Referral Intake Form

Referral Intake Form Template for England and Wales

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Key Requirements PROMPT example:

"I need a Referral Intake Form for my mental health clinic in Cardiff that complies with NHS Wales standards and includes specific sections for risk assessment and previous treatment history, to be implemented by March 2025."

Document background

The Referral Intake Form is a crucial document used across various sectors in England and Wales to facilitate the systematic transfer of clients between services or organizations. It ensures that all necessary information is collected in a structured manner, maintaining compliance with UK GDPR and relevant professional standards. This document is particularly important in contexts where detailed client information needs to be captured and shared securely, such as healthcare, social services, or educational settings. The form typically includes client demographics, referral reasons, consent declarations, and any specific requirements or considerations for the receiving organization.

Suggested Sections

1. Client Information: Basic personal details, contact information, and identifiers of the client being referred

2. Referral Source: Details of referring individual/organization and their relationship to client

3. Reason for Referral: Primary concerns and specific needs prompting the referral

4. Consent Declaration: Client's explicit consent for information sharing and referral processing

5. Privacy Notice: Information about data processing and protection rights under UK GDPR and Data Protection Act 2018

Optional Sections

1. Medical History: Relevant medical information for health-related referrals

2. Risk Assessment: Evaluation of potential risks to client or others, particularly for vulnerable individuals or mental health cases

3. Support Network: Details of family members, carers, or other support persons for cases requiring ongoing support coordination

4. Emergency Contacts: Contact details for emergency situations in high-risk cases or for vulnerable individuals

Suggested Schedules

1. Supporting Documentation: Relevant reports, assessments, or additional information supporting the referral

2. Consent Forms: Copies of signed consent forms and authorizations

3. Service Information: Details about available services and eligibility criteria

4. Privacy Policy: Detailed data protection and privacy information compliant with UK GDPR and Data Protection Act 2018

Authors

Alex Denne

Head of Growth (Open Source Law) @ ��ֱ�� | 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

Relevant Teams

Relevant Roles

Industries

UK GDPR and Data Protection Act 2018: Core data protection legislation governing the collection, processing, and storage of personal data in the UK, including special category data that might be included in referral forms

Privacy and Electronic Communications Regulations (PECR): Regulations covering electronic communications, relevant if the referral form includes electronic communication preferences or processing

Health and Social Care Act 2012: Framework legislation for healthcare services in England, setting out requirements for health service providers and information governance

Care Act 2014: Legislation governing adult social care in England, including requirements for assessment and referral processes

Mental Capacity Act 2005: Law protecting and supporting people who may lack capacity to make certain decisions, relevant for consent sections in referral forms

Mental Health Act 1983/2007: Legislation concerning the assessment, treatment and rights of people with mental health disorders, important for mental health referrals

Equality Act 2010: Law protecting individuals from discrimination and promoting equality, ensuring referral processes are fair and non-discriminatory

Safeguarding Vulnerable Groups Act 2006: Legislation aimed at protecting vulnerable individuals in care settings, relevant for safeguarding sections in referral forms

Children Act 1989 & 2004: Key legislation protecting children's welfare, essential for referral forms dealing with minors or family services

Professional Standards Regulations: Various professional body guidelines (GMC, NMC, HCPC) setting standards for professional conduct and referral processes

Consumer Rights Act 2015: Legislation protecting consumer rights, relevant if the referral involves paid services or consumer relationships

Consumer Protection from Unfair Trading Regulations 2008: Regulations protecting consumers from unfair business practices, applicable to commercial referral relationships

Common Law Duty of Confidentiality: Legal obligation to keep personal information confidential, fundamental to handling referral information

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Medical Intake Form

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Authors

Alex Denne

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