Vous êtes sur la page 1sur 18

Specific

Measurable

Achievable

Realistic

Timeframe

CARE MANAGEMENT PLAN OTARA


DATE OF CLINIC: SW/SUP: CLIENT: INITIAL / REVIEW BRING-UP NEXT: DATE/S OF BIRTH:

CURRENT STATUS:

CURRENT PLACEMENT TYPE:

NO. OF PLACEMENTS: GENOGRAM: PRESENTING CARE ISSUE/S:

TIME IN CARE: TRANSFER:

CURRENT INFO / DISCUSSION NOTES:

PERMANENCY GOAL: Continue - Caregivers care

CONCURRENT GOAL:

CURRENT/IMMEDIATE GOAL:

CONSULTATION WITH:

CURRENT ISSUE/S / BARRIERS IN ACHIEVING GOALS:

CARE CLINIC RECOMMENDATIONS

TASKS TO BE COMPLETED

TIMEFRAME FOR COMPLETION

WHO IS RESPONSIBLE

MEASURES OF SUCCESS:

Specific

Measurable

Achievable

Realistic

Timeframe

CARE MANAGEMENT PLAN OTARA


DATE OF CLINIC: SW/SUP: CLIENT: INITIAL / REVIEW BRING-UP NEXT: DATE/S OF BIRTH:

CURRENT STATUS:

CURRENT PLACEMENT TYPE:

NO. OF PLACEMENTS: GENOGRAM: PRESENTING CARE ISSUE/S:

TIME IN CARE: TRANSFER:

CURRENT INFO / DISCUSSION NOTES:

PERMANENCY GOAL: Continue - Caregivers care

CONCURRENT GOAL:

CURRENT/IMMEDIATE GOAL:

CONSULTATION WITH:

CURRENT ISSUE/S / BARRIERS IN ACHIEVING GOALS:

CARE CLINIC RECOMMENDATIONS

TASKS TO BE COMPLETED

TIMEFRAME FOR COMPLETION

WHO IS RESPONSIBLE

MEASURES OF SUCCESS:

Specific

Measurable

Achievable

Realistic

Timeframe

CARE MANAGEMENT PLAN OTARA


DATE OF CLINIC: SW/SUP: CLIENT: INITIAL / REVIEW BRING-UP NEXT: DATE/S OF BIRTH:

CURRENT STATUS:

CURRENT PLACEMENT TYPE:

NO. OF PLACEMENTS: GENOGRAM: PRESENTING CARE ISSUE/S:

TIME IN CARE: TRANSFER:

CURRENT INFO / DISCUSSION NOTES:

PERMANENCY GOAL: Continue - Caregivers care

CONCURRENT GOAL:

CURRENT/IMMEDIATE GOAL:

CONSULTATION WITH:

CURRENT ISSUE/S / BARRIERS IN ACHIEVING GOALS:

CARE CLINIC RECOMMENDATIONS

TASKS TO BE COMPLETED

TIMEFRAME FOR COMPLETION

WHO IS RESPONSIBLE

MEASURES OF SUCCESS:

Specific

Measurable

Achievable

Realistic

Timeframe

CARE MANAGEMENT PLAN OTARA


DATE OF CLINIC: SW/SUP: CLIENT: INITIAL / REVIEW BRING-UP NEXT: DATE/S OF BIRTH:

CURRENT STATUS:

CURRENT PLACEMENT TYPE:

NO. OF PLACEMENTS: GENOGRAM: PRESENTING CARE ISSUE/S:

TIME IN CARE: TRANSFER:

CURRENT INFO / DISCUSSION NOTES:

PERMANENCY GOAL: Continue - Caregivers care

CONCURRENT GOAL:

CURRENT/IMMEDIATE GOAL:

CONSULTATION WITH:

CURRENT ISSUE/S / BARRIERS IN ACHIEVING GOALS:

CARE CLINIC RECOMMENDATIONS

TASKS TO BE COMPLETED

TIMEFRAME FOR COMPLETION

WHO IS RESPONSIBLE

MEASURES OF SUCCESS:

Specific

Measurable

Achievable

Realistic

Timeframe

CARE MANAGEMENT PLAN OTARA


DATE OF CLINIC: SW/SUP: CLIENT: INITIAL / REVIEW BRING-UP NEXT: DATE/S OF BIRTH:

CURRENT STATUS:

CURRENT PLACEMENT TYPE:

NO. OF PLACEMENTS: GENOGRAM: PRESENTING CARE ISSUE/S:

TIME IN CARE: TRANSFER:

