Multi-Agency Public Protection Arrangements (MAPPA):national guidance 2016

Details from restricted patient Care Plan Dated:

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Patient Name: Date of Birth:

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Restricted patient notification to MAPPA

CJA area MAPPA Coordinator

Name

Address

Notification Only

Notification accompanied by referral to level 2 (should be accompanied by the MAPPA referral form)

Notification accompanied by referral to level 3 (should be accompanied by the MAPPA referral form)

Referral to follow

Patient Details

Name

Date of Birth

Permanent Address

Previous significant address

Sex

Ethnic Origin (Standard Codes)

CHI number

Unit number

Prison number (if known)

CHS number(if known)

PNC number (if known)

ViSOR number(if known)

Notifying Service Details

RMO details (name address telephone no.)

MHO details (name address telephone no.)

Police contact details

(if not known, request for Police contact to be identified)

Responsible Local Authority

Responsible Health Board

Legal Details

Legal Status & Section

Sentencing court

Date of Conviction/Insanity Acquittal *

Date order began *

Date of previous annual review*

Date of next annual review *

MANAGEMENT STAGE

No SUS except urgent clinical/compassionate

Escorted Suspension of detention

Unescorted Suspension of detention

Conditional Discharge

For Determinate Sentences Earliest Liberation date/ Parole Qualifying date

For Life Sentences

Punishment part

Notifiable under part 2, Sexual Offences Act 2003

YES / NO

If yes to above - Detail offence(s) and period of order

Schedule 1 Notification Yes/ No