Paediatric assessment form

These referrals can only be made by social workers from Children's Social Care

It is essential that the social worker attend with the child. If this is not possible, another social worker must attend instead. If it is a joint investigation with the police, a CAIT officer should also attend.

Please be prepared that the medical assessment will take 2-3hrs and attend with all relevant information about the family. 

Consent

Note: Questions marked by * are mandatory

Private & Confidential

*This is a mandatory field. *Has the CYP been deemed Gillick Competent* in relation to this referral or has consent been grated by a person with parental responsibility?............................................ *term used to decide whether a child (under 16 years of age) is able to consent to his or her own medical treatment, without the need for parental permission (Please ensure CYP gave consent to referral if aged 13+)

Yes
No

*This is a mandatory field. Name of person who is providing consent in relation to the child