CURRENT INFO / DISCUSSION NOTES:

PERMANENCY GOAL: Continue - Caregivers care

CONCURRENT GOAL:

CURRENT/IMMEDIATE GOAL:

CONSULTATION WITH:

CURRENT ISSUE/S / BARRIERS IN ACHIEVING GOALS:

CARE CLINIC RECOMMENDATIONS

TASKS TO BE COMPLETED

TIMEFRAME FOR COMPLETION

WHO IS RESPONSIBLE

MEASURES OF SUCCESS:

Specific

Measurable

Achievable

Realistic

Timeframe

CARE MANAGEMENT PLAN OTARA


DATE OF CLINIC: SW/SUP: CLIENT: INITIAL / REVIEW BRING-UP NEXT: DATE/S OF BIRTH:

CURRENT STATUS:

CURRENT PLACEMENT TYPE:

NO. OF PLACEMENTS: GENOGRAM: PRESENTING CARE ISSUE/S:

TIME IN CARE: TRANSFER:

CURRENT INFO / DISCUSSION NOTES:

PERMANENCY GOAL: Continue - Caregivers care

CONCURRENT GOAL:

CURRENT/IMMEDIATE GOAL:

CONSULTATION WITH:

CURRENT ISSUE/S / BARRIERS IN ACHIEVING GOALS:

CARE CLINIC RECOMMENDATIONS

TASKS TO BE COMPLETED

TIMEFRAME FOR COMPLETION

WHO IS RESPONSIBLE

MEASURES OF SUCCESS:

Specific

Measurable

Achievable

Realistic

Timeframe

CARE MANAGEMENT PLAN OTARA


DATE OF CLINIC: SW/SUP: CLIENT: INITIAL / REVIEW BRING-UP NEXT: DATE/S OF BIRTH:

CURRENT STATUS:

CURRENT PLACEMENT TYPE:

NO. OF PLACEMENTS: GENOGRAM: PRESENTING CARE ISSUE/S:

TIME IN CARE: TRANSFER:

CURRENT INFO / DISCUSSION NOTES:

PERMANENCY GOAL: Continue - Caregivers care

CONCURRENT GOAL:

CURRENT/IMMEDIATE GOAL:

CONSULTATION WITH:

CURRENT ISSUE/S / BARRIERS IN ACHIEVING GOALS:

CARE CLINIC RECOMMENDATIONS

TASKS TO BE COMPLETED

TIMEFRAME FOR COMPLETION

WHO IS RESPONSIBLE

MEASURES OF SUCCESS:

Specific

Measurable

Achievable

Realistic

Timeframe

CARE MANAGEMENT PLAN OTARA


DATE OF CLINIC: SW/SUP: CLIENT: INITIAL / REVIEW BRING-UP NEXT: DATE/S OF BIRTH:

CURRENT STATUS:

CURRENT PLACEMENT TYPE:

NO. OF PLACEMENTS: GENOGRAM: PRESENTING CARE ISSUE/S:

TIME IN CARE: TRANSFER:

CURRENT INFO / DISCUSSION NOTES:

PERMANENCY GOAL: Continue - Caregivers care

CONCURRENT GOAL:

CURRENT/IMMEDIATE GOAL:

CONSULTATION WITH:

CURRENT ISSUE/S / BARRIERS IN ACHIEVING GOALS:

CARE CLINIC RECOMMENDATIONS

TASKS TO BE COMPLETED

TIMEFRAME FOR COMPLETION

WHO IS RESPONSIBLE

MEASURES OF SUCCESS:

Specific

Measurable

Achievable

Realistic

Timeframe

CARE MANAGEMENT PLAN OTARA


DATE OF CLINIC: SW/SUP: CLIENT: INITIAL / REVIEW BRING-UP NEXT: DATE/S OF BIRTH:

CURRENT STATUS:

CURRENT PLACEMENT TYPE:

NO. OF PLACEMENTS: GENOGRAM: PRESENTING CARE ISSUE/S:

TIME IN CARE: TRANSFER:

CURRENT INFO / DISCUSSION NOTES:

PERMANENCY GOAL: Continue - Caregivers care

CONCURRENT GOAL:

CURRENT/IMMEDIATE GOAL:

CONSULTATION WITH:

CURRENT ISSUE/S / BARRIERS IN ACHIEVING GOALS:

CARE CLINIC RECOMMENDATIONS

TASKS TO BE COMPLETED

TIMEFRAME FOR COMPLETION

WHO IS RESPONSIBLE

MEASURES OF SUCCESS:

Vous aimerez peut-être aussi