An intake form is completed for every juvenile admitted to the facility and contains at least the following information:

1. (1) Date and time of admission and release;
2. (2) Name and nicknames;
3. (3) Last known address;
4. (4) Legal status (authority for admission);
5. (5) Name of attorney, if any;
6. (6) Name, title, and signature of delivering officer;
7. (7) Specific charge or charges;
8. (8) Sex, date of birth, place of birth, race/nationality;
9. (9) Education and school attended;
10. (10) Employment, if any;
11. (11) Religion/denominational preference;
12. (12) Health status;
13. (13) Medical consent forms;
14. (14) Name, relationship, address, and telephone number of the parent or parents, guardian or guardians, or person or persons the juvenile resides with at time of admission;
15. (15) Driver's license number, Social Security number, and Medicaid number if applicable;
16. (16) Court and disposition, if any;
17. (17) Space for remarks (to include notation of any open wounds or sores requiring treatment, evidence of disease or body vermin, tattoos, etc.);
18. (18) Person recording data;
19. (19) Inventory of property; and
20. (20) Emergency contact person or persons.