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First Name (or Client Reference if known):
Surname (or Client Initials if Client Ref is known):
Date of Session (dd/mm/yy):
Location:--None--LF Caledonian RoadWardour StreetCDCCodecliniQPhoneEmail/letterOutreachOtherOnline
Attendance:--None--AttendedDid not attendCancelled - clientCancelled - LFNot applicable
HIV Advice & Information given?:
Please indicate where the client placed themselves on the scale (0 poor to 20 good)
A: Control over Drug/Alcohol Use
B: Sense of Control around Managing Sexual Risk
C: Do you feel your work with Antidote has improved your knowledge/use of drugs/alcohol?
D: Do you feel your work with Antidote will serve to improve your health and wellbeing?
E: If you are HIV+ or HEPC+, has your work with Antidote helped with you adherence to your meds?
F: How important was it for you to be able to access an LGBT specific drug and alcohol service (0 not at all important to 10 very important):
Referral Category:--None--Discharged - no referralAntidoteLondon Friend counsellingOther LGBT counsellingOther general counsellingOther LGBT serviceSexual health clinicHIV support/managementOther drug serviceOther alcohol serviceHousingMoney/debtStatutory mental health
Referral Detail:--None--PACEELOPTHTPink TherapyStonewallStonewall Housing56 Dean StreetSwishMortimer MarketKobler ClinicGMFACDCLocal serviceLocal authorityOther