Please list the name(s) of the practice nurse(s) who work in your practice: Tick this box if you have no practice nurses Name of Practice Nurse(s) Gender Languages Sessions or half Days of week Willing and (M/F) spoken days worked/ worked interested than English) week (M,T,W,T,F,S) to participate (Y or N) Please list the name(s) of the Practice Manager(s) who work in your practice: Practice Manager(s) Name Gender (M/F) Authorised to give overall consent (Y or N) Please list the name(s) of the receptionist & administrative staff who work in your practice: Tick this box if you have no reception or administrative staff Receptionist or Gender Languages Sessions or Days of Willing Administrative staff (M/F) spoken half days week and member’s Name worked/week worked interested to participate (Y or N) 1. 2. 3. 4.
Please list the name(s) of the practice nurse(s) who work in your practice: Tick this box if you have no practice nurses Name of Practice Nurse(s) Gender (M/F) Languages spoken than English) Sessions or half days worked/ week Days of week worked (M,T,W,T,F,S) Willing and interested to participate (Y or N) Please list the name(s) of the Practice Manager(s) who work in your practice: Practice Manager(s) Name Gender (M/F) Authorised to give overall consent (Y or N) Please list the name(s) of the receptionist & administrative staff who work in your practice: Tick this box if you have no reception or administrative staff Receptionist or Administrative staff member’s Name Gender (M/F) Languages spoken Sessions or half days worked/week Days of week worked Willing and interested to participate (Y or N) 1. 2. 3. 4.
Appendix%2013_HeLP%20GP%20Practice%20Profile%20V1.1%2024102017.docx