SAH Care Plan Generator

1. SAH Consumer Detail客户基本信息

Participant Name姓名

Date of Birth生日

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Preferred Name昵称

Gender性别

Phone Number电话

Funding Level资助级

HCP Supplement补充项

Dementia 失智症

Oxygen 用氧

Enteral 肠内营养

PEG feeding 胃造口进食

Veteran 老兵

Other 其他

Language语言

Interpreter required 需要翻译

Address地址

Completed On完成

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To Review On复查

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2. Health Summary and Special Notes健康摘要

Weight (kg)体重

Height (cm)身高

BMIBMI

Dentures假牙

Mobility行动能力

Vision视力

Hearing听力

Continence控制

Fluids饮水

Cognitive认知

On Antibiotic抗生素

Diet饮食

Food allergy 食物过敏

Enteral feeding 肠内营养

Diabetic 糖尿病饮食

Normal diet 普通饮食

Food intolerance 食物不耐受

Puree 泥状食物

Dental soft 软食

Low sodium 低钠

Low Fat 低脂

Low cholesterol 低胆固醇

High fiber 高纤维

Renal 肾病饮食

Other 其他

Allergy & Reactions过敏

Medical History病史

Social History社会史

Personal Preference偏好

Cultural Preference文化

Advance Care Planning预立计划

Living Arrangement居住

Access to Home入户方式

Remarks备注

3. Contacts联系人

GP Information 家庭医生

Name姓名

Phone电话

Address地址

Specialist Information 专科医生

Name姓名

Phone电话

Specialist Type专科

Address地址

Primary Contact主要联系人

Name姓名

Phone电话

Email电子邮件

Relationship关系

Address地址

Role(s) 角色

Emergency Contact 1紧急联系人1

Emergency Contact 2紧急联系人2

Registered Supporter注册支持者

Associate Provider协作服务商

Guardian监护人

Other其他

Secondary Contact次要联系人

Name姓名

Phone电话

Email电子邮件

Relationship关系

Address地址

Role(s) 角色

Emergency Contact 1紧急联系人1

Emergency Contact 2紧急联系人2

Registered Supporter注册支持者

Associate Provider协作服务商

Guardian监护人

Other其他

Tertiary Contact第三联系人

Name姓名

Phone电话

Email电子邮件

Relationship关系

Address地址

Role(s) 角色

Emergency Contact 1紧急联系人1

Emergency Contact 2紧急联系人2

Registered Supporter注册支持者

Associate Provider协作服务商

Guardian监护人

Other其他

4. Support and Personal Preference支持与偏好

Decision-Making Capacity决策力

Decision-Making Preferences决策偏好

Communication Ability沟通能力

Communication Support Preferences沟通偏好

Communication Barriers

Language 语言障碍

Vocal impairment 发音障碍

Cognitive impairment 认知障碍

Other 其他

Communication Aids

Hearing aids 助听器

Glasses 眼镜

Other 其他

Identify As认同

LGBTQIA+

CALD 文化语言多样

Aboriginal 土著居民

Torres Strait 海峳居民

Other 其他

Religion宗教

Spiritual & Cultural Wellbeing精神文化

Dignity of Risk自主权

Trauma Aware Care创伤护理

Trauma Aware and/or Healing Informed Care applies

5. Emergency Plan紧急计划

5.1 Response Plan 应对方案

Call (000) for emergency

No further action required

5.2 Evacuation Plan 疏散计划

Alternative Residence in an emergency 紧急备用住所

Name姓名

Phone电话

Address地址

How to get there如何到达

Mobility aids辅助具

Important items重要物品

Remarks备注

6. Service Task Summary服务摘要

Clinical Supports 临床支持

Nursing care 护理

Nutrition 营养

Allied health 联合健康服务

RN Clinical CareSERV-0023

Nursing Care ConsumablesSERV-0026

Diet or Nutrition (Nutrition Supports)SERV-0031

Independence 独立生活

Personal care 个人护理

Social support 社区参与

Transport 交通

Respite 喘息服务

Therapeutic services 治疗服务

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

Everyday Living Supports 日常生活

Domestic assistance 家务协助

Shopping 购物

Gardening 园艺

Home maintenance 房屋维修

Meals 餐饮

General House CleaningSERV-0001

Laundry ServicesSERV-0002

ShoppingSERV-0003

GardeningSERV-0004

Home MaintenanceSERV-0005

Home Maintenance ExpensesSERV-0006

Meal DeliverySERV-0007

Meal PreparationSERV-0008

7. Assistive Technology & Home Modification辅助技术与家居改造

Enable each category to record equipment purchased and maintenance schedules.

Managing Body Function 身体功能管理SERV-0061

Self-Care Products 自理产品SERV-0062

Mobility Products 行动辅助SERV-0063

Domestic Life Products 家居生活SERV-0064

Communication Products 沟通辅助SERV-0065

Home Modification Products 家居改造SERV-0067

AT Funding Tier 辅助资助级

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HM Funding Tier 改造资助级

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8. SAH Approval Service List服务审批清单

Select the applicable Care Needs, Goals, Area of Difficulty, and Support Strategies for each service. These selections will appear as TRUE in the generated Excel file.

8.1 Clinical Supports

Nursing Care Services

Nutrition

Allied Health and Other Therapeutic Services

8.2 Independence

Personal Care

Social Support and Community Engagement

Transport

Respite

8.3 Everyday Living

Domestic Assistance

Home Maintenance

Meals

Ready to generate your Care Plan?

Click "Generate Excel" to download a single file containing both the CP Form (full details) and Print CP (submission format) as two separate sheets.

Support at Home Program Services