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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."
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
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
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
Intake Date
Legal Matter
Adverse Party
Case Description
Representation
Attorney-Client Relationship
Confidential Information
Protected Health Information
Incident Date
Jurisdiction
Statute of Limitations
Legal Fees
Retainer
Contingency Fee
Consultation
Prior Representation
Conflict of Interest
Witness
Evidence
Related Documents
Legal Action
Settlement
Authorization
Release of Information
Power of Attorney
Legal Capacity
Subject Matter
Venue
Claims
Privacy and Confidentiality
Authorization and Consent
Information Verification
Document Retention
Fee Arrangement
Scope of Representation
Information Release
Communications Consent
Electronic Communications
Conflict of Interest
File Retention
Termination of Representation
Attorney-Client Privilege
Data Protection
Record Access
Accuracy of Information
Client Obligations
Document Production
Engagement Terms
Jurisdiction and Venue
HIPAA Compliance
Insurance Coverage
Third-Party Disclosure
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