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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 #192 for Kennith Rogahn
Triage

Referral received at 11:57am on Thu 21st Aug, 2025
Person with Dementia
MR Kennith Rogahn 78yrs Male lives alone
099810071800 / 0872896862 kennith_rogahn@example.com 026 Wuckert Glen, Suite 660, Kreigerstad, DQ1 6KQ
Preferred contact times: afternoon
Eaque incidunt doloremque quisquam itaque repellendus.
DOB
19/7/1947
NHS
4114956271
GP
Wilderman Neck Practice
Ethnic group
Roma
Diagnosis
Referral made to memory clinic: No (Appointment date: 14/8/2025)
Wernicke-Koraskoff syndrome (WKS) or other alcohol related dementia
Diagnosing clinician: Darby Daniel
31/8/2023
Sensory impairment: Delectus sequi corrupti labore aut recusandae alias.
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
MISS Gaye (Lavona) Parisian Civil partner
045111376205 / 043268290383 gaye_parisian@example.com 2127 Lockman Forks, Suite 367, New Breanna, LY8 3VM
Referrer
Gidget Kreiger Sapiente hic sed ipsam consectetur minus et neque.
09060 204071 / 0466794255 gidget_kreiger@example.com
Referral source
AUKO I&A

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