Intermediate Care Bed Base Referral

Bed Base Referral

Initial questions
Patient demographics
If contact details are incorrectly input where mandatory the referral cannot be processed
Overseas visitor?
Consent gained?*
Medically optimised for discharge?*
Smoker?*
Patient has consented to information sharing?*
Next of Kin
Tick as appropriate:*
Referrer details
If contact details are incorrectly input where mandatory the referral cannot be processed
Only to be completed if referring from community
Therapy
Is the patient being discharged with any appliances e.g. leg brace or collar?*
Is the patient being discharged to a sit and wait bed (non weight bearing status)*
Confirm that transport is booked to collect from discharge destination*
Admission history
Breathing
If yes; please ensure that this is prescribed on the long term script.
Specialist Nurse Involvement?
Psychological wellbeing
Infection Risk Assessment
Does the patient have any of the following infections:*
Pressure area/skin assessment
Fluid & Nutrition
Elimination
Rest & Sleep
Pain
Current Medication
Any other comments
If you do not receive an email acknowledgement your referral has not been submitted. Please check that all details are correct, mandatory fields completed and re-submit.