Skip to main content
Carers' Resource
You are here
Home
HFH NY Referral
1
Start
2
Complete
Referrer Details
First Name
*
Last Name
*
Job Title
*
Phone Number
*
Email
*
Referring Organisation
Find Referring Organisation
Organization Name
*
Client Details
First Name
*
Last Name
*
Gender
*
- Select -
Female
Male
Transgender
Non-binary
Other
Prefer not to say
Birth Date
*
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year
Year
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
Street Address
*
Street Address Line 2
Street Address Line 3
City
County
Postal Code
*
Phone Number
*
NHS Number
*
Further Demographics
Ethnicity
- None -
Afghani
Arab
Asian / British Asian:Bangladeshi
Asian / British Asian: Indian
Asian / British Asian: Pakistani
Black / Black British: African
Black / Black British: Caribbean
Chinese / British Chinese
Eritrean
Gypsy
Irish Traveller
Kashmiri
Kurdish
Mixed White and Asian
Mixed White and Black African
Mixed White and Black Caribbean
Not Provided
Other: White
Other Asian Background
Other Black Background
Other Ethnic Group
Other Mixed Background
Other White Background
Prefer not to say
Rohingya
Roma
Vietnamese
White Albanian
White and Asian
White British
White Bulgarian
White Croation
White Czech
White East European
White English
White Estonian
White Hungarian
White Irish
White Latvian
White Lithuanian
White Northern Irish
White Polish
White Romanian
White Scottsh
White Slovakian
White Welsh
Age Group
- None -
18-64
65-74
75-84
85+
HFH NY Case
Referring Hospital
- None -
Airedale General Hospital
Bradford Royal Infirmary
Castle Hill Hospital, Cottingham
Darlington Memorial Hospital
Friarage Hospital, Northallerton
Harrogate District Hospital
James Cook University Hospital
Malton Community Hospital
Other
Ripon and District Community Hospital
Scarborough Hospital
Selby War Memorial Hospital
The Friary Community Hospital, Richmond
Whitby Hospital
York Hospital
GP Surgery
Search for your GP
- Search existing GP list -
BD3 8QH
BD5 0NH
BD21 2LD
Abbey Medical Group :: YO10 3RL
Abs Scarborough :: YO12 7SN
Acklam Medical Centre :: TS5 8SB
Addingham Surgery WACA :: LS29 0LZ
Aireborough Family Practice :: LS29 7JN
Alanbrooke Medical Centre :: YO7 3EY
Albert House Clinic :: TS6 6TD
Allerton Health Centre :: BD15 7WA
Allerton Medical Practice :: LS7 4LF
Alma Medical Centre :: TS18 2BP
Ampleforth Surgery :: YO62 4EF
Annfield Plain Surgery :: DH9 7TD
Artful Medical Centre :: LA14 1AF
Ashcroft Surgery :: BD10 0JE
Ashwell Medical Centre :: BD8 9DP
Auckland Medical Group :: DL14 6RP
Auckland Park Hospital :: DL14 6AE
Avenue Family Practice :: SR7 8LF
Avicenna Medical Practice :: BD3 8QH
Ayton & Snainton Medical Practice :: YO13 9JF
Baildon Medical Centre :: BD17 5NH
Bankhouse Surgery :: TS24 7PW
Barkerend Health Centre :: BD3 0QT
Barnard Castle Surgery :: DL12 8HT
