EJ
Eleanor Johnson
DOB: March 12, 1938 (87 yrs)
MBI: 1EG4-TE5-MK72
Dx: Congestive Heart Failure (I50.9)
Admitted: Jun 3, 2026
Period: 2 · Day 94
Attending: Dr. Patel
Active Hospice
NOE Due Today
Period 2
Medicaid Dual
Overview
Forms & Notes
Care Plan
Medications
Billing
Timeline
🩺 Latest Vitals
Jun 4, 2026Pain
3/10
Jun 4
BP
118/72
Jun 4
Pulse
76
Jun 4
O2 Sat
94%
Jun 4
Resp
18
Jun 4
Temp
98.4°
Jun 4
Weight
128 lb
Jun 4
Dyspnea
Mild
Jun 4
👩⚕️ Care Team
Jane Smith, RN
Primary RN
Dr. Anil Patel, MD
Attending Physician
Maria Lopez, MSW
Social Worker
Rev. Thomas Brown
Chaplain
Carlos Rivera
Hospice Aide
Pat Wilson
Volunteer
🛡️ Compliance Status
Election Statement
Jun 3
✅ On filePhysician Certification
Jun 3
✅ On fileNOE — Medicare
Due Jun 5
⚡ File NOWHIS Admission
Due Jun 10
⏳ PendingInitial Assessment (48hr)
Jun 4
✅ DoneCare Plan (5-day)
Jun 8
⏳ Due Jun 8IDG Review
Day 109 est.
⏳ Jun 18Recertification
Period 3
⏳ Due Aug 31👨👩👧 Family & Emergency Contact
Susan Johnson (daughter)
Healthcare Proxy
(612) 555-0182
Primary contact
1842 Oak Street, Atlanta GA 30301
Patient address
DNR Order on file
Jun 3, 2026
✅Advance Directive
Jan 2025
✅📋 Charting — Start a New Form
On File in Medplum
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Open a patient chart (
?id=) to view or create a hospice care plan from Medplum.💊 Comfort Medications
Morphine Sulfate 5mg/5mL oral solution
5 mg q4h scheduled + q2h prn breakthrough
Pain / dyspnea
Lorazepam 0.5mg tablet
0.5 mg q8h prn anxiety/agitation
Anxiety
Haloperidol 0.5mg tablet
0.5 mg q8h prn terminal agitation
Agitation
Furosemide 40mg tablet
40 mg daily for CHF fluid management
Comfort / CHF
Ondansetron 4mg tablet
4 mg q8h prn nausea
Nausea
Docusate Sodium 100mg capsule
100 mg BID preventive bowel regimen
Bowel regimen
Oxygen 2L nasal cannula prn
As needed for dyspnea / O2 sat <90%
Dyspnea
💰 Billing Summary
Full Billing →NOE — Period 2
Due TODAY — Jun 5, 2026
Per Diem Claim — May 2026
94 RHC days · $19,786 billed
Per Diem Claim — Apr 2026
30 RHC days · $6,300 billed
GIP Claim — Apr 18–21
3 GIP days · $2,180 billed
Total billed to date: $28,266 · Total collected: $28,266 · Open A/R: $0
📅 Patient Timeline
Jun 4
RN Visit — Jane Smith
Pain 3/10. O2 sat 94%. Dyspnea mild. Patient comfortable. Family present.
Jun 4
SW Visit — Maria Lopez
Caregiver stress moderate. Discussed respite options. Funeral pre-planning started.
Jun 3
Hospice Admission
Election statement signed. Physician certification obtained. Initial assessment started.
Jun 3
Goals of Care — Dr. Patel
Patient wishes comfort care at home. DNR discussed and signed. Family present.
May 28
IDG Meeting
All disciplines present. Care plan updated. Pain management adjusted.
Apr 21
GIP Discharge — Home
3-day GIP for pain crisis. Discharged home with adjusted comfort kit.
Apr 18
GIP Admission — Pain Crisis
Uncontrolled pain requiring inpatient management. Transferred to GIP.