General Intake Form

General Intake Form Template for Philippines

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Key Requirements PROMPT example:

"I need a General Intake Form for my medical clinic in Manila, compliant with Philippine healthcare regulations and data privacy laws, with specific sections for patient medical history and insurance information to be implemented by March 2025."

Document background

The General Intake Form serves as a fundamental document for organizations operating in the Philippines to gather essential information from clients or service users. This document is designed to comply with Philippine regulations, particularly the Data Privacy Act of 2012 (RA 10173), the Civil Code of the Philippines, and other relevant legislation. The form is typically used at the initiation of a service relationship to collect necessary personal information, contact details, and service-specific requirements. It includes mandatory privacy notices, consent declarations, and data processing disclosures, ensuring both legal compliance and practical utility. Organizations can customize certain sections based on their specific industry requirements while maintaining the core structure and legal compliance elements.

Suggested Sections

1. Personal Information: Basic identification details including full name, date of birth, nationality, and government-issued ID numbers

2. Contact Information: Complete contact details including residential address, mailing address, phone numbers, and email addresses

3. Emergency Contact Information: Details of primary and secondary emergency contacts

4. Data Privacy Notice: Mandatory notice explaining how personal data will be collected, used, stored and protected as per RA 10173

5. Consent Declaration: Express consent section for data collection and processing

6. Basic Medical Information: Essential health information including allergies and current medications

7. Signature and Certification: Declaration of truth and accuracy of provided information with signature and date

Optional Sections

1. Employment Information: Used when the intake is employment-related, including current employer, position, and work history

2. Financial Information: Added when financial services or credit assessment is involved

3. Insurance Details: Included when health or insurance services are relevant

4. Family Information: Used when services extend to family members or dependents

5. Educational Background: Added when relevant for educational or professional services

6. Special Needs or Accommodations: Included when accessibility or special assistance might be required

Suggested Schedules

1. Schedule A - Required Documents Checklist: List of supporting documents that need to be submitted with the intake form

2. Schedule B - Terms and Conditions: Detailed terms and conditions applicable to the services being sought

3. Schedule C - Privacy Policy: Detailed privacy policy and data protection procedures

4. Appendix 1 - Consent Forms: Additional specific consent forms required for particular services or data processing

5. Appendix 2 - Service-Specific Requirements: Additional forms or requirements specific to particular services

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

Financial Services

Education

Professional Services

Legal Services

Insurance

Real Estate

Non-profit Organizations

Government Services

Hospitality

Retail

Telecommunications

Relevant Teams

Operations

Administration

Legal

Compliance

Customer Service

Client Relations

Risk Management

Front Office

Data Protection

Human Resources

Relevant Roles

Administrative Officer

Client Relations Manager

Compliance Officer

Data Protection Officer

Operations Manager

Customer Service Representative

Intake Coordinator

Human Resources Manager

Legal Counsel

Risk Management Officer

Front Desk Manager

Service Delivery Manager

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Authors

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