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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 #60 for Myron Aufderhar
Triage

Referral received at 10:03pm on Mon 19th May, 2025
Person with Dementia
MR Myron Aufderhar 91yrs Male
0773372445 / 0858256230 myron_aufderhar@example.com 44102 Langosh Route, Suite 638, Abrahamland, FP37 5WF
Preferred contact times: morning
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DOB
20/8/1933
NHS
1276677189
GP
Morar Burg Practice
Ethnic group
African
Diagnosis
Referral made to memory clinic: No (Appointment date: 18/11/2024)
Other mixed dementia
Diagnosing clinician: Daria Klein
15/4/2025
Sensory impairment: Animi totam voluptatem fugiat odio a.
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
MRS Viki (Nikita) Brown Other
08772 913446 / 070921215883 viki_brown@example.com 183 Nubia Wells, Apt. 773, Celiashire, PD0 0FI
Referrer
Darren Murray Aperiam unde tempora veniam mollitia molestias.
0888636170 / 04594 587692 darren_murray@example.com
Referral source
Social Services

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