Use of community services Making appointments Please describe how the service use has changed from 1 January 2013 30 September 2013: client’s – Section 7 Social and community participation – At the moment how often would you say the client has contact with each of the following people? (please tick ) (2)=More (4)=Every (6) = Every (8)=Every than once a couple of couple of (5) = (9)=Never (1) = Daily (3)=Weekly (7)=Yearly couple of week weeks months Monthly or NA years Parents Partner Siblings or other relatives Children Carer Friends Other Please describe how the service use has changed from 1 January 2013 30 September 2013: client’s – Please tick () the corresponding boxes relating to the clients social and community participation: What is the marital status now? client’s Married/de facto Single (never married) Divorced/separated Widowed Is the client in an intimate relationship at the moment? Yes No know Don’t
Use of community services Making appointments Please describe how the client’s service use has changed from 1 January 2013 – 30 September 2013: Section 7 – Social and community participation At the moment how often would you say the client has contact with each of the following people? (please tick ) (1) = Daily (2)=More than once a week (3)=Weekly (4)=Every couple of weeks (5) = Monthly (6) = Every couple of months (7)=Yearly (8)=Every couple of years (9)=Never or NA Parents Partner Siblings or other relatives Children Carer Friends Other Please describe how the client’s service use has changed from 1 January 2013 – 30 September 2013: Please tick () the corresponding boxes relating to the clients social and community participation: What is the client’s marital status now? Married/de facto Single (never married) Divorced/separated Widowed Is the client in an intimate relationship at the moment? Yes No Don’t know
Evaluation_of_Outcomes_for_People_Nominated_to_the_Integrated_Services_Programd.docx