Care and Support Plan

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CARE & SUPPORT PLAN

GENERAL INFORMATION

Participant's full name

Participant's address

Age

Participant's contact number

Date of Birth

Is an early childhood early intervention (ECEI) plan required?

Participant's email address

Living arrangement

Primary Disability

NDIS Representative's email

NDIS Representative (decision maker)

NDIS representative's phone #

Next of kin full name

Next of kin's email

Next of kin's phone #

Legal guardian

Legal guardian's phone #

Legal guardian's email

Do you have any pets? If yes, provide details.

Do you have any hobbies?

What do you like to do each day?

What are some things you don't like?

What are some things you like?

Supports provided by AABDS

In home/Community support

Allied Health

Support Coordination

Cleaning/Gardening

Other

HEALTH MANAGEMENT

Medical condition/s

Medications taken

How is the medication administered?

What time/s is the medication administered?

Are you allergic to anything?

How will staff know if you're having an allergic reaction?

How often is the medication administered?

Do you need prompting to take your medication?

If yes, please provide details

What should staff do if you're having a reaction?

Do you have epilepsy or seizures?

How will staff know if you're having a seizure?

What can trigger seizures?

What should staff do if you're having a seizure?

How can you reduce the occurance of seizures?

Do you have regular medical/health appointments you'd like support to attend?

If yes, please provide relevent information.

Is there any other medical information you'd like to share?

PERSONAL CARE PLAN

Do you have any communication barriers?

How can staff reduce/eliminate any communication barriers?

Do you have any sensory concerns? If yes, please provide detail.

Do you require personal care? If yes, please provide more detail.

Do you require toileting assistance? If yes, please provide more detail.

Do you require showering/bathing assistance? If yes, please provide more detail.

Do you require mealtime management? If yes, please provide more detail.

If yes, is a mealtime management plan already in place?

If yes, has a copy of the mealtime management plan been provided to AABDS?

Do you have any dietary requirements? If yes, please provide details.

What foods do you like to eat?

Do you have any mobility challenges?

What foods do you not like to eat?

If yes, please provide further details.

Can you use stairs independently?

Approximately, how far can you walk unassisted?

Do you have any behaviours staff should be aware of?

If yes, is a behaviour support plan already written?

If yes, how can staff help you with these behaviours?

If yes, has a copy of the behaviour support plan been provided to AABDS?

Do you have any challenges in the community?

Do you have anxiety?

How will staff know if you're starting to feel anxious?

Do you have any challenges communicating with people in the community?

If yes, what are your triggers for anxiety?

What can staff do to reduce/eliminate your anxiety?

DISASTER MANAGEMENT

Does the participant live in a known flood area?

Does the participant live in an area that could be affected by bush fires?

DECLARATION by the participant, or person completing this form on behalf of the participant

I declare that the information I have given is true and correct.

Participant's/carer's signature or initals

Date

Name of AABDS representative

AABDS representative's signature

Date

Thanks for submitting!

Reviewed by AABDS Management - Name

Date

To be completed by AABDS Management

Does the participant live alone?

Yes

No

If yes, has the participant been added to the vulnerable person's register?

Yes

No

Does the participant require mealtime management?

Yes

No

Is the participant a child?

Yes

No

If yes, has the participant been added to the mealtime management register?

Yes

No

If yes, has an ECEI plan been completed?

Yes

No

In progress

Is there risk of flood or fire?

Yes

No

If yes, has the participant been added to the Disaster Management register?

Yes

No

In progress

Are there any other areas of concern?

Yes

No

If yes, has a risk and/or hazard report been completed?

Yes

No

AABDS Manager's signature

Call us:

(07) 5351 1664

Find us:

9/19 Birtwill St, Coolum Beach, Qld

Email us:

info@aabds.com.au

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