- 11 Apex Drive, Suite #300A, Marlborough, MA 01752
- Office Phone: (833) 902-9898
- info@epphomecares.com
Home Health Aide – Support Seniors with Essential Care
PATIENT *
ADDRESS *
EMPLOYEE *
EMPLOYEE ID # *
Providing Compassionate & Professional Patient Care
A Certified Nursing Assistant (CNA) plays a vital role in enhancing patient well-being by delivering exceptional care, comfort, and support. From assisting with daily activities to monitoring health conditions, CNAs ensure that each patient receives the highest standard of care.
MON
TUES
WED
THUR
FRI
SAT
SUN
DATE:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
TIME STARTED:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
TIME FINISHED:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
LIVE IN:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Morning Personal Care & Hygiene Assistance
- Assist with bathing, dressing, oral hygiene, and grooming.
- Help with toileting and incontinence care to maintain dignity.
- Reposition patients to enhance comfort and prevent bedsores.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Mobility & Safety Support
- Assist with walking, transfers, and positioning.
- Ensure the use of mobility aids such as walkers, canes, or wheelchairs.
- Monitor home environments for safety hazards and fall prevention.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Meal Preparation & Nutrition Monitoring
- Prepare and serve nutritionally balanced meals based on dietary needs.
- Encourage proper hydration and meal consumption.
- Track food intake and report any concerns to healthcare providers.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Companionship & Emotional Support
- Engage in friendly conversations and meaningful interactions.
- Provide emotional reassurance and comfort for seniors.
- Encourage mental stimulation through games, reading, or hobbies.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Light Housekeeping & Household Management
- Assist with laundry, vacuuming, and organizing personal spaces.
- Maintain a clean and sanitary environment.
- Ensure personal items and essential supplies are easily accessible.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Medication Reminders & Health Monitoring
- Prompt seniors to take medications on time.
- Observe for signs of discomfort, confusion, or health changes.
- Report concerns to family members or healthcare professionals.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
End-of-Shift Responsibilities
- Ensure clients are comfortable and settled for the evening.
- Log daily care updates and communicate any health concerns.
- Brief the next caregiver on important observations and tasks.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Additional Responsibilities as Needed
- Assist in doctor’s visits, grocery shopping, and errands.
- Support seniors in social engagements and light physical activities.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Patient Signature
Patient Signature
MON
TUE
WED
THU
FRI
SAT
SUN
Aide Signature
Aide Signature
MON
TUE
WED
THU
FRI
SAT
SUN
Employee acknowledges and certifies to Evergreen Palm Primary Home Care Services That employee has actually worked the bumber of hours during the period set forth and as further certified by the patient or his authorized agent. Unsigned Duty sheets will not be accepted. Patient acknowledges and certifies that the hours set forth were actually worked and that the work was performed in a satisfactory manner. The patient should not pay the employee directly under any circumstances.
[field id="HHA"]
[field id="PCA"]
[field id="Patient"]
[field id="Address"]
[field id="Employee"]
[field id="Employee ID"]
[field id="dateMon"]
[field id="DateTues"]
[field id="DateWed"]
[field id="DateThurs"]
[field id="DateFri"]
[field id="DateSat"]
[field id="DateSun"]
[field id="StartMon"]
[field id="StartTues"]
[field id="StartWed"]
[field id="StartThurs"]
[field id="StartFri"]
[field id="StartSat"]
[field id="StartSun"]
[field id="FinishedMon"]
[field id="FinishedTues"]
[field id="FinishedWed"]
[field id="FinishedThurs"]
[field id="FinishedFri"]
[field id="FinishedSat"]
[field id="FinishedSun"]
[field id="LiveMon"]
[field id="LiveTue"]
[field id="LiveWed"]
[field id="LiveThurs"]
[field id="LiveFri"]
[field id="LiveSat"]
[field id="LiveSun"]
[field id="WalkMon"]
