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Intake Assessment Form

Intake Assessment Form Template for Denmark

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Intake Assessment Form

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The Intake Assessment Form serves as a crucial first step in establishing a patient's medical record within Danish healthcare settings. This document is designed to be used during initial patient contact or admission, gathering essential information about the patient's health status, medical history, and current concerns. The form complies with Danish healthcare legislation, including the Danish Health Act (Sundhedsloven) and data protection requirements under GDPR and the Danish Data Protection Act. It is structured to support healthcare providers in collecting comprehensive patient information while ensuring all necessary legal and regulatory requirements are met. The Intake Assessment Form includes both mandatory and optional sections to accommodate various healthcare settings and specialties, making it suitable for use in both public and private healthcare facilities throughout Denmark.
Suggested Sections

1. Personal Information: Basic identification details including name, CPR number, address, contact information, and preferred language

2. Emergency Contact Details: Information about primary and secondary emergency contacts

3. Current Healthcare Providers: List of existing healthcare providers, including general practitioner and specialists

4. Primary Concerns: Main reasons for seeking assessment/treatment and current symptoms

5. Medical History: Overview of past and current medical conditions, surgeries, and treatments

6. Current Medications: List of all current medications, including prescription, over-the-counter, and supplements

7. Allergies and Reactions: Documentation of known allergies and adverse reactions

8. Consent and Privacy Notice: GDPR-compliant consent forms and privacy information

9. Assessment Summary: Professional's initial evaluation and recommended action plan

Optional Sections

1. Mental Health History: Detailed mental health history and current status, used when psychological assessment is relevant

2. Social Support Assessment: Evaluation of social support systems and living situation, used for comprehensive care planning

3. Substance Use History: Details about current and past substance use, included when relevant to assessment

4. Dietary Assessment: Evaluation of dietary habits and restrictions, used when nutrition is relevant to care

5. Cultural Considerations: Specific cultural or religious factors affecting care, included when relevant

6. Occupational History: Work-related information and exposures, used when relevant to presenting concerns

7. Insurance Information: Details about health insurance coverage, included for private healthcare settings

Suggested Schedules

1. Pain Assessment Scale: Standardized pain assessment tools and body diagrams

2. Functional Assessment Tools: Standardized scales for assessing daily living activities and mobility

3. Risk Assessment Forms: Standardized tools for assessing specific risks (falls, suicide, etc.)

4. Medication List Template: Detailed medication recording form with dosage and frequency

5. Consent Forms: Additional specific consent forms for specialized procedures or information sharing

6. Privacy Policy: Detailed GDPR-compliant privacy policy and data handling procedures

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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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