SOP_NUMBER: 508.30-att-5
TITLE: Acute Care Unit Discharge Summary Note (Form M70-01-05)
DIVISION: Mental Health Services
TOPIC_AREA: 508 Policy-MH Evaluations/Screenings/Treatment
EFFECTIVE_DATE: 2019-12-09
WORD_COUNT: 124
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/420252
URL: https://gps.press/sop-data/508.30-att-5/

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

ATTACHMENTS:
  1. Acute Care Unit Treatment Plan (Form M70-01-01)
     URL: https://gps.press/sop-data/508.30-att-1/
  2. Acute Care Unit Discharge Summary
     URL: https://gps.press/sop-data/508.30-att-2/
  3. Acute Care Unit Admission Log
     URL: https://gps.press/sop-data/508.30-att-3/
  4. Abbreviated Psychiatric Admission Note (M70-01-04)
     URL: https://gps.press/sop-data/508.30-att-4/
  5. Acute Care Unit Discharge Summary Note (Form M70-01-05)
     URL: https://gps.press/sop-data/508.30-att-5/

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FULL TEXT:
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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.