Low level (e.g. assessment / review / maintenance / supervision) TI 1 – less than daily OR Group therapy only TI 2 Moderate – daily intervention - individual sessions with one person to treat for most sessions OR very intensive Group programme of hours/day ≥6 TI 3 High level Daily intervention with therapist PLUS assistant and/or additional group sessions – TI 4 Very High level very intensive – (e.g. 2 trained therapists to treat, or total 1:1 therapy >30 hrs/week) T score (TD + TI) :…………. EQUIPMENT Describes the requirements for personal equipment No for special equipment Special Equipment Highly Specialist Equipment E 0 Wheelchair/seating Environmental control Requires basic special equipment E 1 Pressure care Communication aid Standing frame Customised seating Off-shelf orthotic Customised standing aid Requires highly specialist equipment E 2 Walking aid Customised orthotic / Other…………………… brace (e.g. electronic assistive technology or highly customized Assisted Ventilation equipment) Requires extremely specialist equipment State equipment type: E3 (ie Really fancy hi-tech trauma equipment only available in MTC!) TOTAL SCORE Needs Totals: Currently gets Reason for unmet need SUMMARY scores (E.g. Not available (NA), declined (D), or Other…) Medical / Surgical / Trauma / M: Medical: / 6 M: NA D Other.. Psychiatric treatment Basic care and support C: Care / 4 C: NA D Other.. (Includes risk management) Skilled Nursing care N: Nursing / 4 N: NA D Other.. Therapy TD: TD: NA D Other.. Therapy: / TI: TI: NA D Other..
TI 1 Low level – less than daily (e.g. assessment / review / maintenance / supervision) OR Group therapy only TI 2 Moderate – daily intervention - individual sessions with one person to treat for most sessions OR very intensive Group programme of ≥6 hours/day TI 3 High level – Daily intervention with therapist PLUS assistant and/or additional group sessions TI 4 Very High level – very intensive (e.g. 2 trained therapists to treat, or total 1:1 therapy >30 hrs/week) T score (TD + TI) :…………. EQUIPMENT Describes the requirements for personal equipment E 0 No for special equipment Special Equipment Highly Specialist Equipment E 1 Requires basic special equipment Wheelchair/seating Pressure care Standing frame Off-shelf orthotic Walking aid Other…………………… Environmental control Communication aid Customised seating Customised standing aid Customised orthotic / brace Assisted Ventilation E 2 Requires highly specialist equipment (e.g. electronic assistive technology or highly customized equipment) E3 Requires extremely specialist equipment (ie Really fancy hi-tech trauma equipment only available in MTC!) State equipment type: TOTAL SCORE SUMMARY Needs scores Totals: Currently gets Reason for unmet need (E.g. Not available (NA), declined (D), or Other…) Medical / Surgical / Trauma / Psychiatric treatment M: Medical: / 6 M: NA D Other.. Basic care and support (Includes risk management) C: Care / 4 C: NA D Other.. Skilled Nursing care N: Nursing / 4 N: NA D Other.. Therapy TD: Therapy: / TD: NA D Other.. TI: TI: NA D Other..
Complex_Neurological_Rehabilitation_-_referral_documents-1.docx