Clemens Health | Daily task and service distinction sheet
Updated 2026-10-05 | (651) 354-1196

Complete one row per activity. These examples show how to describe a request; they do not establish eligibility or authorization.

Activity
Name the task without selecting a program first.
Illustrative entry: Preparing a weekday lunch.
Your notes: ________________________________________

Person's role
What does the person want to do themselves?
Illustrative entry: Choose the meal and assemble ingredients.
Your notes: ________________________________________

Missing help
Describe the assistance or teaching requested.
Illustrative entry: Learn how to check ingredients before making a shopping list.
Your notes: ________________________________________

Separate household need
What additional work should not be folded into the learning goal?
Illustrative entry: Weekly cleaning of the kitchen.
Your notes: ________________________________________

Reviewer and question
Who will clarify the suitable service?
Illustrative entry: Case manager to review training goal and cleaning request separately.
Your notes: ________________________________________

Schedule boundary
Which other support already occurs at this time?
Illustrative entry: Record the existing morning visit before proposing another worker.
Your notes: ________________________________________

Illustrative example
A person asks to learn how to plan lunches. Their sibling asks for a clean kitchen and assumes one new service will do both. The task sheet records a learning request, the person's chosen role, and a separate cleaning need. The team can now discuss IHS training and homemaker scope without pretending that cleaning the room teaches the skill. If personal assistance is also needed during meals, that becomes another explicit question. No service is marked approved merely because its name appears in the comparison.

Next step
Take the task sheet to your case manager or assessment team, then contact providers for the services the team identifies.

This is an optional discussion worksheet, not an official assessment, authorization, service plan, or emergency plan. Keep completed copies private and share through an agreed channel.