SOP 508.31-att-9: CSU Discharge Summary Note (Form M70-02-09)

Division:
Mental Health/Healthcare Services
Effective Date:
December 9, 2019
Topic Area:
508 Policy - Mental Health, Suicide Prevention, ACU/CSU/BTU
PowerDMS:
View on PowerDMS
Length:
130 words

Summary

This form is used to document an offender's discharge from the Crisis Stabilization Unit (CSU) by documenting target symptoms, assessment findings, diagnosis, and ongoing care plans. Mental health counselors and nurses complete this form to summarize the offender's clinical presentation during their CSU stay and outline the level of care and housing assignments following discharge. The completed form is filed in both the offender's medical and mental health records and retained for 10 years.

Key Topics

  • CSU discharge
  • crisis stabilization unit
  • mental health discharge summary
  • psychiatric assessment
  • target symptoms
  • discharge planning
  • mental health documentation
  • offender mental health
  • CSU/ACU
  • crisis intervention
  • discharge note
  • mental health records

Full Text

SOP 508.31
Attachment 9

12/9/19

Georgia Department of Corrections Facility:__________________________________________

CSU Discharge Summary Note Offender: ________________________________________

GDC ID#: _______________________________________

Date: ________________ Race: ______________________ Sex: ________________
_________________________________________________________________________________________

I. Data: Purpose: CSU Discharge Summary
Target Symptoms:_______________________________________________________________

______________________________________________________________________________

Range of Dates: From: ________________________ To: ____________________________

Summary of Discussion: _________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

II. Assessment: (Assessment of target symptoms) ___________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

Diagnosis:___________________________________________________________________________

Comments:__________________________________________________________________________

Level of Care:__________

III. Plan: ( housing and interventions to continue):_____________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

______________________________________________________ _________________________________________________
Signature/Title (Mental Health Counselor or Nurse) Printed/Typed Name

Form no. M70-02-09 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 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.

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)
Machine-readable: JSON Plain Text