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Get CSPI SUMMARY FORM - SASS Cares

INSTRUCTIONS: Check appropriate box(es), provide requested info (e.g., date), & complete applicable sections below. Note: If more than one CSPI is necessary, please complete separate CSPI Summary Forms. However, if two events (e.g., Screening & Terminate) occurred within 72 hours, only one CSPI Summary Form is necessary. Screening (check one): DEFLECTION (complete sections, 1,2,3,4 & CSPI) or HOSPITALIZATION (complete sections 1,2,5, & CSPI) Hospital to hospital transfer.

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