Section IV: A. Health Profile Health Diagnoses/Risks Doctor/Professional Date Date of Support needed by paid No Support Support Area Responsible of last next staff support needed, visit visit needed but (For all areas that are Family checked the provider provides attachments should all include instructions and support description of support) General Making Appointments Health Communicating with Supports Professional During Visits Monitoring Symptoms Help when symptoms occur Allergies Making Appointments (Medication, Communicating with food, Professional During Visits environmental) Monitoring Symptoms Help when symptoms occur Behavioral and Making Appointments Mental Health Communicating with Supports Professional During Visits Monitoring Symptoms Help when symptoms occur Medical and Making Appointments Mental Health Communicating with Risks Professional During Visits Monitoring Symptoms Help when symptoms occur
Health Support Area Diagnoses/Risks Doctor/Professional Responsible Date of last visit Date of next visit Support needed by paid staff (For all areas that are checked the provider attachments should include instructions and description of support) No support needed Support needed, but Family provides all support General Health Supports Making Appointments Communicating with Professional During Visits Monitoring Symptoms Help when symptoms occur Allergies (Medication, food, environmental) Making Appointments Communicating with Professional During Visits Monitoring Symptoms Help when symptoms occur Behavioral and Mental Health Supports Making Appointments Communicating with Professional During Visits Monitoring Symptoms Help when symptoms occur Medical and Mental Health Risks Making Appointments Communicating with Professional During Visits Monitoring Symptoms Help when symptoms occur Section IV: A. Health Profile
POCUniversalWaiverPlanofCareWordversion.docx