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  • Initial Intake Form

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    Barangay Lawaan-ll
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    This document is an intake form used by the office of the Barangay Captain in Talisay City, Cebu Province, Philippines. The form collects personal information about clients, including their name, age, address, education, and referring party. It also gathers family background details and documents the reason for referral, which could include issues like human trafficking, child sexual exploitation, abuse, or other types of exploitation. A section is included to record any initial facts learned about the client's case. The form appears to be used to officially document new cases reported to or referred to the barangay office.

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    This document is an intake form used by the office of the Barangay Captain in Talisay City, Cebu Province, Philippines. The form collects personal information about clients, including their name, age, address, education, and referring party. It also gathers family background details and documents the reason for referral, which could include issues like human trafficking, child sexual exploitation, abuse, or other types of exploitation. A section is included to record any initial facts learned about the client's case. The form appears to be used to officially document new cases reported to or referred to the barangay office.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    Download as docx, pdf, or txt
    22 views2 pages

    Initial Intake Form

    Uploaded by

    Barangay Lawaan-ll
    This document is an intake form used by the office of the Barangay Captain in Talisay City, Cebu Province, Philippines. The form collects personal information about clients, including their name, age, address, education, and referring party. It also gathers family background details and documents the reason for referral, which could include issues like human trafficking, child sexual exploitation, abuse, or other types of exploitation. A section is included to record any initial facts learned about the client's case. The form appears to be used to officially document new cases reported to or referred to the barangay office.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 2

    Republic of the Philippines

    Province of Cebu
    City of Talisay
    Barangay Lawa-an II
    Tel. no. 272-4700

    OFFICE OF THE BARANGAY CAPTAIN

    INITIAL INTAKE FORM


    Case No.
    I. Personal Data
    Name : __________________________________ Nickname : ___________
    Birthdate : __________________________________ Age : ___
    Birth Place: __________________ Contact # : ___________
    Home Address : ___________________________________________________________
    Educational Attainment : ______________________________
    Referring Party : _____________________ Contact # : ___________

    II. Family Background


    Name Relationship to Age Educational Source of
    Client Attainment Income

    III. Reason for Referral:


    _____ Trafficking in Persons, for the purpose of:
    _____Sexual Exploitation ______Forced Labor or Slaverly
    _____Sale of Organs ______Armed Activities
    _____Other types of exploitation,specify____
    _____Child Sexual Exploitation:
    _____Child Trafficking ______Child Prostitution
    _____Child Pornography ______Child Labor
    _____Child Abuse:
    _____Physical Abuse ______Sexual Abuse
    _____Verbal Abuse ______Psychological Abuse
    _____Other types of abuse, specify_____

    IV. Initial Facts Gathered


    ________________________________________________________________________________
    ________________________________________________________________________________
    ________________________________________________________________________________
    ________________________________________________________________________________
    ________________________________________________________________________________
    ________________________________________________________________________________

    Prepared by: Noted By:


    THERESA BAÑES JR. HON. JOSE EDWIN R. ETCOBANEZ
    Barangay Focal Barangay Captain

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