Suicide And Crisis Assessment Form Guidelines Page 6

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Withdraw/isolated
Yes
No
Future orientation
Yes
No
Danger to others
Yes
No
Homicidal thoughts
Yes
No
Current violent thoughts
Yes
No
Access to plan
Yes
No
Violent history
Yes
No
Fears consequences
Yes
No
Risk Assessment Summary:
Self
None
Low
Moderate
High
Others
None
Low
Moderate
High
Wants help
Yes
No
Specifics and action plan:
22
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