PEER SUPPORT Peer Support Interaction "*" indicates required fields Peer Supporter * Required Name of Peer Supporter.Client Name * Required Name of Client being supported.Date of Interaction * Required DD slash MM slash YYYY Date peer support interaction occurred.Follow up date * Required DD slash MM slash YYYY The next appointment date occurs.Duration (Minutes) * Required The amount of time taken for the interaction (in minutes).Travel (Km) Mileage travelled in km, if any.Interaction Type * RequiredOne-on-one interactionEmailGroup discussionFormal MeetingCommunication via social mediaCommunication via direct messagingPhone callVideo callUpdateOtherHow the client was contacted.Interaction Location * RequiredBedside – patient in bedBedspace – patient seatedWard public spaceWard treatment areaOutdoors at Spinal UnitPeer support officePerson’s homeCommunity settingRehab gymOtherWhere the interaction occured.Family Present * RequiredNoYesFamily onlyProvider/Clinician onlyWere family present at the interaction?Topics Covered * RequiredGeneral chatApplication supportBedrestBladderBowelsDischargeEquipmentFatigueFunder processesFutureGoal SettingInjury mechanismMedical issuesModificationsMood/Mental health informationOuting/Community integrationPainPre SCIRehabilitation processesSex/RelationshipsSpasmsTeaching Problem SolvingTransfersTransitional rehabVehicleVocational issuesW/C skillsWounds and pressure areasOther Topics covered during interaction.Notes (optional)General notes about the interaction. Δ
