BAS-Behov Av Stöd 1001191

Behov av stöd och omfattning
– en intervjuguide
Prövningsversion 1
2010-01-19
Lennart Jansson IMS/Socialstyrelsen

Helene Wirandi Socialstyrelsen
Kärstin Eriksson-Blick Försäkringskassan
Rose-Marie Nylander IMS/Socialstyrelsen
Informera sökanden om att denna intervjuguide består av tre delar:
Del I Sökandens funktionsnedsättning, boende, sysselsättning och nuvarande stöd från samhället.
Del II Sökandens behov av stöd samt omfattning av stödet.
Del III Övrig information.
Sökanden
Förnamn: _______________________________________________________________________________
Efternamn:______________________________________________________________________________
Personnummer: _________________________________
Bostadsadress: ________________________________________________________________________
E-post:______________________________________________________
Telefonnummer: ________________________________
Intervju utförd av (namn): ___________________________________________________________
Telefon: ___________________E-post:______________________________________________
Datum för intervju (ååmmdd): ______ - ______ - _____
Typ av ansökan: o Ny ansökan Ankomst datum:______________

o Ansökan om fler timmar
o 2-årsomprövning
o Anmälan
Plats för intervju: o Hembesök

o Kontoret
o Annan plats, vilken? ______________________________________
Närvarande personer vid intervjun:
o Sökanden
o Ställföreträdande (vårdnadshavare, god man, förvaltare)
o Fullmakt:
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o Annan person, vem?
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Del I
Sökandens funktionsnedsättning, boende, sysselsättning och nuvarande stöd
från samhället
1. Kan Du beskriva din funktionsnedsättning och hur den yttrar sig?

(Sammanfatta den sökandes beskrivning av funktionsnedsättningen och vilka svårigheter den medför. Ange även om det är
någon förändring sedan tidigare ansökan).
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2. Utred om någon funktionsnedsättning är tillfällig?
Anteckningar:
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3. Utred om behovet av stöd varierar över tid? (Ex sjukdom som går i skov)
Anteckningar:
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4. Utred sökandens dygnsvila? kl _______ - _______ kl _______ - _______
kl_______ - _______ kl _______ - _______
5. Utred om det finns någon tid på dygnet då den sökande inte behöver stöd?
Anteckningar:
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6. Utred om sökanden någon gång under dygnet behöver hjälp av mer än 1 person
(Dubbelassistans). Ange vid vilka aktiviteter.
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7. Hur bor du?
O Ordinärt boende:
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O Bostad med särskild service O Enligt SOL O Enligt LSS
Typ av bostad: ___________________________________________________
8. Finns det anpassningar och hjälpmedel i bostaden?
O Nej O Ja
Om ja, vilken/vilka? ________________________________________________________________________________
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9. Vistas du regelbundet på andra ställen (t ex fritidshus eller släktings hem)?
O Nej O Ja
10. Finns där anpassningar och hjälpmedel?
O Nej O Ja
Om ja, vilken/vilka? ________________________________________________________________________________
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11. Bor du ensam eller tillsammans med någon annan vuxen?
O Bor ensam
O Bor tillsammans med make/maka/sambo/partner
O Bor tillsammans med förälder/föräldrar
O Bor tillsammans med annan vuxen person
12. Har du hemmaboende barn yngre än 18 år? O Nej O Ja, ålder: ________________________
13. Har du umgängesrätt med barn under 18 år? O Nej O Ja
Om Ja, omfattning: ______________________
Ålder: _____________________________
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14. Vad gör du på dagarna?
Har du arbete/studier/annan dagligt återkommande sysselsättning? O Nej O Ja
(Behov av stöd att utföra arbetet, se fråga 20, sid 79)
(Behov av stöd att genomföra studier, se fråga 21, sid 81)
Beskrivning:
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O Lönearbete Omfattning, tider: ________________________________________________________

O Eget företag
Resor: ________________________________________________________________
O Daglig verksamhet Omfattning, tider: ________________________________________________________
Resor: ________________________________________________________________
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Finns anpassningar och hjälpmedel (miljö/personal) i verksamheten?

