Please Enter Your Relatives Details

This form is designed to collect valuable information about your Relative that we can quickly communicate to our Staff ensuring we provide Person Centred Care at all times. We would appreciate it if you could complete and submit this form at your earliest convenience with as much information and detail as possible.

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* 1. Please provide the following information for your Relative:

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* 2. Please choose the relevant Care Home.

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* 3. What others like and admire about me - Please tell us what other people liked and admired about your relative, was it their sense of humour, their kindness or maybe their generosity. 

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* 4. My Life Story - Please tell us about your relative, where were they born, what was their occupation, were they married, did they have family, where did they live throughout their life, etc.

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* 5. What's important to me - Please tell us here what is important to your relative, are they a family person, do they like a certain routine, do they like animals, etc.

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* 6. How best to support me- please detail what your relatives current situation is, i.e. are they mobile, are they on a special diet, do they like to socialise or not, etc.

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* 7. Conversation topics, subjects that interest me and I like to talk about - please provide bullet points that will quickly give an insight into what your relative likes to talk about and what interests they have.

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* 8. Please provide us with their most favourite songs as well as the reasons why they like a particular song such as the first dance at their wedding if applicable. 10 Songs allows the creation of a "Playlist for Life" that is person centred. 

Thank you for taking the time to provide us with this very important information which will be used to develpo their Care Plan. This will enable us to provide your relative with very person centred care and enable those who care for your relative to quickly become familiar with them and ensure we understand their needs.

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* 9. Please list any significant events in your Relatives Life. These should include positive and negative events allowing Carers to focus on or avoid as appropriate. Include any difficulties they have endured such as the loss of a loved one, alcohol or drug dependency, challenging behavior, etc. Having this knowledge allows the Care provided to be person centred, sympathetic and documented appropriately.

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* 10. Please provide any further information you feel is relevant in the development of a truly Person Centred Care Plan for your Relative.

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* 11. Privacy notice – Placement Enquiries.


We process personal data relating to those who apply for placement in one of Avondale Care Scotland’s Facilities. We do this for assessment purposes, to ensure we are able to meet the individuals' needs and to assist in the running of the business. The personal data may include identifiers such as name, date of birth, personal characteristics such as gender, religion, likes and dislikes and financial information.

We will not share any identifiable information about you with third parties without your consent unless the law allows or requires us to do so. The personal data provided during an assessment process will be retained for a period of at least six months or, if required by law, for as long as is required.

This privacy notice does not form part of an offer or contract between us. If we make an offer of a placement to you, we will provide further information about our handling of your personal information separately.

If you would like to find out more about our data retention policy and how we use your personal data, you want to see a copy of the information about you that we hold or have any questions or issues regarding data protection, please email us with the Subject “Data Protection Request” to enquiries@acscot.care Privacy notice – Placement Enquiries.

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