Case Intake Form Template for United States

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Key Requirements PROMPT example:

Case Intake Form

"Need a Case Intake Form for a small law practice specializing in personal injury cases, with specific sections for medical records and insurance information, compliant with California state regulations and HIPAA requirements."

Document background

The Case Intake Form is a crucial document in U.S. legal practice that serves as the first formal point of contact between a law firm and a potential client. It is designed to capture comprehensive information about the client's legal issues, relevant facts, timeline of events, and other pertinent details necessary for evaluating and pursuing legal action. The form must comply with various federal and state regulations, including privacy laws, professional conduct rules, and data protection requirements. It typically includes sections for personal information, case details, adverse parties, and relevant documentation, helping attorneys assess the merits of the case and potential conflicts of interest.

Suggested Sections

1. Client Information: Basic contact details, identification, and demographic information required for case intake

2. Case Information: Details about the nature of legal issue, incident details, relevant dates, and case type classification

3. Adverse Parties: Information about opposing parties or entities involved in the case

4. Timeline: Chronological sequence of relevant events leading to the legal issue

5. Client Authorization: Formal consent for representation and verification of provided information

Optional Sections

1. Medical Information: Section for recording relevant medical details, treatment history, and healthcare providers for cases involving personal injury or disability

2. Insurance Information: Details of relevant insurance policies, coverage, and claim information for cases involving insurance matters

3. Witness Information: Contact details and relevant information about potential witnesses who may provide testimony

4. Financial Information: Client's financial details, including income, assets, and liabilities for cases involving financial matters

Suggested Schedules

1. Document Checklist: Comprehensive list of required documents and evidence needed for case processing

2. Fee Agreement: Detailed outline of payment terms, fee structure, and billing arrangements

3. Privacy Notice: Required privacy notifications including HIPAA compliance and data protection information

4. Authorization Forms: Standard release forms for obtaining records and information from third parties

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

Legal Services
Healthcare
Insurance
Corporate

Relevant Teams

Legal
Administration
Compliance
Records Management
Client Services

Relevant Roles

Attorney
Paralegal
Legal Secretary
Intake Specialist
Office Manager

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Electronic Intake Forms

Legal framework for electronic intake forms compliant with US federal and state regulations, governing digital information collection and processing.

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Authors

Alex Denne

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