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171450-952500FAMILY NAME:MRNGIVEN NAMES:MALED.O.BM.O.FEMALEADDRESS:Facility:LOCATION:Mental HealthCONSUMERWELLNESS PLANCOMPLETE ALL DETAILS OR AFFIX PATIENT LABEL HEREThis module has been designed by consumers. All consumers are encouraged to complete it in partnership with their clinician and/or nominated carer. The intent of the module is to facilitate consumer involvement in their own care, particularly in terms of symptom management, relapse prevention and crisis planning. It serves as a recovery aid and as a prompt and reminder about what to do to support recovery.Things I do well / skills I haveThings I can do to keep myself well / what helps me stay wellSupport / Treatment / Medications that I have been helpful / or I have likedSupport / Treatment / Medications that have been unhelpful and / or I have dislikedConsumer Name: Signature: Date:350074325600FAMILY NAME:MRNGIVEN NAMES:MALED.O.BM.O.FEMALEADDRESS:Facility:LOCATION:Mental HealthCONSUMERWELLNESS PLANCOMPLETE ALL DETAILS OR AFFIX PATIENT LABEL HEREThings that stress meThings I can do to reduce stressMy early warning signs areThings that help with early warning signsWhen I am unwell and / or to others may notice that IIf I become unwell I would like the following to happen or not to happenContact detail of my nominated support peopleNAMERELATIONSHIPCONTACT DETAILSINPUT INTO PLAN?COPY OF PLAN?Family / Primary carerYESNOYESNOGPYESNOYESNOYESNOYESNOYESNOYESNOREVIEW DATE:Copy provided to consumerYESNOI have been fully informed about my rights and responsibilities (includes receipt of consumer package)YESNOI have been informed of peer support optionsYESNOPeople who have helped me complete the Plan:Consumer Name: Signature: Date: ................
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