ID:1167456754          
<?xml version="1.0" encoding="UTF-8" ?><SystmOneTemplates><!--Exported on 08 Oct 2018 18:40--><!--Exported by PLENDERLEITH, Steve (Dr)--><TemplateDefinition Male="y" Female="y" Type="0"><template Cid="0" width="972" height="636" codes="" readCodesToAutoLinkDrugsTo="" codesToAlwaysInclude="" keyWordLetterTemplateDefaultForPrinting="-1" keyScoringGroup="-1"><page Cid="211" name="Introduction &amp; Patient Consent" colour="-1"><hyperLink Cid="212" x="780" y="12" w="180" h="24" URL="www.futureplanning.org.uk" DisplayText="Future Planning Website"/><formattedText Cid="229" x="237" y="12" w="555" h="36"><p><p><t sz="16" b="b" fg="0xff005eb8">For project information, template updates and additional resources.</t></p></p></formattedText><formattedText Cid="320" x="12" y="12" w="204" h="60"><p><p><t sz="20" b="b">Introduction &amp;</t></p><p><t sz="20" b="b">Patient Consent</t></p></p></formattedText><image Cid="225" x="828" y="552" w="107" h="42" KeyImage="4368" Ratio="y"/><formattedText Cid="331" x="24" y="612" w="456" h="26"><p><p al="1"><t sz="14" b="b" fg="0xffef3511">VERSION 3</t><t sz="14" fg="0xffef3511"> of the </t><t sz="14" b="b" fg="0xffef3511">Future Planning Template</t><t sz="14" fg="0xffef3511"> - October 2018</t></p></p></formattedText><image Cid="226" x="12" y="528" w="156" h="83" KeyImage="4196" Ratio="y"/><formattedText Cid="224" x="324" y="36" w="472" h="41"><p><p><t fnt="Arial" sz="14" b="b" fg="0xff005eb8">Project supported as part of an NHS and Hospice partnership:</t></p></p></formattedText><hyperLink Cid="309" x="780" y="36" w="180" h="24" URL="http://www.futureplanning.org.uk/supported_by.html" DisplayText="Supported by"/><notes Cid="318" x="192" y="516" w="624" h="84" text="Person giving consent and rationale if NOT patient" journal="y" summary="y" bias="60" amendNotes="n" blank="n" code="XaaYM" orientation="Top" presetNotes=""/><formattedText Cid="377" x="12" y="84" w="936" h="84"><p><p><t>The main purpose of this template set is to provide </t><t sz="14" b="b" fg="0xffff0000">a summary</t><t> of the patient&apos;s clinical information to the Summary Care Record (SCR) for teams providing their care during Emergency / Acute Care episodes.</t></p><p/><p><t sz="14" b="b" fg="0xffff0033">Please keep freetext succinct, understandable and relevant to the question asked / box title.</t></p></p></formattedText><formattedText Cid="272" x="12" y="168" w="936" h="96"><p><p><t>By accessing the Summary Care Record;</t></p><p><t>&#x9;&#x9;&#x9;- Ambulance Triage (999/111) and paramedic crews, </t></p><p><t>&#x9;&#x9;&#x9;- GP OOH services,</t></p><p><t>&#x9;&#x9;&#x9;- MAU, ED and any other hospital staff, </t></p><p al="2"><t>with an NHS smartcard, will be able to access this summary information to guide their clinical responses.</t></p></p></formattedText><formattedText Cid="382" x="240" y="276" w="504" h="36"><p><p><t sz="14" b="b" fg="0xffcc00cc">THIS IS THE MOST IMPORTANT CODE IN THE WHOLE TEMPLATE</t><t sz="10" fg="0xffcc00cc">, bar none.</t></p></p></formattedText><vline Cid="378" x="192" y="300" length="48" vertical="y"/><hline Cid="381" x="192" y="348" length="600"/><checkBox Cid="317" x="216" y="312" w="552" text="Consent to share - allows upload to the Summary Care Record" journal="y" summary="y" amendNotes="y" blank="n" code="XaXbZ" reportDefault="-1"/><hline Cid="380" x="192" y="300" length="600"/><vline Cid="379" x="792" y="300" length="48" vertical="y"/><formattedText Cid="316" x="12" y="360" w="936" h="132"><p><p al="1"><t fg="0xff660066">The &quot;</t><t sz="14" b="b" fg="0xffff0000">Consent to Share</t><t fg="0xff660066">&quot; tick box above will enable </t><t u="u" sz="14" b="b" fg="0xff660066">all information from this set of templates</t><t b="b" fg="0xff660066"> to show in the patient&apos;s national Summary Care Record</t><t fg="0xff660066">. </t></p><p al="1"><t fg="0xff660066">In addition, some other coded information from the GP record, such as diagnoses and involved teams, will also be shared to the SCR.