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
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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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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