Intellectual Disability Care Plan Form
Provide key information to support daily care and planning for a person with intellectual disability.
Person’s Full Name
*
First Name
Last Name
Preferred Name (if different)
Age
*
Primary Support Needs
*
Daily Routine & Activities
*
Communication Preferences
Important Likes, Dislikes, or Triggers
Emergency Contact Name
*
Emergency Contact Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Short-Term Goals or Focus Areas
Submit Care Plan
Should be Empty: