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HOME HEALTH AIDE DUTY SHEET 1825 65th Street • Brooklyn, NY 11204 •Tel: 718-584-6900 • Fax: 718-584-6901Instructions: Check ( ✓ ) off all completed tasks. Complete all tasks which are either checked or noted on patient Plan of Care
Emp. Name ________________________________________ Pt. Name ________________________________________________Emp. # ___________________ Coord. __________________ Address ________________________________________________SS# _______________________ Emp.#____________________ Phone _____________ Year _____________ PT ID #: _______1. USE BLACK INK ONLY. SAT SUN MON TUES WED THUR FRI PUT DATE VISITED IN EACH BOX2. Fill this form out every day that you visit this patient. TIME ARRIVED IN PATIENT’S HOME3. You and the patient must sign daily
TIME LEFT4. In case of a patient emergency, call 911 and then PATIENT’S HOME notify Blue Line at (718) 584-6900 TOTAL HOURS5. Mail or bring this form to your Agency every Friday. WORKEDPERSONAL CARE S S M T W T F TREATMENTS/SPECIAL S S M T W T F NEEDS TAKE TEMPERATURE:BATH TUB ORAL RECTAL AXILLARY TOTAL CARE SHOWER TAKE PULSE ASSIST BED TAKE RESPIRATIONSMOUTH CARE/DENTURE CARE COMB WEIGHT PATIENTHAIR CARE SHAMPOO SHAVE RECORD OUTPUT (URINE/BM)GROOMING NAILS ASSIST WITH CATHETER CAREDRESSING EMPTY FOLEY BAGSKIN CARE ASSIST WITH OSTOMY CAREFOOT CARETOILETING: REMIND TO TAKE MEDICATION DIAPER COMMODE BED PAN/URINAL TOILET ASSIST WITH TREATMENTS SPECIFY AS WRITTEN ON POC:NUTRITION PATIENT SUPPORT ACTIVITIESDIET: REGULAR PRESCRIBED CHANGE OF BED LINENPREPARE: BREAKFAST PATIENT LAUNDRY SNACK LUNCH DINNER LIGHT HOUSEKEEPING: PATIENT ROOM KITCHENASSIST WITH FEEDING BATHROOM PATIENT CARE EQUIPMENTRECORD INTAKE: FOOD SHOPPING FLUIDACTIVITY ACCOMPANY PATIENT TO MEDICAL APPOINTMENTTRANSFERRINGASSIST WITH WALKINGDEVICE IN USE: CANE WALKER CRUTCHESASSIST WITH HOME EXERCISE UNIVERSAL/ STANDARDPROGRAM PRECAUTIONSASSIST WITH RANGE OF MOTION MONITOR PATIENT SAFETYEXERCISE: R ARM L ARM R FOOT L FOOT NECKTURNING AND POSITIONING (AT OTHER SPECIFYLEAST Q2) PATIENT/ CAREGIVER HHA SIGNATURE PATIENT/ CAREGIVER HHA SIGNATURESAT WEDSUN THURMON FRITUES
HOME HEALTH AIDE DUTY SHEET 1825 65 th Street • Brooklyn, NY 11204 •Tel: 718-584-6900 • Fax: 718-584-6901 Instructions: Check ( ) off all completed tasks. Complete all tasks which …
Home Health Aide Responsibilities: 1 Help patients with personal hygiene, dressing, bathing, and other daily tasks. 2 Perform basic health care services for patients including checking vital signs or administering prescription medication. 3 Help with general light housekeeping. 4 Make transportation arrangements as needed. More items...
Aides also may be required to obtain certification in first aid and cardiopulmonary resuscitation (CPR). Detail oriented. Home health and personal care aides must adhere to specific rules and protocols to help care for clients. They must carefully follow instructions, such as how to care for wounds, that they receive from other healthcare workers.
Most home health aides and personal care aides work in clients’ homes; others work in small group homes or larger care communities. Some visit four or five clients in the same day, and others only work with one client all day—in some cases staying with one client on a long-term basis.
Many home health and personal care aides work in clients’ homes; others work in group homes or care communities. Some aides work with only one client, while others work with groups of clients.