Prescreening Procedure Checklist

Date/Time Call/page received: Click here to enter text. Time Responded: Click here to enter text. ☐ Under 15 min?

Time decision to P/S: Click here to enter text. Time Face to Face: Click here to enter text. ☐ Under 2 hrs?

Upon notification of an ECO:

Name/Title of initial contact: Click here to enter text.

☐	Contact Initiating/executing officer and ask: ☐MIECO ☐ OIECO

Click here to enter text. Name of Consumer

Click here to enter text. Time ECO was executed/initiated

Click here to enter text. Officer’s Name

Consumer’s current demeanor, behavior and any other observations. As well as criteria for Officer initiated or magistrate issued ECO when available. Click here to enter text.

☐ Officer or ☐ prescreener has given the Consumer a copy of the ECO/TDO info sheet (DC-4050).

☐	Contact Augusta Health Emergency Department:

Click here to enter text. Name of ED person you spoke with

☐ Inform them of ECO and all information obtained from the officer. Also report any relevant additional information if available from EHR.

☐ Ask them to advise Security of the ECO en-route

☐	Contact Western State Hospital; Catawba age 65/+; or CCCA age 17/under:

☐ WSH send email or txt (Client Initials not full name) to ECONotification.wsh@dbhds.virginia.gov

If unable to text or email; call the Info Desk: 540-332-8001 Info Desk staff will send the admission email on our behalf.

☐ Catawba Admissions Line: 540-375-4289

☐ CCCA 540-332-2120

Click here to enter text. Name of State Hospital person you spoke with to inform them Valley CSB has an ECO in progress.

☐	Conduct Prescreening evaluation and necessary collateral contact:

☐ TDO NOT recommended

☐ Call State Hospital and notify they can ‘stand down’.

☐ Complete Prescreening report and other paperwork.

☐ TDO recommended

☐ Complete Prescreening and Fax to:

☐ WSH Business hours: 540-332-8614 / 8024 After Hours: 540-332-8144

☐ Catawba Business hours: 540-375-4399 After hours: 540-375-4374

☐ CCCA @ 540-332-2202

☐ Utilize Psych Bed Registry www.vhi.org/pbr Facility # 801071 for bed search.

☐ Document in PBR the hospitals called, time of call and who you spoke with. Select outcome “other” to access narrative field and document process and final outcome.

PBR Search ID: Click here to enter text.

☐ When an accepting facility is located;

Name of person confirming bed/acceptance: Click here to enter text.

Name of admitting physician: Click here to enter text.

Date/Time TDO Served/Executed: Click here to enter text. (Not when it was issued!)

☐ Petition for TDO to “lock it in”.

☐ When admission facility is outside our catchment area:

☐ Contact MRRJ Control Room (540-245-5231) to notify them of the TDO and need for transportation team. [Remind them to contact LEO/AH Sec. with ETA.]

☐ Fax a copy of the Prescreening to the CSB that will be attending the hearing. See CSB Emergency Services Directory.pdf (in case link doesn’t work, it is saved in same groups folder as this checklist. ES Fax #s by locality start on page 3)

☐ Contact all facilities previously contacted which are still “Pending”, including State Hospital, and notify that bed has been found. (Document that contact in narrative field as final outcome.)

☐ Contact State Hospital to advise that State bed may be needed at hour 6 (4 for geriatric admissions to Catawba) if bed has not been located. Bed search still continues. (Also consult/inform Bob at this time if not before!)

☐ At hour 7 (6 for geriatric admissions to Catawba) contact State Hospital and request they begin to process/review prescreening as State admission appears likely.

☐ Per HPR1 protocol; Petition for TDO to state facility, or alternate facility identified by that state facility no later than 7 hours and 30 min (30 min prior to ECO expiration). Or sooner if they have accepted the Consumer for TDO admission.

☐ At hour 7 and 30 minutes contact State Hospital and inform them TDO has been petitioned/granted for admission to their facility.

☐ Notify HPR1 ES Coordinator Dennis Vaughn: dennis.vaughn@regionten.org