Client Support Profile

Client Support Profile
Client Name*

First NameLast Name
Client D.O.B*

DayMonthYear
Date
Preferred Name
Gender
Preferred Pronoun
Absolute Considerations

Anything that is critical you consider an absolute consider TYPE IN CAPITALS to make them POP out when you look at this form

These are factors that we MUST accommodate within the delivery of our service to the participants/clients above and beyond our standard approach to all Enable’s clients. They are non-negotiable.
I hate it whens.....
Contact Preferences
Scheduling
Please list name and contact details of any person listed in Contact Preferences above that are not the Participant themselves.
Method of Communication
Features of Services delivery (ie location, additional privacy requests beyond our standard privacy considerations, preference for other's involvement, modifications for social environments)
Frequency of inviting feedback (including preferred method of request - ie via QR code, link, sms link, verbal, etc)

Strongly held values and principles / beliefs considerations
Are there any strongly held values and/or principles and beliefs considerations

YesNo
List strongly held values and principles / beliefs considerations

Important aspects of Self to dignify

(beyond standard respect for person as a human being)
Aspects of identity (cultural, ethnic, sexual diversity, gender)
What merits and characteristics they take pride in (ie achievements, place in society, experience, financial worth, independence, knowledge and skills, etc)
What roles/activities/tasks that matter most
What relationships matter the most
Important places/spaces that matter most
Important community memberships
Important future aspirations

Baseline Risk Assessment to person and us
Are there any Known/Predictable Hazards connected to EnableOT Service Delivery

YesNo
List and Number each hazard (eg. "1. agressive dog")
Actions to eliminate/reduce/isolate hazards to protect self or others (start each action with the number of the hazard it corresponds to, you might have more than one action to each hazard - ie "1. call ahead for dog to be restrained" / "1. schedule sessions away from the home")
Emergency/Disaster Care Status - whether their circumstances (capacity, quality and availability of informal and formal supports) means that Enable OT has mandatory responsibilities regarding preparation for, care during, and support after, significant emergencies and disasters. The three categories determine what EnableOT’s actionable responsibilities are: Externally Actioned, Variable Need, or Confirmed Need*

Externally ActionedVariable NeedConfirmed Need
Details of people responsible for formulating and maintaining Emergency/Disaster Plan*
Prepared by:*

First NameLast Name
Author's email address
so that you get a link that you can use when you need to update the form next time
Date

DayMonthYear
Date
Should be Empty:

Strongly held values and principles / beliefs considerations