PREPARED BY: xxxx, RN, CCM, CPUR, LCP
Life Care Plan Completed:
TELEPHONE PRE-EVALUATION: 05/02/12
DATE OF EVALUATION: 05/18/12
DATE REPORT INITIATED: 06/02/12
REPORT FINALIZED: 06/11/1
Stan XXXXX is a 69-year-old Caucasian male seen for evaluation in his residence accompanied by his wife, Suzie, on 5/18/12. Prior to this on-site evaluation, a telephone pre-evaluation was accomplished by xxxx, on 5/2/12 for the purposes of identifying specific demographic information, establishing a list of treating professionals, equipment, supplies and past work history.
His attorney, XXXX, referred Stan for a rehabilitation evaluation. The purpose of this evaluation is to assess the extent to which handicapping conditions impede his ability to live independently and handle all activities of daily living.