PALS - lost property
Reporter name
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Telephone number
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Email address
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Status
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Inpatient
Outpatient
Relative
Visitor
Other
Patient name (if different to above)
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Hospital number
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Date of birth
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Relationship to patient (if applicable)
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Do you need any communication support?
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Yes
No
If yes, what type of support?
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Do you require written information in another format?
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Yes
No
If yes, what format is required?
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Do you have a preferred method of contact?
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Yes
No
If yes, what method is preferred?
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Date when item was lost
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Location(s) item thought to be lost (please include hospital and ward/department where possible)
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Full Description of lost item(s): Please include as much information as possible e.g. make of items, colour, distinguishing features
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Have you contacted the ward/department direct?
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