Notification of reconfiguring services or building a new hospital 1. Premises Legal entity name Premises name 2. Proposal description Please tick the box or boxes that best describes your proposal. Increase in patient client capacity the transfer current clinical services a new build Please describe the proposal. 3. Services and bed numbers Please provide details of services and bed numbers in the table below. Service type Existing bed Proposed changes Proposed final bed numbers to bed numbers numbers Hospital Services Medical services – Hospital Services - Child Health Hospital Services Mental Health – Hospital services Maternity – Hospital Services Surgical – Residential Disability Services Physical – Residential Disability Services Sensory – Residential Disability Services Intellectual – Residential Disability Services Psychiatric – Hospital/rest home (dual service) Hospital services Geriatric (excluding psychogeriatric) – Hospital services Geriatric (psychogeriatric) – Secure Dementia care Rest home care (excluding secure dementia care) Total bed numbers 4. Contact Person to do with changes
Notification of reconfiguring services or building a new hospital 1. Premises Legal entity name Premises name 2. Proposal description Please tick the box or boxes that best describes your proposal. Increase in patient client capacity the transfer current clinical services a new build Please describe the proposal. 3. Services and bed numbers Please provide details of services and bed numbers in the table below. Service type Existing bed numbers Proposed changes to bed numbers Proposed final bed numbers Hospital Services – Medical services Hospital Services - Child Health Hospital Services – Mental Health Hospital services – Maternity Hospital Services – Surgical Residential Disability Services – Physical Residential Disability Services – Sensory Residential Disability Services – Intellectual Residential Disability Services – Psychiatric Hospital/rest home (dual service) Hospital services – Geriatric (excluding psychogeriatric) Hospital services – Geriatric (psychogeriatric) Secure Dementia care Rest home care (excluding secure dementia care) Total bed numbers 4. Contact Person to do with changes
healthcert-notification-reconfiguring-services-building-new-hospital-form-mar18.docx