mouth/denture care
grooming/shampooing hair
nail filing
assisting with dressing
assisting with toileting
observing/reporting changes in member condition
arranging medical trips
picking up prescriptions
accompanying member on medical appointments
reminding member to take medications
providing watchful supervision and oversight
vacuuming
sweeping
dusting
mopping
doing laundry
changing linens
assisting with transfers
assisting with walking
encouraging physical activity
assisting with simple exercise
grocery shopping
assisting with bill paying
assisting with food stamp or other application
preparing meals/clean up
encouraging proper nutrition
assisting with eating
observing and reporting meal
accumulation and food storage or
cooking equipment failure
watching TV
conversation
tablet
computer
games
yard time
gardening
Other:
Required
Was the client sick today for any reasons? If "yes" please explain.
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Your answer
Did the client have any complaints about anything today? If "yes" please explain.
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Your answer
Does the client have any skin problems? If "yes" please explain.
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Your answer
Are there any health concerns with the client? If "yes" please explain.
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Your answer
Are there any safety hazards in the home? If "yes" please explain.
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Your answer
Are there any changes noted in the client condition today? If "yes" please explain.
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Your answer
There was no evidence of abuse, neglect, sexually assault, exploitation, or etc with the client today. If "yes" please explain.
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Your answer
Did your client go to the Emergency Room or Hospital today? If "yes" please explain.
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Your answer
BY PLACING YOUR NAME BELOW, YOU VERIFY THAT ALL DOCUMENTED TASK HAVE BEEN COMPLETED FOR THE STATED CLIENT. CLIENTS WILL BE CALLED DAILY TO VERIFY TASK. TASK FORMS MUST BE TURNED IN AT THE END OF EACH SHIFT IN REAL TIME.
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YES, I UNDERSTAND
Required
DAILY NOTES
Your answer
CAREGIVER FIRST AND LAST NAME
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Your answer
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