Hospital Passport - Template - For People With Learning Disabilities Coming Into Hospital

Aug 31, 2026

Upload by Levi

A hospital passport template designed to support people with learning disabilities during hospital visits. It provides a ready-to-share profile covering personal details, communication preferences, family or carer contacts, support needs, religion and ethnicity, medical history, risks, allergies, and current medication. It also captures day-to-day care preferences, pain and comfort cues, eating and drinking methods, safe mobility and toileting, likes and dislikes, and space for notes, with an instruction to display it at the bedside and include a copy in clinical notes.

LanguageEnglish

CategoryForms

FormatDOC

Pages9

Reading Time3 min

AccessFree to download

Hospital Passport

Personal and communication details

Medical information and interventions

Important care and safety preferences

Likes and dislikes

Notes

Contacts and useful websites

This is my Hospital Passport For people with learning disabilities coming into hospital My name is: If I have to go to hospital this book needs to go with me, it gives hospital staff important information about me. It needs to hang on the end of my bed and a copy should be put in my notes. This passport belongs to me. Please return it when I am discharged. Nursing and medical staff please look at my passport before you do any interventions with me. Things you must know about me Things that are important to me My likes and dislikes Epsom and St Helier University Hospitals NHS Trust Kingston Hospital NHS Trust Mayday Healthcare NHS Trust St George’s Healthcare NHS Trust Foundation of Nursing Studies Croydon Community Learning Disability Team Kingston Community Learning Disability Team Merton Team for People with Learning Disabilities Richmond Specialist Healthcare Team (Learning Disabilities) Sutton Learning Disabilities Team Wandsworth Community Learning Disability Team Things you must know about me Name: Likes to be known as: NHS number: Date of Birth: Address: Tel No: How I communicate/What language I speak: Family contact person, carer or other support: Relationship e.g. Mum, Dad, Home Manager, Support Worker: Address: Tel No: My support needs and who gives me the most support: My carer speaks: Date completed by 1 Things you must know about me Religion: Religious/Spiritual needs: Ethnicity: GP: Address: Tel No: Other services/professionals involved with me: Allergies: Medical Interventions – how to take my blood, give injections, BP etc. Heart Breathing problems: Risk of choking, Dysphagia (eating, drinking and swallowing): Date completed by 2 Things you must know about me Current medication: My medical history and treatment plan: What to do if I am anxious: Date completed by 3 Things that are important to me How to communicate with me: How I take medication: (whole tablets, crushed tablets, injections, syrup) How you know I am in pain: Moving around: (Posture in bed, walking aids) Personal care: (Dressing, washing, etc) Date completed by 4 Things that are important to me Seeing/Hearing: (Problems with sight or hearing) How I eat: (Food cut up, pureed, risk of choking, help with eating) How I drink: (Drink small amounts, thickened fluids) How I keep safe: (Bed rails, support with challenging behaviour) How I use the toilet: (Continence aids, help to get to toilet) Sleeping: (Sleep pattern/routine) Date completed by 5 My likes and dislikes Likes: for example - what makes me happy, things I like to do i.e. watching TV, reading, music, routines. Dislikes: for example - don’t shout, food I don’t like, physical touch. Things I like Please do this: Things I don’t like Don’t do this: Date completed by 6 Notes 7 Contacts and useful websites Community Learning Disability Teams (CLDT) Croydon Community Learning Disability Team (020) 8239 4441/4442 Kingston Community Learning Disability Team (020) 8547 6558 email: cldt@rbk.kingston.gov.uk Lambeth Community Learning Disability Team (020) 7926 5555 Merton Team for People with Learning Disabilities (020) 8545 4490/4545 Richmond Specialist HealthcareTeam (Learning Disabilities) (020) 8487 5315 Sutton Learning Disabilities Team (020) 8770 6080 St George’s Hospital Learning Disability Liaison Team (020) 8725 0097 Wandsworth Community Learning Disability Team 9.30am to 2pm Monday to Friday: (020) 8812 5270. Between 2-5pm and 9-9.30am: 07957 591 977. Out of hours 6pm to 9pm and weekends: (020) 8871 6000 www.easyhealth.org.uk www.intellectualdisability.info www.mencap.org.uk/gettingitright 8 Please contact your local community learning disability team if you have any questions about the passport This Hospital Passport was developed by the South West London Access to Acute Group and based on original work by Gloucester Partnership NHS Trust. Thank you to The Baked Bean Theatre Company, members of our community, Wandsworth Community Learning Disability Team, members of the St Georges Access to Ac

FAQs

What is the purpose of a Hospital Passport in the hospital?

It provides hospital staff with important information about the person, so appropriate interventions and care can be planned and delivered. It should be kept accessible during the hospital stay.

Where should the Hospital Passport be placed and how should it be used?

It needs to hang on the end of the bed, and a copy should be put in the person’s notes. Nursing and medical staff should look at the passport before any interventions.

What types of information are included in the passport?

The passport includes personal details, communication preferences, family or carer contacts, support needs, religion and ethnicity, GP details, allergies, medical history and treatment plan, medication, anxieties, and practical care needs such as eating, drinking, moving, personal care, toileting, sleeping, and safety.

Aug 31, 2026

Upload by Levi