(Utred även särskilda skäl, se även sid 6).
O Nej O Ja, vilken/vilka: _______________________________________________
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O Studier på grundskola/gymnasium/folkhögskola/högskola
O Studier i särskola
Omfattning, tider: ________________________________________________________
Resor: ________________________________________________________________
Finns anpassningar och hjälpmedel (miljö/personal) i studiemiljö?

(Utred även särskilda skäl, se även sid 6).
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O Lov/skolfria dagar
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Tillsyn:_______________________________________________________________
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O Fritids (Skolbarnsomsorg, korttidstillsyn)

O Förskoleverksamhet
Resor: ________________________________________________________________
Finns anpassningar och hjälpmedel (miljö/personal)?

(Utred även om behoven är tillgodosedda av annan t ex korttidstillsyn enl LSS)
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O Annan sysselsättning, vilken? ______________________________________________________________
Resor: ________________________________________________________________
Finns anpassningar och hjälpmedel?
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O Särskilda skäl:_________________________________________________________________
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Särskilda skäl (fortsättning)
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Aktuellt samhällsstöd
Utred den sökandes aktuella hjälp från kommunen, landstinget eller Försäkringskassan.
16. Har du personlig assistans idag?
O Nej O Ja
O Enligt LSS O Enligt LASS
Omfattning: __________________________Anordnare: ____________________________________________________
Anteckningar:
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17. Utred om den sökande har någon annan ersättning från Försäkringskassan pga sin
funktionsnedsättning.
Typ av ersättning och storleken på denna__________________________________________________________________
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18. Har du något stöd från kommunen?
O Korttidsvistelse Omfattning: ______________________________________________________
O Hemtjänst/boendestöd Omfattning: ______________________________________________________
O Färdtjänst/skolskjuts Omfattning: ______________________________________________________
O Annan insats Omfattning: ______________________________________________________
Vilken:____________________________________________________________________________
Anteckningar:
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19. Har du något stöd från landstinget?
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Övrigt
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Del II
Informera om att Del II är uppdelad i 9 områden som berör den sökandes dagliga liv: 1) Personlig vård,
2) Hemliv, 3) Förflyttning, 4) Kommunikation, 5) Arbete, 6) Studier, 7) Samhällsgemenskap, socialt- och
medborgerligt liv, 8) Att vara förälder och 9) Ingående kunskap.
Personlig vård
Det första avsnittet handlar om personlig vård, d v s att tvätta sig och torka sig, kroppsvård, att sköta
toalettbehov, att klä sig, att äta och dricka samt att sköta sin egen hälsa.
01. Klarar du av att på egen hand tvätta och torka dig själv?
(Att tvätta och torka hela eller delar av kroppen, t ex att bada, duscha, tvätta händer, fötter, ansikte och hår och att torka sig)
O Ja gå till fråga 02
O Nej forstätt nedan
01a. Tvätta och torka delar av kroppen

(Ex att rengöra och torka händer, ansikte, fötter och hår)
Beskriv ditt behov av hjälp:
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Dagtid Kväll Natt Dubbel

Sökandens uppfattning av tidsåtgång: 06-19 19 - 22 22 - 06 assistans
Antal Omfattning Antal Omfattning Antal Omfattning Omfattning
01a1. Tvätta och torka delar av kroppen Per dygn:
01a2. Tvätta och torka delar av kroppen Per vecka:
Utredarens bedömning:
01a3. Är sökandens beskrivning av sitt hjälpbehov rimlig? O Ja O Nej
01a4. Är sökandens uppskattning av tidsåtgång rimlig? O Ja O Nej, för hög O Nej, för låg
01a5. Är aktiviteten ett grundläggande behov? O Ja O Delvis O Nej
01a6. Berättigar aktiviteten till assistans? O Ja O Delvis O Nej

