Completes and maintains accurate, complete and timely documentation reflecting the assessment, examination, diagnosis, prognosis, plan of care, education, intervention and evaluation according to Federal, Department of Health (DOH) and The Joint Commission (TJC) requirements. Performs an objective functional evaluation and re-assessment of patient including the use of appropriate tests and measures; patient safety issues and home environment factors; and establishes a plan of care with measurable and functional short term/long term goals.