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Relationship with Client –None–Associated ProviderAuntChildCousinCoworkerDaughterEmployeeEmployerFamilyFatherFriendGrandchildGranddaughterGrandfatherGrandmotherGrandsonGuardianHusbandMotherOther Family MemberParentPartnerSelfSonSupport CoordinatorUncleWife
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Interpreter Required –None–Yes – for spoken language other than EnglishYes – for non-spoken communicationNo
Reason for Enquiry NDISMedicareInformation OnlyOther
Requested Service – Hold Ctrl to select more than one Occupational TherapySpeech PathologyPositive Behaviour SupportOther
Primary Disability: –None–Acquired Brain InjuryADHDAutismCerebral PalsyChildhood Apraxia of Speech (CAS)Global Developmental DelayIntellectual DisabilityLanguage DisorderLiteracyOppositional Defiance DisorderOther Brain InjuryOther NeurologicalOther PhysicalOther PsychiatricSensory Processing Disorder/ Emotional RegulationSpecific Learning Disability / ADDSpeechSpeech Delay / DisorderStuttering
Secondary Disability: –None–Acquired Brain InjuryADHDAutismCerebral PalsyChildhood Apraxia of Speech (CAS)Global Developmental DelayIntellectual DisabilityLanguage DisorderLiteracyOppositional Defiance DisorderOther Brain InjuryOther NeurologicalOther PhysicalOther PsychiatricSensory Processing Disorder/ Emotional RegulationSpecific Learning Disability / ADDSpeechSpeech Delay / DisorderStuttering
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