My Recovery Plan Telford Integrated Community Assessment Team

My Recovery Plan Telford Integrated Community Assessment Team Service start date: …………. . ………… Plan Date………… Person’s details Name: . . . . Home Address: . . . . . Gender : M/F. . . DOB: . . . NHS No. . . . . Care. First No. . . . Your estimated date of discharge from this service: ………. Your Key Worker: ……………. . ………………. . …… Key Worker Job Title: ………………………… Key Worker Contact details: ……………………. Admission details Your goal during your stay with us Reason for admission: …………………. . . . . ………………………. . . . . ………… Current recovery service provided: …. . . . . …………………. . . . . ………… Review of this plan Review Target Actual Date Reviewed By Outcome 72 Hour Review 1 Week Review 2 Week Review 3 Week Review 4 Week Review The recovery service is a short care programme to support you to become more independent. This may be provided following discharge from hospital, TICAT Recovery Plan 010517 Page 1 of 2 as an alternative to hospital admission or to provide a rehabilitation package to promote independence.

My Recovery Plan No. Goal Telford Integrated Community Assessment Team Action to achieve the goal By Who - Person, provider, professional Recovery Plan for: . . . . . NHS No. . . . . This plan was created by: ……………………. . . Role: . . . . Plan Date: ……………………. . Contact details: ………………………. . . By When Care. First No. . . . . Signature: ………………. . . TICAT Recovery Plan 010517 Page 2 of 2