Program De Interventie Specializat.docx

Complexul de Servicii Sociale Jibou Nr. _______ din __________________

PROGRAM DE INTERVENŢIE SPECIALIZAT PENTRU RECREEREA ŞI SOCIALIZAREA COPILULUI Numele şi prenumele copilului: __________________________________________________ Numele cu care doreşte copilul să fie apelat: _________________________________________ Data naşterii: ____/____/_______ Adresă: _______________________________________________________________________ Naţionalitate: __________________________________________________________________ Etnie: ________________________________________________________________________ Religia: ______________________________________________________________________ Tipul de dizabilitate:  Fizic  Somatic  Auditiv  Vizual  Psihic  Neurologic  Asociat  Boli rare  HIV/SIDA Diagnostic:____________________________________________________________________ _____________________________________________________________________________ Persoana de referinţă: ____________________________________________________________ Numele specialistului care răspunde de plan

Alte persoane implicate

Specializarea

Specializarea

Contact

Detalii despre intervenţiile necesare pentru a răspunde nevoilor identificate în Planul personalizat de intervenţie, pentru:  Sănătate:_______________________________________________________________ _______________________________________________________________________  Nevoi fizice şi emoţionale: _________________________________________________ _______________________________________________________________________  Cerinţe speciale de îngrijire: _______________________________________________ ________________________________________________________________________

Data întocmirii, ____/____/_____

Data revizuirii, ____/____/_____

Data următoarei revizuiri, ____/____/______

ACTIVITĂŢI RECREATIVE ŞI DE SOCIALIZARE Activităţi zilnice Data Activitatea

Observaţii

Obiective pe termen scurt: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Obiective pe termen mediu: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Obiective pe termen lung: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

Data

ACTIVITĂŢI OCAZIONATE DE ANUMITE EVENIMENTE Activitatea Observaţii

Obiective pe termen scurt:________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Obiective pe termen mediu:_______________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Obiective pe termen lung:_________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

Data

ACTIVITĂŢI PERIODICE Activitatea

Observaţii

Obiective pe termen scurt:________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Obiective pe termen mediu:_______________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Obiective pe termen lung:_________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

EXTINDEREA RELAŢIILOR SOCIALE Activitatea Persoane implicate

Termen

Observaţii

EVALUARE Vârsta la care a fost pentru prima dată instituţionalizat ____________ Traseul instituţional ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Relaţia cu părinţii ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Relaţia cu colegii ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Interacţiunea cu persoana de referinţă ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Relaţia cu personalul ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Relaţia cu alte persoane ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Observaţii ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________