Home Health Checklist
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Questions and Answers

What is the primary phone number of the patient?

  • 217-259-3321
  • 847-426-0301
  • 217-259-3320 (correct)
  • 847-426-0300
  • Who is the patient's primary care physician?

  • Dr. Allen
  • Dr. Sanjay Patari
  • Dr. Shahab Mohiuddin (correct)
  • Dr. Dave
  • Where is the patient's next appointment with Dr. Sanjay Patari?

  • Surgeon's office (correct)
  • The Oaks of Bartlett
  • The patient's home
  • 935 N Plum Grove Rd, Ste B, Schaumburg IL 60173
  • What is the patient's address?

    <p>388 Jervey Ln, Bartlett</p> Signup and view all the answers

    Does the patient have a Foley?

    <p>Yes</p> Signup and view all the answers

    Who is the patient's contact person?

    <p>Allen (spouse)</p> Signup and view all the answers

    What is the patient's current living situation?

    <p>Lives at home with spouse Allen</p> Signup and view all the answers

    Is the patient able to get to their primary doctor's office for follow-up?

    <p>Yes</p> Signup and view all the answers

    What is the patient's inpatient discharge date?

    <p>June 20, 2024</p> Signup and view all the answers

    Who is the DC planner?

    <p>Dajeet</p> Signup and view all the answers

    Study Notes

    Patient Information

    • Patient's name: Jeanette Short
    • Address: 388 Jervey Ln, Bartlett
    • Primary Phone: 217-259-3320
    • Email: Not provided
    • Referral Source: The Oaks of Bartlett
    • PCP: Dr. Shahab Mohiuddin

    Medical History

    • COVID status: No signs or symptoms, negative test result
    • Last MD Appt: Visited during hospitalization
    • Next MD Appt: Pending
    • Inpatient DC Date/Facility: 6/20/24

    Referral and Orders

    • DC Planner: Dajeet
    • Orders: Yes
    • MD Confirmed: Yes
    • Patient can sign consent
    • Family to contact: Allen (spouse)
    • Contact Info Confirmed: Yes
    • Family needs to be called: Yes

    Living Situation

    • Lives at home with spouse Allen
    • Pharmacy used: Not specified
    • Able to get to primary doctor’s office for follow-up: Not specified
    • MD @ HOME NEEDED: Not specified
    • Equipment needed: Not specified
    • DME Company: Not specified
    • DME ordered: Not specified
    • DME @ Home: Not specified

    Medical Care

    • PT/INR: Not specified
    • Next Lab: Not specified
    • Following MD: Not specified
    • Wounds: Not specified
    • Foley: Not specified
    • Managing MD: Not specified
    • Last Change Date: Not specified

    Additional Information

    • Next appointment with Dr. Sanjay Patari on July 3rd
    • RN/PT/OT: Not specified

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    Description

    A checklist for home health care, including patient information and COVID-19 screening.

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