Alexis Compassionate Care

Get Free Quotes for Our Private Caregivers in Los Angeles County and Ventura County, CA

If you or your loved one is ever in need of a private caregiver from a senior caregiver agency in Ventura County or Los Angeles County, make sure that the one you get will really be able to cater to all your needs, at the fairest price. We at Alexis Compassionate Care make it our duty to provide you the best assistance with your comfort assured.

This checklist is intended to identify the areas of concern that you may want to monitor more closely or gather more information about. Simply fill it out, check all the boxes for your desired service, and submit.

For any questions, feel free to call us at 800-418-8576 or visit our Contact Page for details.

ALEXIS COMPASSIONATE CARE ASSESSMENT FORM

DIRECTIONS: This checklist is intended to identify areas of concern that you may want to monitor more closely or gather more information about.






    Live-alone?

    YesNo

    CAREGIVER NEED:




    PERSONAL CARE

    Bed BathPartial BathShowerTub BathOral Hygiene / Denture CareShampooComb / Brush / Dry Hair

    TOILETING

    Uses BathroomUses BedpanUrinalDiapers / DependsNight Time Care

    SLEEPING PATTERN:


    HOMEMAKING

    Meal Preps:

    BreakfastLunchDinnerSnackDishes

    HOUSEKEEPING

    Linen ChangeLight LaundryKitchen UpkeepBathroomBedroomGrocery ShoppingErrands

    TREATMENTS

    Temperature



    Bld. Pressure


    CatheterOstomy Bag

    ACTIVITIES

    Up as ToleratedTransfer BoardHoyer Lift

    Ambulation:

    With Full AssistCaneCrutchesWalkerWheel Chair

    Bedrest:

    Complete w/ Toilet PrivilegesComplete w/o Toilet PrivilegesTurn & RepositionUse Commode ChairBed / Fracture Pan

    Exercise:

    Range of Motion as taught by RN/PTActive ROMPassive ROM