Parent to Parent of Georgia

Links to Roadmap page and Parent to Parent page

WRITING A SOCIAL HISTORY

DEMOGRAPHIC INFORMATION

Name:
Birthdate:
Social Security Number:
Address:
Telephone Number:
Parents:

PRESENTING PROBLEMS

Description of the disability
Need for the Katie Beckett Waiver

FAMILY INFORMATION

Dad – Name, age, education, occupation, health
Mom – Name, age, education, occupation, health
Siblings – Name, age, grade in school, health

Home – type (apartment, mobile home, house)
location (in town, in the country, in a subdivision)
size (number of bedrooms, acres of land)

BIRTH AND EARLY DEVELOPMENT

Pregnancy – prenatal care, any problems, full term or premature
Delivery – C-Section or Vaginal…Breech
Hospital, Physician, Baby’s Weight, Length of hospital stay
When child’s problems were first detected
Developmental delays
Problems in feeding, movement, sleeping, health

MEDICAL INFORMATION

Allergies
Immunizations
Physicians who see the child
Health problems
Medications
Hospitalizations
Surgeries
Other Medical Treatments (CT Scan, Lab Work, EKG, EEG)
Vision
Hearing
Adaptive Equipment used

TRAINING/EDUCATION

School Program – Teacher, classroom, Special Education
Goals, Support Services (OT, PT, Speech, Adaptive PE)

Early Intervention

Therapy – Physical Therapy How often
Occupational Therapy Where (hospital, home health)
Speech Therapy Therapists names

CURRENT FUNCTIONING

Self Help (eating, bathing, dressing, toileting, grooming)

Language/Speech (understanding what is said…expressing wants)

Motor Skills (using hands, sitting, walking, climbing, etc.)

Social Skills (recognizing people, sociable, doesn’t like to separate from mom)

Cognitive (learning, how they learn best…seeing things, hearing things, etc.)

Put whether child is dependent, needs assistance, or is independent in different areas. Be sure to compare how the child is doing in relation to other children their age…The child may have made lots of progress, but still may be behind others. It is important to note how much assistance is needed and whether it is a verbal reminder, or physically assisting the child.

SUMMARY

Child…age…disability or areas of delay…Importance of medical care and therapy in promoting development…Stress the need for Medicaid.



	HIGHLIGHTS A special needs trust is the only estate planning option that protects assets, enables the beneficiary to receive goods and services from the estate, and still preserves eligibility for government benefits.