What are the penalties associated with non-compliance with your law? Why would it be important to you and your
Intake Assessment Template: Case of __________ Intake Date: Instruction:
Intake Assessment Template: Case of __________ Intake Date: Instruction: Respond to each applicable element (below). Use complete sentences and explain or describe accurately. Identifying/demographic data: Chief complaint/presenting problem: History of present illness: Past psychiatric history (evaluate any past diagnosis): Substance use history: Past medical history: Family history (including medical and