FACE TO FACE CONTENT:
Date
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Month
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Day
Year
Date
Name
First Name
Last Name
Time of Service
Discussion
What services are still being utilized at this time
How are they able to address goals at this time? Which goals can still be addressed and which need to be placed on hold?
Do they need a change in services to ensure their safety and health at this time?
Does the home have the needed supplies to reduce the need to leave home (food, medication)?
Is there anything the household needs at this time? Plan to acquire basic needs?
How is the household adjusting to the required social distancing?
Is anyone in the home symptomatic? (Review preventative strategies):
Is any medical appointment scheduled for the next two months? Will this be rescheduled?
Are there any required medical appointments that cannot be cancelled or rescheduled?
Are all medications current and have prescriptions covering the next two months?
If a prescription is due to expire within two months, has the doctor been contacted to request a short term prescription (3 months) to reduce the need to leave the home?
Has the client had the Pneumonia or Flu vaccine within the past 12 months?
Have there been any incidents reported or any concerns related to incidents or health, safety, or welfare?
Have there been any behavioral concerns with regards to change in routine and social distancing?
Has there been a change in frequency of behavioral issues or overall mood related to change in routine?
How is the household managing the change in routine? What parts of your routine are you able to maintain? What has changed?
What struggles are you or the household experiencing at this time?
What is the client and household doing to stay busy and prevent boredom? (offer suggestions)
Are there any concerns moving forward with regards to social distancing and behavior/mental health? Do they have a variety of things to do in the home?
Are there any warning signs for mental health decline, depression, or anxiety? If yes, discuss treatment options or things to do at home to stay positive and active
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