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Modulo Piano assistenziale individuale definito
OSPITE Sig./Sig.a _____________________________________ Residente dal ___________
Identificazione M 01 Ed-Rev 0.1 Pagina 1 di 3
Data_________________
Nucleo______________
Patologia prevalente:
Alimentazione Libera Masticabile Semiliquida Liquida Diabetica Altro Edentulo
Protesi completa Protesi sup. Protesi inf. Autonoma Con aiuto Dipendente Peso Kg._____________
NOTE
OBIETTIVO DI RECUPERO O MANTENIMENTO
A tavola con: Azioni Risorse Mobilizzazione NOTE Autosuff. Sollevatore Bastone Descrizione___________ Deamb. _____________________ OBIETTIVO DI RECUPERO O MANTENIMENTO Tripodi Mezzi di contenzione Carrozza Descrizione__________ Poltrona _____________________ Allettato Intervento T.d.R. Lesioni da decubito Azioni Risorse
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Azioni Risorse Occupazione Legge gior. Ha le sue attività quali________________ TV Radio ________________ Partecipa alle attività Partecipa alle funzioni religiose A che religione appartiene __________ ____________________________________
NOTE
OBBIETTIVO DI RECUPERO O MANTENIMENTO
Azioni Risorse Firma Operatori Sanitari Presenti Medico____________________________ Coord.Attiv.Sanit,_____________________ Fisioterapista_________________________ Infermiere___________________________
Firma Operatori Socio-Assistenziali presenti Coord.Respons.____________________ R.A.A.___________________________ R.A.A.____________________________ Animatrice_________________________ O.S.S._____________________________ O.S.S._____________________________
Firma Parente di riferimento_____________________ P.A.I. da verificare entro il______________________