Health Visiting Service - handover form (children moving into Kent) | Kent Community Health NHS Foundation Trust

Child details

Child's name

Firstname Surname

Gender(Required)

Female
Male
Prefer not to say

Date of birth(Required)

NHS number (if known)

Ethnicity(Required)

Other, please specify(Required)

Address(Required)

Address line 1 Address line 2 Town County Postcode

GPs name(Required)

GP address(Required)

GP practice name Address Town County Postcode

Which district will the child be living in?(Required)

Parent details

Name of parent/carer/guardian(Required)

Firstname Surname

Date of birth(Required)

Contact number(Required)

Is the address the same as the child's?(Required)

Yes
No

Address(Required)

Address line 1 Address line 2 Town County Postcode

Would you like to add a second parent/carer/guardian?(Required)

Yes
No

Name of second parent/carer/guardian that has parental responsibility

Firstname Surname

Contact number of second parent/carer/guardian

Address (if different to above)

Address line 1 Address line 2 Town County Postcode

What is the relationship to parent?(Required)

Is the referrer different from the parent?(Required)

Yes
No

Referrer details

Referrer's name(Required)

Firstname Surname

Team/service(Required)

Address (if different to above)(Required)

Address line 1 Address line 2 Town County Postcode

Email(Required)

Phone(Required)

Date of handover(Required)

Safeguarding

When completing this section consider including; professionals involved, contact details, when is the next meeting due.

Is there a Child Protection Plan?(Required)

Yes
No

Please provide details(Required)

Is this a Child in Need?(Required)

Yes
No

Please provide details(Required)

Is this a Looked after Child?(Required)

Yes
No

Please provide details(Required)

Are there any domestic abuse concerns?(Required)

Yes
No

Please provide details(Required)

Safe contact number

Alleged perpetrator name / DOB

Are there any further safeguarding concerns?(Required)

Yes
No

Please provide details(Required)

History of Health Visiting Service involvement

Reason for move/who is the child living with?(Required)

What work has been undertaken with the family?(Required)

Which mandated contacts have been completed?

NBV
6-8
9-12
2-2.5

NBV, please provide details(Required)

6-8, please provide details(Required)

9-12, please provide details(Required)

2-2.5, please provide details(Required)

Are they up-to-date with immunisations?(Required)

Yes
No

If no, please provide details(Required)

Are other professionals involvement?(Required)

Yes
No

Please provide details(Required)

Are there any specific concerns?(Required)

Yes
No

Please provide details(Required)

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Health Visiting Service – handover form (children moving into Kent)

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