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ASCENT PSYCHOTHERAPY Centenary: Date of Birth: Alexander: Revalidate of Evaluation: Child and Adolescent Intake I Section Page 1 of 5IDENTIFYING INFORMATION: Name of the person providing information:
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How to fill out child and adolescent intake
01
Begin by gathering all necessary information and documents.
02
Start by filling out the general information section, which includes personal details of the child or adolescent such as name, age, date of birth, and contact information.
03
Move on to the medical history section, where you will provide details about any current or past illnesses, surgeries, medications, allergies, and immunization records.
04
Next, fill out the developmental history section, which focuses on the child's physical, cognitive, emotional, and social development milestones.
05
Proceed to complete the family history section, where you will provide information about any genetic or hereditary conditions that run in the family.
06
In the behavioral assessment section, answer questions regarding the child's behavior, temperament, and any emotional or psychological issues they may be experiencing.
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Finally, review the filled-in intake form for accuracy, make any necessary corrections, and ensure all required fields are completed.
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Once you are satisfied with the form, sign and date it to indicate completion.
09
Submit the filled-out child and adolescent intake form to the relevant party or healthcare provider.
Who needs child and adolescent intake?
01
Any child or adolescent seeking healthcare or therapeutic services may require a child and adolescent intake.
02
This intake form helps healthcare providers gather essential information about the child's medical history, developmental milestones, and family background.
03
It allows healthcare professionals to assess and understand the child's overall health, emotional well-being, and any potential risk factors.
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Various professionals, including pediatricians, psychologists, therapists, and counselors, may use the child and adolescent intake form to provide appropriate care and support based on the individual's needs.
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