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It systematically collects essential patient details, parent or carer contact information, accessibility and communication requirements, and comprehensive referrer and GP practice data. The form also includes specific sections for documenting the clinical reason for referral, current medication history, and patient allergies. It serves as an official request mechanism for medical professionals to coordinate neurodevelopmental services through Help for Psychology, ensuring all necessary administrative and clinical criteria are captured for processing. Note that patients residing outside the Norfolk and Waveney area may have limitations regarding ADHD medication initiation and titration following the assessment 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is this referral form intended for?","Question",{"text":109,"@type":110},"This form is intended for children and young people who are seeking a neurodevelopmental assessment under the 'Right to Choose' pathway.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"What information is required regarding accessibility?",{"text":114,"@type":110},"The form requests information about any specific needs related to vision, hearing, speech, or other communication difficulties, and asks whether the patient or carer requires an interpreter, lip speaker, or BSL interpreter.",{"name":116,"@type":107,"acceptedAnswer":117},"Are there limitations for patients referred from outside the Norfolk and Waveney area?",{"text":118,"@type":110},"Yes, for children referred from outside the Norfolk and Waveney area, the service is unable to offer the initiation and titration of ADHD medication following the assessment.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},306931,1790473593,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":9},13056703019662,"https://ap-avatar.wpscdn.com/avatar/be000253a8e92610077?_k=1778726343310543188","CHILDREN AND YOUNG PEOPLE NEURODEVELOPMENTAL RIGHT TO CHOOSE ASSESSMENT-Referral Form  \nPlease submit GP referrals via email [to](to rtc@help4psychology.co.uk)[ ](to rtc@help4psychology.co.uk)[rtc@help4psychology.co.uk](to rtc@help4psychology.co.uk)  \n\n| Patient Details |  |  |  |\n| --- | --- | --- | --- |\n| Surname: |  | Address: |  |\n| Forename: |  |  |  |\n| Date of Birth: |  |  |  |\n| NHS Number: |  |  |  |\n| Contact\u003Cbr>Telephone No: |  | Postcode |  |\n\n\n| Parent / Carer Information |  |  |  |\n| --- | --- | --- | --- |\n| Name(s): |  | Home Tel No: |  |\n|  |  | Mobile No: |  |\n| Relationship to patient: |  | Email: |  |\n\n\n| Accessibility Requirements |  |  |\n| --- | --- | --- |\n| Please specify below if the patient and or parent/carer has additional needs related to: |  |  |\n|  | Patient: | Parent / Carer: |\n| Vision |  |  |\n| Hearing |  |  |\n| Speech |  |  |\n| Other communication difficulties |  |  |\n| The patient, and or parent / carer requires an:\u003Cbr>□ Interpreter (specify language)\u003Cbr>□ Lip speaker\u003Cbr>□ BSL interpreter |  |  |\n\n\n| Referrer Details |  |  |  |\n| --- | --- | --- | --- |\n| Referrer Name: |  | Date of Request: |  |\n| Discipline: |  | Address: |  |\n| Email: |  |  |  |\n| Contact\u003Cbr>Telephone No: |  |  |  |\n\n| GP Details |  |  |  |\n| --- | --- | --- | --- |\n| Referring GP: |  | Date of Request: |  |\n| GMC Number: |  | Referring Practice: |  |\n| Contact Number: |  | Practice Address: |  |\n| Practice Code: |  |  |  |\n| ICB: |  |  |  |\n| Sub ICB: |  |  |  |\n\n\n| Reason for Referral |\n| --- |\n|  |\n\n\n| Current Medication |\n| --- |\n|  |\n\n\n| Allergies |\n| --- |\n|  |\n\nPlease note, for any child referred to us from outside of the Norfolk and Waveney area, we are unable to offer initiation and titration of ADHD medication following assessment.","cbCaipVmElnIs4fP","https://ap.wps.com/l/cbCaipVmElnIs4fP","pdf",116548,"English","# Patient Details\n# Parent and Carer Information\n# Accessibility Requirements\n# Referrer and GP Details\n# Referral Rationale and Clinical History","[{\"question\":\"Who is this referral form intended for?\",\"answer\":\"This form is intended for children and young people who are seeking a neurodevelopmental assessment under the 'Right to Choose' pathway.\"},{\"question\":\"What information is required regarding accessibility?\",\"answer\":\"The form requests information about any specific needs related to vision, hearing, speech, or other communication difficulties, and asks whether the patient or carer requires an interpreter, lip speaker, or BSL interpreter.\"},{\"question\":\"Are there limitations for patients referred from outside the Norfolk and Waveney area?\",\"answer\":\"Yes, for children referred from outside the Norfolk and Waveney area, the service is unable to offer the initiation and titration of ADHD medication following the assessment.\"}]","Children and Young People Neurodevelopmental Right to Choose Assessment - Referral Form | PDF",1789842572]