[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-245763-105":53,"doc-detail-245763-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","ccp-screeningintake-template","CCP Screening/Intake Template","","CCP Screening/Intake Template is a structured client intake form used to collect referral details, personal demographics, and contact information, then document reasons for seeking CCP services and assessed needs. It includes sections for client priority level, risk factors, and safety-related questions about harming self or others, plus immediate harm checks and substance use considerations. The form captures decision outcomes, action taken, referral status, next steps, and staff signature and position.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/ccp-screeningintake-template/245763/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/ccp-screeningintake-template/245763.png","ImageObject",442,249,{"name":88,"@type":89},"Emma Wilson","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-23","2026-09-12",true,{"@type":98,"interactionType":99,"userInteractionCount":25},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What referral and contact details does the CCP intake template collect?","Question",{"text":108,"@type":109},"It records referral type (self-referral, referred by others, or EAP/EFAP), agency or employer details for walk-ins, and collects phone and address information for the client.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"How does the form assess client risk and safety concerns?",{"text":113,"@type":109},"It asks whether the client has thoughts of harming self or others, whether there is immediate possible harm, and whether the intake worker has concerns about safety. It also includes substance use, family violence, sexual assault, and past suicidal ideation/attempt fields with a risk level selection.",{"name":115,"@type":106,"acceptedAnswer":116},"What sections capture the staff decision and follow-up actions?",{"text":117,"@type":109},"The template includes an Action Taken area, Next Steps for future tasks, whether the client is referred to another service and which services, and it ends with the CCP staff signature and position.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},245763,1791300412,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":25,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":79,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":73},3848291630094,"https://eur-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","SCREENING/INTAKE TEMPLATE  \nClient Name:  Date:    \nCCP Staff Name:    \n\n| Referral\u003Cbr> Self-referral (circle one)\u003Cbr> Referred by other\u003Cbr> EAP/EFAP (circle one) | Phone Walk-In\u003Cbr>Agency Name:  \u003Cbr>Yes No |\n| --- | --- |\n| If yes, employer:   |  |\n\nClient Information  \nName:    \nDate of Birth:    \nHealthcare Number:   Health Care Expiry:    \nGender (circle one): Male Female  \nAddress:    \n___________________________  \n___________________________  \n___________________________  \nPhone Number:  \nHome:    \nCell:    \nOther:    \nIs it okay to leave a message? (circle one) Yes No  \nReasons for Seeking CCP Services  \nWhat brings you here?  \n_________________________________________________________________________________________________________  \n_________________________________________________________________________________________________________  \n_____  \nHow can I help you?  \n_________________________________________________________________________________________________________  \n_____  \nClient’s Need(s)  \n_________________________________________________________________________________________________________  \n_____  \nOther information that may be important to assess client’s needs for service  \n_________________________________________________________________________________________________________  \n_________________________________________________________________________________________________________  \nClient Priority Level and Risk Factors Level of Risk  \nThis section is to be filled out if intake worker has concerns over the safety of the client   \nor of the safety of another person  \nDo you currently have thoughts of harming yourself? (circle response):  \nNo Yes  \nIf yes, use suicide intervention protocol  \nDo you currently have thoughts of harming someone else? (circle response)  \nNo Yes  \nIs there any immediate possible harm to you or someone else?  \nNo Yes  \nIf the client answered yes to any of these questions they are at high risk  \n Current substance use or abuse (if yes, which substance(s)):    \n Family violence (current)  \n Sexual Assault (current)  \n Past suicidal ideation or attempt  \n Other (please identify):    \nRisk Factors (please check all that apply):  \nRisk Level (Circle one):  \nHigh Medium Low  \n\n| Client Priority Level:\u003Cbr>Needs to be seen immediately Needs to be seen within a week | Needs to be seen within 24 hours\u003Cbr>Waitlist |\n| --- | --- |\n\nDecision  \nAction Taken:  \n_________________________________________________________________________________________________________  \n_________________________________________________________________________________________________________  \n_____  \nNext Steps: (please write any actions that may need to be taken in the future)  \n_________________________________________________________________________________________________________  \n_________________________________________________________________________________________________________  \n_____  \nWas client referred to another service? (circle one): Yes No  \nIf yes, which service(s):    \nSignature of CCP Staff:    \nPosition of CCP Staff:","cbCaim8rU8LEHAkJ","https://ap.wps.com/l/cbCaim8rU8LEHAkJ","pdf",782049,"English","# Client Information\n## Reasons for Seeking CCP Services\n## Client’s Need(s)\n## Client Priority Level and Risk Factors\n## Decision","[{\"question\":\"What referral and contact details does the CCP intake template collect?\",\"answer\":\"It records referral type (self-referral, referred by others, or EAP/EFAP), agency or employer details for walk-ins, and collects phone and address information for the client.\"},{\"question\":\"How does the form assess client risk and safety concerns?\",\"answer\":\"It asks whether the client has thoughts of harming self or others, whether there is immediate possible harm, and whether the intake worker has concerns about safety. It also includes substance use, family violence, sexual assault, and past suicidal ideation/attempt fields with a risk level selection.\"},{\"question\":\"What sections capture the staff decision and follow-up actions?\",\"answer\":\"The template includes an Action Taken area, Next Steps for future tasks, whether the client is referred to another service and which services, and it ends with the CCP staff signature and position.\"}]","CCP Screening/Intake Template | PDF",1789230978]