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GO# 2020-57578
DISCLQS~URE
Purpose: DISCLOSURE Date Released: Thursday, 2021-Sep-09 Time Released: 08:47
RNC
GENERAL OCCURRENCEHARDCOPY
Authorized by: C278-ZDEBIAK, WENDY Released by: C288-BROWN, LYNN
RELEAS.ED_TO
MISSING PERSON
Business: PUBLIC INQUIRY SUMMON TO PRODUCE EVIDENCE RE: BURTON INQUIRY
••• CONFIDENTIAL •••
For: C288 Printed On: Thursday, 2021-Sep-09 Page 1 of 17
Exhibit P-185 Page 1
Main offence: MISSING PERSON - COMPLETEDOperational status: INVESTIGATION PENDINGLocation: , CONCEPTION BAY SOUTHDistrict: K Zone: 40 Atom: 150666Approved on: Wednesday, 2020-Oct-28 by: C361 HENLEY, CHRISTINEReported on: Tuesday, 2020-Oct-27 08:48Occurred on: Tuesday, 2020-Oct-27 08:48Submitted by: 568 COLLETT, HARVEY Org unit: Si COMMUNICATIONS TRCDowntime in minutes: 0
CCJS InformationCCJS Status: STILL UNDER INVESTIGATIONOffences committed: MISSING PERSON - COMPLETED
MENTAL HEALTH ACT INC SUIC ATT - COMPLETEDLocation type: DWELLING UNIT
Related Event(s)CP 2020-57578
ReIatedfcrsns
1. COMPLAINANT I - (Case-specific)Sex: FEMALE, Born on:Residing at:
NEWFOUNDLAND & LABRADOR
Phone numbers
Type Phone # Ext.HOME (Primary)
BUSINESS (Priman’)
Particulars
Employer address:Ethnicity: CAUCASIANRemarks:
Linkage t
Ethnicity: CAUCASIAN, NO conditionResulting in: NO INJURIESResident status: RNC JURISDICTIONStatement taken: NONE
Master Name Summaiw
Name:Sex: FEMALE, Born on:Residing at: CONCEPTION BAY SOUTH
*** CONFIDENTIAL ***
General Occurrence Information
For: C288 Printed On: Thursday, 2021-Sep-09 Page2ofl7j
Exhibit P-185 Page 2
Phone numbers
Type Phone #HOME (Primary)
BUSINESS (Primary)
2. MISSING PER 1 - (Case-specific)Sex: MALE, Born on:Residing at: . CONCEPTION BAY SOUTH
NEWFOUNDLAND & LABRADORParticulars
Ethnicity: CAUCASIAN
Linice factors
Ethnicity: CAUCASIAN , NO conditionResulting in: NO INJURIESResident status: RNC JURISDICTIONStatement taken: NONE
Master Name SummaryName:Sex: MALE, Born on:Residing at: ST JOHNS
NEWFOUNDLAND & LABRADOR
Missing Pnwi Details
OTHER - (SPECIFY IN REMARKS), MISSINGYoung offender: NO Photo: NOProbable cause: OTHER - (SPECIFY IN REMARKS)History: REPEATMissing from: OTHER - (SPECIFY IN REMARKS)Dental chart: UNAVAILABLEDisability: DEPENDENT ON MED FOR PHYSICAL I MENTAL HEALTHMissing Pchills
Missing since: Tuesday, 2020-Oct-27 08:48Last seen on: Tuesday, 2020-Oct-27 07:40 Place: HOME
HiMciy Information
Missing before: NORemarks: MISSING FROM , THIRD INCIDENT.Case status: OPEN (NOT LOCATED) CPIC status: NOT ENTEREDMarks available: NOClothes description: NO
3. GUARDIAN-P 1 -
Sex: MALE, Born on:
NEWFOUNDLAND & LABRADOR
CONFIDENTIAL
NEWFOUNDLAND & LABRADOR
Ext.
