Optional Health Assessment Modules Form Page 18
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27UR Number:
Surname:
Given name:
Date of birth:
(Please fill in if no label available)
8. RISK TAKING
YES
I am free from worries about money
I have the personal resources I need to make decisions about my future
I have the privacy I need
I make sure I do nothing that hurts or damages other people
I take full responsibility for my actions
TOTAL
/5
9. COPING AND LIFE FUNCTIONING
YES
I am happy dealing with a range of professional people
I do not let other people down
I eat regularly and have a balanced diet
I look after my health and wellbeing
I meet all of my obligations promptly
TOTAL
/5
10. RECOVERY EXPERIENCE
YES
Having a sense of purpose in life is important to my recovery journey
I am making good progress on my recovery journey
I engage in activities and events that support my recovery
I have a network of people I can rely on to support my recovery
When I think of the future I feel optimistic
TOTAL
/5
FOR STAFF ONLY
Clinician name:
Position:
Signature:
Date:
17
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