Intake Packet
Procedure: Start all client records with a “Section 1” cover sheet follow with these forms:
To be maintained in ALL client records
☐ 2.1 Face Sheet
☐ 2.2B Screening
Formerly known as Application
☐ 2.3 Consent for Treatment revised April 2023
Formerly known as the Admission Agreement. This only needs to be signed once, at the beginning of service.
☐ 2.4 Decision to Enter Care revised 4/2015
Update annually
☐ 2.5 Authorization for Medical Care
Update annually
Formerly known as Consent for Treatment and Consent for Transportation
☐ 2.6 Authorization to Disclose Health Info revised August 2021
Update annually
☐ 2.7 Privacy Practices receipt
☐ 2.8 Acknowledgement of Client Rights Notification revised 4/28/2015
Update annually by reviewing entire welcome packet
☐ 2.9 Admission Assessment
☐ 2.10 Provider owned or controlled residential settings revised August 2021
Update annually
☐ Consent to be photographed
Print complete intake packet here
Does your client need any Program/Population Specific paperwork?
Please use the comment box below to let me know how this works for your program. Thanks! Jenny