个案服务记录表

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1、表5-1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、基本资料姓名性别年龄籍贯婚姻状况联系电话职业学历联系地址个案来源：□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______________________________________________________________________________________________________________________________________

2、_____________________________________________________________________________________________________________3、案主问题分析_________________________________________________________________________________________________________________________________________________________________

3、___________________________________________________________________________________________________________________________________________________________________二、服务计划：（一）服务目标_____________________________________________________________________________________________________

4、______________________________________________________________________________________________________________________________________________（二）介入策略_________________________________________________________________________________________________________________________________

5、_________________________________个案服务记录表第3页共3页三、计划实施过程第阶段服务时间：地点：接触方式：服务目标：过程记录专业反思本次服务总结：下次服务计划：第阶段服务时间：地点：接触方式：服务目标：过程记录专业反思本次服务总结：下次服务计划：注：根据服务次数，自行增加表格。个案服务记录表第3页共3页四、案例评估_______________________________________________________________________________________________________

6、_____________________________________________________________________________________________________________________________________________________________________________________________________________________________五、专业反思___________________________________________________

7、______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

8、______________________________________________________