Timesheet / Care Plan
Goals
- Client will not experience any fall
- Client will participant in ADL
- Client will not experience any skin breakdown
SUN
MON
TUES
WED
THU
FRI
SAT
Date
Time In
Time Out
Client Initial
Codes: F=Frequency, R= Refused, U= Unable to Perform, C= Completed, RD=REDIRECT, PR= PROMPT.
FL= Functional Level ( I=Independent, L=limited, E=Extensive)
CARE PLAN
FL
Frequency
SUN
MON
TUE
WED
THU
FRI
SAT
PERSONAL HYGIENE
Bed / Shower / Sponge Bath
Hair / Skin / Oral Care
FEEDING
Breakfast / Lunch / Diner / PO / Feeder / Cut Food
CLEANING
Bathroom / Kitchen / Dispose trash
Clear pathways
Laundry / Change Linen / Make Bed
Clean Equipment
DRESSING
Shoes / Clothing: on /off
Fold / Hang clothes
Retrieve clothes
Braces/Splints
Reinforce Therapy
AIDE TASK
FL
Frequency
SUN
MON
TUE
WED
THU
FRI
SAT
PRECAUTION
Fall / Seizure
Medication Reminder
TOILETING
BSC / Depends Urinal / Incont.
Accompany to doctor’s office
MOBILITY
Light housekeeping
Wheelchair
Ambulation
Ambulation with Walker
Turn / ROM Reposition
Exercise
Transfer to/from bed/chair
I certify that I have worked the time shown and I have completed the documented tasks.
I certify that I am satisfied with the services listed above./ Initial Assessment
[field id="employee-name"]
[field id="client-name"]
[field id="diagnosis"]
[field id="date-sun"]
[field id="date-mon"]
[field id="date-tue"]
[field id="date-wed"]
[field id="date-thu"]
[field id="date-fri"]
[field id="date-sat"]
[field id="time-in-sun"]
[field id="time-in-mon"]
[field id="time-in-tue"]
[field id="time-in-wed"]
[field id="time-in-thu"]
[field id="time-in-fri"]
[field id="time-in-sat"]
[field id="time-out-sun"]
[field id="time-out-mon"]
[field id="time-out-tue"]
[field id="time-out-wed"]
[field id="time-out-thu"]
[field id="time-out-fri"]
[field id="time-out-sat"]
[field id="client-initial-sun"]
[field id="client-initial-mon"]
[field id="client-initial-tue"]
[field id="client-initial-wed"]
[field id="client-initial-thu"]
[field id="client-initial-fri"]
[field id="client-initial-sat"]
[field id="bed-fl"]
[field id="bed-f"]
[field id="bed-sun"]
[field id="bed-mon"]
[field id="bed-tue"]
[field id="bed-wed"]
[field id="bed-thu"]
[field id="bed-fri"]
[field id="bed-sat"]
[field id="hair-fl"]
[field id="hair-f"]
[field id="hair-sun"]
[field id="hair-mon"]
[field id="hair-tue"]
[field id="hair-wed"]
[field id="hair-thu"]
[field id="hair-fri"]
[field id="hair-sat"]
[field id="breakfast-fl"]
[field id="breakfast-f"]
[field id="brk-sun"]
[field id="brk-mon"]
[field id="brk-tue"]
[field id="brk-wed"]
[field id="brk-thu"]
[field id="brk-fri"]
[field id="brk-sat"]
[field id="bathroom-fl"]
[field id="bathroom-f"]
[field id="bathroom-sun"]
[field id="bathroom-mon"]
[field id="bathroom-tue"]
[field id="bathroom-wed"]
[field id="bathroom-thu"]
[field id="bathroom-fri"]
[field id="bathroom-sat"]
[field id="clear-fl"]
[field id="clear-f"]
[field id="clear-sun"]
[field id="clear-mon"]
[field id="clear-tue"]
[field id="clear-wed"]
[field id="clear-thu"]
[field id="clear-fri"]
[field id="clear-sat"]
[field id="laundry-fl"]
[field id="laundry-f"]
[field id="laundry-sun"]
[field id="laundry-mon"]
[field id="laundry-tue"]
[field id="laundry-wed"]
[field id="laundry-thu"]
[field id="laundry-fri"]
[field id="laundry-sat"]
[field id="clean-fl"]
[field id="clean-f"]
[field id="clean-sun"]
[field id="clean-mon"]
[field id="clean-tue"]
[field id="clean-wed"]
[field id="clean-thu"]
[field id="clean-fri"]
[field id="clean-sat"]
[field id="shoes-fl"]
[field id="shoes-f"]
[field id="shoes-sun"]
[field id="shoes-mon"]
[field id="shoes-tue"]
[field id="shoes-wed"]
[field id="shoes-thu"]
[field id="shoes-fri"]