</t></p><p/><p><t sz="14" b="b" fg="0xffff0000">Verbal or written consent is acceptable</t><t sz="14" b="b" fg="0xff660066">. Consent may also be gained by other clinical teams who should pass this info to the practice as, currently, only GP practices can record this code in the patient record.</t></p><p><t fg="0xff660066">If a patient has a persistent lack of capacity for giving this consent, then their legal representative (LPoA for H&amp;W, court appointed guardian) or an appropriate clinician (ideally with MDT backing) should, acting in the patients best interests, add this consent code to the patient record.</t></p></p></formattedText></page><page Cid="1" name="End of Life" colour="-3342388"><hyperLink Cid="78" x="780" y="12" w="180" h="24" URL="www.futureplanning.org.uk" DisplayText="Future Planning Website"/><title Cid="4" x="24" y="24" width="276" text="End of Life / GSF Register"/><notes Cid="173" x="252" y="60" w="444" h="28" text="Named accountable GP" summary="y" bias="65" reqStat="1" amendNotes="n" blank="n" code="XacWQ" presetNotes=""/><notes Cid="178" x="24" y="108" w="444" h="132" text="End of Life / GSF Review - meeting notes &amp; date" date="y" summary="y" amendNotes="n" blank="n" code="XaLG1" orientation="Top" presetNotes=""/><textarea Cid="8" x="516" y="108" w="444" h="228" text="KARNOFSKY SCORE CRITERIA|100% - Normal; no complaints; no evidence of disease &#x9; |90% - Able to carry on normal activity; minor sign of symptoms of disease &#x9;|80% - Normal activity with effort; some signs or symptoms of disease &#x9;|70% - Cares for self; unable to carry on normal activity or to do active work |60% - Able to care for most needs; but requires occasional assistance &#x9;|50% - Considerable assistance and frequent medical care required &#x9;|40% - In bed more than 50% of the time &#x9;|30% - Almost completely bedfast &#x9;|20% - Totally bedfast and requiring extensive nursing care by professionals and/or family|10% - Comatose or barely rousable|"/><number Cid="142" x="516" y="324" w="444" text="Australia-modified Karnofsky Performance Status scale" bias="25" amendNotes="n" blank="n" code="Xab0M"/><notes Cid="310" x="24" y="252" w="444" h="84" text="EoL Diagnosis or Diagnoses" summary="y" bias="65" amendNotes="n" blank="n" code="XaZjJ" presetNotes=""/><comboBox Cid="6" x="24" y="348" w="444" text="Palliative care Phase Of Illness." journal="y" summary="y" amendNotes="n" blank="n" codes="2128.;212D.;XM1UN;XaQg1"><rc rc="2128." desc=""/><rc rc="212D." desc=""/><rc rc="XM1UN" desc=""/><rc rc="XaQg1" desc=""/></comboBox><formattedText Cid="330" x="24" y="612" w="456" h="26"><p><p al="1"><t sz="14" b="b" fg="0xffef3511">VERSION 3</t><t sz="14" fg="0xffef3511"> of the </t><t sz="14" b="b" fg="0xffef3511">Future Planning Template</t><t sz="14" fg="0xffef3511"> - October 2018</t></p></p></formattedText><view Cid="390" x="24" y="384" w="930" h="214" KeyView="140609"/></page><page Cid="182" name="Frailty" colour="-3342337"><hyperLink Cid="189" x="780" y="12" w="180" h="24" URL="www.futureplanning.org.uk" DisplayText="Future Planning Website"/><title Cid="187" x="24" y="24" width="276" text="Frailty Assessment"/><notes Cid="195" x="252" y="60" w="444" h="28" text="Named accountable GP" summary="y" bias="70" reqStat="1" amendNotes="n" blank="n" code="XacWQ" presetNotes=""/><formattedText Cid="329" x="24" y="612" w="456" h="26"><p><p al="1"><t sz="14" b="b" fg="0xffef3511">VERSION 3</t><t sz="14" fg="0xffef3511"> of the </t><t sz="14" b="b" fg="0xffef3511">Future Planning Template</t><t sz="14" fg="0xffef3511"> - October 2018</t></p></p></formattedText><formattedText Cid="185" x="24" y="108" w="444" h="48"><p><p><t>To calculate the eFI scores for patients in your practice please see the SystmONE electronic Frailty Report in &quot;Reporting &gt; Miscellaneous Reports&quot;.