SOP_NUMBER: 508.31-att-3
TITLE: Abbreviated Psychiatric Admission for CSU (M70-02-03)
DIVISION: Unknown
TOPIC_AREA: Mental Health - Suicide Prevention/ACU/CSU/BTU
EFFECTIVE_DATE: 2019-12-09
WORD_COUNT: 105
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/513936
URL: https://gps.press/sop-data/508.31-att-3/
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
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 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.