Create an intake form for patient care that documents a holistic assessment of your patients. You have the freedom to design the intake form in a traditional way (questions that assess your patients), or you may want to develop an alternate approach (using a visual graphic for patients to circle areas of wellness/concern). Whatever approach you choose, your intake form must be clearly organized, well designed, and assess all of the following domains of care:
Nutritional Assessment
Physiological Assessment
Emotional Assessment
Sociological Assessment
Developmental Assessment
Spiritual Assessment
Cultural Assessment
Family Assessment
Environmental Assessment
Practical Assessment
Prevention Assessment
Community Assessment
Resources
Consult the resource(s) below for help developing your submission.
Perform an internet search for “patient intake form” and you will find a variety of examples.
