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Get Alliance HHA Dept. 021 2012

Com HHA Dept. 021 Effective 4/12 HOME HEALTH AIDE TIMESHEET Alliance Health Services CLIENT NAME First MI Last For the week of Sunday// thru Saturday// MM DATES OF SERVICE Sunday DD Monday YY Tuesday Wednesday Thursday Friday Saturday MM/DD TIME IN AM PM circle AM/PM TIME OUT DAILY TOTAL HOURS TOTAL HOURS FOR WEEK Instruction Cares performed must be documented by staff initials. 2260 Cliff Road Eagan Minnesota 55122 Phone 651-895-8030 Toll Free 1-800-548-0980 Fax 651-895-8070 Email Payroll alliancehealthcare. R Refused document below Bath/Shower Sponge Bath/Bed Bath Shampoo Shave Oral Care/Denture Care Dressing Catheter Care Toilet/Commode Bedpan/Urinal Brief/Pad Incontinent Peri Care Distance Frequency Assist with Transfers Use Transfer Belt Bedbound Weight Bearing Full/Partial Cane/Crutches Walker/Wheelchair PROM U L AROM Apply Limb Prosthesis Braces TEDS/Ace Wraps Lotion to Skin Nail Care Turn Position Foot Soak Non Sterile Drsg Chg Glasses/Contacts Hearing Aide L R Restrict Fluids/Push Fluids Feed Client Meal Prep B L D SN Supplement Given Weight Vacuum Laundry Kitchen/Dishes Bathroom s Empty Garbage Make Bed Change Linen OTHER HOUSEHOLD MEALS SKIN / SENSORY RANGE OF MOTION AMBULATION BLADDER / BOWEL BATH COMMENTS Changes in client condition must be documented and RN Supervisor notified* CLIENT SIGNATURE DATE Office Use Only Please Initial Date NOTE ALL TIMESHEETS MUST BE RECEIVED EVERY MONDAY BY 10 00AM FOLLOWING THE WEEK WORKED. PLEASE CALL AFTER YOU SEND YOUR TIMESHEETS TO MAKE SURE THEY WERE RECEIVED. BLANK TIMESHEETS CAN BE FOUND AT OUR WEBSITE WWW*ALLIANCEHEALTHCARE*COM ADMIN HHA SUP RN SUP. R Refused document below Bath/Shower Sponge Bath/Bed Bath Shampoo Shave Oral Care/Denture Care Dressing Catheter Care Toilet/Commode Bedpan/Urinal Brief/Pad Incontinent Peri Care Distance Frequency Assist with Transfers Use Transfer Belt Bedbound Weight Bearing Full/Partial Cane/Crutches Walker/Wheelchair PROM U L AROM Apply Limb Prosthesis Braces TEDS/Ace Wraps Lotion to Skin Nail Care Turn Position Foot Soak Non Sterile Drsg Chg Glasses/Contacts Hearing Aide L R Restrict Fluids/Push Fluids Feed Client Meal Prep B L D SN Supplement Given Weight Vacuum Laundry Kitchen/Dishes Bathroom s Empty Garbage Make Bed Change Linen OTHER HOUSEHOLD MEALS SKIN / SENSORY RANGE OF MOTION AMBULATION BLADDER / BOWEL BATH COMMENTS Changes in client condition must be documented and RN Supervisor notified* CLIENT SIGNATURE DATE Office Use Only Please Initial Date NOTE ALL TIMESHEETS MUST BE RECEIVED EVERY MONDAY BY 10 00AM FOLLOWING THE WEEK WORKED. PLEASE CALL AFTER YOU SEND YOUR TIMESHEETS TO MAKE SURE THEY WERE RECEIVED. BLANK TIMESHEETS CAN BE FOUND AT OUR WEBSITE WWW*ALLIANCEHEALTHCARE*COM ADMIN HHA SUP RN SUP. .

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