Welfare Advice Advisor

We now have a Welfare Advice Advisor as part of our staff team, they can offer a range of support for someone with money worries. They provide a person-centred approach

Fernbank Medical Centre > Forms > Keep us up to Date > Key information summary

Key information summary

Key information summary (KIS) has been designed to support patients who have complex care needs or long term conditions. KIS allows important information to be shared with Healthcare Professionals in unscheduled care in NHS 24, A&E, Scottish Ambulance Service, Out of Hours Service, Hospital and Pharmacy environments.

This can also identify patients who are at high risk of severe illness, and who may need to shield due to COVID-19.

Help us to keep your information up to date. Please complete the form below with your details.

Key Information Summary

Patient’s Details

First Name *

Last Name *

Email *

Enter Email

Date of birth *

Please use format day/month/year e.g. 12/05/1979

Phone Number *

Is there a keysafe in use? *

Yes

Keysafe number *

Patient’s Next of Kin

First Name of next of kin *

Last Name of next of kin *

Address of next of kin *

Phone number of next of kin *

Is this the person we should contact in an emergency *

Yes

Who should we contact in an emergency?

Address of your emergency contact

Phone number of your emergency contact

Power of Attorney (POA)

Is there a POA in place? *

Yes

First Name of POA *

Last Name of POA *

Address of POA *

Phone number of POA *

Patient’s Care

Are there carers in place?

Yes

Do you have any specific wishes about your care you want us to put on your medical notes?

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.

I consent to the practice collecting and storing my data from this form.

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Welfare Advice Advisor

Key information summary

Patient’s Details

Patient’s Next of Kin

Power of Attorney (POA)

Patient’s Care

Privacy Policy

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