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Intake Referral Form Template for England and Wales

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Key Requirements PROMPT example:

Intake Referral Form

"I need an Intake Referral Form for a mental health service provider that includes specific sections for risk assessment and safeguarding concerns, compliant with NHS standards and suitable for both adult and youth referrals."

What is a Intake Referral Form?

The Intake Referral Form is a critical document used across various sectors in England and Wales to initiate service provision or transfer clients between services. It ensures consistent collection of necessary information while maintaining compliance with UK legislation, including GDPR and relevant sector-specific regulations. The form typically includes client details, reason for referral, risk assessments, and consent declarations. It serves as the primary point of entry for new clients and helps establish the initial scope of service needed.

What sections should be included in a Intake Referral Form?

1. Client Information: Basic personal details including name, date of birth, address, contact information, NHS number or other relevant identifiers

2. Referral Source: Details of the referring organization/individual, including name, role, contact information, and organization details

3. Reason for Referral: Primary concerns, immediate needs, and specific support or services being requested

4. Consent Declaration: Client's explicit consent for information sharing, data processing, and service provision

5. Risk Assessment Summary: Initial assessment of risks, immediate concerns, and any safety considerations

What sections are optional to include in a Intake Referral Form?

1. Medical History: Relevant medical conditions, medications, allergies, and healthcare providers - used when health services are involved

2. Safeguarding Concerns: Details of any safeguarding issues, risks, or vulnerabilities - included when vulnerable individuals are involved

3. Support Network: Information about family members, carers, or other support persons - used when ongoing support coordination is required

What schedules should be included in a Intake Referral Form?

1. Privacy Notice: Detailed information about how personal data will be processed, stored, shared, and individual rights under data protection laws

2. Consent Forms: Additional specific consent documents for particular services or information sharing agreements

3. Supporting Documentation: Space for attaching relevant reports, assessments, or medical records that support the referral

Authors

Alex Denne

Head of Growth (Open Source Law) @ ¶¶ÒõÊÓÆµ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Relevant legal definitions















Clauses















Industries

UK GDPR and Data Protection Act 2018: Core data protection legislation governing how personal information must be collected, processed, stored and protected in the intake referral form

Privacy and Electronic Communications Regulations (PECR): Regulations covering electronic communications and data privacy requirements for any digital handling of the intake form

Health and Social Care Act 2012: Framework legislation for health and social care services, defining responsibilities and standards for care provision and referrals

Mental Capacity Act 2005: Legislation governing decision-making and consent for individuals who may lack capacity to make their own decisions

Care Act 2014: Primary legislation for adult social care, including requirements for assessment, safeguarding, and service provision

Mental Health Act 1983: Legislation governing the assessment, treatment and rights of people with mental health disorders

Equality Act 2010: Legislation ensuring non-discrimination and equal access to services, including requirements for reasonable adjustments and accessible format of forms

Professional Standards Regulations: Guidelines from professional bodies such as GMC, NMC, HCPC that govern professional conduct and standards in referral processes

Children Act 1989 & 2004: Key legislation for child protection and safeguarding requirements in referral processes involving minors

Caldicott Principles: Guidelines governing the handling of patient-identifiable information in health and social care settings

Public Records Act 1958: Legislation governing the management and preservation of public records, including healthcare documentation

Access to Health Records Act 1990: Legislation governing rights of access to health records and requirements for record maintenance

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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