In-Take Packet

3intakepacket copy

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 7/9/2015
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

Save

Save

Save

Save

Save

Save