Date Initials/NHS Funding? Reason for referral Outcome (Circle Escort Bag Admitted to Date/Time Comments/issues/successes Time Number (Circle) indication) those that apply) Y/N ID : Returned to home E.G JC Self UTI Ref RITS/GP N 001 Nightingale 4/1/17 Discharge letter not returned 1/1/17 16:00 4455667788 Council Admitted to Ward 17:00 Returned from A&E Self Ref RITS/GP Council Admitted A&E/Ward Returned from A&E Self Ref RITS/GP Council Admitted A&E/Ward Returned from A&E Self Ref RITS/GP Council Admitted A&E/Ward Returned from A&E Self Ref RITS/GP Council Admitted A&E/Ward Returned from A&E Self Ref RITS/GP Council Admitted A&E/Ward Returned from A&E Self Ref RITS/GP Council Admitted A&E/Ward Returned from A&E Self Ref RITS/GP Council Admitted A&E/Ward
Date Time Initials/NHS Number Funding? (Circle) Reason for referral indication) Outcome (Circle those that apply) Escort Y/N Bag ID Admitted to : Date/Time Returned to home Comments/issues/successes E.G 1/1/17 16:00 JC 4455667788 Self Council UTI Ref RITS/GP Admitted to Ward Returned from A&E N 001 Nightingale 4/1/17 17:00 Discharge letter not returned Self Council Ref RITS/GP Admitted A&E/Ward Returned from A&E Self Council Ref RITS/GP Admitted A&E/Ward Returned from A&E Self Council Ref RITS/GP Admitted A&E/Ward Returned from A&E Self Council Ref RITS/GP Admitted A&E/Ward Returned from A&E Self Council Ref RITS/GP Admitted A&E/Ward Returned from A&E Self Council Ref RITS/GP Admitted A&E/Ward Returned from A&E Self Council Ref RITS/GP Admitted A&E/Ward
red_bag_issue_log_and_data_collection_.docx