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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: Wed, March 4, 2020 For: Recording Data Time: 15  Edit
Notes: Spreadsheet closure details updated and file to Year Destroy box. LG

Date: Wed, January 22, 2020 For: Case Work Time: 30  Edit
Notes: Closure letter Sent, Case File Closed

Date: Wed, January 22, 2020 For: Other Time Available for Clients Time: 15  Edit
Notes: Collate closure documents, prepare postage, update database. Post. LG

Date: Mon, January 6, 2020 For: Other Time Available for Clients Time: 5  Edit
Notes: Hi Sandra How are you going?Would you like to proceed with counselling or would you like your case file closedCould you please let me knowKind regards

Date: Wed, November 20, 2019 For: Other Time Available for Clients Time: 5  Edit
Notes: Hi SandraHow are you going?Would you like to make an appointment for counselling?Kind regardsTherese Rich | Therapeutic Services

Date: Thu, October 24, 2019 For: Other Time Available for Clients Time: 5  Edit
Notes: Hi SandraHow are you Can we make an appointment for counselling?Kind regardsTherese Rich | Therapeutic Services Accredited Mental Health Social Worker

Date: Wed, October 16, 2019 For: Arranging Referrals Time: 10  Edit
Notes: Update client spreadsheet and database. DBK

Date: Mon, October 14, 2019 For: Arranging Referrals Time: 50  Edit
Notes: Take client referral, update database and client spreadsheet and raise client file. DBK

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Referrals:

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Memos:
Date: Mon, October 14, 2019 Action Reqired: No  Edit
Memo: Self referral Sandra Donald
Document:  View Document >>  

Date: Mon, January 13, 2020 Action Reqired: Yes By: 13/01/2020  Edit
Memo: Invite to contact Letter sent
Document:  View Document >>  

Date: Wed, January 22, 2020 Action Reqired: Yes By: 22/01/2020  Edit
Memo: Closure letter
Document:  View Document >>  

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