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Corizon Employee Orientation Manual 2009

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INTRODUCTION TO PRISON HEALTH SERVICES
AND CORRECTIONAL HEALTH CARE

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PRISON HEALTH SERVICES
Prison Health Services, Inc. (PHS) is the founder of the managed healthcare industry.
Since 1978, PHS has delivered value driven healthcare to numerous jails, prisons and
juvenile facilities across the United States.
In 1991, PHS became a publicly traded wholly owned subsidiary of America Service
Group, Inc., (ASGR). “ASGR” is listed on the NASDAQ National Market System.
As a public company, PHS is the only dedicated correctional healthcare company held
accountable to the strict standards of both public and regulatory scrutiny.
Employing over 4,200 healthcare professionals and support staff across the country, we
lead the correctional healthcare field in the application of proven managed care principles
to ensure appropriate, cost-effective healthcare at each of our client facilities.
In January 1999, American Service Group (ASG), the parent company for PHS, acquired
EMSA Government Services, another leading company in managed correctional
healthcare. This further increased the scope of resources, management and clinical talent
available to service our clients. Today, we serve over 275 correctional sites around the
country through 120 contracts that cover over 174,000 lives in 27 states.
The comprehensive healthcare programs we provide all correctional facilities to control
costs by managing inmate healthcare and ensuring each individual receives the most
appropriate level of service in the most appropriate setting. At the same time, we also
insure our clients meet community standards for medical care and assist them in
obtaining accreditation by the National Commission on Correctional Healthcare
(NCCHC), the American Correctional Association (ACA) and numerous state and local
accrediting agencies. PHS also reduces the facility’s liability burden associated with
medical care through an aggressive risk management and legal support function.
MISSION STATEMENT
Prison Health Services, Inc. specializes in setting the benchmark for quality managed
healthcare services to correctional facilities throughout the United States.
VISION STATEMENT
Prison Health Services, Inc. will lead the correctional healthcare field in reputation and
results, differentiated from competitors by the highest standards of operational
excellence, clinical quality and client services.

OUR VALUES
The correctional healthcare industry is evolving every day. We, at PHS believe that all
our employees must share and embrace a singular set of values that do not change. These
values are taught to all new employees and reinforced in the workplace everyday. They
are part of our culture and differentiate us in the marketplace.
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QUALITY
PHS is committed to providing quality healthcare services at a reasonable cost in
accordance with each client’s needs. We never settle for mediocrity, but work
diligently to improve the effectiveness and efficiency in all that we do. We strive
to provide services by which all others are compared.
INTEGRITY
PHS employees conduct business in a professional and ethical manner. We
establish credibility with our clients by consistently performing in accordance
with all contractual agreements and by proactively addressing any potential
deficiencies. We ensure that all employees and independent contractors
understand PHS’ policy on “Ethics and Integrity” to assist them in decision
making.
SERVICES
We are a client service industry. Therefore, our effectiveness in servicing out
clients must be reviewed regularly. We seek continuous feedback from each of
our clients at all levels of their organization. Responding proactively and
appropriately to client needs is a key to our growth. Remember that our clients
may not always be right, but they are never wrong.
CREATIVITY
The correctional healthcare landscape has many emerging issues. Prison Health
Services seeks to acknowledge and reward our employees for creativity. We
establish forums that allow our employees to creatively problem solve and
recognize that their ideas lead to a more empowered, responsive organization.
COMPASSION
We at PHS work with, perhaps, the most unique and challenging population in all
of society. Our roe is to serve and not to judge. We treat this population with
compassion and courtesy. This is demonstrated by providing the appropriate
evaluation, care and treatment services in accordance with all professional
guidelines.
TEAMWORK
PHS possesses a team of leaders in the correctional healthcare industry. We
recognize that the most potent marketing/public relations program is supporting
our employees who, in turn, become spokespersons for out company every day.

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DIVERSITY
PHS supports the philosophy that diversity in experience, education and culture
can only serve as a platform to strengthen our organization. We do not seek to
standardize the individual, but rather to establish an appropriate vehicle where
each individual’s uniqueness can benefit the whole team.
RESPECT
We attribute our success to, and recognize that our future success is dependent
upon, developing our greatest asset: people. Through supervision, evaluation,
development and a compensation system that matches performances and rewards,
we will ensure that employees clearly understand their duties, responsibilities and
authority.
Within the restrictions of a correctional setting, we strive to provide an
environment in which employees can grow, excel and take pride in their
workplace contributions.

