{"Name":"Intake Notes ( Standard)","Composition":{"Sections":[{"Label":"General Intake","Fields":[{"Type":2,"Text":null,"Label":"Intake officer","Options":[],"CurrentValue":null,"IsMultiple":false,"Mode":null,"Checked":false,"ActiveDrawing":null,"SelectedDrawing":null,"Annotations":[],"Rules":{"Required":{"Value":true}},"ProfileFieldType":"None"},{"Type":3,"Text":null,"Label":"Intake information provided by (full name, phone and email. 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What would you / they most like to get out of coming here?","Options":[],"CurrentValue":null,"IsMultiple":false,"Mode":null,"Checked":false,"ActiveDrawing":null,"SelectedDrawing":null,"Annotations":[],"Rules":{"Required":{"Value":true}},"ProfileFieldType":"None"},{"Type":3,"Text":null,"Label":"What times of day / days of week would be impossible to attend appointments? Are telehealth appointments possible? ","Options":[],"CurrentValue":null,"IsMultiple":false,"Mode":null,"Checked":false,"ActiveDrawing":null,"SelectedDrawing":null,"Annotations":[],"Rules":null,"ProfileFieldType":"None"},{"Type":3,"Text":null,"Label":"Other comments / Observations","Options":[],"CurrentValue":null,"IsMultiple":false,"Mode":null,"Checked":false,"ActiveDrawing":null,"SelectedDrawing":null,"Annotations":[],"Rules":{"Required":{"Value":true}},"ProfileFieldType":"None"}]},{"Label":"Branching triage","Fields":[{"Type":6,"Text":"I have a couple of standard safety questions that may or may not apply but I need to ask everyone who presents. Is that OK?","Label":"Safety Questions","Options":[],"CurrentValue":null,"IsMultiple":false,"Mode":null,"Checked":false,"ActiveDrawing":null,"SelectedDrawing":null,"Annotations":[],"Rules":null,"ProfileFieldType":"None"},{"Type":4,"Text":null,"Label":"IF CHILD / ADOL / YOUNG PERSON - \"Are you currently in a relationship with the other parent?\" If no.... then endorse... or if presented by step parent etc then endorse","Options":[],"CurrentValue":null,"IsMultiple":false,"Mode":null,"Checked":false,"ActiveDrawing":null,"SelectedDrawing":null,"Annotations":[],"Rules":null,"ProfileFieldType":"None"},{"Type":4,"Text":null,"Label":"Self / Other harm - \"Have you / they had any thoughts about harming yourself or others? Have you / they ever acted on those, and harmed yourself or someone else?\"","Options":[],"CurrentValue":null,"IsMultiple":false,"Mode":null,"Checked":false,"ActiveDrawing":null,"SelectedDrawing":null,"Annotations":[],"Rules":null,"ProfileFieldType":"None"},{"Type":4,"Text":null,"Label":"Eating Disorder - \"Are you / they experiencing any issues with food, weight or body image?\"","Options":[],"CurrentValue":null,"IsMultiple":false,"Mode":null,"Checked":false,"ActiveDrawing":null,"SelectedDrawing":null,"Annotations":[],"Rules":null,"ProfileFieldType":"None"},{"Type":4,"Text":null,"Label":"Psychosis - \"Have you / they had any experiences like seeing things that other people don't see, hearing voices, disturbing thoughts or images?\"","Options":[],"CurrentValue":null,"IsMultiple":false,"Mode":null,"Checked":false,"ActiveDrawing":null,"SelectedDrawing":null,"Annotations":[],"Rules":null,"ProfileFieldType":"None"}]},{"Label":"History","Fields":[{"Type":1,"Text":null,"Label":"We have a more detailed history form that helps the clinicians understand the background and goals in a little more detail. Are you happy to fill in the history form that I email you now or would you prefer to do it over the phone? ","Options":[{"Label":null,"Value":"Email","Selected":true},{"Label":null,"Value":"I prefer to do it over the phone","Selected":false}],"CurrentValue":null,"IsMultiple":false,"Mode":"Radio","Checked":false,"ActiveDrawing":null,"SelectedDrawing":null,"Annotations":[],"Rules":null,"ProfileFieldType":"None"},{"Type":6,"Text":"Email: Profile > Communication > New Email > Template: History (???)\nPhone: Profile > Admin > Admin forms: History form (???)","Label":null,"Options":[],"CurrentValue":null,"IsMultiple":false,"Mode":null,"Checked":false,"ActiveDrawing":null,"SelectedDrawing":null,"Annotations":[],"Rules":null,"ProfileFieldType":"None"}]}]},"FormType":"SessionNoteAdmin","Files":[],"HasSupplierNotification":false,"NotificationEmails":""}