For: C288 Printed On: Thursday, 2021-Sep-09 Page 3 of 17
Exhibit P-185 Page 3
Type Phone #CELLULAR
HOMEBUSINESS
Particulars
Occupation: LANDLORDRemarks: , NL
4. EDP 1 - (Case-specific)Sex: MALE, Born on:Residing at: , CONCEPTION BAY SOUTH
NEWFOUNDLAND & LABRADOR
Master Name Sumrn’
Name:Sex: MALE. Born on:Residing at: , CONCEPTION BAY SOUTH
NEWFOUNDLAND & LABRADOR
Complaint InformationIncident LocationAddress:Zone: 40 Telephone no:
General Information
Type: FOLLOWUPCase type: MISSING PERSON - IN PROGRESS Priority: 1Time received:Dispatched: Enroute:Scene:Cleared: 18:21:52liow received: TELEPHONEUnit ids: #1 -251 #2-209Call taker LD: CT2 SLANEY, SAMANTHA
corn pJainant Thf2rmation
Name:Home telephone:Business telephone:
Clearance Information
Remarks: REPORT TO FOLLOWFinal Case type: MISSING PERSON - IN PROGRESSReporting offlcierl:818- BURRY, JOSEPHReport expected: YESFounded: YESCleared by: NO FURTHER ACTION INOTES I REMARKS REQUI
CONFIDENTIAL ***
Phone numbers
Ext.(Primary)(Primary)(Primary)
For: C288 Printed On: Thursday, 2021-Scp-09 Page 4 of 171
Exhibit P-185 Page 4
cm RNC
0 GENERAL OCCURRENCE HARDCOPY
G0# 2020-57578 MISSING PERSON
Additional Remarks
2199292 10/27/2020 LAST TIME WAS HANGING OUT IN THE WOODS BEHIND TINYS BAR ANDGRILL CT2 C227 085204 SLANEY, SAMANTHA
CONFIDENTIAL ***
For: C288 Printed On: Thursday, 2021-Sep-09 Page 5 of 17
Exhibit P-185 Page 5
RNC
a GENERAL OCCURRENCE HARICOPY
CO# 2020-57578 MISSING PERSONn
Narrative: SYNOPSIS OF CASE - I
Author: 818 BURRY, JOSEPHRelated date/time: Tuesday, 2020-Oct-27 10:51
Synopsis of Case
[2020-10-27
0852Hrs Unit 251, Cst J. Burry #818 responded to Hy, CBS to a report ofa missing person. Complainant, , called the police to report that
was for the third time from the . He often goes into thewoods and stays there. is 51 years old, last seen around O73OHrs thismorning wearing dark blue jeans, black T-shirt, grey sneakers, zip up PUMAhoodie grey with orange trim and he does not have a cell phone.
0858Hrs Cst Hurry arrived in the area and spoke with CN on the phone. CNadvised that she received a call from night staff around 0744Hrs this morningadvising that had left, no where to be seen on the property. CN saidthat he was in a good mood, he ate his breakfast and too his medications. CNadvised that does walk to the Orangestore, Pipers and Tim Hortons. CstBurry advised that he would search around for prior to obtaining astatement and a missing persons report.
0905-0938Hrs Cst Hurry searched around the around, checking side roads andbusiness with negative results.
O95OHers Cst Hurry completed a missing persons report and obtained a writtenstatement from CN, .
lOO3Hrs Cst Hurry called Sgt Deacy and advised him of teh missing person. SgtDeacy advised taht he would speak with the duty officer and get back to me.
lO4OHrs Sgt Deacy advised that ROVERS have been requested and will be attendedto conduct a search.
Rovers arrived onscene and setup command post at the old RONA parking lot onCBS HY. Rovers members as well as RNC members were searching for .
At approximately l6lOHrs the ROVERS located hiding in a wooded area offPond Rd, CBS near the ROVERS command post. was hiding in a sitting hutalong the river.
told police that he will not go back to the , he doesn’t feelcomfortable there and would rather die than go back. said that he wantsto go to to live where he ha family.
