All names and numbers are fictitious. Any similarity to to any real persons is purely coincidental
Dec 2003 My SAMPLE Caring Agency
Coor/Social: Karen S From: GRANDVIEW
Name: KATHERINE SMITH |
Addr: 12345 - 123 Street | ID # 18958
Calgary, AB,T7U H3D |
Phone: (403) 555-8220 | Desk: 5
Client Number (internal): 259 | Phone: (403) 555-6666
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______________________________________________________________________________
D#|Employee Name |Hours/Work |Hours/Work |Hours/Work |
__|________________|___________|___________|___________|
| | | | |
17|ORANGE,EMMA | 1.00-102S | | | Service Authorized
| | | | |
19|ORANGE,EMMA | 1.00-102S | | |bath in the am
| | | | |
20|GREEN,PIERRET | 0.50-POA | 1.50-SOA | |dressing change after
| | | | |
21|ORANGE,EMMA | 1.00-102S | | |bath
| | | | |
22|ORANGE,EMMA | 1.00-102S | | |shopping on friday.
| | | | |
23|ORANGE,EMMA | 1.00-102S | | |housekeeping on monday
==|================|===========|===========|===========|
24|ORANGE,EMMA | 1.00-102S | | |doctor appointment on
| | | | |
26|ORANGE,EMMA | 1.00-102S | | |tuesday
| | | | |
27|GREEN,PIERRET | 0.50-POA | 1.50-SOA | |
| | | | |
28|BROWN,IRMA | 1.00-102S | | |
| | | | |
29|ORANGE,EMMA | 1.00-102S | | |
| | | | |
30|ORANGE,EMMA | 1.00-102S | | |
==|================|===========|===========|===========|
31|ORANGE,EMMA | 1.00-102S | | | dd/mm/yy
| | | | |
__|________________|___________|___________|___________| Termination: / /
| | | | |
__|________________|___________|___________|___________|
| | | | |
__|________________|___________|___________|___________| Review: 00/01/30
| | | | |
__|________________|___________|___________|___________|_______________________
| | | | |
__|________________|___________|___________|___________| Comments
| | | | |
__|________________|___________|___________|___________|
| | | | |
__|________________|___________|___________|___________|the residence is the
| | | | |
__|________________|___________|___________|___________|brick building behind
| | | | |
__|________________|___________|___________|___________|the care centre down
| | | | |
__|________________|___________|___________|___________|town. Katherine has a
| | | | |
__|________________|___________|___________|___________|small self contained
| | | | |
__|________________|___________|___________|___________|apartment on the third
| | | | |
__|________________|___________|___________|___________|floor.
| | | | |
__|________________|___________|___________|___________|The lift is very slow so
| | | | |
__|________________|___________|___________|___________|allow more time to get
| | | | |
__|________________|___________|___________|___________|to her
| | | | |
__|________________|___________|___________|___________|
| | | | |
__|________________|___________|___________|___________|Dwelling:
| | | | |
__|________________|___________|___________|___________| SENIOR'S RESIDENCE
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