For hospital continence nurses – use this form to request continence and related equipment for patients transitioning to the community. You will need to provide a summary of the continence issues and routine, along with suggested goals re their bowel and/or bladder movement.

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.