SAH Care Plan Generator

1. SAH Consumer Detail

Participant Name

Date of Birth

Preferred Name

Gender

Phone Number

Funding Level

HCP Supplement

Dementia

Oxygen

Enteral

PEG feeding

Veteran

Other

Language

Interpreter required

Address

Completed On

To Review On

2. Health Summary and Special Notes

Weight (kg)

Height (cm)

BMI

Dentures

Mobility

Vision

Hearing

Continence

Fluids

Cognitive

On Antibiotic

Diet

Food allergy

Enteral feeding

Diabetic

Normal diet

Food intolerance

Puree

Dental soft

Low sodium

Low Fat

Low cholesterol

High fiber

Renal

Other

Allergy & Reactions

Medical History

Social History

Personal Preference

Cultural Preference

Advance Care Planning

Living Arrangement

Access to Home

Remarks

3. Contacts

GP Information

Name

Phone

Address

Specialist Information

Name

Phone

Specialist Type

Address

Primary Contact

Name

Phone

Email

Relationship

Address

Role(s)

Emergency Contact 1

Emergency Contact 2

Registered Supporter

Associate Provider

Guardian

Other

Secondary Contact

Name

Phone

Email

Relationship

Address

Role(s)

Emergency Contact 1

Emergency Contact 2

Registered Supporter

Associate Provider

Guardian

Other

Tertiary Contact

Name

Phone

Email

Relationship

Address

Role(s)

Emergency Contact 1

Emergency Contact 2

Registered Supporter

Associate Provider

Guardian

Other

4. Support and Personal Preference

Decision-Making Capacity

Decision-Making Preferences

Communication Ability

Communication Support Preferences

Communication Barriers

Language

Vocal impairment

Cognitive impairment

Other

Communication Aids

Hearing aids

Glasses

Other

Identify As

LGBTQIA+

CALD

Aboriginal

Torres Strait Islander

Other

Religion

Spiritual & Cultural Wellbeing

Dignity of Risk

Trauma Aware Care

Trauma Aware and/or Healing Informed Care applies

5. Emergency Plan

5.1 Response Plan

Call (000) for emergency

No further action required

5.2 Evacuation Plan

Alternative Residence in an emergency

Name

Phone

Address

How to get there

Mobility aids

Important items

Remarks

6. Service Task Summary

Clinical Supports

Nursing care

Nutrition

Allied health and other therapeutic services

RN Clinical CareSERV-0023

Nursing Care ConsumablesSERV-0026

Diet or Nutrition (Nutrition Supports)SERV-0031

Allied Health Services

ServiceCodeDayHoursFrequency

PhysiotherapistSERV-0034

Occupational TherapistSERV-0037

Dietitian or NutritionistSERV-0031

PodiatristSERV-0028

Speech PathologistSERV-0030

Exercise PhysiologistSERV-0036

Social WorkerSERV-0029

Counsellor or PsychotherapistSERV-0038

Music TherapistSERV-0039

ATSI Health PractitionerSERV-0032

ATSI Health WorkerSERV-0033

Independence

Personal care

Social support and community engagement

Transport

Respite

Therapeutic services

Personal Care (Assistance with Self-Care & ADLs)SERV-0020

Group Social SupportSERV-0009

Individual Social SupportSERV-0010

Direct TransportSERV-0016

Indirect TransportSERV-0017

Flexible RespiteSERV-0048

Therapeutic Services

ServiceCodeDayHoursFrequency

AcupunctureSERV-0040

ChiropracticsSERV-0041

Diversional TherapySERV-0042

Remedial MassageSERV-0043

Art TherapySERV-0044

OsteopathySERV-0045

Everyday Living Supports

Domestic assistance

Home maintenance and repairs

Meals

General House CleaningSERV-0001

Laundry ServicesSERV-0002

Meal Delivery & PreparationSERV-0007/0008

7. Assistive Technology & Home Modification

Remarks

8. SAH Approval Service List

The SAH Approval Service List is auto-generated in the Excel output based on the services selected in Section 6. The Excel file will include detailed care needs, goals, and support strategies for each enabled service.

Ready to generate your Care Plan?

Click the "Generate Excel" button in the sidebar to download the complete SAH Care Plan Excel file.

Support at Home Program Services