Volunteer Behavioral Health Care Services
Help today… for a better tomorrow.
Putnam County Law Enforcement Drop-off Form
Name
This field is for validation purposes and should be left unchanged.
Date:
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MM slash DD slash YYYY
Time:
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:
HH
MM
Complaint Number:
Officer Name:
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First
Last
Badge #:
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Phone #:
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Email
Law Enforcement Agency:
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Putnam County Sheriff Department
Cookeville Police Department
Algood Police Department
Baxter Police Department
Monterey Police Department
TTU Police Department
TN HWY Patrol
Other
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Client Name:
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Address:
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Client Emergency Contact:
Emergency Contact Phone:
Please list any medication(s) or medical equipment brought with the client:
Which charge is being diverted?
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None
Public Intoxication
Disorderly Conduct
Criminal Trespass
Underage Consumption
Public Indecency
Obstructing Sidewalk
Misuse of the 911 Emergency Call System
Aggressive Panhandling
Other
Please exclude individuals involved in felony charges such as domestic violence, DUI, or charges where there is a victim.
Specify:
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Description about crime &/or how LE got involved:
Location Client was picked up by LE:
Alcohol/substance abuse:
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Yes
No
Unknown
Please list/describe:
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Describe client's current mental health and/or alcohol/substance abuse needs/issues:
Please provide any helpful info about the client such as history, medical conditions, abnormal behaviors, risk/danger/precautions, etc:
Name of VBHCS staff accepting Law Enforcement Drop Off: