CONFIDENTIAL by liwenting

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									Updated January 2010
                                          PRIVATE AND CONFIDENTIAL




DIRECTORATE OF MEDICINE

Communication Aid Centre/Computer Assessment and Training Service
Speech and Language Therapy Department
Frenchay Hospital, Bristol BS16 1LE

Tel: 0117 3403946
Fax: 0117 9186558
E-mail: cacfrenchay@nbt.nhs.uk                                                                                 AT/




Dear Colleague

RE:       REFERRAL TO COMMUNICATION AID CENTRE FOR WHEELCHAIR MOUNTING ASSESSMENT

Thank you for your enquiry regarding the referral of your patient for wheelchair mounting assessment. A referral form
is attached. Please complete and return the enclosed questionnaire and return it at the same time as the completed
referral form and photographs of the wheelchair.

When I receive the completed referral form, an appointment will be arranged for the patient, carers and you to attend
an initial assessment within the Communication Aid Centre. Please ensure that you are aware of the following,
before making a referral:

Note 1:           It will be the responsibility of the local speech and language therapist to ensure
                  effective support during the loan period.

Note 2:           You will also need to ensure that any equipment borrowed by your patient as part of
                  the assessment process, is insured. See enclosed sheet for more information.

When the period of assessment is complete, a recommendation may be made for the purchase of a suitable system.
Mounting systems can cost up to £600 (excluding VAT). Funding for any recommended system is not part of the
assessment service. It is a matter for resolution between the referrer and the local Health Authority. The
Communication Aid Centre has no role in this negotiation. The referring speech and language therapist should
therefore contact their Trust Budgetholder to alert them that there may be a need for funding.

Please do not hesitate to contact me if you require further information.


Mrs Alison Teague
Specialist Communication Aid Centre Technician

PLEASE ENSURE THAT ALL DETAILS ARE COMPLETED,
PARTICULARLY POST CODES AND PCTs

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Peter Rilett                                        A University of Bristol Teaching Trust                               Ruth Brunt
Chairman                                       A University of West of England Teaching Trust                        Chief Executive
Updated January 2010
                                          PRIVATE AND CONFIDENTIAL
                                                                                                Wheelchair Mounting

                        FRENCHAY COMMUNICATION AID CENTRE
                  REFERRAL FORM FOR EQUIPMENT MOUNTING ASSESSMENT

PLEASE SEND PHOTOGRAPHS OF THE WHEELCHAIR(S) THAT REQUIRE EQUIPMENT MOUNTING ON THEM. WE
NEED FRONT AND SIDE VIEWS OF EACH CHAIR, CLEARLY SHOWING THE FRAME AND ANY POSSIBLE
MOUNTING SITES FOR A CLAMP.

PATIENT DETAILS
Name: _____________________________________                               Date of Birth: ___________________________
Address: _____________________________________________________________________________
Postcode: ____________________ Tel: ___________________________ PCT:____________________
E-mail Address: ________________________________________________________________________
Next of Kin: __________________________________                           Tel: __________________________________
Name and address of accompanying SLT: ___________________________________________________
_____________________________________________________________________________________
E-mail address: ________________________________________________________________________
Tel numbers:       ________________________________________________________________________
                                 (please indicate which days you can be contacted on each number)

Would your patient be happy to receive information via e-mail, and for you to receive information regarding
them, via e-mail?                                                               Yes          No
Are you an NHS Therapist or funded by any other statutory body?                                   Yes          No


Other professionals involved
Name                           Profession                      Address                            Telephone number




GP Name: ____________________________________ Tel no: _______________________________
Address: ___________________________________________________________________________
Postcode: _____________________________                                   PCT: ________________________________

Medical diagnosis: ______________________________________________________________________
SLT diagnosis: __________________________________________________________________________


EQUIPMENT DETAILS

Make and model of wheelchair: (if equipment to be mounted on more than one chair please include
details of all of them)____________________________________________________________________
_____________________________________________________________________________________

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Peter Rilett                                        A University of Bristol Teaching Trust                              Ruth Brunt
Chairman                                       A University of West of England Teaching Trust                       Chief Executive
Updated January 2010
                                          PRIVATE AND CONFIDENTIAL
_____________________________________________________________________________________




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Peter Rilett                                        A University of Bristol Teaching Trust                         Ruth Brunt
Chairman                                       A University of West of England Teaching Trust                  Chief Executive
Updated January 2010
                                          PRIVATE AND CONFIDENTIAL

Communication hardware to be mounted: Please include details of any switches that need mounting as
well as any communication aids____________________________________________________________
_____________________________________________________________________________________

Type of mounting system (if one has already been purchased)__________________________________
_____________________________________________________________________________________

WHEELCHAIR SERVICE (OR PRIVATE COMPANY)

Name of wheelchair service or company responsible for ongoing support and maintenance of the chair(s):
_____________________________________________________________________________________
Contact name, address and phone number of wheelchair service provider: __________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Has permission been given by the wheelchair service provider to fit a mounting system to the wheelchair?

