SERVICE PROVIDER Required Behaviour Documentation

Required Behaviour Documentation
Name*

First NameLast Name
As a person centred practice, we like to have an indication of who the person is and how they interact with people in their life. We request the following documentation, if avaialble to start the process of a comprehensive behaviour report and intervention.
Are there any guardianship orders in place?

YesNo
If yes, please provide details:
Are there any restrictive practices in place?*

YesNo
If yes, are they authorised?

YesNo
Please provide the following documentation, if available:*

EITR service agreement for behaviour support - signed by the person responsibleCurrent NDIS planIf restrictive practices have been authorised - a copy of current authorisationCurrent Medication profile / or copy of their Webster packProof of diagnosis (e.g. medical report - completed by current prescribing therapist)Past Behaviour Support Plan (if available) and /or Care plan (if out of Home Care)Any Person Centred plans or client profilesAny incident reports or ABC data from the past 3-6 monthsMental Health PlanCHAP assessmentMealtime management plan or nutrition and swallowing assessmentAny reports from other occupational therapist & speech pathologist e.g. communication assessment and / or sensory profile.Current living skills assessment
Please attach relevant documents to this form

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