PLEASE BE CERTAIN THAT YOU RESPOND ACCURATELY TO ALL THE QUESTIONS. FAILURE TO DO SO WILL JEOPARDISE YOUR LICENCE AGREEMENT (SHOULD YOU BE OFFERED ACCOMMODATION AT ST ED’S). BY SIGNING BELOW YOU ARE STATING THAT YOU UNDERSTAND & ACCEPT THE ABOVE CONDITION. Please sign………………………. ST EDMUNDS CHARITY RESETTLEMENT PROJECT ASSESSMENT FORM July 2009
DATE OF ASSESSMENT………………………. WHAT ARE YOU LIKE WHEN YOU ARE DRUNK? CLIENT DETAILS NAME
DO YOU CLAIM HOUSING BENEFIT FOR THIS ADDRESS? REFERRAL SOURCE MARITAL STATUS NEXT OF KIN DETAILS NAME ADDRESS TEL
RELATIONSHIP TO YOU FAMILY CIRCUMSTANCES
FINANCIAL INFORMATION
NATIONAL INSURANCE No: PRESENT SOURCE OF INCOME:
DWP
ANY OTHER INCOME
WEEKLY / FORTNIGHTLY / MONTHLY AMOUNT ARE YOU PAID INTO A BANK A/C, B/S A/C OR P/O A/C? WHAT IS YOUR PAY DAY? DO YOU HAVE ANY MONEY STOPPED FROM YOUR BENEFIT(S)? HOW
HAVE YOU HAD ANY HOUSING BENEFIT RELATED DEBTS IN THE PAST 5 YEARS? YES / NO PLEASE SIGN TO CONFIRM ……………………………………………………. DO YOU HAVE ANY OUTSTANDING RENT ARREARS WITH ROCHDALE COUNCIL? DO YOU HAVE ANY OTHER DEBTS? ARE YOU INVOLVED IN ANY LEGAL PROCEEDINGS? ARE YOU IN CONTACT WITH ANY OTHER AGENCIES? e.g. Probation Service
HAVE YOU EVER SERVED A CUSTODIAL SENTENCE? Please give full details. HAVE YOU EVER BEEN CONVICTED OF ANY OF THE FOLLOWING:- DRINK DRIVING DRUNK & DISORDERLY SHOPLIFTING GBH ABH ANY SEX CRIMES ARSON DRUG DEALING OR ANY OTHER OFFENCES HAVE YOU ACTUALLY EVER BEEN ACCUSED, BUT NOT CONVICTED, OF ARSON OR A SEX CRIME? Please give full details. HEALTH INFORMATION
PRESENT GP
HOW WOULD YOU DESCRIBE YOUR GENERAL PHYSICAL HEALTH? HAVE YOU HAD ANY OF THE FOLLOWING:- H.I.V. TEST
IF YES, WHEN WAS THE LAST TEST & WHAT WAS THE RESULT?
DO YOU HAVE ANY CHRONIC MEDICAL CONDITIONS SUCH AS:- ASTHMA STOMACH ULCERS DIABETES BACK PROBLEMS SKIN PROBLEMS OSTEO OR RHEUMATOID ARTHRITIS HEARING PROBLEMS SIGHT PROBLEMS
ANY OTHER CHRONIC MEDICAL CONDITIONS? ARE YOU SEEING A CONSULTANT / ATTENDING HOSPITAL AT PRESENT? FOR WHAT REASON? ARE YOU HAVING, OR HAVE YOU EVER HAD, ANY PSYCHIATRIC TREATMENT OR ARE YOU CURRENTLY SEEING ANY SORT OF MENTAL HEALTH WORKER?
DO YOU SUFFER FROM ANY OF THE FOLLOWING:-
PSYCHOSIS ANXIETY / PANIC ATTACKS DEPRESSION SCHIZOPHRENIA PARANOIA SHORT TERM MEMORY LOSS DO YOU SUFFER FROM ANY MENTAL HEALTH PROBLEM NOT LISTED ABOVE? IF ‘YES’ PLEASE GIVE DETAILS
ARE YOU ON ANY MEDICATION? SEC Service Users are free to take Campral on a prescribed basis while on placement with us if they feel this medication is helpful. SEC Service Users are not permitted to take antabuse or hemenevrin. NB If any prospective service user states that they are taking naltroxene, please see project manager. Please list all medication you are currently taking, prescribed or ‘over the counter’.
HAVE YOU EVER MISUSED PRESCRIBED MEDICATION? IF ‘YES’ WHAT WAS THE MEDICATION & WHEN WAS THE LAST TIME YOU MISUSED IT? HAVE YOU EVER MISUSED OVER THE COUNTER MEDICATION? IF ‘YES’ WHAT WAS THE MEDICATION & WHEN WAS THE LAST TIME YOU MISUSED IT? HAVE YOU EVER TRIED TO HARM YOURSELF? IF ‘YES’ WHAT DID YOU ATTEMPT & WHEN WAS THE LAST TIME YOU TRIED TO HARM YOURSELF? EXAMPLES OF HARM ARE: ASPHYXIATION, CUTTING, BLOOD ‘LETTING’, WALKING IN FRONT OF MOVING TRAFFIC - BUT PLEASE LIST ANY SELF HARM YOU HAVE ATTEMPTED TOGETHER WITH THE DATE OF YOUR LAST HARM ATTEMPT.
