Diagram 1 |
You have an ADL score of greater than or equal to 22. |
and |
You need a turning/repositioning program. |
and |
You need at least one of the following: ■ External catheter; ■ Intermittent catheter; ■ Indwelling catheter care; ■ Bowel program; ■ Ostomy care; or ■ Total in self performance for toilet use. |
and |
You need one of the following services provided by an individual provider, agency provider, a private duty nurse, or through self-directed care when in the in home setting, or provided by AFH/assisted living facility staff, facility RN/LPN, facility staff or private duty nursing when living in a residential setting: ■ Active range of motion (AROM); or ■ Passive range of motion (PROM). |
Diagram 2 |
You have an ADL score of greater than or equal to 22. |
and |
You need a turning/repositioning program. |
and |
You need one of the following services provided by an individual provider, agency provider, a private duty nurse, or through self-directed care when in the in home setting, or provided by AFH or assisted living facility staff, facility RN/LPN, facility staff or private duty nursing when living in a residential setting: ■ Active range of motion (AROM); or ■ Passive range of motion (PROM). |
and |
All of the following apply: ■ You require IV nutrition support or tube feeding; ■ Your total calories received per IV or tube was greater than 50%; and ■ Your fluid intake by IV or tube is greater than 2 cups per day. |
and |
You need assistance with one of the following, provided by an individual provider, agency provider, a private duty nurse, or through self-directed care when in the in home setting or provided by AFH or assisted living facility staff, facility RN/LPN, facility staff, a private duty nurse or nurse delegation when living in a residential setting: ■ Dialysis; or ■ Ventilator/respirator. |