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Low Risk Criteria for Self Harm or Harm to Others
Adults only

NOTE: If patient is intoxicated, perform this screen after sober
  1. No suicide or homicide attempt in past year and did not attempt suicide or homicide on this visit.
  2. No active suicide plan and not homicidal.
  3. Patient expresses a desire to live and not hurt anyone else
  4. Does NOT live alone - is NOT homeless.
  5. Family member or friend staying with or available to patient.
  6. No gun in home.
  7. No current hallucinations or delusions and no history of schizophrenia.
  8. Under 60 years old.

If attending ED physician agrees, patients who meet above criteria may be discharged home without a telepsych consult.
Fax referral form to Community Care Partners of Greater Mecklenburg (CCPGM) with patient information (sticker).
​
CCPGM will contact patient within 24 hours to reassess for danger to self or others and to
arrange further mental health or substance abuse care.
Referral Form
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  • RESIDENCY
    • About CMC
    • A Note from our PD
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
    • Our Research
    • Contact Us
  • FELLOWSHIPS
    • HALM Fellowship
    • Disaster & Operational Medicine
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • Ultrasound
  • Students/Applicants
    • Medical Students at CMC
    • What to look for in a residency
    • Prospective Applicants
    • EM Acting Internship
    • Healthcare Disparities Externship
    • Resident Mentorship
  • People
    • CMC Hype Video
    • Program Leadership
    • Current Chiefs
    • PGY-3
    • PGY-2
    • PGY-1
    • Recent Grads >
      • Class of 2024
      • Class of 2023
      • Class of 2022
    • Alumni
  • Resident Life
    • WF Carpenter Library
    • Current Chiefs
    • Incentive Shifts & Moonlighting >
      • ED Incentive Shifts
      • STICU Moonlighting
      • MICU Moonlighting
    • Schedules >
      • Block Schedule
      • ED Shift Schedule
      • Conference and Resident Lectures
      • Journal Club
      • CQR
      • Simulation
    • Reporting
    • Resources >
      • #FOAMed & Blogs
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Game to End All Games
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction
    • Off Service Rotators
  • Top 20