ACT Closed Record

Program; Recipeint Name, DOA, & D/C

Discharge Summary Includes: Reason for referral, Summary of progress, reason for discharge and plan, discharge diagnosis, meds at time of d/c, Team leader and psychiatrist signature, recipient and/or family signature

Reason: Needs < level of care; referrals completed

Reason: moved out of area; referrals made

Reason: requires medical nursing care; referrals made

Reason: hospitalized/incarcerated > 3 months

Reason: lost to follow up > 90 days

Reason: requests D/C

SPOA/AOT notified

D/C summary sent to receiving provider