</t></p></p></formattedText><notes Cid="190" x="24" y="156" w="444" text="eFI Frailty Index Score" date="y" summary="y" bias="30" amendNotes="n" blank="n" code="XabYS" presetNotes=""/><number Cid="201" x="24" y="204" w="444" text="Canadian Study of Health and Aging clinical frailty scale" bias="25" amendNotes="n" blank="n" code="XaQik" pvlimit="Last" pvtime="12" pvunit="Wks"/><hyperLink Cid="311" x="24" y="228" w="443" h="24" URL="www.futureplanning.org.uk/rockwood" DisplayText="Also known as the ROCKWOOD SCALE - click to view"/><notes Cid="219" x="504" y="108" w="443" h="120" text="Polypharmacy medication review" date="y" journal="y" eipsodicity="2" level="2" amendNotes="n" blank="n" code="XaaCQ" orientation="Top" presetNotes="Consider;       Anticholinergic Medications &amp; reasons for continued use;       Reduced eGFR and current medications affected by this"/><notes Cid="200" x="84" y="444" w="780" h="120" text="Frailty Review - meeting notes and date" date="y" summary="y" amendNotes="n" blank="n" code="X76Ao" orientation="Top" presetNotes=""/><number Cid="221" x="24" y="288" w="443" text="Number of falls in the last 12 months" journal="y" summary="y" level="2" amendNotes="n" blank="n" code="XaISO" pvlimit="Last" pvtime="1" pvunit="Yrs"/><formattedText Cid="275" x="336" y="288" w="150" h="24"><p><p><t sz="11">Enter &quot;0&quot; if no falls.</t></p></p></formattedText><hline Cid="223" x="24" y="408" length="924"/><notes Cid="222" x="504" y="240" w="443" h="120" text="Falls assessment" date="y" journal="y" summary="y" eipsodicity="2" level="2" problem="y" amendNotes="n" blank="n" code="XaJL7" orientation="Top" presetNotes="Consider"/><comboBox Cid="220" x="192" y="372" w="504" text="Frailty Assessment Conclusion" journal="y" bias="60" level="2" amendNotes="n" blank="n" codes="XabdY;Xabdb;Xabdd"><dependency cid="201" comparison="7" value="0.0" keyReport="-1"/><dependency cid="221" comparison="9" value="0.0" keyReport="-1"/><dependencyMode mode="0"/><rc rc="XabdY" desc=""/><rc rc="Xabdb" desc=""/><rc rc="Xabdd" desc=""/></comboBox></page><page Cid="10" name="Prognosis &amp; GSF Meeting" colour="-3342388"><title Cid="11" x="24" y="12" width="396" text="Prognosis &amp; GSF Meeting"/><formattedText Cid="328" x="24" y="611" w="456" h="26"><p><p al="1"><t sz="14" b="b" fg="0xffef3511">VERSION 3</t><t sz="14" fg="0xffef3511"> of the </t><t sz="14" b="b" fg="0xffef3511">Future Planning Template</t><t sz="14" fg="0xffef3511"> - October 2018</t></p></p></formattedText><hline Cid="258" x="12" y="120" length="936"/><textarea Cid="262" x="552" y="48" w="72" h="53" text="Select all that are relevant."/><multiple Cid="202" x="480" y="12" w="468" h="108" text="Awareness of Prognosis" summary="y" bias="65" amendNotes="y" blank="n" codes="XaQIy;XaVzA;XaX1d;XaVzE;XaX1e;XaXBG"><rc rc="XaQIy" desc=""/><rc rc="XaVzA" desc=""/><rc rc="XaX1d" desc=""/><rc rc="XaVzE" desc=""/><rc rc="XaX1e" desc=""/><rc rc="XaXBG" desc=""/></multiple><vline Cid="383" x="12" y="48" length="48" vertical="y"/><formattedText Cid="384" x="24" y="72" w="456" h="48"><p><p><t sz="14" b="b" fg="0xffcc00cc">MOST IMPORTANT CODE FOR THE PRACTICE</t></p><p al="2"><t b="b">- adds patient to the GSF/ Frailty register</t></p></p></formattedText><comboBox Cid="203" x="24" y="48" w="444" text="GSF Stage - possible prognosis" bias="60" amendNotes="n" blank="n" codes="XaZb7;XaZbA;XaZbD;XaZbE"><rc rc="XaZb7" desc=""/><rc rc="XaZbA" desc=""/><rc rc="XaZbD" desc=""/><rc rc="XaZbE" desc=""/></comboBox><checkBox Cid="88" x="24" y="180" w="420" text="Discussion/info around advance care planning" summary="y" amendNotes="n" blank="n" code="Xaa0j" reportDefault="-1"/><title Cid="17" x="60" y="264" width="300" text="GSF stage - Green (Months)" colour="-16737946"/><checkBox Cid="116" x="24" y="216" w="420" text="Under care of social services" summary="y" amendNotes="n" blank="n" code="XaLKF" reportDefault="-1"/><title Cid="16" x="60" y="156" width="300" text="GSF Stage - Blue (&gt;1 year)" colour="-16763956"/><checkBox Cid="144" x="516" y="324" w="432" text="Required rescue medication in place" amendNotes="n" blank="n" code="XaZke" reportDefault="-1"/><formattedText Cid="168" x="516" y="288" w="444" h="24"><p><p><t fnt="Arial Narrow" fg="0xff990033">NOT commissioned in all areas, though SPC/Hospice advice available for clinicians 24/7 all areas.