My DisabilityCare Plan

• Name:
• Disability Care Number:

Contact Information: If you have any questions about your plan and/or changes in circumstance:

• Contact [Your Name], Your Local DisabilityCare Officer. The address & phone number for contacting your nearest DisabilityCare Office can be found below.

My DisabilityCare Plan

My plan consists of the following:

• Part 1: My participant statement. This sets out my goals and personal context, including my living arrangements, informal care and community supports.
• Part 2:** My statement of supports** . This sets out my objectives, the supports that DisablityCare Australia and I agree will help me to achieve my goals ,andthelevel ofchoiceandacontrolthatIwillhaveovermyplan.Italsoincludesthecontact andreviewarrangementsthatIhaverecordedandsayshowmyplanwillemanged.

The name of my planneris:

Otherpeoplewhohelpedmewithdevelopingmoplan:

Part 1: My Participant Statement

Introduction

Goals:

• Goal #
• Goal #
• Goal #
• Goal#

My Life:

The things that are most important to me are?

The things in my life that are really working for me are?

Things that I like are?

The things Would i would Most Like To Change Are?

The Things I Would Really Like TO Try ARE?

Usually Live With:

Current Living Arrangements?:

Social Activities Participate In Home Or Familiar Places WITH Family And Friends?

Part 2: My Statement of Supports

Management of my supports

‘My Budget’ in the ‘Attachments’ section shows how all aspects are managed.

Plan Review Dates

• Start Date: dd/mm/YYYY – Will be reviewed at a later time as per agreement with Disability Care Australia (contact details provided).

My Objectives

My objectives for this plan to help me progress towards my goals:

| What I Want To Achieve | How I Will Achieve It | How I Will Know That I Have Achieved It | |-|-| ||| ||| |||

Informal Supports

My Family And Friends And I Have Agreed That They Will Provide Me With The Following Supports To Help Me Achieve My Objectives: | Type Of Support | Who Will Provide The Support? | |-| ||

Mainstream and community supports

My planner and I have agreed that the following supports will help me to meet my objectives. | Type of support | Where it is from? | How will this be arranged? |-|-|

DisabilityCare Australia reasonable and necessary supports

DisabilityCare Australia will provide funding for the following agreed reasonable and necessary supports. These supports will help me to achieve my objectives. More detail about how the funding for these supports has been calculated is in ‘My Budget’ in the ‘Attachments’ section.

Flexible supports

I agree that I will only purchase supports that are included in this statement of Supports. I understand that:

• I can vary the amount I spend on each of the flexible supports listed here, as long as €xxxx funding for my flexible supports.`
• If €xxx I am self-managing any of my supports, €xxx `understand this means I must comply with the guidelines for self- making supports.*
• If any of my supports are Disability Care Australia managed, I understand this means I must comply with the guidelines for Disabiliy Care Australia managed supports.

Fixed Supports

I agree that I will only purchase supports that are included in this statement of supports.

I understand that:

• I can only purchase the fixed supports listed in this section and I cannot spend more than the total funding on those supports.
• If I am self-managing any of my supports, I understand this means I must comply guidelines for self-managing supports. If any of my supports are DisabilityCare Australia managed, total funding

Attachment A

My budget

The table below explains how my flexible and fixed supports have been calculated and includes other related information.

I understand that for supports with a status of ‘Pending quotation’, I must obtain quotations and submit them for approval before purchasing the support. The ‘Total funding’ column gives an expected maximum value for the support, and the final amount will be determined when quotes are received.

Flexible supports

Flexible supports	Support Item	Effective Start Date	Effective End Date	Status	Total funding	Estimated Usage	How this support will be managed	Information to note about this support
		dd/mm/yy	dd/mm/yy		$
		dd/mm/yy	dd/mm/yy		$
Funding for my flexible supports					$

Date printed: 01/07/2013

Page 9 of 10 Personal Information – In Confidence

disabilitycare Australia

| Fixed Supports | Support Item | Effective Start Date | Effective End Date | Status | Total Funding | Estimated Usage | How This Support Will Be Managed | Information To Note About This Support | |-|-|-|-|-|-|-|-| dd/MM/yyyy &nbsp;&nbsp;$ &nbsp; $<br/>
Total funding For My Plan Is $

Date Printed : 01/July/2013