Subject: Marketing Strategies Q1. Choosing a sales compensation plan is an important decision. However, there is no one-size-fits-all approach. What are some of the factors involved in the compensation process?….
Multidisciplinary Team Intake Form
Multidisciplinary Team Intake Form
Client Information | |||||
Name | Age | Race/ethnicity | Gender | Primary Language | Disability/Special Needs |
Carmen McKensy | 10 | Latina-White | Female | English | none |
Caregiver Information | |||||
Name | Age | Gender | Relationship to client | ||
Maria McKensy | 30 | Latina | Female | Mother | |
Client’s Family and Noted Individuals | |||||
Name | Age | Gender | Relationship to client | ||
Sara McKensy Gregg McKensy | 67 69 | White | Female Male | Grandmother Grandfather | |
Address | |||||
1234 Poorly Kept Neighborhood, Indiana PA | |||||
Alleged Perpetrator(s) | |||||
Name | Age | Gender | Relationship to client | ||
Tom McKensy | 35 | White | Male | Father | |
Address | |||||
1234 Poorly Kept Neighborhood, Indiana PA | |||||
Allegation Information | |||||
Type of abuse | Neglect of education, insufficient food, small for age | ||||
Circumstance of disclosure | School Principal Horace Mann Elementary School Observations | ||||
Geographic location where alleged abuse occurred | 1234 Poorly Kept Neighborhood, Indiana PA | ||||
Description of allegations | |||||
Carmen is small for her age. She searches for food discarded by other children. She doesn’t complete her homework. | |||||
Referent Information | |||||
Referral Source | School Principal | ||||
Additional professional(s)/ Agency(ies) | Carmen’s teachers all indicate she is respectful but doesn’t pay attention well or complete assignments. Child Protective Services doing investigation. | ||||
Medical Information | |||||
Has the client had a medical examination regarding the current allegations? | £ Yes £X No £Unknown at intake | ||||
If so, where? | |||||
Who will bring the client to the Interview? | Family interviewed at home. |