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PRIVATE CONTRACTING FOR INMATE
HEALTH SERVICES
“Privatization,” or the process of government contracting with a private company for the
provision of specified services, has found growing favor at all levels of government and
has taken on many forms. One of the more unusual forms of privatization involves the
provision of healthcare services to inmate in prisons and jails.
Obviously, there are some advantages or benefits in contracting with a private company
for inmate healthcare services. The benefits to healthcare contracting can generally be
grouped into three categories; Financial; Operational; and Management advantages.
Financial:
Cost savings, both direct cost savings resulting from the contract arrangement
itself and indirect cost savings produced by efficiencies in areas not directly
related to but impacted by the healthcare contract, such as transportation and
security.
Budgetary Control (present and future) and knowing the real cost of the services
provided as a result of a fixed-price contract.
Funding of needed capital equipment or improvements, such as the addition of a
dental unit within the correctional facility.
Streamlined purchasing/procurement procedures: Since the private contractor
does not have to follow often cumbersome and time consuming governmental
procedures for purchasing needed medical equipment and supplies, such
necessities can be made available faster. Consequently, the contractor can
quickly take advantage of volume discounts and short-term price reduction
opportunities offered by suppliers.
Operations:
As a specialist, the contractor brings expertise and resources to the table, which
the government may not possess. Correctional healthcare is a unique practice,
which requires specialized healthcare skills and experience.
Expanded or improved healthcare services often result from a contract, since the
contractor has a broader resource base and talent pool to draw upon than may be
available to the government.
As a healthcare specialist, the contractor has ready access tot he latest technology
and medical information. It is the contractor’s business to know, for example, the
latest and most effective treatment or medication to be used in fighting AIDS.

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Management:
The recruitment and day-to-day management of healthcare personnel become the
contractor’s responsibility rather than the correctional facility administers.
Reduction in liability exposure for the county and/or state and its officials, since
the contractor provides medical malpractice insurance.
Government becomes a “buyer” of services rather than a “provider” of services
gaining the added clout and control that nay buyer can exercise over a seller
whom “aims to please.
These are but a few of the advantages which county government may realize through a
contract for healthcare services for its correctional facility. It is an alternative worth
exploring, as many county governments have already discovered.

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Prison Health Services
Organizational Chart
Santa Rita Jail/Glenn Dyer Detention Facility

Sheriff/Coroner

Commander

Captain
GDDF

Captain
SRJ

PHS President/CEO

Captain
SRJ

Health Services Administrator/Regional Manager

Assistant Health Services Administrator

Director of Nursing

Operations and Health Information

Nursing Services

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Vice President

Medical Director

Clinical Staff

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CORRECTIONAL HEALTHCARE

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INTRODUCTION TO THE CORRECTIONAL ENVIRONMENT
The Primary Function of a Correctional Facility Is Security

