282 Riverside Drive, Johnson City NY 13790
Phone # 607-217-4880


Employee's Name:    Aides Title:   Patient Initials:



Punctual, clocks in and out and is Appropriately dressed

Good rapport with patient/family

Demonstrates competence and good judgement in carrying out assignments. Able to recognize, and report incidents and accidents, unusual or emergency events to the appropriate person

Understands her role in assisting with medications

Provides oral hygiene/Denture care

Bathing: Bed/Tub/Shower

Grooming: Shampoo/Shave/Nail Care

Maintains safe environment and safety practices. Demonstrates good transfer technique

Knowledgeable about prevention of decubitus ulcers/turning and repositioning techniques

Practices universal precautions and infection control measures including handwashing and use of hand sanitizer

Prepare/serve meals and special diet in accordance with the Plan of care and patient’s preferences

Maintains clean kitchen/bedroom/bathroom

Runs errands for patients and escorts to doctors appointments as necessary

Attends/completes annual in-service as scheduled

Maintains strict patient confidentiality, HIPAA, Demonstrates understanding of False Claims Act and corporate compliance policies and procedures.




RN Evaluator Name:  License #:  Today's Date: 
RN Signature:

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PCA/HHA Signature:

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