Staffordshire Special School Nurse Service Referral Form

Any child, young person, parent, or professional can access the Special School Nurse either at their school or by email: specialschools.staffs@mpft.nhs.uk.

Referral criteria

Education and training on clinical procedures such as enteral feeding, asthma management, allergy management, epilepsy care and emergency medication administration
Continence, enuresis and constipation advice and assessments
Growth measurements and support for over & underweight concerns
Developmental concerns
Supporting pupils & their families / carers with any newly diagnosed medical conditions
Provide advice for the ongoing assessment and provision of SEND including transition planning
Information, advice and signposting regarding health (physical, behavioural, emotional concerns)
Parental advice regarding identified health needs
Tier 1 emotional concerns
Advice, information and signposting regarding sexual health issues
Assessment of children and young people transferring in to a special school to identify any support required
Advice, information and signposting regarding lifestyle concerns including smoking, drugs or alcohol

Patient's NHS Number Required

Patient's Date of Birth Required

Patient's First name Required

Patient's Surname Required

Patient's Address Required

Patient's School Required

Name & relationship of person with parental responsibility Required

Contact telephone numbers, including any mobile Required

Reason for referral (provide as much detail as possible) Required

Your Details

Your Name Required

Your Designation Required

Your Telephone number Required

Your Email address Required

I agree to the privacy policy

Staffordshire Special School Nurse Service Referral Form

Referral criteria

Your Details

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