Changing to new Shift Patterns If your Company is thinking about changing to new Shift patterns. We describe the processes involved to do this. If you have any questions, please call us. click here to see the Changing Shift Patterns Guide

2003 Copyright. All rights reserved.

Tel: (00 44) 1636 816466 Fax: (00 44) 1636 816882 alec@visualrota.co.uk

CDT website: www.visualrota.co.uk

The Old Vicarage, Station Road, Rolleston, Newark, Nottinghamshire, Great Britain, NG23 5SE

PRE-ADMISSION ASSESSMENT

TITLE	FIRST NAME	SURNAME	LOCATION SEEN AT	ASSESSOR
.

ASSESSMENT DATE

DATE OF BIRTH

NAMED NURSE

ADDRESS OF PATIENT		TEL
NEXT OF KIN		RELATIONSHIP
ADDRESS .		TEL

MEDICAL HISTORY

DOCTOR

TEL

DIAGNOSIS
COMMENTS
MEDICATION
ALLERGIC TO

REASON FOR ADMISSION
DSS LA AA
INFORMATION GIVEN
PAST OCCUPATION
MOBILITY
PERSONAL CARE
MENTAL ALERTNESS
ANXIETIES
SMOKING
DIET
CONTINENCE
RELIGION

EQUIPMENT

WHEELCHAIR	ZIMMER	DENTURES TOP	DENTURES BTM	SPECTACLES	HEARING AID
.

OTHER

.

HOSPITAL HISTORY

HOSPITAL

TEL

LAST VISIT
COMMENTS
.
.

Copywrite CDT @ www.visualrota.co.uk Staff Rostering consultancy & software
This chart & Other charts available as word processor templates.
freephone 0800 01VROTA (0187682) email alec@visualrota.co.uk