Frederick Warwick Smith – Visit Summary – Daily Report Frederick Warwick Smith – Visit Summary – Daily Report Service Date(Required) DD slash MM slash YYYY Support Worker Name(Required)Client Name(Required)1A. Was the client home for visit?(Required) Yes No 1B. If no, please comment further2A. Were all activities completed as per service plan?(Required) Yes No 2B. If no, please comment on what was not completed3A. Did you remain for the whole service?(Required) Yes No 3B. If no, please comment further.4A. Did client request any changes to service?(Required) Yes No 4B. If yes, please provide details.5A. Were there any changes to clients health?(Required) Yes No 5B. If yes, please comment further.6A. Were there any changes to client's appearance?(Required) Yes No 6B. If yes, please comment further.7A. Were there any behavioral changes?(Required) Yes No 7B. If yes, please comment further.8A. Are there any concerns with the client?(Required) Yes No 8B. If yes, please comment further.9A. Are there any WH&S concerns?(Required) Yes No If yes, please comment further.Were there any incidents? (Client or staff-related)(Required) Yes No If yes, please comment further.Please provide a brief summary of service, clients' wellbeing and any other information that should be known.(Required)Time of scheduled vist start time(Required) Hours : Minutes AM PM AM/PM Did Fred have a fall?(Required) Yes No If yes, how many times, at what time and where?Did Fred have a 'near miss' fall?(Required) Yes No If yes, how many times, at what time and where?Did Fred have an incontinent episode?(Required) Yes No If yes, how many times?Please choose which number describes Fred's fatigue today with 0 being worst and 10 being normal(Required) 0 1 2 3 4 5 6 7 8 9 10 Please indicate what Fred's present pain intensity is right now(Required) No pain Mild Discomforting Distressing Horrible Excruciating Please describe the type of pain Fred is experiencing(Required)Please record Fred's Blood Pressure(Required)It is a common occurrence that Fred’s Blood Pressure is high and commonly presents with dizziness/feeling faint. Personal care (showers), getting in/out of bed causes Fred’s blood pressure to peak. Once tested, retest again in 30mins – it usually goes down. If it has not lowered in the first 30 mins, wait another 30 mins and retest again. If remains high, an ambulance needs to be called.Please record Fred's Blood Glucose(Required)Blood glucose readings are taken at mealtimes prior to eating (breakfast, lunch, and dinner). Fred is diabetic. A reading of 10 is too high and Fred is supposed to administer insulin at this level. If Fred refuses insulin, please check again in another 30 minutes. If it has not lowered in the first 30 minutes, please test again in the second 30 minutes. If Fred’s levels haven’t lowered, an ambulance needs to be called.Please record Fred's Heart Rate(Required)
