SOP 508.31-att-6: Crisis Stabilization Unit Discharge Summary
Summary
Key Topics
- Crisis Stabilization Unit
- CSU discharge
- mental health discharge
- offender psychiatric care
- discharge summary
- physician documentation
- nursing continuity of care
- mental health documentation
- inmate mental health
- psychiatric discharge planning
Full Text
SOP 508.31
Attachment 6
12/9/19
Georgia Department of Corrections Facility:__________________________________________
Offender:
Crisis Stabilization Unit Discharge Summary GDC ID#:_____________________ DOB: ______________
Race: _________________ Sex: ______________________
**********************
Attending Physician Summary
Referring Facility: ____________________________________________________________________________
Admitting Date: ___________________ ______ Discharge Date: ________________________________
Admitting Diagnosis: _____________________ Final Diagnosis: ________________________________
Principal Diagnosis: ______________________ Principal Diagnosis: _____________________________
Other Diagnosis: _________________________ Other Diagnosis: _______________________________
Summary of Stay:
Reason for Admission:
Pertinent Physical Findings:
Pertinent Lab Values/X-Ray Results:
Patient CSU Course and Outcome:
Disposition Changes (including medications, treatments and justification for level of classification at discharge.):
Level Change Recommended: [ ] Yes [ ] No Why?
__________________________________________________________________________________________________
Attending Physician Signature Printed/Typed Name Date
Form no. M70-02-06 Page 1 of 2
Retention Schedule: Upon completion, this form shall be placed in the offender’s medical file (Infirmary Section with CSU/ACU packets) 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.
SOP 508.31
Attachment 6
12/9/19
Georgia Department of Corrections Facility: __________________________________________
Crisis Stabilization Unit Discharge Summary
Offender: ___________________________________________
GDC ID#: _____________________________________
**********************
Nursing Summary and Continuity of Care
Vital Signs: Temp___________ Pulse ____________ Respiration _____________ Blood Pressure_______________
Discharge Instructions (Such as how to use medication).:
Discharge Teaching on the Patient's Condition:
Recommended Follow-Up Appointments:
Completed Intra-System Transfer Form PI-2002 [ ] Yes [ ] No
Telephoned Medical Staff at the Receiving Facility [ ] Yes [ ] No
__________________________________________________________________________________________________
Nursing Staff's Signature Printed/Typed Name Date
Form no. M70-02-06 Page 2 of 2
Retention Schedule: Upon completion, this form shall be placed in the offender’s medical file (Infirmary Section with CSU/ACU packets) 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.