CARE PLUS
LICENSED CARE CHARTING
Client Name:______________________________ Month________________Year
_____
Initials indicated
task complete and WNL. “
*” indicates a problem noted on back.
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Date |
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Shift Start time |
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Shift End time |
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Clean & Tidy |
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Bath |
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BG checks |
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Oral Care |
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Change Linen |
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ROM |
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Hair Care |
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Nail Care |
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Wound Care |
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Ostomy Care |
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Nasal/Oral Suction |
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Oxygen Sat |
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Oxygen Admin/check |
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Vent check/clean |
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Nebulizer Tx |
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Nebulizer clean |
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Trach Care/Ties |
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BG check |
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NG tube feed |
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G Tube feed |
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G Tube care |
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Catheter care |
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Exercises/Play |
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Tasks per home POC or on back |
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Meds per home POC or on back |
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Other |
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Other |
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Other |
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__________/_________________________________/______________________________
Initials
Printed Name Signature
Mail your original time card with your original charting every Monday.
