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People looked after by Affinity Care Solutions. It is important to provide all the relevant information about the young person. Please attach the following information to this form: Case summary, care plan, last review report, immigration documents, and chronology. Date of Referral: Name of the Young Person: Date of Birth: Gender: Ethnic Origin: Religion: Languages: Legal Status: Disability: Does young person have a statement of special educational needs? Yes No Current Address: Te.

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