1. Physical Therapy Referral

AMBULATION
Person has been falling, is unsteady or holds onto furniture, c/o dizziness, has poor gait pattern (uneven steps, shuffles, foot drop, etc.) or walks precariously; LE amputation, preparing for prosthesis.

TRANSFERS
Instruction in transfer methods utilizing correct body mechanics; perhaps adaptive equipment needed (Hoyer lift, chair platform) or gait belt training needed.

STRENGTH/ROM Examples: arthritis causing joint problems; any total joint

surgery; c/o “heaviness” in extremities, joint stiffness, contractures; recent healed incisions causing adhesions; deconditioning secondary to illness or disease.


COMFORT
Back, shoulder, neck, hip, knee, etc. Posture instruction.

ENDURANCE
SOB, poor breathing habits, unable to ambulate distances, need to be independent at home, or leave home.

MOBILITY EQUIPMENT NEEDS
Example: walker needed instead of cane, or may have a foot drop and need an ankle foot orthotic. Assess need.

WOUND CARE
Wound care: co-visit by RN and PT to do wound care treatment when treatment orders include a modality (ultrasound, E-stim) to wound care site.

2. Registered Nurse Referral

RANGE OF DIAGNOSIS AND CARE RANGE OF DIAGNOSIS COVERAGE (sampling)
AIDS Gastrostomy
Asthma Head injury
Cancer Hypertension
Catheter Care Joint Replacement
Cardiac Care Osteoarthritis
Cellulitis Paraplegia
CVA Peripheral Vascular Disease
COPD Pneumonia
CHF Transplants
Decubitus Ulcers Urinary Problems
Diabetes Melllitus Wounds - Surgical or Stasis

RANGE OF SKILLED NURSING CARE (assess, treat, educate)
Bedridden patient managment
Blood pressure, orthostatic hypotension
Blood, urine and wound specimens
Case management of complicated cases
Catheter care, Foley catheter insertion
Decubitus ulcers
Diabetic management
Disease progression and complications
Dressing changes
Feeding tubes
IV therapies
Lungs, cardiovascular status
Medication management
Nebulizer usage
Nutrition/diet management
Oxygen safety
Peripheral circulation
Signs/symptoms of specific medication toxicity
Stoma management
Suctioning equipment usage
Wound care, surgical wound management

3. CERTIFIED NURSE AIDE/HOMEMAKER SERVICES CERTIFIED NURSE AIDS:

Work under the supervision of an RN or therapist, to follow a precise care plan and to help with:
- dressing changes
- range of motion exercises
- bladder and bowel programs
- assistance with toileting
- vital signs checks
- skin, foot, nail and hair care
- bathing assistance
- other skilled home health tasks (does not include housekeeping)

4. Homemaker/Personal Care Provider:

Assists with light housekeeping and other less skilled tasks such as:
- changing bed linens
- mopping kitchen/bathroom
- doing laundry
- vacuuming, dusting
- washing dishes
- cleaning bathroom
- grocery shopping
- companionship
- respite care