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Employee Assistance Program for Teachers Intake Clinical Record Please complete and return for our records following the initial session. Counselors Name: Client Number: Referral Date: Date of First
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How to fill out employee assistance program intake-clinical

How to fill out employee assistance program intake-clinical
01
Begin by gathering all necessary information and documents related to the employee seeking assistance.
02
Start by filling out the employee's personal information, such as their name, contact details, and employee ID.
03
Proceed to fill out the employee's demographic information, including their age, gender, and marital status.
04
Provide space to capture the employee's employment details, such as their job title, department, and supervisor's name.
05
Include a section to document the reason for seeking assistance, allowing the employee to provide a detailed description of their concerns or issues.
06
Create a checklist or questionnaire to gather specific information about the employee's mental health or well-being.
07
Ensure that the intake form includes a section for the employee to list any previous or current medical conditions, medications, or treatments.
08
Include a consent form where the employee grants permission for their information to be shared with appropriate professionals involved in the program.
09
Make sure to provide clear instructions on how to submit the completed intake form and whom to contact for any questions or concerns.
10
Finally, review the completed intake form for accuracy and completeness before securely storing it for further assessment and assistance.
Who needs employee assistance program intake-clinical?
01
Employees who are experiencing personal or work-related difficulties that are impacting their mental health or overall well-being.
02
Employees dealing with stress, anxiety, depression, or other mental health issues that may affect their ability to perform their job.
03
Employees facing challenging life events, such as loss, trauma, or relationship problems, and need professional support to cope.
04
Employees struggling with substance abuse, addiction, or dependency issues that require intervention and treatment.
05
Employees requiring assistance in addressing work-life balance, conflict resolution, or improving interpersonal relationships.
06
Employees seeking guidance, counseling, or therapy to enhance their personal development and emotional resilience.
07
Employees who may have received recommendations from supervisors, HR, or colleagues to seek the support of an employee assistance program.
08
Employees who are interested in accessing resources, referrals, or confidential assistance related to their mental health or personal well-being.
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