</t></p></p></formattedText><checkBox Cid="167" x="516" y="264" w="433" text="Hospice/SPC 24hr Advice &amp; Rapid Response Service - Info provided" amendNotes="n" blank="n" code="XaPnl" reportDefault="-1"/><hline Cid="22" x="12" y="252" length="936"/><formattedText Cid="389" x="24" y="132" w="925" h="24"><p><p al="1"><t sz="14" fg="0xffcc00cc">Please record additional information in the Treatment Escalation and Future Planning TABS as appropriate.</t></p></p></formattedText><checkBox Cid="117" x="24" y="288" w="420" text="DS 1500 Disability living allowance completed" date="y" summary="y" amendNotes="n" blank="n" code="9EB5." reportDefault="-1"/><checkBox Cid="119" x="24" y="324" w="420" text="Future equipment needs considered" summary="y" amendNotes="n" blank="n" code="Ua02i" reportDefault="-1"/><checkBox Cid="169" x="516" y="216" w="434" text="Information around finance provided (e.g. CAB)" summary="y" amendNotes="n" blank="n" code="6743." reportDefault="-1"/><formattedText Cid="386" x="516" y="180" w="430" h="24"><p><p al="1"><t>( Particularly important if co-habiting)</t></p></p></formattedText><checkBox Cid="387" x="516" y="156" w="432" text="Discussion or leaflet provided re. Writing Last Will &amp; Testament" amendNotes="n" blank="n" code="Xag0E" reportDefault="-1"/><textarea Cid="388" x="516" y="348" w="432" h="48" text="For each Anticipated Problem document, how &amp; when to use, in the Treatment Escalation TAB"/><formattedText Cid="385" x="516" y="444" w="443" h="32"><p><p al="1"><t>(Allows a competent clinician to diagnose </t><t b="b">{ </t><t>verify </t><t b="b">}</t><t> an expected death)</t></p></p></formattedText><checkBox Cid="161" x="516" y="420" w="444" text="GP, Senior Doctor or MDT confirm imminent expected death" date="y" summary="y" level="3" problem="y" amendNotes="n" blank="n" code="XafjY" reportDefault="-1"/><hline Cid="205" x="12" y="384" length="936"/><title Cid="21" x="60" y="396" width="372" text="GSF stage - Yellow / Amber (Weeks)" colour="-1141200"/><checkBox Cid="81" x="24" y="420" w="420" text="NHS continuing healthcare fast track funding applied for" date="y" journal="y" summary="y" amendNotes="n" blank="n" code="XaVzx" reportDefault="-1"/><checkBox Cid="118" x="24" y="456" w="420" text="Referred to community care team for care needs or introduction" summary="y" amendNotes="n" blank="n" code="XaAQq" reportDefault="-1"/><checkBox Cid="160" x="24" y="492" w="420" text="Hospital bed, mattress &amp; continence equipment in place, if needed" summary="y" amendNotes="n" blank="n" code="Ub0sG" reportDefault="-1"/><hline Cid="204" x="12" y="528" length="936"/><checkBox Cid="121" x="516" y="480" w="432" text="Anticipatory medications FP10 &amp; PRN chart issued" summary="y" amendNotes="n" blank="n" code="XaPmq" reportDefault="-1"/><pageLink Cid="323" x="780" y="504" w="168" h="27" PageNumber="9" DisplayText="Anticipatory Prescribing"/><title Cid="27" x="60" y="540" width="300" text="GSF stage - Red (Days)" colour="-3407872"/><checkBox Cid="84" x="24" y="564" w="420" text="Package of care in place sufficient for needs" summary="y" amendNotes="n" blank="n" code="XE0p4" reportDefault="-1"/><checkBox Cid="85" x="516" y="540" w="432" text="Known to Hospice at Home / End of Life nursing team" journal="y" summary="y" level="2" amendNotes="n" blank="n" code="XaZLA" reportDefault="-1"/><checkBox