Alzhemier Society Peel's Music Therapy Assessment
Life Experiences/History
Name: {{userinfo.name}}Date of Birth: {{userinfo.date_of_birth}}
Locations: {{userinfo.location|join:", "}}
Country of Origin: {{userinfo.country_of_origin}}
Language Spoken: {{userinfo.language_spoken}}
Care Plan: {{userinfo.care_plan}}
ASP Level: {{userinfo.asp_level}}
Diagnosis: {{userinfo.diagnosis}}
History: {{userinfo.history}}
Musical History: {{userinfo.musical_history}}
Music Preferences
Favourite Composer: {{musical_preferences.fav_composer}}Favourite Song: {{musical_preferences.fav_song}}
Favourite Instrument: {{musical_preferences.favourite_instrument}}
Preferred Styles:
{%if musical_preferences.preferred_style%}{{musical_preferences.preferred_style|join:", "}}
{% endif %} Other Styles: {{musical_preferences.other_style}}
Ethnic Music: {{musical_preferences.ethnic}}
Sacred Music: {{musical_preferences.sacred_music}}
{% endif %} Other Styles: {{musical_preferences.other_style}}
Ethnic Music: {{musical_preferences.ethnic}}
Sacred Music: {{musical_preferences.sacred_music}}
Domain Measurable Summaries
{%for domain, domain_data in summary.items%} {% if domain_data %}{{domain}}
| {% for assessment in domain_data.data %} | {{assessment.Updated}} | {% endfor %} {% for field in domain_data.fields %}|
|---|---|---|
| {{field}} | {% for assessment in domain_data.data %} {% if assessment|getattrib:field == '--' or field == 'Updated'%}{{assessment|getattrib:field}} | {% else %}{{assessment|getattrib:field|floatformat:2}} | {% endif %} {% endfor %}
{% for domain, domain_data in domain_measurables.items %}
{% if domain_data %}
{% endif %}
{% endfor %}
{{domain}} Assessment - {{domain_data.date}}
{% for subdomain, measurables in domain_data.items %}
{% if subdomain != "Notes" and subdomain != "date" %}
{% endfor %} {% endif %}
{{subdomain.name}}
{% for measurable in measurables %}
{% if measurable.measurable.name and measurable.value != -1 %}
{{measurable.measurable.name}}: {{measurable.get_value_display}}
{% endif %} {% endfor %}
{% endif %}
{% endfor %}
{% if domain_data.notes %}
Notes:
{% for note in domain_data.notes %}
{{note.note}}{% endif %} {% endfor %}
{% endfor %} {% endif %}
Music Therapist Signature:
Date: {{ date }}