(Föräldrars ansvar, make/makas ansvar)
01a7. Slutlig bedömning av tidsåtgång (om annan än ovanstående):
Grundläggande behov: ________ tim/vecka Andra personliga behov: ________ tim/vecka
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Anteckningar/Kommentarer
01a3. Är sökandens beskrivning av hjälpbehovet rimlig?
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01a4. Är sökandens uppskattning av tidsåtgång rimlig?
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01a5. Är aktiviteten ett grundläggande behov?
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01a6. Berättigar aktiviteten till assistans?
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01a7. Slutlig bedömning av tidsåtgång.
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01b. Tvätta och torka hela kroppen
(Att tvätta och torka hela kroppen inkl hår, tex bad eller dusch)
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Sökandens uppfattning av tidsåtgång: 22 - 06 assistans
06-19 19 - 22
01b1. Tvätta och torka hela kroppen Per dygn:
01b2. Tvätta och torka hela kroppen Per vecka:
01b3. Är sökandens beskrivning av sitt hjälpbehov rimlig? O Ja O Nej
01b4. Är sökandens uppskattning av tidsåtgång rimlig? O Ja O Nej, för hög O Nej, för låg
01b5. Är aktiviteten ett grundläggande behov? O Ja O Delvis O Nej
01b6. Berättigar aktiviteten till assistans? O Ja O Delvis O Nej

01b7. Slutlig bedömning av tidsåtgång (om annan än ovanstående):
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01b3. Är sökandens beskrivning av hjälpbehovet rimlig?
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01b4. Är sökandens uppskattning av tidsåtgång rimlig?
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01b5. Är aktiviteten ett grundläggande behov?
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01b6. Berättigar aktiviteten till assistans?
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01b7. Slutlig bedömning av tidsåtgång.
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02. Klarar du av att på egen hand sköta din kroppsvård?
(Att vårda de delar av kroppen som kräver mer än att tvätta och torka sig såsom hud, ansikte, tänder, hårbotten,
naglar och könsorgan. Innefattar hudvård, tandvård, hårvård, att sköta naglar samt annan kroppsvård)
O Nej fortsätt nedan
02a. Hudvård
(Att sköta vävnad och fukt i sin hud såsom att ta bort valkar och liktornar, att använd fuktbevarande
lotioner/salvor eller kosmetika)
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Sökandens uppfattning av tidsåtgång:
06-19 19 - 22 22 - 06 assistans
02a1. Hudvård Per dygn:
02a2. Hudvård Per vecka:

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02b. Tandvård
(Att borsta tänderna, rengöra med tandtråd, ta hand om tandproteser och tandbryggor)
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Sökandens uppfattning av tidsåtgång: Dagtid Kväll Natt Dubbel

06-19 19 - 22 22 - 06 assistans
02b1. Tandvård Per dygn:
02b2 Tandvård Per vecka:

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02c. Hårvård
(Att sköta sitt hår på huvudet och ansiktet tex att kamma sig, ordna frisyr, raka sig och klippa sig)
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06-19 19 - 22 22 - 06 assistans
02c1. Hårvård Per dygn:
02c2 Hårvård Per vecka:
02c3. Är sökandens beskrivning av sitt hjälpbehov rimlig? O Ja O Nej
02c4. Är sökandens uppskattning av tidsåtgång rimlig? O Ja O Nej, för hög O Nej, för låg
02c5. Är aktiviteten ett grundläggande behov? O Ja O Delvis O Nej
02c6. Berättigar aktiviteten till assistans? O Ja O Delvis O Nej

