Individual Service Plan
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Individual Service Plan Customer Name: Billy West DOB: 22/01/1985 Address: 18 Eastern Terrace Myaree, WA 6154 Ph: 9200 2020 Ph: 0422 200 222 Key Worker: Reg Caremore Review Date: 10/07/2012 Date of Plan: 18/08/2011 PART ONE: INDIVIDUAL SERVICE CONSIDERATIONS Customer Family/Group Home • Unsteady on feet • Lives with parents • Requires healthy food • No transport issues Interchange • Billy lives within 15 minutes from Myaree office.. All parties to this Service Plan Agreement to print their names and sign below: Name Signature Date Customer: Guardian/Advocate: Key Support Worker: Manager: Other Attendee (state relationship): Interchange Inc – Commercial-in-Confidence Individual Service Plan / I-OPS-2010-0011 11/11/2011 Version 4.0 4.
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