CONFIDENTIAL

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					Updated January 2010
                                                 PRIVATE AND CONFIDENTIAL


 Communication Aid Centre
       Frenchay Hospital
                   Bristol




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                                                                            Ref: PAG

Dear Colleague

RE:         REFERRAL OF PATIENTS TO THE COMMUNICATION AID CENTRE

Thank you for your enquiry regarding the referral of your patient.

When we receive the completed referral form, an appointment will be arranged for the patient, carers and
yourself 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 assessment period, but advice and training will be available from the
                             Communication Aid Centre.

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.

Note 3:                      If a device is likely to need to be mounted on a wheelchair, the Communication Aid Centre
                             will need full details of the wheelchair supplier, make of wheelchair and dimensions.

When the period of assessment is complete, a recommendation may be made for the purchase of a suitable
communication aid. Communication aids can cost up to £15,000 (excluding VAT), but the average cost of a
device is usually much less. Funding for any recommended aid 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 us if you require further information.
Yours sincerely



Specialist Speech and Language Therapist
Communication Aid Centre

PLEASE ENSURE THAT ALL DETAILS ARE COMPLETED,
PARTICULARLY POST CODES AND PCTS
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Peter Rilett                                               A University of Bristol Teaching Trust                  Sonia Mills
Chairman                                              A University of West of England Teaching Trust          Chief Executive
Updated January 2010
                                           PRIVATE AND CONFIDENTIAL


                                                                                                     Voice (Amplifiers)
                                  FRENCHAY COMMUNICATION AID CENTRE
                                  REFERRAL FORM FOR VOICE DISORDERS
TYPE YOUR DETAILS IN THE GREY BOXES, THEN USE THE TAB TO MOVE TO THE NEXT BOX.
THE BOXES WILL EXPAND TO FIT WHATEVER YOU WANT TO TYPE IN.
PLEASE PROVIDE US WITH AS MUCH INFORMATION AS POSSIBLE SO THAT WE CAN PLAN FOR THE ASSESSMENT
SESSION FULLY. PLEASE PROVIDE COPIES OF ANY REPORTS THAT YOU FEEL ARE RELEVANT.

PATIENT DETAILS

Name:                                                        Date of Birth:                   Date of Referral:

Address:                                                                                      PCT:
E-mail:
Postcode:                                                    Tel:
Next of kin:                                                 Tel:


Name and address of accompanying SLT:
E-mail Address:
Private Therapist                Yes              No
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:



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




Type of Dysphonia:
Length of time since onset of problem:
Recent Speech and Language Therapy aims:
Does the person have any additional conditions as well as the voice disorder?                     Yes        No
Comment:
Have any amplifiers been used in the past?                                                        Yes        No
Comment:



Communication Environment:
Does the person’s listener group have any hearing impairments?                                    Yes              No
Does the person generally require an amplifier for:                        1:1 conversation
                                                                           Small groups
                                                                           Larger groups
                                                                           Telephone
Any other situations not mentioned above:




Physical Environment:
Is a device needed for use at:               Home                 School            Work          Other
Comment:
Is the environment where the device will be used generally:                         Noisy         Quiet
During the course of the day, would you require an amplifier for use:
Generally in one room                        Between rooms




Physical:
Is the person ambulant?                                    Yes              No
Does the person have any Dyspraxia?                        Yes              No
Are fine motor movements                               Normal              Fair          Poor      Minimal




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Peter Rilett                                          A University of Bristol Teaching Trust                       Sonia Mills
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.



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


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.

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           Sonia Mills
Chairman                                         A University of West of England Teaching Trust   Chief Executive