02c7. Slutlig bedömning av tidsåtgång (om annan än ovanstående):
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02c3. Är sökandens beskrivning av hjälpbehovet rimlig?
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02c4. Är sökandens uppskattning av tidsåtgång rimlig?
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02c5. Är aktiviteten ett grundläggande behov?
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02c6. Berättigar aktiviteten till assistans?
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02c7. Slutlig bedömning av tidsåtgång.
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02d. Nagelvård
(Att rengöra, klippa eller lackera naglarna på händer och fötter)
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06-19 19 - 22 22 - 06 assistans
02d1. Nagelvård Per dygn:
02d2 Nagelvård Per vecka:
02d3. Är sökandens beskrivning av sitt hjälpbehov rimlig? O Ja O Nej
02d4. Är sökandens uppskattning av tidsåtgång rimlig? O Ja O Nej, för hög O Nej, för låg
02d5. Är aktiviteten ett grundläggande behov? O Ja O Delvis O Nej
02d6. Berättigar aktiviteten till assistans? O Ja O Delvis O Nej

02d7. Slutlig bedömning av tidsåtgång (om annan än ovanstående):
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02d3. Är sökandens beskrivning av hjälpbehovet rimlig?
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02d4. Är sökandens uppskattning av tidsåtgång rimlig?
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02d5. Är aktiviteten ett grundläggande behov?
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02d6. Berättigar aktiviteten till assistans?
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02d7. Slutlig bedömning av tidsåtgång.
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03. Klarar du av att på egen hand sköta toalettbehov?
(Förflyttning till toalettstol, förflyttning på och av toalettstol, hantering av kläder före och efter toalettbesök,
rengöring och torkning. Tänk även på kateter, blöja, lavemang etc)
03a. Sköta toalettbehov
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06-19 19 - 22 22 - 06 assistans
03a1. Sköta toalettbehov Per dygn:

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04. Klarar du av att på egen hand klä på och av dig?
(Klä på och av sig, ta fram och lägga undan kläder och skor, ta av och på ytterkläder)
04a. Klä på och av sig
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04a1. Klä på och av sig Per dygn:
04a2. Klä på och av sig Per vecka:

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04b. Ta fram och lägga undan kläder och skor
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06-19 19 - 22 22 - 06 assistans
04b1. Ta fram och lägga undan kläder Per dygn:

och skor
04b2. Ta fram och lägga undan kläder

och skor Per vecka:


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04c. Ta av och på ytterkläder
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06-19 19 - 22 22 - 06 assistans
04c1. Ta av och på ytterkläder Per dygn:
04c2. Ta av och på ytterkläder Per vecka:

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05. Klarar du av att på egen hand sköta din hälsa?
(Att tillförsäkra sig fysisk bekvämlighet, hälsa och fysiskt och psykiskt välbefinnande såsom att
upprätthålla en balanserad diet, lämplig nivå av fysisk aktivitet, hålla sig varm eller kall, undvika
hälsorisker, ha säkra sexualvanor, bli vaccinerad och genomgå regelbundna hälsokontroller)
05a. Sköta din hälsa
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06-19 19 - 22 22 - 06 assistans
05a1. Sköta din hälsa Per dygn:
05a2. Sköta din hälsa Per vecka:

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06. Klarar du av att på egen hand besöka vårdinrättningar och liknande?
(Ex sjukhus, vårdcentral, hjälpmedelscentral, sjukgymnastik. Det gäller regelbundna, planerade, förväntade besök)
06a. Besöka vårdinrättningar eller liknande
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06-19 19 - 22 22 - 06 assistans
06a1. Besöka vårdinrättningar Per dygn:

eller liknande
06a2. Besöka vårdinrättningar

Per vecka:
eller liknande
06a3. Besöka vårdinrättningar Per månad:

eller liknande

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07. Klarar du av att på egen hand äta och dricka mat och dryck?
(Använda matbestick/föra mat och dryck till munnen, dela maten i bitar, fram- och bortplockning, matning via sond.
I begreppet ”kan äta själv” avses inte bara att kunna föra maten till munnen. Det kan finnas andra speciella svårigheter
som gör att det inte går att lämna personen med att själv föra maten till munnen)
08a. Äta frukost
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06-19 19 - 22 22 - 06 assistans
08a1. Äta frukost Per dygn:

