SOP 508.24-att-7: Antipsychotic Monitoring Log (M60-01-07) - Weight & Waist Circumference Record

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

Summary

This form is used to track and monitor weight and waist circumference measurements for incarcerated individuals receiving antipsychotic medications. Healthcare staff must record weight measurements at minimum once every three months and waist circumference measurements at minimum once per year. The completed form is maintained in the offender's medical file and retained for 10 years after the conclusion of mental health services or sentence completion.

Key Topics

  • antipsychotic medications
  • weight monitoring
  • waist circumference
  • metabolic side effects
  • mental health monitoring
  • medication management
  • offender health records
  • quarterly measurements
  • annual measurements
  • M60-01-07 form

Full Text

SOP 508.24
Attachment 7

8/15/22

|ANTIPSYCHOTIC
Weight & Waist Record|Col2|Name|Col4|Col5|
|---|---|---|---|---|
|ANTIPSYCHOTIC
Weight & Waist Record|ANTIPSYCHOTIC
Weight & Waist Record|GDC ID#

|GDC ID#

|GDC ID#

|
|ANTIPSYCHOTIC
Weight & Waist Record|ANTIPSYCHOTIC
Weight & Waist Record|DOB

|DOB

|DOB

|
|ANTIPSYCHOTIC
Weight & Waist Record|ANTIPSYCHOTIC
Weight & Waist Record|Race Gender
|Race Gender
|Race Gender
|
|
YEAR 20_____


|1ST Quarter

|2ND Quarter|3rd Quarter|4th Quarter|
|~~Weight (lbs)~~
MIMIMUM OF ONCE EVERY 3 MONTHS|

||||
|Waist Circumference
MIMIMUM OF ONCE A YEAR|||||
||||||
|
YEAR 20_____


|1~~ST~~ Quarter

|2~~ND~~ Quarter|3rd Quarter|4~~th~~ Quarter|
|~~Weight (lbs)~~
MIMIMUM OF ONCE EVERY 3 MONTHS|

||||
|Waist Circumference
MIMIMUM OF ONCE A YEAR|||||
||||||
|
YEAR 20_____


|1~~ST~~ Quarter

|2~~ND~~ Quarter|3rd Quarter|4~~th~~ Quarter|
|~~Weight (lbs)~~
MIMIMUM OF ONCE EVERY 3 MONTHS|

||||
|Waist Circumference
MIMIMUM OF ONCE A YEAR|||||
||||||
|
YEAR 20_____


|1~~ST~~ Quarter

|2~~ND~~ Quarter|3rd Quarter|4~~th~~ Quarter|
|~~Weight (lbs)~~
MIMIMUM OF ONCE EVERY 3 MONTHS|

||||
|Waist Circumference
MIMIMUM OF ONCE A YEAR|||||
||||||

Form no. M60-01-07

Retention Schedule: Completed forms shall be placed in the offender’s medical file (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.

Attachments (8)

  1. Anxiolytic Informed Consent Form (M60-01-01H) (87 words)
  2. Abnormal Involuntary Movement Scale (AIMS) Assessment Form (637 words)
  3. Lockdown SLU_ACU_CSU Temperature Log (136 words)
  4. Medication Information for Hot Weather (380 words)
  5. Psychology_Psychiatry Transfer Evaluation (187 words)
  6. Initial Psychiatric/Psychological Evaluation (Form M60-01-06) (451 words)
  7. Antipsychotic Monitoring Log (M60-01-07) - Weight & Waist Circumference Record (190 words)
  8. Instructions for Completing Antipsychotic Weight & Waist Record (M60-01-08) (616 words)
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