☐No ☐No, but supported by the person-centered plan Do others knock before entering your home? ☐Yes ☐No Can you close and lock your bedroom door? ☐Yes ☐No ☐No, but supported by the person-centered plan Can you close and lock your bathroom door? ☐Yes ☐No ☐No, but supported by the person-centered plan Do you have a roommate? If yes, did you get to choose your roommate and the person you share your home with? ☐Yes ☐No ☐N/A applicable-person does not have a roommate –Not Do you know how to ask for a new roommate? ☐Yes ☐No ☐N/A applicable-person does not have a roommate –Not Is your home set-up/decorated in a way that you choose? For example, can you move the furniture where you want it? Can you hang things on the walls? Can you change things in your home? ☐Yes ☐No Do you participate in activities that you enjoy? For example, shopping, church, lunch, other activities noted on the CPOC. ☐Yes
☐No ☐No, but supported by the person-centered plan Do others knock before entering your home? ☐Yes ☐No Can you close and lock your bedroom door? ☐Yes ☐No ☐No, but supported by the person-centered plan Can you close and lock your bathroom door? ☐Yes ☐No ☐No, but supported by the person-centered plan Do you have a roommate? If yes, did you get to choose your roommate and the person you share your home with? ☐Yes ☐No ☐N/A –Not applicable-person does not have a roommate Do you know how to ask for a new roommate? ☐Yes ☐No ☐N/A –Not applicable-person does not have a roommate Is your home set-up/decorated in a way that you choose? For example, can you move the furniture where you want it? Can you hang things on the walls? Can you change things in your home? ☐Yes ☐No Do you participate in activities that you enjoy? For example, shopping, church, lunch, other activities noted on the CPOC. ☐Yes
STP091316CG.docx