          Yes             No
OTHER ISSUES

Is any other equipment already mounted on the chair(s)?                   Yes                  No
If you answered yes please give details of equipment, mounting system and site of mounting____________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

Is the weight of the user within the recommended maximum weight limit for the chair? Your wheelchair
service should be able to provide you with the weight limit for the chair.

          Yes             No
Is the wheelchair able to be transported to the Communication Aid Centre for the mounting assessment to
be carried out?

          Yes             No
If the equipment is to be mounted on more than one wheelchair does the client require hoisting to move
from one chair to another?

          Yes             No
Are there any other manual handling issues that need to be considered during the session e.g. special
toileting requirements? Please give details___________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

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Peter Rilett                                        A University of Bristol Teaching Trust                          Ruth Brunt
Chairman                                       A University of West of England Teaching Trust                   Chief Executive
Updated January 2010
                                          PRIVATE AND CONFIDENTIAL


If there are lifting and handling issues, please be aware that, although we are able to provide
disabled toileting and changing facilities, a sufficient number of carers must accompany the client
to in order to carry out any care procedures that may be necessary during the appointment.

Please provide any additional information that you think will help us to plan for your assessment
session at the Communication Aid Centre.
______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

_______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________


CONSENT

Has the patient given consent for this referral?                  Yes              No

Have the carers given consent for this referral? Yes                               No

Have you discussed all the implications of a referral to the CAC with the patient and their carers?

                                                                  Yes              No

Do you feel that the patient fully understands the implications of a referral to the CAC?

                                                                  Yes              No




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Peter Rilett                                        A University of Bristol Teaching Trust                         Ruth Brunt
Chairman                                       A University of West of England Teaching Trust                  Chief Executive
Updated January 2010
                                            PRIVATE AND CONFIDENTIAL



                                                            Communication Aid Centre
                                                                  Frenchay Hospital
                                                                              Bristol




                                  INSURANCE FOR COMMUNICATION EQUIPMENT

       ON LOAN FROM THE COMMUNICATION AID CENTRE (CAC)/COMPUTER ASSESSMENT AND
                               TRAINING SERVICE (CATS)


                                                   NORTH BRISTOL NHS TRUST

People who have equipment on loan from the Communication Aid Centre/Computer Assessment and Training Service MUST
insure the equipment whilst it is in their possession. As a centre, we cannot recommend specific companies or policies.
However, the following gives details of companies who have offered policies to our users in the past.

1.        Household Insurance - You may find that your ordinary household contents insurance covers your equipment. You will need
          to contact the company and ask them to add the named items to the existing policy. If the equipment is in the more
          expensive price range (ie: above £1,500) the insurance company may well require you to pay an additional premium. Your
          speech and language therapist will give you an idea of the approximate replacement cost. You should check that, in the case
          of anything portable, it is covered whilst outside the house or in transit.

                           If you have a Norwich Union Home Plus policy, Norwich Union will give you cover for 1.5 to 1.58% of the
                            cost of the device, on top of the basic premium. This covers the device when it is away from home.

                           Guildhouse Insurance Brokers offer a 10% reduction on the total premium. Tel: 01934 641 999. e-mail:
                            global@guildhouse2000.com

          In both the above cases, you would need to have a household contents insurance policy with the insurance
          company named.

2.        Charitable Associations - SCOPE, Motor Neurone Disease Association, Armed Forces Charitable Funds etc.

3.        SAGA for the over 50’s – Apply to: The Saga Building, Middelburg Square, Folkestone, Kent CT20 1AZ – Tel: 0800 414525.

4.        Local Education Authorities – It is worth checking with your local LEA (if applicable), as some of these do cover
          communication aids outside of school. (These include Nottingham, Portsmouth, Swindon and Surrey.)

5.        Social Services – Worth approaching as they have recently agreed to fund home insurance to cover a communication aid in
          Bristol. Contact your local Social Services Department to enquire further.

6.        Lloyds Direct - offers a household contents insurance policy that will cover communication aids.
          www.lloydstsb.com/insurance.

7.        Norwich Direct - offers a household contents insurance policy that will cover communication aids. www.norwichunion.com.

