"Person-Centered Service Plan was reviewed with Member and or Authorized Representative (AR):",
"mem_imp_pcsp_review"=>"Member/AR verbalized understanding of importance of PCSP Review:",
"mem_agrmt_pcsp_review"=>"Member and or AR in agreement with current PCSP: (If no, include details in Notes)",
"mem_agrmt_intervention"=>"Member and or AR in agreement that the intervention(s) support the goal(s): (If no, include details in Notes)",
"mem_idf_barriers"=>"Member and or AR identified barriers to the achievement of goals: (If yes, include details in Notes)",
"mem_recv_all_authz_services"=>"Member/AR confirm receiving all Authorized Services: (If no, include details in Notes)",
"mem_req_modf_pcsp"=>"Member requested modification to the current PCSP: (If yes, include details in Notes)",
"mem_req_add_serv"=>"Member /AR placed additional service request (s): (If yes, include details in Notes) ",
"mem_stsf_archcare_services"=>"Member is satisfied with ArchCare Services: (If no, include details in Notes)",
"mem_home_culture"=>"Members home is safe, and living conditions are adequate, for the provision of services: (If no, include details in Notes)",
"mem_home_atmp"=>"Members home environment is clean, clutter free, with a clear pathway: (If no, include details in Notes)",
"mem_home_co_detector"=>"Smoke detector and Carbon Monoxide detector present in members home: (If no, include details in Notes)",
"mem_additional_issues"=>" Member identified additional issues/concerns that require care coordination: (If yes, include details in Notes)",
"mem_emerg_visit_last_ninety"=>" Member had an emergency room visit in the last 90 days: (If yes, include detail in Notes).",
"mem_injury_last_ninety"=>"Member experienced a fall with injury in the last 90 days: (If yes, include detail in Notes).",
"mem_recent_unctl_pain"=>"Member expressed experiencing uncontrolled pain at present time: (If yes, include detail such as location, pain level etc in Notes)",
"mem_is_distressed"=>"Member expressed feeling lonely or distressed:",
"mem_influ_vac_last_yr"=>"Member received an influenza vaccination in the last year: (If yes, include approx month, date in Note)",
"mem_covid_vac_last_yr"=>"Member received the COVID-19 vaccine in last year (or as required): (If yes, include approx month, date, the name of vaccine in Note)",
"mem_is_educated"=>"Member confirmed being educated on Advance Directives, (i.e. Health Care Proxy/DNR/MOLST) by Care Manager/staff from ArchCare Community Life: (If yes, include detail in Notes)",
"mem_ppv_vac_last_yr"=>"Member age 65 or older, received a pneumococcal vaccination in the last five years or after age 65: (If yes, include approx month, date in Note)",
"mem_dntl_exm_last_yr"=>"Members received a dental exam in the last year: (If yes, include approx month, date in Note)."
];
$signature_array1=[
'signature_member'=>"Signature of Member:",
'signature_auth_representative'=>"Signature of Authorized Representative:",
'signature_visiting_rn_sw'=>"Signature of Visiting RN/SW:"
];
$checklist_array2=$signature_array2=[];
foreach($checklist_array1 as $key => $val){
$checklist_array2[]=[
'name'=>$key,
'description'=>$val
];
}
foreach($signature_array1 as $key => $val){
$signature_array2[]=[
'name'=>$key,
'description'=>$val
];
}
?>
?>common/frontend/assets/images/logo.png){kind=logo}