Hospital Passport Template - 医院随行护照模板 - 供学习障碍人士使用

Aug 31, 2026

Upload by Aria

Hospital Passport provides a structured, user-focused reference for people with learning disabilities when visiting or receiving hospital care. It consolidates personal identification details, communication preferences, family or carer contacts, support needs, religious and cultural information, allergies, medication, and medical history. It also records interventions, anxiety guidance, pain and safety cues, eating and drinking support, mobility and personal care needs, and toileting and sleep routines. Clear placement instructions support quick staff access and safer, more individualized care.

LanguageEnglish

CategoryForms

FormatDOC

Pages9

Reading Time3 min

AccessFree to download

Hospital Passport - Key Instructions

Personal Details

Medical Information

Support Needs and Communication

Important Preferences and Daily Care

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 Buckinghamshire Community Learning Disability Team HYPERLINK "https://www.hpft.nhs.uk/services/learning-disability-services/buckinghamshire/" https://www.hpft.nhs.uk/services/learning-disability-services/buckinghamshire/ Telephone – 01296 387516 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 Acute working party, Merton CTPLD Community Nurses and the Corporate Design department at Wandsworth Council who all inputted into the redesign of this document. AS.42a (12.09)

FAQs

Hospital Passport需要放在哪里？

需要挂在床尾，并将一份复印件放入病历资料中，以便工作人员查阅。

护理或医疗人员在对我进行干预前需要做什么？

在进行任何操作之前，请查看该护照中的关键信息。

护照通常包含哪些医疗与照护信息？

包含过敏情况、现用药物和病史/治疗计划，以及吞咽风险、用药方式、焦虑应对、疼痛识别、进食饮水方式和安全支持等内容。

Aug 31, 2026

Upload by Aria