| System |
| UnitID |
1 |
1 |
| Date |
2001/5/14 |
2001/5/14 |
| Started |
11:21 |
10:33 |
| Finished |
12:13 |
12:15 |
| General Info |
| Client |
Caroline Slater |
Mark Jones |
| DOB |
9-7-23 |
17-4-80 |
| Address |
14 James St, Innaloo |
6 Short St, Bayswater |
| Phone |
(08) 9658741 |
(08) 9423216 |
| HospitalUnitNumber |
D 674521 |
F2468 |
| ReferralSource |
Silver Chain Sister |
Consultant |
| Doctor |
Dr Elaine Rogers |
Dr Michael Smith |
| DiagnosisDisability |
R(CVA). Weakness in left leg and arm. |
C6/7 Quadriplegia |
| SpecialConsiderations |
Medication,Diabetes, |
Medication, |
| OtherConsiderations |
|
Anxious about returning home |
| Independence |
Supervision, |
Assistance, |
| MobilityAids |
Quadruped, |
Manual Wheelchair, |
| HomeSupport |
Spouse,Family,Domestic Help, |
Family,Carer, |
| Assessment |
Post-discharge |
Pre-discharge |
| Assessor |
Julie Grant |
Sandra Green |
| Organization |
Occupational Therapy |
Occupational Therapy |
| Contact |
(08) 4663322 |
(08) 4939294 |
| External |
| DwellingType |
House,Single Storey,Owner, |
House,Single Storey,Owner, |
| Block |
Slope,Gradient 1:15, |
Slope,Gradient 1:15, |
| BlockOther |
|
|
| KerbAccessRamp |
Yes |
Yes |
| ParkingBay |
3m wide,6m long,850mm wall clear, |
3.8m wide,6m long,1.2m wall clear, |
| ParkingBayOther |
|
|
| HoistClearance |
No |
Yes |
| DirectAccesstoHouse |
Yes |
No |
| Undercover |
No |
No |
| Lighting |
Yes |
Yes |
| Pathways |
1.2m wide, |
1.2m wide,Gradient 1:12, |
| PathwaysOther |
|
|
| Surfaces |
Cement,Unsealed,Uneven,Slippery, |
Paving,Unsealed,Even,Non-slip, |
| Entrances |
Door 950mm wide,Adj.Space 300mm,Step, |
Door 950mm wide,Adj.Space 300mm,Hob, |
| StepsStairsNumber |
3 |
0 |
| StepsStairsWidthmm |
260 |
0 |
| StepRails |
Both,Correct, |
|
| Gates |
Heavy,Open One Side,Open 2 Hands, |
Light,Open Both Sides,Open 1 Hand, |
| Internal General |
| Layout |
Trip Hazards,Cluttered, |
Open Plan,Cluttered, |
| CirculationSpace |
360 degree, |
360 degree, |
| CirculationOther |
|
|
| Doors |
900mm,Sliding,Side Hinge,Open In,Knob, |
900mm,Sliding,Side Hinge,Open In,Knob, |
| DoorOther |
|
|
| Passageways |
1.2m wide |
1.2m wide |
| PassagewaysOther |
|
|
| FloorCoverings |
Carpet,Loose Mats,Uneven, |
Carpet,Non-Sliip, |
| Toilet |
| Toilet_ |
Inside,Separate,Waste Pipe/Side, |
Inside,Ensuite,Waste Pipe/Rear, |
| ToiletDoorAccess_ |
Yes |
No |
| TransferSpace_ |
Yes |
No |
| Height_ |
No |
No |
| PaperFlush_ |
Yes |
Yes |
| Bathroom |
| Bathroom |
Separate,Shower/Bath, |
Ensuite,Shower Recess, |
| Bath |
Height 450mm |
|
| BathOther |
|
|
| ShowerRecess |
|
900mm x 900mm |
| RecessOther |
|
|
| ShowerAccess |
Curtain, |
Glass Screen,Hob, |
| Washbasin |
Height 800mm,Knee/Clear 675mm,Depth 500mm, |
Height 800mm, |
| WashbasinOther |
|
|
| Taps |
Capstan, |
Capstan, |
| AccessShowerTapsRose |
Yes |
Yes |
| AccessWashbasinTaps |
Yes |
Yes |
| Kitchen |
| WorkSurfaces |
Height 900mm,Knee/Clear 675mm,Depth 600mm, |
Height 900mm, |
| WorkSurfacesOther |
|
|
| Sink |
Height 800mm,Depth 600mm,Bowl D 140mm,Pipes Insulated, |
Height 800mm,Knee/Clear 650mm,Depth 600mm,Bowl D140-165mm,Pipes Insulated, |
| SinkOther |
|
|
| Oven |
Upright,Electric, |
Wall,Microwave,Electric, |
| OvenDoor |
Drop down |
Knee/Clear |
| CookTop |
Electric,Side Controls, |
Gas,Front Controls,Piezzo Ignition,Height 800mm, |
| CookTopHeight |
800mm |
|
| AccessOHStorage |
No |
No |
| AccessLowStorage |
No |
No |
| AccessPantry |
Yes |
Yes |
| AccessFridge |
Yes |
Yes |
| AccessDishwasher |
N/A |
No |
| Laundry |
| Location |
Separate |
Separate |
| WashTrough |
Height 900mm,Depth 200mm, |
Height 900mm,Depth 200mm,No Knee Access, |
| Trough(Other) |
|
|
| WashingMachine |
Top Load,Controls Back, |
Top Load,Controls Back, |
| HotWaterSystem |
Gas |
Gas |
| LaundryTaps |
Standard, |
Standard, |
| AccessClothesLine |
Yes |
Yes |
| AccessDryer |
No |
No |
| AccessIroningBoard |
Yes |
Yes |
| TurningSpace |
Yes |
No |
| Bedroom |
| Bed |
Queen/King,Ensemble, |
Double,Spring, |
| Mattress |
Saggy, |
Firm, |
| BedHeight |
440mm |
460mm |
| HeightCompressed |
420mm |
430mm |
| CirculationBed |
Yes |
Yes |
| AccessFurniture |
Yes |
Yes |
| AccessStorage |
Yes |
No |
| Lounge Room |
| Chairs |
Single,Double Seater,Armrests,No Firm Seat, |
Single,Double Seater,Armrests,No Firm Seat, |
| CirculationLounge |
Yes |
Yes |
| AccessEntertainment |
Yes |
Yes |
| Other Features |
| AccessPowerPoints |
No |
No |
| AccessLightSwitches |
No |
Yes |
| AccessDoorHandles |
Yes |
Yes |
| AccessWindows |
No |
No |
| Airconditioning |
No |
Yes |
| HomeSecurity |
No |
No |
| Telephone |
Yes |
Yes |
| Other |
|
|
| Conclusion |
| HomeModifications |
Yes |
Yes |
| ExternalModify |
Surfaces,Gates, |
Entrances, |
| InternalGeneralModify |
Floor Coverings, |
Floor Coverings, |
| RoomsModify |
Bathroom,Laundry, |
Toilet,Bathroom,Laundry, |
| OtherFeaturesModify |
Power Points,Windows, |
Power Points,Windows, |
| ProvisionofEquipment |
Yes |
Yes |
| Equipment |
Rails,Bathboard,Toilet Frame, |
Rails,Shower Chair,Commode, |
| EquipmentOther |
|
|
| AssistiveDevices |
Yes |
Yes |
| Devices |
Shower Hose,Non-slip mat,Personal Care,Kitchen Aids,Laundry Aids, |
Shower Hose,Non-slip mat,Laundry Aids, |
| DevicesOther |
|
|