Is this causing the client any problems? Do they have a desire to stop? (yes to all generate referral) (Free Text) How many units of alcohol a week?............................................... (trigger Bromley assessment) Is this causing the client any problems? Do they have a desire to stop? (yes to all generate referral) (Free Text) Smoking Status: Never / Ex-Smoker / Current: <10 a day / 10-19 a day / >20 a day Physical Is the patient immobile? YES NO Please tick the correct response If YES, Waterlow Score:……………… Has the patient had any problems with their eyes recently? YES NO (Document details and incorporate in care plan) (Free Text) Does the patient require any aids for hearing, sight, mobility, eating or other? YES NO (Document details and incorporate in care plan) (Free Text) Has the patient had any problems with their teeth recently? YES NO (Document details and incorporate in care plan) (Free Text) Does the patient have any problems passing urine or with their bowel movements? YES NO (Document details and incorporate in care plan) (Free Text) Does the patient have any Sexual Health problems or concerns? YES NO
Is this causing the client any problems? Do they have a desire to stop? (yes to all generate referral) (Free Text) How many units of alcohol a week?............................................... (trigger Bromley assessment) Is this causing the client any problems? Do they have a desire to stop? (yes to all generate referral) (Free Text) Smoking Status: Never / Ex-Smoker / Current: <10 a day / 10-19 a day / >20 a day Physical Is the patient immobile? YES NO Please tick the correct response If YES, Waterlow Score:……………… Has the patient had any problems with their eyes recently? YES NO (Document details and incorporate in care plan) (Free Text) Does the patient require any aids for hearing, sight, mobility, eating or other? YES NO (Document details and incorporate in care plan) (Free Text) Has the patient had any problems with their teeth recently? YES NO (Document details and incorporate in care plan) (Free Text) Does the patient have any problems passing urine or with their bowel movements? YES NO (Document details and incorporate in care plan) (Free Text) Does the patient have any Sexual Health problems or concerns? YES NO
CNWL%20(7305)%20Shine%202014%20Final%20Report%20for%20website.docx