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Care Plan Activity Report

Kings Harbor Multicare Center

Resident: Barksdale, Clydia
DOB: 6/15/1928 (96 y)
Unit-Room-Bed: M1 - 114 - A
System/Facility ID: 19302 / 041353

Selection: Scheduled Date: 3/11/2025; With Corrections: From 3/5/2025

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Interventions

1. External transportation options include:

• Ambulance
• Ambulette
• Regular vehicle

Disciplines: Nursing, Social Services
Status: Discharged
Entered On: 3/06/2025
Entered By: Peguero, Jazmin

2. External transportation options include:

• Ambulance
• Ambulette
• Regular vehicle

Disciplines: Nursing, Social Services
Status: Active
Entered On: 1/23/2022
Entered By: Morton, Toni

3. Transportation method (TAL – Transportation Assistance Levels):

• Ambulatory (green – TAL1)
  • with assist
  • without assist
• Stretcher/Gerichair (red – TAL3)
• Wheelchair (yellow – TAL2)

Disciplines: Nursing, Social Services
Status: Active
Effective: 11/09/2021
Entered On: 3/07/2025
Entered By: CUMMINGS, ROBERT, RN

4. Critical supplies for resident are:

• Oxygen tank
• Medications
• Wound Care Supplies
• Tube feeding formula
• Ostomy Care Supplies
• Peritoneal dialysis supplies
• Trach care supplies
• Others (Specify): __________________

Disciplines: Nursing, Social Services
Status: Active
Effective: 11/09/2021
Entered On: 3/07/2025
Entered By: CUMMINGS, ROBERT, RN

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Historical Items

These items are marked as historical (no longer active).

External transportation options include:

• [ ] Ambulance
• [x] Ambulette
• [ ] Regular vehicle

Disciplines: Nursing, Social Services
Status: Discharged
Entered On: 3/06/2025
Entered By: Peguero, Jazmin

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Transportation method (TAL – Transportation Assistance Levels):

• [ ] Ambulatory (green – TAL1)
  • [x] with assist
  • [ ] without assist
• [ ] Stretcher/Gerichair (red – TAL3)
• [ ] Wheelchair (yellow – TAL2)

Disciplines: Nursing, Social Services
Status: Discharged
Entered On: 3/06/2025
Entered By: Peguero, Jazmin

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Transportation method (TAL – Transportation Assistance Levels):

• [ ] Ambulatory (green – TAL1)
  • [x] with assist
  • [ ] without assist
• [ ] Stretcher/Gerichair (red – TAL3)
• [ ] Wheelchair (yellow – TAL2)

Disciplines: Nursing, Social Services
Status: Active
Entered On: 1/23/2022
Entered By: Morton, Toni

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Critical supplies for resident are:

• [ ] Oxygen tank
• [x] Medications
• [ ] Wound Care Supplies
• [ ] Tube feeding formula
• [ ] Ostomy Care Supplies
• [ ] Peritoneal dialysis supplies
• [ ] Trach care supplies
• [ ] Others (Specify):__

Disciplines: Nursing, Social Services
Status: Discharged
Entered On: 3/06/2025
Entered By: Peguero, Jazmin

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:heavy_minus_sign: = Historical Item

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Generated by Anash, Nikol on 4/17/2025 at 9:36 am
Page 105 of 464