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Emeline Krajcik
DOX1204 OPAS 1883 PWD

93 yrs (8/2/1932)

0719198337 / 021392159417

emeline_krajcik@example.com

NHS Number: 7004855112

Demographics missing

Primary Progressive Aphasia (PPA), diagnosed Oct 2024

AA: Lower rate

Council tax: Declined to apply

Driving: Not discussed

Blue badge: Granted

Health & wellbeing LPA: Alternative in place

Property & finance LPA: In place

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Carer

Marion Prohaska (sibling)

DOX1205

OPAS 1884

81 yrs (9/12/1943)

0382859429 / 07114 259919

Health LPA

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File	Case	Uploaded

Safeguarding Concern Form

About the concern

Page 1 of 2

Safeguarding Concern Form for Emeline Krajcik (the "Subject")

Summary of concern

Factual account of what was said or observed. Include dates, times and locations, the person's own words, descriptions of signs/symptoms etc. Refer to Policy for full guidance on recording.

Summary of any immediate actions taken

Eg. Were emergency services called? Any practical support offered etc.

Does the subject have care and support needs?

Eg. Physical or mental health condition

Notes about care and support needs

Do you feel the subject is able to make their own decisions about what happens next?

Notes about decision capabilities

What support / outcome does the subject want?

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Emeline Krajcik DOX1204 OPAS 1883 PWD

Safeguarding Concern Form About the concern

Emeline Krajcik
DOX1204 OPAS 1883 PWD

Safeguarding Concern Form

About the concern