SOP_NUMBER: 508.33-att-1
TITLE: Mental Health Transfer Summary
DIVISION: Health Services
TOPIC_AREA: Mental Health Evaluations/Screenings/Treatment
EFFECTIVE_DATE: 2021-02-18
WORD_COUNT: 120
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/429785
URL: https://gps.press/sop-data/508.33-att-1/

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

ATTACHMENTS:
  1. Mental Health Transfer Summary
     URL: https://gps.press/sop-data/508.33-att-1/
  2. Transfer Log (Attachment 2)
     URL: https://gps.press/sop-data/508.33-att-2/

========================================================================
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.