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Received Ref Name Stage
about 1 month ago #12 Alla DuBuque Triage View
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Process referral #54 for Nakisha (Ethelyn) Nicolas
Triage

Referral received at 11:42am on Thu 15th May, 2025
Person with Dementia
MS Nakisha (Ethelyn) Nicolas 66yrs Female
072169469565 / 090457044479 nakisha_nicolas@example.com 0389 Bailey Summit, Suite 278, New Geneviechester, VN6 2RY
Preferred contact times: afternoon
Repudiandae odit nesciunt iste cupiditate impedit.
DOB
14/8/1958
NHS
3331867721
GP
Wolff Forest Practice
Ethnic group
Any other White background
Diagnosis
Referral made to memory clinic: No (Appointment date: 20/10/2024)
Creutzfeld-Jakob disease (CJD)
Diagnosing clinician: Hyo Davis
27/3/2025
Sensory impairment: Deleniti ipsam quas quibusdam molestiae labore quis.
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
PROFESSOR Zackary Fritsch Other
04708 224718 / 0829904898 zackary_fritsch@example.com 135 Santos Glen, Apt. 374, New Iselahaven, WO01 4YX
Referrer
Wynona Collins Magni nam aperiam natus perferendis.
0292270350 / 05188 370951 wynona_collins@example.com
Referral source
Advice Service

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