Barnoldswick Medical Centre :: BB18 5BG
Beacon Road Medical Centre :: BD6 3ET
Beech Grove Medical Practice :: LS25 6ED
Beech House Surgery :: HG5 0UB
Beech Tree Surgery :: DN14 9LY
Beech Tree Surgery :: YO8 9AJ
Belgrave Surgery :: YO11 1UB
Bentham Medical Practice :: LA2 7JP
BENTHAM SURGERY :: LA2 7JP
Bentley Medical Practice :: TS10 4NW
Bevan :: BD1 3LS
Bewick Crescent Surgery :: DL5 5LH
Bilton Medical Centre :: BD8 8JT
Bingley Cash Clininc :: BD16 4RP
Bingley Dermatology Clinic :: BD16 4RP
Bingley Grammar School :: BD16 4RP
Bingley Medical Pratice :: BD16 4RP
Birch Medical Centre :: BD5 8EL
Birtley Lane Surgery :: DH3 1AX
Birtley Medical Group :: DH3 2QT
Bishop Auckland Primary Care Services :: DL14 6XB
Bishopgate Medical Centre :: DL14 7EJ
Bishops Close Medical Practice :: DL16 6ED
Blacketts Medical Practice :: DL3 7JR
Borough Road & Nunthorpe Medical Group :: TS1 3RY
Boston Spa Surgery :: LS23 6PY
Bowling Highfield Medical Practice :: BD4 9Q
Bowling Highfield Medical Practice :: BD4 7SS
Bradford Moor Practice (Barkerend Health Centre) :: BD3 8QH
Bramham Medical Centre :: LS23 6SF
Bridge End Surgery :: DH3 3SL
Bridge Hub :: BD1 4QH
Brook Square Surgery :: YO12 7AS
Brotton Surgery :: TS12 2FF
Browney House Surgery :: DH7 9YT
Buttershaw Business and Enterprise College :: BD6 3UD
Byron Medical Practice :: SR7 8LF
Cambridge Medical Group :: TS5 5NN
Canalside Health Care Centre :: BD16 4RP
Carmel Medical Practice :: DL3 8SQ
Castle Health Centre :: YO11 2NP
Catterick Medical Centre :: DL9 3PZ
Central Dales Practice :: DL8 3QR
Central Healthcare :: YO11 1UB
Cestria Health Centre :: DH2 3DJ
Chadwick Practice :: TS24 7PW
Chastleton Medical Group :: DH1 5BH
Cheveley Park Medical Ctr :: DH1 2UW
Church Avenue Medical Group
Church Avenue Medical Group - Hampsthwaite :: HG3 2EU
Church Avenue Surgery :: HG1 4HG
Church Lane Surgery - Boroughbridge :: YO51 9BD
Church Lane Surgery - Helperby :: YO61 2NS
City Medical Practice :: BD8 8RA
Claremont Surgery :: YO11 1XE
Clarendon Medical Centre :: BD8 7RT
Clarendon Medical Centre @ Manningham :: BD8 7SY
Claro Medical Centre :: HG4 2RD
Claypath & University Medical Group :: DH1 1QW
Cleckheaton Group Practice :: BD19 3RQ
Cliffe Avenue Surgery :: BD17 6NT
Clifton Court Medical Practice :: DL1 5JN
Clifton Medical Practice :: YO30 6PS
Clifton Park Hospital :: YO30 5RA
Collingham - Church View Surgery :: LS22 5BQ
Consett Medical Centre :: DH8 5YA
Coulby Medical Practice :: TS8 0TL
Cowgill Surgery :: BD14 6ES
Coxhoe Medical Practice :: DH6 4DH
Craghead Medical Centre :: DH9 6AN
Cross Hills Group Practice :: BD20 7LG
Cross Lane Hospital Bcsc :: YO12 6DN
Crossfell Health Centre :: TS3 7RL
Crosshills medical centre-Social prescriber :: LS22 6RT
Cullingworth Medical Practice :: BD13 5HA
Dalton Terrace Surgery :: YO24 4DB
Denholme Surgery :: BD13 4AN
Derwent Practice :: YO17 9RF
