Aisha Begum

Referral

Referred 4 days ago · Heartlands discharge team · Owner Priya Sandhu · 71 Slade Road (Dawson's)

Referral

Referral source

Heartlands discharge team

Referrer

Olu Adeniyi · dischargeteam@heartlands.example.nhs.uk

Placing authority

Birmingham City Council

Current situation

In hospital

Local connection

Yes

Reason for the referral

On ward 12 at Heartlands after a fall at home. Occupational therapy want a ground-floor room with a level-access shower.

Case note

Ward 12 sent the referral through. Occupational therapy to confirm the ground-floor room before we take her details.

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
18 Sep 2026
Heartlands discharge team · in hospital
Olu Adeniyi