Healthy & Home Referral

Healthy and Home aim to ensure that patients are aware of the voluntary sector organisations that exist and how they can enable them to remain happy and safe following their discharge from the Hospital.

Our Criteria for referrals:

Patients who are elderly or frail and need some support to return to their own home
Individuals suffering from chronic conditions including Long Covid
Those living in deprived wards of Warrington and Halton
People from our hidden communities; people with a learning disability, people who experience difficulties with their Mental Health, people who have drug and alcohol issues and those suffering from domestic violence.

All referrals to Healthy and Home must be over 18 years old.

Your details

First Name ^*

Last Name ^*

Phone Number ^*

Email ^*

Department ^*

Other department detail

Patient information

Title

First Name ^*

Middle Name

Last Name ^*

Birth Date ^*

Street Address ^*

City ^*

Postal Code ^*

County

Phone Number ^*

Patient's Ethnicity

Referral details

NHS Number ^*

GP Surgery

Do they have a diagnosis of dementia?

Yes

No

Do they have any sensory impairments?

Yes

No

Discharge Pathway

Pathway 0

Pathway 1

Pathway 2

Pathway 3

Discharge Date

Current Ward

Next of Kin ^*

Reason for referral ^*

Is there anything else we need to be aware of?