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Daily Record Form - A New Client - Test
Daily Record Form – A New Client TEST
Name of Support Worker
*
First
Last
Date of Support Session
*
MM slash DD slash YYYY
Time Shift Started
*
:
Hours
Minutes
Time Shift Ended
*
:
Hours
Minutes
1. A new question
*
please comment
2. Test
*
Did the client eat all their breakfast?
*
Yes
No
I dont know
How much pain was the client in today? number between 1 and 10
*
1
2
3
Morning
*
Did the client brush their teeth on their own?
Afternoon
*
Evening
*
3. Activities & Daily Living Skills
Specify what activities have been done and document details on how CLIENT engaged. Record prompt level. Refer to OT Guidelines| Prompt Level.
*
4. Diet & Nutrition
CM specify level of support HERE| Prompt Level
Breakfast
*
Lunch
*
Dinner
*
Water
*
Other Fluids
*
Other Food
*
5. Therapy Input
Prompt Level needed to complete activity. Refer to Guidelines.
Occupational Therapy
*
Neuropsychology
*
Physiotherapy
*
Speech and Language Therapy
*
6. Fatigue Management
*
7. Goals
*
Detail how client and team have worked towards their goals – note goal number and title
8. Care Plans
*
Actions or Practice as Specified in Care Plan Guidelines – detail how client and team have followed their care plans
9. Behaviour / Mood (include times of happiness)
Temper/ behavioural outbursts complete a separate ABC, note here if separate ABC completed
Morning
*
Afternoon
*
Evening
*
10. COGNITIVE OBSERVATIONS
Record cognitive difficulties observed below and strategies used to assist | Prompt Level
Memory:
*
Initiation:
*
Insight:
*
Planning:
*
Problem Solving:
*
Information processing:
*
Perseveration:
*
Temperature monitoring:
*
11. Mobility/Exercise
e.g. hydro, gym, note client ability / any problems / needed prompting | Prompt Level
Morning
*
Afternoon
*
Evening
*
12. Staff Contact with Clients family
*
13. Note any staff or client contact with Team Leader or Case Manager
*
Include Matters or Concerns Regarding CLIENTS Health and Well-Being or Requests Made for Assistance Over and Above That Agreed in The Care Plan
14. Incidents/Accidents
*
Brief description – Fill in form and email to CM/ACM
15. Risks and action taken to minimise them
16. Staff Contact with Primary Health/Social Care Services regarding Client and any appointments
17. Nights
*
Note sleep hygiene
18. Any Other Feedback
