Your life. Your plan.
What happened and what might help
Use this with the person and their chosen supporters. Record observations and the person’s own account. You can leave questions blank. It does not diagnose a cause or replace urgent help. Keep completed records private and share only what is needed for care.
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When, where and usual support
Date, time, place and activity. What matters to the person? Who was helping? Use roles rather than unnecessary personal details.
Health and earlier events
Any pain, bowel, sleep, eating or medicine concerns? What happened earlier? What health advice or help is needed?
A: what happened just before
What was said or changed? Were noise, demands, waiting or unavailable support involved? Describe observations, not assumed reasons.
B: what happened
What did the person say or do? Describe what was seen or heard and how long it lasted. What is uncertain?
C: what happened afterwards
What did supporters do? What changed? How did the person respond? What seemed to help or make things harder?
The person’s view and next steps
What does the person say or show about the experience? What support will change, who will arrange it and when will it be reviewed?