SOP 508.15-att-5: Requested Records Log

Division:
Mental Health Services
Effective Date:
August 15, 2022
Topic Area:
508 Policy-MH Evaluations/Screenings/Treatment
PowerDMS:
View on PowerDMS
Length:
56 words

Summary

This is a tracking form used by mental health staff to document and manage requests for offender records from other facilities or locations. The form records offender identifying information, where records were requested from, dates of request and receipt, and any follow-up actions needed. Completed forms must be retained in the mental health area for four years.

Key Topics

  • records request
  • mental health records
  • offender information
  • tracking log
  • records management
  • inter-facility requests
  • follow-up actions
  • GDC number
  • mental health documentation

Full Text

# Requested Records Log

Facility: ____________________________________________

SOP 508.15
Attachment 5

8/15/22

|Offender Name|GDC #|Social Security #|Location Records
Requested From|Date Request
Mailed/Faxed|Date Records
Received|Follow-Up Actions|Col8|
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Form no. M31-01-05 Page 1 of 1

Retention Schedule: Completed forms shall be maintained in the mental health area for four (4) years, then destroyed or archived.

Attachments (5)

  1. Mental Health Evaluation for Services (Form M31-01-01) (795 words)
  2. Mental Status Evaluation (Attachment 2) (79 words)
  3. Authorization for Release of Information (Mental Health Services) (359 words)
  4. Parole Evaluation Log (Form M31-01-04) (53 words)
  5. Requested Records Log (56 words)
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