Get Nursing Supervisory Summary Form - University Of Illinois At Chicago

The Nursing Supervisory Summary Form is essential for documenting the care and services provided to a child. This guide offers clear, step-by-step instructions for completing the form online, ensuring that users can navigate each section with ease and confidence.

Follow the steps to fill out the form accurately and efficiently.

1. Press the ‘Get Form’ button to obtain the Nursing Supervisory Summary Form and open it in your editing tool.
2. Begin by entering the child's name at the top of the form. Ensure accuracy as this will be a key identifier throughout the document.
3. Fill in the dates that the summary covers in the designated section.
4. Enter the nursing agency and the name of the nursing supervisor responsible for the child's care.
5. Indicate the child’s age and birthdate in the relevant fields accurately.
6. Provide the DSCC number and community affiliation where applicable.
7. Outline the primary and secondary diagnosis along with a list of therapies provided to the child.
8. Document any family issues that have arisen in the past 60 days, including staffing issues or changes in family structure.
9. Note structural changes to the dwelling and any loss of utilities, including notes on actions taken.
10. Address transportation difficulties and identify any other agencies involved with the child and family.
11. Update the current list of trained caregivers, if there are any changes.
12. Specify the amount of nursing hours prescribed and provided weekly during the documented time period.
13. Indicate the number of respite hours provided and usual days and times of service for nursing.
14. Clarify whether the nurse accompanies the child to school and indicate if services are funded by DSCC or the school district.
15. Detail any changes in insurance benefits and any hospitalizations or emergency room visits during this period.
16. Summarize the child's clinical status, noting any medications, dosages, diet, nutrition details, and significant changes.
17. Describe the most recent supervisory visit, including date, attendees, and discussed issues.
18. Finally, ensure that the nursing supervisor signs the form and includes the date.

Complete the Nursing Supervisory Summary Form online today to ensure comprehensive documentation of the child's care.