Premier Home Health Care
Transitional Care
Visits List
NP CARDIAC (Non-CHF) CLINICAL PATHWAY - Visit 1
Validation
1
Assessment
2
Nutrition
3
Physical Exam
4
Lab Data
5
Education & Equipment
6
Plan
7
Signature
History of Present Illiness
Allergies reviewed
Yes
No
Allergies:
select "Yes" or "No"
Meds reviewed and reconciled
BBlocker (if not, why not)
Yes
No
Why:
ACE/ARB (if not, why not)
Yes
No
Why:
ASA (if not, why not)
Yes
No
Why:
SATIN (if not, why not)
Yes
No
Why:
select "Yes" or "No"
Anticoagulant (which one)
Diuretics
Others (Specify)
NA + Diet
Fluid Restriction
Yes
No
Current Weight
General Appearance
O2 Saturation
Blood Pressure
Respiratory Rate
Temprature
Pulse
Select:
Regular
Irregular
Afih
Neck Exam
Distended Neck Veins
Bruits
Lung Exam
Select:
Rales
Rhonchi
Breath Sounds
Cardiac Exam
Select:
Murmers
Rubs
Gallops
Abdominal Exam
Select:
Ascites
Hepatomegaly
Extermities
Edema (how much)?
Integument
Basic Metabolic, Liver Tests
INR (If on Warfarin)
CBC
Dig level (If on Dig)
HgA1C (If Diabetes)
Lipid Profile
TSH
CXR
EKG
ECHO
EF
Date:
Scale in home
Yes
No
Educated on daily weight recording
Yes
No
Oxygen in home
Yes
No
CPAP
Yes
No
Educated on
Post-procedure sxs (If applicable)
Yes
No
Antocoagulation instruction (If applicable)
Yes
No
"Red Flag" Symptoms
Yes
No
When and Whome to call if feeling worse
Yes
No
Activity and Dietary restrictions
Yes
No
Use and Safety of Oxygen (If present)
Yes
No
Smoking cessation (If needed)
Yes
No
Final Medication Reconciliation
Yes
No
"Teach back" method used
Yes
No
Order Labs including daily INR (If needed)
Yes
No
CHHA needed (for LMW heparin bridging)
Yes
No
Review/Arrange appointments with PCP and/or Specialist
Yes
No
Respiratory therapist needed
Yes
No
Rehab needed
Yes
No
Immunizations needed for next visits
Flu
Yes
No
Pneumonia
Yes
No
Shingles
Yes
No
Instructions Report
Report with instructions left with patient
Yes
No
Report Sent To
Care Team
Yes
No
PCP
Yes
No
Specialist
Yes
No
CHHA (If appropriate)
Yes
No
Finished
Please sign here!
Go to Visit 2
Prev
Next
1
Validation states
2
Alerts
3
Payment Info
4
Other Info
Step 1
Step 2
Step 3
Step 4