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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