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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: Client Service Type:
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: Tue, March 31, 2020 For: Recording Data Time: 15  Edit
Notes: No DOB recorded for adult. No services provided. No Permission to Destroy on file. Spreadsheet closure details updated and file to Year Destroy box estimated date. LG

Date: Thu, July 18, 2019 For: Arranging Referrals Time: 10  Edit
Notes: Last phone attempt to contact client prior closing file with closure letter.

Date: Tue, June 18, 2019 For: Arranging Referrals Time: 5  Edit
Notes: 10.50am further attempt to contact client on number provided. A f message was not left as it was unclear if client received voice mails.

Date: Thu, June 13, 2019 For: Arranging Referrals Time: 5  Edit
Notes: 9.03amrecieved a talking test message further to referral received for counselling. This message was not able to be interpreted. A further call was made to the client no message left as it was unclear if client received voice mails.

Date: Wed, June 12, 2019 For: Arranging Referrals Time: 5  Edit
Notes: Called at 10.06am further to referral received for counselling no message left as it was unclear if client received voice mails.

Date: Tue, June 11, 2019 For: Arranging Referrals Time: 5  Edit
Notes: Two calls 3.43pm and 4.13pm were made to try to ascertain if the client would like to proceed with counselling.

Date: Mon, June 10, 2019 For: Arranging Referrals Time: 5  Edit
Notes: Contacted regarding message for counselling support. Jasmin spoke about her daughter, she discussed a psychologist report and it was explained to Jasmin that we are a counselling service.

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Referrals:

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Memos:
Date: Tue, June 18, 2019 Action Reqired: No  Edit
Memo: Telephone message - self referral potentially for daughter.
Document:  View Document >>  

Date: Tue, June 18, 2019 Action Reqired: No  Edit
Memo: 7 day closure letter.
Document:  View Document >>  

Date: Thu, July 18, 2019 Action Reqired: No  Edit
Memo: Closure letter Jasmin Blackie.
Document:  View Document >>  

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