8.        MCIS Ltd – Charity Insurance Specialists – Tel: 0121 2332722.

9.        No Household Policy – Ellisbatesgroup provide all risks cover on AAC, communication or medical aids, anywhere in the UK
          and on short trips abroad. Also covers communal environments such as schools, care homes, supported accommodation etc.
          Includes cover for items on loan by PCTs, Charities, Schools etc. Currently approximately £75 per annum for items up to the
          value of £7,500 and £150 per annum for items up to the value of £15,000. www.ellisbatescare.com or contact Steve
          Arthington on 01423 724519.

10.       CompuCover – specifically designed for cover to laptops, desktops, printers, peripherals etc, anywhere in the world,
          including whilst travelling. www.compucover.co.uk.



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Peter Rilett                                          A University of Bristol Teaching Trust                              Ruth Brunt
Chairman                                         A University of West of England Teaching Trust                       Chief Executive
Updated January 2010
                                             PRIVATE AND CONFIDENTIAL

11.       Age Concern will offer a contents policy in hospitals and nursing homes. However, the top limit for a single item is currently
          £2,000. They are going to review this.

12.       J.S Insurance is a specialist IT insurance company on the Internet. It is part of the Jade Stanley Company. It can provide
          single item insurance for communication aids such as the My Tobii, but only for a twelve month contact at a cost of £300. The
          telephone number is 0870 7556101.

13.       Tett Hamilton Insurance Company will insure individual items belonging to people in residential homes, as named items on
          the Home’s insurance policy.



The Communication Aid/Computer Assessment and Training Service Centre would be happy to provide you with a supporting letter, if
required.


Notes:             1.       We can only release equipment for loan periods if insurance cover is in place.
                   2.       Leaving equipment in unattended cars may well invalidate the insurance cover.




JD/PAG
January 2010




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Peter Rilett                                          A University of Bristol Teaching Trust                                 Ruth Brunt
Chairman                                         A University of West of England Teaching Trust                          Chief Executive
Updated January 2010
                                           PRIVATE AND CONFIDENTIAL


MOUNTING QUESTIONNAIRE                                                          To be returned by………………………

Name of User……………………………………………………………………………………………………………..

1.        What is the make of the wheelchair
          and seating system?                                     _________________________________________

2.        What is the model of the wheelchair?                    _________________________________________

3.        Is this an electric/powered wheelchair?                                                     Yes No
4.        If YES, how is the wheelchair controlled                _________________________________________

          Where is this equipment positioned                      _________________________________________

5.        Does the user propel the chair themselves?                                                  Yes No
6.        If the user self propels, is their steering accurate?                                       Yes No
7.        What is the weight limit of the chair?                  _________________________________________

8.        Is the seating system likely to be altered or reviewed                                      Yes No
          within the next six to twelve months?

9.        What is the user’s weight?                              _________________________________________

10.       Is the user’s weight likely to fluctuate?                                                   Yes No
11.       If YES, will this have an impact on the weight limit for the wheelchair?                    Yes No
12.       Is there anything else permanently or temporarily attached to the                           Yes No
          wheelchair, eg: bags, switches etc?

13.       If YES, what are the items and what is the approximate weight______________________________
          ________________________________________________________________________________
          ________________________________________________________________________________

14.       Does the user have any movements or postures that are likely to                             Yes No
          affect the position of any equipment that is mounted on to the chair?

15.       If YES, what are these______________________________________________________________
          ________________________________________________________________________________

16.       Are there any narrow doors or tight corners within the user’s                               Yes No
          environment that will have an impact upon where the device is mounted?

17.       Does the user need to be able to get to desks or tables while the device                    Yes No
          Is mounted on the wheelchair?

18.       How does the user transfer to and from the wheelchair? ________________________________
          ______________________________________________________________________________

19.       From which side are caring activities carried out?                                          Right Left
20.       Is the wheelchair ever folded up, dismantled or altered, eg: for transport?                 Yes No
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Peter Rilett                                        A University of Bristol Teaching Trust                          Ruth Brunt
Chairman                                       A University of West of England Teaching Trust                   Chief Executive
Updated January 2010
                                          PRIVATE AND CONFIDENTIAL

21.       If yes please describe how.___________________________________________________

22.       Address of Wheelchair Services responsible for maintenance of Wheelchair……………………………………

……………………………………………………………………………………………………………………………………….

Please include any additional information that may help us to plan for your mounting assessment, eg photographs,
drawings etc.




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Peter Rilett                                        A University of Bristol Teaching Trust                         Ruth Brunt
Chairman                                       A University of West of England Teaching Trust                  Chief Executive

								
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