Clinical Research in Southampton
Southampton Children's Hospital

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Family history questionnaire (breast service)

Description: Breast Imaging Unit / FH Service Level C Princess Anne Hospital Southampton SO16 5YA Tel: 023 8120 8709 FAMILY HISTORY ENQUIRY FORM Please ensure this questionnaire is retuned be
Url: /Media/UHS-website-2019/Docs/Services/Breast-service/Family-history-questionnaire-breast-service.docx

Prenatal referral form

Description: Prenatal Referral for Genetics * If unsure whether you need to refer, contact genetic counsellor on 023 8120 6170 * Complete an e
Url: /Media/UHS-website-2019/Docs/Services/Genetics/prenatal-referral-form1.docx

Advance care plan: heart conditions - patient information

Description: Advance care planning is an opportunity for you to collect your thoughts and wishes about your future care.
Url: /Media/UHS-website-2019/Patientinformation/Heartandlungs/Advance-care-plan-heart-conditions-3410-PIL.pdf

Request on behalf of a patient form

Description: Request On Behalf of a Patient Section 1 PATIENT DETAILS Family Name First Name Date of Birth NHS number Hospital number Address Postco
Url: /Media/UHS-website-2019/Docs/Services/Radiology/Records/Request-on-behalf-of-a-patient-form.docx

Access to health request form

Description: Access to Health Request Section 1 PATIENT DETAILS Family Name First Name Date of Birth NHS number Hospital number Address Postcode If
Url: /Media/UHS-website-2019/Docs/Services/Radiology/Records/Access-to-health-request-form.docx

UHS NHS FT Electronic Data Management System Access for External Monitors and Regulators for Research for email

Description: Department of Research and Development University Hospital Southampton NHS Foundation Trust C Level West Wing, Mailpoint 218 Southampton SO16 6YD P
Url: /Media/Southampton-Clinical-Research/BRC-CRF-templates/UHS-NHS-FT-Electronic-Data-Management-System-Access-for-External-Monitors-and-Regulators-for-Research-for-email.pdf

My_data_and_research

Description: This document explains how health researchers use information from patients. If you are asked to take part in
Url: /Media/Southampton-Clinical-Research/COVID-19/My-data-and-research.pdf

Sample storage and disposal

Description: University Hospital Southampton NHS Foundation Trust LABORATORY MEDICINE G1.12 Sample storage & Disposal v6 G1.12 G1.12 SAMPLE STORAGE & DISPOSAL
Url: /Media/UHS-website-2019/Docs/Services/Pathology/Lab-med/Sample-storage-and-disposal-G1.12.pdf

Telephoning Results and Ranges

Description: University Hospital Southampton NHS Foundation Trust LABORATORY MEDICINE G3.2 Telephoning Results and Ranges G3.2 3.2 TELEPHONING RE
Url: /Media/UHS-website-2019/Docs/Services/Pathology/Lab-med/Telephoning-Results-and-Ranges.pdf

Patient request form

Description: Patient Request Form Section 1 YOUR DETAILS Family Name First Name Date of Birth NHS number Hospital number Address Postcode If appl
Url: /Media/UHS-website-2019/Docs/Services/Radiology/Records/Patient-request-form.docx

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