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Clinical Holiday Intervention List
Clinical Holiday Intervention
Clinical Holiday Intervention Add
Inquiry number
Name
Date of birth
1. Features of caregiver(During Intervention procedure)
Parent: Mother (MSL)
Difficult
Sensitive
Concerned
Unaware
Supportive
Denial
Demanding
Impolite
Language Barrier
Parent: Father (MSL)
Difficult
Sensitive
Concerned
Unaware
Supportive
Denial
Demanding
Impolite
Language Barrier
Caregiver (MSL)
Difficult
Sensitive
Concerned
Unaware
Supportive
Denial
Demanding
Impolite
Language Barrier
Whom communicate to: (MSL)
Mother
Father
Caregiver
Caregiver’s Name and relationship
Other information:
What approach is used?
Concerns of parent/patient*
Client observation: Preferences, concerns noted, associated issues
Information parallel therapist and supervisor to be aware of
Information parallel therapist and supervisor to be aware of
Cheat Sheet:
Date of upload
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