Reason for Outcome (Part I: Essential Information and/or Part II: Personal Profile) Important TO: Important FOR: Outcome (Part III: Shared Planning) # Enter Name Important TO (Describe what is really important TO the person) I no longer need/want supports when By when (enter the date outcome is expected to be achieved) Mark the profile areas that apply: Work & Alternates Relationships Money Learning & Other pursuits Home Health & Safety Community & Interests Transportation & Travel Support Activities (for above Outcome, per service, noted in each Part V, Plan for Supports) Who Will be doing what (Enter a support activity; always begin with How often I no longer need/want supports when the person’s name)
Reason for Outcome (Part I: Essential Information and/or Part II: Personal Profile) Important TO: Important FOR: Outcome (Part III: Shared Planning) # Enter Name Important TO (Describe what is really important TO the person) I no longer need/want supports when By when (enter the date outcome is expected to be achieved) Mark the profile areas that apply: Work & Alternates Learning & Other pursuits Community & Interests Relationships Home Transportation & Travel Money Health & Safety Support Activities (for above Outcome, per service, noted in each Part V, Plan for Supports) Who Will be doing what (Enter a support activity; always begin with the person’s name) How often I no longer need/want supports when
pc%20outcome%20worksheet%20blank%206-4-15%20final%20for%20online.docx