IGENO GATE – NON-MEDICAL CARE PLAN 1. Client & Care Setup Client Name Select Client Client A Client B Client ID Care Plan Type Initial Weekly Update Start Date Care Location Home Facility 2. Functional Status ADL Level Independent Assisted Dependent IADL Level Independent Assisted Dependent Status Change Unchanged Declined Improved If changed, explain 3. Personal Hygiene Bathing Independent Assist Full Support Grooming Independent Assist Oral Care Independent Assist Instructions 4. Mobility & Transfers Mobility Level Walks independently Needs support Wheelchair Bedridden Assistive Devices None Cane Walker Wheelchair 5. Nutrition & Hydration Feeding Type Independent Assisted feeding Dietary Instructions Fluid Reminder Yes No 6. Medication Support Reminder Required Yes No Reminder Schedule Observations None Refusal Side effects Missed dose 7. Emotional Support Emotional State Calm Anxious Depressed Confused Activities Conversation Walking Reading TV / Music Family Interaction 8. Safety & Risk Fall Risk Low Medium High Supervision Continuous Periodic 9. Daily Routine Morning Midday Afternoon Evening 10. Monitoring Appetite Good Fair Poor Sleep Good Disturbed Behavior Change No Yes 11. Alerts Issue Observed None Fall Weakness Confusion Action Taken Nurse informed Family informed 12. Family Communication Update Shared Yes No Mode WhatsApp Call Summary 13. Caregiver Notes 14. Confirmation Caregiver Name Date Submit Care Plan
