My Health Passport This passport has been developed by me with the help of the Health Transition Team from Walsall Healthcare NHS Trust 1
Personal Emergency Contact Information: My name is xxxxxx xxxxxxx, I prefer to be called xxx or xxxxx My date of birth is xx.xx.1991 and my Nhs number is xxxxxxxxxx. I am British/Pakistani My home address is 8, xxxxx xxxxxxx Walsall I speak English and Urdu and do not need an interpreter. I do not have any special cultural things I need you to be aware of. In case of Emergency my parents are next of kin, but please contact Xxxxxx my sister on 01922 xxxxxxx My GP is Dr xxxxxx xxxxxxxxx, Walsall, WS1 xxxx 2
About my medication: Medication Type, such as tablet, injection Dose Time (s) Reason for taking this medication Gastric reflux Losec Tablet 20mg BD Sodium Valporate Tablet 4 tabs am 3 tabs pm BD Epilepsy Beclazone Inhaler Nebuliser 2x day BD Asthma Paracetamol As required Pain I am allergic to: None known I need help with my medication: I need an adult to administer all my medication. 3
I have problems with my heart: No I have problems with my breathing: Yes I have a Bipap machine which I use mostly at night. I need an adult to help me use it. If I have been in my chair a long time, I sometimes get short of breath and need to come out onto the bed. If I have a seizure and can t breathe I need to use it. I will soon be getting a cough assist machine If I get a chest infection I may need to use my Bipap more often. I have regular nebulisers and chest physio to help me clear my chest. I have problems with swallowing: Yes I can t swallow hard food I need my food to be mashed. Sometimes when I have a drink it goes down the wrong way. This makes me cough. I find it easier to eat in an upright position, not in my wheelchair. 4
I have epilepsy. I haven t had a fit for nearly 12 months since I have been on the sodium valporate. I know when I am going to have a fit and like to taken out of the chair and put on the bed lying on my back. If I have not come out of the fit after 5 minutes, please phone for an ambulance. After my fit I cannot understand what anyone is saying to me for a couple of minutes. I feel really drowsy and would like to stay on the bed until I feel better. I also have a problem with low blood sugar if I don t eat. I become drowsy, dizzy and feel sick. If my blood sugar is really low I need to go to hospital. Details of my longstanding medical condition I have a neuromuscular condition which results in a progressive weakness of my muscles. This does not affect my brain and thinking. I can t do anything for myself except speak. I am sometimes in a lot of pain especially in my back. This eases if I come out of my chair. When I am unwell I am in more pain than usual. When I am in my wheelchair I cannot turn my head to my left, but in my home chair I cannot see to my right side. If I am admitted to hospital you need to tell: Name Parents Organisation 01922 xxxxxxx Name Xxxxxxx Organisation 01922 xxxxxxx Name Organisation Name Organisation 5
I do not need any help to communicate I do not have any problems with my hearing I need help with all aspects of personal care. Toileting: In the morning when I first get up I am taken to the toilet, I am put onto a commode or chair over the toilet until I shout that I am ready. On a school morning after breakfast I go to the toilet. At lunchtime, after I have eaten I am again taken to the toilet, at school it is once when I get there and again at 3pm. In the evenings I go about 6 or 7pm, then again at about 12am when I go to bed. On school days I go about 10.30 before I go to bed. Sometimes I get diarrhoea but I don t know why this happens. Getting up: I need to be dressed by an adult and then hoisted or lifted out of bed into my chair. Feeding: I need all my food mashed up and fed to me, small amounts at a time to give me time to swallow. Washing and cleaning teeth: I need this to be done by a carer. When I wake up I like my face to be washed. Showering: At the moment this is twice a week on Wednesday and Sunday. My carers do this for me, I prefer this to be at night as I get a better sleep afterwards. 6
I need help with getting around I need to be hoisted or lifted into my wheelchair and then pushed by an adult. I need help at night time. I need to be turned at night. The number of times depends on how much pain I am in. I also need someone to monitor my night time ventilation all through the night. I do not have any mental health needs I need help with eating and drinking I need all my food mashed and fed to be in small amounts to give me time to swallow. I particularly like vegetables, some Asian food and Chinese food, but I enjoy trying new foods. I like roast dinners 7
My family and friends: What is important to my life My friend xxxxx is very important to me. She is at college in Herewood. We talk nearly every day online. To go to college so that I can do a media course Things I enjoy most: Shopping and spending my money!! I also enjoy surfing the internet on my laptop, using MSN and Facebook. I sometimes like watching TV, especially Disney and High School Musical. I also like watching Paul O Grady I like listening to music and singing. I enjoy writing poems I put them on facebook Things I enjoy doing with my friends: Shopping, talking, going to the cinema I do not drink or smoke 8
My Health Team Professional Children s Adult Consultants: Dr Sxxxxxx Xxxxx xxxxxxx Orthopaedic Respiratory Dr Nxxxxxx Dr Bxxxxxxxxxx Medical Cardiologist Neurologist Dr Rxxxxxx SALT Social Serices OT Liz Sxxxxxxxxxx Xxxxxx xxxxxxx PT xxxxxxx xxxxxxxxxxxxxx Neuro Comm Rehab Team Xxxxxx xxxxxxx Transitions Case Manager Kathie Dxxxxxx Xxxxx xxxxxxx Kathie Dxxxxxx Xxxxxx xxxxxxx Dentist Brace Street Xxxxxx xxxxxxx Social Worker Sharon Cxxxxx Xxxxxx xxxxxxx Nurse Parmjit Sxxxxxx Xxxxxx xxxxxxx Optician Manor Hospital Xxxxxx xxxxxxx Wheelchair services Rose Hxxxxxx Xxxxxx xxxxxxx YPHA Audiologist This Health Passport is protected by copyright law and is wholly owned by Walsall Healthcare NHS Trust and the named service user. Its use is monitored by MidTECH, the NHS Innovations Intellectual Property Hub for the West Midlands. You may not copy, reproduce, publish, republish, post, transmit, modify, adapt, translate, manipulate, add to, delete from, distribute or otherwise use any of the content in whole or in part, in any medium without the permission of the copyright owner. 2011 NHS Walsall Healthcare NHS Trust. All rights reserved 9