Reece Hollins

Referral

Referred 2 days ago · Hospital discharge (QE) · Owner Amina Rafiq · 51 Church Road (Concept)

Referral

Referral source

Hospital discharge (QE)

Referrer

Marie Doughty · discharge.team@uhb.example.nhs.uk

Placing authority

Birmingham City Council

Current situation

In hospital

Local connection

Yes

Reason for the referral

Medically fit to leave ward 410 at the QE but has nowhere to be discharged to. The ward is asking for a placement this week.

Case note

Ward 410 want him out this week. Basics taken off the referral form; the rest when we can sit down with him.

Tenant — identity

2 of 7

Full name

Date of birth

NI number

Gender

Ethnicity

Contact number

Tenant — physical descriptors (SD3)

0 of 5

Skin tone

Hair colour

Eye colour

Height (cm)

Build

Referral (SD2)

4 of 4

Referral agency

Referrer name

Reason for referral

Referral date

Property

1 of 4

Room address

Building address

Fire assembly point

Fire exit locations

Charges (weekly)

0 of 6

Basic rent

Eligible service charge

Ineligible service charge (total)

Ineligible — utilities

Ineligible — support

Total weekly charge

Max arrears (= 2 × ineligible total)

Staff / provider

2 of 2

Support worker name

Support provider

Dates

1 of 1

Agreement date

Pack

10 sheets

Standard pack · SD1–SD10

SD1 Licence agreementNeeds 5 details
SD2 Referral, risk & GDPR consentNeeds 5 details
SD3 Missing person profileNeeds 11 details
SD4 Confidentiality agreementReady
SD5 Authorisation to actNeeds 2 details
SD6 Fire evacuation planNeeds 2 details
SD7 Fire safety inductionNeeds 1 detail
SD8 Service charge scheduleNeeds 3 details
SD9 Resident rights & responsibilitiesNeeds 1 detail
SD10 Photo ID consentNeeds 2 details

Activity

Referral received
20 Sep 2026
Hospital discharge (QE) · in hospital
Marie Doughty