Cid="162" x="516" y="576" w="432" text="Comm Pal Care Syringe Driver Admin Order completed" summary="y" amendNotes="n" blank="n" code="XaaD3" reportDefault="-1"/><pageLink Cid="325" x="780" y="600" w="168" h="27" PageNumber="9" DisplayText="Anticipatory Prescribing"/></page><page Cid="49" name="Treatment Escalation" colour="-3358246"><title Cid="50" x="24" y="12" width="348" text="Treatment Escalation Planning TEP"/><hyperLink Cid="156" x="780" y="12" w="180" h="24" URL="www.futureplanning.org.uk" DisplayText="Future Planning Website"/><notes Cid="54" x="24" y="60" w="924" h="72" text=" Emergency contact details." summary="y" bias="70" amendNotes="n" blank="n" code="XaXTm" presetNotes="Contacts information entered elsewhere in SystmONE is unlikely to be visible to acute care teams via the Summary Care Record.;1st Contact Name:    Tel./Mobile:      Alt. Tel:       Address:         Awareness of wishes/other notes:;2nd Contact Name:   Tel./Mobile:      Alt. Tel:       Address:         Awareness of wishes/other notes:"/><notes Cid="53" x="492" y="144" w="456" h="96" text="Home access info &amp; risks eg pets &amp; other" journal="y" level="3" problem="y" amendNotes="n" blank="n" code="XaYR5" orientation="Top" presetNotes=""/><multiple Cid="122" x="24" y="156" w="444" h="84" text="Power of Attorney" summary="y" bias="75" amendNotes="y" blank="n" codes="XaYlh;XaOc5;Ua0Sq;XaOc4;Ua0Sn"><rc rc="XaYlh" desc=""/><rc rc="XaOc5" desc=""/><rc rc="Ua0Sq" desc=""/><rc rc="XaOc4" desc=""/><rc rc="Ua0Sn" desc=""/></multiple><formattedText Cid="270" x="84" y="576" w="204" h="60"><p><p><t sz="11" fg="0xff660066">Where is the original stored?</t></p><p><t sz="11" fg="0xff660066">Add a summary of relevant details:</t></p></p></formattedText><notes Cid="59" x="24" y="552" w="924" h="72" text="Has Advance Decision to Refuse Treatment (ADRT)" summary="y" bias="70" amendNotes="n" blank="n" code="XaYld" presetNotes="Where is the ADRT held:-;|Briefly record issues covered by the ADRT:-;|In which settings do these apply:-"/><formattedText Cid="172" x="24" y="252" w="936" h="132"><p><p><t fnt="Arial" sz="14" b="b">Treatment Escalation Planning (TEP) Levels</t></p><p><t fnt="Arial" sz="14" b="b" fg="0xff660066">Intensive:</t><t fnt="Arial" fg="0xff660066">&#x9;Transfer to hospital for treatment if appropriate. Critical care, intubation and ventilation should be considered.</t></p><p><t fnt="Arial" sz="14" b="b" fg="0xff660066">Hospital:</t><t fnt="Arial" fg="0xff660066">&#x9;Transfer to hospital if appropriate, but not for critical care, intubation or ventilation.</t></p><p><t fnt="Arial" sz="14" b="b" fg="0xff660066">Home: </t><t fnt="Arial" fg="0xff660066">&#x9;Treat with normal and rescue medications (mostly oral, nebs, SC &amp;/or syringe driver) at home with support from GP. Admission to hospital to be avoided unless measures fail and following discussion with Palliative Care or other involved Specialist Team and GP.</t></p><p><t fnt="Arial" sz="14" b="b" fg="0xff660066">Comfort:</t><t fnt="Arial" fg="0xff660066">&#x9;Palliative Meds via SC, oral or per rectal route, positioning, wound care and other measures to relieve symptoms. Admission to hospital to be avoided unless comfort measures fail and following discussion with Palliative Care Team.