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Initial Intake Form

Initial Intake Form Template for Singapore

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Key Requirements PROMPT example:

Initial Intake Form

"Need an Initial Intake Form for my Singapore-based medical clinic that complies with healthcare regulations and includes sections for medical history, insurance information, and emergency contacts, to be implemented by March 2025."

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Document background
The Initial Intake Form serves as a crucial first step in establishing a formal relationship with new clients in Singapore. This document is designed to collect essential information while ensuring compliance with Singapore's Personal Data Protection Act (PDPA) and other relevant regulations. It typically includes sections for personal information, service requirements, consent declarations, and specific information relevant to the service being provided. The form helps organizations maintain proper records, ensure regulatory compliance, and gather necessary information for service delivery.
Suggested Sections

1. Personal Information: Basic contact details, identification information including name, NRIC/passport number, address, contact numbers, and email

2. PDPA Consent Declaration: Formal declaration of consent for data collection and processing as required by Singapore's PDPA 2012

3. Purpose Declaration: Clear statement outlining the specific purposes for which the information is being collected and how it will be used

4. Declaration of Truth: Client's attestation that all provided information is true, accurate and complete to the best of their knowledge

Optional Sections

1. Medical History: Detailed medical background including conditions, medications, and previous treatments - used for healthcare service intake only

2. Financial Information: Financial details including income, assets, and financial history - used for financial service intake only

3. Emergency Contacts: Alternative contact information for emergency situations - recommended for healthcare or high-risk services

4. Employment Details: Current employment status, employer information, and job details - used when relevant to service provision

Suggested Schedules

1. Privacy Policy: Detailed explanation of how personal data will be collected, used, disclosed and protected in accordance with PDPA requirements

2. Terms and Conditions: General terms governing the service provision and use of collected information

3. Required Documents Checklist: List of supporting documents that need to be submitted along with the intake form

4. Service-Specific Requirements: Additional forms or requirements specific to the particular service being provided

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

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alex.den.21@genieai.co
Industries

Personal Data Protection Act (PDPA) 2012: Core legislation governing personal data handling in Singapore. Regulates the collection, use, and disclosure of personal data, requires explicit consent, mandates purpose notification, and sets standards for data security and retention.

Electronic Transactions Act (ETA): Legislation governing electronic transactions and documents. Covers electronic signatures, records, and ensures legal recognition of electronic documents in Singapore.

Evidence Act: Legislation pertaining to record-keeping requirements and the admissibility of electronic records in legal proceedings in Singapore.

Professional Services Regulations: Industry-specific regulations that may impose additional requirements for information collection depending on the sector (medical, legal, financial services).

Employment Act: Primary legislation governing employment relationships in Singapore, including requirements for collecting and maintaining employee information.

Healthcare Laws: Specific healthcare-related legislation including Private Hospitals and Medical Clinics Act, NHG guidelines, and healthcare data protection requirements.

Financial Services Laws: Regulations from Monetary Authority of Singapore (MAS), including Anti-Money Laundering and Know Your Customer (KYC) requirements for financial services.

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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