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08b. Dela maten i bitar, fram- och bortplockning i samband med frukost
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06-19 19 - 22 22 - 06 assistans
08b1. Dela maten i bitar, fram- och
bortplockning i samband med Per dygn:
frukost

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09a. Äta lunch
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06-19 19 - 22 22 - 06 assistans
09a1. Äta lunch Per dygn:

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09b. Dela maten i bitar, fram- och bortplockning i samband med lunch
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06-19 19 - 22 22 - 06 assistans
09b1. Dela mat i bitar, fram. och
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med lunch

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10a. Äta middag
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06-19 19 - 22 22 - 06 assistans
10a1. Äta middag Per dygn:

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10b. Dela maten i bitar, fram- och bortplockning i samband med middag
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06-19 19 - 22 22 - 06 assistans
bortplockning i samband med Per dygn:
middag

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11a. Äta mellanmål
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06-19 19 - 22 22 - 06 assistans
11a1. Äta mellanmål Per dygn:

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11b. Dela maten i bitar, fram- och bortplockning i samband med mellanmål
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plockning i samband med Per dygn:
mellanmål

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12. Är det något annat du behöver hjälp med när det gäller personlig vård?
O Nej gå till fråga 13
O Ja fortsätt nedan
12a. Övrigt personlig vård
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06-19 19 - 22 22 - 06 assistans
12a1. Övrigt personlig vård Per dygn:
12a2. Övrigt personlig vård Per vecka:
12a3. Övrigt personlig vård Per månad:

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12a7 Berättigar aktiviteten till assistans?
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Hemliv
Detta avsnitt handlar om matlagning, att göra inköp och ärenden, hushållsarbete.
13. Klarar du av att på egen hand laga mat?

(Planera och organisera och laga enklare måltider, planera, organisera och laga sammansatta måltider,
städa upp efter matlagning).
13a. Planera, organisera och laga enklare måltider

(Frukost, mellanmål, värma färdigmat)
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13a1. Planera, organisera och laga
Per dygn:
enklare måltider
13a2. Planera, organisera och laga

enklare måltider Per vecka:

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13b. Planera, organisera och laga sammansatta måltider
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06-19 19 - 22 22 - 06 assistans
13b1. Planera, organisera och laga
Per dygn:
sammansatat måltider
13b2. Planera, organisera och laga

sammansatta måltider Per vecka:

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13b6 Berättigar aktiviteten till assistans?
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13c. Städa upp efter matlagning
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13c1. Städa upp efter matlagning Per dygn:
13c2. Städa upp efter matlagning Per vecka:

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14. Klarar du av att på egen hand göra inköp och andra ärenden?
(Planera inköp, ta dig till och från inköpsstället, plocka ihop varor, frakta hem varor, plocka in varorna,
besöka bank, post, apotek och betala räkningar)
14a. Planera, genomföra inköp och andra ärenden
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06-19 19 - 22 22 - 06 assistans
14a1. Planera, genomföra inköp och Per dygn:

andra ärenden
14a2. Planera, genomföra inköp och

Per vecka:
andra ärenden
14a3. Planera, genomföra inköp och Per månad:

andra ärenden

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15. Klarar du av att på egen hand att sköta hushållsarbetet?
(Städa hemmet, tvätta och torka kläder, sköta växter, ta hand om husdjur, underhålla hjälpmedel, underhålla fordon)
15a. Städa hemmet

(Städa upp och damma, sopa, skura, torka golv, tvätta fönster och väggar, rengöra badrum, toaletter och
hemmet möbler, bädda sängen, samla ihop skräp, sopor och avfall för att kasta)
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15a1. Städa hemmet Per dygn:
15a2. Städa hemmet Per vecka:
15a3. Städa hemmet Per månad:

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15b. Tvätta och torka kläder och andra textilier, enklare klädvård
(Samla ihop, tvätta, torka, stryka, vika och plocka in i lådor/skåp. Enklare klädvård såsom att laga och ändra)
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15b1. Tvätta och torka kläder och Per dygn:

andra textilier, enklare klädvård
15b2. Tvätta och torka kläder och

Per vecka:
15b3. Tvätta och torka kläder och Per månad:


