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NIDA5 NIMH4 BPDRF1 TREATMENT NOTES 2003-2008

OTHER:

B.

There is some

of serious self-injury or suicide. (See Q5.)

However,

emergency interventions likely to exacerbate rather than resolve long term risk.

C.

Emergency intervention is needed to prevent suicide. (Check All that apply) Took to ER at

of medically serious self-injury or

Arranged for outreach evaluation for INVOLUNTARY COMMITMENT (Describe):

Arranged for a POLICE WELLNESS CHECK

CALLED 911 for medical aid. HOSPITALIZATION ARRANGED at : COMMENTS on emergency intervention.:

, to be admitted by Dr.:

on (day)

D.

Significant that apply)

as to imminent risk, I will get a second opinion from: (Check All

SUPERVISOR: CRISIS CLINIC SUPERVISOR TEAM MEMBER or COLLEAGUE:

MEDICAL EXPERT: PRIMARY THERAPIST: OTHER:

7)

1.) 2.) 3.) 4.) 5.) 6.) 7.)

12 hrs How? 24 hrs, How? 48 -72 hrs, How? Next individual session Next group session Next pharmacotherapy session Other: Describe:

C : \ D o c u m e n t s a n d S e t t i n g s \ e r i n w 6 \ L o c a l S e t t i n g s \ T e m p o r a r y I n t e r n e t F i l e s \ O L K 8 7 \ 2 0 0 8 - 1 0 - 1 0 _ I m m i n e n t _ R i s k _ A n d _ A c t i o n _ P l a n . d o c

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