Assist with toileting
Select appropriate clothing
Ensure hearing aid is in
Brushes teeth and wash face

Notes:

• Loud or sudden noises
• Being rushed or feeling overwhelmed
• Changes in routine
• Being left alone for long periods

• Listening to 1950’s music
• Stroking his hand
• Spending time in the garden

• Feeling the sun on my face
• Blowing bubbles
• Coloring

• Learning to write numbers
• Making a new friend
• Helping out with small pets
• Swimming real fast

• Personal hygiene - see 'brushing my teeth' video: https://youtu.be/MvaZ4cQ33tI
• Transitioning between activities
• Fixing my own sandwich

• My headphones
• My stuffed animal dog

• Sam identifies as male

• Sam has a strong Irish background

• Sam is Catholic

• Autism
• Attention deficit with hyperactivity

• Abilify
• Ritalin
• No longer taking Concerta

• Sam is in the 3rd grade in special education classes.
• He attends Westbook elementary school.
• His teacher is Miss Jones.
• He has an IEP.

• If Sam is engrossed in an activity, he might forget to use the bathroom until it’s too late.
• Sometimes he neglects to zip his fly.

• Sam is lactose intolerant and should not have dairy products.
• Sam does not like more than 1 food on his plate at a time.
• He likes to eat one thing at a time.

• Sam likes to sleep with 3 blankets or a heavy weighted blanket.
• If he has trouble falling asleep, play the video of his sister singing, “You are my Sunshine”:

• Sam is not allowed visits with his biological father.
• Sam should not have more than 30 minutes of screen time each day.

• IEP
• Safety Plan
• Consent to Treat

• Irritable bowel

• Omeprazole
• Stool softener

• HyVee on Fisher's Road, (913) 123-4567
• Sam should not have more than 30 minutes of screen time each day.

• Medication Court Order
• Immunization Record
• Consent to Treat