This Is Me

Information to help you support your loved one in hospital

For some people, changes such as moving to an unfamiliar place like hospital can be unsettling and distressing. ‘This is me’ provides information about the person at the time that the document is completed. It can help health and social care staff to build a better understanding of who the person really is, what matters to them and how to care and support them in hospital. It will go with the person as they leave hospital too. If the person needs further care and support at home or moves to residential care, this information can contribute to a one-page profile, and to the person’s life story information.

The form is simple to fill in and complements the information that nursing colleagues will be gathering.

For us to work together in caring for your loved one, please put as much information as you can in the boxes below.

This Is Me

A way to capture what is important in caring for your loved one
  • Using a photograph is optional, but it can be really helpful for hospital staff.
    Accepted file types: jpg, png.
  • Preferred name
  • Even if they struggle physically to do these things do they like to talk about them?
  • Do they become upset if these things are not in place?
  • Anything that may upset or cause anxiety. This could be personal worries, eg money, family concerns, or being apart from a loved one, or physical needs, eg being in pain, constipated, thirsty or hungry. What does your loved one do or how do they act when they are in pain?
  • What makes him/her feel better if they are anxious or upset. Does your loved one like touch? Who is the best person to talk to your loved one if they are upset?
  • Does your loved one need information written down? Is there a better time of day to have discussions with me?
  • Does your loved one like to sing songs? Do I like to talk about my childhood?
  • In adding your name to this field, you agree that the information in this leaflet may be shared with health and care workers.

This is a pilot document based on the earlier work of the Alzheimer’s Society who developed the original ‘This is me’. This version was developed with Doncaster and Bassetlaw Hospitals NHS Foundation Trust in partnership with Helen Sanderson Associates.

Privacy Notice

It is the Trust’s intention to provide understandable Privacy Notices (PNs) on its website and in all of our main Patient Waiting Areas. More information can be found by clicking on the link below.

Information Governance


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