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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 #225 for Liza Bergnaum
Triage

Referral received at 1:22pm on Thu 28th Aug, 2025
Person with Dementia
MX Liza Bergnaum 78yrs Female lives alone
0672584478 / 081125605480 liza_bergnaum@example.com 568 Mills Causeway, Suite 584, South Houston, QL7 9MN
Preferred contact times: any
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DOB
21/10/1947
NHS
7882215198
GP
Mitchell Port Practice
Ethnic group
White and Black African
Diagnosis
Referral made to memory clinic: No (Appointment date: 26/10/2024)
Primary Progressive Aphasia (PPA)
Diagnosing clinician: Jenelle Greenholt
15/1/2023
Sensory impairment: Commodi quas laboriosam distinctio sunt atque animi 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
DR Archie Schowalter Nephew
097247430352 / 085796560209 archie_schowalter@example.com 05266 Jae Garden, Suite 405, Lake Elidatown, GC73 4DQ
Referrer
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0968200991 / 060562415888 bula_mraz@example.com
Referral source
AUKO GG

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