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The UK's Healthcare Law Service 
Robert Campbell & Company

FREE NURSING CARE ASSESSMENT

Please complete the following form as completely as possible, and click the 'Submit' button to send the form to us. Doing so places you under absolutely NO OBLIGATION following the assessment.

Information you share with us will be kept confidential and not disclosed to anyone else without your permission. We are registered under the Data Protection Act 1998 and our conduct is regulated by the Law Society.


SECTION 1 - Patient Details
Your Name:
Your date of birth:  for security purposes.
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I am The:  Son   Daughter   Wife   Other (Select one)  of  
  An NHS patient about to be discharged into a 
private nursing home at own cost;  OR:
An NHS patient who  was discharged
      into a private nursing home at own cost;
In either case:  Actual or anticipated discharge date:
Name of Patient: 
Patient date of birth:  for security purposes.
Address  of Patient: 

SECTION 2 - Circumstances
Please  set out the patient's symptoms and treatment received, doctor's diagnosis and whether you believe he/she should be entitled to Free Nursing Care and why:..

SECTION 3 - Steps taken to obtain free nursing care
Here describe briefly what has been done and the current outcome...


SECTION 4 - Trust responsible for care
Name and address of Trust responsible for the patients care:


SECTION 5  - Any other relevant information
Approximate financial losses (Care fees) £?:
Please tell us anything else of relevance. For example has the patient’s condition recently worsened? Is there an outstanding complaint to the Ombudsman?:


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© web content copyright © Robert Campbell 2008
web design and code  © 56kb.com 2008

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