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Referrals

External referral form
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Received Ref Name Stage
2 months ago #206 Denyse Zemlak Triage View
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Process referral #161 for Russell (Garland) Metz
Triage

Referral received at 1:56pm on Wed 27th Aug, 2025
Person with Dementia
MR Russell (Garland) Metz 91yrs Male
07416 474218 / 0457577428 russell_metz@example.com 9400 Metz Plain, Suite 593, Port Burl, YQ4 3AG
Preferred contact times: morning
Fuga earum sed ut quo excepturi.
DOB
14/8/1934
NHS
9195173188
GP
Aldo Forge Practice
Ethnic group
African
Diagnosis
Referral made to memory clinic: Yes (Appointment date: 13/5/2025)
Fronto-temporal lobe dementia
Diagnosing clinician: Thomas Leuschke
26/3/2024
Sensory impairment: Aspernatur libero qui temporibus repellendus blanditiis perspiciatis.
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 Erick (Santo) Kunde Son
0407737453 / 09847 697970 erick_kunde@example.com 1609 Norberto Gateway, Suite 084, Lowebury, IP70 9UP
Referrer
Keesha Runolfsdottir Dignissimos illum enim nihil accusamus possimus.
03029 254911 / 06894 672191 keesha_runolfsdottir@example.com
Referral source
Memory Clinic

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