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Advice, support and care for adults
Resources for professionals
Out of county placements online form
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Annex B: Fair Cost of Care Report, Home Care Adults aged 18+
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Out of county care and support placements
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Care Quality Commission - Local System Review Report, Staffordshire
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Out of county placements online form
Name
First name
Last name
Job title
Organisation
Phone
Email
Next Page
Placement details
Name of individual
First name
Last name
Date of birth
Social services reference number / NHS number
Service type
Please select
Care home
Home care
Supported living
Extra care
Name of provider
Address / location of support
Date of provision commencing
Date of provision ending (if known)
Please note:
you will be required to submit this form again when the date of provision ending is known.
Previous Page
Next Page
Do you wish to be contacted regarding ongoing care review arrangements whilst provision is in place? Please note: organisations need to be aware there may be a charge associated if Staffordshire undergoes reviewing arrangements on your behalf.
Yes
No
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