Download Family Form 2 (PowerPoint 633KB)

Completed sample of Family Form 2
Parents have asked to be given the opportunity
to complete Family Form 2 at home where the
relevant information is kept. This gives the
opportunity for the form to be completed when
not under pressure in an interview process, thus
reducing the stress of an interview situation.
The everyday care needs of the patient
are recorded on pages 1, 2 and 3 of the
Family Form 2.
For emergency admissions, the form
should be completed on arrival to the
ward area.
Page 1 of 4
This form is for in-patient use only and it
can last up to one year. It may be
annotated for subsequent admissions.
If the patient has significantly changed,
or the form has become illegible due to
repeated admissions, the parents may be
asked to complete a new form.
The ‘More about’ sections provide
the parents & patient with
information to help them complete
the form.
Page 2 of 4
External organisations require the
hospital to demonstrate that we have
assessed the needs and identified the
preferences of the children and their
families, for example a nutritional
assessment and a preference for single
sex accommodation.
Whilst the patient is in the hospital,
this form must be kept at their
bedside. Once they are discharged it
must be filed by the ward
administrator in the patient’s medical
records.
Page 3 of 4
Immunisations and infectious disease
changes that have happened since the
patient’s last visit are recorded on
page 4 of the Family Form 2. The
Immunisation and Infectious Disease
Record must also be updated with this
information.
Changes to the patient’s school or
health and social care team are
recorded on page 4 of the Family Form
2. PIMS must also be updated with this
information.
The “official” is the admitting nurse. The documented
information needs to be reviewed for completeness.
Further questions may need to be asked and recorded.
This ensures a full assessment has been made and
preferences identified.
Page 4 of 4