VOCATIONAL     Have You Worked in the Past? No Yes None / NA Unknown List Past Employment: Where Was Your Most Recent Job? What Type of Work Did You Do? How Long Were You There? Reason for Leaving: Employment Comments: Do You Have Your Social Security Card?  No  Yes Are You Interested in Working During Your Stay?  No  Yes Preferred Type of Work: Vocational Comments: WELLNESS Wellness Indicators     Client Understands the Wellness Concept? Good Fair Poor Unknown     Client Strives to be Physically Fit? Good Fair Poor Unknown     Client Initiates and Continues Physical Activities? Good Fair Poor Unknown     Client Complies With Diet? Good Fair Poor Unknown     Client Practices Healthy Lifestyle? Good Fair Poor Unknown     Client Participates in Fitness Activities? Good Fair Poor Unknown  Good  Fair  Poor  Unknown Client Ambulates without Difficulty?  Good  Fair  Poor  Unknown Use of Leisure Time: Wellness Comments: 6
VOCATIONAL Have You Worked in the Past?  No  Yes  None / NA  Unknown List Past Employment: Where Was Your Most Recent Job? What Type of Work Did You Do? How Long Were You There? Reason for Leaving: Employment Comments: Do You Have Your Social Security Card?  No  Yes Are You Interested in Working During Your Stay?  No  Yes Preferred Type of Work: Vocational Comments: WELLNESS Wellness Indicators Client Understands the Wellness Concept?  Good  Fair  Poor  Unknown Client Strives to be Physically Fit?  Good  Fair  Poor  Unknown Client Initiates and Continues Physical Activities?  Good  Fair  Poor  Unknown Client Complies With Diet?  Good  Fair  Poor  Unknown Client Practices Healthy Lifestyle?  Good  Fair  Poor  Unknown Client Participates in Fitness Activities?  Good  Fair  Poor  Unknown Client Ambulates without Difficulty?  Good  Fair  Poor  Unknown Use of Leisure Time:  Good  Fair  Poor  Unknown Wellness Comments: 6
54573%20(1-11)%20cws%20rehabilitation%20initial%20assessment.docx