G

ef centru

Nr...........din.

FIA INDIVIDUAL

- reevaluare-

Nume i prenume

Data evalurii..

Situaia familial

Comportament social

Date privind evoluia beneficiarului

...............

Evaluare medical

Greutate

nlime.

TA-AV..

Alergii...

Regim Alimentar..

.

Preferine alimentare

Sntate bucal dentiie......................................................................................................

..............................................................................................................................................

Continen..............................................................................................................................

Medicaie curent .................................................................................................................

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Aspect exterior( stare fizic, autonomie personal)

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Locomoie, mobilitate generala(funcie motorie)

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Contactul...............................................................................................................................

...............................................................................................................................................

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Vz,auz, comunicare............................................................................................................

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Evaluare psihopedagogic

Nivel de contien.................................................................................................................

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................................................................................................................................................................................................................................................................................................

Comportamentul...................................................................................................................................................................................................................................................................

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Stare mental i cogniie:

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Dezvoltare emoional:

................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................Imaginea despre sine nsui:

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Temperamentul

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Siguran personal/riscuri

................................................................................................................................................................................................................................................................................................

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Activiti, preocupri, hobby-uri, nevoi culturale, religioase,etc.

CONCLUZII I RECOMANDRI

Asistent social

Asisten medical

Asisten psihopedagogic

Asisten psihologica

Propunem meninerea msurii de instituionalizare n ...........................i ntocmirea planului individualizat de intervenie.

ntocmit,

Asistent social,

Medic Dr.

Asistent medical

Psihopedagog

Psiholog

CENTRUL DE RECUPERARE SI REABILITARE A PERSOANELOR CU HANDICAP

Nr/ Vizat,

ef centru

RAPORT DE CONSILIERE

ntocmit astzi..

Locul ntlnirii..

Durata....

Motivul consilierii.....

.......................................................................................................................................

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Beneficiarul/Beneficiara...............................................................................................

CNP...............................................................................................................................

Domiciliul (stabil/reedina).........................................................................................

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Obiectivele consilierii...................................................................................................

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Metode........................................................................................................................................................................................................................................................................................................................................................................................................

Gradul de implicare al beneficiarului..........................................................................

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Probleme ridicate de beneficiar....................................................................................

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Concluzii i recomandri..............................................................................................

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Semntura persoanei consiliate, Semntura asistentului social,

Vizat

ef centru

Nr/

PLAN INDIVIDUALIZAT DE INTERVENIE

Nume i prenume beneficiar : Grad de dependen : Independent;CNP..

SERVICII

TipulInstitutia responsabil Obiective generalePerioada de ncepere/Perioada de desfurareResponsabil de caz

ngrijire i asistena medical- Tratament pentru poliartrit reumatoid

- Tratament adecvat pentru orice afeciune aprut;

- Consult stomatologic

- Consultaii medicale de specialitate;

- Prevenirea mbolnvirilor,Educaie sanitar;

-Alimentaie corespunztoare vrstei;

- Asigurarea regimului alimentar

- Asigurarea nevoilor de bazMedicAsisteni medicali

Recuperare prin terapie ocupaional i educaional-Formarea i educarea unor abilitai i a unor deprinderi de munc;

- Socializare i petrecerea timpului liber -Cunoaterea responsabilitilor individuale prevzute n regulamentul de ordine interioar

-Familia punctul meu de sprijin

Instructor ergoterapie/educaie

Psihopedagog

Integrare/reintegrare social- Educaie pentru societate

-Identificarea domiciliului prinilor

- ndrumare vocaional :suport n formarea i orientarea profesional

Asistent social

ntocmit : Medic Dr.

Asistent medical

Psihopedagog

Asistent social