Support Coordination

Support Coordination

Plan Review Report
To be used by Support Coordinators and participants

This pro-forma is to be used by Support Coordinators to support participants to review their current NDIS plan and prepare for their next plan. All sections of the form are to be completed by engaging with the Participant and their informal support network (where appropriate Many sections of this report have been pre-populated with current plan information to assist Support Coordinators with completing this report. The NDIS is committed to building the capacity of participant to self-direct their supports and develop their goals. This form guides a participant to review their current plan and consider their goals for their next plan. It also enables participants to advise the NDIA of any changes that we need to be aware of.

Upon Completion Please send report

Subject: 9 Month Report for - Participants Name and Number
Upon Completion Please send report Subject: 9 Month Report for - Participants Name and Number VICNORTH@ndis.gov.au
Participant Details:
Name
NDIA Number
Plan Start Date

MonthDayYear
Date
Date of Birth

MonthDayYear
Date
Gender
Address
Phone number
Email Address
example@example.com
Preferred Contact Person
Contact Details for Participant:

Preferred contact may include current support worker/family member or other:
Name
Relationship to participant
Address
Email Address
Email Address
example@example.com
Special Considerations: ATSI/CALD (Interpreter)
Support Coordinator Details
Service provider name
Contact name
Address
Phone Number
Email Address
example@example.com
Is this a new or existing support coordination arrangement?

NewExisitging
Participant statement

Living arrangements, Relation and support
Participant statement Living arrangements, Relationships and supports

Describe your current living arrangements (For example: Who do you usually live with? Typeof accommodation? Any changes to your living arrangements?)
Describe the family and friends you see regularly, the people who play an important role in your life and how they help you. Have your relationships and supports changed?
Current Plan
Any new informationto be included
Daily life - Describe your day to day life

Describe the activities you participate in (For example: education, training, work, volunteering, social activities What is working well for you? What would you like to change or improve? What do you enjoy? Have there been changes to your activities of daily life?
Current Plan
Any new information to be included
Current goals
Looking at your current NDIS plan, how do you think you have progressed towards your goals? Were there things that got in your way?

What are your goals for the next plan period?

Type a question

	Goal	Achieved Goal Yes/No	Continue Goal Yes/No	Evidence and Outcomes to achieving Goal (For example: capacity building therapy; transport; equipment)	Barriers/impacts to achieving goal (if not achieved)
Goal 1
Goal 2
Goal 3
Goal 4
Goal 5

New goals
Are there any new goals
Are there any new goals that you would like in your new plan? What are the things that are most important to you now? What are the things you would most like to change? What would you like to do with less help from others? Are there new things you would like to try?

Strategies (your steps towards this goal and who might help you)

Plan Review Report V1.3 APPROVED 2016-12-20 Page 5 of 8

New goals

	Your New Plan Goal	Strategies (your steps towards this goal and who might help you)
Your New Goal 1
Your New Goal 2
Your New Goal 3
Your New Goal 4

My Informal and Community / Mainstream Support

Informal Support

My Informal - (Please add or remove supports as applicable)

	Support Type	Support Description	New or Current Support	Any Comments
1
2
3
4
5

Mainstream Community Supports - (Please add or remove supports as applicable)

Community/Mainstream Supports - (Please add or remove supports as applicable)

	Support Type	Support Description	New or Current Support	Any Comments
1
2
3
4
5

Funded Supports
Funded Supports

Please review the current supports and provide justification for any proposed changes to current supports.
Core Budget Support Type

Core Budget Support Type

	Frequency	Claim Method (eg, self-manage; provider claim; financial intermediary)	Expenditure $Alocated$used	Current Service Provider	Continue Support Yes/No	Request to adjust support increase decrease add new support Include justification
Consumables
Daily Activities
Social Community and Civic Participation

CAPACITY BUILDING Budget Support Type

CAPACITY BUILDING Budget Support Type

	Frequency	Claim Method (eg, self-manage; provider claim; financial intermediary)	Expenditure $...../$.....	Current Service Provider	Continue Support Yes/No	Request to adjust support (eg. increase; decrease; add new support). Include justification.
Improved Daily Living
Support Coordination
Transport

Risks
Risks

Please identify any risks during the course of the current plan (e.g. health; safety in home/community; provision of supports; sustainability of informal supports; employment; exploitation; financial including ability to self-manage; decision making; home/accommodation; other).
Please review the current supports and provide justification for any proposed changes to current supports.

(eg, self-manage; provider claim; financial intermediary)

Request to adjust support (eg. increase; decrease; add new support Include justification

Risk

	Risk	Description/Comments
Risk 1
Risk 2
Risk 3
Risk 4

Support Coordination

Please provide sufficient supporting information to inform the participant’s new NDIS plan.
Support Coordination hours in current plan and expenditure to date?
Please provide justification for Support Coordination hours requested in new plan?
Current level of engagement with participant?
Please list any barriers to implementation?
supporting evidence (eg, therapy reports) provided in preparation for plan review.
implementation?
Please list all additional supporting evidence (eg, therapy reports)provided in preparation for plan review.
Any further comments?
Date

DayMonthYear
Date
Signature

Clear
Document version
Should be Empty:

Support Coordination

Participant Details:

Contact Details for Participant:

Support Coordinator Details

Participant statement

Current goals

New goals

Are there any new goals

My Informal and Community / Mainstream Support

Mainstream Community Supports - (Please add or remove supports as applicable)

Funded Supports

Funded Supports

Core Budget Support Type

CAPACITY BUILDING Budget Support Type

Risks

Risks

Support Coordination