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Occupational Therapy Service
PO Box 70063, London, SE159EG
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Tel: 020 7525 Click here to enter extention number
Date: Click here to enter a date.
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Dear Click here to enter recipient name.
I attach a copy of my report summary as agreed on my recent visit to you and your child.
This copy is for you to keep and it gives you information about the action we agreed to help [Click here and type in child's name] manage at home. I recommend you keep this report in a safe place.
Please ring me if anything is unclear or you have any questions.
My contact details and availability are shown on the last page of the summary report.
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Southwark Social Care Occupational Therapy Report
[Click here and type in child's name] ID [Click here and type in carefirst ID]This is a summary of the occupational therapy assessment that was completed on [Click here and type in assessment date]
Southwark Social Care Occupational Therapy Report
[Click here and type in child's name] ID [Click here and type in carefirst ID]This is a summary of the occupational therapy assessment that was completed on [Click here and type in assessment date]
A full copy of the assessment report is available on request
Your identified needs / Action agreed / Action and tasks completed ()
Agreement to collect & share your information with others
This is confirmation of the level to which you are happy for the Occupational Therapy Service to collect information about yours and your child’s circumstances and to share
this information with others
Permission [Click here and type in was or was not ] given for the Occupational
Therapy Service to contact your child’s GP, Hospital Consultant or other
relevant professional or person involved in your child’s care to obtain more
information about your child’s medical condition and/ or functional level.
Record of any limitations: [Click here and type in any limitations or delete if none ]
You [Click here and type in were or were not] willing for information to be passed onto or discussed with other health, social care or education staff if this will help meet your child’s needs.
Is follow up contact / information required in another format?
Yes * No *Specify:[Click here and type format ]
Contact details for the Occupational Therapist who carried out the assessment:
OT :[Click here and type in your name]
Southwark Council
OT Service
3rd Floor
132 Queens Road
London
SE152HP
Direct line no: 020 [Click here and type in your telephone number }]
Days usually available: [Click here and type in the ays you are available }]
Signature :