Information for health and social care staff about what is in my health and care passport and how to use it

This health and care passport has

• important, personalised information about me when I am well and when I am unwell – including my communication needs
• an important role to keep me safe

It will enable you to carry out legal duties about;

• my Mental Capacity and shared decision making
• providing my reasonable adjustments

It does not contain clinical information. Please refer to my clinical records including the NHS Spine, Summary Care record and the reasonable adjustment digital flag.

This template is based on the “About me” standard developed by the Professional Record Standards Body

Name I like to be called 

People need to know what you like to be called. It might be different from the name on your medical records. For example, your name might be Alexandra but you would like to be called Alex.

Full name

This should be your full legal name – your name on your medical records. This information will help staff to find your medical records.

I want people to refer to me as male (he/his), female (she/her), non-binary (they/ them) (delete the words that are not needed). 

Date of birth 

This information will help staff to find your medical records and check you are the right person they need to speak to.

NHS Number (if you know it) 

You can find this from the NHS app and on letters you receive from the NHS. If you can include your NHS number it will make it easier for staff to find your details on their computer systems. If you don’t know what it is you can leave this section blank

What is important for me and my health– how to keep me safe

• think of any conditions you have that will need to be known about quickly. This could be things like epilepsy, mental health diagnosis, allergies, choking risks / dysphagia, diabetes for example.
• you don’t need to include lots of detail. They could be brief but important points. If there is an important document that will help health and care staff to help keep you safe, please provide the name of the documents and how to get it.

For example:

• i have dysphagia, there is a risk I can choke. See my eating and drinking plan. You can ask my carer for my eating and drinking plan.

What is most important to me

This information can help staff make you feel safe and relaxed. It could help them explain things to you. This could include

• how I like to be spoken to and cared for, my values, spirituality/religion, ethnicity, culture, pets, goals and aspirations for example.
• you can include things you like to do and talk about, like leisure activities, visiting places, sport and exercise, listening to music, employment, education, volunteering for example.

If you have an advance decision plan or a Do Not Attempt cardiopulmonary resuscitation (DNACPR) please say here and confirm details of who staff need to talk to about it.

If you want to know more about advance care planning you can find out more at this link: Making a plan for your heath and care if you become very ill.

People who are important to me 

• details of who is important to you and their relationship to you. They could be family members, carers, friends, members of staff for example.
• please include each person’s
  • Name
  • Phone number
  •  Relationship to you
  • How you want the person to be involved
• think about how you want the people important to you to be involved in your care and support in both emergency and normal situations. Think about how you stay in contact with the people important to you. Is there anyone you don’t want to be contacted. Who should be contacted and why. How can they be contacted – please include a phone number
• if you have a Deputy for Care and Welfare please include their name and state they are a deputy for Care and Welfare.

My communication 

In this section you should try to include:

• a short description of how you usually communicate including any communication aids you use, for example a hearing aid or Augmentative and Alternative Communication (AAC) device.
• if there are differences about how you communicate and how others should communicate with you when you are well and when you are unwell.
• your preferred language for communication, and if your first language is not English.
• how you would communicate when you are in pain or distress and if there are any pain assessment tools that you prefer.
• how to support you to make choices
• how you give feedback or show you are unhappy with something.
• how you like to receive information.
• how you would like others to engage and communicate with you, including how you would like to be addressed.
• if you have a communication plan or use tools to support you to communicate please say who to contact to find out more about these.

My health and wellbeing 

• a description about how you feel on a typical day through to a day when you are unwell or really unwell.
• include anything that might cause you to become unwell and how to prevent it happening. For example, not drinking enough water could cause constipation.
• include any signs that indicate you might be becoming unwell.
• describe what is different on a bad day, how you engage with others and how you feel.
• include how your everyday life is affected by any medical conditions like dementia and any symptoms such as itchiness, coughing, pain and how you manage these conditions and symptoms.

Please do and please don’t

• a description of things you need people around you to do, For example:
  • to me not to my carer
  • remind me to take my medication
  • encourage me to wash my hands regularly
  • explain to me what is happening and why
  • respond to my communication.
• a description of things you need people around you to not do. For example:
  • talking about  certain topics
  • making assumptions about you
  • providing support when it is not wanted
  • talking to you in a certain way.

How and when to support me

A description of how and when you want someone caring for you to support you. This could include:

• support needs in an emergency (for example taking blood)
• support you need to maintain important routines or to carry out particular activities, such as personal care routines, eating and drinking, bedtime routines, taking medications, moving and handling.
• support needed with wearing glasses, hearing aids, false teeth for example and making informed choices or understanding dangers and risks, managing your emotions, moods and behaviours, memory or confusion.
• how your support needs change in different environments. Do include any triggers that might result in you needing further support and strategies for avoiding or addressing the triggers.
• how you want the support to be provided.

Also worth knowing about me

This section is for you to add anything else that you think health and social care staff need to know about you.

• a description of what is also worth knowing about you for the people who are caring or supporting you.
• this could include a short history of your life (work, volunteering, groups you are part of, where you have lived, important events in your life).

Date this information was updated

Supported to write this by

Where relevant, this is a record of the name, relationship/role and contact details of the person who supported you to write this section such as, carer, family member, advocate, professional.