Republic of the Philippines

JH Cerilles State College

Bachelor of Science in Social Work
Province of Zamboanga del Sur
Municipality of San Miguel
-oOo-

Date : ____________
Case Number: ____________

SOCIAL CASE STUDY REPORT

I. IDENTIFYING INFORMATION

Name of Client :
Household ID Number :
Sex :
Age :
Date of Birth :
Place of Birth :
Civil Status :
Religion :
Educational Attainment :
Address :
Occupation :
Monthly Income :
Work experiences :
Skills :
Membership in Organization :
Ethnicity :
Contact Number :
Case Category :

II. FAMILY COMPOSITION

Name Age Birthdate Educational Relation to Occupation Monthly Skills

Attainment Client Income

III. SOURCES OF INFORMATION

From the Client:
From the Neigboor:

- (name of source of information and relationship to the client)

 IV. PRESENTING PROBLEM
a. Circumstances of contact and purpose
b. Presenting problem and consequences
c. Plans for resolution of problem

V. BACKGROUND INFORMATION
a. Family history circumstances and information of marriage, present
situation
b. Place of origin
c. Work/ Income history (past and current)
d. Information of birth and education/ Health status of children
e. Efforts to improve conditions and effects

VI. ASSESSMENT
a. Overall situation, level of well-being/ problem identified and cause and
effect relationship
b. Strength and resources
c. Capacities and resources of the client, family and community
d. Observation about how the client functions

VII. RECOMMENDATION
Summary of actions to address the presented and identified problems

Prepared by:

DARLENE DARYL SALADAGA-NAYO,RSW,MSW

Instructor-I
TREATMENT PLAN/INTERVENTION PLAN

Objectives Activities Time Frame Person Expected

Responsible Output

Prepared by:

DARLENE DARYL SALADAGA-NAYO, RSW, MSW

Instructor -I