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The following is an example of documentation available from the ACL Computer program.

 

 

 

 

 

PATIENT IDENTIFICATION: Pt is a 35 year old male born and raised in Russia. Pt lived always with his mother.

Pt is in the US since 5 1/2 years. In August 92 pt worked in St. Monica at the Public Library. Pt now receives SSI. Pt has a Ph.D. in 18th century Russian literature. Has been harassed in Russia with loss of job and death threats (per mother) due to publishing controversial literature related to discovery of old Jewish texts in the Lenin Library. Pt has not been able to work in the US for a long period of time.

PATIENT ETIOLOGY: Pt has been admitted to HUCLA 5/24/96 due to transfer from Cedar Sinai. Pt's mother admitted him to Cedar Sinai as Pt was deteriorating, He had A/H delusions that the FBI was after him and that he had committed crimes of sexual assault. Pt was disorganized, isolative, responding to internal stimuli and had poor hygiene. Pt has already been diagnosed in Russia with CPS, Pt has first been hospitalized for a mental illness at the age of 5 in Russia. Per chart Pt has been first hospitalized in US 3 years ago for CPS. Pt had since then several hospitalizations and most recently at Cedar Sinai, from there transferred to HUCLA due to ending of medical coverage. Pt himself is a very poor historian at this time, all information has been given by mother .

PATIENT'S OBSERVED SYMPTOMS: Pt is isolative, pressured slurred speech, paranoid, guarded, Pt still expresses delusions to be pursued by FBI for his "crimes", poor concentration, short attention span, poor living skills, unable to care for self, requires cues to shower, make bed attend activities, Pt has flat affect.

PATIENT’S PHYSICAL/MEDICAL IMPAIRMENTS/DISABILITIES: Impaired thyroid activity MODE DESCRIPTION: 42% Cognitive Assistance: The person needs 24 hour supervision to remove dangerous objects and solve problems due to minor changes in routine activities. May fix self a cold snack or sandwich. 42% minimum cognitive assistance requires on-site supervision to recognize and correct hazards. Individual preferences in doing I or 2 important activities may be honored.

8% Physical Assistance for fine motor actions on all objects used in activities of daily living.

EXPLANATION OF ESTIMATED CREDIBILITY: Daily observation on the unit, attendance in activities, ]:I observation in cognitive assessment.

 

PATIENT AWARENESS OF/ADJUSTMENT TO IMPAIRMENT DISABILITY

Patient shows slight awareness.

Patient accepts financial assistance.

Patient accepts medical assistance.

Pt and caretaker require education about the illness and the role the caretaker plays . Pt is totally dependent on mother , he has no interests outside his home, he has no friends, his only interest is reading, they have no connection to a support group and Pt has no responsibilities at home.

 

ECONOMIC STATUS

Patient has family.

Patient receives SSI and/or SSD.

 

SOCIAL SUPPORT

Patient's family or SO aware of illness.

Patient's family or SO needs education.

Pt’s mother is aware of illness, further education, support group and resources are offered and available .

PATIENT'S COGNITIVE ABILITIES ARE: The person's best ability to function at this time has been observed in the following behaviors'.

Pays Attention to Activity to be Done

**Aware of activities with a sequence of steps: beginning, middle. and end for a sequence of steps to complete an activity.

**Notices objects in plain sight, within arms reach.

**Recognizes familiar possessions, new possessions, supplies used in self-care routines. Aware of friendly social greetings

Motor Control of Doing Routine Activities

**Sequences own actions and sustains awareness of goal for the duration of the activity.

**Does not spontaneously look at the sample. notes when shown.

**Does not set up to do an activity or clean up when finished.

**Recognizes errors in size, shape, or color when asked; may not choose to correct the error, may repeat the error, or abandon the task if not helped. Asks for assistance.

**Recognizes day/night rhythms for doing activities. Measures passage of time by daily routine activities. Uses understanding of pattern to put pieces together to form a design tries to match the sample.

**Verbal Communication by Remembering Current and Past Activities/Possession Self-generates verbal directions for next step in familiar task.

**Asks another person for assistance.

**Recognizes cultural taboos for rape, murder, violence, copulation, and relieving self in public.

THE SELECTED SHORT TERM GOALS THAT CORRESPOND WITH THE CURRENT 4.0 ACL'S ABILITY TO FUNCTION ARE:(PERIOD=2 days

FUNCTIONAL GOALS:

Will be goal-directed to sequence -,;elf through steps to complete a familiar self-care routine with set-up, increased time, and 42% cognitive assistance to solve new problems, make new motor adjustments, and to remember safety precautions.

Will comply with 42% cognitive assistance needed to perform instrumental activities effectively and safely.

Will be oriented to name place, and familiar daily routine.

Will set own priorities for preferred activities to establish individual differences.

Will recognize errors when doing instrumental activities, ask for assistance and attempt to fix mistakes, or abandon the task to comply with social standards.

 

Treatment Method: Allow ample time for completion of routines, 2-3 times average rate. Memorization of new steps will be extremely slow.

Caregiver instructions:

Involve patient at home in responsibilities, daily routine for daily living and extracurricular activities to improve time management , encourage involvement outside the home, to improve stress management , time management, socialization and reality testing.

