This gives hospital staff important information about YOU

Please take it with you if you have to go into hospital

Ask the hospital staff to keep it with your nursing notes

Make sure that all the nurses who lookafter you read it

ALL NURSES and MEDICAL STAFFMUST READ

The Policy on Supporting People with Learning Disabilities in

Lancashire Teaching Hospital Settings

HOSPITAL INFORMATIONfor people with learning

disabilities

Date completed: ……………………………….

Completed by: …………………………….………………………..

Relationship/Designation: ………………………………………..

RED

AMBER

GREEN

RED ALERT - Things you must know about me

My name:……………………………………………………………………………………………..

Telephone number:………………………………………….

Date of Birth:……………………….. NHS number:…….……………………

My religion:……………………………………………………………………

Name of Doctor: Dr……………………………… Practice:……………………………..

Contact number:……………………………………………

If you need to contact someone who knows me really well please contact:

Name: …………………………………………….. Relationship: …………………………………

Contact Number: ………………………………………………

Heart (heart problems):

Breathing (respiratory problems):

Choking:

Allergies:

Current Medication:

Brief Medical History:

Level of communication/comprehension:

Medical Interventions – how totake my blood, give injections,medication, BP etc.

PainHow you know I am in pain

AMBER - Things that are really important to me

Communication/Information SharingHow to communicate with me, how to help me understand things

Seeing/HearingHow to communicate with me, how to help me understand things

Eating (swallowing)Food cut up, choking, help with feeding

Level of Support

Who needs to stay and how often

Drinking (swallowing)Small amounts, choking

Moving aroundPosture in bedWalking aids

Going to the ToiletContinence aids, help toget to the toilet

Taking MedicationCrushed tablets, injections, syrup

Sleepingsleep pattern/routine

Keeping safeBed rails, sitting, controllingbehaviour, absconding

Personal careDressing, washing, dentures,glasses, hearing aid etc.

Not feeling myselfIf I am bored, upset, worried,lonely or need some attention

GREEN - Things I would like to happenLikes and Dislikes

THINGS I LIKE

Please do this:

THINGS I DONOT LIKE

Don’t do this:

Think about - what upsets you, what makes you happy, things you liketo do; i.e. watch TV, reading, listening to music. How you want people

to talk to you (don’t shout). Food likes and dislikes. Physical touch,restraint, special needs, routines and things that keep you safe

Developed by Preston Primary Care NHS Trust, adapted from the original produced by Gloucestershire Partnerships NHS Trust