DRINKING & TREATMENT HISTORY
WHAT AGE WERE YOU WHEN YOU STARTED DRINKING? WHAT AGE WERE YOU WHEN YOU BECAME DEPENDENT? WHEN DID YOU LAST HAVE AN ALCOHOLIC DRINK? HAVE YOU EVER UNDER TAKEN ANY OF THE FOLLOWING DETOX METHODS:- A HOME MEDICAL DETOX? IF ‘YES’ HOW MANY & WHAT WAS PRESCRIBED? WHEN WAS YOUR LAST HOME MEDICAL DETOX? A HOSPITAL OR CLINIC DETOX? IF ‘YES’ HOW MANY? WHEN WAS YOUR LAST HOSPITAL / CLINIC DETOX? HAVE YOU EVER GONE COLD TURKEY? IF ‘YES’ HOW MANY TIMES & WHEN WAS THE LAST TIME? HAVE YOU EVER HAD DT’S AS IN SWEATS & SHAKES? HAVE YOU EVER HAD DT’S AS IN AUDIO OR VISUAL HALLUCINATIONS - OR BOTH? HAVE YOU EVER HAD ALCOHOLIC FITS? HAVE YOU EVER HAD ALCOHOLIC BLACKOUTS HAVE YOU EVER USED ANY OTHER SUBSTANCES –EVER – SUCH AS:-
HEROIN
ANY OTHER SUBSTANCES WITH DATE(S) OF LAST USE:
DRUG USE: HAVE YOU EVER INJECTED ANY DRUGS (INCLUDING, IN THE PAST, TEMAZEPAM ‘JELLIES’)? IF YOU ANSWERED ‘YES’ TO THE ABOVE QUESTION DID YOU EVER SHARE ANY OF THE WORKS (INCLUDING FILTERS & SPOONS)? PLEASE TELL US ABOUT ANY PROBLEMS YOU ARE EXPERIENCING AT THE PRESENT TIME
DO YOU HAVE ANY CULTURAL / RELIGIOUS NEEDS?
ARE YOU INVOLVED IN ANY OF THE FOLLOWING ON A REGULAR BASIS?
SPORTS / HOBBIES FURTHER EDUCATION JOB RETRAINING VOLUNTARY WORK SOBRIETY SUPPORT GROUPS ANYTHING ELSE NOT MENTIONED RELATIONSHIPS
ARE YOU IN A RELATIONSHIP AT PRESENT? DOES YOUR PARTNER HAVE A PROBLEM WITH ALCOHOL? WHO ARE THE PEOPLE CLOSEST TO YOU AT PRESENT? HOW WOULD YOU DESCRIBE THE ABOVE RELATIONSHIP(S)?
USE OF TIME
WHEN DID YOU LAST WORK?
WHAT WERE YOU EMPLOYED AS? DO YOU FEEL CONFIDENT IN THE FOLLOWING AREAS? COOKING CLEANING SHOPPING BUDGETING WASHING / IRONING BASIC HOME MAINTENANCE SUCH AS CHANGING A PLUG ETC. FORM FILLING DEALING WITH EXTERNAL AGENCIES BEFORE SIGNING PLEASE TAKE A MOMENT TO READ THROUGH WHAT YOU HAVE TOLD ME TO ENSURE THAT IT IS ACCURATE
. SERVICE USER / APPLICANT EMERGENCY ACCOMMODATION DETAILS
SERVICE USER / APPLICANT: . FLAT NO: . (if applicable) AT: 87 / 110 (delete as appropriate if applicable) SHOULD A SITUATION ARISE WHEREBY YOU WERE TO NEED EMERGENCY ACCOMMODATION, HAVE YOU ANYWHERE TO GO? (i.e. PARENT, FRIEND, PARTNER) YES / NO (delete as appropriate) IF “YES” PLEASE GIVE NAME, ADDRESS AND TELEPHONE NUMBER OF PERSON WILLING TO OFFER EMERGENCY ACCOMODATION: NAME: . ADDRESS: . . . . TELEPHONE NUMBER: . Signed: . date: .
OO Programming with Java Ruurd Kuiper (Kees Huizing)More classes, more objects: object structuresPrograms are complex, so humans need program structuringDecomposition and abstraction of code for DATA and manipulationGrouping and naming of DATA and manipulation code for subtasks -For PROGRAMMING a subtask, WRITE a class, for getting a subtaskPERFORMED, WRITE (!) that an object of that class i
Very Good (from first rotation) CC: JR is a 47 year old white male who is admitted to the hospital for the first time for fainting this afternoon. Source: JR and his wife JR and his wife were attending an outdoor company picnic earlier this afternoon. As the patient was eating a BBQ lunch and drinking beer (three in total); he began to feel that his surroundings were spinning. He reports