"R" REFUSED "OOB" OUT OF BUILDING

APT#: RESIDENT PLAN OF CARE PLAN OF CARE

LEVEL:

1.) 2.) 3.) 4.) 5.)

6.) 7.) 8.) 9.) 10.) MEDICATION REMINDERS

SUN. DATE
MORNING 7a.m.- 9a.m. SIGNATURE NOON 12p.m.- 2p.m. SIGNATURE MID-EVE 4p.m.-5p.m. SIGNATURE NIGHT 7p.m.-9p.m. SIGNATURE PRN Time SIGNATURE

MON.

TUES.

WED.

THURS.

FRI.

SAT.

BATH SCHEDULE
SUN. MON. TUES. WED. THURS. FRI. SAT.

LAUNDRY SCHEDULE
SUN. MON. TUES. WED. THURS. FRI. SAT.

# OF LOADS

SAT.

SAT.

SAT.