Your Details First Name * Last Name * Who are you prescribing on CCG (Health) East and North Herts - C1 behalf of ? * CCG (Health) and West Herts - C2 Please select which Geographical area CCG (Health) Cambridge and Peterborough - C3 you work in, pertinent to your Health and Community Services (HCC) E & N Herts - H1 employer, or the Agency you are Health and Community Services (HCC) S & W Herts - H2 employed by. Tick ONE box only See and Solve East and North Herts - S1 See and Solve South and West Herts - S2 Hertfordshire Community Trust Childrens Services - L1 Hertfordshire Partnership Foundation Trust (HPFT) P1 – Care by Us Agency - AC, Goldsborough Care Agency - AG Hertfordshire Action on Disability Agency - AH CCG - Out of County (Health Only) - C0 Sensory Services These are the ONLY Options available Main area of Work * Children - C Please indicate the type of work you Health - H undertake Hospice - O Tick ONE box only. Learning & Physical Disabilities - L Mental Health - M Older People - P Social Care S – Sensory (Agency - As above) Community or Hospital Community - C based * Hospital - H Community or Hospital based (Hospice Staff please select Hospital) Tick ONE box only. Job Category * Admin - ARO Please choose one of the categories Community Care Officer - CC which closely reflects your role. This is Learning & Physical Disabilities (Qualified) - LQ relative to what type of equipment you Learning & Physical Disabilities Assistant - LA order. We are attempting to keep the number of different job titles to a Mental Health (Qualified) - MQ minimum Mental Health Assistant - MA Tick ONE box only. Nursing (Qualified) - NQ Nursing Assistant NA – Sensory Services Professional Social Worker - SW Occupational Therapist (Qualified) - TQ Physiotherapist (Qualified) - PQ Therapy Assistant TA – These are the ONLY Options available Full Email Address * Working days and hours * Office Telephone Number (Direct Line NOT Call centres) *
Your Details First Name * Last Name * Who are you prescribing on behalf of ? * Please select which Geographical area you work in, pertinent to your employer, or the Agency you are employed by. Tick ONE box only CCG (Health) East and North Herts - C1 CCG (Health) and West Herts - C2 CCG (Health) Cambridge and Peterborough - C3 Health and Community Services (HCC) E & N Herts - H1 Health and Community Services (HCC) S & W Herts - H2 See and Solve East and North Herts - S1 See and Solve South and West Herts - S2 Hertfordshire Community Trust Childrens Services - L1 Hertfordshire Partnership Foundation Trust (HPFT) – P1 Care by Us Agency - AC, Goldsborough Care Agency - AG Hertfordshire Action on Disability Agency - AH CCG - Out of County (Health Only) - C0 Sensory Services These are the ONLY Options available Main area of Work * Please indicate the type of work you undertake Tick ONE box only. Children - C Health - H Hospice - O Learning & Physical Disabilities - L Mental Health - M Older People - P Social Care – S Sensory (Agency - As above) Community or Hospital based * Community or Hospital based (Hospice Staff please select Hospital) Tick ONE box only. Community - C Hospital - H Job Category * Please choose one of the categories which closely reflects your role. This is relative to what type of equipment you order. We are attempting to keep the number of different job titles to a minimum Tick ONE box only. Admin - ARO Community Care Officer - CC Learning & Physical Disabilities (Qualified) - LQ Learning & Physical Disabilities Assistant - LA Mental Health (Qualified) - MQ Mental Health Assistant - MA Nursing (Qualified) - NQ Nursing Assistant – NA Sensory Services Professional Social Worker - SW Occupational Therapist (Qualified) - TQ Physiotherapist (Qualified) - PQ Therapy Assistant – TA These are the ONLY Options available Full Email Address * Working days and hours * Office Telephone Number (Direct Line NOT Call centres) *
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