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Initial Intake Form
"Need an Initial Intake Form for my Singapore-based medical clinic that complies with healthcare regulations and includes sections for medical history, insurance information, and emergency contacts, to be implemented by March 2025."
1. Personal Information: Basic contact details, identification information including name, NRIC/passport number, address, contact numbers, and email
2. PDPA Consent Declaration: Formal declaration of consent for data collection and processing as required by Singapore's PDPA 2012
3. Purpose Declaration: Clear statement outlining the specific purposes for which the information is being collected and how it will be used
4. Declaration of Truth: Client's attestation that all provided information is true, accurate and complete to the best of their knowledge
1. Medical History: Detailed medical background including conditions, medications, and previous treatments - used for healthcare service intake only
2. Financial Information: Financial details including income, assets, and financial history - used for financial service intake only
3. Emergency Contacts: Alternative contact information for emergency situations - recommended for healthcare or high-risk services
4. Employment Details: Current employment status, employer information, and job details - used when relevant to service provision
1. Privacy Policy: Detailed explanation of how personal data will be collected, used, disclosed and protected in accordance with PDPA requirements
2. Terms and Conditions: General terms governing the service provision and use of collected information
3. Required Documents Checklist: List of supporting documents that need to be submitted along with the intake form
4. Service-Specific Requirements: Additional forms or requirements specific to the particular service being provided
Authors
Service Provider
Client
Consent
Data Collection Purpose
Data Protection Officer
PDPA
Authorized Representatives
Services
Confidential Information
Processing
Third Party
Data Subject
Information
Form
Emergency Contact
Terms and Conditions
Privacy Policy
Effective Date
Collection
Use
Disclosure
Records
Withdrawal of Consent
Consent Declaration
Data Protection
Purpose of Collection
Information Use and Disclosure
Confidentiality
Record Keeping
Data Accuracy
Access and Correction Rights
Withdrawal of Consent
Data Retention
Third Party Disclosure
Emergency Contact Authorization
Declaration of Truth
Electronic Communication Consent
Marketing Preferences
Data Security
Cross-border Transfer
Service-Specific Requirements
Liability
Amendment Rights
Governing Law
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