Get (spa) Referral Form Ver - Leicestershire Children's Health Services ...

This guide provides clear and comprehensive instructions for filling out the (SPA) Referral Form for Leicestershire Children's Health Services online. By following each step, you will ensure that all necessary information is provided accurately and efficiently.

Follow the steps to complete the referral form online.

1. Click the 'Get Form' button to obtain the form and open it in the editor.
2. Begin by entering the forename and surname of the child in the respective fields. Ensure that all names are spelled correctly as this is important for identification purposes.
3. Provide the child's NHS number or unique number in the designated field to assist in locating their medical records.
4. Fill in the referrer's name and designation to identify the individual making the referral.
5. Include the names of the parent's or guardian's names if they differ from the child's name.
6. Enter the family’s address, including the postcode, and indicate how long the family has lived in the UK.
7. Select the gender of the child and specify their date of birth (DOB) using the provided field.
8. Indicate the home languages spoken, both written and spoken, and tick the box if an interpreter is needed.
9. Discuss the concerns leading to the referral in detail, specifying the nature of the issue, duration, and its impact on the child's daily life, including school, nursery, and home environments.
10. List any current medications and their respective dosages if applicable.
11. Provide information on any actions or advice that has already been attempted regarding the child's situation.
12. Indicate if the child has special educational needs (SEN) and provide the appropriate details regarding their current status.
13. Specify if the child is a looked after child and provide any details regarding a social worker if applicable.
14. List any other services previously involved with the child, such as Social Care or Health services.
15. Provide contact details of the child's G.P., health visitor, or school nurse, along with their telephone numbers if known.
16. Complete the opinions and any comments from the child and/or parent or caregiver.
17. Ensure you, as the parent or caregiver, consent to the referral and any necessary assessments by signing and dating the form.
18. Feel free to attach any relevant additional information that could aid in the referral process.
19. Once completed, save changes, and then download or print the form to return it to the Single Point of Access at the specified address.

Complete the referral form online to ensure the child's health needs are addressed promptly.