Today, most people acknowledge the fact that inmates are totally dependent upon the
healthcare personnel of the correctional facility for their medical, dental and mental health
needs. Therefore, it is the responsibility of the healthcare professional to ensure that
inmates receive unimpeded access to healthcare services as well as timely evaluation and
treatment.
The dimensions of healthcare practice in correctional facilities encompass the same
characteristics that guide healthcare professionals in other health care settings: philosophy
and ethics, responsibilities, functions, roles, skills and legal authority. Healthcare
professionals who work in correctional facilities must strive to achieve the goal of
preserving and promoting the health of the incarcerated individual while working with the
following realities:
The primary goal of the facility is security.
Inmates are usually poor, uneducated, disproportionately minorities, and
commonly, of a low socioeconomic status.
Inmates are often alcoholics, drug abusers and/or have mental health
disorders.
Inmates frequently have not had health insurance and have had limited
access to healthcare services while in the community.
This results in a population base that has a higher risk for diseases such as heart disease,
hypertension, diabetes and other chronic illnesses. In addition, inmates have a high
incidence of communicable diseases such as Tuberculosis, Hepatitis B, HIV, and other
sexually transmitted diseases.
The major thrust of correctional health nursing is the provision of primary care services
for the facility’s population from the time of entry, through transfer and release. Primary
health services in the field include the use of all aspects of the nursing processing while
carrying out screening activities, providing direct healthcare services, analyzing
individual health behaviors, and providing health education. Correctional healthcare
professionals must assist inmates to assume responsibility for their own health to the best
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of their ability, knowledge and circumstance. The primary roles of a nurse in the
correctional environment include:
INTAKE SCREENING
TRIAGE
SICK CALL
CHRONIC CARE CLINICS
SUICIDE PREVENTION
HEALTH ASSESSMENTS
INFECTION CONTROL
PATIENT EDUCATION
EMERGENCY SERVICES
SEGREGATION CHECKS
DIAGNOSTIC TESTING
MEDICATION ADMINISTRATION
JAILS – A jail is a place of confinement for persons held in lawful custody under the
jurisdiction of a local government – city and/or county.
Jails tend to have a transient, short-term population staying less than one
year.
Individuals entering the jail may be poor, often disproportionately
minorities, and frequently without health insurance.
Many are in obvious need of healthcare services.
Health conditions common in the jail environment include chronic
illnesses, sexually transmitted diseases, alcoholism and drug abuse, mental
illness, and developmental disabilities.
PRISONS – A prison is a place of confinement, usually under State or Federal
jurisdiction, for individuals convicted of serious crimes.
Prisons are long term facilities, usually with a stable base population
staying more than one year.
An inmate will only be admitted to a prison after being in a jail; therefore,
healthcare needs have usually been identified and treatment initiated.
The healthcare delivery system should emphasize health maintenance and
the management of chronic illnesses.
HEALTHCARE IN THE CORRECTIONAL ENVIRONMENT – The correctional
facilities present a challenging environment for the delivery of healthcare. Some
correctional facilities are faced with deficiencies which may affect an inmate’s health
status:
Overcrowding
Inadequate Ventilation
Insufficient Diets
Poor Sanitation
The lack of recreation and exercise facilities
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DELIBERATE INDIFFERENCE – Supreme Court decisions in the 1970’s determined
that the right to adequate healthcare for inmates is protected by the 8th Amendment of the
U.S. Constitution. In Estelle v. Gamble, the courts held that “deliberate indifference to
serious medical problems of inmates constitutes cruel and unusual punishment”. The
court’s decision was influenced by the fact that inmates are not given a choice to evaluate
various healthcare settings and providers. The constitution does not specifically state that
inmates are entitled to the best care available. Inmates are entitled to adequate healthcare.
That is, inmates have the right to quick and efficient healthcare that treats and prevents
serious healthcare problems. Court judgments have determined “adequate healthcare for
inmates” includes:
Access to healthcare services
Healthcare professionals to evaluate and treat inmates
Provision of healthcare consistent with that of the community.
Availability of appropriate service.
Continuity of care, follow-up, referral services, and discharge planning.
Management of the facility’s healthcare system by healthcare professionals, not
correctional staff.
CORRECTIONAL HEALTHCARE STANDARDS – Prison Health Services has
recognized accreditation as a way to show that established standards are being met. Many
PHS facilities comply with voluntary accreditation standards set forth by the National
Commission on Correctional Healthcare (NCCHC) and the American Correctional
Association (ACA). The standards cover:
Facility Governance and Administration
Managing a Safe and Healthy Environment
Healthcare Services Support
Inmate Care and Treatment
Health Promotion and Disease Prevention
Special Needs and Services
Health Records
Medical-Legal Issues
Standards have been established for jails, prisons, and juvenile detention facilities. The
standards are developed through a consensus process by a task force comprised of
healthcare, legal, and correctional professionals. The task force determines the
requirements necessary for providing adequate healthcare services in the correctional
environment.

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The accreditation standards are stated in broad terms to afford each institution some
flexibility in program design and operation. The goal of accreditation is not to
standardize healthcare programs, but to assure that the appropriate resources and services
are available to meet the minimum requirements. There are a variety of ways in which a
program may meet the standard.
The main difference between of NCCHC and the ACA accreditation programs is the
scope of the process. ACA evaluates and accredits the entire facility while the NCCHC
program targets health services.
POLICIES AND PROCEDURES
Prison Health Services’ healthcare programs each have a complete set of site specific
polices and procedures that are designed to be in compliance with local, state, and federal
guidelines. Additionally, the policies and procedures are designed to be in compliance
with the standards set forth by NCCHC and ACA. The policies and procedures are
designed to provide direction to the healthcare staff. Each staff member is required to
familiarize him/herself with the policy and procedure manual.
A manual that specifies the healthcare policies and procedures at a given facility is
essential. Such a document serves as an important reference for the existing healthcare
staff and as an excellent training tool for orienting new healthcare staff to the facility. A
policy is the facility’s official position on a particular issue related to an organization’s
purpose. The procedure describes how the policy is carried out.
When revisions are made in the manual, they must be dated and signed by the health
authority. For ease of access, each policy should be cross-referenced with the appropriate
ACA and NCCHC standard or standards.
Annual review of policies, procedures, and programs is good management practice. This
process allows the various changes made during the year to be formally incorporated into
the agency’s manual. More important, the process of annual review facilitates decision
making regarding previously discussed, but unresolved, matters.
STATE RULES AND REGULATONS
In addition to complying with correctional standards of care, some state governments may
have specific legislative laws and/or regulations related tot he delivery of healthcare in
correctional facilities. In California, Title 15 is the regulation governing standards in adult
and juvenile detention facilities. Often, specific state laws or regulations correlate directly
to national standards.
RESPONSIBLE HEATLH AUTHORITY
The responsibilities of the health authority include arranging for all levels of healthcare
and providing quality, accessible health services to inmates. The health authority may be
a physician, a health administrator, or an agency (e.g., health department). When this
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authority is other than a physician; final medical judgments rest with a single designated,
licensed responsible physician.
The responsible health authority at this facility is the Health Services Administrator.
The responsible physician at this facility is the Medical Director.
MEDICAL AUTONOMY – National standards require that in all matters of healthcare
delivery, the healthcare staff, not security personnel, have complete responsibility and
authority. However, the healthcare staff must work closely with security personnel and
must work within the security requirements of the facility. The healthcare staff is subject
to the same security regulations as other employees.
Prison Health Services has designated the Health Services Administrator as the on-site
health authority. The health authority is responsible for arranging for all levels of
healthcare and providing quality, accessible healthcare services to inmates.
The physician is the designated responsible physician. The responsible physician
has final authority regarding all medical decisions.
Corrections, custody, and administrative staff should not become involved in
providing direct medical treatment or in analyzing and evaluating the validity of
health requests.
ACCESS TO INMATES – The Health Services Administrator has the responsibility, on
a day-to-day basis, to ensure that proper coordination is maintained between the health
services and the correctional staff assigned to moving inmates to and from the health unit.
Situations such as lockdowns will arise in which the healthcare staff may be
delayed in performance of certain duties due to security reasons. Lockdowns may
occur sporadically or at regularly scheduled times.
Head-counts performed by security staff provides an accounting for each and
every inmate occur at scheduled times throughout a 24-hour period.
In the jail setting the healthcare staff should have access to the inmate
immediately upon arrival to ensure that his/her health status is appropriate for the
jail setting.
Administrative and disciplinary segregation status should not prevent healthcare
personnel from accessing an inmate.
HEALTHCARE STAFF MEETINGS
Healthcare staff meetings occur on a monthly basis. All healthcare unit staff is expected
to attend the meetings. The meetings include discussion of relevant correctional
healthcare issues as well as continuing education in-services and updates.