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15b7 Berättigar aktiviteten till assistans?
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15c. Sköta växter, ta hand om husdjur
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15c1. Sköta växter, Per dygn:

ta hand om husdjur
15c2. Sköta växter,

Per vecka:
ta hand om husdjur
15c3. Sköta växter, Per månad:

ta hand om husdjur

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15d. Underhålla hjälpmedel och fordon
(Reparera och ta hand om hjälpmedel, besöka hjälpmedelscentralen. Städa, tvätta och tanka fordon)
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06-19 19 - 22 22 - 06 assistans
15d1. Underhålla hjälpmedel Per dygn:

och fordon
15d2. Underhålla hjälpmedel

Per vecka:
och fordon
15d3. Underhålla hjälpmedel Per månad:

och fordon
15d4. Är sökandens beskrivning av sitt hjälpbehov rimlig? O Ja O Nej
15d5. Är sökandens uppskattning av tidsåtgång rimlig? O Ja O Nej, för hög O Nej, för låg
15d6. Är aktiviteten ett grundläggande behov? O Ja O Delvis O Nej
15d7. Berättigar aktiviteten till assistans? O Ja O Delvis O Nej

15d8. Slutlig bedömning av tidsåtgång (om annan än ovanstående):
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15d4. Är sökandens beskrivning av hjälpbehovet rimlig?
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15d5. Är sökandens uppskattning av tidsåtgång rimlig?
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15d6. Är aktiviteten ett grundläggande behov?
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15d7. Berättigar aktiviteten till assistans?
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15d8. Slutlig bedömning av tidsåtgång.
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16. Är det något annat du behöver hjälp med när det gäller hemlivet?
16a. Övrigt hemlivet
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06-19 19 - 22 22 - 06 assistans
16a1. Övrigt hemlivet Per dygn:
16a2. Övrigt hemlivet Per vecka:
16a3. Övrigt hemlivet Per månad:

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Förflyttning
Detta avsnitt handlar om att röra sig på olika sätt t ex genom att ändra kroppsställning, förflytta
sig i bostaden eller att förflytta föremål. Det handlar om förflyttning som inte sker i samband med
aktiviteter som behandlas i övriga avsnitt.
17. Klarar du av att på egen hand ändra kroppsställning, förflytta dig i bostaden
eller förflytta föremål?
(Här ingår ändra läge i sängen, sätta dig upp från liggande, böja dig framåt/åt sidan, ställa dig upp från sittande,
förflyttning i bostaden samt förflytta föremål).
17a. Ändra kroppsställning

(Ändra läge i sängen, sätta sig upp från liggande, böja sig framåt/åt sidan, ställa sig upp från sittande)
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17a1. Ändra kroppsställning Per dygn:
17a2 Ändra kroppsställning Per vecka:

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17b. Förflyttning i bostaden
(Ex ta dig ur/i sängen/stol eller mellan stolar, förflytta dig mellan olika rum i bostaden)
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17b1. Förflyttning i bostaden Per dygn:
17b2 Förflyttning i bostaden Per vecka:

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17c. Förflytta föremål/handräckning
(Lyfta och bära föremål ex ett glas. Gripa/plocka små föremål ex mynt, penna. Bära föremål från en plats till en annan)
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17c1. Förflytta föremål/handräckning Per dygn:
17c2 Förflytta föremål/handräckning Per vecka:

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18. Är det något annat du behöver hjälp med när det gäller förflyttning?
18a. Övrig förflyttning
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18a1. Övrig förflyttning Per dygn:
18a2. Övrig förflyttning Per vecka:
18a3. Övrig förflyttning Per månad:

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Kommunikation
Detta avsnitt handlar om att kommunicera med andra
19. Klarar du av att på egen hand kommunicera med andra?

