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Intake Worksheets (Blank and Example)

Provided by the Medical University of South Carolina, this document covers their sample intake forms.
File Type: pdf
File Size: 74 KB
Categories: THIB24
Tags: worksheet

About SCTRC

Since 2010, the South Central Telehealth Resource Center (SCTRC) has been providing telehealth training and technical assistance. We offer a wide variety of services and resources to help develop, maintain, and expand telehealth services. While we strive to help anyone reaching out to us for assistance, we prioritize the needs of those who work with rural and other underserved communities and populations in our region — Arkansas, Mississippi, and Tennessee. The SCTRC offers in-person and virtual assistance including on-site demos at our regional telehealth training centers, and popular online resources here such as billing and reimbursement guides, beginner courses, a variety of webinars and recordings, podcasts, and more. The SCTRC team is eager to hear more about your efforts and to brainstorm how we could work together to expand telehealth adoption.

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Staff & Advisory Council

The SCTRC is staffed by telehealth professionals with backgrounds in nursing, business, education & instructional design, and mass media/communications.

Staff Directory »

The SCTRC also works with a dedicated group of professionals who comprise the SCTRC Advisory Council. This group provides a grassroots voice for the telehealth initiatives needed in Arkansas, Mississippi, and Tennessee.

Advisory Council List »

The SCTRC is proud to be part of the National
Consortium of Telehealth Resource Centers
SCTRC / UAMS Institute for Digital Health & Innovation

The South Central Telehealth Resource Center is made possible by Grant #U1UTH42528 from the Office for the Advancement of Telehealth, Health Resources and Services Administration, DHHS, and the support of the UAMS Institute for Digital Health & Innovation. Please note: This information, content, and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. The information and tools presented on the SCTRC website should not be considered legal advice. The SCTRC is not guaranteeing that any information provided will result in reimbursement from a payer. All materials are strictly for informational and educational purposes. The SCTRC encourages you to check with the appropriate state agency for further information and direction for legal opinions, interpretation of the laws, regulations, and/or policies. Additionally, please consult with your legal counsel or attorney if seeking legal opinions. © 2024 Board of Trustees of the University of Arkansas acting for and on behalf of the University of Arkansas for Medical Sciences. All Rights Reserved.

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