| System |
| UnitID |
1 |
1 |
| Date |
2001/5/14 |
2001/5/14 |
| Started |
12:16 |
12:40 |
| Finished |
12:39 |
13:03 |
| Client Details |
| Surname |
Baxter |
Trent |
| GivenName |
June |
George |
| Gender |
Female |
Male |
| DateofBirth |
12-9-19 |
16-7-17 |
| Address |
5 Lyons St, Cannington, Perth, WA |
7 Archer Way, Mandurah, WA |
| PhoneContact |
(08) 9632074 |
(08) 96543298 |
| MaritalStatus |
Widowed |
Married |
| LiveWith |
Alone |
Spouse |
| Accomodation |
Unit, Owner, |
Retirement Village, Owner, |
| AccomodationOther |
|
|
| PreferredLanguage |
English |
English |
| LanguageOther |
|
|
| AssessmentLocation |
At Home |
At Home |
| Assessor |
Mary Lang |
Janice Harper |
| Medical History |
| DrGP |
Dr Alan Miller |
Dr Lyn Miller |
| DrContact |
(08) 57893424 |
(08) 67853246 |
| Diagnosis |
Osteoarthritis in hips and knees. Diabetes. |
Right below-knee amputee. Diabetes. Cataract. |
| Disability |
Muscle Weakness and Pain. |
Reduced mobility, blurred vision, confusion |
| Medication |
Analgesics |
Insulin. Celebrex. |
| SpecialisedTreatments |
|
|
| SpecialisedTreatmentsOther |
|
|
| Disorientated |
No |
Yes |
| Wandering |
No |
No |
| DisruptiveBehaviour |
No |
No |
| HearingImpairment |
Yes |
Yes |
| SightImpairment |
Yes |
Yes |
| SpeechImpairment |
No |
No |
| PerceptualImpairment |
No |
No |
| CognitiveImpairment |
No |
Yes |
| Incontinent |
No |
No |
| Other |
|
Confusion and memory loss |
| Personal Care |
| Eating |
Independent, |
Independent, |
| Dressing |
Independent, |
Needs Assistance, |
| Grooming |
Independent, |
Needs Assistance,Assisitive Devices, |
| Bathing |
Independent,Assistive Devices, |
Needs Assistance,Assistive Devices, |
| Toileting |
Independent,Assistive Devices, |
Needs Assistance,Assistive Devices, |
| BladderBowel |
Independent, |
Independent, |
| TakeMedication |
Independent |
Needs Assistance |
| Transfers |
| Chair |
Independent, |
Needs Assistance,Assistive Devices, |
| Bed |
Independent |
Assistive Devices |
| BathShower |
Independent,Assistive Devices, |
Needs Assistance,Assistive Devices, |
| Toilet |
Independent,Assistive Devices, |
Needs Assistance,Assistive Devices, |
| Ambulation |
| Mobility |
Independent,Assistive devices, |
Needs assistance, |
| MobilityAids |
Walking Stick, |
Crutches, |
| Environment |
| MealPreparation |
Independent, |
Needs Assistance, |
| FollowSpecialDietifnecessary |
Independent, |
Needs Assistance, |
| Shopping |
Needs Assistance, |
Dependent, |
| Laundry |
Needs Assistance, |
Dependent, |
| LightHousework |
Needs Assistance, |
Needs Assistance, |
| HomeMaintenance |
Needs Assistance, |
Dependent, |
| UseTelephone |
Independent, |
Needs Assistance, |
| PublicTransport |
Needs Assistance |
Dependent |
| UsePrivateTransport |
Needs Assistance, |
Needs Assistance, |
| ManageFinances |
Independent |
Needs Assistance |
| HomeModification |
No |
No |
| Home Safety |
| Layout |
Safe |
Unsafe |
| FloorSurfaces |
Unsafe |
Unsafe |
| StepsStairs |
Unsafe |
Unsafe |
| Security |
Safe |
Unsafe |
| Heaters |
Safe |
Unsafe |
| SmokeDetector |
Safe |
Unsafe |
| Emergency |
Safe |
Unsafe |
| Care Services |
| Carer |
Yes |
Yes |
| Caregiver |
Family, |
Family, |
| PrimaryCaregiver |
Provide care to others |
Have poor health |
| TypeofCare |
Community,Flexible,Low Level, |
Residential,Low Level, |
| Residential |
Respite, |
Hostel, |
| ResidentialOther |
|
|
| Community |
Care Package,Home Help, |
|
| TypeofFlexibleCare |
Domestic and occasional respite |
|
| AlliedHealthSupport |
Occupational Therapy |
Physiotherapy |