Get Plan Of Care Using Unlicensed Proxy Caregivers 2020-2025

Completing the Plan Of Care using unlicensed proxy caregivers is essential for ensuring proper health maintenance for clients. This guide will provide you with clear, step-by-step instructions to help you navigate the online form with ease.

Follow the steps to successfully complete the form.

1. Use the 'Get Form' button to access the form and open it in your preferred editing tool.
2. Enter the client's claim number in the designated field to identify their case.
3. Fill in the start of care date to indicate when the care will commence.
4. Specify the initial training date for the unlicensed proxy caregivers responsible for the client.
5. Provide the medical record number associated with the client for accurate tracking.
6. Indicate the frequency of skill rechecks for the caregivers to ensure they maintain the required competencies.
7. Record the assessment date to document when the evaluation took place.
8. Complete the annual reevaluation date unless there has been a change in the client's condition.
9. Fill in the client’s name, address, and telephone number for identification and contact purposes.
10. Provide the client's date of birth to verify their identity.
11. Enter the provider number for the individual or organization responsible for the care.
12. Include the provider's name, address, and telephone number for reference.
13. Specify the client's sex as per the available options.
14. Detail the principal diagnosis and applicable ICD code and date, if required.
15. List any surgical procedures alongside their ICD and date, if applicable.
16. Mention other pertinent diagnoses and their corresponding ICD codes where required.
17. Document the medications prescribed, including dose, frequency, and route, indicating if they are new or changed.
18. Complete the vital signs section with blood pressure, heart rate, respiration rate, and temperature.
19. Outline any necessary treatments to be administered.
20. List Durable Medical Equipment (DME) and supplies required for the client.
21. Describe safety measures to be observed, including universal precautions and infection control.
22. Specify any dietary or nutritional requirements the client may have.
23. Identify any allergies the client has to ensure proper care.
24. Document functional or physical limitations the client faces.
25. List the activities permitted for the client's well-being.
26. Assess the mental and cognitive status of the client, documenting any relevant observations.
27. Indicate the stability of the client's condition, noting if it is stable or if there are other observations.
28. Detail health maintenance activities, including their frequency and duration, plus any adaptations needed.
29. Outline goals and objectives for the client's care.
30. Collect the nurse’s signature and training date as verification.
31. Prepare discharge plans to ensure proper transition after care.
32. Provide the physician's name, address, telephone, and fax number for future communication.
33. Confirm the physician's recommendation for care services in compliance with the client's consent for unlicensed caregivers.
34. Ensure the date of signature is completed to validate the document.
35. Finally, the physician's or authorized prescriber's signature must be obtained.
36. Once all fields are filled out, users can save changes, download the document, print, or share it as needed.

Complete your Plan Of Care using unlicensed proxy caregivers online today for efficient document management.