[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-176591-105":53,"doc-detail-176591-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","case-management-assessment-tool-health-form","Case Management Assessment Tool - Health Form","","Case Management Assessment Tool for health-focused intake and ongoing case evaluation, collecting structured information on education, reading literacy, race/ethnicity, housing situation, income and expenses, transportation and insurance. Includes health and wellness sections covering allergies, diagnosed conditions, prescription use, hospitalizations, dental care, overall health rating, nutrition and meal patterns, ADL/IADL functioning, substance use willingness and counseling referrals, STD testing and safer-sex needs, plus mental health status including orientation, cognition, judgment, insight, grooming, psychiatric history, life crises, and counseling interest or prior services.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/case-management-assessment-tool-health-form/176591/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/case-management-assessment-tool-health-form/176591.png","ImageObject",442,249,{"name":88,"@type":89},"Ethan Miller","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/octet-stream","2026-10-27","2026-09-02",true,{"@type":98,"interactionType":99,"userInteractionCount":15},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What information does the assessment collect under the Health section?","Question",{"text":108,"@type":109},"It captures known allergies, diagnosed health problems, prescription medication use, history of hospitalization, and other health-related notes. It also includes overall health rating, meal frequency, and balanced diet checks.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"How does the form address nutrition and daily wellbeing?",{"text":113,"@type":109},"It asks how many meals the client eats each day and whether the diet appears balanced across fruits, vegetables, grains, proteins, and dairy. It also provides a place for additional comments on nutritional needs.",{"name":115,"@type":106,"acceptedAnswer":116},"What mental health and risk-related topics are included?",{"text":117,"@type":109},"It evaluates grooming/appearance, orientation, motor coordination, thought content, memory, judgment, insight, and substance influence. It also includes questions on psychiatric history, life crises, willingness to talk or seek counseling, and referrals related to STD testing and safer sex/drug use education.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},176591,1788324946,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":15,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":15,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":125,"read_time":79},687207017582,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","INNOVATIVE SOLUTIONS, LLC\nCase Management Assessment Tool\nGeneral:\nDate of Assessment: \u0013 FORMTEXT \u0014 _________    \u0015\n********************************************************************************************\nPlease refer to original intake and assessment for any demographic information.\n************************************************************************************\nEducation:\nEducational level:  Grade School \u0013 FORMCHECKBOX \u0014\u0015\tHigh School/GED\u0013 FORMCHECKBOX \u0014\u0015\tAssociates Degree\u0013 FORMCHECKBOX \u0014\u0015\nUndergraduate Degree \u0013 FORMCHECKBOX \u0014\u0015\tGraduate/Post Grad. Degree \u0013 FORMCHECKBOX \u0014\u0015\nReading Ability/Literacy: High \u0013 FORMCHECKBOX \u0014\u0015\tModerate \u0013 FORMCHECKBOX \u0014\u0015\tLimited \u0013 FORMCHECKBOX \u0014\u0015\nRace/Ethnicity:\nRace: \u0013 FORMCHECKBOX \u0014\u0015  African American/Black\t\t\u0013 FORMCHECKBOX \u0014\u0015  Latino/Hispanic\n\u0013 FORMCHECKBOX \u0014\u0015  Asian/Pacific Islander\t\t\u0013 FORMCHECKBOX \u0014\u0015  Native American\n\u0013 FORMCHECKBOX \u0014\u0015  Black/Non-Hispanic\t\t\u0013 FORMCHECKBOX \u0014\u0015  White/Non-Hispanic\n\u0013 FORMCHECKBOX \u0014\u0015 Other: \u0013 FORMTEXT \u0014     \u0015\nHousing:\nApartment/Condo \u0013 FORMCHECKBOX \u0014\u0015       House \u0013 FORMCHECKBOX \u0014\u0015     Mobile Home \u0013 FORMCHECKBOX \u0014\u0015   Group Home \u0013 FORMCHECKBOX \u0014\u0015 Transitional \u0013 FORMCHECKBOX \u0014\u0015   Homeless \u0013 FORMCHECKBOX \u0014\u0015\nRent \u0013 FORMCHECKBOX \u0014\u0015    Own \u0013 FORMCHECKBOX \u0014\u0015    Other \u0013 FORMCHECKBOX \u0014\u0015\nAlso check one of the following: Permanent (stable) \u0013 FORMCHECKBOX \u0014\u0015    Non-Permanent \u0013 FORMCHECKBOX \u0014\u0015\nCurrent Housing Programs:  HOPWA \u0013 FORMCHECKBOX \u0014\u0015                      Section 8 \u0013 FORMCHECKBOX \u0014\u0015              Housing Authority \u0013 FORMCHECKBOX \u0014\u0015\nNone \u0013 FORMCHECKBOX \u0014\u0015           Unknown \u0013 FORMCHECKBOX \u0014\u0015            Other: \u0013 FORMTEXT \u0014     \u0015\nAre there other persons (Adults/Non-dependent Children) in the household? Yes \u0013 FORMCHECKBOX \u0014\u0015  No \u0013 FORMCHECKBOX \u0014\u0015\nIf yes, please note below:\nDoes the client have dependent children?  