Assessment booklet

0BAssessment Checklist

Name of Client:
Name of Case Manager:
Date of Assessment:

CHCCSM005 Develop, facilitate and review all aspects of case management

CHCCCS004 Assess co-existing needs

CHCCSM004 Coordinate complex case requirements

**Tick the items already discussed with the client.

Version: 1.0	Page 2 of 2
Created: April 2021	Last Reviewed: April 2021

Central Australian Institute of Technology Pty Ltd | CRICOS: 03217C |TOID: 22302

PRESENTING CONCERNS

☐ Client’s concerns

☐ Client’s view of his/her concerns

☐ Client’s expectations

☐ Brief history of the presenting concerns

☐ Length of duration of the concerns

☐ Prior attempts to resolve the concerns

☐ Previous involvement with social agencies/services for assistance with the concerns

PAST MEDICAL HISTORY and BACKGROUND

☐ Family history

☐ Past illnesses and conditions

☐ Hospitalisations

☐ Surgeries and procedures

☐ Significant injuries

☐ Medications

☐ History of mental concerns

PREVIOUS AGENCY INVOLVEMENTS

☐ List all the agencies and the services provided to the client

PSYCHOSOCIAL and BEHAVIOURAL HEALTH

☐ Client’s feelings and emotions

☐ Meaning of the circumstances to the client

☐ Mechanisms used by the client to handle the situation

☐ Attitude/appearance/behavior

☐ Thought process and insight

PSYCHOSOCIAL SUPPORT SYSTEMS

☐ Status of client’s relationship with:

☐ Family

☐ Relatives

☐ Friends

☐ Other groups/support

RISK ASSESSMENT

☐ Risk and vulnerability factors

☐ Depression/mental health issue

☐ Drug and/or alcohol misuse/abuse

☐ Suicidal ideation and/or tendencies

☐ Isolation

☐ Access to weapons

☐ Ever harmed or threatened people/ animals

☐ Controlling behaviours

☐ Unemployed

☐ History of violent behavior

☐ Recent separation

☐ Financial difficulties

NEED FOR SHORT-TERM and LONG-TERM SUPPORT

☐ Short-term needs

☐ Long-term needs

STRENGTHS, WEAKNESSES, GOALS

☐ Personal attributes, talents, skills, environmental strengths

☐ Interests, aspirations, goals

☐ Perceived barriers

ADDITIONAL INFORMATION

☐ Expectations of client

☐ Any person the client does not want to see and/or have contact with

☐ Any information that the client does not wish to be disclosed

☐ Special service request

☐ Other additional information

Client assessment completed by:
Signature:	Date: