The individual Needs and Services plan should include the following for an all inclusive assessment and development of objectives.
Date of Admission, Age, DOB, Height, Weight, Physician, Legal Status, Identifying Number, Social Security Number, and Regional Center CSC
Family names, addresses, and phone numbers
Assessment data: Communication, Expressive, Receptive, Mode of Communication
Bathing, Dressing, Hygiene
Health, Seizures, Allergies, Diagnosis, Mobility, Hand use
Vision and Hearing
Other sections should include Key Relationships, Special needs and Adaptive Equipment, Preferences, Communication Supports Needed, Behavioral Supports Needed, Community Supports Needed, Social/Sexual Supports Needed, Vocational Status, Personal Self Care Supports needed, Supports needed to Utilize Adaptive Equipment, Money Management Supports Needed, Capability of Self Administration of Medicines, Recreational Interest Survey, Vision for the Future.
Next, Health Information; Health Status, Medication, Nutritional Status, Mobility, Dental Status.
Information for Training Objectives should list each objective, the responsible person and Progress which has been made (or not). Following the list of Training Objectives should be the ID team recommendations and items for follow up.
The Legal Status must be addressed; own guardian? under age of 18, parents are legal guardians? under guardianship/conservatorship?
Informed Consent Representation is addressed outlining who will give written consent for placement, medical treatment, rights, and financial decisions. This will be the individual, the guardian or conservator, or closest available relative who is close in terms of blood or marital ties who cares for the individual.
Lastly, a Financial Review indicating the balance of the personal account and the date of the last deposit into the account.
All persons participating in the development of the Needs and Services Plan should sign a dated attendance sheet.