Profile Picture

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

@else

@endif

Resident Name & Dates

First Name

Middle Name

Last Name

Preferred Name

Admission Date:

Placement End Date @if(isset($data['placement_end_date'])) @else @if($role == 'admin' || (((isset($perm['resident'][$data['id']]) && ($perm['resident'][$data['id']]==1)) || ((isset($data['home_id']) && (isset($perm['resident']['bulk_'.$data['home_id']])) && ($perm['resident']['bulk_'.$data['home_id']]==1)) && ((isset($perm['resident'][$data['id']]) && ($perm['resident'][$data['id']] == 1)) || !isset($perm['resident'][$data['id']] ))) || ( ( (isset($perm['resident']['bulk'])) && ($perm['resident']['bulk'] == 1) ) && ((isset($perm['resident'][$data['id']]) && ($perm['resident'][$data['id']] == 1)) || !isset($perm['resident'][$data['id']] )) )) && $role!='visitor')) End Date @endif @endif

Please Select Which Option Is Relevant To The Resident?

Key Worker:

Detailed Information:

Care Home:

Contact Details

Contact Detailss

Email Address (This is used as login email)

Mobile Number

Status

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

No

Date Of Birth:

Calculated Age:

Gender

Religion Of Resident:

Religion Of Parents

Room Number:

Preferred Name:

National Insurance Number:

Billing Details:

Universal Pupil Number:

School Attended Or Educational Provision:

Attends School Run By Care Group?:

Education Details:

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

No

Is The Young Person Likely To Bully Others?

Yes

No

Has The Young Person Had Any History Of Being Verbally Aggressive To Others?

Yes

No

Is There Any History Of Criminal Damage In Residential Units?

Yes

No

Was The Above Either Serious Or Frequent?

Yes

No

Is There Any History Of Non-Accidental Injury?

Yes

No

Is The Young Person Currently On The ' At Risk Register'?

Yes

No

Is There Any History Of Sexual/Emotional Abuse?

Yes

No

Is The Young Person Sexually Active?

Yes

No

Is This Young Person On Any Contraception?

Yes

No

Is There Any Reason To Believe The Young Person Is Sexually Coercive Or May Abuse Other Young People?

Yes

No

Does The Young Person Demonstrate Any Sexualized Behaviour?

Yes

No

Is There Any History Of Self Harm?

Yes

No

Is There Any History Of Drug /Alcohol Abuse?

Yes

No

Is There Any History Of Arson Either Attempted Or Convicted?

Yes

No

Does The Young Person Understand Consequences?

Yes

No

Is There Any History Of The Young Person Being Outspokenly Racist/Sexist In Expression?

Yes

No

Does The Young Person Understand Personal Responsibility?

Yes

No

Can The Young Person Relate Well To Adults?

Yes

No

Can The Young Person Relate Well To Peers?

Yes

No

Does The Young Person Have Any Communication Difficulties?

Yes

No

Is There A History Of The Young Person Being Missing?

Yes

No

Does Young Person Smokes?

Yes

No

Does Young Person Takes Drugs

Yes

No

Is Young Person Involved In Solvent Abuse?

Yes

No

Does Young Person Make Allegations?

Yes

No

Is Young Person On Medication ?

Yes

No

Registered Disabled?

Yes

No

Does Young Person Has Eating Disorder?

Yes

No

Does Young Person Suffer From Enuresis?

Yes

No

Does Young Person Suffer From Soiling ?

Yes

No

Does Young Person Suffer From Hiv/Aids?

Yes

No

Are There Any Geographical Area The Young Person Can Not Be Placed ?

Yes

No

Does Young Person Suffer From Hepatitis B Or C?

Yes

No

Is Young Person Fire Starter?

Yes

No

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 & Leaving Details

Discharge Destination Type:

Destination Type If Other:

Discharge Destination Address:

Postcode

Leaving Details

Previous Address:

Address Of Parents:

@if($role == 'admin' || (((isset($perm['resident'][$data['id']]) && ($perm['resident'][$data['id']]==1)) || ((isset($data['home_id']) && (isset($perm['resident']['bulk_'.$data['home_id']])) && ($perm['resident']['bulk_'.$data['home_id']]==1)) && ((isset($perm['resident'][$data['id']]) && ($perm['resident'][$data['id']] == 1)) || !isset($perm['resident'][$data['id']] ))) || ( ( (isset($perm['resident']['bulk'])) && ($perm['resident']['bulk'] == 1) ) && ((isset($perm['resident'][$data['id']]) && ($perm['resident'][$data['id']] == 1)) || !isset($perm['resident'][$data['id']] )) )) && $role!='visitor'))