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Intake Assessment Form

Intake Assessment Form Template for Ireland

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Key Requirements PROMPT example:

Intake Assessment Form

"I need an Intake Assessment Form for a mental health counseling service in Dublin, compliant with Irish healthcare regulations and GDPR, that includes detailed sections on risk assessment and crisis management."

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Document background
The Intake Assessment Form is a crucial document used across various service providers in Ireland to initiate client engagement and assess service needs. This document serves as the primary tool for collecting essential information about clients when they first access services, ensuring a standardized approach to information gathering while maintaining compliance with Irish legislation, including GDPR and relevant sector-specific regulations. The form includes sections for personal information, medical history, risk assessment, and consent, with optional modules that can be added based on specific service requirements. It is designed to be comprehensive yet flexible, allowing service providers to gather necessary information while respecting privacy rights and data protection requirements. The document is particularly important for maintaining accurate records, ensuring appropriate service delivery, and establishing a clear service provider-client relationship from the outset.
Suggested Sections

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

2. Emergency Contact Details: Contact information for next of kin or emergency contacts

3. Presenting Issues: Primary reason for seeking assessment/support and current concerns

4. Medical History: Relevant medical conditions, medications, and healthcare providers

5. Current Living Situation: Housing status, living arrangements, and household composition

6. Risk Assessment: Immediate safety concerns and risk factors that need to be addressed

7. Consent and Data Protection: GDPR-compliant consent statements and information about data processing

8. Declaration: Client signature, date, and confirmation of information accuracy

Optional Sections

1. Educational/Employment History: Include when assessment is related to educational, vocational, or employment support services

2. Substance Use History: Include when assessment is for addiction or mental health services

3. Legal Status: Include when working with immigrants, refugees, or in legal support contexts

4. Cultural/Religious Considerations: Include when service provision needs to account for specific cultural or religious requirements

5. Financial Assessment: Include when service involves financial support or means-tested services

6. Previous Service History: Include when client has engaged with similar services before

Suggested Schedules

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

2. Consent Forms: Detailed consent forms for specific aspects of service provision

3. Privacy Notice: Detailed GDPR-compliant privacy notice explaining data handling practices

4. Service Agreement: Terms and conditions of service provision

Authors

Alex Denne

Head of Growth (Open Source Law) @ tiktok³ÉÈË°æ | 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

Education

Disability Services

Addiction Services

Community Services

Legal Services

Refugee and Immigration Services

Elder Care

Youth Services

Relevant Teams

Intake and Assessment

Client Services

Clinical Operations

Admissions

Compliance

Data Protection

Quality Assurance

Front Desk Operations

Care Coordination

Records Management

Relevant Roles

Case Manager

Intake Coordinator

Social Worker

Healthcare Administrator

Clinical Director

Program Manager

Service Coordinator

Admissions Officer

Mental Health Professional

Client Services Manager

Compliance Officer

Data Protection Officer

Industries







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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