CONFIDENTIAL ***
For: C288 Printed On: Thursday, 2021-Sep-09 Page 6 of 171
Exhibit P-185 Page 6
ra RNC‘‘ GENERAL OCCURRENCE HARDCOPY
GO# 2020-57578 MISSING PERSON
lE57Hrs Cst Burry conveyed to the PAU of the Waterford Hospital. Theowner advised that he would attend also, .
l7l6Hrs Cst Burry arrived at the PAt) with and staff were familiar withhim and his situation.
EDP completed, File concluded.]
++÷Officer Reminders÷++=> Missing Person Report: Complete the Missing Person Detail Page=> Theft of Motorized Vehicle: Complete the Stolen Vehicle Detail Page=> Seized Vehicle:
Complete paper forms - R12 Property Form AND Impounded Vehicle Form
*** CONFIDENTIAL ***
For: C288 Printed On: Thursday, 2021-Sep-09 Page 7 of 171
Exhibit P-185 Page 7
Author: 818 BURRY, JOSEPHRelated date/time: Tuesday, 2020-Oct-27 18:12
PERSONS
CPIC REMOVAL REQUEST
]WANT I ]ELOPEE [X ]MISSING PERSON
SURNAME:
Gi:
G2:
DOE:
[
[LOCATED/FOUND DATE: [2020] - [101 - [27] TIME: [1610 1
PLACE:
[Pond RD, CBS
REMARKS:
[Located safe.
Yr Mt Dy
I
VEHICLE RELATED:
]STOLEN VEHICLE ISTOLEN LICENSE PLATE
TYPE:
LICENSE ft:PROV:
LICENSE YEAR: [VIN:
RECOVERY CONDITION STATUS:
I
RECOVERY DATE:
RECOVERED BY:
]-[ ]—[ ] TIME:Yr Mt Dy
STREET LOCATION: MUNICIPALITY: [ I
I
*** CONFIDENTIAL ***
For: C288 Printed On: Thursday, 2021-Scp-09 Page 8 of 171
Nirnajjyç: CPIC REMOYAL REOVEST -1
Exhibit P-185 Page 8
RNC
0
GENERAL OCCURRENCE HARDCOPY!
004 2020-57578 MISSING PERSON
REMARKS:
]ARTICLES [ ]SEcURITIES
TYPE:
Si:
92:
REMARKS:
C ]
REMOVAL FROM CPIC:
INVESTIGATING OFFICER; [joseph burryRAEK; [cst ] REG#: [818 1
DATE AUTHORIZED: [2020 ]-[10-]-[27Yr Mt Dy
*** CONFIDENTIAL ***
For: C288 Printed On: Thursday, 2021-Sep-09
________ __________- _________-
Page 9 of Y I
Exhibit P-185 Page 9
Continuation Report[2020-10-27 Received a cal from Cst. Burry that had gone missingfrom his home. Contacted duty officer and informed him of same and of
outstanding issue and medical concerns. The approval for GSR to becalled out was given.
I contact Rovers command and they conducted a call out for a search with amuster point of the old Ronna building in Kelligrews off route 60.
11:55 I arrived on scene and several of the rovers vehicles along withsearchers were already on scene and gearing up.
12:00 tasked unit 247 with Cst. Philpot and Cst. Jamison to check with staff atTinys bar and see if staff has seen him or they have any security footage. Withthe low cloud and rain the ability to us a helicopter is not a option.
1215 Search team made up and teams sent to roadways west as far as Seal Coveand East to Foxtrap access road.
12:25 Cst. Philpot reported back that they had on camera heading West at730.
12:40 Cst. Burry going to check roadways East from Hollywood. Unit 247checking area of Red bridge convince for video footage.
13:04 Red Bridge Convince did not have on video.
13:20 Negative result on any of teams searching the road ways.
