.COM_NORMAL

Skilled communication assessment: clear speech, intact language; functional hearing/vision adequate for care [with aids]; health literacy adequate, comprehension confirmed by teach-back; no unmet interpreter/AAC need; understands plan and can consent. RN judgment applied to identify barriers, arrange accommodations, and verify comprehension given {dx}. Continued skilled monitoring indicated.

.COM_ASSESS

Speech {clear/dysarthric/aphasic}; language {intact/expressive/receptive deficit}; primary language {...}; English proficiency {...}; interpreter need {y/n}; functional hearing {adequate/impaired, aids}; functional vision {adequate/impaired, lenses}; health literacy {adequate/limited}.

.COM_ACCOMMODATION

Accommodation: {qualified interpreter/large print/demonstration/simplified language/AAC device/hearing-aid use}; effectiveness {confirmed}; comprehension {teach-back result}.

.COM_SKILL

Identified barrier {...}; arranged {interpreter/accommodation}; adapted teaching; verified comprehension by teach-back; coordinated {SLP/audiology/vision}; ensured informed participation/consent.

.COM_TEACH

Delivered teaching via {language/accommodation}; reviewed {aid use/strategies} with {pt/cg}; method {teach-back/return-demo}; mastery {##}%.

.COM_COORD

Provider notified at {time} re {acute speech change/barrier/consent concern}; reported {content}; order received {interpreter/materials/referral}; reassessment {when}.

.COM_SAFETY

Arrange accommodation for any barrier to safe or emergency communication; 911 for new slurred speech or new comprehension difficulty (possible stroke).

.COM_NECESSITY

Skilled nursing required today to {action} for {RN-level reason} given {dx}, resulting in {measurable effect}.