MDS Project Data Entry Forms 2007/08

5. Bereavement Support

This section is about bereavement support clients, i.e. relatives/carers of a deceased patient who receive bereavement care.

Count client contacts with staff and with fully trained volunteers.

Social work support for patients (not bereavement clients) should be included as outpatient or home care as appropriate.

Please answer for the year 1/4/2007 to 31/3/2008.

All fields marked with * are mandatory. Use Tab Key or mouse to navigate through the fields. Do not use the Enter/Return key.

Enter your Data Set (MDS) Number here:*
(If you do not know your Data Set Number, please e-mail: mds@ncpc.org.uk giving your organisation name and postcode)

Organisation Name:*

If the service began during this period, give the date of opening here:

5.1	All clients
	Give the total number of clients receiving bereavement support during the year, whether new or existing referrals. Count each client only once. A client is someone who receives face-to-face contact. Do not include those who only receive telephone contact.

5.2	Bereavement support contacts- total
	Give the total number of face-to-face bereavement support contacts in the year
	IMPORTANT NOTE Count a group session as a number of individual client contacts, i.e. one group session with 10 clients present would count as 10 contacts.

5.3	Bereavement support contacts - analysis
	Now give the number of contacts (adding up to 5.2 above) in these categories:

	a) Type of contact
	Home visit
	Individual counselling (not home visit)
	Group session with staff
	Group session without staff (e.g. mutual support group)
	Other

	b) Main staff member (if any) for each contact
	Counsellor
	Social worker
	Clinical nurse specialist
	Other registered nurse
	Doctor
	Other staff member
	Volunteer
	None (e.g. mutual support group)

5.4	Telephone contacts
	If your service keeps a record of telephone contacts, give the total number of telephone calls to or from bereavement support clients.

Please add any comments

Your Details   (Please complete all the fields marked with an asterisk)
Full Name* :
Email Address:	A copy of the completed form will automatically be sent to this email address.
Telephone: