SOP 508.16-att-1: Counselor Discharge Summary Note

SOP 508.16
Attachment 1

5/9/18

GEORGIA DEPARTMENT OF CORRECTIONS Facility: ____________________________

Mental Health Discharge Progress Note Name: _____________________________

“ Discharge Summary” ID#: _______________________________

Date: ________________ DOB: ______________________________

Race: __________ Sex: ______________

I. Data: Purpose: Discharge from Mental Health Services.

The treating psychiatrist/APRN _________________________ and/or Clinical
(name)
Director/psychologist ______________________ in collaboration with the Mental
(name)
Health Unit Manager __________________________ and the Mental Health Counselor
(name)
have decided to discharge this offender from the caseload. The offender was Level II

from ___________ to ___________ and (was/was not) on medication.
(date) (date) (circle)

The offender’s medication was discontinued _________________________________
(date)

II. Assessment:

Diagnosis: __________________ Unchanged/Changed as of____________________
(circle) (date)

Comments: ____________________________________________________________

III. Plan: ___ ____Discontinue Mental Health Services_______________________________

________________________________________________________________________

Page ___ of ___ [ ] Attachment

Form no. M32-01-01

Retention Schedule: Completed forms shall be placed in the offender’s health file (medical – section 5). At the end
of the offender’s need for mental health services and/or sentence, the mental health file shall be placed within the
offender’s health record and retained for 10 years.