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COMMUNICATION OF SPECIAL-NEEDS PATIENTS
Prison Health Services’ policy requires healthcare staff to notify correctional personnel
whenever an inmate has a significant medical illness, mental health illness, or
developmental disability that will affect the inmate’s housing or program assignment,
imposition of disciplinary sanction, or transfer to another institution.
In cases of identified special-needs patients, where correctional personnel initiate action,
consultation will be made with medical personnel before any changes are implemented.
In an emergency, correctional personnel may take action immediately to protect the
inmate, staff or others.
Inmates who have special needs include, but are not limited to, the following conditions:
1.
2.
3.
4.
5.
6.
7.
8.

Chronically ill
Communicable diseases
Physically disabled
Pregnant
Frail or elderly
Terminally ill
Mentally ill
Developmentally disabled

Typical cases where such medical/correctional consultation is required include, but are not
limited to:
1.
2.
3.
4.
5.
6.
7.

Housing assignment
Program assignments
Disciplinary segregation
Medical segregation
Intra-system transfer
Hospitalized inmates
Work assignment limitations
Upon arrival at the facility, the intake/receiving nurse will assess and determine
whether an inmate meets the criteria of special needs. If an inmate meets the
criteria, the individual will be recommended for the housing unit best equipped to
meet his special needs.
If an inmate is determined to have special needs, the nurse communicates with
custody staff to ensure that the inmate is appropriately housed.
Once assigned to a housing unit, the nurse will arrange for follow-up evaluation
during sick call by a nurse, mid-level or higher clinician. The findings will be
communicated to correctional personnel to provide housing, work assignment,
and program participation appropriate for the patient.

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Prior to transfer to another facility, a Transfer Summary will be completed to
identify special requirements that will need to be considered while in transit and
upon arrival at the inmate’s destination.
PRIVACY OF CARE
Healthcare will be provided with consideration for the inmate-patient’s dignity and
privacy. A staff member of the same gender will be present when undressing is necessary
or required for a physical examination or for exposure of an inmate’s private area.
A correctional staff member will be present only in circumstances where security
warrants it. A primary purpose of custody staff is to ensure the safety of health care staff
while performing their duties. Custody staff are instructed and trained in confidentiality
of health information and health records.
Reasonable efforts should be made to provide the inmate with visual and auditory
privacy from other staff members and other patients.
The inmate is informed in advance of medical examinations and treatments and
will be asked for their consent. An inmate may refuse treatment.
Verbal and physical interaction with the inmate should be done in such a way as
to encourage the inmate’s subsequent use of health services.
NOTIFICATION IN EMERGENCIES
Custody staff will notify the inmate’s family, next of kin, legal guardian, or personal
representative in the case of an emergency, serious illness, serious mental illness, injury
or death.
Information regarding whom to notify should be obtained from each inmate by
the correctional staff, during the admitting/booking procedure and should be kept
current and accessible.
The medical staff will make the assessment of a serious illness or death and
communicate to the facility administrator or his/her designee.
The facility administrator, or designee, will then notify the next of kin, legal
guardian, or personal representative.
In case of serious illness or injury, notification will be done via telephone or by
written communication when telephone contact is not possible.
The facility administrator will notify the next of kin in all cases of inmate death.
The PHS medical director should be notified of all deaths via a mortality incident
report.
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In the event of an inmate death the following will be followed: The charge nurse
will notify:
1. Medical Director, who will decide which MD, will report to the
facility.
2. Physician on call. Please note: In the event of an inmate death, the
PHS MD on call must report to the facility in which the death occurred
to prepare a death summary.
3. Health Services Administrator (HSA)
4. Director of Nursing (DON) or designee
5. The Mortality Incident Form is given to HSA or DON.
6. Copies of the health record are made for distribution.
The physician or Charge Nurse will complete a Mortality Incident Form and review the
chart for completeness.
Four copies of the medical record must be copied at notification of death by the Health
Information Services Department (HISD) or, if HISD not available, by a nursing
supervisor or charge nurse. Three copies of the document are forwarded to the Sheriff’s
Office and one copy to Director of Health Information Management (HIM) for
distribution to PHS Patient Safety Committee.
FORENSIC INFORMATION – The role of the healthcare staff is to serve the health
needs of the inmate population. The position of the healthcare staff as neutral, caring,
healthcare professionals is compromised when they are asked to collect information from
inmates to be used against them. Forensic information may be collected with the written
consent of the inmate. Forensic information includes:
Psychological evaluations for use in adversarial proceedings
Body cavity searches
Blood draws for DNA or other analysis
Healthcare staff should not become involved in disciplinary actions or writing up
disciplinary reports.

