Continence equipment prescription and order form: Hospital discharge

For hospital continence nurses – complete this form to request continence and related equipment for patients transitioning to the community. Provide a summary of the continence issues and routine along with suggested goals. For help completing this form, see the separate notes document.

Also complete this form when a major review of the continence equipment requirements is conducted (usually every two years) or there has been a change to the continence regime.