Form NDP20F "Health Hazard/Risk for Falls" - Alabama

What Is Form NDP20F?

This is a legal form that was released by the Alabama Department of Mental Health - a government authority operating within Alabama. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2018;
  • The latest edition provided by the Alabama Department of Mental Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form NDP20F by clicking the link below or browse more documents and templates provided by the Alabama Department of Mental Health.

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Download Form NDP20F "Health Hazard/Risk for Falls" - Alabama

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NDP 20f
July 2018
NAME __________________________________________________
HEALTH HAZARD/RISK for FALLS
Date
Problem
Goal/Outcome
Interventions
Date
Evaluation
NOTES
Related To:
1. No falls x 1yr
(Address all items listed
NURSING
in “goal/outcome”
□ Risk for fall due
2. No injury
1. Initial and ongoing
column. If goal not met,
to:
related to falls
nursing
revise plan)
□ Age (65<)
3. Verbalize at
assessment/Review
□ Chronic medical
least 2 safety
of Systems
conditions
measures to
2. Assess VS
(T/P/R/BP)
□ cognitive
prevent falls
________ (frequency)
impairments
3. Assess contributing
□ Dizziness
factor(s) including
□ Visual difficulties
review of all meds
□ Impaired physical
4. Make changes to
Mobility
environment as
□ History of falls
needed
□ Medications
5. Complete fall
□ other (list)
assessment
______
(frequency)
6. Teach appropriate
use of safety measures
AEB:
(state specifics)
□Last fall ________
7. Other (list)
(date)
DELEGATE
1.Assist with meds as
ordered
2. Take VS as
ordered/directed
3. Assist with
ambulation as needed
Health Hazard/Risk for Falls
NDP 20f
July 2018
NAME __________________________________________________
HEALTH HAZARD/RISK for FALLS
Date
Problem
Goal/Outcome
Interventions
Date
Evaluation
NOTES
Related To:
1. No falls x 1yr
(Address all items listed
NURSING
in “goal/outcome”
□ Risk for fall due
2. No injury
1. Initial and ongoing
column. If goal not met,
to:
related to falls
nursing
revise plan)
□ Age (65<)
3. Verbalize at
assessment/Review
□ Chronic medical
least 2 safety
of Systems
conditions
measures to
2. Assess VS
(T/P/R/BP)
□ cognitive
prevent falls
________ (frequency)
impairments
3. Assess contributing
□ Dizziness
factor(s) including
□ Visual difficulties
review of all meds
□ Impaired physical
4. Make changes to
Mobility
environment as
□ History of falls
needed
□ Medications
5. Complete fall
□ other (list)
assessment
______
(frequency)
6. Teach appropriate
use of safety measures
AEB:
(state specifics)
□Last fall ________
7. Other (list)
(date)
DELEGATE
1.Assist with meds as
ordered
2. Take VS as
ordered/directed
3. Assist with
ambulation as needed
Health Hazard/Risk for Falls
NDP 20f
July 2018
Date
Problem
Goal/Outcome
Interventions
Date
Evaluation
NOTES
4. Monitor for
unsteadiness
5. Keep be in lowest
position
6. Ensure appropriate
room lighting especially
at night
7. Encourage shoes
with nonskid soles
8. Encourage use of
handrails especially in
bathroom
Other (list)
RN SIGNATURE:
DATE:
Health Hazard/Risk for Falls
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