ABSTRACT

188 189 190 191 192 193 194 195 196 197 198 Confidential Patient Information

Patient Name (or attach ID Label)

Hospital/NHS Number

Date of Birth

Address

Email

Home Telephone Number

Work Telephone Number

Mobile Telephone Number

ALL STAFF SIGNING FOR CARE MUST RECORD BELOW DETAILS OF THEIR FULL NAME, POSITION AND SAMPLE SIGNATURE

POSITION

FULL NAME

SIGNATURE

INITIAL

EXT

Date of Initial Assessment

Date of Follow-Up Appointment

1.

2.

3.

4.

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CNS

Clinical Nurse Specialist

Add

Adductor

S/N

Staff Nurse

Flex

Flexion

SpR

Specialist Registrar

Ext

Extension

PT

Physiotherapist

UL

Upper limb

OT

Occupational Therapy

LL

Lower Limb

SALT

Speech and Language Therapist

R

Right

Pt

Patient

L

Left

ICP

Integrated Care Pathway

DIP

Distal Interphalangeal Joint

ITB

Intrathecal Baclofen

PIP

Proximal Interphalangeal Joint

BT

Botulinum Toxin

MCP

Metacarpophalangeal Joint

IP

Intrathecal Phenol

MTP

Metatarsophalangeal Joint

ISC

Intermittent Self-catheterisation

EMG

Electromyography

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