INTERPROFESSIONAL CARE FRAMEWORK FOR CONTINUOUS INTERPROFESSIONAL CARE (based on the WHO’s International Classification of Functioning, Disability and Health) Name:

HEALTH CONDITION/S

IMPAIRMENT (BODY FUNCTIONS AND STRUCTURES) ACTIVITY LIMITATION & PARTICIPATION RESTRICTION

Component & Domains Assessment / Change in … Action steps Responsible person(s)

Component & Domains Performance and capacity Action steps Responsible person(s)

Mental functions & structures of nervous system

Learning and applying knowledge

Pain & Sensory functions, structures of the eye, ear & related structures & pain

General tasks and demands (planning, financial management)

Systems and structures involved in voice & speech

Communication (verbal and non-verbal)

Functions and structures of cardiovascular, haematological, immunological & respiratory systems

Mobility (indoors, outdoors, transport)

Functions and structures of digestive, metabolic & endocrine systems

Self-care (personal, health maintenance)

Functions and structures of genitourinary & reproductive systems

Domestic life

Functions & structures of skin & related functions

Interpersonal interactions and relationships (family, intimate, informal)

Neuromuscular & movement-related functions & structures related to movement

Major life areas (education, employment)

Community, social and civic life (community, recreation, leisure, religion)

ENVIRONMENTAL FACTORS PERSONAL FACTORS

Component & Domains Barriers & Facilitators Action steps Responsible person(s)

Component & Domains Positive / negative Action steps Responsible person(s)

Products & technology

Natural environment & human-made changes to environment

Support & relationships (incl. genogram & current relationships

Attitudes

Services, systems & policies

PRIORITY LIST

Action Desired outcome Responsible persons Notes:

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