SOP_NUMBER: 508.29-att-3
TITLE: Suicide Precautions Rounds
WORD_COUNT: 201
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/407636
URL: https://gps.press/sop-data/508.29-att-3/

ATTACHMENTS:
  1. Suicide Risk Assessment Instrument
     URL: https://gps.press/sop-data/508.29-att-1/
  2. Suicide Precautions Treatment Plan
     URL: https://gps.press/sop-data/508.29-att-2/
  3. Suicide Precautions Rounds
     URL: https://gps.press/sop-data/508.29-att-3/
  4. Suicide Precautions Log
     URL: https://gps.press/sop-data/508.29-att-4/

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FULL TEXT:
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SOP 508.29
Attachment 3

7/1/20







|Suicide Precautions (SP)<br>Rounds<br>(to be completed by the<br>psychiatrist/psychologist during rounds<br>on offenders/detainees on SP status)|Facility: ________________________<br>Offender: _______________________<br>GDC ID#: ______________________<br>DOB: __________________________<br>Race: ___________ Sex: __________<br>Date: __________________________|
|---|---|
|<br>D.  Offender/Detainees current concerns:   __________________________________<br>___________________________________________________________________<br>___________________________________________________________________<br>___________________________________________________________________<br>Suicide risk indicators: ________________________________________________<br>___________________________________________________________________<br>___________________________________________________________________<br>___________________________________________________________________<br>Mental Status:_______________________________________________________<br>___________________________________________________________________<br>___________________________________________________________________<br>___________________________________________________________________<br>|<br>D.  Offender/Detainees current concerns:   __________________________________<br>___________________________________________________________________<br>___________________________________________________________________<br>___________________________________________________________________<br>Suicide risk indicators: ________________________________________________<br>___________________________________________________________________<br>___________________________________________________________________<br>___________________________________________________________________<br>Mental Status:_______________________________________________________<br>___________________________________________________________________<br>___________________________________________________________________<br>___________________________________________________________________<br>|
|<br>A.   Current assessment (include risk/protective issues): ______________________________<br>     ___________________________________________________________________<br>     ___________________________________________________________________<br>     ___________________________________________________________________<br>The main psychiatric diagnoses is: [  ] unchanged<br>     [  ] changed to:______________________________________________________<br>|<br>A.   Current assessment (include risk/protective issues): ______________________________<br>     ___________________________________________________________________<br>     ___________________________________________________________________<br>     ___________________________________________________________________<br>The main psychiatric diagnoses is: [  ] unchanged<br>     [  ] changed to:______________________________________________________<br>|
|<br>P.   Suicide Precautions Status: [  ] no change<br>     [  ] change to_______________________________________________________<br>     Property restriction/safety precautions: [  ] no change<br>     [  ] change (add or delete) as follows:____________________________________<br>     ___________________________________________________________________<br>     ___________________________________________________________________<br>     Recommended therapeutic interventions: _________________________________<br>     ___________________________________________________________________<br>     ___________________________________________________________________<br>     ___________________________________________________________________<br>     Recommended Level: ______<br>|<br>P.   Suicide Precautions Status: [  ] no change<br>     [  ] change to_______________________________________________________<br>     Property restriction/safety precautions: [  ] no change<br>     [  ] change (add or delete) as follows:____________________________________<br>     ___________________________________________________________________<br>     ___________________________________________________________________<br>     Recommended therapeutic interventions: _________________________________<br>     ___________________________________________________________________<br>     ___________________________________________________________________<br>     ___________________________________________________________________<br>     Recommended Level: ______<br>|
|<br>________________________________________         ___________________<br> Signature (PhD or MD)                                          Date<br>|<br>________________________________________         ___________________<br> Signature (PhD or MD)                                          Date<br>|


Form no. M69-01-03                                                                               Page 1 of 1

Retention Schedule: Completed forms shall be placed in the offender’s mental health file section 1) and a copy in the medical record
(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.