Clients Name
Did the client engage in a conversation with you? YesNo
Has the client taken all their medication? YesNo
Did you assist your client with oral care? YesNo
Are there any changes in the client’s mental condition? YesNo
Was meal preparation provided for the client? YesNo
Has the client taken a shower, bath, or sponge bath today? YesNo
Did the client eat their food? YesNo
Did you perform any light housekeeping duties? YesNo
Are there any significant changes in the client’s physical condition that might be a cause for concern? YesNo
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