(Uttrycka dig och förstå vad andra uttrycker, använda teckenspråk, bliss etc. Det är inte alltid sökanden kan svara själv
på denna fråga, ställe den då till god man, förälder eller annan ställföreträdande som är med under utredningen)
19a. Beskriv dina svårigheter att kommunicera med andra om/när det krävs en
tredje person för att du ska kunna göra dig förstådd eller förstå.
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19a1. Kommunikation Per dygn:
19a2 Kommunikation Per vecka:

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Arbete
Detta avsnitt besvaras endast om den sökande arbetar.
20. Klarar du av att på egen hand utföra ditt arbete?

20a. Utföra arbete
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20a1. Utföra arbete Per dygn:
20a2. Utföra arbete Per vecka:
20a3. Utföra arbete Per månad:

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Studier
Detta avsnitt besvaras endast om den sökande studerar.
21. Klarar du av att på egen hand genomföra dina studier?

21a. Genomföra studier
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21a1. Genomföra studier Per dygn:
Per vecka:
21a2. Genomföra studier
21a3. Genomföra studier Per månad:

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Samhällsgemenskap, socialt och medborgerligt liv
Här handlar det om den praktiska hjälpen/stödet för att den sökande ska kunna delta i olika
samhällsaktiviteter. Förflyttning skall medräknas inom respektive aktivitet.
Tänk på att inte ta upp behovet av samma aktivitet två eller flera gånger.
22. Klarar du av att på egen hand delta i samhällsaktiviteter?

22a. Delta i samhällsaktiviteter

(Ex delta i organisationer/föreningar, utöva religion och andlighet, delta i politiskt liv)
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22a1. Delta i samhällsaktiviteter Per dygn:
22a2. Delta i samhällsaktiviteter Per vecka:
22a3. Delta i samhällsaktiviteter Per månad:

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23. Klarar du av att på egen hand utöva fritidsaktiviteter?
23a. Utöva fritidsaktiviteter

(Ex delta i eller utöva lek-, spel- eller sportaktiviteter, träning, kulturliv, hobbies, läsning, musikintressen,
semesterresor, umgås med vänner/familj/släkt)
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23a1. Utöva fritidsaktiviteter Per dygn:
23a2. Utöva fritidsaktiviteter Per vecka:
23a3. Utöva fritidsaktiviteter Per månad:

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Att vara förälder
Detta avsnitt besvaras endast om den sökande är förälder till barn under 19 år
24. Har du några svårigheter att utöva ditt föräldraskap?

O Ja forstätt nedan
24a. Att vara förälder
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24a1. Att vara förälder Per dygn:
24a2. Att vara förälder Per vecka:
24a3. Att vara förälder Per månad:

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Ingående kunskap
25a. Utred vad det är för särskild kunskap som krävs

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25b. Utred i vilka situationer som denna kunskap/kompetens krävs

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Del III
Övrig information
26. Finns det behov av stöd inom något annat område som inte berörts?
(Instruktion: Gå tillbaka i intervjuguiden och reflektera över om det är några svårigheter som inte berörts).
O Nej O Ja
Anteckningar:
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27. Finns det behov av jour eller beredskap?
O Nej O Ja
Anteckningar:
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28. Är sjukvårdande insatser utredda? (Även särskilda skäl vid sjukhusvistelse)
O Nej O Ja
Anteckningar:
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29. Finns det idag något avtal med någon assistansanordnare?
O Nej O Ja, vilken: _____________________________________________________________

Anteckningar:
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91

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Behov av stöd och omfattning

Lennart Jansson IMS/Socialstyrelsen

Informera sökanden om att denna intervjuguide består av tre delar:

Del II Sökandens behov av stöd samt omfattning av stödet.

Del III Övrig information.

Datum för intervju (ååmmdd): ______ - ______ - _____

Typ av ansökan: o Ny ansökan Ankomst datum:______________

Plats för intervju: o Hembesök

Närvarande personer vid intervjun:

o Annan person, vem?

