Case Intake Form Generator for the USA

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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

Clauses
Industries

Privacy Laws: Key privacy regulations including HIPAA for medical information, Gramm-Leach-Bliley Act (GLBA) for financial information, and state-specific privacy laws like CCPA in California

Professional Responsibility Rules: Ethical guidelines including ABA Model Rules, state-specific attorney ethics rules, and attorney-client privilege considerations

Data Collection and Storage: Federal data protection requirements, state-specific data breach notification laws, and electronic record-keeping requirements

Non-Discrimination Laws: Anti-discrimination legislation including ADA, Civil Rights Act, Age Discrimination in Employment Act, and state-specific anti-discrimination laws

Statute of Limitations: Relevant federal and state statutes of limitations for different types of cases and jurisdictional requirements

Legal Practice Requirements: State bar association rules, local court rules, and jurisdictional requirements for legal practice

Document Retention: State-specific requirements for maintaining client records and professional liability considerations

Informed Consent: Requirements for client authorization and disclosure obligations in legal practice

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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