Transcription of APPRAISAL/NEEDS AND SERVICES PLAN
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APPRAISAL/NEEDS AND SERVICES PLAN
STATE OF california HEALTH AND HUMAN SERVICES AGENCYCALIFORNIA department OF social SERVICESCOMMUNITY CARE LICENSINGAPPRAISAL/ needs AND SERVICES PLANCLIENT S/RESIDENT S NAMEDATE OF BIRTHADDRESSAGEFACILITY LICENSE NUMBERSEXMALEADMISSIONUPDATEFEMALEDATECH ECK TYPE OF needs AND SERVICES plan :TELEPHONE NUMBER( )FACILITY NAMEPERSON(S) OR AGENCY(IES) REFERRING CLIENT/RESIDENT FOR PLACEMENTL icensing regulations require that an appraisal of needs be completed for specific clients/residents to identify individual needs and develop a service plan formeeting those needs . If the client/resident is accepted for placement the staff person responsible for admission shall jointly develop a needs and servicesplan with the client/resident and/or client s/resident s authorized representative referral agency/person, physician, social worker or other appropriateconsultant.
california department of social services community care licensing lic 625 (6/12) confidentail person(s) responsible method of needs objective/plan time frame for implementation evaluating progress
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