Page 675 - 2015 2nd Half No Table

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30/11/2015

3
The Doctor’s Folder / pub Book Issue: 1!
Notes From the: 09/02.2016
Date of initial referral: 21/01.2016
Date of assessment: 03/02.2016.
Place of assessment: Patient’s Home
Page Numbers: 32,33,34,35,36,37
32

London Borough of Enfield

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 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
Patient’s rights

Name: Simon Cordell
Address: 109 Burncroft Avenue, Enfield, Middlesex
Post Code: EN3 7JQ
Phone no: 07961833021
Male: Yes
Female: “Blank”
Age/Dob: 26 Jan 1981 (35 years old)
Ethnic Origin (DoH coding): Dual heritage, white & black Caribbean Not
discussed during assessment
Religion:
Preferred language: English
Interpreter needed?