SOP_NUMBER: 508.31-att-6
TITLE: Crisis Stabilization Unit Discharge Summary
DIVISION: Health Services
TOPIC_AREA: 508 Policy - Mental Health, Suicide Prevention, ACU, CSU, BTU
EFFECTIVE_DATE: 2019-12-09
WORD_COUNT: 290
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/513939
URL: https://gps.press/sop-data/508.31-att-6/

SUMMARY:
This form documents the discharge of an offender from the Crisis Stabilization Unit (CSU) and serves as the official record of their mental health treatment and outcome. It requires attending physicians and nursing staff to document the reason for admission, diagnosis, course of treatment, medications, and follow-up care instructions. The completed form is filed in both the offender's medical file and mental health file and retained for 10 years after the conclusion of mental health services or sentence completion.

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

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 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.