@include('partials.breadcrumbs')

Edit Resident @include('layouts.crmnov')

@if(isset($data['resident_pic']) && $data['resident_pic']!='' && file_exists(public_path('crm/resident/'.$data['resident_pic'])))

@else

@endif

First Name

Middle Name

Last Name

{{--

Start Date

End Date

--}}

Preferred Name

ADMISSION DATE:

PLACEMENT END DATE

End Date

RESIDENT IN SCHOOL:

YES

DETAILED INFORMATION:

Key Worker:

Care Home:

Contact Details

Email Address (This is used as login email)

Status

Local Authority

PLACING AUTHORITY:

Social Worker Name

Social Worker Email

Social Worker Phone Number

PRACTICE MANAGER:

INDEPENDENT REVIEWING OFFICER:

Billing Information

Personal Details

LEGAL STATUS:

IS THIS AN EMERGENCY PLACEMENT?:

YES

DATE OF BIRTH:

Calculated Age:

Gender

Male

Female

Transgender

Other (self-defined)

Religion Of Resident:

RELIGION OF PARENTs

ROOM NUMBER:

PREFERRED NAME:

NATIONAL INSURANCE NUMBER:

BILLING DETAILS:

EDUCATION DETAILS:

UNIVERSAL PUPIL NUMBER:

SCHOOL ATTENDED OR EDUCATIONAL PROVISION:

ATTENDS SCHOOL RUN BY CARE GROUP?:

SEN STATEMENT:

Reg Number:

Health Details

NHS NUMBER:

DOCTOR ON ADMISSION:

DOCTOR:

DENTIST:

OPTICIAN:

HOSPITAL:

MEDICAL NEEDS::

KNOWN ALLERGIES:

PERSON WITH RESPONSIBILITY:

HAS THE YOUNG PERSON HAD ANY HISTORY OF PHYSICAL ASSAULT ON ADULTS?

HAS THE YOUNG PERSON HAD ANY HISTORY OF PHYSICAL ASSAULT ON PEERS?

IS THE YOUNG PERSON LIKELY TO BE VICTIMIZED?

YES

IS THE YOUNG PERSON LIKELY TO BULLY OTHERS?

YES

HAS THE YOUNG PERSON HAD ANY HISTORY OF BEING VERBALLY AGGRESSIVE TO OTHERS?

YES

IS THERE ANY HISTORY OF CRIMINAL DAMAGE IN RESIDENTIAL UNITS?

YES

WAS THE ABOVE EITHER SERIOUS OR FREQUENT?

YES

IS THERE ANY HISTORY OF NON-ACCIDENTAL INJURY?

YES

IS THE YOUNG PERSON CURRENTLY ON THE 'AT RISK REGISTER'?

YES

IS THERE ANY HISTORY OF SEXUAL/EMOTIONAL ABUSE ?

YES

IS THE YOUNG PERSON SEXUALLY ACTIVE?

YES

IS THIS YOUNG PERSON ON ANY CONTRACEPTION?

YES

IS THERE ANY REASON TO BELIEVE THE YOUNG PERSON IS SEXUALLY COERCIVE OR MAY ABUSE OTHER YOUNG PEOPLE?

YES

DOES THE YOUNG PERSON DEMONSTRATE ANY SEXUALIZED BEHAVIOUR?

YES

IS THERE ANY HISTORY OF SELF HARM?

YES

IS THERE ANY HISTORY OF DRUG /ALCOHOL ABUSE?

YES

IS THERE ANY HISTORY OF ARSON EITHER ATTEMPTED OR CONVICTED?

YES

DOES THE YOUNG PERSON UNDERSTAND CONSEQUENCES?

YES

IS THERE ANY HISTORY OF THE YOUNG PERSON BEING OUTSPOKENLY RACIST/SEXIST IN EXPRESSION?

YES

DOES THE YOUNG PERSON UNDERSTAND PERSONAL RESPONSIBILITY?

YES

CAN THE YOUNG PERSON RELATE WELL TO ADULTS?

YES

CAN THE YOUNG PERSON RELATE WELL TO PEERS?

YES

DOES THE YOUNG PERSON HAVE ANY COMMUNICATION DIFFICULTIES?

YES

IS THERE A HISTORY OF THE YOUNG PERSON BEING MISSING?

YES

DOES YOUNG PERSON SMOKES?

YES

DOES YOUNG PERSON TAKES DRUGS

YES

IS YOUNG PERSON INVOLVED IN SOLVENT ABUSE?

YES

DOES YOUNG PERSON MAKE ALLEGATIONS?

YES

IS YOUNG PERSON ON MEDICATION?

YES

REGISTERED DISABLED?

YES

DOES YOUNG PERSON HAS EATING DISORDER?

YES

DOES YOUNG PERSON SUFFER FROM ENURESIS?

YES

DOES YOUNG PERSON SUFFER FROM SOILING ?

YES

DOES YOUNG PERSON SUFFER FROM HIV/AIDS?

YES

ARE THERE ANY GEOGRAPHICAL AREA THE YOUNG PERSON CAN NOT BE PLACED ?

YES

DOES YOUNG PERSON SUFFER FROM HEPATITIS B OR C?

YES

Is YOUNG PERSON FIRE STARTER?

YES

HAS THE YOUNG PERSON HAD ANY HISTORY OF POLICE CASE?

WHAT IS THE PROPOSED STAFFING RATIO FOR THE YOUNG PERSON

OTHER IMPORTANT HEALTH DETAILS:

DISCHARGE DESTINATION TYPE::

DESTINATION TYPE IF OTHER:

DISCHARGE DESTINATION ADDRESS:

POSTCODE

LEAVING DETAILS

PREVIOUS ADDRESS:

ADDRESS OF PARENTS: