Lead Clinician Name Professional Role: Registration Number Signature Date: Others included in the decision making. (also see p 14) Young Person (if appropriate; optional) (to ensure their opinions have been included in the decision making) Name Signature Date Person/ Persons with parental responsibility (see page 4) (to ensure their opinions have been included in the decision making) Name Signature Role Date 1 2 3 4 Other 1 2 3 Clinicians have a duty to act in a patient’s best interests at all times. If a parent or legal guardian is present at the time of their child’s collapse, they may wish to deviate from the previously agreed plan and under these circumstances their wishes should be respected, provided they are thought to be in the best interests of the child/ young person. The child/young person or parents /guardian can change their mind about any of the preferences on the care plan at any time. Additional Notes To ensure that the information this child has an advanced care plan can be shared with the emergency department and added to the special register on PAS please email the document to Dr Vanessa Holme, Consultant Paediatrician ().
Lead Clinician Name Professional Registration Number Role: Signature Date: Others included in the decision making. (also see p 14) Young Person (if appropriate; optional) (to ensure their opinions have been included in the decision making) Name Signature Date Person/ Persons with parental responsibility (see page 4) (to ensure their opinions have been included in the decision making) Name Signature Role Date 1 2 3 4 Other 1 2 3 Clinicians have a duty to act in a patient’s best interests at all times. If a parent or legal guardian is present at the time of their child’s collapse, they may wish to deviate from the previously agreed plan and under these circumstances their wishes should be respected, provided they are thought to be in the best interests of the child/ young person. The child/young person or parents /guardian can change their mind about any of the preferences on the care plan at any time. Additional Notes To ensure that the information this child has an advanced care plan can be shared with the emergency department and added to the special register on PAS please email the document to Dr Vanessa Holme, Consultant Paediatrician ().
CYPACP-East-Lancs-Hosp-Trust-v1.1-no-macro.docx