Salveo HomeCare - My Care Plan

Mitigation Strategies
Triggers & Indicators
If yes, Description of Risk
Mitigation Strategies
Triggers & Indicators
Type a question
Mitigation Strategies
Triggers & Indicators
If yes, Description of Risk
Triggers & Indicators
If yes, Description of Risk
Mitigation Strategies
Mitigation Strategies
Triggers & Indicators
If yes, Description of Risk
My Care Plan
Care Partner Email
example@example.com
Date of initial submission

DayMonthYear
Date of initial submission
This care plan has been developed to align with your current health, goals, preferences, and support needs. Your voice, choices, and lived experience are central to shaping how your care is delivered. This care plan outlines the services and supports in place to help you live the life you choose at home, in your community, and on your own terms.
This Care Plan was created collaboratively, in partnership with you, and reflects our commitment to CARE values.

C–COMPASSION ensuring compassion extends to both our customers and our dedicated staff.

A–ADAPTABILITY be aware of different needs and preferences of our customers and delivering services in accordance with those needs

R–RESPECTevery customer is unique, and we value their individuality, diversity and choices

E–EMPOWERING improving the quality of life of every customer and engaging them in every decision that affects their care
This Care Plan Is For:
Full Name*

First NameLast Name
Preferred Name*
Date of Care Plan*

DayMonthYear
Date
Purpose of this Care Plan*
Version
e.g. second care plan = version 2.
My Aged Care Reference ID*
Date of Birth*

DayMonthYear
Date
Phone Number*
Care Recipient or Representative's Email*
of the person signing the care plan - e.g. MPOA's email if applicable
Address*

Street Address

Street Address Line 2

SuburbState

Post Code
Gender Identity*
Place of Birth*
Aboriginal or Torres Strait Islander?*

NoYes, AboriginalYes, Torres Strait IslanderYes, both
Cultural Background*
Preferred Language/s*
Is an interpreter required?

YesNo
Things To Consider About My Cultural, Diversity, Values and Belief*
My care worker preferences?*

FemaleNo preferenceMale
My care worker, communication and service delivery preferences*
Important things i need my care workers to know when communicating with or delivering services to me.
Package Level*
Care Management Type*
Applicable Supplements or Additional Funding*
Is additional support or the use of remaining funds from the home care package needed?*

YesNo
Details of additional supports needed
additional support
Person Responsible for making decisions: *
People involved in developing My Care Plan:*
Specify name and relation to the Care Recipient. Separate by comma, e.g. Jane Doe - Daughter, John Doe - Son
If there is a Guardian or Power of attorney, a copy of the power of attorney paperwork has been provided*

YesNoNot applicable
Guardian or Power of attorney comments
Guardian or Power of attorney
Is there an Advance Care Directive in place?*

YesNoNot advised
Is there an Advance Care Plan in place?*

YesNoNot advised
Comments
My Support People

My Support People*

	Name	Role/Relation	Contact Number
Person #1
Person #2
Person #3
Person #4

Important Things To Know About Me
Family Background and Life History
OLD - Life History
Interests
Informal Supports*
Medical Information
My Medical History
Allergies and Alerts*
Include the reaction if know. Type Significant allergies or alerts in CAPS LOCK. Separate by comma, e.g. ANAPHYLAXIS TO DAIRY, allergy to nuts, WANDERER
Is medication required?*

YesNo
Is prompting needed?

YesNo
Is assistance needed?

YesNo
Is medication administration needed?

YesNo
Details of medication assistance needed
If applicable
Is there medication management plan in place?

YesNo
Upload a copy of the medication management plan

Cancelof

	Details
Goal
Current needs and challenges
What are you able to do?
How will we do this?
What are the considerations, and how will we support your choices?
When will it be done? (time, day, frequency)
Start Date
Review Date
Has this goal been achieved? (Yes, No, In Progress)
Comments (In relation to the goal being achieved)

	Details
Goal
Current needs and challenges
What are you able to do?
How will we do this?
What are the considerations, and how will we support your choices?
When will it be done? (time, day, frequency)
Start Date
Review Date
Has this goal been achieved? (Yes, No, In Progress)
Comments (In relation to the goal being achieved)

	Details
Goal
Current needs and challenges
What are you able to do?
How will we do this?
What are the considerations, and how will we support your choices?
When will it be done? (time, day, frequency)
Start Date
Review Date
Has this goal been achieved? (Yes, No, In Progress)
Comments (In relation to the goal being achieved)

	Details
What do I want to achieve?
Current needs and challenges
What are you able to do?
How will we do this?
What are the considerations, and how will we support your choices?
When will it be done? (time, day, frequency)
Start Date
Review Date
Has this goal been achieved? (Yes, No, In Progress)
Comments (In relation to the goal being achieved)

	Details
Goal
Current needs and challenges
What are you able to do?
How will we do this?
What are the considerations, and how will we support your choices?
When will it be done? (time, day, frequency)
Start Date
Review Date
Has this goal been achieved? (Yes, No, In Progress)
Comments (In relation to the goal being achieved)

	Applicable?	Details
Care Management
Living Companion
Personal Care
Domestic Assistance
Nursing Care
Home and Garden Maintenance
Social Support
Transport
Allied Health Services
Continence Management
Skin integrity
Medication Management or Assistance
Meal Management or Assistance
Activities of daily living
Memory
Cognition
Falls Frequency
Communication
Personal Alarm
Financial Management
Behaviours

	Name	Role
1
2
3
4
5

Record of Edits