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Embed code for: My Hospital Passport
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My Hospital Passport For people on the autism spectrum Hospital staff, please consult this passport before you assess me or carry out any interventions. Please keep this passport with my notes at the end of my bed and return to me when I am discharged. Personal information Name: I like to be called: Date of birth: NHS number: If I am admitted to hospital there are matters that will need to be dealt with urgently. Please assist me by contacting: Name: Relationship: Phone number: Other people I would like you to contact in connection with my treatment and care: Name: Relationship: Phone: Name: Relationship: Phone: Name: Relationship: Phone: I have an Advance Directive: Yes No 2 How I would like you to communicate with me: How I communicate: Please do not assume there is nothing wrong with me if I don’t express pain the in the same way. How I experience pain: How I communicate pain: 3 Things I can’t cope with that cause me distress: How you can avoid distressing me: My medication and my medical history: Please don’t make any changes to my medication without first talking to: Name: Role: Phone number: 4 Other things you should know about me: Because I have autism please do not assume that I do not have mental capacity. The Mental Capacity Act has five key principles 1. Every adult has the right to make his or her own decisions and must be assumed to have capacity to do so unless it is proved otherwise. 2. People must be supported as much as possible to make a decision before anyone concludes that they cannot make their own decision. If a lack of capacity is established it is still important to involve the person as far as possible in making decisions. 3. People have the right to make what others regard as an unwise or eccentric decision. Everyone has their own values, beliefs and preferences which may be different to other people. They should not be treated as lacking capacity for that reason. 4. Anything done for, or on behalf of, a person who lacks capacity must be done in their best interests. 5. Anything done for, or on behalf of, people without capacity should be the least restrictive of their basic rights and freedoms. Information on the Mental Capacity Act is available from www.publicguardian.gov.uk About autism Autism is a lifelong developmental disability that affects how a person communicates with, and relates to, other people. It also affects how they make sense of the world around them. It is a spectrum condition, which means that, while all people with autism share certain difficulties, their condition will affect them in different ways. Some people with autism are able to live relatively independent lives but others may have accompanying learning disabilities and need a lifetime of specialist support. People with autism may also experience over- or under- sensitivity to sounds, touch, tastes, smells, light or colours. Asperger syndrome is a form of autism. People with Asperger syndrome are often of average or above average intelligence. They have fewer problems with speech but may still have difficulties with understanding and processing language. About The National Autistic Society We are the leading UK charity for people with autism (including Asperger syndrome) and their families. With the help of our members, supporters and volunteers we provide information, support and pioneering services, and campaign for a better world for people with autism. Around 700,000 people in the UK have autism. Together with their families they make up around 2.8 million people whose lives are touched by autism every single day. From good times to challenging times, The National Autistic Society is there at every stage, to help transform the lives of everyone living with autism. We are proud of the difference we make. The National Autistic Society 393 City Road, London EC1V 1NG Switchboard: 020 7833 2299 Autism Helpline: 0808 800 4104 Minicom: 0845 070 4003 Email: email@example.com Website: www.autism.org.uk Thanks to John Davies at BT for helping design this passport.