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For patients to be admitted to neurological rehabilitation

High quality in neurological
rehabilitation Patient´s details

    Patient´s details
    Contact person
    Parents
    Spouse/partner
    Children
    Take care of patient
    Address contact person
    Costs paid by
    Diagnosis /diagnoses
    Guardian
    Transferred from
    Return possible
    Onset of disease / day of accident
    Complications
    Seizures
    Instable fractures
    Heterotopic ossifications
    Algodystrophy
    Contractures
    Infections
    Multidrug resistant organisms (MDRO)
    Provided with
    Malfunction
    kg
    Collaboration in care and therapy
    Further treatment
    Where could the patient be transferred to after his/ her treatment in our hospital if (s)he cannot be dismissed
    to his/ her home? [must be filled in necessarily]
    1. Patient’s condition must be monitored in the intensive care unit
    2. Tracheostoma
    3. Intermittent ventilation
    4. Disturbance of orientation (confusion)requires supervision
    5. Behaviour disorder requires supervision (including threatening patient‘s own life or life of others, e.g. manifest suicidality
    6. Severe communication disorder
    7. Dysphagia requiring supervision
    8. Eating and drinking (with assistance, if food is cut up small before eating)
    9. Getting from wheelchair to bed and vice versa (including: sitting up in bed)
    10. Personal hygiene (washing face, combing hair, shaving, brushing teeth)
    11. Going to the toilet (Putting on/off clothes, wiping oneself properly, flushing the toilet)
    12. Taking bath or shower
    13. Walking on the flat
    14. Going up/down stairs
    15. Dressing/undressing (including: tying shoelaces, fastening buttons)
    16. Bowel control
    17. Bladder control
    IMPORTANT: To be able to provide uninterrupted treatment and to plan an optimum therapy we ask you to make sure that the
    patient brings all medical reports, findings etc. (particularly X-ray, CT and NMR images) which you have received, AND the current medication when admitted to our hospital!

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