Suicide Watch Disposition

IDAHO DEPARTMENT OF CORRECTION
Suicide Watch Disposition
Inmate Name(Last,First,MI) IDOC # Date Time
What was the incident?
Did the inmate require medical intervention at the facility? YES ❑ NO ❑
If yes, what level of medical intervention was needed?
Cn
c
a
0Did the inmate require treatment at a community hospital? I YES ❑ NO ❑
Z If yes, what level of medical intervention was needed?
What was the inmate's stated intent?
❑ Alert,Oriented x4 ❑ Disoriented ❑Reports Hallucinations ❑Endorses Delusions
Grooming/Hygiene Eye Contact Affect Mood Thought Speech Movement/Activity
Process
O ❑Appropriate to ❑Appropriate ❑Appropriate ❑Appropriate ❑Appropriate to ❑Appropriate ❑Appropriate to
situation to situation to situation to situation situation to situation situation
`a ❑Neat/Clean ❑Fair ❑Flat 0Angry ❑Lo ical ❑Ra id ❑Restless
(D ❑Unkempt ❑Good [3 No Emotion ❑Cheerful []Goal directed []Slow []Slowed
rt []Dirty ❑None ❑Tearful ❑Calm []Disorganized ❑Pressured []Active
<•
[]Other ❑Smiling Mad []Moving from []Slurred []Agitated
topic to topic
uickl
❑Depressed ❑Hopeless ❑Irrelevant 1 ❑Loud []Aggressive
[]Euphoric I ❑Anxious I ❑Distractible I ❑Quiet
❑Ramblin
nDisposition
H Acute Suicide Watch ❑ Non-Acute Suicide Watch E]
N
3
m
The Shift Commander was notified of the disposition I ❑
Shift Date Time
Commander's Notified: Notified:
Name:
NAME TITLE SIGNATURE
315.02.01.001
(Last updated on 10/26/2016)