SOP 209.01-att-9: MH/MR Evaluation for Disciplinary Action
Summary
Key Topics
- MH/MR evaluation
- mental health assessment
- disciplinary competency
- mental illness
- intellectual disability
- mitigating circumstances
- disciplinary hearing
- institutional discipline
- mental health services
- competency evaluation
Full Text
SOP 209.01
Attachment 9
11/6/17
GEORGIA DEPARTMENT OF CORRECTIONS FACILITY: _________________________
MH/MR SERVICES NAME: _____________________________
MH/MR EVALUATION FOR DISCIPLINARY ACTION ID#: _______________________________
DOB: ______________________________
RACE: ___________ SEX: ____________
MH/MR OFFENDER’S DISCIPLINARY REPORT DATED: ____________________________________
DISCIPLINARY REPORT NUMBER: _______________
I. A review of the Disciplinary Report and the offender’s mental health status indicates the
following:
_____ The Offender is competent to proceed with the disciplinary investigation and hearing.
_____ The Offender is not competent to proceed with the disciplinary investigation and hearing.
II. A review of the circumstances surrounding the infraction and the offender’s mental status
indicated the following:
_____ There are no mitigating MH/MR circumstances surrounding the offender’s violation of
institutional/department rules.
_____ There are mitigating MH/MR circumstances surrounding the offender’s violation of
institutional/department rules.
Mitigating MH/MR circumstances or sanctions to be considered by the Disciplinary Hearing Officer are
Listed below:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
________________________________________________________ _____________________
MH/MR Evaluator Title Date
________________________________________________________ _____________________
MH/MR Clinical Consultant Date
________________________________________________________ _____________________
Hearing Officer Signature Date
Form M34-01-01
Retention Schedule: Upon, completion, the original shall go to the Disciplinary Hearing Officer and a copy
shall be placed in the Mental Health Record and in the offender’s institutional file, except for those
overturned or dismissed, and shall be maintained according to the official records retention schedule for
institutional files.
SOP 209.01
Attachment 9
11/6/17
Retention Schedule: Upon, completion, the original shall go to the Disciplinary Hearing Officer and a copy
shall be placed in the Mental Health Record and in the offender’s institutional file, except for those
overturned or dismissed, and shall be maintained according to the official records retention schedule for
institutional files.