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) @ ��Ƶ | 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
Social Services
Education
Mental Health Services
Disability Services

Relevant Teams

Admissions
Care Coordination
Clinical Services
Social Services
Quality Assurance

Relevant Roles

Case Manager
Social Worker
Healthcare Professional
Service Coordinator
Intake Specialist

Find the exact document you need

Medical Intake Form

A standardized template for collecting patient information in England and Wales, compliant with UK healthcare and data protection regulations.

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Let's create your Intake Referral Form

What is a Intake Referral Form?

What sections should be included in a Intake Referral Form?

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

What schedules should be included in a Intake Referral Form?

Authors

Alex Denne

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