Plan of Care

    Basic Details

    MaleFemale

    AmbulatoryNon Ambulatory

    Advance DirectivesDNR

    Care Service Plan

    IndependentAssistance NeededDependentNot Applicable

    IndependentAssistance NeededDependentNot Applicable

    IndependentAssistance NeededDependentNot Applicable

    IndependentAssistance NeededDependentNot Applicable

    IndependentAssistance NeededDependentNot Applicable

    IndependentAssistance NeededDependentNot Applicable

    IndependentAssistance NeededDependentNot Applicable

    IndependentAssistance NeededDependentNot Applicable

    IndependentAssistance NeededDependentNot Applicable

    IndependentAssistance NeededDependentNot Applicable

    IndependentAssistance NeededDependentNot Applicable

    IndependentAssistance NeededDependentNot Applicable

    IndependentAssistance NeededDependentNot Applicable

    IndependentAssistance NeededDependentNot Applicable

    IndependentAssistance NeededDependentNot Applicable

    IndependentAssistance NeededDependentNot Applicable

    IndependentAssistance NeededDependentNot Applicable

    IndependentAssistance NeededDependentNot Applicable

    IndependentAssistance NeededDependentNot Applicable

    IndependentAssistance NeededDependentNot Applicable

    IndependentAssistance NeededDependentNot Applicable

    IndependentAssistance NeededDependentNot Applicable

    IndependentAssistance NeededDependentNot Applicable

    IndependentAssistance NeededDependentNot Applicable

    IndependentAssistance NeededDependentNot Applicable

    IndependentAssistance NeededDependentNot Applicable

    IndependentAssistance NeededDependentNot Applicable

    IndependentAssistance NeededDependentNot Applicable

    Service Schedule

    Service/Special Needs

    (Special condition, infections, fears, issues, meals, DMEs)

    Medication

    (Mention medicine name, dosage, time, frequency and treatment.)

    Interests & Goals


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