</t></p></p></formattedText><comboBox Cid="52" x="359" y="29" w="396" text="Who does the patient live with?" summary="y" amendNotes="y" blank="n" codes="13F2.;13F3.;13FH.;Ua0Ig;Ua0IT;Ua0Lj;XaAyp"><rc rc="13F2." desc=""/><rc rc="13F3." desc=""/><rc rc="13FH." desc=""/><rc rc="Ua0Ig" desc=""/><rc rc="Ua0IT" desc=""/><rc rc="Ua0Lj" desc=""/><rc rc="XaAyp" desc=""/></comboBox><notes Cid="181" x="24" y="372" w="924" h="168" text="Anticipated problems due to medical conditions" summary="y" bias="70" amendNotes="n" blank="n" code="XacZx" orientation="Top" presetNotes="Example: Lower Respiratory Tract Infection      Rx Level: HOME      Management &amp; Patient Wishes: For trial of PO antibiotics, not for IV, if deteriorates stop antibiotics and palliate;Problem: Signs of infection e.g. UTI                      TEP Level:                   Mx &amp; Wishes:;Problem: Poor oral intake/f ood &amp; fluid                  TEP Level:                  Mx &amp; Wishes:;Problem: Falls without obvious injury                    TEP Level:                  Mx &amp; Wishes:;Problem: Falls with suspected injury or fracture  TEP Level:                  Mx &amp; Wishes:;Problem: Signs of possible CVA                             TEP Level:                  Mx &amp; Wishes:;Problem:                                                                      TEP Level:                  Mx &amp; Wishes:"/></page><page Cid="107" name="TEP Observations" colour="-3096098"><title Cid="134" x="24" y="12" width="348" text="Observations to be considered "/><hyperLink Cid="157" x="780" y="12" w="180" h="24" URL="www.futureplanning.org.uk" DisplayText="Future Planning Website"/><notes Cid="135" x="12" y="48" w="936" h="48" text="If diabetic, usual BM range &amp; response if abnormal" summary="y" bias="70" amendNotes="n" blank="n" code="XaJYg" presetNotes=""/><checkBox Cid="137" x="12" y="108" w="300" text="Known Chronic type 2 respiratory failure" amendNotes="y" blank="n" code="XaO5m" reportDefault="-1"/><notes Cid="136" x="12" y="144" w="936" h="48" text="Patient at risk of CO2 retention - please document" journal="y" bias="70" level="3" problem="y" amendNotes="n" blank="n" code="P8yz." presetNotes=""/><title Cid="125" x="12" y="204" width="514" text="CO2 Retention Risk Factors (BTS guidelines 2012)"/><textarea Cid="124" x="12" y="228" w="432" h="192" text="|Patients may be at risk of CO2 retention and therefore respiratory depression with higher oxygen concentrations if:|&#8226;    They have a past history of CO2 retention|&#8226;    They have chronic chest disease, such as COPD, musculoskeletal disease or chronic neuromuscular conditions|&#8226;    They have all 3 of the following risk factors; |    &#x9;           o    long term smoker|&#x9;           o    &gt;50 years old|&#x9;           o    unexplained exertional dyspnoea|"/><notes Cid="138" x="492" y="240" w="455" h="120" text="Home O2- reason for use &amp; acceptable O2 sats range" summary="y" bias="30" amendNotes="n" blank="n" code="XE1Sx" orientation="Top" presetNotes=""/><notes Cid="140" x="12" y="408" w="936" h="60" text="Heart rate and rhythm - record useful information" summary="y" bias="70" level="3" amendNotes="n" blank="n" code="XaaBH" presetNotes=""/><notes Cid="139" x="12" y="480" w="936" h="72" text="Any longstanding abnormal signs or findings" journal="y" summary="y" bias="70" level="2" amendNotes="n" blank="n" code="2Z..." presetNotes=""/><hline Cid="393" x="24" y="564" length="923"/><checkBox Cid="394" x="240" y="576" w="432" text="FP: My Wishes leaflet patient info added" date="y" summary="y" amendNotes="n" blank="n" code="XaZYs" reportDefault="-1"/><formattedText Cid="395" x="240" y="600" w="612" h="48"><p><p><t>Please tick this box if entering information that a patient, or other person with permission to do so, has submitted to the practice using the Future Planning: My Wishes form.