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Referrals

External referral form
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Received Ref Name Stage
15 days ago #179 Lashaunda Lowe Triage View
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Process referral #156 for Kerrie Lemke
Triage

Referral received at 5:55pm on Mon 7th Apr, 2025
Person with Dementia
MS Kerrie Lemke 85yrs Female lives alone
0540092452 / 03312 337577 kerrie_lemke@example.com 51708 Walter Forge, Apt. 493, Welchland, UN6 1VF
Preferred contact times: morning
Commodi laboriosam explicabo unde natus debitis.
DOB
27/2/1940
NHS
8172695594
GP
Kunze Fork Practice
Ethnic group
Pakistani
Diagnosis
Referral made to memory clinic: Yes (Appointment date: 18/10/2024)
Huntingdon's disease
Diagnosing clinician: Cordelia Bode
23/6/2022
Sensory impairment: Voluptate occaecati recusandae blanditiis laudantium distinctio.
Referral reason
Social activities / isolation
Physical / mobility
Financial / allowances & benefits
Legal / LPA & Wills
Safety in the home
Dementia information
Support for carer / respite
Personal care
Insight
Cognitive ability
Health & wellbeing
Planning for the future
Assistive technology
Aide-memoire
Support for Memory Clinic appointment
Other
Additional notes
This is some text written by the referrer about the pwd's situation.
Carer
MR Brice Bradtke Husband
0376018959 / 0672366456 brice_bradtke@example.com 57445 Quitzon Ports, Suite 935, Port Randalside, FB99 1AY
Referrer
Melania Crist Enim assumenda harum repudiandae ab soluta quo.
0684334193 / 08075 781718 melania_crist@example.com
Referral source
CMHT

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