个案服务记录表

个案服务记录表

个案编号 立案日期 接案社工

一. 案主背景

1、基本资料 个案来源： □案主或其家人求助 □社工发掘 □ 转介 转介服务填写此项：

转介人姓名：__________________ 工作单位及职务：

电话号码： 地址： 主要问题：

2、案主的背景资料

_________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________

3、案主问题分析

_________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________

二、服务计划：

（一）服务目标

_________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ （二）介入策略

_________________________________________________________________________________

_________________________________________________________________________________

表5-1

三、计划实施过程

注：根据服务次数，自行增加表格。

四、案例评估

_________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________

五、专业反思

_________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________

社工（签名）:___________________ 日期: