{"id":612,"date":"2019-02-28T14:26:07","date_gmt":"2019-02-28T14:26:07","guid":{"rendered":"http:\/\/djcareservices.com\/?page_id=612"},"modified":"2019-03-05T15:35:55","modified_gmt":"2019-03-05T15:35:55","slug":"consent-to-care-and-support","status":"publish","type":"page","link":"http:\/\/djcareservices.com\/consent-to-care-and-support\/","title":{"rendered":"Consent to Care and Support"},"content":{"rendered":"\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f611-o1\" lang=\"en-GB\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/wp-json\/wp\/v2\/pages\/612#wpcf7-f611-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"611\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.9.3\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_GB\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f611-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<p>Under the General Data Protection Regulation (\u2018GDPR\u2019) there are occasions when D&J Care Service must obtain explicit consent to use your information, known as \u2018Personal Data\u2019. Personal Data includes, but is not limited to your name, address, telephone number, and email address.\n<\/p>\n<p><label> Your Name (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"SU-Name\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"SU-Name\" \/><\/span> <\/label>\n<\/p>\n<p><label> Date of Birth (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"SU-Date-of-Birth\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"SU-Date-of-Birth\" \/><\/span><\/label>\n<\/p>\n<p><label> Address<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"SU-Address\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"SU-Address\" \/><\/span><\/label>\n<\/p>\n<p><label> Name of Next of Kin<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Name-of-NOK\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Name-of-NOK\" \/><\/span><\/label>\n<\/p>\n<p><label> Telephone Number of NOK<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Telephone-Number-NOK\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"Telephone-Number-NOK\" \/><\/span><\/label>\n<\/p>\n<p><label> Address of NOK<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Address-of-NOK\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Address-of-NOK\" \/><\/span><\/label>\n<\/p>\n<p><label> Email of NOK<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Email-of-NOK\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Email-of-NOK\" \/><\/span><\/label>\n<\/p>\n<p><label> GP Name<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"GP-Name\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"GP-Name\" \/><\/span><\/label>\n<\/p>\n<p><label> GP Telephone Number<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"GP-Tele\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"GP-Tele\" \/><\/span><\/label>\n<\/p>\n<p><label> GP Address<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"GP-Address\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"GP-Address\" \/><\/span><\/label>\n<\/p>\n<p>I hereby give my permission for D&J care Service to share personal information with other service providers in connection with my care, including accessing and sharing my medical, and if applicable, mental health and Care Plan. I agree to a referral being made to (add local supportive services), in order to support my needs. I understand that (the host organisations) may hold information gathered about me from the various agencies and as such my rights under the Data Protection Act will not be affected.\n<\/p>\n<p>Statement of Consent:<br \/>\n\u2022\tI understand that personal information is held about me.<br \/>\n\u2022\tI have had the opportunity to discuss the implications of sharing or not sharing information about me.\n<\/p>\n<p>To deliver care:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"To-deliver-care:\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"To-deliver-care:[]\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"To-deliver-care:[]\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Store personal information:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Store-personal-information:\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"Store-personal-information:[]\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"Store-personal-information:[]\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Sharing personal information:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Sharing-personal-information:\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"Sharing-personal-information:[]\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"Sharing-personal-information:[]\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Contacting family and other professionals:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Contacting-family-and-other-professionals:\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"Contacting-family-and-other-professionals:[]\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"Contacting-family-and-other-professionals:[]\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Call an ambulance consent:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Call-an-ambulance-consent:\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"Call-an-ambulance-consent:[]\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"Call-an-ambulance-consent:[]\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span>\n<\/p>\n<p><label>A \u201cbest interests\u201d decision has been taken to proceed with the proposed care and treatment, and this is confirmed by the person\u2019s relative\/legal representative. The reasons for the decision are as follows. Summary of reasons (together with details of any proposed review, etc) <span class=\"wpcf7-form-control-wrap\" data-name=\"A-best-interests-decision\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"A-best-interests-decision\" \/><\/span><\/label>\n<\/p>\n<p>Your consent to share personal information is entirely voluntary and you may withdraw your consent at any time. Should you have any questions about this process, or wish to withdraw your consent please contact: (Dora Amoako)\n<\/p>\n<p><label>Name of witness\/representative\/ or service user:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Name-of-witness\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Name-of-witness\" \/><\/span><\/label><br \/>\nTo be signed by a witness\/representative\/ or service user\n<\/p>\n<p><label>Relationship to service user:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Relationship-to-service-user\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Relationship-to-service-user\" \/><\/span><\/label>\n<\/p>\n<p>Is an \u201cAdvance Decision\u201d in place?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Advance-Decision\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"Advance-Decision[]\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"Advance-Decision[]\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Is there a Lasting Power of Attorney or Equivalent in place?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Lasting-Power-of-Attorney\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"Lasting-Power-of-Attorney[]\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"Lasting-Power-of-Attorney[]\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span><br \/>\nIf yes ensure a copy is placed on file.\n<\/p>\n<p>Manager accepting responsibility for the decision:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Manager-accepting-responsibility\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"Manager-accepting-responsibility[]\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"Manager-accepting-responsibility[]\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span>\n<\/p>\n<p><label>Signature<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Signature\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\"audio\/*,video\/*,image\/*\" aria-invalid=\"false\" type=\"file\" name=\"Signature\" \/><\/span><\/label>\n<\/p>\n<p><label>Signature Date<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"SignatureDate\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"SignatureDate\" \/><\/span><\/label>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Send\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v14.4.1 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Consent to Care and Support - DJ Care Services<\/title>\n<meta name=\"robots\" content=\"index, follow\" \/>\n<meta name=\"googlebot\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta name=\"bingbot\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"http:\/\/djcareservices.com\/consent-to-care-and-support\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Consent to Care and Support - DJ Care Services\" \/>\n<meta property=\"og:url\" content=\"http:\/\/djcareservices.com\/consent-to-care-and-support\/\" \/>\n<meta property=\"og:site_name\" content=\"DJ Care Services\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/DJCareservices\/\" \/>\n<meta property=\"article:modified_time\" content=\"2019-03-05T15:35:55+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary\" \/>\n<meta name=\"twitter:creator\" content=\"@DJCareServices\" \/>\n<meta name=\"twitter:site\" content=\"@DJCareServices\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebSite\",\"@id\":\"http:\/\/djcareservices.com\/#website\",\"url\":\"http:\/\/djcareservices.com\/\",\"name\":\"DJ Care Services\",\"description\":\"\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":\"http:\/\/djcareservices.com\/?s={search_term_string}\",\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-GB\"},{\"@type\":\"WebPage\",\"@id\":\"http:\/\/djcareservices.com\/consent-to-care-and-support\/#webpage\",\"url\":\"http:\/\/djcareservices.com\/consent-to-care-and-support\/\",\"name\":\"Consent to Care and Support - DJ Care Services\",\"isPartOf\":{\"@id\":\"http:\/\/djcareservices.com\/#website\"},\"datePublished\":\"2019-02-28T14:26:07+00:00\",\"dateModified\":\"2019-03-05T15:35:55+00:00\",\"inLanguage\":\"en-GB\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"http:\/\/djcareservices.com\/consent-to-care-and-support\/\"]}]}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","_links":{"self":[{"href":"http:\/\/djcareservices.com\/wp-json\/wp\/v2\/pages\/612"}],"collection":[{"href":"http:\/\/djcareservices.com\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"http:\/\/djcareservices.com\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"http:\/\/djcareservices.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/djcareservices.com\/wp-json\/wp\/v2\/comments?post=612"}],"version-history":[{"count":4,"href":"http:\/\/djcareservices.com\/wp-json\/wp\/v2\/pages\/612\/revisions"}],"predecessor-version":[{"id":637,"href":"http:\/\/djcareservices.com\/wp-json\/wp\/v2\/pages\/612\/revisions\/637"}],"wp:attachment":[{"href":"http:\/\/djcareservices.com\/wp-json\/wp\/v2\/media?parent=612"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}