</t></p></p></formattedText></page><page Cid="33" name="Future Planning" colour="-3342388"><hyperLink Cid="155" x="780" y="12" w="180" h="24" URL="www.futureplanning.org.uk" DisplayText="Future Planning Website"/><title Cid="46" x="60" y="492" width="204" text="Support Available"/><checkBox Cid="164" x="576" y="540" w="371" text="Attends Hospice Daycare or other supportive service." summary="y" amendNotes="y" blank="n" code="XaIt6" reportDefault="-1"/><comboBox Cid="47" x="456" y="492" w="492" text="Hospice/specialist palliative care team involved?" summary="y" amendNotes="y" blank="n" codes="XaXqW;XaXoP;XaLKI;XaIlk;XaIpa"><rc rc="XaXqW" desc=""/><rc rc="XaXoP" desc=""/><rc rc="XaLKI" desc=""/><rc rc="XaIlk" desc=""/><rc rc="XaIpa" desc=""/></comboBox><hline Cid="45" x="36" y="480" length="902"/><notes Cid="132" x="24" y="384" w="432" h="84" text="Referral to coroner required. Please give details." summary="y" bias="35" amendNotes="n" blank="n" code="Xab5P" orientation="Top" presetNotes="Reason for referral?;|Is patient / family aware of need for referral?;|Has discussion taken place with coroner already?;|"/><notes Cid="97" x="492" y="384" w="456" h="84" text="Wishes to be tissue donor. Please give details " journal="y" level="2" problem="y" amendNotes="n" blank="n" code="139.." orientation="Top" presetNotes="Please provide details;|Any wish or objections to donating specific organs or tissues;|Issues discussed with patient and/or  family;|Patient/family/NoK understanding of the process of donation after death;|Any arrangements agreed with University, Research or other organisations. Please give contact details."/><notes Cid="250" x="24" y="288" w="924" h="84" text="Wishes &amp; requirements following death. " summary="y" bias="70" amendNotes="n" blank="n" code="94Z.." presetNotes="Are there any religious,cultural, family or patient requirements/wishes?|E.g. Preparation of the body.|Is the patient to be buried or cremated?|A patient with a fear of being &quot;buried alive&quot; may be re-assured to see this raised to ensure that Verification is undertaken thoroughly.|If an undertaker has already been identified, please detail here.;||Concerns regarding bereavement?"/><title Cid="40" x="60" y="264" width="357" text="Considerations for care after death"/><hline Cid="39" x="12" y="252" length="948"/><multiple Cid="99" x="24" y="528" w="516" h="96" text="Other involved specialist teams" summary="y" bias="65" amendNotes="y" blank="n" codes="XaIN4;XaAP9;XaJO4;XaIN5;XaAPj;YA483;XaIvk;XaAPU;XaAOr;XaARD;XaAPC;XaARU;XaAQQ;XaE4n"><rc rc="XaIN4" desc=""/><rc rc="XaAP9" desc=""/><rc rc="XaJO4" desc=""/><rc rc="XaIN5" desc=""/><rc rc="XaAPj" desc=""/><rc rc="YA483" desc=""/><rc rc="XaIvk" desc=""/><rc rc="XaAPU" desc=""/><rc rc="XaAOr" desc=""/><rc rc="XaARD" desc=""/><rc rc="XaAPC" desc=""/><rc rc="XaARU" desc=""/><rc rc="XaAQQ" desc=""/><rc rc="XaE4n" desc=""/></multiple><comboBox Cid="396" x="24" y="204" w="432" text="Patient CPR Status" amendNotes="n" blank="n" codes="XaZVX;XaZ9c"><rc rc="XaZVX" desc=""/><rc rc="XaZ9c" desc=""/></comboBox><formattedText Cid="397" x="24" y="228" w="432" h="24"><p><p><t b="b" fg="0xffff0000">This record does NOT replace the need for a uDNACPR or ReSPECT form</t></p></p></formattedText><multiple Cid="398" x="492" y="144" w="447" h="96" text="Awareness of CPR" bias="70" amendNotes="y" blank="n" codes="XaLwc;XaLwd;XacqM;XacqN;Xabld"><rc rc="XaLwc" desc=""/><rc rc="XaLwd" desc=""/><rc rc="XacqM" desc=""/><rc rc="XacqN" desc=""/><rc rc="Xabld" desc=""/></multiple><title Cid="34" x="24" y="12" width="351" text="Considerations for ongoing care "/><notes Cid="93" x="24" y="48" w="924" h="72" text="Patient, Family/NoK wishes &amp; preferences for care" summary="y" bias="70" amendNotes="n" blank="n" code="XaXUG" presetNotes="This section provides space to record the hopes, wishes and preferences of those involved in the remaining life of this patient. And their concerns and fears.;|Preferences that are not specific enough for an ADRT form could be recorded here.;|A description of family dynamics!;|Difficulties with communication?;|In short anything that may help to inform clinical and social care staff to provide more effective care and support.;||Management of anticipated medical problems should be entered on the Avoiding Unplanned Admissions 1 TAB."