Drug & Alcohol Single Point of Access
Authorised Access Only
Online DASPA Referral Form (TPN)
Welcome to the DASPA online referral form for professionals. By completing this form, you are confirming that the person being referred has consented and is aware of the referral being made. Please be as detailed as possible and ensure all details and support needs are correct and accurate before submitting. We may be unable to process the referral if there is limited information and if this is the case, we will endeavour to contact you or the person being referred. If this information cannot obtained, it may result in the referral not being actioned.
If you would like to upload any relevant paperwork ie assessment / risk assessment
Please confirm that the person being referred has given consent. We will collect personal information which could be shared with referral organisations. We may have to contact you for further information if necessary to ensure the referral is forwarded to the correct team.For further information you can visit our Barod website.
Full Name of Referrer
Please ensure your name and contact information is correct in order so we can contact you if necessary.
What service area do you work in?
Alcohol Care Team (within hospital setting)
Health - Community
Health - Inpatient
Mental Health - Community
Mental Health - Inpatient
Domestic Abuse Services
Is this referral for
Mixed Other/Multiple Ethnic Background
Out of Area
Substance use issues
Please give brief outline of substance use including quantity, route of use and how often.
If no substance, add more information into notes above
2-3 Times a Week
3-5 Times a Week
Think about risk of harm to self, risk of harm to others, any offences that have included violence, any risk of harm to lone workers? If none write N/A in box
Children Safeguarding Current involvement
Child protection arrangements
If none write N/A in box . Please give Social Worker name and involvement.
Cwm Taf GP
Abercwmboi Medical Centre
Abercynon Health Centre
Brookside Medical Centre
Castle View Surgery
Cwm Gwyrdd Medical Centre
Cwmaman Health Centre
Cynon Vale Medical Practice
De Winton Health Centre
Dowlais Medical Practice
Ferndale Medical Centre
Forest View Medical Centre
Foundry Town Clinic
Garth View Surgery
Gwaunmiskin Road Surgery
Health Centre University of South Wales
Hillcrest Medical Centre
Hirwaun Health Centre
Maendy Place Surgery
Morlais Health Centre
New Tynewydd Surgery
Old School Surgery
Parc Canol Practice
Park Lane Surgery
Penrhiwceiber Medical Centre
Pontcae Medical Practice
Pontnewydd Medical Centre
Porth Farm Surgery
Practice 1 Kier Hardie Health Park
Practice 2 Kier Hardie Health Park
Practice 3 Kier Hardie Health Park
Rhos House Surgery
Richards Street Cilfynydd
St Andrews Surgery
St Johns Medical Practice
Station Yard Pontypridd
Taff Vale Practice
The Health Centre Pontypridd
The Medical Centre Taffs Well
The Surgery Creigiau
The Surgery Elm Road
The Surgery Pontypridd
The Surgery St Davids Street
The Surgery Tonypandy (Llwynypia)
Treharris Primary Care Centre
Troed Y Fan Medical Practice
Ynyshir Medical Centre
Bron y Garn Surgery
Cwm Garw Practice
New Street Surgery
Oak Tree Surgery
Ogmore Vale Surgery
Porthcawl Medical Practice
The Medical Centre
The Portway Surgery
Are you pregnant
Include reasons why this is being prescribed and any other relevant information.
Physical and/or mental health problems
Is this a Counselling referral
Please tick that criteria has been met.
The person has a Keyworker and will remain open to them while Counselling ongoing
Has had 3 sessions or more with current worker
Issues identified that require counselling
Has not received counselling sessions via Barod in past 12 months
Please confirm all of these in order to confirm eligibility.
Please give brief overview of issues that require addressing
Please indicate issues to be addressed eg: Bereavement, relationships, ACE's
Please choose the PRIMARY Support Need
Barod Under 18 - CYP referral
Out of Work Service
Physical health assessment
Pre Detox (referral to be made no longer than 8-10 weeks prior to detox)
Substance use needing social work intervention (SMSWT)
Unknown - assessment required
YPDAS - Young Person Drug and Alcohol Service (Tier 3)
Is this a Alcohol Liaison Referral
Please tick yes only if referring via Alcohol Liaison Nurse
Is this referral from VAWDASV Team?
Will you continue to work with this person?
Please indicate yes or no and any relevant information in box provided below.
Service User Support Needs / Requirements
Include here support needs and any information in relation to restrictions on contact ie text only or where the client would like appointments (home / office / community)
Joint Allocation Meeting - Admin use only
Barod Internal Referrals Only
Would you like an Email Confirmation?
If you need email confirmation that your referral has been successfully received then tick this box. Please note that the email will contain the last name of the referral and a unique TPN Reference Number that we will use to refer to this person. This will also be provided on the next screen when you submit these details.
© 2024 DASPA Database Version 3.0.0