Backup Time Sheet for Nattingham Home Care

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Aide / Caregiver Name* This field is required.
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Client Name ?* This field is required.
Please Select
Please Select
Rebecca Adkins #5899
Victoria Bartlett #6599
Jessie Chapman #1602
Susan Deshaies #4848
Joyce Farley #4903
Lorri Gessendorf #6699
Pauline Henry #0099
Rosemarie Jordan #1301
Lorraine Kreig #7902
Robin Lara #3702
Mary Maloney #6599
Donna Orr #6102
Marie Richard #0791
Alice Sanford #2502
Delores Scarborough #9301
Robert Stanley #0299
Timothy Twitty #1269
Heike Webster #9011
Last 4 of medicaid number, health plan id or 6 digit DOB are listed with name as the unique identifier
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Date of Service* This field is required.
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Scheduled Shift Start Time* This field is required.
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Scheduled Shift End Time* This field is required.
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Actual Time In* This field is required.
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Actual Time Out* This field is required.
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Minutes
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Total Hours Worked* This field is required.
How many hours did you work approximately?
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Personal Care* This field is required.Select all that apply
Bathing / Shower Assistance
Dressing Assistance
Grooming / Hair Care
Oral Hygiene
Skin Care
Nail Care
Foot Care
Shaving Assistance
Toileting Assistance
Incontinence Care
Catheter Care
Colostomy Care
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Nutrition & Meals* This field is required.Select all that apply
Meal Preparation
Feeding Assistance
Encouraged Fluids
Recorded Intake
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Mobility & SafetySelect all that apply
Ambulation Assistance
Transfer Assistance
Turn & Position
Encourage Deep Breathing
Encourage Coughing
Bed Check / Safety Monitoring
Cleared Walkways
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Housekeeping Tasks* This field is required.Select all that apply
Laundry
Dishes
Trash Removal
Vacuuming
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Housekeeping Tasks Continued...* This field is required.Select all that apply
Sweeping
Wet Mopping
Dusting
Bathroom Cleaning
Refrigerator Cleaning
Linen Change / Bed Making
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Community Support* This field is required.Select all that apply
Grocery Shopping
Prescription Pickup
Companionship
Medication Reminder (Verbal Only)
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Vital Signs / MonitoringSelect all that apply
Pulse / Blood Pressure
Temperature / Respirations
Other Monitoring Completed
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Notes / Additional Documentation
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Employee Signature* This field is required.
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Client Signature* This field is required.
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Date Signed* This field is required.
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Month
Day
Year
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All documentation must remain: Accurate Timely Professional HIPAA-conscious Fact-based Document only services actually completed during the scheduled shift.
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Nattingham Home Care | Internal Backup Time Sheet Documentation Form
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