/><comboBox Cid="94" x="24" y="132" w="432" text="Preferred place of death" journal="y" summary="y" bias="65" level="2" amendNotes="y" blank="n" codes="XaJ3g;XaJ3h;XaJ3k;XaJ3j;XaJ3i;XaQiX;XaYsj;XaQzq;XaQzt;XaQzr;XaXOt"><rc rc="XaJ3g" desc=""/><rc rc="XaJ3h" desc=""/><rc rc="XaJ3k" desc=""/><rc rc="XaJ3j" desc=""/><rc rc="XaJ3i" desc=""/><rc rc="XaQiX" desc=""/><rc rc="XaYsj" desc=""/><rc rc="XaQzq" desc=""/><rc rc="XaQzt" desc=""/><rc rc="XaQzr" desc=""/><rc rc="XaXOt" desc=""/></comboBox><comboBox Cid="38" x="24" y="168" w="432" text="Status of internal cardiac defibrillator" amendNotes="y" blank="n" codes="Xa8D5;XaNR7;XaYZM"><rc rc="Xa8D5" desc=""/><rc rc="XaNR7" desc=""/><rc rc="XaYZM" desc=""/></comboBox><formattedText Cid="399" x="540" y="168" w="85" h="48"><p><p><t sz="11">Discussion </t></p><p><t sz="11">   or Decisions</t></p></p></formattedText></page><page Cid="280" name="CPR Decision" colour="-1712148"><hyperLink Cid="283" x="768" y="12" w="180" h="24" URL="www.futureplanning.org.uk" DisplayText="Future Planning Website"/><formattedText Cid="282" x="24" y="12" w="616" h="36"><p><p><t fnt="Arial" sz="18" b="b" fg="0xffff0033">CARDIOPULMONARY RESUSCITATION DECISIONS</t></p></p></formattedText><formattedText Cid="391" x="24" y="60" w="744" h="240"><p><p><t fnt="Comic Sans MS" sz="18" fg="0xffff0000">PAGE IN DEVELOPMENT</t></p><p><t fnt="Arial" sz="14" b="b">Will be released in Future Planning Version 3.2 as soon as possible</t></p><p/><p><t fnt="Arial" sz="14">A Hampshire and Isle of Wight STP supported work group is being established, which aims to use the Future Planning template to replace the lilac uDNACPR form. This will allow digital recording of CPR decisions, automatic transfer of this info to both the Summary Care Record and CHIE and, for the next year or so, printing of adapted ReSPECT forms populated with CPR and other information from the Future Planning template.</t></p><p/><p><t fnt="Arial" sz="14">Communication via the LMC and CCG newsletters will take place when the new TAB and linked resources are ready for publication.</t></p></p></formattedText></page><page Cid="326" name="Anticipatory Meds" colour="-3342388"><title Cid="332" x="24" y="12" width="276" text="Anticipatory Prescribing"/><hyperLink Cid="371" x="780" y="12" w="180" h="24" URL="www.futureplanning.org.uk" DisplayText="Future Planning Website"/><formattedText Cid="392" x="24" y="48" w="744" h="288"><p><p><t fnt="Comic Sans MS" sz="18" fg="0xffff0000">PAGE IN DEVELOPMENT</t></p><p><t fnt="Arial" sz="14" b="b">Will be released in Future Planning Version 3.1. Hopefully in later October 2018.</t></p><p/><p><t fnt="Arial" sz="14">Please do not wait for version 3.1 before starting to usw the Future Planning template. We are aware some practices have been doing just that while waiting for Version 3. There will always be a new version sometime in the Future!</t></p><p/><p><t fnt="Arial" sz="14">In response to the Report of the Gosport War Memorial Independant Panel Jan 2018, Hampshire &amp; Isle of Wight Palliative Care Physicians, working with pharmacy and GP colleagues, are aiming to develop a standard simple Anticipatory Prescribing template. This page will link to the new template and will also aid with the consistent printing or NHSmailing of the Community Syringe Driver and PRN Administration Orders used by both Solent and Southern Health community teams.</t></p><p/><p><t fnt="Arial" sz="14">Communication direct to practice managers/IT managers will take place when the new TAB and linked resources are ready for publication.</t></p></p></formattedText></page></template><Name>Future Planning GP Version 3</Name><Description>End of life, frailty, prognosis/GSF, TEP &amp; future planning template</Description><Category>Future Care Planning</Category><Icon>CHDRiskUnknown</Icon><Source>132543</Source><SourceGroup>-1</SourceGroup><Position>-1j-36d1d-3k113s-21b3t19292n-t-3p-3a3h1o3g1735f-1o3u-31-1p3e2d-2s3m1d3a</Position></TemplateDefinition></SystmOneTemplates>