Derwentside Gp Extended Access Service :: DH8 0BW
Dipton Surgery :: DH9 9DA
Dishforth Medical Centre :: YO7 3EZ
District Nursing Team
Doctors Lane Surgery :: DL11 7TH
Dr A Azam & Partners :: BD7 3EG
Dr A Masood - USE THE CITY MEDICAL PRACTICE :: BD8 9DW
Dr Akester & Partners :: HG4 3SE
Dr Banks - The Leeds Road Surgery Harrogate :: HG2 8AY
Dr Basu :: BD8 9DW
Dr Brady & Partners :: LS23 6PY
Dr Catriona Osman :: LS25 6ED
Dr El-Eliwi & Dr Akbar :: BD3 8QH
Dr F Gupta's Practice :: BD11 1JU
Dr Gilkar & Partner :: BD5 0NX
Dr Hutchings & Partners :: BD4 9QA
Dr Ingram & Partners :: HG4 2AX
Dr J F Robinson - Dr Fletcher & Partners :: HG4 2AX
Dr Jandu & Partners :: BD9 4LH
Dr Jim Welford :: BD8 9PB
Dr Knight & Partner :: LS22 6JS
Dr KP Mall & Partners :: BD5 0NX
Dr Longfield & Dr De Haar :: BD5 8EL
Dr M. A Iqbal & Partners :: BD8 9LB
Dr Mawson A & Partners :: LS22 5BQ
Dr Mills & Partners :: BD4 9QA
Dr Moss & Partners - Harrogate :: HG1 5JP
Dr Moss & Partners - Jennyfield :: HG3 2XT
Dr Moss & Partners - Killinghall :: HG3 2DG
Dr Nicholls J.A :: LS23 6RN
Dr R. Madhu :: BD10 8RU
Dr Rasool :: TS23 2DG
Dr Roberts & Partners :: BD10 8RU
Dr Simpson & Partners :: TS28 5PZ
Dr U Akbar :: BD8 9DW
Dr Wilson and Partners :: BD8 9LB
Drs Lambert & Ng :: DH9 7XT
Duke Street Surgery :: LA14 1LF
Dunelm Medical Practice :: DH7 7DG
Dyneley House Surgery :: BD23 2HZ
East Durham Medical Group :: TS28 5PZ
East ICC :: HG1 5AR
East Parade Medical Practice :: YO31 7YD
Eastfield Medical Centre :: YO11 3LJ
Eastgate Medical Group :: HG5 0AD
Eastgate Medical Group - Harrogate :: HG2 7LU
Eccleshill Health Centre :: BD10 0ED
Eccleshill Village Surgery :: BD2 2HX
Egton Surgery :: YO21 1TX
Eldwick and Guilstead Medical Practice :: BD16 3PA
Elm Tree Surgery :: TS17 6PG
Elvington Medical Practice :: YO41 4DY
Epcs Dermatology - Westbourne Green :: BD8 8RA
Epcs Womens Health - Westbourne Green :: BD8 8RA
Eskrick Surgery :: YO19 6LE
Eston Grange Nhs Health Care Centre :: TS6 6TD
Evenwood Medical Practice :: DL14 9SU
Fairlawns Hub :: S6 1TT
Falsgrave Surgery :: YO11 1UB
Family/friends :: BD8 9DW
Farrow Medical Center :: BD3 0HX
Farrow Road Medical Centre
Ferryhill And Chilton Medical Practice :: DL17 8JJ
Filey Surgery :: YO14 9AE
Fisher medical AWC Modality :: BD23 1EU
Foss Park Hospital Bcsc :: YO31 8TA
Fountains Hall Medical Practice :: BD1 3RA
Frizinghall Medical Centre :: BD9 4LH
Front Street Surgery :: YO24 3BZ
Fylingdales Medical Centre :: DL7 9NJ
Gainford Surgery :: DL2 3BE
Gale Farm Surgery :: YO24 3BU
Gillygate Surgery :: YO31 7WQ
Girlington Medical Practice :: BD8 9PB
Gladstone House Surgery :: TS26 8DF
Glebe House surgery, Bedale :: DL8 2AT
Grange Park Surgery :: BD7 3AH
Grange Park Surgery :: LS29 7HG
Grassington Medical Centre :: BD23 5LS
Great Ayton Surgery :: TS9 6BL
Great Lumley Surgery :: DH3 4LE
Guiseley & Yeadon Medical Practice :: LS19 7PS