[field id="shoes-sat"]
[field id="fold-fl"]
[field id="fold-f"]
[field id="fold-sun"]
[field id="fold-mon"]
[field id="fold-tue"]
[field id="fold-wed"]
[field id="fold-thu"]
[field id="fold-fri"]
[field id="fold-sat"]
[field id="retrieve-fl"]
[field id="retrieve-f"]
[field id="retrieve-sun"]
[field id="retrieve-mon"]
[field id="retrieve-tue"]
[field id="retrieve-wed"]
[field id="retrieve-thu"]
[field id="retrieve-fri"]
[field id="retrieve-sat"]
[field id="braces-fl"]
[field id="braces-f"]
[field id="braces-sun"]
[field id="braces-mon"]
[field id="braces-tue"]
[field id="braces-wed"]
[field id="braces-thu"]
[field id="braces-fri"]
[field id="braces-sat"]
[field id="reinforce-fl"]
[field id="reinforce-f"]
[field id="reinforce-sun"]
[field id="reinforce-mon"]
[field id="reinforce-tue"]
[field id="reinforce-wed"]
[field id="reinforce-thu"]
[field id="reinforce-fri"]
[field id="reinforce-sat"]
[field id="fall-fl"]
[field id="fall-f"]
[field id="fall-sun"]
[field id="fall-mon"]
[field id="fall-tue"]
[field id="fall-wed"]
[field id="fall-thu"]
[field id="fall-fri"]
[field id="fall-sat"]
[field id="medication-fl"]
[field id="medication-f"]
[field id="medication-sun"]
[field id="medication-mon"]
[field id="medication-tue"]
[field id="medication-wed"]
[field id="medication-thu"]
[field id="medication-fri"]
[field id="medication-sat"]
[field id="bsc-fl"]
[field id="bsc-f"]
[field id="bsc-sun"]
[field id="bsc-mon"]
[field id="bsc-tue"]
[field id="bsc-wed"]
[field id="bsc-thu"]
[field id="bsc-fri"]
[field id="bsc-sat"]
[field id="accompany-fl"]
[field id="accompany-wkly"]
[field id="accompany-sun"]
[field id="accompany-mon"]
[field id="accompany-tue"]
[field id="accompany-wed"]
[field id="accompany-thu"]
[field id="accompany-fri"]
[field id="accompany-sat"]
[field id="lighthousekeeping-fl"]
[field id="lighthousekeeping-f"]
[field id="lighthousekeeping-sun"]
[field id="lighthousekeeping-mon"]
[field id="lighthousekeeping-tue"]
[field id="lighthousekeeping-wed"]
[field id="lighthousekeeping-thu"]
[field id="lighthousekeeping-fri"]
[field id="lighthousekeeping-sat"]
[field id="wheelchair-fl"]
[field id="wheelchair-f"]
[field id="wheelchair-sun"]
[field id="wheelchair-mon"]
[field id="wheelchair-tue"]
[field id="wheelchair-wed"]
[field id="wheelchair-thu"]
[field id="wheelchair-fri"]
[field id="wheelchair-sat"]
[field id="ambulation-fl"]
[field id="ambulation-f"]
[field id="ambulation-sun"]
[field id="ambulation-mon"]
[field id="ambulation-tue"]
[field id="ambulation-wed"]
[field id="ambulation-thu"]
[field id="ambulation-fri"]
[field id="ambulation-sat"]
[field id="ambulation-walker-fl"]
[field id="ambulation-f"]
[field id="ambulation-walker-sun"]
[field id="ambulation-walker-mon"]
[field id="ambulation-walker-tue"]
[field id="ambulation-walker-wed"]
[field id="ambulation-walker-thu"]
[field id="ambulation-walker-fri"]
[field id="ambulation-walker-sat"]
[field id="turn-fl"]
[field id="turn-f"]
[field id="turn-sun"]
[field id="turn-mon"]
[field id="turn-tue"]
[field id="turn-wed"]
[field id="turn-thu"]
[field id="turn-fri"]
[field id="turn-sat"]
[field id="exercise-fl"]
[field id="exercise-f"]
[field id="exercise-sun"]
[field id="exercise-mon"]
[field id="exercise-tue"]
[field id="exercise-wed"]
[field id="exercise-thu"]
[field id="exercise-fri"]
[field id="exercise-sat"]
[field id="transfer-fl"]
[field id="transfer-f"]
[field id="transfer-sun"]
[field id="transfer-mon"]
[field id="transfer-tue"]
[field id="transfer-wed"]
[field id="transfer-thu"]
[field id="transfer-fri"]
[field id="transfer-sat"]
[field id="date-submitted"]
[field id="date-rn"]
[field id="rn-print-name"]
[field id="date-certify"]