It's Monday. Your new client just left after a ninety-minute intake. You've got pages of handwriting — the marriage, the job at the hospital, the brother who overdosed, the sleep that stopped in March — and a blank biopsychosocial template sitting there, ready to swallow your next hour.
Five weeks in now. We've cleared note debt, gotten insurance to say yes, handled the parent email, built treatment plans, and written psychoeducation your clients actually read. Today: the intake writeup — plus an honest catch I want to name out loud.
Today's one idea: turn a short de-identified summary into a structured biopsychosocial draft, so the first-session writeup takes half the time.
First, the one rule — and the honest catch
Never put client names, records, or identifying details into an AI tool. Ever. You bring the clinical judgment and de-identified inputs; the AI helps with structure and wording.
Here's the catch, said plainly: an intake is the most saturated document you own. Name, employer, family, dates, diagnoses, quotes — it's PHI top to bottom. If you tried to scrub the raw intake line by line, the stripping would cost you more than the tool ever saves. That's the de-identification tax, and on this note it's real.
So we don't scrub the intake. We never paste it at all.
The redaction reflex
Don't de-identify the document. Write your own six bullets from memory instead. It's faster than redacting, and nothing identifying ever leaves your desk.
Instead of "Maria, 34, a nurse at St. Mary's, referred by her PCP for panic attacks since her father died in March," you write:
Adult client, recent bereavement
Presenting problem: panic episodes since a family loss
History themes: caregiving-role strain, recent grief
Functional impact: sleep disruption, trouble concentrating at work
Strengths and supports: steady work history, one close relationship to lean on
Relevant history to reflect: brief prior counseling, no hospitalizations
Generic. No name, no employer, no date. That short list is all the AI ever sees.
The workflow
The real win here is a scaffold you build once and reuse on every intake. Two prompts.
Prompt 1 — build your reusable template (do this one time):
You are helping a licensed therapist build a reusable, blank biopsychosocial intake template — no client data. Create section headers with one short prompting question under each, covering: presenting problem, history of the present concern, past mental health and treatment, relevant medical history, family and relational history, developmental and social history, substance use, strengths and supports, risk considerations, and clinical formulation. Keep it concise and standard for an outpatient setting. Output a clean template I can save and reuse.Save that. It's yours now.
Prompt 2 — draft one intake from your bullets:
You are helping a licensed therapist turn a de-identified bullet summary into a structured biopsychosocial intake draft, using standard outpatient section headings. Here are the de-identified details:
- Presenting problem: [...]
- History themes: [...]
- Functional impact (sleep, work, relationships): [...]
- Strengths and supports: [...]
- Relevant history I want reflected: [...]
Write in professional clinical language. Wherever a specific identifier, date, or quote belongs, leave a clearly marked [add in EHR] placeholder instead of guessing. Use only the details I provided. Do not invent history, symptoms, quotes, or a diagnosis.Finish it like the clinician you are
The draft is scaffolding, never the finished note. Open your EHR, drop the real names, dates, and quotes into those [add in EHR] spots, and let the specifics live where they belong — inside your secure system. The formulation, the risk assessment, the diagnosis, the medical necessity language: those are yours. The AI organized the frame. You do the clinical thinking.
The blank template used to be the hard part — that hour of shaping the same ten sections from scratch after a draining intake. Now the frame is already there when you sit down. What's left is the part only you can do.
Try it this week
Before your next intake, run Prompt 1 once and save the template. After the session, write your six bullets and run Prompt 2. Time it against your usual writeup.
Then hit reply and tell me which intake section eats the most of your time — formulation, social history, risk? I'm building the next issue from what you send back.
Talk soon,
Shaun
P.S. Know a therapist who dreads intake week? Forward this. The template alone might hand them back an evening.
A quick but important note: this newsletter is for general educational and informational purposes only. It shares time-saving ideas, not advice. The views here are the author's own and don't represent any employer, school district, or agency. Nothing here is legal, clinical, compliance, or supervisory advice, and AI can be wrong. Always follow your licensing board's rules and your employer's and state's policies (especially on AI use), along with your HIPAA and FERPA obligations, and check with the right person before acting on anything significant. You are the professional: review and finalize everything yourself. And never put client names or protected health information into any AI tool.