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Page 1 of 1DENTAL REFERRAL and Declarations is available via website www.charityhospital.org.nz This form can be faxed, posted or delivered. PATIENT DETAILS Family name ___ First name ___ D.O.B___FemaleMalePatients
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Create a daily routine to ensure consistent care and support.
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Who needs cerebral palsyliving with paralysis?

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Individuals diagnosed with cerebral palsy and living with paralysis require specialized care and support.
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Their caregivers, family members, and healthcare providers also play a crucial role in ensuring their well-being.
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Cerebral palsy is a group of disorders that affect movement and muscle coordination. Living with paralysis means experiencing a loss or impairment of motor function.
Individuals who have been diagnosed with cerebral palsy and are living with paralysis are required to file.
Individuals can fill out the necessary forms provided by healthcare providers or disability services with information about their diagnosis and level of paralysis.
The purpose is to document and track the condition of individuals with cerebral palsy living with paralysis for medical and support purposes.
Information such as diagnosis of cerebral palsy, level of paralysis, any treatments or therapies received, and any assistive devices used must be reported.
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