Hackness Road Surgery :: YO12 5SD
Haigh Hall Medical Centre :: BD10 9AZ
Hallgarth Surgery :: DL4 2HP
Harewood Medical Practice :: DL9 3JD
Harrogate Medical Centre :: HG3 2SE
Hart Medical Practice :: TS24 9DN
Hartfields Medical Practice :: TS26 0US
Hartlepool Nhs Healthcare Centre :: TS24 7PW
Havelock Grange Practice :: TS24 7PW
Hawkshead Medical Practice :: LA22 0NU
Haworth Medical Practice :: BD22 8DH
Haxby :: YO32 2LL
Health care first :: WF11 8NQ
Heaton Medical Practice :: BD9 6LL
Helmsley Medical Centre :: YO62 5HD
Hemlington Medical Centre :: TS8 9JH
Highfield DN team :: BD4 9QA
Highfield Medical Practice :: BD4 9QA
Hillfoot Clinic :: LS28 7QR
Hillfoot Surgery :: LS28 7QR
Hillside Bridge :: BD3 0BS
Hillside Bridge
Hillside Practice
Hirsel Medical Centre :: TS3 6AL
Hollyns Health & Wellbeing - Allerton :: BD15 7WA
Hollyns Health & Wellbeing - Clayton (was Mayfield Medical Centre) :: BD14 6NF
Holycroft Surgery :: BD21 1SA
Horton Bank Practice :: BD7 4PL
Horton Grange Primary School :: BD7 4PL
Horton Park Medical Practice :: BD7 3EG
Hovingham Surgery :: YO62 4LA
Hunmanby Surgery :: YO14 0NN
Huntcliff Surgery :: TS12 1BJ
I G Medical
I Hussain :: BD8 9DP
Idle Medical Centre :: BD10 8RU
IG Medical :: LS29 8TH
Ilkley & Wharfedale Medical Practice :: LS29 8TQ
Ilkley grammar school :: LS29 8TH
Imphal Medical Centre :: YO10 4HD
Jennyfield Health Centre :: HG3 2XT
Jorvik Gillygate Practice :: YO1 7NP
Journee Medical Practice :: TS26 8DB
Jubilee Medical Group :: DL5 4SE
Jupiter House Surgery :: SR8 4PF
Keighley Health Centre :: BD21 1SA
Kensington Partnership :: BD8 9LB
Kensington Partnership :: BD7 3HU
Kilmeny surgery :: BD21 1LA
Kilmeny Surgery :: BD21 1LA
King Street Surgery :: LA1 1RE
Kings Medical Centre :: TS3 6AL
Kingsway Medical Centre :: TS23 2LS
Kingswood Surgery :: HG2 7SA
Kirkby Malzeard & Masham Surgeries :: HG4 3SE
Kirkbymoorside Surgery :: YO62 6AR
Lagan Surgery :: TS10 1TZ
Lambert Medical Centre :: YO7 1LU
Lanchester Medical Centre :: DH7 0LP
Langbaurgh Nhs Medical Centre :: TS10 1SR
Lawson Street Practice :: TS18 1HU
Leeming Medical Centre :: DL7 9NJ
Leyburn Medical Practice :: DL8 5EP
Leylands Medical practice :: BD9 5PZ
Ling House Waca Social Prescribing service
Linthorpe Surgery :: TS5 6HA
Lister Surgery :: BD8 8RA
Little Horton Lane Medical Centre :: BD5 0NX
Local Care Direct (Manningham) :: BD8 7SY
Long Lee Surgery :: BD21 4TT
Low Moor Medical Centre :: BD12 0TH
Low Moor Medical Practice :: BD12 0TH
Lower Grange Medical Centre :: BD8 0QN
Manningham Medical Pratice :: BD8 7SY
Manor Medical Practice :: BD8 9PB
Manor Medical Practice (was Carlton Medical Practice) :: BD8 9PB
Market Weighton Group Practice :: YO43 3FF
Marlborough Surgery :: SR7 7JE
Marsh House Medical Practice :: TS23 2DG
Marske Medical Centre :: TS11 6BW
marton cum grafton
