Sensible Care

Participant Care Profile

Care Manager's Email Address

Person completing form

Date *

Client Name

Preferred name

Gender

Language/s (including fluency) / Communication Preferences

Cultural Considerations

Risks & Allergies
Blood thinners, diabetes, pacemaker, etc.

Relevant Health Details

Is the Participant on Blood Thinners?

YesNo

Provide Further Details

Does the Participant have a Pacemaker?

YesNo

Provide Further Details

Are there any pets at the property?

YesNo

Provide further details
What type, breed, can they be locked away if requested, are they friendly, etc.

Equipment Available / Equipment Used
Example: Encourage participant to take walker when shopping

Living Situation
Where living & who is living there

Access to home
Entry Instructions, etc.

Parking & Special Instructions
Parking on street, parking signs, etc.

Background Information
Family, culture, lifestyle, routines, habits, etc.

Likes / Hobbies / Interests

Service

Goals

Tasks

Risks

Save and Complete Later