ACF-905-HA

==== REFERRAL DETAILS ====

• Age: 65

• Sex: Female

• Height/Weight: 5'2" ; 122 lbs

• Ethnicity: White/Caucasian

• Insurance Type: Medicaid-UHC

• MQD-1147 Points: 20

==== MEDICAL STATUS ====

• Diagnosis: Primary DX: Pressure injury of skin on buttock, Secondary DX: Sepsis, cellulitis, schizophrenia, generalized weakness, metabolic encephalopathy, TR dorsal food wound, diarrhea.

• Mental Status: Oriented x2 – Knows who & where they are.

• Behavioral Conditions: Pt has normal or minimal impairment of vision, hearing and speech (with/without corrective device), has difficulty communicating needs/wants, problem with long-ter or short term memory, disoriented (partially or intermittently; requires supervision), needs supervision or assistance with feeding, transfers with physical/moderate assitance of another person, patient is bed bound/non-ambulatory. Able ot assist with bed mobility, incontinent of bowel and bladder, unable to safely bathe without moderate assistance, physical assistance needed on a regular basis.

==== CARE NEEDS ====

• Mobility: Bedbound

• Oxygen & Respiratory Support: Oxygen therapy

Caregiver Referral List

ACF-905-HA