If referral is for Autism Diagnostic Service please complete – SCREENING TOOL SCORE please see attached screening tool – Score …….. If referral is for Forensic Service - Forensic information must be completed INVOLVED LD PROFESSIONALS for admin use only – HEALTH SOCIAL WORK OUTCOME (including if person fits the criteria for LD Service Y/N ) HAS GP BEEN CONSULTED? HAS REFERRAL BEEN DISCUSSED WITH MEMBER OF LEARNING DISABILITY TEAM? HAS CONSENT BEEN GIVEN FOR THIS REFERRAL? If no or unable please give details HAS CONSENT BEEN GIVEN TO SHARE INFORMATION? If no or unable please give details IF REFERRAL FOR AUTISM HAS REFERRAL BEEN DISCUSSED WITH THE FAMILY? YES / NO – Please now E-mail form to or – Or send hard copy to - Scottish Borders Learning Disability Service Church Street Earlston TD4 6HR 840200 Fax: 01896 840222 Tel: 01896
If referral is for Autism Diagnostic Service – please complete SCREENING TOOL SCORE – please see attached screening tool Score …….. If referral is for Forensic Service - Forensic information must be completed INVOLVED LD PROFESSIONALS – for admin use only HEALTH SOCIAL WORK OUTCOME (including if person fits the criteria for LD Service Y/N ) HAS GP BEEN CONSULTED? HAS REFERRAL BEEN DISCUSSED WITH MEMBER OF LEARNING DISABILITY TEAM? HAS CONSENT BEEN GIVEN FOR THIS REFERRAL? If no or unable please give details HAS CONSENT BEEN GIVEN TO SHARE INFORMATION? If no or unable please give details IF REFERRAL FOR AUTISM – HAS REFERRAL BEEN DISCUSSED WITH THE FAMILY? YES / NO Please now E-mail form to – or Or send hard copy to - Scottish Borders Learning Disability Service Church Street Earlston TD4 6HR Tel: 01896 840200 Fax: 01896 840222