MEDICAL - San Diego State University



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Introduction/Overview Worksheet

MEDICAL

I understand my medical condition __ Yes __ No

I can:

__ Make medical appointments __ Find adult primary care & specialty doctors

__ Make decisions about my medical care o Can describe my medical condition

__ Take care of my medical care/daily treatments __ Talk to doctors alone

__ Understand my insurance/Medicaid/KidCare coverage

__ Refill medications/supplies

INDEPENDENT LIVING

As an adult, I will live with:

__ By myself with no supports/assistance __ By myself with supports/assistance __ Friends __ Parents __ Group home __ Other (specify): ………………………………………………………………………………………………

………………………………………………………………………………………………

I will be able to:

__ Care for my own personal needs __ Care for my own personal needs with help

__ Unable to provide self care, can direct others o Require total personal care assistance

My transportation will be provided by (check all that apply):

__ Self __ Family __ Public transportation (bus or taxi) __ Medicaid transportation

__ Other (specify): ………………………………………………………………………………………………

………………………………………………………………………………………………

I will need transportation for (check all that apply):

__ Medical appointments __ Shopping __ School __ Work __ Recreation

EDUCATION

I know my interests, skills, and strengths in school __ Yes __ No

I know my educational goals on the transition plan __ Yes __ No

I understand my education rights (under IDEA, Section 504, ADA) o __ Yes __ No

I understand that I can participate in my IEP meetings by age 14 or sooner __ Yes __ No

I am happy with the services that I receive from school __ Yes __ No

Youth/young Adult Transition Worksheet

Last Name

CMS Enrollee’s Name: _______________________________

Age and DOB: ______________________________________

Date Reviewed: _____________________________________

FINANCIAL

I can manage by myself (check all that apply): __ A budget

__ Checking account __ Paying bills __ Financial decisions __ Savings account

With help, I can manage with (check all that apply): __ A budget

__ Checking account __ Paying bills __ Financial decisions __ Savings account

If I need some help with any of these in the future, I will be helped by:

__ Family member __ Other (please specify) ………………………………………………………………………………………………

………………………………………………………………………………………………

EMPLOYMENT/VOCATIONAL TRAINING

__ I know my interests, skills and strengths for a job and a career

I am getting ready for a job by (check all that apply):

__ Household chores __ Work/study program __ Volunteering

__ Part-time or summer job __ Job shadowing __ Other (please specify): ………………………………………………………………………………………………

………………………………………………………………………………………………

After high school, I will enter:

__ Post-secondary school (specify community college, university, or college) __ Vocational training program (please specify): ………………………………………………………………………………………………

………………………………………………………………………………………………

__ Other continuing education (please specify): ………………………………………………………………………………………………

__ Supported employment __ Full time o Part time

__ Full time employment without supports __ Part time employment without supports __ Apprenticeship program __ Sheltered workshop

I have spoken with the following people about employment and vocational training:

__ School guidance counselor __ Vocational Rehabilitation

__ Regional Center Case Manager __ Other (please specify agency or organization): ………………………………………………………………………………………………

………………………………………………………………………………………………

SOCIAL/RECREATION

I belong to (check all that apply): __ Scouts __ Sports team

__ School club/activity o Church organization o Other (specify)

I spend time with friends (outside of school or work): __ Yes __ No

I would like to have more opportunities to have fun including, social events and recreation: __ Yes __ No

I know how to speak to and interact with (check all that apply): __ Teachers __ Employer __ Co-workers __ Store clerks

__ Healthcare providers __ Police/Fire fighters __ Friends __ Peers __ Adults you know __ Strangers

TRANSITION INFORMATION STILL NEEDED

__ Insurance __ Adult healthcare __ SSI __ Medicaid/Waivers

__ School __ Employment __ Independent Living __ IDEA, Section 504, ADA rights and responsibilities __ Transportation

__ Vocational Rehabilitation __ Social/Recreation Other:

………………………………………………………………………………………………

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