Participant intake checklist Participant intake checklist Please enable JavaScript in your browser to complete this form. Participant Intake Checklist Participant Intake Checklist Territory Disability Service Assessment Information Assessment done by Date of intake I have explained the following information to (Participant Name) Signed by staff Date Checklist Topics TopicTick Eligibility criteria for entry to the service, and procedures for prioritising access Individual’s right to access a support person of their choice to assist them when entering or exiting a service, and in developing their personalised plan Information and support which can be offered to assist individuals using the service How the service works with individuals accessing services to develop a personalised plan to assist them to achieve their goals, and the format of the copy of the plan Procedures for accessing or nominating a support person of their choice Support which will be provided, how the support will be delivered, and how frequently the personalised plan will be reviewed Privacy and confidentiality policy and procedures in relation to the use of, and access to personal information held Procedures for release of personal information to another party and the requirement for informed consent How the individual accessing services can participate in decision making processes to assist the service to improve Add any other relevant matter here Declaration The above information has been explained to me. Signed by individual Date Signed by nominated support person Date Submit Reset Submit
