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Client Details:
First Name: Last Name:
Address:
Address:
City:
State: Post Code:
Postal/Shipping Address:
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Address:
Address:
Post City:
State: Post Code:
Client Details:
DOB: Indigenous Status:
Gender: Country of Birth:
Language:    
School:  
Living Arrangements: Child Protection Client Status:
Source Of Referral: Child Safety Client:
Reason For Referral: Client Group:
Referral Date: dd/mm/yyyy Closed Date:
Counsellor: Reason for Closure:
Unprogressed: Drop-In:
Pre-School: Consent for Govt to Contact:
Highest Schooling: Receiving Centerlink?
Marital Status: Active?:
       
Who Received Service:  Client  Partner  Family  Friend  Parent/Carer
Contacts:
Phone: Mobile:
Email:
Comments:
Disabilities:
 Intellectual / Learning     None
 Not Stated / Inadequately Described     Other
 Physical / Diverse     Psychiatric
 Sensory / Speach 
Other Identified Issues:
 Aggressive Behaviours     Anger
 Anxiety     Attachment Disorder
 Bullying     Criminal Involvement
 Depression     Dissociation
 Domestic Violence     Drug / Alcohol Misuse
 Eating Disorder     Employment Problems
 Financial     Flashbacks
 Grief     Housing
 Interpersonal Relationships     Isolation
 Loneliness     Low Self-Esteem
 Mistrust     Nightmares
 Parenting Skills     Phobias
 Poor Impulse Control     Post - Trauma
 Problematic Sexual Behaviours     Revictimisation
 School Problems     Self Harming Behaviour
 Sexual Dysfunctions     Sexuality
 Sexually Abusive Behaviours     Sleep Disturbances
 Somatic Complaints     Suicidal Ideation / Behaviours
 Witness to Domestic Violence 
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Client Status:
 Improved Life Skills  Support Still Required
Therapeutic Interventions:

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Date: Fri, January 25, 2019 For: Case Work Time: 30  Edit
Notes: Close client file

Date: Tue, January 22, 2019 For: Phone Contact Time: 5  Edit
Notes: 2:30pm Telephone contact to client Michael Owens from counsellor Lyn Alma was unsuccessful. OUTCOME: Unable to leave a message on client message bank as there was a message saying "This mail box is full please try again later."

Date: Tue, January 22, 2019 For: Writing Case Notes Time: 5  Edit

Date: Wed, January 16, 2019 For: Phone Contact Time: 5  Edit
Notes: 4:00pm Telephone contact to client Michael Owens from counsellor Lyn Alma was unsuccessful. OUTCOME: Unable to leave a message on client message bank as there was a message saying "This mail box is full please try again later."

Date: Wed, January 16, 2019 For: Writing Case Notes Time: 5  Edit

Date: Tue, January 8, 2019 For: Client Related Meetings Time: 30  Edit
Notes: Allocated to counsellor Lyn Alma

Date: Tue, January 8, 2019 For: Phone Contact Time: 5  Edit
Notes: 11:15am Telephone contact to client Michael Owens from counsellor Lyn Alma was unsuccessful. OUTCOME: Unable to leave a message on client message bank as there was a message saying "This mail box is full please try again later."

Date: Tue, January 8, 2019 For: Writing Case Notes Time: 5  Edit

Date: Wed, January 2, 2019 For: Client Related Meetings Time: 30  Edit
Notes: DISCUSSION: client to remain on waiting list. OUTCOME: Christie to keep contact with client via phone until she is allocated a counsellor.

Date: Wed, January 2, 2019 For: Phone Contact Time: 10  Edit
Notes: Tried to contact Michael to let him know that after today's allocation his file is still on the waitlist. No one answered and I was unable to leave a message due to his inbox being full.

Date: Wed, January 2, 2019 For: Writing Case Notes Time: 15  Edit

Date: Tue, December 18, 2018 For: Arranging Referrals Time: 60  Edit
Notes: Created client file

Date: Tue, December 18, 2018 For: Client Related Meetings Time: 30  Edit
Notes: Michael's file was discussed during allocation with his file being placed on the waitlist.

Date: Tue, December 18, 2018 For: Phone Contact Time: 5  Edit
Notes: Tried to contact Michael to let him know that after today's allocation his file has been placed on the waitlist. No one answered left a message

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Referrals:

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Memos:
Date: Tue, January 8, 2019 Action Reqired: No  Edit
Memo: Referral dated 18-12-2018
Document:  View Document >>  

Date: Fri, January 25, 2019 Action Reqired: No  Edit
Memo: Client Outcome Evaluation form
Document:  View Document >>  

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