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Standex Systems Ltd • 39 Charter Gate • Northampton • NN3 6QB • Phone: 01604 646 633 • Fax: 01604 644 646 • E-Mail: [email protected]
Domiciliary Care Order Form
RECORDS System NoQuantity
per 50Quantityper 100
Your OrderQuantity
Admission 21.133 £21.50 £29.00
Support Plan 21.134 £43.45 £58.50
AM Visit Care Plan 21.135 £21.50 £29.00
Lunch Visit Care Plan 21.136 £21.50 £29.00
PM Visit Care Plan 21.137 £21.50 £29.00
Night Visit Care Plan 21.138 £21.50 £29.00
Care Plan Evaluation 21.054 £21.50 £29.00
Manual Handling 21.139 £21.50 £29.00
Personal Plan 21.140 £21.50 £29.00
Medication Record 21.141 £21.50 £29.00
Sta� Sign Sheet 21.142 £21.50 £29.00
Financial Transaction 21.143 £21.50 £29.00
Daily Log 21.144 £21.50 £36.00
Support Network 21.060 £21.50 £29.00
Personal Care 21.065 £21.50 £29.00
Bowel Chart 21.066 £21.50 £29.00
Food Chart 21.067 £21.50 £29.00
Weight Chart 21.068 £21.50 £29.00
Body Chart 21.069 £21.50 £29.00
Falls Risk Assessment 21.074 £21.50 £29.00
MUST Tool 21.073 £21.50 £29.00
Pressure Ulcer Assessment 21.076 £21.50 £29.00
RECORDS Unit PriceYour Order
QuantityA4K £2.95
MSIPS £4.50
BM-4R £12.00
Total Cost for Files & Folders £ :
Files & Folders Additional Items
RECORDS Unit PriceYour Order
Quantity
£
£
£
£
Total Cost for Additional Items £ :
Total Cost of System ex Del & VAT £ :
Forms
RECORDS System NoQuantity
per 50Quantityper 100
Your OrderQuantity
General Risk Assessment 21.079 £21.50 £29.00
Risk Assessment Evaluation 21.080 £21.50 £29.00
Communication Sheet 21.092 £21.50 £29.00
This is Me 21.293 £21.50 £29.00
Personal History 21.059 £21.50 £29.00
Mental Capacity Assessment 21.061 £21.50 £29.00
Lasting Power of Attorney 21.063 £21.50 £29.00
Consent 21.335 £21.50 £29.00
Future Wishes 21.064 £21.50 £29.00
Cornell Depression Scale 21.285 £21.50 £29.00
Depression Scale 21.083 £21.50 £29.00
Communication Sheet 21.092 £21.50 £29.00
Family Communication 21.095 £21.50 £29.00
Total Cost for Forms £ :
1
Standex Systems Ltd • 39 Charter Gate • Northampton • NN3 6QB • Phone: 01604 646 633 • Fax: 01604 644 646 • E-Mail: [email protected]
Terms & Conditions:“the Company” means Standex Systems Limited
“the Customer” means the person, � rm or company ordering the Goods
Payment/Ownership:The Customer shall pay the full price of the Goods received to the Company within 30 days of the date of invoice. Risk in the
Goods shall pass to the Customer immediately upon the Goods leaving the Company’s premises. Until the Company has been paid in full for all Goods supplied by it to the Customer under any Contract whatsoever between the Customer and the
Company, the Company shall remain the legal and bene� cial owner of the Goods.
Complaints Procedure:Unless any complaints about the quality or quantity of the Goods are received by the Company within three days of delivery thereof the Customer shall be deemed to have accepted the goods. Loss or Damage, claim within three days, non-delivery
within 10 days of despatch date, errors claimed for immediately on receipt.
Returns Procedure:No Goods to be returned without prior authorisation from the Company. A standard handling charge of 25% is applicable
for Customer initiated returns.
Please complete order form below:
Home/Establishement:
Address:
Position:
Print Name (Block Capitals):
Postcode:
Tel/Fax:
No of Beds: Date of Order:
Purchase Order Number:
Please stamp here using o� cial company stamp:If no stamp available please con� rm order on Letterhead paper quoting our reference number. Please also sign and date this.
Domiciliary Care Order Form