INFORMED CONSENT
All examinations and procedures governed by traditional informed consent practices
within the jurisdiction are observed in inmate-patient care. The informed consent of next
of kin, guardian or legal custodian applies when required by law.

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Informed consent is the written agreement of the inmate to treatment, examination, or
procedures after the inmate receives information about the nature, consequences, and
risks of the proposed treatment or procedure.
Exceptions to the requirement for informed consent include life-threatening conditions,
emergency care of inmates who are unable to comprehend information given, and public
health matters mandated by the public health authority. When care is provided without
written informed consent, the clinician must exercise his/her best medical judgment.
Thorough documentation should be completed in the health record regarding all aspects
of the inmate’s condition and the reason for medical intervention.
The physician/dentist will fully inform the inmate of the risks and benefits in
cases of invasive procedures and/or dental extractions, and ensure the inmate is
provided with answers to any questions he/she may have.
Following informing the inmate, the physician will complete the Informed
Consent Form and have the inmate sign it. The form becomes part of the health
record. A witness should be present in addition to the physician, dentist, or nurse.
The complete, signed consent form is placed in the inmate’s health record.
The physician/dentist may obtain informed consent for any case in which he/she
feels is appropriate to do so. However, the following are examples of when a
physician/dentist should obtain informed consent prior to performing:
a.
b.
c.
d.
e.

Dental Extractions
Incision and drainage
Removal of moles, warts, etc.
All procedures requiring use of local anesthesia
Sutures

RIGHT TO REFUSE TREATMENT
An inmate may refuse at any time of being offered health evaluation, treatment, or care.
The refusal should be in writing and describe the nature of the condition for which
evaluation, treatment, or care is offered and the nature of the service to be provided. The
requirement for written refusal generally is satisfied by the signature of the inmate on the
refusal document. In the event the inmate refuses to sign the refusal document, a witness
signature is needed. The witness acknowledges the inmate read the refusal form or had it
read to him/her in a language understood by the inmate.
Facilities should not maintain a policy that allows inmates to give an overall refusal that
encompasses all future treatments. By refusing treatment at a particular time, the inmate
does not necessarily waive his/her right to subsequent healthcare. Healthcare
professionals should counsel inmates against refusals of treatment, including inmates
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who have refused a particular treatment, when it is believed to be in the inmate’s best
interest.
A refusal of treatment is to be in writing on a Release of Responsibility form and must be
countersigned by the medical staff if the inmate refuses to sign. Medical request forms
(a.k.a., sick call slips) have a Release of Responsibility section included.
It is the responsibility of the healthcare staff to assure that the inmate who refuses
medical treatment understands the purpose of the proposed care, how the care will
be provided, and the consequences and risks of their refusal.
In situations where the inmate refuses care and refuses to sign a Release of
Responsibility form, the nurse documents on the form and in the progress notes.
A second staff member countersigns the form as witness to the inmate’s refusal.
An inmate who refuses essential medical care should be evaluated by a clinician.
In extreme cases, the administrator of the facility may be notified by the Health
Services Administrator or responsible physician of such refusal of care.
When an inmate refuses to come to the medical unit for scheduled appointments
or treatments, every effort should be made to have the inmate brought to the
medical unit for a healthcare professional to verify their refusal of care.
The nurse will counsel the inmate who refuses to take critical medications on the
importance of taking their medications. The nurse will explain the possible risks
involved in refusing to take critical medications. The nurse will document the
counseling session fully in the progress notes.
Medication refusals are documented on the MAR indicating how and why the
patient refused the medication and the follow actions will be taken:
a. First refusal – document refusal, and encourage inmate to take medication
b. Second refusal – document refusal, and counsel inmate if possible
c. Third refusal – document refusal, counsel inmate, and notify the clinician
By refusing treatment at a particular time, the inmate does not necessarily waive
his/her right to subsequent healthcare. It does not absolve the healthcare staff
from offering and rendering other aspects of healthcare that are deemed
appropriate for the inmate and for which the inmate-patient does not refuse.
A refusal of care which could endanger the inmate should be reported to the responsible
physician and/or the health authority and the facility administrator.

