SOP_NUMBER: 508.31-att-10
TITLE: Crisis Stabilization Unit (CSU) Admission Cover Page
DIVISION: Mental Health Services
TOPIC_AREA: 508 Policy - MH Suicide Prevention/ACU/CSU/BTU
EFFECTIVE_DATE: 2019-12-09
WORD_COUNT: 93
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/513947
URL: https://gps.press/sop-data/508.31-att-10/

SUMMARY:
This is a cover page form used to document the admission and discharge of inmates to the Crisis Stabilization Unit (CSU), a mental health crisis facility within the Georgia Department of Corrections. The form captures basic patient identification information including facility location, offender name, GDC ID number, date of birth, race, and sex. Completed forms are filed in both the offender's medical file and mental health file and retained for 10 years following the end of mental health services or sentence completion.

KEY_TOPICS: Crisis Stabilization Unit, CSU admission, mental health crisis, inmate mental health, crisis intake form, admission documentation, discharge documentation, mental health records, offender identification, psychiatric hold

ATTACHMENTS:
  1. CSU_ACU Daily Nursing Clinical Assessment
     URL: https://gps.press/sop-data/508.31-att-1/
  2. Crisis Stabilization Unit Psychiatric Admission Form (M70-02-02)
     URL: https://gps.press/sop-data/508.31-att-2/
  3. Abbreviated Psychiatric Admission for CSU (M70-02-03)
     URL: https://gps.press/sop-data/508.31-att-3/
  4. Crisis Stabilization Unit Treatment Plan
     URL: https://gps.press/sop-data/508.31-att-4/
  6. Crisis Stabilization Unit Discharge Summary
     URL: https://gps.press/sop-data/508.31-att-6/
  7. Crisis Stabilization Unit Admission Log
     URL: https://gps.press/sop-data/508.31-att-7/
  8. CSU Referral Report (M70-02-08)
     URL: https://gps.press/sop-data/508.31-att-8/
  9. CSU Discharge Summary Note (Form M70-02-09)
     URL: https://gps.press/sop-data/508.31-att-9/
  10. Crisis Stabilization Unit (CSU) Admission Cover Page
     URL: https://gps.press/sop-data/508.31-att-10/

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FULL TEXT:
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SOP 508.31
Attachment 10

12/9/19

## PATIENT IDENTIFICATION


Facility: ________________________________________


Offender:________________________________________


GDC ID#: _____________________ DOB: ____________


Race: _________________ Sex: ____________________

# **CRISIS STABILIZATION UNIT ADMISSION**


Date of Admission: _______________________


Date of Discharge: _______________________


Form no. M70-02-10                                                                                 Page 1 of 1

Retention Schedule: Upon completion, this form shall be placed in the offender’s medical file (Infirmary Section on the top of the CSU packet)
and a copy in the 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.