AFC Caregiver Log Name of Agency: Consumer Name: Month/Year: AFC FLOW SHEET 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Activities of Daily Living (ADL) Use codes: 0Independent (no help needed), 1Set up, 2Super 2026

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  1. Click ‘Get Form’ to open it in our editor.
  2. Begin by entering the 'Name of Agency', 'Consumer Name', and 'Month/Year' at the top of the form.
  3. In the AFC Flow Sheet section, record daily activities for each day of the month. Use the provided codes (0 for Independent, 1 for Set up, 2 for Supervision) to indicate the level of assistance required for each activity.
  4. For Incontinence Care, document occurrences by checking appropriate boxes and noting any specific care provided.
  5. Fill out sections for Instrumental Activities of Daily Living (IADL) using similar coding to reflect assistance levels.
  6. Complete the Daily Notes section with any unusual activities, ensuring to date and initial each entry.
  7. Finally, have both primary and alternate caregivers sign or initial where indicated at the bottom of the form.

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