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Referrals

External referral form
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Received Ref Name Stage
21 days ago #91 Donald Glover Triage View
21 days ago #29 Jeffery Kuvalis Triage View
21 days ago #55 Willian Kilback Triage View
21 days ago #40 Susannah Kovacek Triage View
22 days ago #13 Phebe Kris Triage View
22 days ago #50 Raymond Christiansen Triage View
22 days ago #2 Jimmie Oberbrunner Triage View
22 days ago #47 Douglass Dietrich Triage View
22 days ago #56 Joi Jast Triage View
22 days ago #49 Brad Towne Triage View
22 days ago #23 Giovanni Hintz Triage View
22 days ago #99 Benjamin Rau Triage View
22 days ago #4 Dylan Ledner Triage View
22 days ago #18 Glenn Brekke Triage View
22 days ago #60 Myron Aufderhar Triage View
22 days ago #69 Rodrick Friesen Triage View
23 days ago #71 Ashleigh Brown Triage View
23 days ago #73 Oren Rowe Triage View
23 days ago #37 Colton Lynch Triage View
23 days ago #51 Emile Schaden Triage View
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Process referral #18 for Richie (Glenn) Brekke
Triage

Referral received at 10:48pm on Mon 19th May, 2025
Person with Dementia
PROFESSOR Richie (Glenn) Brekke 85yrs Male
096959887692 / 0559712403 richie_brekke@example.com 786 Vanda Spring, Suite 251, Cartwrightton, MS8 3OE
Preferred contact times: afternoon
Fugit exercitationem ipsum totam quaerat voluptatibus facilis omnis dignissimos.
DOB
26/2/1940
NHS
5945691178
GP
Abdul Groves Practice
Ethnic group
Gypsy or Irish Traveller
Diagnosis
Referral made to memory clinic: Yes (Appointment date: 9/3/2025)
Wernicke-Koraskoff syndrome (WKS) or other alcohol related dementia
Diagnosing clinician: Sheron Hegmann
4/5/2024
Sensory impairment: Ullam vero distinctio sapiente illo.
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 Shella Walker Civil partner
090793308498 / 065404866331 shella_walker@example.com 791 Mayola Pine, Suite 391, New Rebeca, IE06 6VJ
Referrer
Karon Lueilwitz Ipsam fuga qui maiores exercitationem tenetur.
08833 301399 / 04378 636955 karon_lueilwitz@example.com
Referral source
AUKO DOX

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