This is me

Name: Tell us your full name and what you like to be called

Where I live: The area (not the full address) where you live and how long you have lived there

The people who know me best: This might be a:

• partner
• family member
• friend
• carer

I would like you to know: Include anything you think is important about who you are and will help staff to get to know and care for you. For example:

• I have dementia
• I have never been in hospital before
• I prefer female carers
• My partner and I are not married
• I am allergic to...
• I am left-handed
• I also speak another language

My personal history, family and friends, pets and any treasured possessions: Include things like:

• where you were born
• where you went to school/college/university
• whether you're married or not
• whether you any children, grandchildren or great grandchildren 
• let us know about you friends
• whether you have any pets
• any items you like to have near you - photographs, books, jewellery etc. 

My cultural, religious and spiritual background: Include information about your cultural or religious community if this is important to you. For example:

• Do you like to attend religious services?
• Do you celebrate certain festivals, holidays and events?
• Do you observe certain practices on particular days or at specific times?
• Do you follow certain hygiene practices?
• Are aspects of your clothing and appearance important to you?
• Are there certain foods you don't eat?

My interests, jobs and achievements: List any accomplishments that you are proud of. This might include: 

• clubs and memberships
• hobbies
• sports
• any past jobs
• volunteering activities

Favourite places I have lived and visited: Include any old childhood homes that are important to you and any favourite or important places you have visited. 

The following routines are important to me: 

• What time do you usually get up/go to bed?
• What times do you prefer to eat meals?
• Do you enjoy a snack, walk or nap at a particular time of the day? 

Things I like to do for myself: Include ways in which you like to be independent such as:

• dressing
• eating
• personal hygiene

Things I might want help with: Include things you might struggle with like:

• dressing
• eating
• personal hygiene

Things that may worry or upset me: Include anything that you may find troubling like: 

• concerns
• being away from a loved one or being alone
• physical needs such as being in pain, constipated, hungry or thirsty
• environmental factors that may make you feel anxious, like open doors, loud noises or the dark

What makes me feel better I am anxious or upset: Include things that may help if you become unhappy or distressed like: 

• comforting words
• music
• TV
• Does it help to have company, or do you prefer quiet time alone?

My hearing and eyesight: 

• Can you hear well?
• Do you need a hearing aid?
• How is it best to approach you?
• Is the use of touch appropriate?
• Do you wear glasses or need anything else to help you see well?

How we can communicate: 

• How do you usually communicate? Verbally, using gestures, pointing or a mixture?
• Do you read and write, and does writing things down help?
• How do you tell us if you're in pain or discomfort or if you're thirsty or hungry?
• Include anything that might help staff know what you need. 

My mobility: 

• Are you mobile?
• Do you need help to get around?
• Do you need a walking aid?
• Can you use stairs?
• Do you need help to stand up if you're sitting down?
• Do you need handrails?
• Do you need a special chair or cushion?
• Do your feet need to be raised to make you comfortable?

Things that help me sleep: Include your usual sleep patterns and bedtime routine.

• What time do you like to go to sleep?
• Do you like the light to be left on?
• Do you struggle to find the toilet at night?
• Do you have a favourite position in bed, special mattress or pillow?

My personal care: 

• List your usual practices, preferences and how much help you need in the bath, shower or other.
• Do you prefer to wash at a particular time of day?
• Do you prefer a male or female carer?
• Do you have preferences for brands of soaps, cosmetics, toiletries, continence aids, shaving or teeth cleaning products and dentures?
• Do you care for style your hair in a particular way?
• How often do you wash your hair?

How I take my medication: 

• Do you need help to take medication?
• Do you prefer to take liquid medication?

My eating and drinking: 

• Do you prefer tea or coffee?
• Do you have favourite meals or food that you don't like?
• Do you need help to eat or drink?
• Can you use cutlery or do you prefer finger foods?
• Do you need things to help you eat?
• Does your food need to be cut into pieces?
• Do you wear dentures to eat?
• Do you have trouble swallowing?
• Do you have any dietary requirements?

Other notes about me: Include any details that aren't listed above and help to show who you are. For example:

• your favourite TV or radio shows
• significant events in your past
• expectations, hopes or dreams you have
• any plans you have made
• if you have a power of attorney and who this is - this will be someone who will make important decisions about your care if you can't
• where health and social care workers can find important information