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Referrals

External referral form
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Received Ref Name Stage
23 days ago #91 Donald Glover Triage View
23 days ago #29 Jeffery Kuvalis Triage View
23 days ago #55 Willian Kilback Triage View
23 days ago #40 Susannah Kovacek Triage View
23 days ago #13 Phebe Kris Triage View
23 days ago #50 Raymond Christiansen Triage View
23 days ago #2 Jimmie Oberbrunner Triage View
23 days ago #47 Douglass Dietrich Triage View
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24 days ago #99 Benjamin Rau Triage View
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24 days ago #60 Myron Aufderhar Triage View
24 days ago #69 Rodrick Friesen Triage View
24 days ago #71 Ashleigh Brown Triage View
24 days ago #73 Oren Rowe Triage View
24 days ago #37 Colton Lynch Triage View
24 days ago #51 Emile Schaden Triage View
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Process referral #46 for Helene Stoltenberg
Triage

Referral received at 12:10pm on Sun 11th May, 2025
Person with Dementia
PROFESSOR Helene Stoltenberg 87yrs Female
0665416475 / 063739894870 helene_stoltenberg@example.com 2616 Breitenberg Corner, Suite 531, Beauton, GP92 1YG
Preferred contact times: any
Praesentium omnis eveniet assumenda reiciendis.
DOB
31/3/1938
NHS
8210365444
GP
Bernhard Park Practice
Ethnic group
Any other ethnic group
Diagnosis
Referral made to memory clinic: Yes (Appointment date: 19/3/2025)
Alzheimer's disease
Diagnosing clinician: Manda Cormier
8/3/2023
Sensory impairment: Perspiciatis perferendis illum laborum recusandae tempore.
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 Frederic Prohaska Grandson
02164 153649 / 06811 527689 frederic_prohaska@example.com 296 Shelli Oval, Suite 012, Emmyville, HC97 4TY
Referrer
Libbie Sauer Earum occaecati eum sunt laudantium sequi quasi.
0361670913 / 0480284569 libbie_sauer@example.com
Referral source
CMHT

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