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Humble, TX 77346
info@thehomecarefamily.com
281-888-0385
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Change in Condition
Client Information
Client name:
Condition Information
Change in condition
Client seems different than usual.
Client shows reduced talking or alertness.
Client is newly agitated, confused or sleepy.
Client shows signs of pain.
Change in mobility
Change in ability to stand or walk
There has been an observed or unobserved fall or slip.
Change in eating or drinking.
Change in chewing, swallowing, or breathing.
Change in toileting.
Discomfort, smell, or change in frequency associated with urination.
Client has diarrhea or constipation.
Change in skin condition or increase in swelling.
New skin rash or wound.
Client is deceased.
Other
Change in condition description:
Date discovered:
Date reported:
Reporter Information
Person reporting the change in condition:
Medical personnel or family consulted:
Yes
No
Unknown
Date and time medical personal and/or family consulted:
Name of medical personnel and/or family:
Direction in care given by medical personnel and/or family member:
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