Jack Kirlin
DOX1170 OPAS 1849 PWD

76 yrs (20/11/1948)

04895 149764 / 092860167512

jack_kirlin@example.com

NHS Number: 9901003474

Lives alone

Mixed dementia, diagnosed Aug 2025

AA: Application declined

Council tax: Declined to apply

Driving: Not discussed

Blue badge: Granted

Health & wellbeing LPA: In place

Property & finance LPA: Alternative in place

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Background

PWD's personal background e.g. who are they, what did they do, what do they enjoy etc.

Dementia Symptoms Experienced

What effect is dementia having on their memory and behaviours? Are they aware of the diagnosis (insight)?

Medication

What dementia medication are they taking? How are they finding it? Who assists? Do they have a blister pack?

Physical Health and Mobility

How physically healthy / mobile are they? Any falls? Any sensory impairment? Any assistive/preventative tech in place? Personal care?

Diet and Nutrition

Care and Support

Will appear below list of carers. How are they coping? Is the support fit for purpose?

Social Engagement

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Financial / Legal / Future Planning

Will appear below 'Core Advice' on summary

Notes / Comments

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