NHS CONTINUING CARE ABOUT THE CHILD OR YOUNG PERSON EQUALITY MONITORING – Please provide us with some information the child or young person this application relates to. This will help us to understand whether everyone is receiving fair and equal access to NHS Continuing Care. All the information you provide will be kept completely confidential. No identifiable information about you will be passed on to any other bodies, members of the public or press. 1 What is your sex? Tick one box only. 4 What is your ethnic group? Male Tick one box only. Female A White Transgender British Irish Any White background, write below 2 Which age group applies to you? Tick one box only. B Mixed 0 White and Black Caribbean 1-4 White and Black African 5-9 White and Asian 10-14 Any other Mixed background, write below 15-17 18 + C Asian, or Asian British Indian Pakistani Bangladeshi 3 Do you have a disability as defined by the Any other Asian background, write below Disability Discrimination Act (DDA)? Tick one box only. D Black, or Black British The Disability Discrimination Act (DDA) defines Caribbean a person with a disability as someone who has a African physical or mental impairment that has a Any other Black background, write below substantial and long-term adverse effect on his or her ability to carry out normal day to day E Chinese, or other ethnic group activities. Chinese Any other, write below Yes No
NHS CONTINUING CARE ABOUT THE CHILD OR YOUNG PERSON – EQUALITY MONITORING Please provide us with some information the child or young person this application relates to. This will help us to understand whether everyone is receiving fair and equal access to NHS Continuing Care. All the information you provide will be kept completely confidential. No identifiable information about you will be passed on to any other bodies, members of the public or press. 1 What is your sex? Tick one box only. Male Female Transgender 2 Which age group applies to you? Tick one box only. 0 1-4 5-9 10-14 15-17 18 + 3 Do you have a disability as defined by the Disability Discrimination Act (DDA)? Tick one box only. The Disability Discrimination Act (DDA) defines a person with a disability as someone who has a physical or mental impairment that has a substantial and long-term adverse effect on his or her ability to carry out normal day to day activities. Yes No 4 What is your ethnic group? Tick one box only. A White British Irish Any White background, write below B Mixed White and Black Caribbean White and Black African White and Asian Any other Mixed background, write below C Asian, or Asian British Indian Pakistani Bangladeshi Any other Asian background, write below D Black, or Black British Caribbean African Any other Black background, write below E Chinese, or other ethnic group Chinese Any other, write below
2016_staffs_and_sot_dst_use_8_7_16.docx