Your goal during your stay with us My Recovery Plan Telford Integrated Community Assessment Team Service start date:…………..………… Plan Date…………………… Your estimated date of discharge from this service: ……….………. Your Key Worker:……………..………………...………….……..…… Key Worker Job Title: ………………………………………………… Key Worker Contact details: …………………………………………. Person’s details Name: ........................................................................ Home Address: ..................................................................................... Gender : M/F ......................... DOB: .............................................. NHS No. ....................................... CareFirst No. ............................... Admission details Your goal during your stay with us Reason for admission:………………….......................................………… …………………………………......................................…………………… Current recovery service provided: …......................................…………. Review of this plan Review Target Actual Date Reviewed By Outcome 72 Hour Review 1 Week Review 2 Week Review 3 Week Review 4 Week Review The recovery service is a short care programme to support you to become more independent. This may be provided following discharge from hospital, as an alternative to hospital admission or to provide a rehabilitation package to promote independence. TICAT Recovery Plan 010517 Page 1 of 2

My Recovery Plan Telford Integrated Community Assessment Team No. Goal Action to achieve the goal By Who - Person, provider, professional By When Recovery Plan for: ......................................................................................... NHS No. .................................. CareFirst No. ......................................... This plan was created by: ………………………………………... Role: ............................................................ Signature:………………………………... Plan Date:……………………………………….. Contact details:……………………………………………... TICAT Recovery Plan 010517 Page 2 of 2