13:30 Had the rovers make the call to have ATV attend along with Argo toconduct search of the walking trails both East and West of our position.
15:00 No new sighting from teams or from Public. Teams have serached to Napaon the trail system and have cover tail to Seal Cove. Still have two teams outin vehicles driving the roadway plus two police units.ATV and Argo still driving the trail system and other side trails in the area.
16:05 Received a call from Comm Center that had been spotted in the areaof Pond Road about a hour ago. Had All teams responded to the pond rd area.
16:16 was located by team 1 in the woods beside Pond Rd. They
*** CONFIDENTIAL ***
Narrative: CONTINUATION REPORT - ICONTINUATION REPORT
Author: 640 DEACY, COHNRelated date/time: Tuesday, 2021-Jul-27 10:23
For: C288 Printed On: Thursday, 2021-Sep-09 Page 10 of 171
Exhibit P-185 Page 10
• RNCGENERAL OCCURRENCE HARDCOPY
GO# 2020-57578 MISSING PERSON
drove up and noticed him standing on the side of the road at the start of thetrail.
16:25 was turned over to Cst. Bury. Cst. Bury and I spoke withand he expressed how unhappy he was at the and did not want to
stay there. At this point staff from the home attended scene and they wereinformed that Mr. would be taken the PAT) to been seen. Also AdultSocial Services was contacted.
16:45 All Rovers and Rovers assists have been returned to Rona and were on wayback to the Rover building.
*** CONFIDENTIAL ***
For: C288 Printed On:_Thursday,_2021-Scp-09 Page 11 of El
Exhibit P-185 Page 11
it.;y RNC
0 GENERAL OCCURRENCE HARDCOPYGO# 2020-57578 MISSING PERSON
Narrative: FILE CONCLUSION - IEDP Follow up
Author: 789 COSTELLO, SHERIRelated date/time: Wednesday, 2020-Nov-il 13:20
File Conclusion Form
RNC File 4: [20-57578Concluding Remarks
2020 11 11
Cst. Abbott was assigned MCRT while writer was working in Labrador (2 weeks)Writer learnt that Cst. Abbott had printed off the EDP and added it to theLedger and Spreadsheet.MCRT Clinician completed follow up with client and this was documented onEastern Health’s Meditech system. Clinical Lead authorized closure of EDPJHas all property/persons been added/removed from CPIC/ICAN?[ ) Yes [ ] NoComplainant Notified? [ ] Yes [ I No Reg.#:
Date: Time:In Person t ] By Telephone [ I By LetterMessage Left With:
Motor Vehicle RecoveryUnknown
Not RecoveredRecovered - No DamageParts and/or Accessories MissingDestroyed - Not Burned
Person Who Found Vehicle
Name;
I Unfounded
LX I Not Cleared
I Cleared by Charge
Destroyed - Burned
I ) Condition UnknownRecovered - With Damage
[X I Not applicable
Accused Under 12 Years of AgeAccused Committed to Mental HospitalAccused Outside Canada, Cannot be Returned
*** CONFIDENTIAL
How Notified?
Type of Fraud
[XIII1)I I
Not ApplicableCheque
Transaction Card
Telemarketing
Number of Counts: [ ISecurities/Financial InstrumentsFalse Claims - Insurance
I False Claims - Government
Computer [ I Other
Location:
Date:Time;
CCJS
For: C288 Printed On; Thursday, 2021-Sep-09 Page 12 or171
Exhibit P-185 Page 12
Suicide of Accused
C ] Death of AccusedDeath of Complainant
C ] Beyond Control of Dept
C ] Diplomatic Immunity
Complainant Declined to Lay ChargesAccused Involved in Other IncidentsAccused Already SentencedDepartmental DiscretionDiversionary Program
Concluded Date: [20 11 11[Cst. Costello
I By Reg#: [789 Name:
Approved Date:
(Supervisor)
Signature:
Signature:
By Reg#: C ] Name:
*** CONFIDENTIAL ***
-
RNC
0 GENERAL OCCURRENCE HARDCOPYGO# 2020-57578 MISSING PERSON
For: C288 Printed On: Thursday, 2021-Sep-09 Page 13 of 171
Exhibit P-185 Page 13
Emotionally Disturbed Person (SDP) Contact Form
EDP DOEEDP Phone ft
[196 8-12-21
[834-4800II
Date and Time of EDP ContactDate [2020-10-27 3 Time [1610
Brief Synopsis of Incident and Behaviour Observed:
[ left the this morning at O73OHrs and police could notlocate him. hides from police and the ROVERS search and rescue.is a risk to himself as he has gone missing for days in the past. With the coldweather coming, his safety is an issue.]
