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Client Information
Todays Date
Client ID
Needs Assessment and Screening
AI Assistance
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State what service was performed for the client
Suggestions
Selection Suggestions
Peer Support Plan
Goal 1
Goal 2
Intervention Strategies
(Describe the interventions that will be used to help the client achieve each goal)
Progress Toward Goals
(Document ongoing progress, barriers faced, and any adjustments made to the support plan)
Health Management Skills
Health Management Skills
Educating Clients About Chronic Health Conditions
Helping Clients Understand the Impact of Chronic Health Conditions on Daily Life
Assisting Clients in Finding and Using Healthcare Services
Improving Client Communication with Healthcare Providers
Medication Management
Educating Clients on the Importance of Medication Adherence
Helping Clients Manage Medication Schedules and Recognize Side Effects
Healthy Lifestyle Practices
Nutrition and Diet
Educating Clients on Diets That Support Health and Manage Conditions
Helping Clients Incorporate Culturally Appropriate Foods and Recipes
Physical Activity
Educating Clients on Safe and Effective Exercises for Health
Helping Clients Understand the Benefits of Physical Activity
Stress Management
Teaching Clients Culturally Sensitive Stress Reduction Techniques
Community Engagement and Support
Peer Support
Facilitating Mutual Support and Experience Sharing Among Clients
Helping Clients Connect with Peers to Reduce Isolation
Community Health Workers (CHWs)
Supporting Clients in Working with Care Coordinators
Helping Clients Engage with Healthcare Providers and Care Teams
Family and Caregiver Support
Educating Families About Chronic Health Conditions and Client Needs
Helping Clients Create a Supportive Home Environment
Mental Health and Emotional Well-Being
Counseling Services
Providing Culturally Sensitive Mental Health Counseling to Clients
Teaching Clients Coping Strategies for Chronic Pain and Fatigue
Emotional Resilience
Helping Clients Build Emotional Resilience to Manage Long-Term Illness
Teaching Clients Techniques to Enhance Emotional Well-Being
Practical Life Skills
Financial Management
Guiding Clients on Managing Healthcare Costs and Insurance
Referring Clients to Financial Assistance Services
Time Management
Helping Clients Balance Healthcare Routines and Daily Activities
Assisting Clients in Prioritizing Tasks for Better Time Management
Home Safety and Accessibility
Helping Clients Make Their Home Safe and Accessible for Their Health Needs
Supporting Clients in Making Home Modifications for Independence
Referrals (if applicable)
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Referral Made
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Details
(Provide details if a referral was made to more intensive or emergency services)
Documentation Shared
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Discharge Statement:
Individual Left Without Notice
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Date of Discharge
Discharge Summary
Signatures
Provider Signature
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Provider Signature Date
Supervisor Signature
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