Biopsychosocial Intake Form

Biopsychosocial Intake Form Template for England and Wales

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Key Requirements PROMPT example:

I need a Biopsychosocial Intake Form for my private psychology practice in Cardiff, focusing on adult patients with anxiety and depression, which must comply with GDPR and include detailed sections on medication history and current treatment plans.

Document background

The Biopsychosocial Intake Form is a crucial document used across healthcare settings in England and Wales to gather comprehensive patient information. It enables healthcare providers to assess patients holistically, considering biological, psychological, and social factors that influence health and wellbeing. The form supports compliance with UK healthcare regulations and data protection laws while facilitating effective treatment planning and care coordination. It's particularly valuable for initial assessments and establishing baseline information for ongoing care management.

Suggested Sections

1. Personal Information: Basic demographic data, contact information, and emergency contacts including name, address, date of birth, NHS number

2. Medical History: Current and past medical conditions, medications, allergies, hospitalizations, and treating physicians

3. Mental Health History: Previous mental health diagnoses, treatments, therapies, hospitalizations, and medication history

4. Social History: Family structure, living situation, support systems, relationships, and social functioning

5. Risk Assessment: Current risk factors, safety concerns, self-harm history, and crisis planning

6. Consent Statement: Information sharing permissions, treatment consent, and GDPR compliance statement

Optional Sections

1. Educational History: Academic background, challenges, and achievements - used for children/young adults or when academic performance is relevant

2. Employment History: Work history, occupational functioning, and work-related stressors - used for working-age adults

3. Cultural Assessment: Cultural factors affecting treatment, including religious beliefs, cultural practices, and language preferences

4. Substance Use History: Details about current and past substance use, including alcohol, tobacco, and other drugs

Suggested Schedules

1. Privacy Notice: Detailed information about data processing, storage, sharing, and patient rights under UK GDPR

2. Screening Tools: Standardized assessment forms including PHQ-9, GAD-7, and other relevant psychological measures

3. Crisis Plan Template: Emergency contact information, crisis management procedures, and safety planning

4. Service Information Sheet: Details about available services, treatment options, and relevant healthcare pathways

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
Mental Health Services
Social Services
Educational Institutions

Relevant Teams

Mental Health
Primary Care
Social Services
Medical Records
Quality Assurance

Relevant Roles

Clinical Psychologist
Psychiatrist
General Practitioner
Social Worker
Mental Health Nurse

Industries

UK GDPR and Data Protection Act 2018: Primary legislation governing the collection, processing, and storage of personal data, including special category health data. Requires explicit consent, data minimization, and strict security measures.

Health and Social Care Act 2012: Framework legislation for healthcare delivery in England, affecting how health information is managed and shared between providers.

Mental Health Act 1983: Legislation governing the assessment, treatment and rights of people with mental health disorders, impacting how mental health information is collected and used.

Mental Capacity Act 2005: Laws regarding decision-making capacity and consent, crucial for determining ability to provide information and consent to treatment.

Care Act 2014: Legislation covering adult social care and safeguarding, affecting how vulnerable adults' information is collected and protected.

Equality Act 2010: Ensures non-discrimination and accessibility in form design and implementation, protecting individuals with protected characteristics.

Human Rights Act 1998: Fundamental rights legislation affecting privacy, dignity, and fair treatment in healthcare contexts.

Common Law Duty of Confidentiality: Legal obligation to keep personal information confidential, affecting how patient information is handled and shared.

Caldicott Principles: Guidelines for handling patient-identifiable information in healthcare settings, ensuring appropriate information sharing and protection.

Children Act 1989 and 2004: Legislation protecting children's welfare and safety, affecting how information about minors is collected and handled.

Safeguarding Vulnerable Groups Act 2006: Framework for protecting vulnerable individuals, impacting information collection and sharing related to safeguarding concerns.

NHS Records Management Code of Practice: Guidelines for managing healthcare records, including retention periods and security requirements for patient information.

HCPC Standards: Professional standards from the Health and Care Professions Council affecting record-keeping and information management practices.

BPS Guidelines: British Psychological Society professional guidelines influencing psychological assessment and record-keeping practices.

NICE Guidelines: National Institute for Health and Care Excellence standards affecting clinical assessment and documentation requirements.

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Authors

Alex Denne

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