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LONG TERM PERSONAL CARE SERVICES LT PCS WEEKLY SERVICES LOG SINGLE EMPLOYEE New Dhh Louisiana 2015
Saturday 1st Departure Time W/ Initials 2nd Arrival Time W/ Initials 2nd Departure Time W/ Tasks Indicate Task Completed Each Day W/Initials Eating Bathing Dressing Grooming Transferring Ambulation Toileting Light Housekeeping Food Preparation Storage Shopping Laundry Medication Reminders Assist To Sched Med Appts Assist To Arrange Med Trans Accompany To Med Appts Daily Total Of Hours WEEKLY TOTAL HOURS of LT-PCS HOURS DSW SUPERVISOR S REVIEW SIGNATURE DATE Use of this line is optional NOTE...
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