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Diane Care’s For You Home Care Service, LLC

CLIENT CARE RECORDHome Health Aide

Initial each task performed as instructed by care plan

 Sat Sun Mon Tues Wed Thurs Fri
Date /:
Clock In:
Clock Out:
PERSONAL CARE
Bath
Oral Hygiene
Hair Care
Assist Dressing
Shave
Skin Care
Nail Care
NUTRITION
Prepare Meal
Assist Eating
Encourage Fluid
ACTIVITIES
Ambulation
Transfer: Bed/Chair
Turn/Reposition
ROM Exercises
RECORD
Remind of Meds
Food Intake
Fluid Intake
HOMEMAKING
Linen Change
Laundry
Wash Dishes
Light Housework
Grocery Shopping
Errands
Other
ELIMINATION
Bowel Movement
Urination
Daily Goals Met
Safety Measures Followed

Please return to the Agency office each week.

OBSERVATIONS/COMMENTS

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