Use this with the person if they want to share a short introduction at an appointment, with a new care worker or during a handover. They can complete it themselves, dictate it or choose someone to help. Leave out anything they do not want in this copy.
It is optional. It does not replace the service’s assessment, care plan, medicine list or handover. Services remain responsible for keeping and sharing their own records.
Keep each answer brief (up to 250 characters). Nothing typed here is sent to us or saved by this tool. Print or save a PDF only if you want to keep a copy; store it securely and agree who will receive it.
Agreed with the person where possible. Check that this copy is current and who it may be shared with.
Download a one-page blank PDF. You can write on a printed copy or fill the boxes in a PDF viewer that supports forms.
For medicines, use the current list from their prescriber or pharmacy and raise discrepancies with the team. For urgent concerns, use urgent help rather than waiting for someone to read a summary.
A different worker every visit · Record information-sharing preferences in more detail · Write down concerns for the GP
Last full source check: . Next source check due: . What these dates mean.
About this template and its sources
The headings are our practical prompts. NHS England’s care expectations describe plans made with the person, support-network involvement, communication needs and a named worker. The template is not an official NHS form or a substitute for these arrangements. The confidentiality guide explains sharing concerns and the person’s choices.
Last full source check: 10 November 2026
Independent information, not a medical or crisis service. This guidance has not been clinically reviewed. How we use sources.