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Home
About Us
Our Official Charity Partner
Meet the Team
Clients
Testimonials
Acquired or Traumatic Brain Injury
Spinal Injury
Other Medical Conditions
Live Vacancies
Register CV
Candidates
Apply online
Supporting Our Official Charity Partner
Subject Access Requests
Refer a Friend Scheme
Care Packages for Brain and Spinal injury
Contact Us
Submit a Daily Record
Daily Record Form - Paul S
Step 1 of 9
11%
Username:
Client Name
*
Name (s) of Support Workers on shift today
*
Today's Date
*
Date Format: DD slash MM slash YYYY
Shift Start Time
*
:
HH
MM
AM
PM
Shift End Time
*
:
HH
MM
AM
PM
Accessing the community
Brief Overview of today (what, when, how)
*
Describe Paul's day in more detail – eg. what he did, time spent on activities, any help required and why this help was needed.
Comments on how support worker thought shift went?
*
Describe any support given planning the day.
*
Did Paul access the community today?
Yes
No
Did Paul require your support or intervention when out and about?
Yes
No
What kind of support/intervention did Paul need?
*
Did Paul put himself at risk out in the community?
*
Yes
No
If yes, please give details.
Were there any falls/near falls that required SW intervention.
Motivation and initiation
Details of any support around initiation and motivation
*
Where prompts and encouragements needed to motivate Paul today?
*
Yes
No
If yes, please give details:
*
Did Paul respond to these prompts?
*
Yes
No
Fatigue and emotional
Did Paul suffer from any levels of fatigue today?
*
Yes
No
Did this disrupt any planned activities?
*
Yes
No
If you answered yes to either of the 2 previous questions, please rate Paul's fatigue level on scale of 0-5 with 5 being very fatigued.
*
0
1
2
3
4
5
What rest period or other intervention was needed by Paul?
What decisions was Paul required to make today?
Was Paul able to make decision with the support that you provided?
Yes
No
if yes, please state Paul's choice
Psychological and emotional
Were there any instances of mood disturbance, anxiety or stress observed today?
*
Yes
No
If you answered yes to the previous question, please give a brief description of the instances that occurred and the actions that you took?
How would you describe Paul's mood today?
Please describe in details any cognitive difficulties you observed Paul experiencing today?
Appointments
Has Paul attended any appointments today?
*
Yes
No
If yes, please give details.
Please advice if Paul cancelled or missed an appointment today?
Nutrition and fluids
Please give an overview of Paul's meals today.
*
Has Paul been participating in meal preparation?
*
Yes
No
If yes, please provide more details.
What kind of support you provided in meal preparation?
*
Have you supported Paul with preparation of drinks?
*
Yes
No
Please select an approximation of Paul's fluid intake today?
*
0.5L-1L
1L-1.5L
1.5L-2L
Medication
Did Paul take his medication?
*
Yes
No
If no- why not?
Did you need to prompt Paul to take his medications during your shift today?
*
Yes
No
Do you have any concerns you would like to highlight to the Case Manager or LHG?
*
Yes
No
Please give a full description of your concerns
*
Do you have any safeguarding concerns?
*
Yes
No
If you answered yes to the question above, please give details
*
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