Resources available (explain in detail)

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  Persons/Family:
  

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  Financial:
  

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  Community:
  

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  Support Groups:
  

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  Socialization:
  

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  Food preparation and areas of need:
  

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  Shopping, housekeeping and maintenance of home:
  

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  Transportation:
  

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  Ambulation:
  

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  Medication/IV therapy:
  

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  Treatments:
  

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  Wound Care:
  

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  Supplies:
  

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  Self-Care (specify):
  

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  Homemaker/maintenance (specify):
  

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  Physical layout of home (specify)(include home safety):
  

Referrals (date, source, services):

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  Social services
  
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  Rehabilitationl services
  
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  Dietary
  
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  Home care
  
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  Respiratory/O2:
  
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  Psychiatric:
  
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  Equipment:
  
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  Supplies:
  
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  Education (diabetes, OB etc.)
  

This model identifies three arenas of the patient’s environment which impact his/her health status: (1) family, (2) health care system, and (3) community. All arenas interact to affect the equilibrium of the individual. An arena is an identified area in the patient’s environment with which he interacts and by which he is influenced. Each arena must be addressed in the plan of care and areas identified that are specific to the patient.

Each arena should function to fulfill the following purposes for the individual:

1. 
   Promote life, dignity, and integrity
   
2. 
   Promote positive change and adaptive health behaviors
   
3. 
   Promote optimal growth/development and maturation
   

Health Care System is that system which provides health care for the individual for a given health problem and includes but is not limited to the acute care agency, nursing care, nutrition, medical care, therapists, pharmacies, rehabilitative facilities, adult and child protective services, and durable medical equipment providers.

Family is the primary group within which the patient lives and interacts; the group may be (1) nuclear, (2) extended, (3) single parent (4) significant others, or (5) a combination of these. Information to be included but is not limited to: housing, physical support, home safety, financial support, meal preparation, transportation, roles within the family, ethnicity, social class and family dynamics, including unique communication patterns.

Community is the geographical area in which the individual lives and or works and which has meaningful impact on the individual’s health status; this may be an extended area as well as the immediate area where the patient lives. This community includes but is not limited to churches, support groups, grocery stores, senior citizen center, public transportation, office on aging, meals prepared and delivered to the home, communication alert systems, legal assistance, community action, law enforcement agencies, leisure, recreation, educational opportunities, and county indigent funding.