SOP 508.30-att-5: Acute Care Unit Discharge Summary Note (Form M70-01-05)

Division:
Mental Health Services
Effective Date:
December 9, 2019
Topic Area:
508 Policy-MH Evaluations/Screenings/Treatment
PowerDMS:
View on PowerDMS
Length:
124 words

Summary

This form is used to document the discharge of an offender from the Acute Care Unit (ACU) of the Georgia Department of Corrections mental health services. It captures the offender's target symptoms, assessment findings, diagnosis, level of care, and discharge planning information including housing and ongoing mental health interventions. The completed form is retained in the offender's mental health file for 10 years or until the offender no longer requires mental health services and/or completes their sentence.

Key Topics

  • acute care unit
  • ACU discharge
  • mental health discharge
  • discharge summary
  • target symptoms
  • mental health assessment
  • diagnosis
  • level of care
  • discharge planning
  • mental health documentation
  • offender mental health
  • form M70-01-05

Full Text

SOP 508.30
Attachment 5

12/9/19

GEORGIA DEPARTMENT OF CORRECTIONS Facility: _____________________________________

MENTAL HEALTH SERVICES Offender: ____________________________________

Acute Care Unit Discharge Summary Note GDC ID#________________ DOB: ______________

Date: ______________________ Race: ___________________ Sex: ________________

**********************

I. Data: Purpose: Acute Care Unit Discharge Summary.

Target Symptoms: ____________________________________________________________________________

___________________________________________________________________________________________

Range of Dates: From ___________________ To ____________________________

Summary Discussion: _________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

II. Assessment: (assessment of target symptoms) _______________________________________________________________

____________________________________________________________________________________________________

___________________________________________________________________________________________________

Diagnosis: _________________________________________________________________________________

Comments: _________________________________________________________________________________

___________________________________________________________________________________________

Level of Care: _______________

III. Plan: (housing and interventions to continue): _________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________________
Mental Health Counselor or Nurse Signature/Title Printed/Typed Name

Form no. M70-01-05 Page 1 of 1

Retention Schedule: Upon completion this form shall be placed in the offender’s mental health file (section 1). 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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