THE SELECTED LONG TERM GOALS THAT CORRESPOND WITH AN EXPECTED ACL OF 4.2 ARE: (PERIOD = 2 -4 weeks)

FUNCTIONAL GOALS:

** Will initiate and complete routine ADL's with available supplies, with 38% cognitive assistance to solve new problems, make new motor adjustments, attend to unseen areas, and to remember safety/medical precautions.

** Will perform new exercise and mobility routines with 38% cognitive assistance to make new motor adjustments, remember safety/medical precautions.

** Will use adaptive equipment with familiar movement patterns to complete routine tasks, with 38% cognitive assistance to remember safety/medical precautions.

** Will be able to sequence self through simple instrumental activities with set-up and sample, matching one striking 'king feature at a time.

**Will learn way around building, neighborhood to avoid getting lost.

**Will ask for assistance if lost.

**Will ask about day and date to keep track of the passage of time.

THERAPIST'S GOALS:

Grossly test for memory. (Short-term memory will probably test as impaired.)

TREATMENT METHODS-. Initiation of activities, memory of prior activities and how to do them,

(Allow ample time for task completion; 2-3 times average rate. Processing speed is slow. memorization of new steps will be very slow.)

Self-Care-.

FEEDING: Remind patient to check temperatures of hot foods (if using impaired extremity, assist with handling/consuming hot liquids and foods). Train in highly desired social manners.,

ORAL HYGIENE: Provide familiar tools in accessible location. Reinforce routine time.

GROOMING: Provide necessary, safe objects in visible locations, Store supplies in familiar and visible locations. Reinforce routine time.

DRESSING: Simplify selection by reducing number of available garments, or group into ready-to-wear combinations. Suggest changes for inappropriate choices

WORK AND SOCIAL RELATIONS

Prevent unrealistic expectations and social conflict that have a greater than average chance of occurring by-.

** Supervising by showing how to do a new activity, one step at a time. Do not depend on signs or posted notes as reminders.

 

Submitted by: ___________________________________ Date: 05/06/96

Rosemarie Andrews OTR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dates 4/11/96 4/15/96 4/16/96 4/17/96 4/18 4/19 4/19
Visit Ref seen x3 seen x3 seen x1 Re Re seen x1  
ACL 3.6 3.8 3.8     4.0 4.0
Therapist              
Initials              

 

Cognitive Functional Level has Stabilized from 3.6 to 4.0

INTERPRETATION:

Pt has been very depressed, isolative, withdrawn, paranoid. Progress is very slow but appears to be steady. Pt is with supervision compliant with medication. Pt initially required 50% moderate cognitive assistance to follow through with grooming, dressing and bathing. As of 4/19/96 pt requires 42% minimum cognitive assistance. Pt is cooperative on !:I but has been refusing most groups. Pt attended exercise x l, orientation x 3, grooming x l, 1:1 x 4. We will encourage pt to attend all groups and to get involved in individual project ADM 4.0 - 4.2 selection. The ACL 4.0 - 4.2 is not related to pts verbal presentation or intellectual achievement it is only related to pt's level of living skills.

 

SYMPTOMS / COMPLICATIONS:

Pt has Dx CPS and is depressed. Pt requires prompting and verbal cues to get out of bed and to attend activities. Pt is isolative, withdrawn and does not initiate interaction with peers or staff. pt appears at this time to almost have reached baseline and is expected to have level 4.2 at time of D/C.

Submitted by ________________________ 05/06/96

 

 

 

 

SUMMARY

SUMMARY OF INITIAL CONDITION: Pt has been at a very low functioning level when he was admitted to HUCLA, on ACL 3.6, pt has been improving to ACL 4.2 on D/C. Pt initially was very isolative, withdrawn, paranoid, responding to internal stimuli, preoccupied with delusions, pt was unable to perform daily hygiene routine without prompting and assistance.

Patient's Initial ACL: 4.0

SUMMARY OF PATIENTS TREATMENT: Pt attended overall exercise x2, orientation x 7, grooming x 1(pt clipped his nails), 1:1 x 5, family meeting x 1, structured task group x 4.

Pt was involved in structured task group and was able to complete ADM project level at level 4.2.

Description of Patients Initial ACL level: 42% Cognitive Assistance: The person needs 24 hour supervision to remove dangerous objects and solve problems due to minor changes in routine activities. May fix self a cold snack or sandwich. 42% minimum cognitive assistance requires on-site supervision to recognize and correct hazards. Individual preferences in doing I or 2 important activities may be honored.

8% Physical Assistance for fine motor actions on all objects used in activities of daily living.

Patient's Current ACL: 4.2

DESCRIPTION OF PATIENT'S CURRENT ACL LEVEL: 38% Cognitive Assistance: The person needs 24 hour supervision to remove dangerous objects outside of the visual field and to solve problems arising from minor changes in the environment. The person may spend a daily allowance, walk to familiar locations in the neighborhood, or follow a simple, familiar bus route. 38% minimum cognitive assistance is required to recognize and correct hazards in routine activities.

8% Physical Assistance for fine motor actions on all objects used in activities of daily living.

