Copy and edit this outline:
Subject:
Confidential collateral information regarding [name / date of birth if appropriate]
Confidential collateral information regarding [name / date of birth if appropriate]
Opening:
I am providing factual observations that may be relevant to assessment, treatment or safety.
I am providing factual observations that may be relevant to assessment, treatment or safety.
Observations:
[What you directly observed, when it occurred, and how it differs from the person’s usual functioning.]
[What you directly observed, when it occurred, and how it differs from the person’s usual functioning.]
Risks or urgent concerns:
[Specific statements or behaviours; avoid speculation.]
[Specific statements or behaviours; avoid speculation.]
Supports currently in place:
[Housing, medications, appointments, family supports and service contacts.]
[Housing, medications, appointments, family supports and service contacts.]
Confidentiality request:
Please record this information and consider whether identifying me as the source could create a safety concern.
Please record this information and consider whether identifying me as the source could create a safety concern.
Sincerely,
[Name]
[Contact information]