1. Kan Du beskriva din funktionsnedsättning och hur den yttrar sig?

2. Utred om någon funktionsnedsättning är tillfällig?

4. Utred sökandens dygnsvila? kl _______ - _______ kl _______ - _______

kl_______ - _______ kl _______ - _______

O Bostad med särskild service O Enligt SOL O Enligt LSS

Typ av bostad: ___________________________________________________

8. Finns det anpassningar och hjälpmedel i bostaden?

Om ja, vilken/vilka? ________________________________________________________________________________

9. Vistas du regelbundet på andra ställen (t ex fritidshus eller släktings hem)?

10. Finns där anpassningar och hjälpmedel?

Om ja, vilken/vilka? ________________________________________________________________________________

11. Bor du ensam eller tillsammans med någon annan vuxen?

13. Har du umgängesrätt med barn under 18 år? O Nej O Ja

Om Ja, omfattning: ______________________

O Lönearbete Omfattning, tider: ________________________________________________________

O Daglig verksamhet Omfattning, tider: ________________________________________________________

Finns anpassningar och hjälpmedel (miljö/personal) i verksamheten?

O Nej O Ja, vilken/vilka: _______________________________________________

Finns anpassningar och hjälpmedel (miljö/personal) i studiemiljö?

O Nej O Ja, vilken/vilka: _______________________________________________

O Fritids (Skolbarnsomsorg, korttidstillsyn)

Finns anpassningar och hjälpmedel (miljö/personal)?

O Nej O Ja, vilken/vilka: _______________________________________________

O Annan sysselsättning, vilken? ______________________________________________________________

Omfattning, tider: ________________________________________________________

Finns anpassningar och hjälpmedel?

O Nej O Ja, vilken/vilka: _______________________________________________

16. Har du personlig assistans idag?

O Enligt LSS O Enligt LASS

Omfattning: __________________________Anordnare: ____________________________________________________

18. Har du något stöd från kommunen?

O Korttidsvistelse Omfattning: ______________________________________________________

O Hemtjänst/boendestöd Omfattning: ______________________________________________________

O Färdtjänst/skolskjuts Omfattning: ______________________________________________________

O Annan insats Omfattning: ______________________________________________________

19. Har du något stöd från landstinget?

O Nej forstätt nedan

01a. Tvätta och torka delar av kroppen

Beskriv ditt behov av hjälp:

Dagtid Kväll Natt Dubbel

01a1. Tvätta och torka delar av kroppen Per dygn:

01a2. Tvätta och torka delar av kroppen Per vecka:

01a3. Är sökandens beskrivning av sitt hjälpbehov rimlig? O Ja O Nej

01a5. Är aktiviteten ett grundläggande behov? O Ja O Delvis O Nej

01a6. Berättigar aktiviteten till assistans? O Ja O Delvis O Nej

01a7. Slutlig bedömning av tidsåtgång (om annan än ovanstående):

Grundläggande behov: ________ tim/vecka Andra personliga behov: ________ tim/vecka

01a3. Är sökandens beskrivning av hjälpbehovet rimlig?

01a4. Är sökandens uppskattning av tidsåtgång rimlig?

01a5. Är aktiviteten ett grundläggande behov?

01a6. Berättigar aktiviteten till assistans?

01a7. Slutlig bedömning av tidsåtgång.

Beskriv ditt behov av hjälp:

Datum för intervju (ååmmdd): - - _

4. Utred sökandens dygnsvila? kl ___ - _ kl _ - ___

kl___ - _ kl _ - ___

Omfattning: Anordnare: __________________________

Grundläggande behov: tim/vecka Andra personliga behov: tim/vecka

Grundläggande behov: tim/vecka Andra personliga behov: tim/vecka

Grundläggande behov: tim/vecka Andra personliga behov: tim/vecka

Grundläggande behov: tim/vecka Andra personliga behov: tim/vecka

Grundläggande behov: tim/vecka Andra personliga behov: tim/vecka

Grundläggande behov: tim/vecka Andra personliga behov: tim/vecka