Overview

This assessment is designed to reflect the individual's current functioning level throughout a four year period.  The purpose of this evaluation is to identify the strengths and needs of the individual and should be used to develop the Individual Service Plan (ISP).

Applicable Staff

All ID Staff authorized to use Avatar may view the assessment.  Directors/Supervisors, ID Staff, and Nurses will be able to complete the form.

Usage

The form is client and episode specific and can be accessed from the Home View, within a client chart, or by menu path Avatar CWS/Mercy Modeled Clinical Forms/Mercy ID Forms/Individual Assessment.  The Individual Assessment is to completed every year at a minimum, or whenever an update to the ISP occurs.

ID Individual Assessment Section

This section contains the required Date and Program information along with instructions for scoring the assessment.  If any response is NA it should neither be counted toward the total possible or individual score.

Money Management/Budget/Banking Section

Data including paper bills and coins, checks, banking, monthly bills, and income:

Followed by:

Time and Calendar Awareness Section

Data including alarm clocks, weekends, date/days, months, seasons, etc.

Nutrition/Menu Planning/Grocery Shopping Section

Data including food vs. non-food, meal preparation and planning, cooking items, food storage, etc.

Followed by:

Household Skills Section

Data including cleaning rooms and appliances, using and checking appropriate supplies, handling refuse, and general housekeeping skills.

Followed by:

Laundry Section

Data including knowing when laundering is required, using laundry basket, using washer/dryer/detergent, and folding/hanging clothes.

Communication Skills Section

Data including understanding of spoken words and emotions, expression of needs/emotions, empathy, and use of common language.

Safety Section

The Safety Section has 7 subsections to capture data in the following areas:

• Household Safety
• Smoking Safety
• Community Safety
• Heat Safety
• Fire Safety
• Water Safety/Swimming
• Poisons

Self Medication Section

Data including recognizing their medication and its container, communication of correct amount and administration to self, knowing medication schedule.

Personal Needs Section

The Personal Needs Section has 2 subsections to capture data in the following areas:

• Health
• Hygiene

Recreation/Socialization/Community Integration Section

Data including identifying familiar people, social activities, peer and community interactions, conversations, etc.

Followed by:

Sexuality Section

Data including accurate gender identification of self and others, identification of body parts, understanding of intercourse and pregnancy, etc.

Followed by:

Supervision Section

Does the client require supervision while in the facility or community?

Notes Sections

There are 5 types of notes that can be included with the assessment if desired.  They are as follows:

• Levels of Performance, Progress and Growth - including functioning skills, communication, etc.
• Progress and Growth - self medication, health, motor skills, activities, socialization
• Safety - poisons, heat sources, fire, water
• Pre Vocational - skills, functioning, recommendations
• Personal Adjustment - finances, property, functional and medical limitations, areas to develop

General Comments Section

Data including functional strengths/weaknesses, likes/dislikes, interests, and preferences.

Summary Section

The Summary Section allows sending the assessment to other team members. 

  - "Completed assessment must be sent to all team members 30 days prior to the ISP meeting."

ISP is the Individual Service Plan, the written details of the supports, activities, and resources required for the individual to achieve personal goals.

Click the blue Submit button when complete to enter the form into the client record.  A printable report with signature page will open to collect all required signatures.  Send to the HIM department for scanning into the record as per this procedure.  HIM Processes 

Tips & FAQ

Any selection can be cleared by selecting it and pressing F5.

Technical Information

Menu Location (Avatar CWS/Mercy Modeled Clinical Forms/Mercy ID Forms/Individual Assessment)

SQL Table(s)

RAD Envelope (if applicable)

Related Forms and Reports (data from one form feeds another report/form)