RED
AMBER
Things you
must know
about me
GREEN
Things that are
Things that
really important
I like and
for me
My Hospital Traffic
NAME……………………………………………………………………
I LIKE TO BE CALLED………………………………..
dislike
Light
PHOTO
This document gives hospital staff important information about me,
which will help them to understand my needs and make any
reasonable adjustments required.
I will bring this with me when I come to hospital for any
appointments.
A copy should be to be put in my notes and stored in a place where
people (who need to) can easily see it.
It is important that ALL of the hospital staff
who look after me read this document.
Adapted from; Elliott, K. and Dean, E. (2006), Gloucestershire Partnership NHS Trust by Derbyshire
Children’s at Derby Teaching Hospitals NHS Foundation Trust (2016)
Widgit Symbols @ Widget Software 2002 to date
RED
(Things you must know about me)
Name:
Date of Birth:
NHS/Hospital No:
Safeguarding Plan
in Place:
Legal Parental
Responsibility:
Address:
Family / Siblings:
Tel No:
GP:
GP Address:
Yes:
No:
Yes:
No:
Religion:
Religious Requests:
Main Language:
GP Tel No:
Professionals involved:
Interpreter
Required:
Role:
Base/Tel No:
Diagnoses/medical conditions:
Allergies:
Current medication:
How medication is administered:
Pain (how you know that I am in pain):
e.g. changes in behaviour, pointing to a particular area, becoming upset
Reasonable adjustments (how to help me stay calm and safe):
e.g. first appointment, access to a quiet room/area
Risk and safety issues (including who needs to stay with me):
e.g. lack of safety awareness, any behaviours which may be displayed, 1:1 support
Personal Resuscitation Plan (PRP) in place?
YES / NO
Please note:Value judgements about quality of life and healthcare must be made in consultation with you,
your family, carers and other professionals, following the principles of the Mental Capacity Act (2005).
AMBER
(Things that are really important for me)
COMMUNICATION/
INFORMATION
SHARING
How to communicate
and help me to
understand things
(e.g. signing, symbols)
SEEING & HEARING
Any problems with
vision or hearing (e.g.
glasses, hearing aids)
EATING &
DRINKING
e.g. problems with
swallowing, choking,
help with feeding,
cutting food up
SENSORY NEEDS/
STIMULATION
e.g. sensitive to
noise/touch, seeking
movement, sensory
strategies/activities
MOBILITY
e.g. use walking aids,
postural support,
positioning, motor
skills, orthotic
support
TOILETING &
PERSONAL CARE
e.g. washing, dressing,
teeth brushing,
soiling/wetting
SLEEP
e.g. sleep pattern,
bedtime routines,
sleep medication
GREEN
(Things that I like and don’t like)
Think about - what you like to do i.e. watching TV, reading, listening
to music, computer games, sports, pets. Things you don’t like i.e. crowded noisy
places, too many people talking.
games.
Things I like:

Things I don’t
Think about – what upsets
like:
Other Important Information
School:
Completed by:
(Parent/Carer responsibility to complete + update)
Care Package:
(i.e. Short
Breaks /
Residential)
Date:
(Amended/
updated version)
x