All items must be filled out completely. All Individual Written Rehabilitation Programs (IWRPs) must be typed. Client name and board number are required when submitting an IWRP. Any IWRP lacking completeness will be returned to the provider with a request from the RRO indicating what items need to be completed.

1.) EMPLOYMENT GOAL:

Check off only one employment goal. If it needs to be changed in the future, use the IWRP Amendment Form.

2.) WAGE INFORMATION:

Include all appropriate information.

3.) COMPLETION DATE:

Record estimated date when all services will be completed. (This will usually be the end date of the 60 days Post Placement Activity Follow-up).

4.) VOCATIONAL GOAL:

Multiple vocational rehabilitation goals may be listed. [ Ex. (page 1 of IWRP) "Accountant and related occupations". Job title of the related occupations must be recorded in the narrative section of IWRP. If employment is obtained in one of the related occupations a plan amendment must be filed.]

5.) FUNCTIONAL LIMITATIONS:

Describe and list client's functional limitations as stated by the treating, evaluating and/or impartial physician.

6.) TRANSFERABLE SKILLS:

List the actual skills learned/performed on the job that can be used in another job.

7.) ESTIMATED COST:

List the estimated total cost for each service and hours involved. Do not merely list your hourly fee.

8.) PROGRAM JUSTIFICATIONS:
 

a. Client Profile-work history, education, disability, limitations, abilities, interests, diagnosis, prognosis, treatment, etc..

b. Justify why the employment goal chosen is appropriate and why the others are not. Record the following statements and answer:

Return To Wwork (RTW) same employer, same job modified is not possible because…… (explain)

RTW same employer, different job is not possible because…… (explain)

RTW different employer, similar job is not possible because ….. (explain)

RTW different employer, different job is not possible because ….. (explain)

Retraining is not possible because ….. (explain)

(c) Describe details on how each service will be provided.

(d) Describe and delineate client and provider responsibilities.

( Ex. "Counselor will be responsible for making all arrangements to start school in the Fall. Client will be responsible for daily attendance, maintaining a C average and contacting the counselor once every two weeks," etc.)

(e) Record exact job modification(s), if any.

(f) Summarize why the VR service(s) selected will help achieve the vocational goal.

(g) Justify the job demand by recording results of market research in clients' immediate geographical area.