Assesses psychosocial, emotional, and / or economical factors affecting patient's limitations and potential for and / or lack of improvement.
Assesses patient’s needs for long term care including home and family situation, exploring alternatives to in home care arrangement for placement.
Counsels patient, caregiver regarding long term planning and decision making.
Collaborates with physician and other member of health team to develop a Plan of care.
Communicates significant information regarding patients with other members of health care team and makes necessary recommendation, suggestion to improve the Plan of care.
Clinical notes should be written each visit and include progress, or lack of, specific plans, goals, anticipated length of service, referrals made, and follow-up on referrals.
Submits initial evaluation visit, interim evaluations (as deemed necessary) and discharge evaluation from Social Services. These are required documentation.
Identifies high risk indicators potentially endangering patients and provides intervention reports of the situation to the Director of Nurses and proper authorities.
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Licensed Master Social Worker • Houston, TX, US
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