Little Bushey Surgery

Useful Resources

BBC Health News

E-cigarettes: How safe are they?26 Jun 2019 13:29They are much less harmful than smoking, despite a ban on sales of e-cigarettes in one US city.
Prostate cancer: New urine test hope26 Jun 2019 03:32The test sorts early cancers according to risk, so many men might be spared over-treatment, researchers say.
Child obesity drive 'stalled by Brexit'25 Jun 2019 02:10Slow progress is being made on junk food advertising restrictions and calories labelling, it is claimed.
Do you know the hygiene hot spots in your home?25 Jun 2019 02:14Where and when you should be cleaning to avoid infections and illness in your family, according to experts.
MMR vaccination rates in slight fall among children in Scotland25 Jun 2019 14:27Uptake rates from children receiving the vaccine by five years of age have dropped slightly but remains high at 96.6%
Pret allergy death: Parents 'delighted' by 'Natasha's law' plan25 Jun 2019 11:20The new rules follow the death of teenager Natasha Ednan-Laperouse who had a fatal allergic reaction.

Hertfordshire Active Living

This form enables health professionals working with you to find out how you are managing at home, and whether you need any extra help to reduce your risk of falling and getting hurt in future.

Anyone who is aged over 75, can fill in this form. A carer, family member or a health professional - such as a doctor or nurse - can fill in the form with you if you need help.

If the answers you give show that you are at a higher risk of falling, the people involved in your care will be able to signpost you to further advice and support.

1Hertfordshire Active Living

Name

Date of Birth

2Section A

Do you have difficulty getting to the loo in time at home?

Are you unsteady or have you had a fall in the past year?

Are you finding it more difficult to remember things?

3Section B

Are you aged over 85?

Are you male?

Do you have any health problems that limit your activities?

Do you need someone to help you on a regular basis?

Do you have any health problems that require you to stay at home?

Can you count on someone in time of need?

Do you often use a stick, frame or wheelchair to get around?

Please add up all of your scores, what is your total?

4What next?

If you have answered ‘YES’ to any of the questions in Section A or if your total score in Section B is 4 or more, with your consent we may refer you to HertsHelp.

Please tick the box if you agree to be referred to HertsHelp.

5If you answered the questions in this form and:

• you haven’t had any falls in the past year

• you don’t have any problems with getting to the toilet

• you are not experiencing memory problems,

• your total score added up to three or less

Then you are not currently considered to be at a high risk of losing your independence or falling.

See the Health in Herts website - www.hertsdirect.org/healthinherts for advice and tips on staying healthy and active at home or out and about, or visit your local library for information on clubs and healthy activities. If you want to speak to someone about any support needs that you have, call the county-wide advice line ‘HertsHelp’ on 0300 123 4044.

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key known only to the GP practice and is accessed over a secure connection by nominated Practice staff. Our practice has a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

I consent to my information being used for the purposes described above and wish to submit this online form to
Little Bushey Surgery • Little Bushey Surgery, California Lane, Bushey, Herts, WD23 1EZ.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.

Submit Form