PAG service specific assessment template Name: Date of birth: With input by carer: Likes to be called: With input by other: Has the person had a recent No Unsure Yes: Other current support services assessment: If yes, agency and date: (if known): Part 1: Individuality, social and emotional wellbeing Conversation starter: I would like to understand more about you as a person so we can work out together what might suit and interest you. Can you tell me a bit about yourself.... Category Areas Response Interpretation for PAG Action or referral Carer, family members, history About you Significant others, friends, diversity Enjoyment, work, What you volunteering, hobbies, (Consider past, interests, good/bad present, future) days, opportunities Your social Communication, preference socialising preferences Physical health, fitness, Keeping healthy opportunities Learning, thinking, Brain health memory, mental health, opportunities
PAG service specific assessment template Name: Likes to be called: Date of birth: With input by carer: With input by other: Has the person had a recent assessment: No Unsure Yes: If yes, agency and date: Other current support services (if known): Part 1: Individuality, social and emotional wellbeing Conversation starter: I would like to understand more about you as a person so we can work out together what might suit and interest you. Can you tell me a bit about yourself.... Category Areas Response Interpretation for PAG Action or referral About you Carer, family members, history Significant others, friends, diversity What you (Consider past, present, future) Enjoyment, work, volunteering, hobbies, interests, good/bad days, opportunities Your social preference Communication, socialising preferences Keeping healthy Physical health, fitness, opportunities Brain health Learning, thinking, memory, mental health, opportunities
PAG-service-specific-assessment-and-care-plan-templates-11-June-2015.docx