SOP 508.22-att-3: Mental Health Sexual Allegation Follow-Up Report

Division:
Mental Health Administration
Effective Date:
May 3, 2018
Reference Code:
VG55-0001
Topic Area:
508 Policy - MH Administration/Staff/Certification
PowerDMS:
View on PowerDMS
Length:
100 words

Summary

This form is used to document and follow up on sexual allegations involving offenders in GDC custody. Staff complete this report when an offender is involved in a sexual allegation (whether offender-on-offender or staff-on-offender) and place the report in both the offender's medical record and mental health file. The document is confidential and must be retained for 10 years after the offender no longer needs mental health services or completes their sentence.

Key Topics

  • mental health evaluation
  • sexual allegation
  • offender-on-offender
  • staff-on-offender
  • follow-up report
  • mental health file
  • medical record
  • confidential form
  • sexual misconduct
  • incident documentation

Full Text

SOP 508.22
Attachment 3

5/3/18

GEORGIA DEPARTMENT OF CORRECTIONS Facility: _______________________________

MENTAL HEALTH SEXUAL ALLEGATION Name: _________________________________

FOLLOW - UP REPORT GDC #: ________________________________

DOB: _________________________________

Race: _________________ Sex: ___________

This offender was involved with a sexual allegation on _________________ (date).

The allegation was ____________________________________________.
(offender-on-offender; staff-on-offender)

____________________________________________________ ________________________
Signature/Title Date

Printed name: ____________________________________________________
# CONFIDENTIAL

Form no. M55-01-03

Retention Schedule: Upon completion, the original form shall be placed in the offender’s medical record (section 5) and mental health file
(section 4). 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.

Attachments (4)

  1. Sexual Allegation Notification and Evaluation Log (87 words)
  2. Consent to Sexual Abuse Evaluation (343 words)
  3. Mental Health Sexual Allegation Follow-Up Report (100 words)
  4. Mental Health Initial Sexual Allegation Evaluation (616 words)
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