Consent to Care and Treatment

Name

Forename

Title

Date

CONSENT TO CARE AND TREATMENT 1. SERVICE USER / ADVOCATE

Administer First Aid (Name)

Call for a GP to visit me where required (Name)

Call for an ambulance / paramedics to visit me where required (Name)

Arrange for me to be taken to a hospital A&E Unit where necessary (Name)

Obtain prescriptions for my use where necessary (Name)

CONSENT TO CARE AND TREATMENT 2. WITNESSED BY (Staff Member)

Administer First Aid (Name)

Call for a GP to visit me where required (Name)

Call for an ambulance / paramedics to visit me where required (Name)

Arrange for me to be taken to a hospital A&E Unit where necessary (Name)

Obtain prescriptions for my use where necessary (Name)

Sign by ticking the box below

I hereby confirm that the information above is accurate.

Disclaimer

Embrace Health Care will not accept a partially complete application and if any of the forms are missing we can not guarantee your application will be considered. For each form you will receive a confirmation email confirming the submission and we recommend that you retain this as proof. On submission you will be redirected to the next form but you do not need to complete within a specified time as long as all are received prior to the closing data of the advertised position.