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My communication and health passport

Please bring this passport with your child to all of their health appointments.

This will help health professionals provide personalised care and treatment for your child.

About me

My NHS number is

My Sheffield Children’s number is

Widgit icon of person pointing to themselves

My name is

I like to be called

My pronouns are

Widgit icon of a calendar

My date of birth is

Widgit icon of person standing inside a house

I live

Widgit symbol of a child and two adults inside a circle

Who I live with

My parents or carer are called

What you need to know about my family

Widgit symbol of mobile phone

Our house telephone number is

Our mobile number is

Speech bubble with Irish, English and Romanian flag

The languages we speak are

Widgit symbol of religious symbols

My religion is

My ethnicity is

Widgit symbol of allergies

My allergies are

Widgit symbol of doctor

My doctor or GP is

The surgery address is

The surgery telephone number is

Widgit symbol of someone inside a building pointing to a white square

My school is

My reasonable adjustments

Reasonable adjustments are small changes under the Equality Act (2010) that a doctor, nurse or health professional can make to your appointment.

You can use this Reasonable Adjustments Care plan to help you in other appointments like a dentist, GP or opticians.

You can ask for your reasonable adjustments to be recorded by your health care professional.

Widgit symbol of person reading a book with a thumbs up next to them

I need you to give me information in this way:

Easy Read
Braille
Phone call
Large print
Another language:

Widgit symbol of a person in a wheelchair with a green box around them

I need help to go to my appointments:

Wheelchair access
Hoist
I cannot walk far
I need to use a lift
I need an accessible parking space

A clock with part of the clockface coloured red and an arrow pointing around the outside from 12 to 4, meaning during an event

I need more time at my appointment to understand information and instructions

Speech bubble with Irish, English and Romanian flag

I or my parent or guardian need an interpreter
in language:

Widgit symbol of someone sitting on a chair looking at their watch

When I come to the hospital I need help with:

A quiet place for me to wait for my appointment
I need the first appointment of the day, as I find waiting very hard
I need the last appointment of the day, as I need my daytime routine

Widgit symbol of two people communicating using a board

This is how I communicate:

I use Makaton
I use British Sign Language
My parent or guardian with interpret my body language
I use a talk mat
I use electronic augmentative and alternative communication (AAC)

Widgit symbol of a person smiling with a green tick in a thought bubble

This is how you can help me understand information:

It helps me when I see pictures
Speak to me in short sentences and wait for me to reply
Do not use jargon. Use simple words to help me understand
Speak to my parent or guardian and they will explain it to me

Widgit symbol of a person smiling and pointing to themselves with excited lines around them

Extra things about me and my reasonable adjustments:


About me and my health

Widgit symbol of doctor

The doctor or consultant who knows me best is

A hand with its palm up, holding a person

Other people or medical teams that help me are

Square containing a medical green cross

These are my medical and neurological conditions:
I have a learning disability
I have autism

Widgit symbol of baby

I was born a premature baby    No      Yes
I was born weeks premature

Widgit symbol of medicines

Help I need to take my medicine:

The medicate I take:


Widgit symbol of two people with an arm around the other

Help I need to stay safe:


A group of people including one person in a wheelchair, outlined by a blue circle

Help I need with mobility or postural management:


Widgit symbol of cutlery and a drink

Help I need to eat and drink:


I have a risk of choking
I have dysphagia

Widgit symbol of needle syringe

I have specialist nutritional needs    No      Yes

My feeding regime is:


Widgit symbol of metabolic condition

I have a metabolic condition    No      Yes

This is my emergency plan:


Widgit symbol of person helping another write

Consent and support I need to make decisions:

Widgit symbol of two people with an arm around the other

I have an advanced care plan    No      Yes

Widgit symbol of green plus inside a building

I am enrolled in a clinical trial    No      Yes

Widgit symbol of person with electric and red lines around their head

I have epilepsy    No      Yes

My seizure and management plan is:


Widgit symbol of person's mouth open and two blue arrows in a circle
My breathing

I have a respiratory emergency plan    No      Yes

I have a tracheostomy    No      Yes

Size:
Type:
Length:
Suction tube:

Widgit symbol of person's heart
My heart

I have congenital heart disease or cardiac problem    No      Yes

Widgit symbol of an eye and an ear

This is the help I need with my eyesight and hearing:


 


How to care for me

Widgit symbol of person with electric around them

This is how to help me tell you about my pain:


Widgit symbol of a happy face, confused face and sad face

This is how you can help me tell you about my feelings:


Widgit symbol of sensory needs

This is how you can help me and my sensory needs:


Widgit symbol of fear and anxiety

These are the things that make me feel anxious, worried or scared:


Widgit symbol of someone washing themselves

This is help I need to get washed and dressed:


Widgit symbol of someone sitting down on a toilet

This is the help I need to use the toilet:


Widgit symbol of someone sleeping

This is the help I need to get to and stay asleep:



My likes and dislikes

Widgit symbol of someone happy

This is what I like, or what helps me:


Widgit symbol of someone sad

This is what I dislike or avoid:


My passport was completed with my by

Contact us

For support with reasonable adjustments in hospital please get in touch with the learning disability lead nurse on 0758 434 5848 or email scn-tr.autism-ld@nhs.net

Is something missing from this resource that you think should be included? Please let us know

Contact us

Disclaimer

Please note this is a generic information sheet relating to care at Sheffield Children’s. The details in this resource may not necessarily reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If you have specific questions about how this resource relates to your child, please ask your doctor.

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NHS

Western Bank
Sheffield
S10 2TH

United Kingdom

Switchboard: 0114 271 7000

Interesting Facts


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