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Halton & St HelensREFERRAL TO ADULT CONTINENCE PROMOTION SERVICE INCOMPLETE REFERRALS WILL BE RETURNED PATIENT\'S DETAILS Date of referralRequires: New Assessment ? Review ? NameD.O.B. NHS No. GenderAddressPostcodePatient
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How to fill out halton-adult-continence-referral-formdoc

01
To fill out the halton-adult-continence-referral-form.doc, follow these steps:
02
Open the form in a word processing software like Microsoft Word.
03
Begin by entering the current date of referral in the designated field.
04
Fill in the patient's personal information, such as their name, address, phone number, and date of birth.
05
Provide relevant medical history details, including any previous diagnosis, treatments, or surgeries related to incontinence.
06
Indicate the type of incontinence the patient is experiencing, such as stress incontinence, urge incontinence, or overflow incontinence.
07
Specify any medications the patient is currently taking for incontinence, along with dosage information.
08
Include information about any other healthcare professionals involved in the patient's care for incontinence.
09
Describe the patient's symptoms and how they impact their daily life.
10
If the patient has any specific concerns or preferences regarding their treatment, mention them in the form.
11
Finally, sign and date the form to complete the referral process.
12
Ensure that all the information provided is accurate and up-to-date before submitting the form.

Who needs halton-adult-continence-referral-formdoc?

01
The halton-adult-continence-referral-form.doc is needed by individuals who require specialized evaluation and management for adult continence issues.
02
These may include adults who experience urinary incontinence (involuntary leakage of urine) or fecal incontinence (involuntary bowel movements).
03
The form is necessary for those seeking referral to a healthcare professional or clinic specializing in adult continence care.
04
It helps ensure that the appropriate information is collected and shared to facilitate the assessment and potential treatment of the individual's condition.
05
Anyone who believes they may benefit from specialized continence care can utilize the halton-adult-continence-referral-form.doc.

What is Halton-Adult-Continence-Referral-.doc Form?

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It is a form used for referring adults for continence services in Halton.
Healthcare providers and professionals responsible for the care of adults with continence issues.
The form can be filled out by providing relevant patient information, medical history, and details of the continence issues.
The purpose is to facilitate the referral process for adults requiring continence services in Halton.
Patient demographics, medical history, current continence issues, and any relevant treatment received.
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