Disability Services Case Closure Assessment
Client Name
Client ID / Reference
Date of Assessment
Case Information
Case Start Date
Case Closure Date
Reason for Closure
Goals Achieved
Client Withdrew
Service No Longer Required
Transferred to Another Service
Other
Goals & Outcomes
Summary of Goals Set
Evaluation of Outcomes Achieved
Unmet Needs
Recommendations
Recommended Follow-up or Referral
Additional Comments
Assessor Name
Assessor Position
Signature