The Relationship Map should be completed by the individual and as many informants as necessary to develop a complete picture of an individual's support system and then combined to develop a comprehensive Relationship Map. Complete the blocks provided as follows:

Inner block:	Individual's name.	Fourth block:	People the individual knows and does things with occasionally.

Second block:	Individuals closest to the individual - family and intimate friends.	Fifth block:	People the individual knows casually; acquaintances.

Third block:	Friends; people the individual likes and does things with regularly.	Sixth block:	People whose job it is to be with the individual (dr, staff, etc).

Go over the information with the individual on Intake, obtain signatures and submit to the Program Administrator. For Annual and Quarterly Reviews, use this information for reference only and have the client sign the Topics form as proof the client received this information. Provide a copy if the client wants one.
Individual	Signature	Date
Individual
Guardian/Representative
Staff
relmap 06-04