Client Intake and Consent Form
v2.1
Purpose. Intake officers and case managers complete this form with the person at the assessment visit to record who they are, what they want from Willow, their consent to collect and share information and who supports their decisions.
1.Completing this form
Complete this form with the person, not about them. Use an interpreter where needed and take the time to explain each section. Where the person has a guardian, nominee or other legally authorised decision maker, record their details and confirm their authority.
2.Privacy statement
Willow collects personal and health information to plan and deliver safe support and to report to funders as required by law. Information is stored securely, shared only with the person's consent or where the law requires, and the person is able to see and correct their record. Read this statement to the person before asking for consent.
3.Rights and complaints
Give the person the plain language rights statement and explain how to make a complaint to Willow, to the Aged Care Quality and Safety Commission, the NDIS Quality and Safeguards Commission or another relevant body, and how to contact an independent advocate. Tick the box only after this has been explained.
4.Risk screening
Ask the screening questions about falls, memory, medication, family violence, thoughts of self harm and the safety of any children in the home. Where a screen is positive, note it on the form and escalate to the program manager the same day.
5.After the visit
Enter the person in the Client Register, upload the completed form, and complete the Individual Support Plan within five working days.