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WS22A: Codes and Fields for Completion
Please remember that all fields on the form are mandatory and that
forms that are incorrectly completed will be faxed/e-mailed back to the
referrer for completion; this will cause delay and may result in your
client not receiving the appropriate equipment in a timely manner.
Please ensure all fields are fully completed (including but not
exclusively, client height, weight and address/contact information).
Please read the following prior to completing the WS22A.
1.
EOL. The form provides for more detail relating to the end of life
service (EOL). The fields require a yes/no response in respect of
the following:
a) GSF (Gold Standards Framework) – Is the client on the Gold
Standards Framework for end of life care? (Timescale Months –
Year).
b) DS1500 – Timescale Weeks – Months.
c) Is this a case of planned EOL?
d) Is this an emergency or emergency discharge for unplanned
EOL?
2.
Ethnic Codes. The form provides for more detailed information
regarding the ethnicity of the client. The sheet below gives the
codes that must be used on the WS22A when addressing ethnic
origin.
3.
Residential status/Property type codes. See codes below.
Notes for clarification:
 DFG asks the referrer to indicate whether the client has applied/will
apply for a disabled facilities grant.
 Diagnosis code outlines the reason for provision.
 ‘Referral Date’ is the date of completion of the form/transmission to
CES.
 The ‘Date Decision Made to Provide’ is the date of the assessment.
 The form will be date-stamped on arrival at CES, and it is this date that
will be used for performance monitoring.
 Risk assessment - either completed or ongoing - confirms that the
referrer has complied with their duty to carry out such an assessment.
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 Where pressure care is ordered, the referrer must state the category of
pressure ulcer present (see below)
 Special Orders: these are Priority 3, and must be sent with the Special
Order referral form. This form is an evidence-based rationale as to why
bespoke equipment is required to meet an individual’s assessed need.
ETHNIC CODES FOR ELMS
1A
1B
1C
1D
1E
1F
1G
1H
1I
1J
1K
1L
1M
1N
1O
1P
1Q
1R
1S
Asian/Asian British – Indian
Asian/Asian British – Pakistani
Asian/Asian British - Bangladeshi
Asian/Asian British - Other
Black/Black British – African
Black/Black British - Caribbean
Black/Black British - Other
Chinese
Mixed White and Asian
Mixed White and Black African
Mixed White and Caribbean
Mixed Other
Any Other Ethnic Group
White - British
White - Irish
White - Other
White - Gypsy/Traveller
White – Travellers of Irish Heritage
Refused to give
Residential Status/Property Type Codes for ELMS
HA
NH
OOCC
PAR
RENT
RH
Housing Association
Nursing Home
Owner Occupier
Parents or Other Family Member’s Home
Private Landlord
Residential Home
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Diagnosis Codes for ELMS
DIAGNOSIS
CODE
Stroke, CVA, TIA (including SAH)
C01
CVD
C02
Diabetes
C03
Renal
C04
Respiratory
C05
Terminal illness
C06
Multiple organ failure
C07
Peripheral vascular disease
C08
Motor/sensory impairment
C09
Neurological conditions (MS, PD, head and spinal injury)
C10
Cancer
C11
Orthopaedic/rheumatology (to include falls, fractures, RA, OA)
C12
Dementia/Confused State
C13
Paediatric
C14
Post operative
C15
Pressure Ulcer Care
C16
PLEASE NOTE – The relevant code must be added to the
WS22a when ordering equipment. If not, the form will be
returned and this will obviously delay delivery.
PRESSURE ULCER CATEGORIES
CATEGORY 1 Non – blanchable erythema of intact skin. Discolouration of the skin,
warmth, oedema, indurations or hardness may also be used as indictors, particularly
on individuals with darker skin.
CATEGORY 2 Partial thickness skin loss involving epidermis, dermis, or both. The
ulcer is superficial and presents clinically as an abrasion or blister.
CATEGORY 3 Full thickness skin loss involving damage to, or necrosis of,
subcutaneous tissue that may extend down to, but not through, underlying fascia.
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CATEGORY 4 Extensive destruction, tissue necrosis, or damage to muscle, bone,
or supporting structures with or without full thickness skin loss.