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First name
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Last name
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Job title
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Phone extension
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Which NHS staff group do you work in?
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Nursing and midwifery (qualified)
Medical and dental
Admin and clerical
Healthcare Scientists
Estates and ancillary (estates, domestic services, catering)
Allied Health Professional
Additional clinical support (e.g. Healthcare Assistant/Theatre Assistant)
Public Governer
Main site location
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Warrington
Halton
CMTC
Cross site
Community or other
Department or ward location (eg Ward A5, A&E, IT Department etc)
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Electronic Patient Record (Lorenzo) user?
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Yes
No
Any other languages spoken?
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