[field id="WalkTues"]
[field id="WalkWed"]
[field id="WalkThurs"]
[field id="WalkFri"]
[field id="WalkSat"]
[field id="WalkSun"]
[field id="TransMon"]
[field id="TransTues"]
[field id="TransWed"]
[field id="TransThurs"]
[field id="TransFri"]
[field id="TransSat"]
[field id="TransSun"]
[field id="BathMon"]
[field id="BathTues"]
[field id="BathWed"]
[field id="BathThurs"]
[field id="BathFri"]
[field id="BathSat"]
[field id="BathSun"]
[field id="SkinMon"]
[field id="SkinTue"]
[field id="SkinWed"]
[field id="SkinThurs"]
[field id="SkinFri"]
[field id="SkinSat"]
[field id="SkinSun"]
[field id="HairMon"]
[field id="HairTues"]
[field id="HairWed"]
[field id="HairThurs"]
[field id="HairFri"]
[field id="HairSat"]
[field id="HairSun"]
[field id="ShaveMon"]
[field id="ShaveTues"]
[field id="ShaveWed"]
[field id="ShaveThurs"]
[field id="ShaveFri"]
[field id="ShaveSat"]
[field id="ShaveSun"]
[field id="NailMon"]
[field id="NailTues"]
[field id="NailWed"]
[field id="NailThurs"]
[field id="NailFri"]
[field id="NailSat"]
[field id="NailSun"]
[field id="OCMon"]
[field id="OCTues"]
[field id="OCWed"]
[field id="OCThurs"]
[field id="OCFri"]
[field id="OCSat"]
[field id="OCSun"]
[field id="DressMon"]
[field id="DressTues"]
[field id="DressWed"]
[field id="DressThurs"]
[field id="DressFri"]
[field id="DressSat"]
[field id="DressSun"]
[field id="TPMon"]
[field id="TPTues"]
[field id="TPWed"]
[field id="TPThurs"]
[field id="TPFri"]
[field id="TPSat"]
[field id="TPSun"]
[field id="DevMon"]
[field id="DevTues"]
[field id="DevWed"]
[field id="DevThurs"]
[field id="DevFri"]
[field id="DevSat"]
[field id="DevSun"]
[field id="WeightMon"]
[field id="WeightTues"]
[field id="WeightWed"]
[field id="WeightThurs"]
[field id="WeightFri"]
[field id="WeightSat"]
[field id="WeightSun"]
[field id="ToiletMon"]
[field id="ToiletTues"]
[field id="ToiletWed"]
[field id="ToiletThurs"]
[field id="ToiletFri"]
[field id="ToiletSat"]
[field id="ToiletSun"]
[field id="ICMon"]
[field id="ICTues"]
[field id="ICWed"]
[field id="ICThurs"]
[field id="ICFri"]
[field id="ICSat"]
[field id="ICSun"]
[field id="REMon"]
[field id="RETues"]
[field id="REWed"]
[field id="REThurs"]
[field id="REFri"]
[field id="RESat"]
[field id="RESun"]
[field id="SSMon"]
[field id="SSTues"]
[field id="SSWed"]
[field id="SSThurs"]
[field id="SSFri"]
[field id="SSSat"]
[field id="SSSun"]
[field id="MedMon"]
[field id="MedTues"]
[field id="MedWed"]
[field id="MedThurs"]
[field id="MedFri"]
[field id="MedSat"]
[field id="MedSun"]
[field id="PreMon"]
[field id="PreTues"]
[field id="PreWed"]
[field id="PreThurs"]
[field id="PreFri"]
[field id="PreSat"]
[field id="PreSun"]
[field id="diet"]
[field id="fluid"]
[field id="DFMon"]
[field id="DFTues"]
[field id="DFWed"]
[field id="DFThurs"]
[field id="DFFri"]
[field id="DFSat"]
[field id="DFSun"]
[field id="EnMon"]
[field id="EnTues"]
[field id="EnWed"]
[field id="EnThurs"]
[field id="EnFri"]
[field id="EnSat"]
[field id="EnSun"]
[field id="AccMon"]
[field id="AccTues"]
[field id="AccWed"]
[field id="AccThurs"]
[field id="AccFri"]
[field id="AccSat"]
[field id="AccSun"]
[field id="RteMon"]
[field id="RteTues"]
[field id="RteWed"]
[field id="RteThurs"]
[field id="RteFri"]
[field id="RteSat"]
[field id="RteSun"]
[field id="RecMon"]
[field id="RecTues"]
[field id="RecWed"]
[field id="RecThurs"]
[field id="RecFri"]
[field id="RecSat"]
[field id="RecSun"]
[field id="ChangeMon"]
[field id="ChangeTues"]
[field id="ChangeWed"]
[field id="ChangeThurs"]
[field id="ChangeFri"]
[field id="ChangeSat"]
[field id="ChangeSun"]
[field id="MaintainMon"]
[field id="MaintainTues"]
[field id="MaintainWed"]
[field id="MaintainThurs"]
[field id="MaintainFri"]
[field id="MaintainSat"]
[field id="MaintainSun"]
[field id="PatientMon"]
[field id="PatienTues"]
[field id="PatienWed"]
[field id="PatienThurs"]
[field id="PatienFri"]
[field id="PatienSat"]
[field id="PatientSun"]
[field id="ShoppingMon"]
[field id="ShoppingTues"]
[field id="ShoppingWed"]
[field id="ShoppingThurs"]
[field id="ShoppingFri"]
[field id="ShoppingSat"]
[field id="ShoppingSun"]
[field id="DivMon"]
[field id="DivTues"]
[field id="DivWed"]
[field id="DivThurs"]
[field id="DivFri"]
[field id="DivSat"]
[field id="DivSun"]
[field id="OtherMon"]
[field id="OtheTues"]
[field id="OtheWed"]
[field id="OtheThurs"]
[field id="OtheFri"]
[field id="OtheSat"]
[field id="OtheSun"]
