SOP 508.30-att-1: Acute Care Unit Treatment Plan (Form M70-01-01)

Division:
Mental Health/Medical Services
Effective Date:
December 9, 2019
Topic Area:
Mental Health Evaluations, Screenings, and Treatment
PowerDMS:
View on PowerDMS
Length:
147 words

Summary

This form is used to document treatment plans for offenders admitted to the Acute Care Unit within GDC facilities. It records patient identification information, admission diagnoses, identified problems with corresponding goals and target dates, planned interventions, and responsible staff members. The completed form becomes part of the offender's mental health file and is retained for 10 years after the offender no longer needs mental health services or completes their sentence.

Key Topics

  • acute care unit
  • treatment plan
  • mental health treatment
  • mental health counselor
  • intervention plan
  • offender mental health
  • psychiatric treatment
  • problem-goal-intervention
  • mental health file
  • M70-01-01

Full Text

SOP 508.30
Attachment 1

12/9/19

|Acute Care Unit
Treatment Plan|Patient Identification
Facility: _________________________________________
Offender: ________________________________________
GDC ID#: ___________________ DOB: _______________
Race: ______________ Sex: ________________________|Col3|
|---|---|---|
|
Admission Diagnosis: ___________________________________________________________
|
Admission Diagnosis: ___________________________________________________________
|
Admission Diagnosis: ___________________________________________________________
|
|Problem #______


|Problem #______


|Problem #______


|
|Goal:


Target Date:|Goal:


Target Date:|Goal:


Target Date:|
|Interventions:






|Interventions:






|Person Responsible:
______________________
______________________
(Title)
Enter Date: _____________
Revised/Resolved: _______
Date: __________________|
|Problem #_______


|Problem #_______


|Problem #_______


|
|Goal:


Target Date:|Goal:


Target Date:|Goal:


Target Date:|
|Interventions:






|Interventions:






|Person Responsible:
______________________
______________________
(Title)
Enter Date: _____________
Revised/Resolved: _______
Date: __________________|
|
________________________________________ ___________________________________
Patient Signature Date Mental Health Counselor Signature Date|
________________________________________ ___________________________________
Patient Signature Date Mental Health Counselor Signature Date|
________________________________________ ___________________________________
Patient Signature Date Mental Health Counselor Signature Date|

Form no. M70-01-01 Page 1 of 1

Retention Schedule: Upon completion, this form shall be placed in the offender’s mental health file. 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 (5)

  1. Acute Care Unit Treatment Plan (Form M70-01-01) (147 words)
  2. Acute Care Unit Discharge Summary (86 words)
  3. Acute Care Unit Admission Log (58 words)
  4. Abbreviated Psychiatric Admission Note (M70-01-04) (139 words)
  5. Acute Care Unit Discharge Summary Note (Form M70-01-05) (124 words)
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