Service Assessment Tool Patient Name* Phone*Alternate NumberSelect City*Select City*BangaloreChennaiDelhiHyderabadKolkataBelow is the worklist of nurses performing at the patient home. Based on your selection we would recommend the category of nurseBasic assessment / vital monitoring* Select All Temperature / Pulse /Respiration/Blood pressure/ Spo2 monitoring /GRBS monitoring Hygenic care* Select All Hair care,Nail Care,Skin Care,Back Care, mouth care Provides bath Room bath,assisted Bath, Bed Bath Bed Making , Use of multifunction bed Elimination needs* Select All Diaper change , Offering bed pan, offering urinal, Urine bag empty, Care of Urobag Enema administration Bladder wash, Bladder irrigation Condom cathetersation Foley’s catheterization-male, Foley’s catheterization-Female Nutritional needs* Select All Helping in oral feeding (will not prepare food independently) RT placement RT feeding & management Jejunostomy PEG tube feeding & management TPN administration Ambulation and Exercises* Select All Assist in change of position assistance with walker, cane, and wheelchair mobilization simple daily exercises Range of motion exercises Lung excercises with spirometry Psychological support and diversion therapy* Select All Assistance in reading newspaper spiritual support engagement activities such as play therapy Oxygen Therapy* Select All Oxygen administration by Face mask Oxygen administration with Nasal cannula / face mask Use of Oxygen cylinder BI-PAP /CPAP management Tracheostomy care Nursing procedures* Select All Hot & Cold applications Steam inhalation Nebulization Assist in minor wound dressing (laparoscopic, lacerations & 2nd & 3rd grade bed sore) Oro nasal suction BLS Medication administration:* Select All Oral medicines Topical (Ointment) Eye drops installation Ear drop installation SC (Insulin administration) Insertion of Suppositories IV injection IM injection IV Fluids administration Assist in major wound dressing IV cannulation ECG taking Advanced Assessment and preventive care* Select All Braden scale assessment & Bedsore management , VIP score (Visual infusion phlebitis), Pain Assessment , ECG monitoring CAUTI , CLABSI, SSI Specialised services* Select All Chemo port dressing change PICC line Dressing change Colostomy care and dressing change urostomy care and dressing Change Care of death Care of dialysis patient Administer medication through syringe pump Administer medication through infusion pump GCS Monitoring CVP Monitoring Emergency drugs & High alert medication Ventilator case management Management of Drains Patient Requires PCA ServicePatient Requires HHA ServicePatient Requires Basic ServicePatient Requires Specialty ServicePatient Requires Critical ServiceNameThis field is for validation purposes and should be left unchanged.
