New Plan Meeting

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Persons in attendance

• Participant Name

• New or existing participant?

  New

  Existing

• Plan dates

• Is the participant happy to continue with your services?

  Yes

  No

  N/A

• Has there been a change in funding? In what areas?

• Have you discussed conflict of interest?

  Yes

  No

  N/A

Are there Changes requested?

• Does the participant want changes to any of their services?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Reason given for change/ no change in services

Core supports

• What category of core provider change requested?

  Select Day program Drop in provider cleaner lawn maintenance SIL provider Other

  • Day program
  • Drop in provider
  • cleaner
  • lawn maintenance
  • SIL provider
  • Other

• What services were discussed?

  Select Dundaloo Valley Aruma Pluto Life Without Barriers Lifestyle Solutions Quality Individual Support Breakthru Northcott Other

  • Dundaloo
  • Valley
  • Aruma
  • Pluto
  • Life Without Barriers
  • Lifestyle Solutions
  • Quality Individual Support
  • Breakthru
  • Northcott
  • Other

• Service decided on

  Select Dundaloo Valley Aruma Pluto Life Without Barriers Lifestyle Solutions Quality Individual Support Breakthru Northcott Other

  • Dundaloo
  • Valley
  • Aruma
  • Pluto
  • Life Without Barriers
  • Lifestyle Solutions
  • Quality Individual Support
  • Breakthru
  • Northcott
  • Other

Capacity Building Supports

• What services does the participant require?

  Select OT Psychology Physiotherapy Speech Therapy Dietician Behaviour support Practitioner Exercise physiologist Other

  • OT
  • Psychology
  • Physiotherapy
  • Speech Therapy
  • Dietician
  • Behaviour support Practitioner
  • Exercise physiologist
  • Other

• Were multiple providers offered?

  Yes

  No

  N/A

• Chosen OT Provider?

  Dundaloo Allied Health

  Mayo

  Allied Life Partners

  Access Potential

  Other

• Chosen psychology provider

  Select Dundaloo Allied Health Intalink Mayo Ava Read Greg Willcox Catholic Care Other

  • Dundaloo Allied Health
  • Intalink
  • Mayo
  • Ava Read
  • Greg Willcox
  • Catholic Care
  • Other

• Chosen positive behaviour support practitioner

  Select Dundaloo Allied Health Kameleon Benevolent Society CPBS Rosewood Centre Other

  • Dundaloo Allied Health
  • Kameleon
  • Benevolent Society
  • CPBS
  • Rosewood Centre
  • Other

• Chosen physiotherapist

• Chosen dietician

• Chosen exercise physiologist

Comments

• Any further discussion?