OPTIONAL MODULE 7: UR Number:

FOR STAFF ONLY

GOALS Surname:
Given name:
Date of birth:
(Please fill in if no label available)

PURPOSE
PURPOSE OFOF MODULE
MODULE INTRODUCTION
INTRODUCTION FOR FOR CLIENT
CLIENT
To map outthe
assess a clients
client’sgoals.
perceived physical health. “Now I’d like you to think
“Now I am going to ask you about
youryour goalshealth
physical and some
and of the priority
conduct areas
a basic
you’d like to address”
physical health check.”
WHO CAN ADMINISTER THIS MODULE?
This
Only module can
complete bemodule
this completed byare
if you theaclient withdoctor
medical the clinician assisting
or a nurse. INSTRUCTIONS
INSTRUCTIONS
through prompts that may reflect any earlier discussion about problems, 1. IIntroduce
nvite client to think
module to about
client. their satisfaction with a range of areas in
goals and priorities. 2. their life out ofand
As questions 10.perform relevant tests.
3. IFormulate
2. responses
nvite the client andabout
to think note what
actions to beneed
would taken.
to happen to improve
that area of their life.
3. A sk client to rank priorities (or reflect on which are the most important/
urgent) in discussion with you.
4. G ive client a copy of their goals form to take home as a resource they
can refer to as desired.

PROBLEM SATISFACTION WHAT WOULD HAVE TO CHANGE TO

PRIORITY
AREA OUT OF 10 INCREASE MY SCORE OUT OF 10?

ALCOHOL AND/OR
DRUG USE

HEALTH
(PHYSICAL & MENTAL)

SOCIAL LIFE
& FRIENDS

RELATIONSHIPS
(PARTNER OR FAMILY)

HOUSING

JOB/
EDUCATION

MONEY
& FINANCES

EXERCISE

LEGAL ISSUES
& CRIME

FOR STAFF ONLY

Clinician name: Position: Signature: Date:

14