Transcription of Questionnaire Situational Information Version 4 - …
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Questionnaire Situational Information Version 4 - …
Revised 5-21-15 Rule Florida Questionnaire Situational Information Version EFFECTIVE 2-15-08 To be used by Certified Administrators Only Produced for the Person s Name Area Date Florida Questionnaire for Situational Information Version Purpose and Use of this Questionnaire The Questionnaire for Situational Information is a Questionnaire designed to gather key Information about a person that will describe his or her life situation for the purpose of planning supports over a 12*month period. These descriptions reflect a person s needs for assistance in key life roles and areas of daily activity. The first portions of the Questionnaire are entitled Life Changes and Community Inclusion. These areas of inquiry focus on a person s need for assistance in order to adjust to life changes while living, working, fulfilling valued roles, and participating in his/her community. The next portion of the Questionnaire is titled Functional Status and focuses on a person s need for assistance during the normal course of a routine day, including sight, hearing, communication, and ambulation.
Revised 5-21-15 Rule 65G-4.0213 Florida Questionnaire Situational Information Version 4.0 EFFECTIVE 21508 To be used by Certified Administrators Only
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