Intake Assessment Form Template for Singapore

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Key Requirements PROMPT example:

Intake Assessment Form

"Need an Intake Assessment Form for our new mental health clinic in Singapore, compliant with PDPA requirements and including specific sections for psychological evaluation and risk assessment, to be implemented by March 2025."

Document background

The Intake Assessment Form is a crucial document used across various service sectors in Singapore to standardize the initial information gathering process. This document must comply with Singapore's PDPA and sector-specific regulations while collecting comprehensive client information. The form typically includes personal details, medical history, social circumstances, and necessary consent declarations. It serves as the foundation for service planning and helps ensure appropriate care delivery while maintaining legal compliance.

Suggested Sections

1. Personal Information: Basic demographic data, contact information, and identification details of the client

2. Privacy Notice: PDPA-compliant statement about data collection, usage, storage and sharing

3. Consent Declaration: Client's acknowledgment and consent for data collection, usage and sharing

4. Emergency Contact: Alternative contact information for urgent situations and next of kin details

Optional Sections

1. Medical History: Comprehensive health information including current conditions, medications, allergies, and past medical procedures

2. Financial Assessment: Details of financial situation including income, expenses, assets and liabilities for means-testing purposes

3. Risk Assessment: Evaluation of potential risks or vulnerabilities including mental health status and safety concerns

4. Family Background: Information about family composition, living arrangements and support systems

5. Language and Cultural Preferences: Preferred language of communication and relevant cultural considerations

Suggested Schedules

1. Supporting Documents Checklist: Comprehensive list of required documentation to be submitted with the intake form

2. Service Terms and Conditions: Detailed terms of service provision, client responsibilities and rights

3. Privacy Policy: Detailed data protection and usage policies in compliance with PDPA

4. Consent Forms: Additional specific consent forms for various services or data sharing arrangements

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

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Healthcare
Social Services
Mental Health
Education
Elder Care

Relevant Teams

Admissions
Patient Services
Clinical Operations
Social Services
Compliance

Relevant Roles

Social Worker
Healthcare Administrator
Clinical Coordinator
Intake Specialist
Case Manager

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Authors

Alex Denne

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