SOP 508.33-att-1: Mental Health Transfer Summary

Division:
Health Services
Effective Date:
February 18, 2021
Topic Area:
Mental Health Evaluations/Screenings/Treatment
PowerDMS:
View on PowerDMS
Length:
120 words

Summary

This form is used to document and transfer mental health information when an offender is being moved between GDC facilities. It captures the offender's current mental health status, diagnoses, medications, suicide precautions, treatment progress, and housing recommendations to ensure continuity of mental health care during facility transfers.

Key Topics

  • mental health transfer
  • offender mental health
  • mental health documentation
  • suicide precautions
  • involuntary medication
  • treatment summary
  • mental health records
  • facility transfer
  • psychiatric evaluation
  • offender mental status

Full Text

SOP 508.33
Attachment 1

2/18/21

GEORGIA DEPARTMENT OF CORRECTIONS Facility: __________________________________

Mental Health Services

MENTAL HEALTH TRANSFER SUMMARY

Offender: ________________________________

GDC ID#: ________________________________

DOB: ____________________________________

Race: ________________ Sex: _______________

Principal Diagnosis: ______________________________________________________________________________________

Other: ___________________________________________________________________

Other: ___________________________________________________________________

Current Mental Status: _______________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

Current Medication(s): _______________________________________________________________________________

___________________________________________________________________________________________________

Suicide Precautions Status: (Yes) (No)

Offender is on Involuntary Medication Status: (Yes) (No)

Last Hearing Date: ____________________ Next Review Date: _________________

Housing Recommendations: __________________________________________________________________________

Current Treatment (Non-Pharmacological): _____________________________________________________________

___________________________________________________________________________________________________

Summary of Progress Made in Treatment at Current Facility: ______________________________________________

___________________________________________________________________________________________________

Reason for Transfer: ________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

________________________________/__________________________ _____________________
_MH Staff Signature/Title_ _Date_

Page 1 of 1

Retention Schedule: Completed forms will be placed in the offender’s mental health record (section 1). At the end of the offender’s need

for mental health services and/or sentence, the mental health record will be placed in the offender’s health record and retained for 10
years.

Attachments (2)

  1. Mental Health Transfer Summary (120 words)
  2. Transfer Log (Attachment 2) (50 words)
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