12/4/23, 3:38 PM
Recovery Play - MH Services
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// preview version only
Recovery Play - MH Services
Demographics:
NHI:
Name:
Phone No.
Age:
Address:
D.O.B.
Gender:
GP:
GP Phone No.
Status and Dates:
Plan Date:
*
Expected Review Date:
*
Legal Status:
Legal Status is automatically updated (from i.PM) each time the Recovery Plan form is edited.
Edits will be over written next update.
Instructions:
Recovery Plans are developed predominantly for use by the Service user, to facilitate their own care.
Inclusive language should be used indicating participation of the Service User in their own recovery.
Social Indicators:
Accommodation
* Definitions
Status:
Dependants:
None
Infants, Children + Adolescents (0-17)
Adult (18 - 64)
Elderly (65+)
Other*
Support Needs:
Details:
Paid
Not in paid employment (<1 hr / wk)
Part time paid (1 - 30 hr /wk)
Full Time Employment (>30 hr / wk)
Retired *
Employment:
(select one)
Occupation:
Education /
Pre-school
Primary
Intermediate
Secondary
Tertiary
Trades / Other NZQA
Other / Non NZQA
None *
Training
Description:
Meaningful
Activities:
*
Carer Role
Child Care / Parenting
Community Centre
Voluntary Work
Recreation / Sport
Other
None*
Usual GP
*
Practice:
GP
*
Engagement
Level:
Service User Perspective:
This area can be used to record:
Service User Perspective, Wellness Statement, Overarching Goal for Recovery, Relationship with Family / Support Networks.
Shared Perspective:
under the Offical Information Act 1982
This area can be used to record:
A collaborative statement, mutually agreed upon, between Service user & Clinicians / Clinical Team
Family / Whanau Perspective:
Released
My Risk Summary:
This area can be used to record:
My Understanding of My Risks and My Safety Plan
Transition / Discharge Plan(s):
Strategies for next transition from high to low acuity; or to primary care and self management.
This section can be used for inpatient to community and community to primary care transitions.
*
Main Goals / Objectives:
.
My Goals / Objectives Are:
.
Actions, Interventions and Strengths:
By Whom/When?
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Recovery Play - MH Services …
1.
*
*
*
2.
3.
4.
5.
Other Goals / Objectives
.
Other Goals / Objectives: (please list)
.
Other Interventions:
.
By Whom / When?
.
Completed Goals / Objectives (optional):
This area can be used to store completed goals / objectives to share with the service user.
Attach Documents:[Add Document]
Find Document:
Early Warning Signs, Triggers:
Primary or Presenting Problem:
Early Warning Signs, Triggers and Actions:
.
My Early Warning Signs / Triggers Are: -
.
Whenever I Have These Signs I Will:
1.
*
*
2.
3.
4.
Please ensure most important Early Warning Sign is at top of the list
Other Information / MDT Review:
This field can be used to record any additional information relevant to the Service User's care and recovery.
under the Offical Information Act 1982
Advanced Directive:
Advanced
Directive
Status:
Details of Current Medications:
Released
*
If no relevant medications please state "none"
Support Team:
Keyworker:
* Search
Clear
Telephone:
*
Waikato DHB Team:
*
My Psychiatrist:
Search
Clear
Telephone:
My Psychologist:
Search
Clear
Telephone:
My Nurse is:
Search
Clear
Telephone:
My Social Worker is:
Search
Clear
Telephone
My Occupational Therapist
Search
Clear
Telephone
is:
My Doctor or GP is:
Telephone:
My support people are:
Telephone:
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Recovery Play - MH Services …
Other people involved in
Telephone:
my care are:
If I have concerns I will
contact:
Administration Detail:
Authored By:
*
Designation:
*
IPM Referral No.
<<-- If this field blank. Choose Referral at Top of Page!
*
Expand All
Spell Check...
Search Page
Clear Codes
under the Offical Information Act 1982
Released
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