Martonside Medical Centre :: TS4 3BU
Masham Surgery ( with Kirkby Malzeard) :: HG4 4DZ
Mayfield Medical Centre :: BD14 6NF
Mayford House Surgery :: DL7 8AW
Mckenzie Group Practice :: TS25 3DQ
Mckenzie House Surgery :: TS25 1QU
Meadowside Medical Pract :: LA1 3AQ
Melrose Surgery :: TS23 2JW
Menston & Guiseley Practice :: LS20 8AR
Millfield Surgery :: YO61 3JR
Minster Health :: YO31 7WE
Modality AWC
Moor Croft Foss Park Hospital :: BD3 8QH
Moor Park Medical Practice :: BD3 8QH
Moorlands Surgery :: DL3 9JP
Moorside Surgery :: BD2 3AA
Moss Healthcare :: HG1 5JP
Mowbray House Surgery :: DL7 8FW
Mughal Medical Centre :: BD7 3HY
Murton Medical Centre :: SR7 9AB
Neasham Road Surgery :: DL1 4YL
Nestr Primecare Serv Ltd Ooh :: YO11 3YS
New Otley Road Medical Practice :: BD3 0BS
New Vision Bradford :: BD1 3DN
Newlands Medical Centre :: TS1 3RX
Newton Way Surgery :: BD17 5NH
NHS :: BD21
Nidderdale Group Practice - Dacre Banks :: HG3 4DX
Nidderdale Group Practice - Pateley Bridge :: HG3 5AT
Nidderdale Group Practice- Birstwith :: HG3 3AJ
Normanby Medical Centre :: TS6 6TD
North House Surgery :: HG4 1HL
North Shore Medical Practice :: TS18 2EP
North Street Medical Practice :: BD21 3AU
Norton Medical Centre :: TS20 2UZ
Norwood House Surgery :: YO12 7EJ
Not known
Oak Glen Surgery :: BD16 3PA
Oak Lane Surgery :: BD8 8RA
Oakfield Medical Practice :: TS3 6AL
Oakworth Medical Practice :: BD22 0HJ
Old Forge Surgery :: DL12 0QE
One Medicare Surgery :: BD21 3AU
Orchard Court Surgery :: DL3 6HZ
Out of education
Oxford Road Medical Practice :: DL16 6BQ
Park Avenue Surgery :: TS10 3LA
Park End Clinic :: TS3 7EA
Park Grange Medical Centre :: BD7 2BL
Park Parade Surgery :: HG1 5AR
Park Road Medical Center :: LS20 8AR
Park Surgery :: TS1 3QY
Parkgate Surgery :: DL1 5LW
Parklands Medical Centre :: BD5 0SG
Parklands Medical Practice :: BD6 2DD
Parkside Medical Centre :: BD7 3EG
Parkway Medical Centre :: TS8 0TL
Pease Way Medical Centre :: DL5 5NH
Peasholm Surgery :: YO12 7RE
Peel Park At Hillside Bridge :: BD3 0BS
Peel Park Surgery :: BD2 4RA
Pelton & Fellrose Medical Group :: DH2 1HS
Petergate Surgery :: YO30 4RZ
Peterlee Primary Care Services :: SR8 1AD
Phoenix Medical Group :: DH6 3HW
Pickering Medical Group :: YO18 8BL
Picton Medical Centre :: BD8 9DW
Pinfold Medical Practice :: DL13 5NX
Pocklington Group Practice :: YO42 2BS
Posterngate Surgery :: YO8 4QH
Primrose Surgery :: BD3 0BS
Priory Medical Group :: YO24 3WX
Quakers Lane Surgery :: DL10 4BB
Queens Park Medical Centre :: TS18 2AW
Queens Road Surgery :: DH8 0BW
Queenstree Practice :: TS23 2LA
Rainbow Surgery :: TS10 4NW
Reeth Medical Centre :: DL11 6SU
Resolution Health Centre :: TS3 6AL
Ripon Spa Surgery :: HG4 2BE
Rockwell Medical Centre :: BD10 8DP
Rooley Lane Medical Centre :: BD4 7SS
Royds Healthy Living Centre :: BD6 3UD
Saltaire Medical Practice :: BD18 4RX
