Applicant's first name:
*
Age:
NHS Number: We will use this to prepare your hospital passport. This is deemed mandatory by the local authority to offer this but you do not need to agree. If you don't wish a hospital passport to be completed for you, please state so here.
Applicant's surname:
*
Home Address:
*
Buddies preferred name: This may be your full name or a version / identification you have.
Service user’s cognitive or physical difficulties/disabilities.:
Responsible adult care worker / social worker: Name, telephone, team
Service users Gender preference for personal care: To protect the dignity,of the S.U. and respect their needs and wishes, thy may prefer same sex staff to support them with personal care
Gender identification: When we use pronouns like “she” or “he” to identify a person without asking them what pronouns they use, we may be making an assumption about that person’s gender that differs from their gender identity. Some people express their gender in a non-binary way and use pronouns such as they/them or ze/hir/hirs. People who look to be one gender to you may identify as another gender.
What support services are presently being accessed or provided: Please let us know of any services currently attended and any previous services. You may wish to add why these are not giving the full range of support and outcomes you would want or expect
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Person ID: This will be 5 to 6 numbers, no letters
Carers View: Please record your own view of the person and what they need to get the most out of Buddies Day Service. This could include the level of support needed, best interventions, communiation support, what works well and what does not.
Adult Conversation: If you are using a personal budget, these details will be in the Care Plan. If you have a copy then we will be happy to complete this from a copy of the care plan. If this is a comissioned service, we will already have your care plan ad will complete this section for you.
This is who I am and what is important to me: This should be a brief description of the type of person you are, the tings you like to do, the people that are important to you and your communication, medication, nuttrition needs (including chewing and swallowing), personal hygiene support requirements, safety in the community, triggers that will cause an emotional reaction (not just challenging behaviour but situations that might frighten or result in emotional upset)
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Initial assessment of care needs based on clinical diagnosis:
Social Worker conversation: Copy of statement of need
Local authority assessment: Copy of the details recorded by carers in assessment of needs
Lead professionals views: Copy of lead professionals statement