SOCIAL CASE STUDY REPORT

Format
I – IDENTIFYING INFORMATION
Name :
Age :
Sex :
Civil Status :
Present Address :
Birthdate :
Birthplace :
Ethnicity/Tribe :
Religion :
Highest Educational Attainment:
Occupation :
Income :
Type of Client : CNSP/CICL/NA/WEDC/PWD
(Walk-in, Referred, Reached-out
I – IDENTIFYING INFORMATION
Name :
Age :
Sex :
Civil Status :
Present Address :
Birthdate :
Birthplace :
Ethnicity/Tribe :
Religion :
Highest Educational Attainment:
Occupation :
Income :
Type of Client : CNSP/CICL/NA/WEDC/PWD
Source of Referral :(Walk-in, Referred, Reached-out
I – IDENTIFYING INFORMATION
Name :
Age :
Sex :
Civil Status :
Present Address :
Birthdate :
Birthplace :
Ethnicity/Tribe :
Religion :
Highest Educational Attainment:
Occupation :
Income :
Type of Client : CNSP/CICL/NA/WEDC/PWD
Source of Referral :(Walk-in, Referred, Reached-out
II – FAMILY COMPOSITION
Age Sex Civil Relationship Educational Occupation Monthly
Status to the Client Attainment Income
Name
II – FAMILY COMPOSITION
Age Sex Civil Relationship Educational Occupation Monthly
Status to the Client Attainment Income
Name

Note:
 Family members living in the same
household are included
 Arrangement is from oldest to youngest
 Relationship to the client
III – PROBLEM PRESENTED
• 2 to 3 sentences are enough

Courtesy: Salih A. Zangcala, Batch 2024

III – PROBLEM PRESENTED
• 2 to 3 sentences are enough

Courtesy: Salih A. Zangcala, Batch 2024

or

The client verbalized that she is suffering from health

complications that caused her difficult to work. Thus, seeking medical
assistance.
III – PROBLEM PRESENTED
• 2 to 3 sentences are enough

Courtesy: Salih A. Zangcala, Batch 2024

or

The client verbalized that she is suffering from health

complications which affects her daily living. Thus, seeking for medical
assistance.
III – PROBLEM PRESENTED
• 2 to 3 sentences are enough

Courtesy: Salih A. Zangcala, Batch 2024

If the problem is mental or health condition of the

client. Mention the authorized person who diagnosed
the illness with brief description/explanation.)
IV – BACKGROUND INFORMATION

A.The Client

B.The Family

C. The Environment
IV – BACKGROUND INFORMATION
A.The Client

B.The Family

C. The Environment

Courtesy: Salih A. Zangcala, Batch 2024

IV – BACKGROUND INFORMATION
A.The Client

B.The Family

C. The Environment

Courtesy: Salih A. Zangcala, Batch 2024

IV – BACKGROUND INFORMATION
B. The Family

A.The Family

C. The Environment

Courtesy: Salih A. Zangcala, Batch 2024

IV – BACKGROUND INFORMATION
C. The Environment

A.The Family

C. The Environment

Courtesy: Salih A. Zangcala, Batch 2024

IV – BACKGROUND INFORMATION
C. The Environment

A.The Family

C. The Environment

Courtesy: Salih A. Zangcala, Batch 2024

 V – ASSESSMENT STATEMENT
 Write in a paragraph form
 Review the four components of assessment

• Define the client’s problem

• Causes and effects that contributes to the problem

• Assess the client’s and the family’s strengths and

weaknesses

• Possible interventions with possible results in

response to the presented problem, needed
resources, agencies to be tapped, who will give
assistance, tangible or intangible support
 V – ASSESSMENT STATEMENT
 Write in a paragraph form
 Review the four components of assessment

• Define the client’s problem

• Causes and effects that contributes to the problem

• Assess the client’s and the family’s strengths and

weaknesses

• Possible interventions with possible results in

response to the presented problem, needed
resources, agencies to be tapped, who will give
assistance, tangible or intangible support
VI – PLAN OF INTERVENTION
General Goals:

Specific Activities Responsible Expected Time

Objectives Person Output/Outcome Frame
VI – PLAN OF INTERVENTION
General Goals:

Specific Activities Responsible Expected Time

Objectives Person Output/Outcome Frame

at least 3 activities in each

specific objectives
VI – PLAN OF INTERVENTION
General Goals:
To facilitate the improvement of the client’s health
condition through access to different medical
services.

or

After six months, the client will be able to improve

her health condition through access to medical
services.
VI – PLAN OF INTERVENTION
General Goals:
To facilitate the improvement of the client’s health
condition through access to different medical
services.

or

After six months, the client will be able to improve

her health condition through access to medical
services.
VI – PLAN OF INTERVENTION
General Goals:
To facilitate the improvement of the client’s health
condition through access to different medical
services.

or

After six months, the client will be able to improve

her health problem through access to medical
services.
 VII – EVALUATION

Activity:
Assist the client for medical assistance.

Expected Output/Outcome:
• Diagnosed the medical condition of the
client.
• Provide the needed resources for
medications.

Courtesy: Salih A. Zangcala, Batch 2024

 VII – EVALUATION

Activity:
Assist the client for medical assistance.

Expected Output/Outcome:
• Diagnosed the medical condition of the
client.
• Provide the needed resources for
medications.

Courtesy: Salih A. Zangcala, Batch 2024

VIII– RECOMMENDATIONS

• Review the unfinished and/or in

progress interventions as basis for
recommendations.

• Consider the total family approach

Prepared by:

Signature Over Printed Name of Social Work Intern

Checked and noted by:

Signature Over Printed Name Agency Field Supervisor

Supporting Documents:
• Photo Documentations
• Results of Medical Laboratories
• Doctor’s Prescription
• Acknowledgment Receipt (Donor)
• Communication letters
• Documents that will justify or prove your
work/activity has been implemented
Reminders:
- SCSR shall be printed in a A4 bond paper
- Single space
- Times New Roman font style
- 12 font size
- Margin: 1.5 L, 1 T, 1 R, 1 B
Thank you