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Referrals

External referral form
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Received Ref Name Stage
2 months ago #191 Leticia O'Connell Triage View
2 months ago #172 Kanesha Dare Triage View
2 months ago #225 Liza Bergnaum Triage View
2 months ago #207 Wilmer Jones Triage View
2 months ago #138 Johnny Schoen Triage View
2 months ago #177 Laurie Hartmann Triage View
2 months ago #145 Isaura Lebsack Triage View
2 months ago #205 Elizabeth Bartell Triage View
2 months ago #208 Marty Upton Triage View
2 months ago #161 Garland Metz Triage View
2 months ago #163 Anjanette Wuckert Triage View
2 months ago #135 Danilo Braun Triage View
2 months ago #215 Melba Quitzon Triage View
2 months ago #169 Johanna Bergstrom Triage View
2 months ago #173 Jaquelyn Hayes Triage View
2 months ago #216 Andre Tromp Triage View
2 months ago #224 Debby Jacobs Triage View
2 months ago #174 Shaunda Koss Triage View
2 months ago #179 Augustine Gutmann Triage View
2 months ago #166 Marisa Marks Triage View
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Process referral #180 for Reinaldo Kautzer
Triage

Referral received at 5:03pm on Sun 17th Aug, 2025
Person with Dementia
MR Reinaldo Kautzer 83yrs Other
0289191586 / 09748 410725 reinaldo_kautzer@example.com 663 Feeney Port, Suite 740, Olaberg, VD82 0RP
Preferred contact times: afternoon
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DOB
22/11/1941
NHS
7153550011
GP
Wilderman Neck Practice
Ethnic group
Caribbean
Diagnosis
Referral made to memory clinic: Yes (Appointment date: 12/8/2025)
Huntingdon's disease
Diagnosing clinician: Hosea White
14/4/2025
Sensory impairment: Eligendi officia impedit quos reprehenderit rem culpa nemo.
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 Guy (Quentin) Walter Nephew
0750835821 / 0406472609 guy_walter@example.com 935 Marquardt Dam, Suite 331, East Robchester, SL3 0SM
Referrer
Becky Lebsack Assumenda nobis hic placeat molestiae.
0299898333 / 09918 042568 becky_lebsack@example.com
Referral source
Memory Clinic

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