Appendix 3

FORENSIC DIRECTORATE

Absconder Information

Missing Person

______

Personal Details MAPPA status

1)Name….

2) Also known as

3) Age 4) DOB 5) DOA

6) Home Address/ Ward

7) MHA Legal Status

8) Is the person able to be arrested by police?

9)NOK Name & Address

10)Who to inform if AWOL

a)NOK

b)Social Services

c)MAPPA

d)Other

Description

11) Height 12) Weight

13) Build/Frame 14) Shoe Size

15) Ethnicity 16)

17) Colour of Eyes 18) Glasses

19)

21)

22) Posture/Gait

Clothing

23) Free text re clothing style/currently wearing/access to:

Accessories

24) Jewellery 25) Bags

26) Other (specify)

27) Photograph

Mobile Phone Information

28) In possession of mobile phone

29) Make 30) Network

31) Mobile Phone Number

______

Financial Information

32) Access to cash33) Credit/Debit cards


34) In possession of cash35) Bank accounts

______

Medication

36) Currently prescribed medication

37) Purpose of medication.

38) Last medication administered 39) Next medication due

40) Effect of not taking medication

physical Psychiatric

Illness/Diagnosis

41) physical

Psychiatric

Substance Misuse

42) Alcohol

43) Non-prescribed drugs

44) Solvent abuse

45) Other

Previous History

46) Abscond History

Previously absconded:

DateWhere foundTime

TimesWhen found

Circumstances

Police involved

Reason for their abscond

Staff’s suspected reasons

Clinical review

Changes to security

Sanctions imposed

47) Self Harm History


48) Violent History

Brief History

Date

Outcome

Nature

49) Recent behaviours/presentation

Any significant changes since circs

Changes of meds

Sanctions imposed/threatened

Other

50) Risk Assessment

What is the current assessment of the likelihood of harm occurring and what level of harm is likely to be suffered - taking into account all current prevailing factors.

Risk of self harm

Aggravating factors

Risk of harm to identified person(s)

Risk of harm to identified group(s)
[children, family, others]

Risk of harm to general public

How likely to interact in public

How likely to cope in public

Possible areas individual would

frequent [i.e. parks, home areas, etc]

Family/Friends/Known contacts:

Name
Address
Telephone No:
Last known contact:
Name
Address
Telephone No:
Last known contact:
Name
Address
Telephone No:
Last known contact:
Name
Address
Telephone No:
Last known contact:

Information completed by:

Name
Title
Date

Reviewed by:

Name
Title
Date

Reviewed by:

Name
Title
Date

Reviewed by:

Name
Title
Date

Reviewed by:

Name
Title
Date

Information received by:

Name
Title
Date

Information received from:

Name
Title
Date

1

Northumberland, Tyne and Wear NHS Foundation Trust

Appendix 3 – ID DATA Sheet Forensics - V02 - Issue 1 – Issued June 2015

Part of VIA-PGN-01–Taking Patients Photographs within Inpatient Settings to Maintain Patient Safety – NTW(0)45 Visual Imaging/Audio Recording