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DHSChild and Youth Mental Health Service Redesign Demonstration Projects

Part 1 — Consortium details

#1 Lead Agency — CAMHS or Adult Mental Health Service

Name of area mental health service

Health service

Agency number

Name of person endorsing the submission

Title

Contact person for project queries

Title

Telephone number

Facsimile number

Email

Consortium Partner #2 — CAMHS or Adult Mental Health Service

Name of area mental health service

Health service

Tasks/aspects/scope of work to be undertaken

Primary contact person for this project

Title

Email

Consortium Partner #3 — Primary health sector agency

Name

Address

Tasks/aspects/scope of work to be undertaken

Primary contact person for this project

Title

Email

Consortium Partner #4 — PDRSS

Name

Address

Tasks/aspects/scope of work to be undertaken

Primary contact person for this project

Title

Email

Other

Name

Page 27 of 34

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