Please enable JavaScript in your browser to complete this form.Who is filling this form? Please select the option that applies to you: *Care AssessorService UserFamily MemberOtherHas the service user or a representative been informed of the details of the changes to their care plan and have they confirmed they are OK with it? *YesNoWhat has changed in the care plan? I have gone through the changes to the care plan with the service user, ensuring that they understand the potential risks and benefits of the proposed treatment options. I have encouraged the service user to ask any questions they may have and have provided answers to the best of my ability. Once the service user has fully understood the care plan, they have voluntarily given their consent to proceed with the care plan as outlined. I have also made it clear to the service user that they have the right to withdraw their consent at any time and request a change in their care plan.I understand the changes to the care plan provided to me. I understand the potential risks and benefits of the proposed treatment options and have had the opportunity to ask any questions I may have. I voluntarily give my consent to proceed with the care plan as outlined. I understand that I have the right to withdraw my consent at any time and to request a change in my care plan.CommentsName *Signature *Clear SignatureDate *Submit
