IHSP Plan — terms — Kindful Restoration

👤 Member Information

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Member—

DOB—

MCI—

Phone—

Language—

Health plan—

Address—

Member data pulled from CRM at plan creation.

Plan period — From

Plan period — To

Referral #

CS Provider / Staff

🏥 Service Type

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Services being provided

🎯 Identified Needs

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Identified needs

🏠 Housing History

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No housing history entries. Click "+ Add entry" to add one.

📊 Current Status

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Current housing and support status

✅ SMART Goals & Interventions

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Specific · Measurable · Achievable · Relevant · Time-bound

Problem

Goal

Interventions

📝 Assessment Plan

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Assessment and plan summary

📋 Documentation Requirements

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Required documentation — check when obtained

✍ Authorization & Signatures

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⚠ This IHSP must be signed by the assigned CHW/staff before submission. Member or guardian acknowledgment is required.

Date of last IHSP update

Auto-filled from most recent save.

Next review due

Recommended: 3 months from today.

CHW / Staff signature

Click to sign →

Staff cell number

Member / Guardian acknowledgment

Signature canvas (draw or send via SMS)

Process Case Notes