Fillable Autism Spectrum Condition This is my Passport (Derbyshire County Council)

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Autism Spectrum Condition This is my Passport (Derbyshire County Council)

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The Autism Spectrum Condition This is my Passport (Derbyshire County Council) form is 6 pages long and contains:

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Country of origin: UK
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This is my
Autism Spectrum Condition
Passport
This passport will help you understand my Autism
Spectrum Condition, as well as the:
Things you MUST know about me
Things that are IMPORTANT to me
My LIKES and DISLIKES
Please consult my passport whilst working with me and
before you do any interventions or referrals for me.
My name is:
This passport belongs to me, please return it
to me when I leave.
This passport has been developed by:
Things you MUST know about me:
Name:
Likes to be known as:
Date of birth:
Address:
Tel:
How I communicate:
Family contact/carer/other support worker:
Relationship e.g. Mum, Dad, social worker, etc:
Their tel:
My ethnicity:
My support needs:
My sensory triggers e.g. noise, light, smells:
Any other professionals involved in my care:
Allergies:
Physical needs:
Learning difficulties:
Mental health needs:
Things that are important to me:
How I prefer to communicate:
Environments I prefer:
How I would like the outcome of today’s
meeting recorded e.g. please write-up
everything we have discussed:
When I get upset/anxious I may:
How to help me when I am upset/anxious:
Abilities that may be affected by my Autism
e.g. my concentration, my memory, my social
conversation:
My Likes and Dislikes:
Things I like: Things I dislike:
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Autism Spectrum Condition This is my Passport (Derbyshire County Council)

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Completed 1 August 2020

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