A future where every journey is a safe one

Continence equipment prescription and order form: Community form (for provider use only)

Summary:

For community continence nurses – use this form to request continence equipment for your patient. You will need to provide a summary of the continence assessment, along with your recommendations.

The form should also be completed when a major review of the continence equipment requirements is conducted (usually every two years) or when there has been a change to the current continence regime.

For help completing this form, see the separate notes document.