Social Case Study Report
I. Identifying Information
Name:
Age:
Sex:
Civil Status:
Date of Birth:
Place of Birth:
Religion:
Tribe:
Monthly Income:
Type of Client: (Walk-in, Reached Out, Transferred, Referred, Involuntary)
Sources of Information:
Primary: The Client
Secondary: Significant Others
Tertiary: Existing Data (School, Medical, Barangay, and Police Records if applicable)
II. Family Composition
Name Sex Civil Status Relationship Occupation Monthly
to Client Income
Note: Please include the client in the table. The order must be from eldest to youngest family member
III. Problem Presented
Client’s Name, The Problem, The Cause
IV. Background of the Problem
Why the problem exists
V. Client’s Background
A. The Client
B. The family
C. The Environment
VI. Assessment Statement
Opening Causal
Change Potential
Professional Judgement
VII. Goal: SMART
VIII. Intervention Plan
Objectives Activity Resources Persons Time Frame Expected
Needed Involved Outcome
Note: Only activities that corresponds to the client’s problem must be included in this table.
IX. Evaluation
What is the client’s condition, before and after the services were given. Include the outcomes of your
interventions indicated on your intervention plan.
X. Recommendation
XI. Termination/ Continuation
Note: Terminate if the goal is achieved, continue if the intervention/s is/are still “ongoing”