Dwellness™ • Staff Communication Log

Staff Communication Log

Dwellness™ customization for:

Your Patient

Staff Communication Log

        
Date:                                                      Location:                                          

Observations

Energy levels and mood:                                                                                                                        

                                                                                                                                                           

Movement:                                                                                                                                           

                                                                                                                                                           

Respiratory – lungs, cough:                                                                                                                    

Procedures

Medications – time and dose:                                                                                                                  

                                                                                                                                                           

Food Blend via

Time (09:15 snack)                       Usual Am’t = 60mL     Given                 Notes                                     

Time (10:15 snack)                       Usual Am’t = 120mL    Given                 Notes                                     

Time (12:00 lunch)                       Usual Am’t = 360mL    Given                 Notes                                     

Time (14:15 snack)                       Usual Am’t = 180mL    Given                 Notes                                     

Additional Water by G-tube

11:15 – Am’t given                       Notes                                                                                                 

13:15 – Am’t given                       Notes                                                                                                 

Sips of Water by Mouth

Time                   Amount                        Notes                                                                                     

Time                   Amount                        Notes                                                                                     

Time                   Amount                        Notes                                                                                     

Time                   Amount                        Notes                                                                                     

Other cares and notes

Suctioning:                                                                                                                                           

Toileting:                                                                                                                                              

                                                                                                                                                           

Progress Points

[List points from the CSP on which we want your patient to make progress, much like an IEP.]