Person-Centered Review Instructions: Include the full outcome as reflected on Describe progress toward each outcome the shared plan or in a previous update in first column. (Based upon the Plan for Supports: Support Activities and Include the start and status for each outcome in Instructions, activity data and target dates). column 2. Evaluate each outcome in the last two columns. DESIRED OUTCOMES Describe what has been tried Describe what will be changed Number and and learned since the last or improved and what will stay date/status of Statement review. What are you pleased the same. outcome: about and concerned about? [Enter tried, learned, pleased [Enter what is changing, Outcome Start date: and concerned] improving and staying the Number and Met same] Statement] Partially met Not met [Enter Outcome Start date: [Enter tried, learned, pleased [Enter what is changing, and concerned] improving and staying the Number and Met same] Statement] Partially met Not met [Enter tried, learned, pleased [Enter what is changing, Outcome date: and concerned] improving and staying the Number and Met same] Statement] Partially met Not met Please describe any significant events not reported above: (All significant changes in health including new diagnosis and conditions have been included in ISP revision for monitoring) Yes No N/A Please describe any additional medical information including medical appointments, medication changes, physical complaints, health issues, safety restrictions, or other risks and how these will be addressed: Has informed consent been obtained for the use of Yes No N/A currently prescribed psychotropic medications? Please explain the reasons, in detail, this person continues to need high intensity supports (Day Support or and/or overnight safety supports (Residential) as indicated in the Plan for Supports, if applicable: Describe the individual’s satisfaction with supports: Will this be followed by a service authorization request in to reflect changes in support hours? Yes, because hours are changing Not needed: no change in support hours
Person-Centered Review Instructions: Include the full outcome as reflected on the shared plan or in a previous update in first column. Include the start and status for each outcome in column 2. Evaluate each outcome in the last two columns. Describe progress toward each outcome (Based upon the Plan for Supports: Support Activities and Instructions, activity data and target dates). DESIRED OUTCOMES Number and Statement date/status of outcome: Describe what has been tried and learned since the last review. What are you pleased about and concerned about? Describe what will be changed or improved and what will stay the same. Outcome Number and Statement] Start date: Met Partially met Not met [Enter tried, learned, pleased and concerned] [Enter what is changing, improving and staying the same] [Enter Outcome Number and Statement] Start date: Met Partially met Not met [Enter tried, learned, pleased and concerned] [Enter what is changing, improving and staying the same] Outcome Number and Statement] date: Met Partially met Not met [Enter tried, learned, pleased and concerned] [Enter what is changing, improving and staying the same] Please describe any significant events not reported above: (All significant changes in health including new diagnosis and conditions have been included in ISP revision for monitoring) Yes No N/A Please describe any additional medical information including medical appointments, medication changes, physical complaints, health issues, safety restrictions, or other risks and how these will be addressed: Has informed consent been obtained for the use of currently prescribed psychotropic medications? Yes No N/A Please explain the reasons, in detail, this person continues to need high intensity supports (Day Support or and/or overnight safety supports (Residential) as indicated in the Plan for Supports, if applicable: Describe the individual’s satisfaction with supports: Will this be followed by a service authorization request in to reflect changes in support hours? Yes, because hours are changing Not needed: no change in support hours
person-centered-review-2017.docx