This questionnaire is designed to try to ensure you get the best help possible and for us to understand a better knowledge of you illnesses.
Surname…………………………… First Name……………………………………..
Name & address of GP………………………………………………………………..
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What is your state of health? ................................................................................
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How many cigarettes do you smoke a day? ………………………………………..
How much cannabis do you smoke a day? ……………………………………......
What medication, if any, do you take regularly? …………………………………..
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Are you disabled within the meaning of the Disability Discrimination Act? Yes/no
Description of disability: ……………………………………………………………….
Is there anything you feel I have missed out on and feel I should know of? ……
…………………………………………………………………………………………….
…………………………………………………………………………………………….
I hereby declare the all information given above is true to the best of my knowledge.
Sign: ………………………………… Date.……………………
P4
M1
How my health plan meets the health and wellbeing needs of my individual:
My health plan meets the wellbeing and needs of my individual by helping him understand the key factors which are triggering his illnesses and addiction that seems to make him have anger bursts, mild psychosis episodes, stages of feeling alone and also occasional moments of being paranoid. The main key factor of his problems is cannabis abuse.
My individual and I have agreed that smoking cannabis doesn’t help with his psychosis, impulsive anger disorder, depression or anxiety as it causes him to forget and also makes him feel he doesn’t need to take his medication. Making him this health action plan will help him understand what he needs to do to make his life better, which will give him a healthier and more stable environment to live in. This action plan is also giving him the understanding that taking his medication regularly will give him the control over his psychosis and other illnesses and to stop them controlling him. I’ve also advised that he consults with his doctor on regular bases about the dosage of his medication and how often he should take them. This will also give him a sense of control which is a very key point with his whole situation.
Also making a plan of cutting down smoking and looking into ways that can replace the urge of want to smoke. I’ve also advised him to find a hobby as well to take his mind off smoking cigarettes and his other drug taking. We will be recapping how his hobby and progress is going and if it hasn’t helped maybe look at joining a club or a course of some sort. With him doing something with his time we have both agreed that is will be a major help with his anxiety and depression. Once we’ve established the best course of action we will then eventually try to quit smoking entirely which will give him more energy, money and a much better health.
My health plan also recognises my individual’s circumstances and preferences by realising what his circumstances are and how his health is affected and what needs to be done to improve how he is living.
M1
