Intake Assessment Form Template for England and Wales

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Key Requirements PROMPT example:

Intake Assessment Form

I need an Intake Assessment Form for my mental health clinic that includes detailed risk assessment sections and cultural considerations, ensuring compliance with NHS standards and GDPR requirements for implementation by March 2025.

Document background
The Intake Assessment Form is a crucial document used across various service sectors in England and Wales to systematically collect and record information about new clients or service users. It serves as the primary tool for initial assessment and forms the foundation for service provision planning. The form must comply with UK GDPR, the Data Protection Act 2018, and sector-specific regulations. It typically includes sections for personal information, needs assessment, risk evaluation, and consent declarations. Organizations use this document to ensure consistent data collection, maintain legal compliance, and facilitate appropriate service delivery.
Suggested Sections

1. Personal Information: Basic demographic data, contact details, and identifiers including name, date of birth, address, phone, email

2. Emergency Contacts: Next of kin and alternative contact information including relationship, contact details and access permissions

3. Consent Declaration: Data processing and information sharing permissions, including GDPR compliance statements and opt-in/opt-out choices

4. Primary Assessment Areas: Core evaluation criteria relevant to service provision, including presenting needs, current situation, and support requirements

5. Risk Assessment: Initial evaluation of key risks and safety concerns, including immediate safeguarding needs and risk mitigation strategies

Optional Sections

1. Medical History: Detailed health information including current conditions, medications, allergies, and previous treatments - used in healthcare settings

2. Safeguarding Concerns: Additional protection needs assessment including vulnerability factors and specific safeguarding measures required

3. Cultural/Religious Requirements: Specific cultural or religious considerations that may impact service delivery or support arrangements

Suggested Schedules

1. Privacy Notice: Detailed information about data processing, storage, sharing, and individual rights under GDPR

2. Service-Specific Assessments: Additional specialized assessment tools and criteria specific to particular service areas

3. Consent Forms: Supplementary consent documentation for specific services or information sharing arrangements

Authors

Clauses
Relevant Industries
Relevant Teams
Relevant Roles
Industries

UK GDPR and Data Protection Act 2018: Primary legislation governing how personal data must be collected, processed, and stored. Essential for ensuring the intake form complies with data protection principles and individual rights.

Privacy and Electronic Communications Regulations (PECR): Specific rules for privacy of electronic communications, relevant if the intake form involves any electronic data collection or communication methods.

Equality Act 2010: Ensures the intake form doesn't discriminate against protected characteristics and includes provisions for reasonable adjustments in accessibility.

Mental Capacity Act 2005: Relevant for healthcare or social care settings, governing how to assess and act in the best interests of individuals who may lack capacity to make decisions.

Health and Social Care Act 2012: Framework legislation for healthcare providers, relevant if the intake form is used in healthcare settings.

Care Act 2014: Governs adult social care and safeguarding provisions, important for intake forms in care settings or involving vulnerable adults.

NHS Act 2006: Fundamental legislation governing NHS services and responsibilities, relevant for healthcare-related intake forms.

Children Act 1989 and 2004: Key legislation for safeguarding children and young people, essential if the intake form involves minors.

Professional Standards Guidelines: Various professional body requirements including GMC, NMC, and HCPC guidelines that may affect information collection and handling.

Caldicott Principles: Guidelines for handling patient-identifiable information in healthcare settings, ensuring appropriate information governance.

Public Sector Bodies Accessibility Regulations 2018: Requirements for making digital services accessible to all users, including those with disabilities.

Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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