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Page 1 of 1DENTAL REFERRAL and Declarations is available via website www.charityhospital.org.nz This form can be faxed, posted or delivered. PATIENT DETAILS
Family name ___ First name ___
D.O.B___FemaleMalePatients
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Create a daily routine to ensure consistent care and support.
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Who needs cerebral palsyliving with paralysis?
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What is cerebral palsy living with paralysis?
Cerebral palsy is a group of disorders that affect movement and muscle coordination. Living with paralysis means experiencing a loss or impairment of motor function.
Who is required to file cerebral palsy living with paralysis?
Individuals who have been diagnosed with cerebral palsy and are living with paralysis are required to file.
How to fill out cerebral palsy living with paralysis?
Individuals can fill out the necessary forms provided by healthcare providers or disability services with information about their diagnosis and level of paralysis.
What is the purpose of cerebral palsy living with paralysis?
The purpose is to document and track the condition of individuals with cerebral palsy living with paralysis for medical and support purposes.
What information must be reported on cerebral palsy living with paralysis?
Information such as diagnosis of cerebral palsy, level of paralysis, any treatments or therapies received, and any assistive devices used must be reported.
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