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Referrals

External referral form
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Received Ref Name Stage
23 days ago #189 Devin Ziemann Triage View
23 days ago #151 Ty Blanda Triage View
23 days ago #191 Rod Torphy Triage View
23 days ago #137 Ethel Reichert Triage View
24 days ago #139 Coy Christiansen Triage View
24 days ago #153 Osvaldo Wilkinson Triage View
24 days ago #224 Marco Dare Triage View
24 days ago #148 Maxwell Stehr Triage View
24 days ago #181 Maurice Leannon Triage View
24 days ago #178 Ruben Grady Triage View
24 days ago #136 Germaine Nader Triage View
24 days ago #170 Sherwood Kovacek Triage View
25 days ago #182 Leandra Satterfield Triage View
25 days ago #155 Lyndon Kulas Triage View
25 days ago #175 Lena Lesch Triage View
25 days ago #146 Duane Purdy Triage View
25 days ago #188 Felipe Wyman Triage View
26 days ago #143 Sebastian O'Conner Triage View
26 days ago #194 Francesco Kirlin Triage View
26 days ago #225 Ladawn Turcotte Triage View
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Process referral #139 for Coy Christiansen
Triage

Referral received at 11:57am on Thu 3rd Apr, 2025
Person with Dementia
MR Coy Christiansen 82yrs Male
057383574636 / 0525593589 coy_christiansen@example.com 7959 Shanahan Shores, Suite 101, South Setsukoside, XA4 7HN
Preferred contact times: afternoon
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DOB
28/5/1942
NHS
4370046513
GP
Sung Expressway Practice
Ethnic group
Caribbean
Diagnosis
Referral made to memory clinic: No (Appointment date: 19/10/2024)
Wernicke-Koraskoff syndrome (WKS) or other alcohol related dementia
Diagnosing clinician: Annemarie Carter
10/2/2023
Sensory impairment: Natus nulla maiores earum mollitia cum excepturi veritatis.
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 Bradley (Lino) Legros Civil partner
053998588437 / 0426827811 bradley_legros@example.com 97720 Alphonso River, Suite 226, Rosellefort, UA96 2GD
Referrer
Noel Nitzsche Quos mollitia modi animi quibusdam facere id enim harum.
0877891935 / 0645847333 noel_nitzsche@example.com
Referral source
AUKO I&A

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