SOP_NUMBER: 508.25-att-1
TITLE: Certificate of Referral for Emergency Admission (Form M65-01-01)
DIVISION: Mental Health Services
TOPIC_AREA: Mental Health Evaluations/Screenings/Treatment
EFFECTIVE_DATE: 2022-08-02
WORD_COUNT: 136
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/290537
URL: https://gps.press/sop-data/508.25-att-1/

SUMMARY:
This form is used to document and process emergency psychiatric hospital admissions for incarcerated individuals who require immediate mental health intervention. The original certificate is submitted to the psychiatric hospital, with copies retained in both the offender's mental health file and medical file. Completed forms are retained for 10 years following the end of the offender's need for mental health services or upon sentence completion.

KEY_TOPICS: emergency admission, psychiatric hospital referral, mental health crisis, emergency mental health evaluation, inmate mental health, certificate of referral, psychiatric emergency, mental health documentation, emergency psychiatric care, form M65-01-01

ATTACHMENTS:
  1. Certificate of Referral for Emergency Admission (Form M65-01-01)
     URL: https://gps.press/sop-data/508.25-att-1/
  2. Certificate of Mental Condition (Form M65-01-02)
     URL: https://gps.press/sop-data/508.25-att-2/
  3. Emergency Admission Rights of Offenders (Form M65-01-03)
     URL: https://gps.press/sop-data/508.25-att-3/
  4. Notification of Involuntary Hospitalization Due Process Committee Hearing
     URL: https://gps.press/sop-data/508.25-att-4/
  5. Involuntary Psychiatric Hospital Admission Review (Form M65-01-05)
     URL: https://gps.press/sop-data/508.25-att-5/

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FULL TEXT:
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SOP 508.25
Attachment 1
8/2/22


Form no. M65-01-01 Page  1 of 2

Retention Schedule: Completed forms shall be given to the Psychiatric Hospital (original), a copy placed in the offender’s mental health

file (section 5) and medical file (section 5). At the end of the offender’s need for mental health services and/or sentence, the mental
health file will be placed within the offender’s health record and retained for 10 years.


SOP 508.25
Attachment 1
8/2/22


Form no. M65-01-01 Page  2 of 2

Retention Schedule: Completed forms shall be given to the Psychiatric Hospital (original), a copy placed in the offender’s mental health

file (section 5) and medical file (section 5). At the end of the offender’s need for mental health services and/or sentence, the mental
health file will be placed within the offender’s health record and retained for 10 years.