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GRIEVANCE MECHANISM
Each facility has a mechanism in place to allow inmates to express their complaints
regarding healthcare services. Healthcare complaints are included in the formal
grievance process. Inmates are told soon after they are admitted what the grievance
procedures are. If someone other than a member of the medical staff responds to inmates’
grievances, medical staff input is solicited prior to responding to an inmate’s complaint.
Grievance mechanisms are an important component of a facility’s quality improvement
program. While not all complaints from inmates are well founded, those that are can help
administrators to identify problems with specific providers or procedures.
Prison Health Services requires compliance with the written grievance procedure
regarding complaints about healthcare services.
The Health Services Administrator will work with the facility administrator to
ensure that there is a well-defined procedure for handling inmate complaints.
When a complaint about healthcare services is received, the medical record is
reviewed, and if necessary, the inmate is interviewed. A written response is given
to the inmate within the time constraints require by the facility’s plan.
Immediate resolution is expected if the complaint involves the inmate’s access to
healthcare.
Reasonable effort will be made to resolve the inmate’s complaint to his/her
satisfaction.
If the complaint cannot be resolved to the inmate’s satisfaction, the inmate may
request an appeal in which case the written grievance will be reviewed through
the facility review process.
Review of inmate healthcare complaints is included in the Quality Improvement meetings
and identified problems are viewed as opportunities to improve care.
MEDICAL RESEARCH
Prison Health Services supports the involvement of inmates in non-invasive medical
research that has been reviewed and approved by external research and ethics boards and
that offers potential benefit to the participants. The FDA must approve the participation
of inmates in research programs.
Inmates are only allowed to participate on a voluntary basis and must sign an Informed
Consent prior to involvement.
Research of an experimental nature is prohibited.

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Prior to any inmate becoming involved in medical research, the responsible
physician and Health Services Administrator must have evidence that all federal
regulations regarding inmate participation in medical research have been met.
All proposed medical research involving inmates should be thoroughly reviewed
by external research and ethics committees prior to initiating inmate participation.
Included in appropriate research topics for inmate populations are those that
study:
a. Possible causes, effects, and processes of incarceration
b. Conditions particularly affecting inmates as a group
c. Practices, both innovative and established, which are intended and
reasonably can be, expected to improve the health and well being of the
subjects.
SERVICES PROVIDED TO HEALTHCARE STAFF BY SECURITY
The healthcare services unit in a correctional facility cannot operate efficiently without
the support of security personnel. The cooperation and collaborative efforts of healthcare
and security personnel allows for efficient healthcare services. The roles of security
personnel include:
Escorting inmates to and from the healthcare services area.
Transporting inmates to healthcare appointments in the local community.
Escorting healthcare staff through the facility. Healthcare activities such as
medication administration and sick call should be performed at the same time
each day to facilitate the scheduling of security personnel.
Security personnel should be present or available in the healthcare services unit
whenever inmates are in the area. This includes the supervision of inmates who
may be in the healthcare services unit performing janitorial duties.
When indicated, security personnel should be available to healthcare personnel
during inmate healthcare encounters. It is possible to maintain privacy of care
with a security chaperone in the room.
Security personnel should not be involved in collecting medical requests,
scheduling appointments, taking vital signs or inmate histories, filing healthcare
forms or records, or performing direct patient care activities.
SERVICES PROVIDED TO SECURITY AND VISITORS BY THE
HEALTHCARE STAFF
In the event of a medical emergency, the on-site Prison Health Services’ healthcare staff
may provide healthcare services to correctional staff and visitors within the correctional
facility to stabilize their medical condition until ambulance services arrive. Prison Health
Services healthcare personnel should not be involved in providing routine services to
anyone other than the inmate population.

