SOCIAL CASE STUDY REPORT

I. Identifying Data

Name or Nickname: “PATCHO”

Age: 17 years old
Date of Birth: April 18, 2005
Place of Birth: Urdaneta City
Gender: Male
Civil Status: Single
Religion: Roman Catholic
Highest Educational Attainment: Grade 11 (In school youth)
School: Urdaneta City National High School
Address: Zone 1, San Jose, Urdaneta City Pangasinan
Contact numbers: N/A
Case category: CICL

II. Source of Referral:

The client was referred by the CSWDO of Urdaneta City, who was in the custody of the Bahay Pag- Asa
Center.

A. Primary :
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B. Secondary :
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C. Existing Data :
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III. Family Composition:

Name Relationsh Ag Sex Civ Highest Occupation Month Religio

ip with the e il Educationa ly n
Client Stat l Incom
us Attainment e
Manoy Benitez Father 45 Marri College Medical Roman
M ed Graduate Representativ Catholi
e c
Raquel Benitez Mother 43 Marrie High School None Roman
M d Graduate Catholi
c
Marco Benitez Brother 18 Single In School N/A
M
Miguel Benitez Brother 10 Single In school N/A
M

IV. Problem Presented

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V. Background Information

A. Problem
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B. Client
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C. Family Background
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D. Community
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VI. ASSESSMENT
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VII. PLAN INTERVENTION

Goal:
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Target Area Objectives Action plan Time Resources Responsible Expected

Frame needed Person/Agency Output
VIII. RECOMMENDATION/ EVALUATION:
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Prepared by:

(NAME AND SIGNATURE OF PRACTITIONER)

Social Work Practitioner

Checked and reviewed by:

(Name and Signature of Supervisor) (Name and Signature of Supervisor)

Agency Supervisor School Supervisor