Scarborough Medical Group :: YO12 6UB
Scotts road medical centre :: YO8 4LB
Sherburn Group Practice :: LS25 6ED
Shipley College :: BD18 3EG
Shipley Medical Practice
Silsden & Steeton Medical Practice :: BD20 0DG
Silsden and Steeton Group Practice :: BD20 0DG
Sleights and Sandsend Medical Practice :: YO22 5DP
Snaith Medical Group :: DN149DY
Social Prescriber Ling House Surgery Keighley
South Milford Surgery :: LS25 5AA
Spa Surgery :: HG1 5AR
Speedwell Surgery :: HD1 4TS
Spring Gables Surgery :: HG3 3AJ
Springbank Surgery - Green Hammerton :: YO26 8BN
Springfield Surgery
Springs Medical Centre :: LS29 8TH
Springs Medical Centre :: LS29 8TH
St Andrews Surgery :: BD21 2LD
St Lukes- NHS :: HG1 5AR
Steeton Surgery :: BD20 6NU
Stockwell Road Surgery :: HG5 0JY
Sunnybank & Cowgill Medical Pratice :: BD12 9NG
Sunnybank Medical Centre :: BD12 9NG
Sunnybank Medical Practice :: BD12 9NG
Tadcaster Medical Centre :: LS24 8HD
The Avicenna Medical Practice :: BD3 8QH
The Better Health Generation :: D3 8QH
The Coatham Road Surgery :: TS10 1SR
The Danby Practice :: YO21 2PA
The Densham Surgery :: TS18 1HU
The Dovecot Surgery :: TS18 1HU
The Endeavour Practice :: TS1 2NX
The Erimus Practice :: TS1 2NX
The Eston Surgery :: TS6 6TD
The Fens Medical Centre :: TS25 3DQ
The Friary Surgery :: DL10 4UJ
The Garth :: TS14 7DJ
The Green House Surgery :: TS10 4NW
The Headland Medical Centre :: TS24 0NZ
The Health Centre, Knaresborough Road :: HG2 7LU
The Horden Group Practice :: SR8 4LD
The Koh Practice :: TS26 8DB
The Leeds Road Practice :: HG2 8AY
The Leeds Road Practice (Spofforth) :: HG3 1AP
The Lister Surgery :: BD8 8RA
The Lunesdale Surgery :: LA6 2HQ
The Marshes :: DN14 9DY
The Ridge Medical Centre Manningham :: BD8 8RA
The Ridge Medical Practice
The Ridge Medical Practice - Wibsey Surgery :: BD6 1HA
The Ridge Medical Practice- Buttershaw Surgery :: BD6 3UD
The Ridings Medical Group :: YO8 6LY
The Rockwell and Wrose Practice :: BD2 1QG
The Saltaire And Windhill Medical Partnership :: BD18 1QB
The Spa Surgery :: HG1 5AR
The Springfield Surgery :: BD16 4RP
The Willows Medical Centre :: BD13 2GD
Thornbury Medical Practice :: BD3 7HZ
Thornton & Denholme Medical Pratice :: BD13
Thornton Medical Centre :: BD13 3LG
Thornton Primary School :: BD3 7HZ
Tockwith Surgery :: YO26 7PR
Tong Medical Practice :: BD4 9QA
Topcliffe Surgery :: YO7 3RP
Townhead Health Centre :: BD24 9JA
Townhead Surgery :: BD24 9JA
Undercliffe Health Care Centre :: BD2 4RA
Valley View Surgery :: BD2 4RA
Waddiloves Health Centre - NHS Bradford District Care Foundation Trust :: BD8 7BT
Westbourne Green Community Hospital :: BD8 8RA
Westcliffe Medical Centre :: BD18 3EE
Wetherby Surgery :: LS22 6JS
Wharfedale, Airedale and Craven Alliance :: LS29 8TG
Whetley Academy :: Bd8
Whetley Hill Medical Centre :: BD8 8NL
Whetley Medical Centre (The Family Practice) :: BD8 9DW
