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Assessment for Asperger Syndrome

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Assessment for Asperger Syndrome - Practitioner Referral Form

Please read the following eligibility criteria for our service and provide details of the difficulties the patient is experiencing for a diagnostic assessment to be considered. Please note: we will correspond with the patient’s GP whilst they are open to our service.

Declaration: We are unable to accept referrals for individuals who are currently open to secondary care services or who present a risk to self or others. We are not able to manage risk or co-ordinate care for those on our waiting list or those with a diagnosis. Individuals currently open to secondary care should not be discharged specifically to obtain an Aspergers assessment with Outlook South West if they have ongoing mental health needs. Instead, they should remain within that team and seek an assessment as part of their ongoing care package. This would also be the case if an individual has a particularly complex mental health history/presentation and has had extensive input from secondary care services. Similarly, if an individual has a known learning disability, then an assessment would be better suited to take place within the Learning Disability Service. In these instances, an individual’s assessment and care package should be discussed with the relevant secondary care service or with commissioners if required.

By making this referral to Outlook South West, you are confirming that the individual gives their consent and that they meet the eligibility criteria outlined above for our service.

If yes, patient should discuss accessing an assessment within their care team
If yes, please give details and ensure patient is suitable given our remit
If yes, please consider whether patient is within our remit and give details of precautions if necessary
If yes, please give details. Note: We do not usually provide a reassessment if someone has a diagnosis

Below is a brief questionnaire for autism and Asperger Syndrome. This is not a diagnostic tool. This measure serves as a screen for the presence of symptoms related to Asperger Syndrome and provides guidance for referring people to the Adult Asperger Service.

Please read the following statements carefully, and rate how strongly you agree or disagree with each one.

(e.g parent/spouse/partner)

Using the subheadings below, please could you provide a description of the difficulties that the patient is experiencing that have led you to request an assessment for Asperger Syndrome.