Crisis Line Consulted: [NO[PAU is the best option
MCRT Requested: [NO
[PAU is the best option
EDP Outcome
If no, reason why below (mandatory)
I If no, reason why below (mandatory)
If Detention is made, complete below MHCTA Detention information:
Time of Arrival at Hospital:Time cleared from Hospital:
Medical Clearance Required: [ ]No
This section to be completed by MCR Team Officer
Follow up Action Taken and Service provided by the MCRT team
IEDP Contact Form forwarded to Health Authority
]Health Authority confirmed that action was taken on EDP Contact Form
Additional Remarks
I
Narrative: EDP FORM - I
Author: 818 BURRY, JOSEPHRelated date/time: Tuesday, 2020-Oct-27 18:07
[Accepted Voluntary Escort
[[
]Yes
CONFIDENTIAL ***
For: C288 Printed On: Thursday, 2021-Sep-09 Page 14 of 171
Exhibit P-185 Page 14
RNC
0 GENERAL OCCURRENCE HARDCOPY!
GO# 2020-57578 MISSING PERSON
*** CONFIDENTIAL ***
For: C288 Printed On: Thursday, 2021-Scp-09 Page 15 of 171
Exhibit P-185 Page 15
Assignment lHformaon
Assigned to: 789 COSTELLO, SlIER! Rank: CONSTABLECapacity: INVESTIGATION Org unit: ST JOHNS - PLATOON A - WESTAssigned on: Wednesday, 2020-Oct-28 07:18 by: C361 HENLEY, CHRISTINEReport due on: Wednesday, 2020-Dec-09
Submissicp/ApprQnllnfQrmatiqi!
Submitted on: Wednesday, 2020-Nov-liChecked by: 568 COLLETT, HARVEYApproved on: Tuesday, 2020-Dec-IS by: 568 COLLETT, HARVEYFollowup status: CONCLUDED
YktimLCcmplainantlnforrnatkm
Complainant/Victim notified: NO
*** CONFIDENTIAL
Follow Up Report # 1
For: C288 Printed On: Thursday, 2021-Sep-09 Pag6ofifl
Exhibit P-185 Page 16
END OF HARDCOPY ***
*** CONFIDENTIAL ***
For: C288 Printed On: Thursday, 2021-Scp-09 Page 17 of 17j
Exhibit P-185 Page 17
ItS Communications Log (ICS 309)
1. INCIDENT NAME AND ACTIVATION NUMBER 2. OPERATIONAL PERIOD (Date/rime)MissIng person çrom
3. RADiO NET NAME (for NCOs) OR POSITION ITACTICAL 4. RADIO OPERATOR (Name, Call Sign)
5. FREQUENCYICHANNEL
Time From Call To Call Msg # MessageSign Sign
2020/10/2711:50:0 5340 700, 701, 702, 703 arrIved on scene011:55:0 5339 Sgt Deacey Arrived on scene012:20:0 5341 Two RNC officers showed up012:25:0 5342 RNC officer check Tinys Bar and Grill and they0 picked up on their security camera
headed west bound at 073012:26:0 5343 Cst Phllpot and CstJamlson where sent to Red0 bridge store to check their cameras12:27:0 5344 Alan Kean and Keith Bartlett driving the street0 west bound as far as upper gullies and will doall side roads in between12:33:5 Team 5345 Teams 2 headed out In 702 to search road4 2 ways west as far as seal cove12:42:2 5346 Cst Bur,y headed to search the main HWY froir2 Holywrood east
12:44:4 1 5347 Asked to search up legion road as far as kent5 lumber13:01:5 RNC 5348 Cst Phllpat and CstJamlnson ceecked red4 bridge store security cameras and did not see
. They are now gone to check the sideroads west of CP
