PATIENT OR FAMILY MEMBER
Please give this slip to the staff on the ward


NOTE TO NURSING STAFF OF
PRINCESS ROYAL UNIVERSITY HOSPITAL


NAME OF PATIENT:

..............................................................................................................
(BLOCK CAPITALS PLEASE)

The patient named above is a Roman Catholic.

Please ensure that he/she is registered as such.

The patient wishes to be visited by and receive spiritual care from any of the priests, deacons or ministers of communion from the Roman Catholic chaplaincy team.

Signed by the patient

.................................................................................................................

Date.........................................................................................................


ALTERNATIVELY, IF THE PATIENT IS UNABLE TO SIGN:

Signed by a family member

................................................................................................................

Relationship to patient

......................................................................................................................

Date...............................................................................................................


Many thanks for your care in this matter.