ASSESSMENT FORM- CLIENT A CLIENT PARTICULARS Name: Name of Case Manager: Date of Assessment: Presenting Concerns Past Medical History and Background Previous Agency Involvements Psychosocial and Behavioural Health Psychosocial Support Systems Risk Assessment Need for Short-term and Long-term Support Strengths Weaknesses Goals ACTION PLAN- Client A Name of Client: Date of Assessment: Goal Issues Plan/Strategy Person/Service Responsible Target Date Guidance: The Guidance: The Guidance: There Guidance: The Guidance: The issues and goals goals should be may be more responsible time frame (target recorded should measurable so than one activity person date) should be reflect the words that you, as the for each may appropriate and and sentiments of case manager, issue/goal. include you, specific to the the client. It and the client other service issue, goal, should include will organisations, plan/strategy risk or potential know when they the client's (i.e., exact date risk to the client. have been family/caregiver, should be achieved or and other provided). need formal/informal to be support. reevaluated The client receiving support should be given appropriate responsibility in implementing and pursuing their plan