Yes \u0013 FORMCHECKBOX \u0014\u0015       No \u0013 FORMCHECKBOX \u0014\u0015\nIf yes, complete the following:\nTransportation:\nInsurance:\nFinancial Resources:\nHousehold Income per month (includes income of client and other household members) \u0013 FORMTEXT \u0014     \u0015\nIncome                   \t\t\t\t\tExpenses\nLegal Issues:\nLegal Documents Status:  Please check as appropriate.\nLegal Problems Status:  Please indicate information as appropriate.\nHealth:\nAre there any known allergies (drugs, food, and animals, other)? Yes\u0013 FORMCHECKBOX \u0014\u0015  No \u0013 FORMCHECKBOX \u0014\u0015\nPlease list known allergies \u0013 FORMTEXT \u0014     \u0015\nDoes the client have any diagnosed health problems (heart disease, TB, hepatitis, other)? Yes\u0013 FORMCHECKBOX \u0014\u0015  No \u0013 FORMCHECKBOX \u0014\u0015\nAre you currently taking any prescription medication?           \u0013 FORMCHECKBOX \u0014\u0015 Yes (complete below)  \u0013 FORMCHECKBOX \u0014\u0015 No\nHas the client ever been hospitalized?       Yes \u0013 FORMCHECKBOX \u0014\u0015       No \u0013 FORMCHECKBOX \u0014\u0015\nIf yes, please complete the following:\nDental:\nDoes the client receive dental care?  Yes \u0013 FORMCHECKBOX \u0014\u0015       No \u0013 FORMCHECKBOX \u0014\u0015\nDoes the client have mouth/dental problems that affect what or how much she/he can eat: Yes \u0013 FORMCHECKBOX \u0014\u0015       No \u0013 FORMCHECKBOX \u0014\u0015\nIs there a history of opportunistic infections? Please check yes or no)\nOther?\nOn PCP prophylaxis?  Yes \u0013 FORMCHECKBOX \u0014\u0015       No \u0013 FORMCHECKBOX \u0014\u0015\u000bIs there a history of other HIV related conditions?  (Please check yes or no)\nHow does the client rate his/her overall health? \u0013 FORMCHECKBOX \u0014\u0015 excellent     \u0013 FORMCHECKBOX \u0014\u0015 good    \u0013 FORMCHECKBOX \u0014\u0015 fair     \u0013 FORMCHECKBOX \u0014\u0015 poor\nHow many meals does the client eat each day? \u0013 FORMCHECKBOX \u0014\u0015 0-1              \u0013 FORMCHECKBOX \u0014\u0015 2-3        \u0013 FORMCHECKBOX \u0014\u0015 4-5     \u0013 FORMCHECKBOX \u0014\u0015 6+\nDoes the client seem to have a well balanced diet (fruits, vegetables, grains, proteins and dairy)? Yes \u0013 FORMCHECKBOX \u0014\u0015       No \u0013 FORMCHECKBOX \u0014\u0015\nPlease make any other comments you feel necessary to describe nutritional needs: \u0013 FORMTEXT \u0014     \u0015\nADL’s/IADLs:\nDescribe client’s ability to function independently in the following areas.\nRecreation/Leisure:\nSpirituality:\nSubstance Use:\nIdentify current or past use of any substances including alcohol, tobacco, prescrip","cbCaikIczxrXtRVl","https://ap.wps.com/l/cbCaikIczxrXtRVl","doc",432128,"English","# General\n## Education\n## Reading Ability and Race/Ethnicity\n## Housing\n## Financial Resources\n## Legal Issues\n## Health\n## Dental\n## ADL’s/IADLs\n## Substance Use\n## Risk\n## Mental Health","[{\"question\":\"What information does the assessment collect under the Health section?\",\"answer\":\"It captures known allergies, diagnosed health problems, prescription medication use, history of hospitalization, and other health-related notes. It also includes overall health rating, meal frequency, and balanced diet checks.\"},{\"question\":\"How does the form address nutrition and daily wellbeing?\",\"answer\":\"It asks how many meals the client eats each day and whether the diet appears balanced across fruits, vegetables, grains, proteins, and dairy. It also provides a place for additional comments on nutritional needs.\"},{\"question\":\"What mental health and risk-related topics are included?\",\"answer\":\"It evaluates grooming/appearance, orientation, motor coordination, thought content, memory, judgment, insight, and substance influence. It also includes questions on psychiatric history, life crises, willingness to talk or seek counseling, and referrals related to STD testing and safer sex/drug use education.\"}]","Case Management Assessment Tool - Health Form | DOC"]