PROVIDER’S NAME:Aalpha Resources, LLC
Day Of Week:SundayMondayTuesdayWednesdayThursdayFridaySaturday
Date
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TIME
Sunday
Monday
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Eating
Sunday
Monday
Tuesday
Wednesday
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Friday
Saturday
 
Bathing
Sunday
Monday
Tuesday
Wednesday
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Friday
Saturday
 
Dressing
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
 
Grooming
Sunday
Monday
Tuesday
Wednesday
Thursday
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Saturday
 
Transferring
Sunday
Monday
Tuesday
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Thursday
Friday
Saturday
 
Ambulation
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
 
Toileting
Sunday
Monday
Tuesday
Wednesday
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Friday
Saturday
 
Light Housekeeping
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
 
Food Preparation & Storage
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
 
Shopping
Sunday
Monday
Tuesday
Wednesday
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Friday
Saturday
 
Laundry
Sunday
Monday
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Friday
Saturday
 
Medication Reminders
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
 
Assist to Scheduled Medical Appointment
Sunday
Monday
Tuesday
Wednesday
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Assist to Arrange Medical Transportation
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
 
Accompany to Medical Appointments
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
 
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Section Break

DATE:

PROGRESS NOTES:

- Observed changes in physical and mental condition (if applicable)

- Documentation of any SIGNIFICANT DEVIATION from what is in the Plan of Care (POC)

- Important information for the next worker or caregiver

Note data
DATE:
NOTE:
 
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