№ files_lp_3_process_7_062500
Medical referral form issued by a multi-agency autism service in West Wales for requesting an adult autism diagnostic assessment, collecting personal, developmental, clinical and consent information for health and social care review.
Organisation: West Wales Integrated Autism Service (GAI Gorllewin Cymru)
Address: Ty Gwili, Heol Bronwydd / Bronwydd Road, Caerfyrddin / Carmarthen, SA31 2AJ
Contact telephone: 01267 283070
Document type: Medical referral form
Service area: West Wales
Subject: Adult Autism Spectrum Disorder diagnostic assessment
Sections: Service User’s Details; Referrer Details; GP Details; Developmental History; Current Difficulties; Risk Information; Consent and Information Sharing
Data protection framework: General Data Protection Regulations
Intended users: Adults seeking ASD assessment; Professionals; Parents; Carers
Issuing body type: Multi-agency health and social care team
Administrative process: Weekly referral meeting with written outcome notification to service user and GP
Price: 8 / 10 USD
The file will be delivered to the email address provided at checkout within 12 hours.

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