Intake Assessment Form

Intake Assessment Form Template for Australia

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Key Requirements PROMPT example:

"I need an Intake Assessment Form for my new mental health practice opening in March 2025, focusing on youth clients aged 12-25, with specific sections for mental health screening and parental consent for minors."

Document background

The Intake Assessment Form is a standardized document used across Australian healthcare and social service sectors for collecting comprehensive client information at the point of service entry. This document is essential for service providers to gather relevant personal, medical, and social information while ensuring compliance with the Privacy Act 1988 (Cth), Health Records legislation, and other applicable Australian regulations. The form typically includes sections for demographic information, medical history, current needs assessment, risk evaluation, and consent for service provision. It serves as a foundational document for establishing the service relationship and ensuring appropriate care planning. The Intake Assessment Form must be completed before service provision begins and should be regularly reviewed and updated to maintain accuracy of client information.

Suggested Sections

1. Client Personal Information: Basic demographic information including name, date of birth, contact details, and preferred contact method

2. Emergency Contact Details: Information about primary and secondary emergency contacts

3. Privacy Statement and Consent: Statement about how information will be collected, used, and stored, with client consent section

4. Medical History: Current medical conditions, medications, allergies, and relevant past medical history

5. Current Presenting Issues: Description of current concerns or reasons for seeking services

6. Risk Assessment: Basic screening for immediate risks to self or others

7. Current Support Services: List of other healthcare providers or support services currently involved

8. Insurance and Payment Information: Medicare details, private health insurance, or other funding arrangements

9. Declaration and Signature: Client verification of information accuracy and consent to assessment

Optional Sections

1. Cultural and Linguistic Information: For services requiring cultural safety assessment - includes cultural identity, language preferences, and interpreter needs

2. Disability Support Requirements: For clients with disabilities - includes accessibility needs and support requirements

3. Mental Health Assessment: For mental health services - includes mental health history and current psychological status

4. Substance Use Assessment: For addiction or general health services - includes current and past substance use patterns

5. Family/Social History: For services where family context is relevant - includes family structure and social support networks

6. Education/Employment History: For vocational or rehabilitation services - includes educational background and employment status

7. Legal Status: For services involving legal requirements - includes relevant legal orders or requirements

Suggested Schedules

1. Risk Assessment Tool: Standardized risk assessment scale or checklist

2. Consent Forms: Detailed consent forms for specific services or information sharing

3. Privacy Policy: Detailed privacy policy and information handling procedures

4. Service Agreement: Terms and conditions of service provision

5. Assessment Scales: Relevant standardized assessment tools or scales specific to the service type

Authors

Alex Denne

Head of Growth (Open Source Law) @ tiktok��˰� | 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

Mental Health Services

Social Services

Disability Services

Aged Care

Allied Health

Community Services

Rehabilitation Services

Drug and Alcohol Services

Youth Services

Family Services

Relevant Teams

Intake and Assessment

Clinical Operations

Patient Services

Administrative Services

Quality Assurance

Medical Records

Front Office

Care Coordination

Clinical Governance

Compliance

Relevant Roles

Clinical Manager

Intake Coordinator

Social Worker

Healthcare Administrator

Medical Receptionist

Practice Manager

Case Manager

Mental Health Professional

Allied Health Professional

Program Coordinator

Admissions Officer

Patient Services Manager

Clinical Director

Nurse Manager

Quality Assurance Officer

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Authors

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