Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Patient Details
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Patient Name
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Marital Status
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Date of birth
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Ethnic background
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Religion
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Place of birth
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Current address
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Preferred name
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NHS number
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Next of kin and relationship
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Next of kin address and telephone number
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Care manager and details
PHYSICAL NEEDS
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Overview of medical history and current physical diagnosis
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Current medication
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Allergies
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Elimination needs
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Breathing
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Sleeping
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Waterloo score
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Skin integrity
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Pain
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Sight
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Hearing
Psychiatric diagnosis (present day and history)
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Communication
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Mental health presentation
Abilities and risks
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Personal hygiene and dressing (and possibility of self neglect)
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Eating and drink (including associated risks)
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Mobility and associated risks (falls risk)
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Social abilities and associated risks (behaviours that may effect others)
Spiritual needs
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Religious and spiritual requirement including diet and prayer