[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-170632-105":3,"detail-sidebar-cat-1-en-105":81,"doc-detail-170632-en":127},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","under-18s-right-to-choose-referral-form","Under 18's Right to Choose - Referral Form","","Referral form for Children and Young People services covering the Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) assessment pathways. The GP completes and signs the form, then emails it with supporting documentation. It explains eligibility by age ranges, the screening step to decide whether a full assessment is needed, and where assessments are delivered (face-to-face for ASD; face-to-face or online for ADHD with suitability determined case by case). It also lists exclusion criteria and data protection/privacy notice handling, with no backdating of referrals.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/under-18s-right-to-choose-referral-form/170632/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/under-18s-right-to-choose-referral-form/170632.png","ImageObject",442,249,{"name":42,"@type":43},"Quinn","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/vnd.openxmlformats-officedocument.wordprocessingml.document","2026-10-22","2026-09-01",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",10,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"Who is allowed to complete and sign this referral form?","Question",{"text":63,"@type":64},"The form should only be completed and signed by a GP.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How does the screening process work after Psicon receives a referral?",{"text":68,"@type":64},"A parent or guardian is invited to carry out screening to determine whether the child meets the threshold for a full assessment.",{"name":70,"@type":61,"acceptedAnswer":71},"What are the service exclusion criteria?",{"text":72,"@type":64},"The service excludes children or young people with co-morbid mental health difficulties and/or risk to self/others, and those with a moderate to severe learning disability.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},170632,1790871438,{"code":4,"msg":82,"data":83},"success",[84,89,94,99,104,109,113,118,123],{"id":85,"doc_module":22,"doc_module_name":25,"category_name":86,"show_sort_weight":87,"slug":88},11,"Presentations",90,"presentations",{"id":90,"doc_module":22,"doc_module_name":25,"category_name":91,"show_sort_weight":92,"slug":93},12,"Resumes",80,"resumes",{"id":95,"doc_module":22,"doc_module_name":25,"category_name":96,"show_sort_weight":97,"slug":98},14,"Invoices",70,"invoices",{"id":100,"doc_module":22,"doc_module_name":25,"category_name":101,"show_sort_weight":102,"slug":103},15,"Posters",60,"posters",{"id":105,"doc_module":22,"doc_module_name":25,"category_name":106,"show_sort_weight":107,"slug":108},16,"Social Media",50,"social-media",{"id":110,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":111,"slug":112},17,40,"forms",{"id":114,"doc_module":22,"doc_module_name":25,"category_name":115,"show_sort_weight":116,"slug":117},18,"Letters",30,"letters",{"id":119,"doc_module":22,"doc_module_name":25,"category_name":120,"show_sort_weight":121,"slug":122},21,"Paper Templates",5,"papers-templates",{"id":124,"doc_module":22,"doc_module_name":25,"category_name":125,"show_sort_weight":4,"slug":126},158,"General","general-158",{"code":4,"msg":82,"data":128},{"doc_id":79,"user_id":129,"nickname":42,"user_avatar":130,"doc_module":22,"category_id":110,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":136,"language":137,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":138,"faqs":139,"seo_title":140,"seo_description":12,"update_tm":141,"read_time":30},962075114765,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","\u0003NHS Template\u0004\n\u0003Children & Young People Right to Choose Referral Form\u0004\n\u0003August 2024\t\u0004\n\u000f\nUnder 18's Right to Choose\nThis form should only be completed and signed by GP. For this service, please email this referral form (along with any other supporting documentation) to: \u0013HYPERLINK \"mailto:kmicb.psicon.childrens@nhs.net\"\u0014kmicb.psicon.childrens@nhs.net\u0015\nAutism spectrum disorder (ASD) assessment pathway:\nPsicon accept new referrals for Children and Young People (CYP) aged 3y 0m – 17y 364 days for autism spectrum disorder (ASD). Once Psicon receive the referral, parent/guardian will be invited to carry out the screening process to determine whether the CYP meets the threshold for a full assessment. Assessments for autism are currently only offered face-to-face at our clinic in Basingstoke, Hampshire.\nAttention Deficit Hyperactivity Disorder (ADHD) assessment pathway:\nPsicon accept new referrals for CYP aged 6y 0m – 17y 364 days for ADHD. Once Psicon receive the referral, parent/guardian will be invited to carry out the screening process to determine whether the CYP meets the threshold for a full assessment. Assessments for ADHD can be either face-to-face at our clinic in Basingstoke, or online. Online assessments are not suitable for all children, and we can only carry these out for those who are deemed to be clinically suitable.  A decision on whether an individual child is suitable to be seen online is made on a case-by-case basis once the referral has been reviewed.\nExclusion Criteria for the service:\nCYP who present with co-morbid mental health difficulties and/or risk to self/others.\nCYP with a moderate to severe learning disability.\n\u000f\nPsicon handle personal information in accordance with the Data Protection Act 2018 and the General Data Protection Regulations 2018. We will process personal information in ways that respects individual rights and in line with our company values, exercising the highest standards of confidentiality, integrity, and trust. For more information, please see the P\u0013 HYPERLINK \"https://www.psicon.co.uk/legal/privacy-policy\" \u0014rivacy Notice\u0015. You can also request a copy from one of our reception areas or by emailing \u0013 HYPERLINK \"mailto:righttochoose@psicon.co.uk\" \u0014righttochoose@psicon.co.uk\u0015\nPlease note that we are unable to backdate referrals. Referrals will be processed by the date this form is received to kmicb.psicon.childrens@nhs.net","cbCaio2j81WYhzxP","https://ap.wps.com/l/cbCaio2j81WYhzxP","docx",323352,8,"English","# Autism spectrum disorder (ASD) assessment pathway\n## Eligibility and process\n# Attention Deficit Hyperactivity Disorder (ADHD) assessment pathway\n## Eligibility, screening, and online suitability\n# Exclusion criteria\n# Privacy notice and data protection\n# Referral submission and no backdating","[{\"question\":\"Who is allowed to complete and sign this referral form?\",\"answer\":\"The form should only be completed and signed by a GP.\"},{\"question\":\"How does the screening process work after Psicon receives a referral?\",\"answer\":\"A parent or guardian is invited to carry out screening to determine whether the child meets the threshold for a full assessment.\"},{\"question\":\"What are the service exclusion criteria?\",\"answer\":\"The service excludes children or young people with co-morbid mental health difficulties and/or risk to self/others, and those with a moderate to severe learning disability.\"}]","Under 18's Right to Choose - Referral Form | DOCX",1788273543]