Has the client been assessed by referrer as having Y/N? substantial difficulty to engage in assessment/safeguarding process? Does the client have substantial difficulty in: (select all Understanding Y/N? that apply) relevant information Retaining Y/N? information Using or Y/N? weighing up information Communicating Y/N? views, wishes and feelings Has the client been deemed by referrer as having no Y/N? appropriate person to support them to engage in assessment/safeguarding process? If are persons involved with the client, but referrer has deemed them not appropriate, please provide names and contact details and explain why: Has the client been supported with Information and Y/N? Advice around the assessment/safeguarding process? the client is at in the required area of support; this will help us triage the case more rapidly (Please tick only one) Stage: Please tick only one Beginning of process Pre-assessment Post assessment Area of Support required (please tick only one) A needs assessment under Section 9 A carer’s assessment under Section 10 Preparation of a care and support plan or support plan under Section 25 A review of a care and support plan or support plan under Section 27 A safeguarding enquiry or Safeguarding Adult Review Consent Has client consented to this referral? Y/N?
Has the client been assessed by referrer as having substantial difficulty to engage in assessment/safeguarding process? Y/N? Does the client have substantial difficulty in: (select all that apply) Understanding relevant information Y/N? Retaining information Y/N? Using or weighing up information Y/N? Communicating views, wishes and feelings Y/N? Has the client been deemed by referrer as having no appropriate person to support them to engage in assessment/safeguarding process? If are persons involved with the client, but referrer has deemed them not appropriate, please provide names and contact details and explain why: Y/N? Has the client been supported with Information and Advice around the assessment/safeguarding process? Y/N? the client is at in the required area of support; this will help us triage the case more rapidly (Please tick only one) Stage: Please tick only one Beginning of process Pre-assessment Post assessment Area of Support required (please tick only one) A needs assessment under Section 9 A carer’s assessment under Section 10 Preparation of a care and support plan or support plan under Section 25 A review of a care and support plan or support plan under Section 27 A safeguarding enquiry or Safeguarding Adult Review Consent Has client consented to this referral? Y/N?
Care-Act-Referral-Form-v1.docx