The sections are Administrative Data, Medical Events, Activities of Daily Living, Behaviors, Specialized Services, Diagnosis and Plan of Care Summary.
Decubitus level: enter the most severe level (0-5) as defined in the instructions.
Activities of daily living: measure the capability of the patient to perform each ADL 60% or more of the time it is performed during the past week (7 days).
Physician visits: the patient must be medically unstable to enter any physician visits, otherwise enter a zero.
Plan of care: it does not have to be completed if the information is already provided by your own form, which is attached to this H/C-PRI.
| Question | Answer |
|---|---|
| Form Name | DOH-694 |
| Form Length | 4 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 12 min |
| Edition | 12/05 |
| Issuing agency | New York State Department of Health |
| Other names | DOH-694, DOH 694, HC-PRI, PRI, Patient Review Instrument, Hospital and Community Patient Review Instrument |
| Official source | DOH-694 (Rev 12/05), New York State Department of Health |
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