Accessible Information Standard

The Accessible Information Standard aims to make sure that disabled people have access to information that they can understand and any communication support they might need.

Should you have any requirements or know of a patient who needs support please let the Practice know and we will help provide support whether that is by providing information in large print or putting a patient in touch with British Sign Language (BSL), an interpreter, email or braille.

Further information can be obtained on the NHS website: www.england.nhs.uk/accessibleinfo

Charities including Action on Hearing Loss, CHANGE, Sense and the Royal National Institute of Blind People (RNIB) will also be able to provide further support.

We will be collecting this information initially for new patients on registering, and for patients who are known to the practice to have a disability which requires communication via a specific method.

If you require a specific method of communication because of a disability, please inform the practice as soon as possible to ensure this information is recorded or complete the Accessible Information Standard Form below. You can also download the form (DOCX, 18KB). Please fill it in then hand in at reception.

Accessible Information Standard

We wish to understand and record any particular communications needs you might have.

We will then do our best to meet your needs in all contacts with the practice.

Is your communication with others affected by a health problem or disability which has lasted or expected to last at least 12 months

If YES please complete the rest of questionnaire.

If No you do not need to answer any further questions.

The Accessible Information Standard Aims to ensure that patients (or their carers) who have a disability or sensory loss can receive, access and understand information, E.g. in large print, braille or via email, and professional communication support if needed.

This applies to patients and their carers who have information and/or communication needs relating to a Disability, Impairment or Sensory Loss. It also applies to parents and carers of patients who have such information and /or communication needs, where appropriate.

Individuals most likely to be affected by the standard include people who are blind or deaf, who have some hearing and/or visual loss, and people with a learning disability. However this list is not exhaustive.

Do you have communication needs?

Please state any sensory impairment

Do you have any special communication requirements?

How do you prefer to be contacted?

What is your preferred method of communication?

How would you like us to communicate with you?

Can you explain what support would be helpful?

What is the best way to send you information?

What communication support could we provide for you?

Name

Date of Birth

Do you have a carer?

If so do they require communication assistance?

What is your main carer’s name?

Do you consent to the practice contacting your main carer regarding you care?

What is the best way to contact them?

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

I consent to my information being used for the purposes described above and wish to submit this online form to Crossfell Health Centre • Crossfell Road, Berwick Hills, Middlesbrough, Cleveland, TS3 7RL.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.

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