1. TRANSFER AGREED ACCORDING TO LEAD AGENCY POLICY
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This MUST be completed before MAPPA G is sent to the local MAPPA Co-ordination unit / Co-ordinator.
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2. OFFENDER INFORMATION
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This should be completed in full by the referrer.
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3. MAPPA STATUS
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This must be completed in full to ensure that the next review is undertaken in the required timescales.
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4. SENDING AREA INFORMATION
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This information relates to the MAPPA lead agency in the sending area i.e. the person who has completed the MAPPA G.
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5. ADMINISTRATION
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This section should be completed by the sending area MAPPA Co-ordination unit / Co-ordinator and sent to the MAPPA Co-ordinator in the receiving area to ensure that the next MAPPA meeting occurs with in the required time frame.
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Please complete sections 1 to 5 of this form and send it to your local MAPPA Co-ordinator 6 months before the release of a MAPPA offender
1. CATEGORY OF OFFENDER
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The offender must fall into one of the MAPPA Categories summarised below. Please state which one applies.
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1. Registered sexual offender
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YES / NO
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2. Violent or other sexual offender who has been sentenced to 12 months or more custody for a Schedule 15 offence under the Criminal Justice Act 2003 and is transferred to hospital under s.47/49 MHA 1983, or is detained in hospital under s.37 with or without a restriction order under s.41
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YES / NO
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3. Other dangerous offender – has been cautioned for or convicted of an offence which indicates that he or she is capable of causing serious harm AND which requires multi-agency management. This might not be for an offence under Sch.15 of the Criminal Justice Act 2003.
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YES / NO
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2. OFFENDER INFORMATION
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Last name:
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First name:
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Date of birth:
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Aliases:
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Last known address:
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Gender:
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Ethnicity:
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3. CONVICTION / CAUTION INFORMATION
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Index offence:
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Date of conviction / caution:
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Sentence:
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4. VICTIM CONCERNS
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Is the victim known to the victim contact scheme?
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YES / NO
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If YES:
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Please state what information has been provided
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5. NOTIFYING AGENCY INFORMATION
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Referring agency:
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Name:
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Grade:
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Office:
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Telephone number(s):
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Email address:
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Date sent to MAPPA Co-ordinator:
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6. INFORMATION HELD BY MAPPA CO-ORDINATOR
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Is there any information known to MAPPA, including information held on ViSOR regarding this offender, to help manage the risk he presents to the public?
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YES / NO
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If YES:
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Please confirm that the information has been passed to the referring agency
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Date information sent
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If you are planning discharge for this patient as part of his long-term rehabilitation into the community, please complete sections 1 to 6 of this form and send it to your local MAPPA Co-ordinator.
1. CATEGORY OF OFFENDER
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The patient must fall into one of the MAPPA Categories summarised below. Please tick one box below.
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1. Registered sexual offender
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2. Violent or other sexual offender who has been sentenced to 12 months or more custody for a Schedule 15 offence under the Criminal Justice Act 2003 and is transferred to hospital under s.47/49 MHA 1983, or is detained in hospital under s.37 with or without a restriction order under s.41
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3. Other dangerous offender – has been cautioned for or convicted of an offence which indicates that he or she is capable of causing serious harm AND which requires multi-agency management. This might not be for an offence under Sch.15 of the Criminal Justice Act 2003.
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2. OFFENDER INFORMATION
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Last name:
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First name:
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Date of birth:
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Aliases:
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Last known address before hospitalisation:
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Gender:
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Ethnicity:
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3. DETAINED IN HOSPITAL
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Name of responsible clinician:
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Hospital:
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Details of community leave arrangements (include dates and addresses)
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Details of permanent release / discharge if known (include dates and addresses)
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Date of next CPA if applicable:
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Date of next tribunal if applicable:
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Please indicate the basis for detention from the options below:
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Guardianship order under s.7 MHA 1983
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YES / NO
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Hospital order under s.37 MHA 1983
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YES / NO
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Restriction order under s.41 MHA 1983
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YES / NO
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Transfer from prison under s.47 MHA 1983
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YES / NO
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4. CONVICTION / CAUTION INFORMATION
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Index offence:
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Date of conviction / caution:
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Sentence:
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5. VICTIM CONCERNS
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Has the victim asked to be kept informed of relevant dates and decisions by the Hospital Managers?
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YES / NO
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If YES:
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Please state what information has been provided
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6. NOFIFYING AGENCY INFORMATION
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Name of notifying hospital:
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Name:
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Grade:
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Office:
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Telephone number(s):
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Email address:
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Date sent to MAPPA Co-ordinator:
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7. INFORMATION HELD BY MAPPA CO-ORDINATOR
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Is there any information known to MAPPA, including information held on ViSOR regarding this patient, to help manage the risk he presents to the public?
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YES / NO
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If YES:
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Please confirm that the information has been passed to the referring agency
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Date information sent
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