San Mateo — Mental Health Diversion Progress Report

Source: https://sanmateo.courts.ca.gov/system/files/local-forms/mental-health-diversion-progress-report.pdf

Superior Court of California, County of San Mateo MHDPR

MENTAL HEALTH DIVERSION PROGRESS REPORT [PENAL CODE § 1001.36]

INSTRUCTIONS

1. Submit report via email 7 days in advance of Next Court Date: __________________

2. Include client name and next court date in subject line.

3. Email to dept25@sanmateocourt.org with courtesy copy to DA_Mental_Health_Unit@smcgov.org and

   Defense Counsel: _______________________________________________

I. CLIENT INFORMATION

Client Name: Pronouns: DOB:

Case number(s):

II. PROVIDER INFORMATION

Provider Name: Title:

Agency: Provider Phone / Email:

III. PROGRESS REPORT

Reporting Period:

Services Received:

Current Diagnosis:

☐ Different from previous diagnosis. Explanation:

Current Medication(s):

☐ Different from previous medication. Explanation:

Rev. 02/19/2026

Superior Court of California, County of San Mateo MHDPR

Dates Client Met with Providers Since Last Report: If appointment types varied, specify e.g. 1/2/26 – psychiatry, 1/3/26 – indiv therapy

Date of Next Scheduled Appointment:

During the reporting period, the client is:

Satisfactorily meeting the requirements of his/her/their treatment plan (engaged in treatment, attending appointments regularly, keeps in touch with provider, making progress towards treatment goals, etc.).

Partially meeting the requirements (attendance at treatment is not consistent, needs further engagement, making some progress, but could be increased, etc. – comment below).

Non-compliant – is not attending treatment (comment below).

In need of a higher level of care (comment below).

Pursuant to PC 1001.36(g)(4)(5) the client is gravely disabled as defined in WI 5008(h)(1)(B) and should be referred to the conservatorship investigator.

Comments:

Anticipated or Recommended Changes to Current Treatment Plan:

SIGN

Provider Signature Date

☐ Please check if applicable: I am trained in assessing for WIC 5150 criteria. I also provide records and reports based upon my clinical treatment. I am not a forensic psychiatrist, and I have not received training regarding how to assess a patient’s overall risk to the community or whether they are appropriate for Mental Health Diversion. I have not assessed either this patient’s overall risk in the community nor this patient’s appropriateness for Mental Health Diversion. If the Court would like an opinion on these matters, I will not be able to provide one and recommend the patient request a forensic psychiatric assessment on this matter.

Rev. 02/19/2026