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Has Huntington s CNA tried to grab R5 by R5 s right arm but R5 bumped into bathroom door and hit her left wrist area. Original x-ray was negative on 7/5/2013. On 1/14/2014 at 4 00 pm E17 stated that on 7/4/2013 R5 was ambulated to the bathroom by E17 and that a gait belt was not used. I forgot the gait belt at the nursing station but went ahead and ambulated and transferred R5. A gait belt is used if indicated on the care plan. A facility report dated 7/10/2013 as Final Report documents that...

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1. Begin by gathering all the necessary materials such as a 1000 palm form, a pen or pencil, and any additional supporting documents that may be required.
2. Carefully read through the instructions provided on the form to familiarize yourself with the required information and any specific guidelines.
3. Start by entering your personal details in the corresponding fields, including your full name, address, contact information, and any other requested information.
4. Ensure that all the information provided is accurate and up-to-date, as any errors or omissions could lead to delays or rejections.
5. Fill out the form point by point, following the order and sequence specified. Pay close attention to any specific instructions for each section.
6. If there are any additional sections or attachments required, make sure to complete and attach them accordingly.
7. Double-check all the information filled out on the form to ensure its accuracy and completeness.
8. Once you have reviewed and confirmed all the information, sign the form in the designated area using your legal signature.
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