Whitby Group Practice :: YO21 1SD
Wibsey & Queensbury Medical Practice -Wibsey :: BD6 1TD
Wibsey and Queensbury Medical Practice - Queensbury :: BD13 2AG
Wilsden Medical Practice :: BD15 0NJ
Wilsden Medical Practice (Cullingworth) :: BD13 5HA
Windhill Green Medical Centre :: BD18 1QB
Windsor House Group Practice :: LS27 9NB
Woodhead Road Surgery :: BD7 2BL
Woodroyd Medical Centre :: BD5 8EL
Woodside Surgery :: HX3 6EL
Wrose Health Centre :: BD2 1QG
Yarm Medical Practice
GP Practice
If your GP surgery is not listed above in the GP list, please input here.
District
*
- Select -
Craven
Hambleton
Harrogate
Richmondshire
Ryedale
Scarborough
Selby
Admission Reason
*
Hospital Admission Date
*
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year
Year
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
2051
2052
2053
2054
2055
2056
2057
2058
2059
2060
2061
2062
2063
2064
2065
2066
2067
2068
2069
2070
2071
2072
2073
Hospital Discharge Date
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year
Year
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
2051
2052
2053
2054
2055
2056
2057
2058
2059
2060
2061
2062
2063
2064
2065
2066
2067
2068
2069
2070
2071
2072
2073
Referral Category
- None -
Discharge Hub
HASS - NYCC Reablement Team
HASS - Other
Health & Adult Services
Health - GP
Health - Hospital
Health - Medical Practice
Health - Rapid Assessment Team
Other
Self
Voluntary Agency
Pathway
*
- Select -
0 = Going home without support
1 = Going home with support
2 = Temporary bed setting e.g. rehab
3 = Complex
Patient already at home?
*
Yes
No
Is there a homecare package?
*
Yes
No
Have you also referred the patient to any other agencies? Please give details if so:
Lives with?
Alone
Care Home
Lodger
Sibling (Brother/Sister)
Son/Daughter
Spouse/Partner
Parent(s)
Who supports this person, e.g. spouse, carer, friend, neighbour?
Is Carer?
Yes
No
Is Cared For?
Yes
No
Primary Incapacity
*
- Select -
Dementia
Dual Sensory Loss
Frailty/Temporary Illness
Hearing Impaired
Learning Disability
Mental Health
Other - Loneliness & Isolation
Physical Disability
Substance Misuse
Visually Impaired
Any cognitive impairment/dementia?
*
Yes
No
Covid-19 Diagnosed?
*
Yes
No
Support required after discharge?
Is feedback required?
*
Yes
No
Safeguarding, Health & Safety and key information
Are there any safeguarding concerns, or other safety issues with this referral?
Yes
Subject
*
Details of Safeguarding Concern
*
Absconding
Aggression & intimidation
Child Criminal Exploitation
Child Sexual Exploitation
Domestic Abuse
Emotional Abuse
Financial abuse
Neglect
Other
Physical Abuse
Sexual Abuse
Sexualised Behaviour
Substance Misuse
Vulnerable adult exploitation
Safeguarding Alert
*
- Select -
Adult at risk
Child Protection
Not safeguarding - Adult who has no care or support needs
Details
*
Leave this field blank