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SHERIFFS OFFICE STANDARDS OF PERFORMANCE:
“THE CARDINAL SINS”
The Alameda County Sheriff has discussed expectations of conduct and standards of
performance. All civilian employees and contractors are expected to abide by these rules.
It is understand that the Sheriff and/or his designee will meet out severe discipline up to
and including termination for those employees culpable of the following misconduct:
1. Accepting gratuities of any sort or description.
2. Making disparaging utterings or writing disparaging ethnic remarks, whether
or not intended as humor.
3. Misrepresenting or lying in instances involving official County business,
either orally or in writing.
4. Consumption of controlled substances or being present where controlled
substances are being used or knowingly becoming intoxicated through the use
prescribed drugs.
5. Engaging in any form of sexual harassment; this includes any unwanted
comments or contact as defined in the sexual harassment policy.
a. Becoming involved in an inappropriate or romantic relationship with an
inmate.
Although not specifically listed as one of the Sheriff’s five priority conduct concerns, he
nonetheless stated that discipline would be forthcoming to any employee engaging in
retribution against fellow employees based on political sympathy or affiliation, political
persuasion or political choice.
The afore-mentioned expectations of conduct for employees of the Sheriff’s Office do not
alter or lessen any current written policy governing the conduct of such employees.

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INTERACTING WITH INMATES

Your attitude and behavior toward the inmates determine the quality of healthcare and
security in the facility. Be caring and considerate, yet firm. Treat the inmates with
dignity, but always maintain an attitude of professionalism. Sometimes body language
speaks louder than words. Maintain body language that communicates a concern
balanced with professionalism.
Inmates may tend to be manipulative and demanding. Accommodate inmate needs and
requests when appropriate; when in doubt, seek help. Always set firm limits with
inmates and be consistent in applying these limits to all inmates while ensuring
compliance with policies, procedures, regulations, and routines of both the correctional
and health services departments. If you feel an inmate’s special needs require
intervention of another department, never promise specifics.
Because of the nature of the correctional environment, aggressive approaches may be
used to maintain an inmate. The aggressive behaviors may be verbal or physical and, at
times may require the use of force and/or restraints. THESE APPROACHES INVOLVE
SECURITY PERSONNEL ONLY AND ARE NEVER TO BE USED BY
HEALTHCARE PERSONNEL. If this need arises remove yourself to a safe area, as
previously specified by security personnel.
Your attitude and behavior reflects on Prison Health Services. You should always be
cooperative, courteous, pleasant and professional.
Maintain an open and honest relationship with security staff. Do not hesitate to ask
questions or voice concerns. The only stupid question is the one not asked. If you have a
concern regarding a situation, discuss it with security staff when there are no inmates
present.
Never go against what security staff asks you do in a situation. Never position yourself
between inmate and security personnel. If a situation arises, you become another
obstacle for security to deal with before they can deal with the crisis.
Do not share personal information with information with inmates. Any conversation you
have with another person or on the telephone you can be sure an inmate is trying to listen.
24 hours per day, 7 days per week, safety and security is everyone’s job.

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CCHP Program
Health practitioners working in correctional settings face challenges unique to the
correctional environment. Managing difficult patients, working within strict security
regulations, dealing with overcrowded facilities, and understanding the complex legal and
public health considerations of providing healthcare to incarcerated populations are just
some of the challenges that distinguish correctional healthcare from health services in
other settings.
The National Commission on Correctional Health Care (NCCHC) offers a national
certification, Certified Correctional Health Professional (CCHP), which recognizes your
knowledge of national standards for providing health services in correctional settings.
Certification under the CCHP program identifies you, as someone who mastered the
unique knowledge needed to provide care in these unique settings.
CCHP is a symbol of accomplishment and recognition of self-improvement. It is highly
regarded by peers, staff and others. A Certified Correctional Health Professional is one
who has shown mastery of national standards and the knowledge expected of leaders
working in the field of correctional healthcare. In some employment settings, CCHP
certification is rewarded with special bonuses.
The CCHP designation can be used with your name or letterhead, business cards, and all
forms of address. In addition, CCHP’s receive many benefits.
A certificate suitable for framing
A lapel or tie pin with CCHP insignia
Special discounts on NCCHC publications
Special discounts on NCCHC educational conferences
A press release to send to employee newsletters and local media
Listing in a national directory
Special networking and publishing opportunities
A subscription to the Journal of Correctional Healthcare
Persons meeting the basic application requirements participate in an examination. Upon
receiving a passing score, certification is awarded for one year. Each year, CCHP’s are
required to register participation in at least 18 hours of relevant continuing education
activities.
All correctional healthcare professions, such as physicians, nurses, mental health
workers, nurse’s aids, etc. are eligible to participate in the CCHP certification program.
Other professionals working in the area of correctional healthcare, such as attorneys,
administrators, medical record technicians, etc. are also eligible to participate.
For further information about the Certified Correctional Health Professional program,
contact the National Commission on Correctional Healthcare on the website
www.ncchc.org .