13:10:6 1 5349 Just finished searching legion road113:11:0 1 5350 Asked to search sIde roads on their way back413:56:5 2 5351 return to command for lunch713:56:5 5352813:57:1 1 5353 arrived at cp with lunch914:06:2 5354 Matthew P, Keith B, Alan K headed to base toB gettheargo14:12:1 5355 Cst Philpot and CstJaminson returned from5 search with no luck14:37:4 team 5356 Paul S and Craig M headed on AW to check t7 3 raIlway along conception bay as far as
holyrood14:38:0 2 5357 Going to search red bridge road and all side9 I streets
ICS 309
Exhibit P-185 Page 18
15:17:2 2 5358 Melanie OBrian joined team2315:19:1 5359 Conrad A, Michael C and Chris H now team 40 with Conrad being TL. Team is to search trail
off Red bridge road15:19:3 2 5360 To search CBS hwy east as far as foxtrap3 access road15:27:4 2 5361 NotifIed that team 4 had completed their7 search of the trail and that team 2 was on
their way to pick them up15:28:1 2 5362 CP asked that they stay with them to finish1 search of road way15:31:4 3 5363 Have searched East as far as Napa on the trail2 and all side trails, looking for further
instruction15:31:4 3 5364 Have searched East as far as Napa on the trail3 and all side trails, looking for further
instruction15:32:0 3 5365 Asked to turn around and head west as far a3 seal cove15:32:3 1 5366 ArrIved back to CP with argo115:33:4 2 5367 Asked to return to command015:36:5 2 5368 on the way315:39:4 2 5369 returned to command715:42:1 5370 Team 5 created as argo team. it Matthew P,5 Chris H and Conrad A to join team 3 in search
along trailway15:42:3 5371 Michael C to stay with team 2 to search CBS7 hwy15:43:0 3 5372 Meet argo team at the end of harveys path716:09:5 5373 RNC were notified that was seen on2 pond road about an hour ago.
16:10:0 5374 All teams were sent to pond road area to8 search surrounding area16:16:4 5375 Team 1 located at this lat and long6 47.499817 53.02032716:17:0 5376 request that all teams return to command0
6. PREPARED BY (Name, Call SIgn) 7. DATE & TIME PREPARED
ICS 309
Exhibit P-185 Page 19
R3 TEMENT
Page/1
of ‘ F
rSurname:
•.w!tt fl.flhIWIIt5I t,DLh,fl,th ii fllP,eil,Il yy Fir,’ noAddress.
Detect o1
() CWJ6JiIian Witness Stateaent PW Police Witness Statenrnnt
Coate; ci Time Location Statement Taken.
/
D- / 1Ctt 1z tC9_4( r’i_7& -/ - -
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- %.n( /4_ — t:.’ 7 t’t’’/ t%%cç
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- —..-- —-————_____ --—-—______________________
-
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c;nclucled ?. £“LlM
signature:
C ‘2:1 /.J -‘ I crr .-* !‘oi-vI1 /
flNcR3-g 52 15
Exhibit P-185 Page 20
0
//1/
(Rank)
MISSING PERSONS REPORT
While Copy: investigalorYellow Copy: File
File#a’ - “ 15/ 5-
Subject: Sex Phone if,.. -
14 / v/n.
Adriress I D.O.D
Deschptlot / heIght Weight Eyq• /s r//D4sJ, t,’J’” Jy.) ,V/4 //csi ,c!: , /,:
Mental/Physical Condition: / / -, -.iQ-je(/ (iç,n,-( , 5r&(/óf ,(J2 /
-
t’f ,fl1Y/%!Place of Work/School: Phone if
1.
