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Initial Intake Form
"Need an Initial Intake Form for my Singapore-based medical clinic that complies with healthcare regulations and includes sections for medical history, insurance information, and emergency contacts, to be implemented by March 2025."
1. Personal Information: Basic contact details, identification information including name, NRIC/passport number, address, contact numbers, and email
2. PDPA Consent Declaration: Formal declaration of consent for data collection and processing as required by Singapore's PDPA 2012
3. Purpose Declaration: Clear statement outlining the specific purposes for which the information is being collected and how it will be used
4. Declaration of Truth: Client's attestation that all provided information is true, accurate and complete to the best of their knowledge
1. Medical History: Detailed medical background including conditions, medications, and previous treatments - used for healthcare service intake only
2. Financial Information: Financial details including income, assets, and financial history - used for financial service intake only
3. Emergency Contacts: Alternative contact information for emergency situations - recommended for healthcare or high-risk services
4. Employment Details: Current employment status, employer information, and job details - used when relevant to service provision
1. Privacy Policy: Detailed explanation of how personal data will be collected, used, disclosed and protected in accordance with PDPA requirements
2. Terms and Conditions: General terms governing the service provision and use of collected information
3. Required Documents Checklist: List of supporting documents that need to be submitted along with the intake form
4. Service-Specific Requirements: Additional forms or requirements specific to the particular service being provided
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