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Gema Douglas
DOX1527 OPAS 2206 PWD

65 yrs (29/7/1959)

0459169719 / 03908 347359

gema_douglas@example.com

NHS Number: 2965105611

Demographics missing

Creutzfeld-Jakob disease (CJD), diagnosed Feb 2025

AA: Higher rate

Council tax: Disregard granted

Driving: Advised to inform

Blue badge: Granted

Health & wellbeing LPA: Not discussed

Property & finance LPA: In place

edit

Cared for

Tamekia Halvorson (other)

DOX1528

OPAS 2207

72 yrs (22/4/1953)

05940 261344 / 06772 211130

Health LPA Finance LPA

Edit

Number	Completed at
5	16th Nov 2024	edit
4	10th May 2024	edit
3	8th Nov 2023	edit
2	7th May 2023	edit
1	5th Nov 2022	edit

Safeguarding Concern Form

About the concern

Page 1 of 2

Safeguarding Concern Form for Gema Douglas (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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Gema Douglas DOX1527 OPAS 2206 PWD

Safeguarding Concern Form About the concern

Gema Douglas
DOX1527 OPAS 2206 PWD

Safeguarding Concern Form

About the concern