{"text":"Walking Aid Issue Form \nWalking Aid Details \nTN \nNHS \nGreater Glasgow \n0605555324 Make: 6\ufb01 r\\\ufb01q_ \u2014 A \u00bbD . and Clyde \ng!l::g:)w, Lanarkshire \u2014_\u2014 Batch\/Lot No: cb (1\u2018 \nG5 9PQ ; Manufacturer Date: \nDOB \/ CHI No: Patient Weight: (if applicable) , \nWalking Aid(s) issued: Stick(s) x [ | Crutch(es) x %er x [ 1 Mobilator x [ ] Deltax [] \n4 wheeled walkerx [] other (please state) New aid E\/Recycled aid [ ] \nInfection Control and Safety Inspection Yes | No | N\/A \nIs the walking aid clean, in accordance with NHSGG&C infection control procedures? _ \u2018\u00ab\/' \nAre ferrules in good condition? c\/\" \nAre wheels correctly fitted, secure, aligned and able to freely rotate? v \nAre there any dents \/ bends in the metal? Vi \nAre handles or legs damaged? v \nAre adjustable mechanisms functioning freely? 'V \nAre clip mechanisms locking securely? (\/ \nAre folding mechanisms functioning freely and locking securely? \u2018\/ \nAvre brakes in good working order? v \nAre padded components in good condition? 'V \nDoes the walking frame sit evenly on a flat surface? L\u2014 \nChecklist \u2019 Yes | No | N\/A \nHas the walking aid been adjusted to the correct height? L 7 \nIs the patient safe to use the walking aid independently? \nAny comments? (\/ \nHas the patient been taught r]ow to use the walking aid. correctly indoors? J_\/ \nHas the patient been taught how to use the walking aid correctly on the stairs? Ve \nHas the patient been taught how to use the walking aid outdoors \/ kerbs \/ slopes? L \nHas the appropriate walking aid leaflet peen provided to the patient? l.\/ \nDischarged from service v \nCurrently attending physiotherapy L~ \nReferral for further assessment \/ physiotherapy required? \nDate referral completed: [ \nDeclaration: \n| confirm the walking aid(s) provided to the above named is deemed safe and suit \nPrint Name: f(%tJiP%-c ko) \nSignature: \n< \nable at thelate of issue. \nGrade\/Role: 247\" \nDate: & l 10 l 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