The Care Plan is a document developed by the Interdisciplinary team and client collaborate in the creation of longitudinal treatment plans. It is a frequent tool used to improve the quality of the patient care in home living, supportive living and long term care settings.

The care plan must reside in the client's record (in paper format or electronic), and must be create in collaboration with the client, and shared with other health care providers involved in their care. Plans typically include a problem list (e.g. unmet care needs), measurable treatment goals by using standardized assessments, a symptom management plan, a list of active medications, recommended community services, interventions and a schedule for periodic review.

These resources are applicable to all Care Streams unless stated in the title of the document.

Interdisciplinary Team Conference

• CCHSS Care Plan Requirements
• Interdisciplinary Team Conference Checklist for Home and Community Care & Type B Continuing Care Homes
• Interdisciplinary Team Conference Checklist for Type A Continuing Care Homes
• Interdisciplinary Team Conference Form (Sample)
• Practice Guide Using interRAI Assessments (Timelines)

Public Guardian & Trustee

• Adult Guardianship and Trusteeship Act
• Alberta Office of the Public Guardian
• Decision Making & Health Care Planning
• Guide to Capacity Assessment under the Personal Directives Act
• Personal Decision Making