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Version: SEND14_EHCP (w.o example)_28 Aug 14_v4.8

Surrey Education, Health and Care Plan

template

Surrey Education, Health and Care Plan for: [NAME]

CONFIDENTIAL. Open to practitioners, young people and parents/carers

One page profile template:

EHCP of [NAME] [DATE] [VERSION (v of V)] 2

PHOTO (Optional)

What people like about me and what I like about myself

What is important to meHow best to support me

A

Date:

CONFIDENTIAL. Open to practitioners, young people and parents/carers [Name]’s Surrey Education, Health and Care Plan

[NAME, D.O.B]

ContentsSurrey EHCP Code of Practice sections Pages[Name]’s Surrey Education, Health and Care Plan

A Views, interests and aspirations

[Name]’s special educational needs B SEN

[Name]’s health needs C Health needs[Name]’s social care needs D Social care needs[Name]’s outcomes E Outcomes[Name]’s outcomes F Special education provision

[Name]’s outcomes G Any health provision reasonably required

[Name]’s outcomesH1 Social care provision under S2 of Chronically Sick and Disabled Persons Act 1970

[Name]’s outcomes H2 Any other social care provisionEducation placement I Name and type of setting[Name]’s personal budget J Personal budgetSign off page NAAppendices K Advice and information gathered

K Appendices Appendix number Document title Author Page number

[Name]’s Action Plan Page number: Check box when completed:

Who has been included in writing this plan

Further details


Version: (dd/mm/yyyy)Draft or Final

DateOriginal EHCP:Amendment 1:Amendment 2:Amendment 3:


Family name: First name:Known as:Date of birth: Gender:NHS/NI/ICS/other registration numbers:Parent/carer names:Who has parental responsibility?:LAC status:Siblings:Contact address for child or young person:Contact addresses for parent/carers:Telephone: Mobile:Email:EHCP coordinator name:Type and name of education setting:Year group: Placed out of year:Ethnicity: First language:Language used at home: Religion:Main communication method:Language interpretation support needed:GP name and contact details:Current consultants details:Other practitioners who are/have been involved (name, email, telephone):Times that are difficult for me or family to attend appointments:Barriers that might make it more difficult for me or family to attend appointments:Other relevant plans:Other useful information:

[Name]’s story – play, health, schooling, independence, friends and relationships, further education, future plans etc


B


[Name]’s family’s story

More information on how to support [Name] and [his/her] family

[Name]’s aspirations

[Name]’s family’s aspirations for [him/her]

How [Name] and [his/her] family have taken part in this plan

[Name]’s special educational needs (see Appendix B for SEN assessment reports)


CONFIDENTIAL. Open to practitioners, young people and parents/carers Summary of main special educational needs

More detailed information:

1. Cognition and learning:

2. Communication and interaction:

3. Social, mental and emotional health:

4. Sensory and physical:

[Name]’s health needs


C

CONFIDENTIAL. Open to practitioners, young people and parents/carers Health needs that result in special educational needs

Non-educational health needs

[Name]’s social care needs


D

CONFIDENTIAL. Open to practitioners, young people and parents/carers Social care needs that result in special educational needs*

Parental needs to support their child identified by social care assessment

Non-educational social care needs (with consent if appropriate)

* (or require provision for Children and Young People under 18 under 5.2 of the Chronically Sick and Disabled Person Act 1970)



[Name]’s outcomes

Overarching theme: Learning and development / learning skills and moving into employment (change for age group)Summary of learning and development / learning skills and moving into employment needs:

Aspiration:Person centred outcome:

Target Which need is this linked to?

Actions to support this target

By whom?By when?

Does it include: Please specify Provision (F)F G H1 H2


E

CONFIDENTIAL. Open to practitioners, young people and parents/carers Overarching theme: Home and independenceSummary of home and independence needs:




By whom?By when?



CONFIDENTIAL. Open to practitioners, young people and parents/carers Overarching theme: Health and wellbeingSummary of health and wellbeing needs:




By whom?By when?



CONFIDENTIAL. Open to practitioners, young people and parents/carers Overarching theme: Friends, relationships and communitySummary of friends, relationships and community needs:




By whom?By when?




continued

What are the arrangements for reviewing [Name]’s outcomes?

What are the arrangements for setting and monitoring [Name]’s Action Plan?


E


Education placement (only to be completed in final EHCP)

Placement Name:Address:

Contact number:Type:Local authority:

Level of support/banding information


I


[Name]’s personal budget

This section provides information on any Personal Budget that will be used to secure provision in the EHCP and to meet the outcomes detailed in the plan.

Potential Education FundingPotential Health FundingPotential Social Care FundingTotal Indicative Budget

Request for EHCP Personal Budget YES/NOWhere a third party or direct payment request is being made, who is the intended recipient (full responsibility)?

Contact details (if not already known)Name:Role:Address:Telephone:Email:

Personal Budget Details

Outcome

(what do I want to achieve through the

use of budget)

Goods, Service and/or Provision

(how do I intend to use the budget)

Frequency

(how often will I receive goods,

service or provision)

Type

(how do I want the budget organised, third party and/or direct payment)

Source

(education, health, social care and/or own

contributions

Sign off pageEHCP of [NAME] [DATE] [VERSION (v of V)] 15

J


Who can [Name]’s plan be shared with?

Agreeing the planThis plan is agreed by:Name: Role/organisation Signature Date



Appendices


K

CONFIDENTIAL. Open to practitioners, young people and parent/carers NOT PART OF LEGAL EHCP DOCUMENT

[Name]’s Action Plan for [his/her] next steps and short term targets (Completed after EHCP issued)

Next steps / short term targets How will we support [Name] to achieve this? By when? What will success look like?


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