CHCPRT001 AT02-SA01 Risk of Harm Fax Report WRD PRT.docx

Health only yes 2 details about the child or young

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(Health only) Yes 2. DETAILS ABOUT THE CHILD OR YOUNG PERSON Child or young person’s name Aliya Smith Date of birth (or expected date) 02/Feb/2008 Age or approximate age Unborn Gender Male v Female Not known Tick if applicable Aboriginal Torres Strait Islander Both Cultural background Africa School / Pre- School attended or other child care (Family Day Care / nanny arrangements etc) School Child or young person’s The confidentiality of information contained within this facsimile transmission may be protected by statute. Unauthorised disclosure or misuse of such confidential information obtained as a result of mistaken transmission may incur a liability for criminal penalty. Information contained within this facsimile transmission is intended only for use of Community Services. Any other recipient is requested to immediately notify the sender by telephone so that arrangements can be made for return of the transmission to the sender. 2
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name Date of birth (or expected date) Age or approximate age Unborn Gender Male Female Not known Tick if applicable Aboriginal Torres Strait Islander Both Cultural background School / Pre- School attended or other child care (Family Day Care / nanny arrangements etc) Child or young person’s name Date of birth (or expected date) Age or approximate age Unborn Gender Male Female Not known Tick if applicable Aboriginal Torres Strait Islander Both Cultural background School / Pre- School attended or other child care (Family Day Care / nanny arrangements etc) Child or young person’s name Date of birth (or expected date) Age or approximate age Unborn Gender Male Female Not known Tick if applicable Aboriginal Torres Strait Islander Both Cultural background School / Pre- School attended or other child care (Family Day Care / nanny arrangements etc) The confidentiality of information contained within this facsimile transmission may be protected by statute. Unauthorised disclosure or misuse of such confidential information obtained as a result of mistaken transmission may incur a liability for criminal penalty. Information contained within this facsimile transmission is intended only for use of Community Services. Any other recipient is requested to immediately notify the sender by telephone so that arrangements can be made for return of the transmission to the sender. 3
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3. FAMILY DETAILS Family’s address 47 walker street, Rhodes, NSW2138 Suburb Home phone 08 252-6565 Interpreter required v No Yes Please identify language spoken Disability issues Current whereabouts of child / young person Live with uncle 4. NAME OF PARENTS/ CARERS & THEIR RELATIONSHIP TO THE CHILD OR YOUNG PERSON Name Nick Smith Address (if different from above) Phone (if different from above) Relationship Uncle Name Address (if different from above) Phone (if different from above)
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  • Three '16
  • unknown
  • Confidentiality, Secrecy, Fax

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