ACQ Vol 10 No 2 2008

Work– l i f e balance : preserv i ng your soul

SUNDAY

SATURDAY

On Monday this patient: Needs a swallowing review

Patient unable to be seen due to: _ ___________________________________________________ Other relevant information:

Needs initial swallowing assessment Needs communication assessment Needs education regarding: ____________________________________________________ Needs liaison with: ____________________________________________________ Other (please specify) ____________________________________________________

_ ___________________________________________________

_ ___________________________________________________

_ ___________________________________________________

_ ___________________________________________________

_ ___________________________________________________

COMPLETED BY THE PATIENT’S USUAL SPEECH PATHOLOGIST: Feedback from service provided on Monday: Swallowing Patient placed NBM Patient commenced oral feeding Diet was upgraded Diet was downgraded

Patient reviewed with no change to diet Change to patient’s recommendations:

Improvement/deterioration in medical condition (give details): Commenced/continued swallowing therapy (give details): Other relevant information (eg: feeding strategies, carers/family issues, compliance, progress discharge planning) Communication Assessment conducted aphasia dysarthria dyspraxia voice Assessment type: informal formal (give details) Therapy – focusing on: Other relevant information: (eg: information provided to family/carers, handouts given, exercises given, etc) SPEECH PATHOLOGY PLAN: MRN: _ _____________________________________________ DOB: ____/ ____/ _____ Surname: _ __________________________________________ First Name: _______________________ Street: _ _____________________________________________ Suburb:_____________________________ Postcode: ______ (Insert medical record sticker) Appendix B. Speech pathology patient database

Telephone:

NOK: ___________________________________ LMO: ___________________________________ DVANo: _________________Wt o � Gold � o

Medical Officer:

Speech Pathologist:

Date Referred: ____/____/____ (by _____________ )

Reason for Referral: ___________

Date 1st seen: ____/____/____ ICD – 10 Completed � o Therapy Diagnosis: _____________________________________________________________________________________________ Medical Diagnosis: _____________________________________________________________________________________________

CLINICAL INFORMATION:

Date Discharged: ____/____/____

Discharge Destination: _______________________________

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ACQ uiring knowledge in speech , language and hearing , Volume 10, Number 2 2008