.CHF_ZONE

HF zone {green/yellow/red}: weight {###} lb vs dry {###} lb ({+/- #} lb / {#} days, threshold {#}); edema {grade/level}; orthopnea {# pillows}; PND {y/n}; SpO2 {##}%; action {none / PRN diuretic / MD notified}.

.CHF_MEDS

GDMT: diuretic {drug/dose} response {weight/volume}; ACE-I/ARB/ARNI, beta-blocker, MRA, SGLT2i tolerated; K+ {#}, renal {#}; no abrupt beta-blocker stop; labs due {date}.

.CHF_TEACH

Reviewed daily weights, {report threshold}, green/yellow/red zones, sodium {### mg} and fluid {### mL} limits with {pt/cg}; method {teach-back}; mastery {##}%.

.CHF_SAFETY

Call for weight gain > {#} lb/{#} days, worsening orthopnea/PND/dyspnea, or SpO2 < {##}%; 911 for pink frothy sputum, severe SOB, or chest pain.

.CHF_NECESSITY

Skilled nursing required today to {action} for {HF risk} given heart failure, resulting in {measurable effect}.