Submitted by: ___________________________________ Date: 04/26/96

Rosemarie Andrews OTR

 

 

 

ABILITIES

 

Patient's Abilities ACL: 4.2

DESCRIPTION OF PATIENTS ABILITIES: The person's best ability to function at this time has been observed in the following behaviors:

** Pays Attention to Part of a Simple Activity

** Aware of objects placed in plain sight, within 24" in front of them or to the right/left side.

** Aware of simple projects to assemble consisting of a flat design with size, shape, color, or number up to 2, and a sample to compare.

** Watches a demonstration of graded physical exercises.

Motor Control of Matching or  Striking Cue

** Uses objects in plain sight, placed 24" in front of then on one side.

** Refers to sample when cued.

** Recognizes error on own and requests assistance to correct error. Requests for supplies in vague or ambiguous terms.

** Matches sample, one feature at a time.

** Does not clean up, note trash when cued.

** Spends a daily allowance.

** Verbal Communication by Following Social Rituals Inflexibly

** Interrupts conversations of others to relate conversation to self.

Submitted by: _______________________________ Date: 04/26/96

Rosemarie Andrews OTR

 

 

 

 

SAFETY PRECAUTIONS

 

ACL USED FOR PATIENT’S SAFETY PRECAUTIONS: 4.2

SAFETY PRECAUTIONS FOR THIS PATIENT: The following warnings are ways of preventing common safety problems. The person is at greater than average risk for having these problems.

MOVING/WALKING

** Prevent accidents by escorting while walking in traffic and preventing from stepping in front of cars.

** Prevent falls by installing grab bars in bathroom and where dressed.

** Prevent injury, overexertion, or lack of effectiveness by supervising exercise program and anticipating potential complications.

BATHROOM ACTIVITIES

** Prevent flooding by checking to see that the water is turned off.

** Prevent falls by not walking on wet, slippery floor and making sure that all needed items are in tub/shower. ** ** Install a non-skid rug on floor tiles.

** Prevent falls in bath tub by making sure that the bath mat is pushed down tight.

** Prevent electrical shock or bums by removing electrical appliances from the bathroom (radio, hair dryer, curling iron, razor, stereo.)

DRESSING

** Avoid embarrassment by assisting with clothing selections.

EATING

** Prevent burns by allowing preparation of cold snack or sandwich.

** Prevent adverse reaction to medications by knowing side effects and possible complications and reporting to doctor.

** Prevent poor compliance with taking medication by handing measured liquids and pills to the person anti checking swallowing.

** Prevent overdose by storing medications out of sight in child-proof containers.

** Prevent running out of medications by checking on supply and renewing prescriptions.

HOUSEKEEPING

Prevent accidents in the home that have a greater than average chance of occurring by taking the following precautions:

Injury

** Consider the value of monitoring the individual with a night light,

** Organize self-care supplies in a cupboard or drawer with items used daily in plain sight. Remove unnecessary, poisonous, or burnable items. Avoid changes in packaging that can be confused with another product, such as liquid soap for hand lotion.

** Remove access to power tools, flammable, toxins, cutting tools (knives, saw, shovel), and hot tools (iron, glue gun, stove, coffee pot).

** Do not leave alone to supervise the care of a child or a pet.

** Do not leave alone to prepare hot food that could bum or catch on fire.

** If a stove is used, check to be sure the stove is turned off, move pot holders, paper, and anything else that could bum away from heat, turn pot handles toward stove, and carry boiling water.

Falls

** Anchor down electrical cords, tape down curled or frayed rugs, and restrict access to wet or highly polished floors.

** Prevent climbing to reach something by replacing light bulbs, taking things in and out of cupboards. washing windows and curtains, hanging pictures, painting walls/woodwork.

Fires

** Take out the trash, remove stacks of papers and paper boxes.

** Prevent starting a fire with fluid, gas, or paraffin.

** Prevent burns by restricting possible contact with high heat sources.

** Remove electrical cords draped over or near a heat source and frayed cords.

** Turn appliances off during a power outage, ground plugs, remove excessive appliances from a circuit/outlet, and replace fuses with correct limit on amperage.

** With an electric blanket, prevent use of a hot water bottle or an extra blanket to avoid electric shock or burns.

** Check cigarettes for smoldering ashes, not smoking in bed, and not leaving ash tray on chair arm.

** Install and maintain smoke detectors, fire extinguisher.

** Plan and rehearse an escape route and an alternative route.

** If a fire occurs, close windows and doors and get out* If in doubt, get out.

WORK AND SOCIAL RELATIONS

Prevent unrealistic expectations and social conflict that have a greater than average chance of occurring by:

** Supervising by showing how to do a new activity, one step at a time. Do not depend on signs or posted notes as reminders.

** Avoiding reading to get new information or to remind of what to do next.

** Limiting work hours to 2-3 hours per day,

** Allowing 2-3 times the normal rate to get the job done.

** Providing standby supervision while working.

Submitted by: _____________________________ Date: 04/26/96

Rosemarie Andrews OTR

 

 

Copyright 2001 Allen Conferences, Inc.
Last modified: December 29, 1998