№ lp_1_24805
File format: docx
Character count: 4730
File size: 51 KB
Administrative referral form outlining required clinical, medical, consent, and eligibility information for adult patients being referred to a hospital-based special care dentistry service.
Age group:
Adults aged 16 and over
Geographic area:
Bristol, United Kingdom
Healthcare sector:
Dentistry
Dental specialty:
Special Care Dentistry
Document type:
Patient referral form
Issuing institution:
Bristol Dental Hospital
Receiving department:
Patient Access Team
Referral urgency options:
Urgent; Routine
Referral purpose:
Specialist opinion; Specialist opinion and treatment
Clinical information required:
Dental needs; past dental history; difficulties encountered
Medical information required:
Medical history; medications; allergies; smoking and drinking history; involvement of other medical specialties
Accessibility information:
Communication ability; interpreter needs; mobility; transport requirements
Consent requirement:
Patient or carer consent to referral
Acceptance criteria:
Adults with complex medical, physical, neurological, behavioural, psychiatric, bariatric, or allergy-related needs unsuitable for primary care
Regulatory references:
NHS; GDC/GMC
Source type:
Administrative healthcare form used within secondary care referral pathways
Price: 8 / 10 USD
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The file will be delivered to the email address provided at checkout within 12 hours.
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The product description is provided for reference. Actual content and formatting may differ slightly.
Year:
2024
Region / City:
Australia
Document Type:
Regulatory submission for PBS listing
Organization:
Biogen Australia Pty Ltd
Drug Name:
Omaveloxolone (Skyclarys®)
Indication:
Friedreich’s ataxia in adults and adolescents aged 16 years and older
Dosage Form:
Capsule 50 mg, oral administration
Regulatory Status:
Orphan drug status granted by TGA, EMA and FDA approvals
Submission Date:
26 June 2024
PBAC Meeting:
March 2025
Population:
Patients aged 16 years and older with Friedreich’s ataxia
Treatment Phase:
Initial and continuing treatment
Prescriber Type:
Dental, Medical Practitioners, Nurse Practitioners, Optometrists
Restriction Type:
Authority Required (telephone/online PBS Authorities system)
Clinical Criteria:
Genetic confirmation of FXN mutation, presence of clinical symptoms, management under a specialist or consultation with specialized unit if needed
Treatment Criteria:
Must be given with best supportive care, hemodynamically stable in case of cardiac history
Administrative Advice:
Queries directed to Services Australia, prescribing information available online
Year:
2025
Region / City:
London
Topic:
Neonatal BCG vaccination program
Document Type:
Protocol
Organization / Institution:
NHSE
Author:
Alice Waters
Target Audience:
Healthcare professionals involved in neonatal care and immunization
Period of validity:
Not specified
Approval Date:
Not specified
Date of changes:
September 2025
Acute Inpatient Psychiatric Admission Form for Patients Aged 10–17 with Neurodevelopmental Disorders
Patient Name:
____________________________________________
Date of Birth:
____________________
Home Address:
_________________________________________________________________________
Parent/Guardian Name/Phone/Email:
______________________________________________________
Expected Admission Type:
Voluntary / Involuntary
Referral for:
Acute Inpatient Psychiatric Treatment, approximately 30 days
Target Population:
Patients aged 10–17 with autism spectrum disorder, intellectual disability, or related neurodevelopmental disability
Current Psychiatric Provider:
UNC Psychiatry Outpatient (if applicable)
Diagnoses:
_____________________________________________________________________________
Current Medications:
____________________________________________________________________
Medical Problems:
______________________________________________________________________
Isolation Precautions:
No / Yes
Past Medical Hospitalizations or Surgeries:
__________________________________________________
Previous Psychiatric Treatment:
___________________________________________________________
Substance Use:
_________________________________________________________________________
Post-Treatment Residence Confirmed:
No / Yes
Department of Social Services / Child Protective Services Involvement:
_________________________
Consent for Medical Treatment:
___________________________________________________________
Last COVID Test:
___________________
Laboratory Results:
Within normal limits / Not done / Any abnormalities: ______________________
Pregnancy Status:
No / Yes
Seizure History:
No / Yes, well-controlled / Yes, uncontrolled
Last Vital Signs:
T______ P______ BP______ RR______ O2 Sat _____ Weight______ Height_______ BMI_________
Pending/Past Legal Problems:
_____________________________________________________________
ADL Support:
Independent / Needs Assistance with Eating, Hygiene, Walking (specify assist device)
Communication Method:
Verbally (sentences/words/phrases), Sign language, Pictures, Device, Gestures
Sensory Needs:
Hearing impaired / Visually impaired / Over/undersensitive to ____________________
Year:
2023
Institution:
Yorkville University
Program:
Master of Arts in Counselling Psychology (MACP)
Document Type:
Practicum Guidelines
Target Group:
Counselling students and supervisors
Age Group:
7-9 years
Purpose:
Developing entry-level counselling skills with children
Revision Date:
16/01/2023
Context:
Practicum training and supervision requirements
Year:
2023
Region / City:
Australia
Theme:
Animal Welfare, Research Protocol
Document Type:
Research Guidance
Institution:
Australian National University (ANU)
Author:
ANU Veterinary Services
Target Audience:
Researchers, Animal Technicians, Veterinary Staff
Period of Validity:
Ongoing
Approval Date:
Not specified
Amendment Date:
Not specified
Year:
2024
Region / City:
Australia
Topic:
Mental Health Assessment
Document Type:
Guidance
Organization / Institution:
Department of Health and Aged Care
Author:
Commonwealth of Australia
Target Audience:
Australian health professionals
Effective Period:
May 2024
Approval Date:
May 2024
Date of Updates:
Not specified
Note:
Year
Theme:
Gender incongruence treatment
Document type:
Medical Protocol
Agency / Organization:
Indigo Gender Service
Target audience:
Healthcare providers
Year:
2023
Region / City:
Bath and North East Somerset
Theme:
Inclusion Support for Children with Special Educational Needs
Document Type:
Request Form
Institution / Organization:
Bath and North East Somerset Council
Author:
Early Years Special Educational Needs Disability and Inclusion Team (SENDIT)
Target Audience:
Early Years Settings, Families, Educational Professionals
Period of Validity:
N/A
Approval Date:
N/A
Date of Changes:
N/A
Context:
A request form for securing inclusion support funding for young children with special educational needs in early years settings in Bath and North East Somerset, requiring submission of documentation and parental consent.
