NDIS Support Plan Form

This iROCK/Participant Support Plan is a tailored document created by us (the service provider) within the National Disability Insurance Scheme (NDIS) framework. Its main purposes are to define the specific services and supports we (the provider) will offer to an NDIS participant, set clear objectives and goals in alignment with the participant's NDIS goals, allocate a budget for these services, establish a schedule for service delivery, and outline the monitoring and review process to ensure the participant's needs are consistently met. This plan serves as a roadmap to help the service provider provide individualised support that enhances the participant's quality of life and independence.
Support Plan Start Date

MonthDayYear
Date
Support Plan Review Date (Annual)

MonthDayYear
Date
Support
Description
How the support will be provided
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Gender

FemaleMaleOther
Aboriginal or Torres Strait Islander Origin?

NoYes, AboriginalYes, Torres Strait IslanderYes, both Aboriginal and Torres Strait Islander
Cultural Background and Preferences
Preferred Language
Interpreter Required?

YesNo
Privacy Preferences
Financial Management Arrangements
Participant Contact Information
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Phone
Email Address
example@example.com
Emergency Information
Does the participant require assistance in an emergency?

YesNo
Does the participant have a Personal Emergency Alarm?

YesNo
Name

First NameLast Name
Decision Making

Please specify all the people assisting the Participant with descision making

Health and Medication information:
Allergies
Disability, Diagnosis or Medical Condition
Covid-19 Vaccination Doses

Full Vaccination Booster of 3 doses2 Doses of a COVID-19 vaccine1 Dose of a COVID-19 vaccineHas not received a COVID-19 vaccineParticipant is exempt due to medical reasons
General Practitioner Details
Name
Practice
Phone Number
Email
example@example.com
Medication Details
Is Medication required?

YesNo
Is Assistance and Administration required?

YesNo
Describe any ongoing health issues the participant has, including mental health issues
Describe any ongoing health issues the participant has, including mental health issues
Does the participant have a health or mental health care plan?

YesNo
Is the participant currently receiving end of life care/have an End of Life Care Plan?

YesNo
Does the participant have a signed DNR Order in place?

YesNo
Preventative Health Measures
If support is required by the participant, what arrangements are in place to proactively support the participant with preventative health measures, including helping them to access recommended vaccinations, dental check-ups, comprehensive health assessments, and allied health services?
Preventative Health Measures
Disability Supports
Mobility

Needs assistanceDoes not need assistanceIs independentIs not independent
Details and Aids used
Hearing

Nil issuesSome issuesHearing impaired
Details and Aids used
Vision

Nil issuesSome issuesVision impaired
Details and Aids used
Memory/Cognition

Nil issuesSome issuesCognitively impaired
Details and Aids used
Communication
Needs assistance

Needs assistanceDoes not need assistance
How does the participant prefer to communicate?

VerballyNon-verbal/vocaliseSign languageAuslanMakatonKey Word SignPoint/gestureAugmentative and Alternative Communication (AAC)
Details and Aids used
Continence

Needs assistanceDoes not need assistance
Details and Aids used
Particpant's Behaviour Supports
Does the participant have a current Positive Behaviour Support Plan?

YesNo
Does the participant require a Functional Behaviour Assessment or Restrictive Practice Behaviour Support Plan regarding behaviours of concern?

YesN
Does the participant display or engage in any behaviours of concern that require specific support?
Does the participant have a current risk assessment relating to their behaviour or support needs?

YesNo
Additional Information
Community Participation Supports
Does the participant need assistance getting around the community?
What type of transport does the participant mainly use?
Does the participant need assistance to use transport?
Does the participant engage or participate in any recreational, community based, employment or training activities?
Does the participant need assistance to access any of these activities?
Risk Assessment
Refer to your completed participant risk assessment to complete the following section

Service Provision
Participant's NDIS Goals
Participant's personal preferences (likes/dislikes)
Participant's Strengths
Participant's motivation for enrolling at iROCK
Participant's iROCK related goals (music and/or personal or social)
Participant's time for music making at home each week, when away from iROCK days/hours/mins
Link between Participant's iROCK related goals and their personal NDIS goals/Social and Community Participation?
Supports iROCK can provide to assist Participant to work towards and/or achieve goals specified
I agree that I have given permission for my Support Plan to be distributed only to the people involved in

I agree that I have been involved in the development of my plan of care, my goals and the servicesthe development and support of my care including nominated advocates/representatives and may be included in any referrals made on my behalf
Date

MonthDayYear
Date
Signature

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Communication