2014-12-09 Infrastructure & Services Committee Agenda

INFRASTRUCTURE & SERVICES COMMITTEE MEETING AGENDA                  9 DECEMBER 2014


                                                                 ATTACHMENT 1


                                ComLink Mobility


REGISTRATION QUESTIONS
Full Name
DOB
Address
Emergency Contact
Height & Weight
Hearing or Vision impaired
Are you able to drive at the moment? If not Why?
Can you catch public transport? If not Why?
What would you be needing our service for?
How are you getting to your appointments at the moment?
Pensions – What type of pension are you on?
Any Family/friends to assist on the Coast?
Do you have anyone travelling with you on regular basis? If so may need to be
registered also.
Any mobility aids? Wheelchair – can they transfer ?
Allergies of any kind eg medication, bee stings, epi pen??

EXTRA QUESTIONS UNDER 65 - DISABILITY
PRIMARY DISABILITY
PRIMARY DISABILITY DETAILS
OTHER SIGNIFICANT DISABILITIES
OTHER SIGNIFICANT DISABILITY DETAILS
IS THE DISABILITY PERMANET OR LIKELY TO BE PERMANENT
MEDICAL CONDITION & LIST OF MEDICATION


APPOINTMENT QUESTIONS When Making a Booking
WHERE
WHEN
HOW LONG
TRAVELLING ALONE
SHOPPING ALONE
HOSPITAL – WHAT ARE THEY HAVING DONE - UNDERGOING ANAESETIC –
LOCAL OR GENERAL
DR APPT – ASK FOR DR’S NAME - IS THIS A GENERAL CONSULTATION???
QUESTION LENGTH OF TIME IF OVER 2/3 HRS – MAYBE HAVING
PROCEDURE DONE??
IF TRAVELLING WITH HUSBAND OR WIFE OR ANY OTHER MEMBER OF
FAMILY OR CARER PUT NAME OF THAT PERSON IN ALSO




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