SOP 508.31-att-3: Abbreviated Psychiatric Admission for CSU (M70-02-03)

Division:
Unknown
Effective Date:
December 9, 2019
Topic Area:
Mental Health - Suicide Prevention/ACU/CSU/BTU
PowerDMS:
View on PowerDMS
Length:
105 words

Summary

This is a streamlined psychiatric admission form used for readmitting offenders to the Crisis Stabilization Unit (CSU) within 30 days of previous discharge. The form documents the offender's chief complaint, history of present illness, mental status examination, clinical assessment, and diagnostic impressions. A psychiatrist must complete and sign the form within 24 hours or the next business day, and the completed form is retained in the offender's medical file for ten years.

Key Topics

  • psychiatric admission form
  • CSU readmission
  • abbreviated psychiatric evaluation
  • mental health screening
  • crisis stabilization unit
  • chief complaint
  • mental status examination
  • diagnostic impressions
  • psychiatrist evaluation
  • offender mental health

Full Text

SOP 508.31
Attachment 3

12/9/19

|ABBREVIATED PSYCHIATRIC
Admission Form
(For readmission to CSU ≤ 30 days)|PATIENT IDENTIFICATION
Facility:__________________________________
Offender: ________________________________
GDC ID#: _______________________________
DOB: _________________________
Race: __________________ Sex: ____________|
|---|---|
|
Chief Complaint:





History of Present Illness:




Mental Status:




Assessment:





Diagnostic Impressions:______________________________________________________

__________________________________________________________________________

__________________________________________________________________________



(To be completed within 24 hours or next business day.)

__________________________________________________________________________
Psychiatrist's Signature Printed/Typed Name Date

|
Chief Complaint:





History of Present Illness:




Mental Status:




Assessment:





Diagnostic Impressions:______________________________________________________

__________________________________________________________________________

__________________________________________________________________________



(To be completed within 24 hours or next business day.)

__________________________________________________________________________
Psychiatrist's Signature Printed/Typed Name Date

|

Form no. M70-02-03 Page 1 of 1

Retention Schedule: Upon completion, this form shall be placed in the offender’s medical file (Infirmary Section with CSU/ACU packets) and
retained for ten (10) years.

Attachments (9)

  1. CSU_ACU Daily Nursing Clinical Assessment (299 words)
  2. Crisis Stabilization Unit Psychiatric Admission Form (M70-02-02) (218 words)
  3. Abbreviated Psychiatric Admission for CSU (M70-02-03) (105 words)
  4. Crisis Stabilization Unit Treatment Plan (124 words)
  5. Crisis Stabilization Unit Discharge Summary (290 words)
  6. Crisis Stabilization Unit Admission Log (61 words)
  7. CSU Referral Report (M70-02-08) (732 words)
  8. CSU Discharge Summary Note (Form M70-02-09) (130 words)
  9. Crisis Stabilization Unit (CSU) Admission Cover Page (93 words)
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