SOP_NUMBER: 508.24-att-7
TITLE: Antipsychotic Monitoring Log (M60-01-07) - Weight & Waist Circumference Record
DIVISION: Mental Health Services
TOPIC_AREA: 508 Policy-MH Evaluations/Screenings/Treatment
EFFECTIVE_DATE: 2022-08-15
WORD_COUNT: 190
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/290564
URL: https://gps.press/sop-data/508.24-att-7/

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

ATTACHMENTS:
  1. Anxiolytic Informed Consent Form (M60-01-01H)
     URL: https://gps.press/sop-data/508.24-att-1/
  2. Abnormal Involuntary Movement Scale (AIMS) Assessment Form
     URL: https://gps.press/sop-data/508.24-att-2/
  3. Lockdown SLU_ACU_CSU Temperature Log
     URL: https://gps.press/sop-data/508.24-att-3/
  4. Medication Information for Hot Weather
     URL: https://gps.press/sop-data/508.24-att-4/
  5. Psychology_Psychiatry Transfer Evaluation
     URL: https://gps.press/sop-data/508.24-att-5/
  6. Initial Psychiatric/Psychological Evaluation (Form M60-01-06)
     URL: https://gps.press/sop-data/508.24-att-6/
  7. Antipsychotic Monitoring Log (M60-01-07) - Weight & Waist Circumference Record
     URL: https://gps.press/sop-data/508.24-att-7/
  8. Instructions for Completing Antipsychotic Weight & Waist Record (M60-01-08)
     URL: https://gps.press/sop-data/508.24-att-8/

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FULL TEXT:
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SOP 508.24
Attachment 7

8/15/22










|ANTIPSYCHOTIC<br>Weight & Waist Record|Col2|Name|Col4|Col5|
|---|---|---|---|---|
|ANTIPSYCHOTIC<br>Weight & Waist Record|ANTIPSYCHOTIC<br>Weight & Waist Record|**GDC ID#**<br>  <br>|**GDC ID#**<br>  <br>|**GDC ID#**<br>  <br>|
|ANTIPSYCHOTIC<br>Weight & Waist Record|ANTIPSYCHOTIC<br>Weight & Waist Record|**DOB**<br> <br>|**DOB**<br> <br>|**DOB**<br> <br>|
|ANTIPSYCHOTIC<br>Weight & Waist Record|ANTIPSYCHOTIC<br>Weight & Waist Record|**Race                                             Gender** <br>|**Race                                             Gender** <br>|**Race                                             Gender** <br>|
|<br>**YEAR      20_____** <br>  <br> <br>|**1ST Quarter** <br><br>|**2ND Quarter**|**3rd Quarter**|**4th Quarter**|
|~~**Weight (lbs)**~~ <br>**MIMIMUM OF ONCE EVERY 3 MONTHS**|<br> <br>||||
|**Waist Circumference**<br>**MIMIMUM OF ONCE A YEAR**|||||
||||||
|<br>**YEAR      20_____** <br>  <br> <br>|**1**~~**ST**~~** Quarter** <br><br>|**2**~~**ND**~~** Quarter**|**3rd Quarter**|**4**~~**th**~~** Quarter**|
|~~**Weight (lbs)**~~ <br>**MIMIMUM OF ONCE EVERY 3 MONTHS**|<br> <br>||||
|**Waist Circumference**<br>**MIMIMUM OF ONCE A YEAR**|||||
||||||
|<br>**YEAR      20_____** <br>  <br> <br>|**1**~~**ST**~~** Quarter** <br><br>|**2**~~**ND**~~** Quarter**|**3rd Quarter**|**4**~~**th**~~** Quarter**|
|~~**Weight (lbs)**~~ <br>**MIMIMUM OF ONCE EVERY 3 MONTHS**|<br> <br>||||
|**Waist Circumference**<br>**MIMIMUM OF ONCE A YEAR**|||||
||||||
|<br>**YEAR      20_____** <br>  <br> <br>|**1**~~**ST**~~** Quarter** <br><br>|**2**~~**ND**~~** Quarter**|**3rd Quarter**|**4**~~**th**~~** Quarter**|
|~~**Weight (lbs)**~~ <br>**MIMIMUM OF ONCE EVERY 3 MONTHS**|<br> <br>||||
|**Waist Circumference**<br>**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.