SOP_NUMBER: 508.31-att-9
TITLE: CSU Discharge Summary Note (Form M70-02-09)
DIVISION: Mental Health/Healthcare Services
TOPIC_AREA: 508 Policy - Mental Health, Suicide Prevention, ACU/CSU/BTU
EFFECTIVE_DATE: 2019-12-09
WORD_COUNT: 130
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/513945
URL: https://gps.press/sop-data/508.31-att-9/

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

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 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.