Dote Reported Missing:,/,c/7 Time:
Date Last Seen: / Time: -
-,/,& /Jr (/)e
Next of Kin: D.O.S. - -
Address: Phone P
Cornplnlnanl D.O.D.
Address. Phone if: Home ,Work . -
Name Address Phone NumberFamily Doctor
Social Worker
Councflor
Teacher
Close FrIends/AssocIates
Name Address Phone Number
Placed on Yes:
Media Notified Yes: No: Date/lime:C.LD. Notified Yes: No: Date/Time:
No:Photograph Attached Yes: No:Statement Attached Yes: No:
H In company with another person give:
Name:
Address: Phone if:Repeat Occurrence: Yes: No:
Date Reported Missing: Dale Located:Area Located:
/7
7 (-4/ A/flSignature Reg N
Exhibit P-185 Page 21
Mc al Health Care and Treatmec ct Template(ReporUEscort Form)
EscortlpatlentjDetaljjee •H.Surname: 01. 02:
0GB: Sex: El Male Q Female Q Child/Youth CYFS Notification Required: El Yes El No
CYFS Contacted: El Yes No CYFS Representative Notifled:
Parent/Guardian: Contacted: El Yes El No
Civic Address: Phone#:
Type of Dispatch Call: ç.;, , Who Contacted Police:
Location Escorted From: 1 friLocation Escorted To: I
Reason(s) For Detention: --‘--,‘j /‘‘ 17
Additional information (Check all boxes that app/y)
Suicide Risk El Yes El No Security Risk El Yes El No Medical Risk El Yes El No
Danger IssuesActive to Self Active to Others Passive to Self
El Suicidal Thoughts El Homicidal El Poor Self Care
El Suicidal Act El Aggressive El Poor Judgment
El Self-mutilation I El Weapons Present fl Clothing Inappropriate For Weather
Medical InformationFamily Doctor: Hospital Associated With:
PsychIatrist: Other Professional Agency
Are they taking medications? El Yes El No I (If Yes) List
Pharmacy Name and Number:
AppearancelBehaviorGeneral [ El CooperativelPolite El Rude El Proper Clothing El Maintains Eye Contact
Hygiene ElClean El Dirty El Body Odor El Malnourished
Activity ElsIow El Agitated El RestlesslFidgety El Abnormal Movements
ThinkingDisorganized Thinking El None El Mild I El Moderate I El Severe
Abnormal Speech El Rapid El Loud/Swearing El Few Words El Other
Odd Beliefs I El Paranoid El Grandiose El Bizarre El Other
HallucInatIons El Voices El isions El Abnormal Sensations El Other
Describe Other
MoodEl Rapid change of mood I El Mood not appropriate For situatIon
El Happy El Sad ElAngry El Flat ElAnxious
Orientation (Ask and record responses)
Day: Month: Year: Location:
DwellingEl Food in Fridge El Rotten Food El Clean El Dirty El Disorganized El Fire Hazard
Alcohol UseEl AdmItted Quantity: El Suspected Comments:
Drug UseEl Admitted I El Suspected Drug Type: El Cocaine El Marijuana El Other:
ActionEl No Action El Voluntary to Hospital El Involuntarily Committed
El Follow up with Professional Name:
El Arrested/Charged Charges:
Commentsfll’/(!741 s ,4-/ /;:,
JJ4•. /A’tLIC cJt.CompletedBy: Reg#: >9 Date: ;7t- (-zReceived By: LLbIA.r Facility: ‘? Date:
IRNC File#: J h
IISC# 257Reolotil 21)131)407
0
C-.
VhiIv Copy To Her reoL-imini b Ilcaith (art ()flci.UYcII,in Cop,- To üt Aitatlicil To File
Exhibit P-185 Page 22