SOP_NUMBER: 508.28-att-5
TITLE: Observation Cell Notification (Form M68-01-05)
DIVISION: Mental Health Services
TOPIC_AREA: 508 Policy - MH Suicide Prevention/ACU/CSU/BTU
EFFECTIVE_DATE: 2019-08-12
WORD_COUNT: 72
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/519760
URL: https://gps.press/sop-data/508.28-att-5/

SUMMARY:
This form is used to notify appropriate personnel when an inmate is placed in an observation cell for mental health monitoring or suicide prevention purposes. The completed form must be distributed to the Warden/Superintendent, faxed to the Statewide Mental Health Director, and filed in the inmate's mental health record. Mental health files are retained for 10 years after the inmate no longer requires mental health services or completes their sentence.

KEY_TOPICS: observation cell, suicide prevention, mental health notification, inmate monitoring, mental health file, form M68-01-05, record retention, behavioral management, ACU, CSU, BTU

ATTACHMENTS:
  1. Certificate of Approval for Crisis Stabilization Unit (CSU), Acute Care Unit (ACU), and Observation Cells
     URL: https://gps.press/sop-data/508.28-att-1/
  2. Offender Critical Incident Notification Form
     URL: https://gps.press/sop-data/508.28-att-2/
  3. Observation Cell Log
     URL: https://gps.press/sop-data/508.28-att-3/
  4. Suicide/Self-Injurious/Assaultive Behavior Information Form
     URL: https://gps.press/sop-data/508.28-att-4/
  5. Observation Cell Notification (Form M68-01-05)
     URL: https://gps.press/sop-data/508.28-att-5/
  6. Cell Analysis Form (M68-01-10)
     URL: https://gps.press/sop-data/508.28-att-6/

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FULL TEXT:
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SOP 508.28
Attachment 5

8/12/19


Form no. M68-01-05 Page  1 of 1


Retention Schedule: Completed forms shall be given to the Warden/Superintendent (original), faxed to the
Statewide Mental Health Director and a copy placed in the offender’s mental health file (section 8). 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.