Care Home - Health and Care Summary Record To be completed when a new resident arrives at a Care Home in Lambeth and Southwark To be reviewed and updated at regular intervals to ensure it is up to date To be included within the Red Bag in an emergency if a resident is being taken to hospital Date of admission to Care Home: This form was initially completed on (DD/MM/YYYY): If information in this form has been updated since the original completion, please note in individual sections Date of birth: Gender: NHS number: Resident’s name: Preferred name: Care home details Next of Kin information: Name: Name: Address: Relationship: Contact details: Unit/floor: Record Is there a legal Power of Attorney for: Health and Welfare?: Yes/No Property and Finance?: Yes/No Name: Name: Contact details: Contact Details: Summary Funding arrangements (CCG/Local Authority/Self-funder/Other)? Care Religion / Spirituality / Culture: and Details of GP (in case clarification required regarding medication, PMH): Health Other key professionals involved in care (please give name, role, and contact details): - Home Is there a current DOLS in place? Yes / No Is there a named or Yes / No IMCA Advocate? If yes, provide a name and contact details: Care Safeguarding Updated on: Are there any ongoing safeguarding concerns? Yes / No Comments / actions:
Care Home - Health and Care Summary Record To be completed when a new resident arrives at a Care Home in Lambeth and Southwark To be reviewed and updated at regular intervals to ensure it is up to date To be included within the Red Bag in an emergency if a resident is being taken to hospital Date of admission to Care Home: This form was initially completed on (DD/MM/YYYY): If information in this form has been updated since the original completion, please note in individual sections Resident’s name: Preferred name: Date of birth: Gender: NHS number: Care Home - Health and Care Summary Record Care home details Name: Address: Unit/floor: Next of Kin information: Name: Relationship: Contact details: Is there a legal Power of Attorney for: Health and Welfare?: Yes/No Name: Contact details: Property and Finance?: Yes/No Name: Contact Details: Funding arrangements (CCG/Local Authority/Self-funder/Other)? Religion / Spirituality / Culture: Details of GP (in case clarification required regarding medication, PMH): Other key professionals involved in care (please give name, role, and contact details): Is there a current DOLS in place? Yes / No Is there a named IMCA or Advocate? Yes / No If yes, provide a name and contact details: Safeguarding Updated on: Are there any ongoing safeguarding concerns? Yes / No Comments / actions:
Health%20and%20Care%20Summary%20Record.docx