booked for 60 -90 minutes Date entered UK Date became LAC No. moves in UK Legal update (order, any on-going issues) Consent Y To undertake an Initial Health Y □ □ To access and share health Assessment and medical Please use appropriate information N treatment N □ □ pages of form “Consent/PR/LAC” Is the YP felt to be Fraser Consent by birth parent/ other adult No Yes □ □ competent? with PR/ authorised service manager if Able to give their own consent child does not have capacity Please encourage parent to complete form PH Foster Carer Name County ADDITIONAL SUPPORTING INFORMATION (can attach other files if information held elsewhere) Telephone FC GP Address Telephone GP Social Address Worker Name Telephone SW Address County Other professionals / □ organisations (inc. voluntary) involved? □ What is the young person’s “story”? What is already known about their reason for leaving their country of origin and their experiences there? What has the young person already shared about their journey and their experiences? Are there any known health issues? Has the young person already had any medical attention since arrival in the UK? If yes, what and where? Are there any records? Have you made any other referrals for this young person?
booked for 60 -90 minutes Date entered UK Date became LAC No. moves in UK Legal update (order, any on-going issues) Consent Please use appropriate pages of form “Consent/PR/LAC” To access and share health information Y □ N □ To undertake an Initial Health Assessment and medical treatment Y □ N □ Is the YP felt to be Fraser competent? Able to give their own consent Consent by birth parent/ other adult with PR/ authorised service manager if child does not have capacity Please encourage parent to complete form PH No □ Yes □ Foster Carer Name Telephone FC Address GP Telephone GP Address Social Worker Name Telephone SW Address County County □ □ ADDITIONAL SUPPORTING INFORMATION (can attach other files if information held elsewhere) Other professionals / organisations (inc. voluntary) involved? What is the young person’s “story”? What is already known about their reason for leaving their country of origin and their experiences there? What has the young person already shared about their journey and their experiences? Are there any known health issues? Has the young person already had any medical attention since arrival in the UK? If yes, what and where? Are there any records? Have you made any other referrals for this young person?
app_a_act_req.docx