Year:
2016
Region / City:
Australia
Topic:
Aged care, occupational health
Document type:
Job description
Organization / Institution:
ReturnToWorkSA
Author:
Not specified
Target audience:
Healthcare professionals, aged care providers
Effective period:
Not specified
Approval date:
Not specified
Amendment date:
Not specified
Year:
2026
Region / City:
Fremantle, WA
Subject:
Aged care resources and services licensing agreement
Document Type:
Agreement
Organization / Institution:
Gevers Goddard Jones Pty Ltd
Author:
Gevers Goddard Jones Pty Ltd
Target Audience:
Service providers, home care and residential care organizations
Validity Period:
Not specified
Approval Date:
27 January 2026
Modification Date:
Not specified
Note:
Contextual Description
Year:
2023
Region / City:
Australia
Topic:
Healthcare, Aged Care, Primary Care
Document Type:
Toolkit
Organization:
National MyMedicare PHN Implementation Program
Author:
National MyMedicare PHN Implementation Program
Target Audience:
Healthcare professionals, General Practitioners, Residential Aged Care Homes (RACH) staff
Period of validity:
Ongoing
Approval Date:
Not provided
Date of amendments:
Not provided
Year:
2026
Region / city:
Australia
Topic:
Aged care, trauma-informed care
Document type:
Briefing note
Organization / institution:
Helping Hand Aged Care
Author:
Not specified
Target audience:
Executive Leadership Team, Board
Period of validity:
Not specified
Approval date:
Not specified
Date of changes:
Not specified
Year:
2023
Region / City:
Bath and North East Somerset
Theme:
Early Childhood Education, Special Educational Needs (SEND)
Document Type:
Request Form
Organ / Institution:
Bath and North East Somerset Council
Author:
Early Years Special Educational Needs Disability and Inclusion Team (SENDIT)
Target Audience:
Parents, carers, and educational settings in Bath and North East Somerset
Period of Validity:
Not specified
Approval Date:
Not specified
Date of Changes:
Not specified
Year:
2023
Region / City:
Australia
Topic:
Animal Welfare, Research Protocol
Document Type:
Guidelines
Organization:
Australian National University
Author:
ANU Veterinary Services
Target Audience:
Researchers, Animal Technicians, Veterinary Staff
Period of Validity:
Not specified
Approval Date:
Not specified
Date of Changes:
Not specified
Context:
Guidelines for assessing the health and welfare of older mice in research using a standardized scoring system in line with ethical protocols.
Year:
2022
Region / City:
London, United Kingdom
Topic:
Dental Implantology, Governance, Charity Operations
Document Type:
AGM Notice and Reports
Organization / Institution:
Association of Dental Implantology (ADI)
Author:
Richard Cantillon (Acting Executive Director)
Target Audience:
ADI members, dental professionals, charity stakeholders
Period of Validity:
2022
Approval Date:
Not specified
Date of Changes:
Not specified
Year:
2012
Region / City:
Falls Church, VA
Topic:
TRICARE Dental Program, Data Exchange
Document Type:
Interface Control Document (ICD)
Organization / Institution:
DHSS Program Executive Office
Author:
Not specified
Target Audience:
DHSS Program Executive Office, TMA Contract Operations Office
Period of Validity:
Ongoing
Approval Date:
June 7, 2012
Date of Changes:
May 25, 2012
Note:
Year
Note:
Year
Institution:
University of Glasgow
Target Audience:
BDS Students
Year:
2014
Region / City:
United States
Topic:
HIPAA compliance, Dental practice, Patient information security
Document Type:
Guidance document
Organization / Institution:
American Dental Association (ADA)
Author:
American Dental Association
Target Audience:
Dental practices, healthcare providers
Period of validity:
Not specified
Approval Date:
Not specified
Modification Date:
Not specified