Page 270 - 6. 2016 Diary 1st half New 26-05-21 No Table

Approved Mental Health Professional Assessment Form.
-For use when compulsory powers are being considered
Assessing AMHP: Sam Curtis.

Hospital Not applicable
Dr Kripalani, Consultant Psychiatrist, Lucas House, 305 - 309
Fore Street, Edmonton, London, N9 OPD Tel 020 8702 3100
GP Nightingale House Surgery, 1 Nightingale Road, N9 8AJ
Tel 020 88059997 /cmhn / Goodie Adama, Care Coordinator
and Community Mental Health Nurse, Lucas House, cmht 305 -
309 Fore Street, Edmonton, London, N9 OPD Tel 020 8702
3100
Page Numbers: 32,33,34,35,36,37
London Borough of Enfield
Approved Mental Health Professional Assessment Form
For use when compulsory powers are being considered Barnet,
Enfield and SSM1 Haringey.
RIO Number: 11214451
Copy for: Service user file Social Services records
GP
Please note this form can be completed electronically or in
hardcopy. To complete this form electronically, please the use
mouse pointer or the tab key on the keyboard to go to the next
form field.
Patient’s details: --
Name: Simon Cordell
Address: 109 Burncroft Avenue, Enfield, Middlesex
Post Code: EN3 7JQ
Phone no: 07961833021
Male: Yes
Female:
Age/Dob: ***
Ethnic origin: (Do coding)
Religion
Preferred language: English
Interpreter needed? No
Assessing AMHP
26 Jan 1981 (35 years old)
Dual heritage, white & black Caribbean
Not discussed during assessment
English: Yes
Sam Curtis
Services involved ease stats name, address.
Not applicable
Dr Kripalani. Consultant Psychiatrist,
Lucas House,
305 - 309 Fore Street.
Edmonton, London,
N9 OPD.
Tel: 020 8702 3100