MANAGEMENT PLAN MANAGEMENT PLAN

							         NORTH METROPOLITAN AREA HEALTH SERVICE                           Surname                                 Sex U.R. No.
                    MENTAL HEALTH
                                                                          Forenames                                     D.O.B.
                 _____________________________________________ Hospital

                                                                          Address


                 MANAGEMENT PLAN                                          Ward                    Registrar             Consultant

                                                                          Use Patient I.D Label When Available

                               MANAgEMENT PLAN - PREPARATION fOR POSTNATAL PERIOd
         Purpose - This form is to be completed by the ‘Small Known Team’ to ensure liaison
         has occurred with relevant service and/or agencies in preparation for the client’s postnatal period.
         date:                                               Pregnancy:                               due date:
         Management Plan Team Members                                                                 Contact details
         Mental Health Clinician Name:




         Named Midwife:




         General Practitioner’s Name (if shared care):




         Patient Assessment (considering current and future health care needs)




         Arrangements / referrals made                                       By Whom                  date:




                                                                                                                                     MANAGEMENT PLAN

         Actions / follow up                                                 By Whom                  date:




         Next Review date                                    Copy sent to all team involved in management’s plan?
                                                             Yes _______ No _______
         Client Consent/Acknowledgment of involvement in the Management Plan (In Client’s Own Handwriting):

         Client’s Full Printed Name: ____________________________________________________________________________

         Client’s Full Signature: ________________________________________________________________________________
G2/11
MAY 08
         Dated: ______________________________________________________________________________________________