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> Information Request to Health and Social Care Connect

Information Request to Health and Social Care Connect

Fair Processing Notice

To find out how we will process and use your personal information in connection with this request please see our Privacy Statements.

This form should only be used by Professionals (working in partner organisations).

If your referral is urgent please call Health and Social Care Connect on 0141 287 0555. Please be aware that the response time for online referrals can be up to 72 hours.
If out with normal working hours or at the weekend and you require support you can also contact Glasgow and Partners Emergency Social Work Service on 0300 3431505. This includes referrals for Child or Adult Protection concerns.
Referrer's Details
1. Your Name*
2. Agency you work for*
3. Your Designation*
4. Office Address *
5. Postcode*
6. Email address*
7. Contact Phone Number*
Child's details
1. Child's Name*
2. Date of Birth*
3. Home Address*
4. Postcode (if known)
5. Previous Address
Are you requesting information on more than one child?*
1. Are you requesting information on more than one child?*
2. Are you requesting information on more than one child?**
  
  No
  
  Yes
3. How many other children are included in your request?*
4. How many other children are included in your request?
  
  1
  
  2
  
  3
  
  4
Additional Child
1. Child's Name
2. Date of Birth
3. Home Address
4. Postcode (if known)
5. Previous Address
Additional Child
1. Child's Name
2. Date of Birth
3. Home Address
4. Postcode (if known)
5. Previous Address
Additional Child
1. Child's Name
2. Date of Birth
3. Home Address
4. Postcode (if known)
5. Previous Address
Additional Child
1. Child's Name
2. Date of Birth
3. Home Address
4. Postcode (if known)
5. Previous Address
Parent / Carers Details
1. Parent / Carer 1
2. Date of Birth
3. Current Address (if different from child)
4. Parent / Carer 2
5. Date of Birth
6. Current Address (if different from child)
Label
1. Reason for Request*
Label

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