SCOPING NEUROLOGY REHABILITATION PROVISION ACROSS YORKSHIRE AND THE HUMBER STRATEGIC CLINICAL NETWORK. (YH SCN)
The aim of this exercise is to gather a picture of the current provision of neuro rehabilitation services across the area covered by the YH SCN. Please complete one form for each individual service provided.
Q1.1 Name *
Your answer
Q1.1a Address of main base *
please give the address of the main base for the neuro re hab service
Your answer
Q1.1b Postcode *
please provide a postcode for the main base of the neuro re hab service
Your answer
Q1.2 E-Mail *
Your answer
Q1.3 Contact number *
Your answer
Q1.4 Does your service provide neuro rehabilitation? *
Q1.4a Is your service specifically commissioned? *
Q1.5 Does the service solely provide Neuro rehabilitation? *
Q1.6 Which Clinical Commissioning Group area does your service cover (tick all that apply) *
Required
Q1.7 Does your Neuro rehab service cover *
Yes
No
A) In Patients Re Hab?
B) Out Patients Re Hab?
C) Community Re Hab Services?
Q1.8 If YES to Q1.7A - Does your In-patients re-hab service include
Yes
No
Consultant in accredited rehabilitation medicine
Speech and Language Therapy
Dieticians
Physiotherapy
Clinical psychologists
Occupational Therapists
Social workers
Other please state below
if other please state here
Your answer
Q1.8a What geographical area does your In-patients re-hab service cover? e.g. Leeds West, North Debyshire, East Riding of Yorkshire
Your answer
Q1.9 If YES to Q1.7B - Does your Out-patients re-hab service include
Yes
No
Consultant in accredited rehabilitation medicine
Speech and Language Therapy
Dieticians
Physiotherapy
Clinical psychologists
Occupational Therapists
Social workers
Other please state below
if other please state here
Your answer
Q1.9a What geographical area does your Out-patients re-hab service cover? e.g. Leeds West, North Debyshire, East Riding of Yorkshire
Your answer
Q1.10 If YES to Q1.7C - Does your Community re-hab service include
Yes
No
Consultant in accredited rehabilitation medicine
Speech and Language Therapy
Dieticians
Physiotherapy
Clinical psychologists
Occupational Therapists
Social workers
Other please state below
if other please state here
Your answer
Q1.10a What geographical area does your Community re-hab service cover? e.g. Leeds West, North Debyshire, East Riding of Yorkshire
Your answer
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