Health and Social Care – Northern Ireland Call Report HSCNI Call Report Please leave blank Please leave blank Please leave blank Type of call (VRS or VRI) * VRS Call? VRI Call ? Type of call (VRS/VRI) - Leave blank - Use above Please select form below.....VRS call (outgoing call attempted/made)VRI session (as if interpreter in the room) Type of call (VRS/VRI) - Leave blank - Use above Type of call/session.... * Please select…GP (General Practitioner)Allied Health Professionals (AHPs)AudiologyChild and Adolescent Mental Health services (CAMHS)Dental services (Community)Dental services (Hospital)Dietary/DieticianE.D. (Emergency Department/ Accident & Emergency)Health CentreHealth VisitorHospital (General)Mental Health (Hospital)Mental Health (Community)Mental Health Services for Older PeopleDeaf and Mental Health services (DAMHS)MidwiferyOptician/OptometristOphthalmologyPaediatricsPharmacy/ChemistSocial Work/WorkerOther... If 'Hospital' can you identify which (where possible)? ...Belfast Trust Hospitals... Royal Victoria HospitalBelfast City HospitalMater HospitalMusgrave Park HospitalChildren’s HospitalRoyal MaternityForster Green HospitalKnockbracken ...Northern Trust Hospitals... Antrim Area HospitalBraid Valley HospitalCauseway HospitalDalriada HospitalHolywell HospitalMid-Ulster HospitalMoyle HospitalRobinson HospitalWhiteabbey Hospital ...South Eastern Trust Hospitals... Ards Community HospitalBangor Community HospitalDowne HospitalLagan Valley HospitalUlster Hospital ...Southern Trust Hospitals... Armagh Community HospitalCraigavon Area HospitalDaisy Hill HospitalLurgan HospitalSouth Tyrone HospitalSt Luke’s Hospital ...Western Trust Hospitals... Altnagelvin Area HospitalGrangewood HospitalLakeview HospitalSouth West Acute (Enniskillen)Omagh Hospital and Primary Care ComplexWaterside Hospital (Gransha) If 'Hospital' is contacted, please provide more detail: Please select...DermatologyGeriatrics/GerontologyGynaecologyOncologyPaediatric / Children’s ServicesOTHER If 'Other...' please describe (one word would be helpful) If 'Other...' please describe (one word would be helpful) If Social Worker is contacted, please provide more detail’ and add following options Please select...Family & Childcare FCCHospitalLearning DisabilityMental HealthOlder PeoplePhysical DisabilitySensory DisabilityOTHER If 'Allied Health Professionals (AHPs)' selected, can you please provide more detail and add following options DieticianOccupational Therapy (OT)Physiotherapy (PT)Podiatry/ChiropodyPhysiotherapy (PT)Radiography (X-Ray, CT)Speech & Language Therapy (SLT)OTHER HSC Trust area calling from - If known :o) Please select...Belfast TrustNorthern TrustSouth Eastern TrustSouthern TrustWestern TrustNI Ambulance ServiceUnsure HSC Trust area calling from - If known :o) User feedback User happy with service User not happy with service Please comment on user feedback (no details of call back later/not connecting/back screens etc) Submit Call report If you are human, leave this field blank.
