referral-form-employers.doc

referral-form-employers.doc - Referring a nurse or midwife...

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Referring a nurse or midwife to the NMC For employers and managers We need accurate information to assess your referral and, if appropriate, do something about it. Ensuring referrals are appropriate and contain all information required means we can act and respond quickly. Please read information on https://www.nmc.org.uk/making-a-referral-as-an-employer/ , refer to Advice and information for employers of nurses and midwives (NMC, 2011) or call 020 7637 7181 . If you are not an employer or manager who is referring a registered nurse, midwife or specialist community public health nurse, please use a different referral form available on www.nmc.org.uk/referral-forms If you have any questions or if you would like this form in a different format or in Welsh language or you require assistance with completing this form , please phone 020 7681 5688 or email us at [email protected] How to complete this form electronically To fill in each section, click on a grey field and start typing, or double-click a grey box to mark it checked. How to complete this form by hand Write your responses using BLOCK CAPITALS or in clear, legible handwriting. If you need more space for further information, write a summary in each box, attach additional information separately and reference the additional information in each box on this form. Please do not simply write ‘see attached’ . Checklist before submitting this form 1. Read our information on “Concerns, complaints, referrals” pages on our website: https://www.nmc.org.uk/concerns-nurses-midwives/concerns-complaints-and- referrals 2. Complete all sections of the form 3. Provide all required information, documents and evidence. How to submit a referral By email Type your full name in the signature box, save and email this form and electronic copies of supporting evidence to [email protected] . Please note: attachments are limited to 25MB , so please send larger files separately. By fax Fax this form and copies of supporting evidence to 020 7580 3410. By email and post Email this form and evidence as above, but send hard copies of the supporting evidence and a signed, printed copy of this form to the address below. Nursing and Midwifery Council Page 1 of 10
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By post Write your responses using BLOCK CAPITALS or in clear, legible handwriting. Sign your name, seal this form in an envelope with copies of the supporting evidence, and send it to: Nursing and Midwifery Council Screening Manager Fitness to Practise 1 Kemble Street London, WC2B 4AN We will write to let you know we have received your referral and that we are considering it. We will then keep you informed about what is happening.
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