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Health - Initial

Health - Initial
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These are a broad set of questions which cover the areas of mental health, physical health, wellbeing, and substance use. We will be asking questions to recognise any connections between your health and behaviour, and to identify any specialist referrals that are required.
 
 
 
Which case study are you assessing?
 
Case study 1
 
Case study 2
 
 
 
Are you registered with a GP?
 
Yes
 
No
 
 
 
                                    ** Find My Way Prompt
 
 
 
Where are you registered?
Name : 
Surgery : 
Address 1 : 
Address 2 : 
City : 
Postcode : 
  : 
Phone : 
Email Address : 
Country : 
 
 
 
Will you give your consent to share your medical details?
 
Yes
 
No
 
 
 
Would you like any support to register 
With a GP?
 
Yes
 
No
 
 
 
                        ** Vulnerabilities - Volunteer and Mentoring
 
 
 
Are you registered with a dentist?
 
Yes
 
No
 
 
 
Would you like any support to register with a dentist?
 
Yes
 
No
 
 
 
Consider intervention
                              ** Vulnerabilities - Volunteer and mentoring
 
Yes
 
No
 
 
Where are you registered?
Name : 
Surgery : 
Address 1 : 
Address 2 : 
City : 
Postcode : 
  : 
Phone : 
Email Address : 
Country : 
 
PW Assessment POC