Intake Form

An intake form serves as a comprehensive tool used in collaborative care (CoCM) to gather essential information about a patient's mental health condition, history, and current needs. It helps the care team understand the patient's symptoms, background, and treatment preferences, enabling the creation of a personalized care plan. The form also facilitates communication and coordination among healthcare providers, ensuring a holistic and integrated approach to the patient's care.

Starting a New Intake Form

To start a new intake form, navigate to the “Actions” menu on a patient profile. The new intake form will appear!

A fresh new intake form, ready to be filled out!

NOTE: If an intake form is modified and stays untouched for 5 minutes, it will now be auto-saved!

A Tour of the New Intake Form

On the upper left-hand side of the intake form is an index that shows all of the sections of the intake form. As you scroll down the form, the index will update to show you where you are on the form. If you click on the section names in the index, you can jump directly to them.

On the upper right-hand side of the new intake form is a patient information card. This information is pulled in from the patient’s profile. Regardless of where you scroll on the intake form, this section remains fixed, so you can always refer to it at any time.

The middle section of the intake form contains all of the fields that can be filled out. All fields are optional except for:

• The PHQ-9/PHQ-A score (or the checkbox indicating that the patient declined the assessment)
• The GAD-7/SCARED score (or the checkbox indicating that the patient declined the assessment)
• The "Time Spent" field

Filling Out the Intake Form

A provider can fill out as much or as little of the intake as they like, but are encouraged to be thorough. Most of the fields on the new intake form are unstructured free-text fields, which maximizes the flexibility of the form and allows it to accommodate different use cases and workflows.

There are 7 sections of the intake form:

• Patient Details

  This is where you can input patient demographic information.

• Areas of Concern

  This is where you can document a primary and, if applicable, a secondary area of concern. These dropdown fields are populated with the most recent diagnoses recorded on the patient profile. If you select a diagnosis for the primary area of concern, you cannot select that diagnosis again for the secondary area of concern. 

• Clinical-Summary

  This is where you can provide an overview of the patient's mental health condition, including primary symptoms, diagnosis, and relevant history. It supports treatment planning and ensures consistent communication among the care team. The summary also serves as a baseline for monitoring progress and facilitates coordination with other healthcare providers.

• Assessment-Screenings

  This is where you can attach assessment scores to the intake form as a baseline, and/or document a fresh assessment for the patient. There are 4 assessments built into the intake form: PHQ-9, GAD-7, AUDIT, and DAST.

  By default, all assessments of each type from the past 30 days will appear in each section. If there are no assessments of a specific type within the last 30 days, then you will see a button prompting you to do a new assessment. For the PHQ-9 and GAD-7, you will also see a checkbox that you can check if the patient declined the assessment.

  - A PHQ-9/PHQ-A score is required on intake. Please select one of the assessment scores from the past 30 days (if available), or do a new assessment. Optionally, you can indicate that the patient declined to take the assessment by checking the “Patient Declined Assessment” checkbox.

  - A GAD-7/SCARED score is required on intake. Please select one of the assessment scores from the past 30 days (if available), or do a new assessment. Optionally, you can indicate that the patient declined to take the assessment by checking the “Patient Declined Assessment” checkbox.

  - An AUDIT score is optional. If the patient hasn’t taken an AUDIT in the past 30 days, there will be no AUDIT scores to choose from, and you will need to do a new assessment if you want to include on on the intake form.

  - A DAST score is optional. If the patient hasn’t taken a DAST in the past 30 days, there will be no DAST scores to choose from, and you will need to do a new assessment if you want to include on on the intake form.

  - A PCL-5 score is optional. If the patient hasn’t taken a PCL-5 in the past 30 days, there will be no PCL-5 scores to choose from, and you will need to do a new assessment if you want to include on on the intake form.

• Biopsychosocial-Spiritual

  This section of the intake form assesses the patient's biological, psychological, social, and spiritual factors influencing their mental health. This holistic approach helps in understanding the full context of the patient's life, guiding individualized treatment planning, and promoting comprehensive care. It also identifies strengths and resources that can support the patient's recovery and well-being. All fields in this section are optional.

• Treatment-Information

  This section outlines the patient's current and proposed treatment plans, including medications, therapies, and other interventions. It helps in setting clear goals, monitoring progress, and ensuring that the care provided is aligned with the patient's needs and preferences. This section also facilitates communication and coordination among the care team, supporting a unified approach to the patient's mental health care.

• Program-Information

  This section provides specific information about the collaborative care model program, including the roles of the care team members, the scope of services offered, and how care is coordinated. It helps clarify expectations for the patient and ensures they understand the structure and processes of their treatment within the program. This section also outlines how communication and follow-up will be managed, promoting a cohesive and supportive care experience.

  This section consists of an optional “Acuity” field, which can be used to indicate the patient’s acuity level. It also contains a “Time Spent” field where you can indicate the time spent on intake. The value entered in the time spent field will appear in the notes and will factor into monthly time calculations for the purposes of billing. Finally, there is a “Consent” subsection, which outlines the consent that is implied upon signing & submitting the intake form.

NOTE: The “CoCM Information” field in this section can be pre-populated on the back end with default text that appears in all intake forms, should you desire. This pre-populated text can be modified inside the intake form.

Saving an In-Progress Intake Form

 At any point, as you are completing the intake form, you can click the “Save Progress” button on the right-hand side. Once the form is saved, you will see a time/date stamp in the upper left-hand corner indicating when the intake form was last saved.

Signing & Submitting an Intake Form

At any time, you can sign and submit an intake form by clicking the “Sign & Submit” button on the right-hand side. All required fields must be filled out before signing & submitting; if you try to sign & submit with required fields. If fields are not filled out, the form will highlight those fields so you can complete them.

                                               

Resuming an In-Progress Intake Form

 If you’ve saved an in-progress intake form for a patient, you can resume it at any time by visiting the “Actions” menu on the patient’s profile and clicking “Resume Intake.”

                                                       

Where to Find a Signed & Saved Intake Form

Once signed & saved, intake forms are saved as notes and are no longer editable. You can find completed intake forms in the “Notes” section of the patient profile. You can scroll through the intake form in the right-hand panel, or you can expand it to view it larger.

Any fields that were not filled in on the intake form will still appear, with an “N/A” value to indicate that they weren’t filled out. However, if a required assessment was declined by the patient, you will see that in the intake note instead of “N/A.”

                                                    

Copying to the EHR

All notes, including intake notes, can be easily copied and then pasted into the EHR. Simply click the “Copy Note” button at the bottom of the note.

                                            

NOTE: At this time, you can find legacy intake forms in PDF format on the “Documents” tab of the patient profile. In the future, we plan to migrate all old intake forms to notes so that all intake forms can be accessed from the same place. If you do not see the new intake form in the "Actions" menu, please contact us at [e-mail].