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MANAGING SAFE AND
HEALTHY ENVIRONMENT

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SAFETY AND SECURITY GUIDELINES

SAFETY ISSUES – All staff should be concerned with minimizing exposure of self and
others to potentially dangerous situations and preventing accidents and injuries to staff
and inmates.
Healthcare personnel must work within the security requirements of the facility to
assist in maintaining a safe environment.
Identification tags must be worn above the waist at all times.
Healthcare personnel must maintain control of all keys and equipment.
The healthcare service area must be locked when unoccupied.
Healthcare personnel must not access restricted areas and must limit movement in
the facility when directed by security personnel.
Do not allow an inmate in the clinic area unless an officer is present. Never leave
an inmate in a clinic room. Do not allow inmate to handle keys.
Healthcare personnel are required to dress professionally. Revealing and tight
clothing should not be worn.
CONTRABAND
Contraband is defined as goods or merchandise of which possession is forbidden.
Because of the need for security, many common items are considered to be contraband.
In the correctional setting, any items not specifically approved by security for an inmate
to have in his/her possession are considered contraband. In addition, facility regulations
may prohibit healthcare and correctional personnel from bringing some items classified
as contraband into the facility. The healthcare staff must consider virtually everything to
be contraband.
Many items directly related to the delivery of healthcare services are classified as
contraband.
Healthcare items, including but not limited to: needles, syringes, Q-tips, tongue
blades, alcohol wipes, and items that contain metal or glass.
Items for basic hygiene are provided by the correctional facility. Therefore, all
basic hygiene items not provided directly by the facility are considered
contraband. Do not give inmate soap, contact solution, lotion or any other
hygiene items unless provided through Prison Health Services or the correctional
facility.

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DO’S AND DON’TS OF CORRECTIONAL HEALTHCARE
DO’S
1. Pocket your keys securely.
2. Lock and close doors behind you when
leaving the room. Keep all clinic area
doors locked when unoccupied.
3. Lock all cabinets and drawers in the
Healthcare Services Unit.
4. Dispose of “sharps” properly and
quickly. Count “sharps” at end and
start of each shift with a co-worker.
5. Have a deputy present during
inmate exams involving the
genitorectal area.
6. Ask an inmate to leave the room and
Lock the door if you must go to another
area.
7. Leave the office door open and
accessible while an inmate is present.
8. Concern yourself with health issues
only.
9. If you suspect an inmate knows of a
scheduled appointment day or times
notify your supervisor and the HSA and
the schedule will be changed.
10. Lock your valuables in a secured
area, i.e., your vehicle.

11. Always have security check items
you are unsure, ask the Sheriff’s Office
staff if an item is considered to be
contraband.
12. Check with the Sheriff’s Office staff
before giving an inmate something that
may be considered contraband.
13. Maintain a safe distance from
inmates at all time. Distance should be
greater than an arm’s length. Walk
around a group of inmates. Stand with
your back against the wall if a group of
inmates is being moved along a
hallway and you are in the area.
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DON’TS
Don’t leave keys available for others,
especially for inmates.
Don’t leave a door open and accessible for
entry.
Don’t leave cabinets open, leaving supplies
or instruments accessible.
Don’t leave “sharps” lying around. Never
take the word of a co-worker that the
sharps count is correct.
Don’t examine an inmate involving the
genitorectal area without a chaperone.
Don’t leave an inmate in an examination
room unattended.
Don’t barricade yourself inside a room or
hallway with an inmate.
Don’t interfere with security matters.
Don’t tell an inmate, his relatives, or others
of an impending outside appointment or
trip. An escape can be planned, putting
custody staff and inmate in danger.
Don’t bring anything into the facility,
which you don’t need or which may be
considered contraband. We are all subject
to search.
Don’t bring anything with you into the
facility for an inmate no matter how trivial;
this includes, but is not limited to,
magazines, newspapers or clippings.
Don’t give contraband to an inmate: gum,
glue, metal articles, sharp instruments,
pins, Q-tips, alcohol wipes, paper soufflé
cups, etc.
Don’t walk toward or into a group of
inmates. Never get locked in an enclosed
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14. Conversation with inmates should have
a good balance between professional
and business.
15. Be professional, courteous and
cautious when responding to telephone
calls. Refer inquiries to management.

Don’t carry a message from one inmate to
another.

Don’t share or discuss information
concerning an inmate with anyone over the
phone. You never know to whom you are
speaking.
16. Always refer the inmate to their
Don’t sharpen a pencil, lend a pen, provide
Security officer if they make a
paper to write a letter, lend a lighter or
seemingly minor request for something. match, provide extra tape for a bandage
Security makes the decision as to what (adhesive or scotch tape), give them a
an inmate is allowed to keep.
cigarette, a paper cup, etc.
17. Follow all established polices and
Don’t deviate from established polices and
procedures.
procedures.
18. Limit discussions with inmates to
Don’t discuss the pros and cons of an
inmate’s case. In addition, do not discuss
their health conditions.
another inmate, a correctional staff member
or a healthcare staff co-worker with an
inmate.

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QUALITY IMPROVEMENT PROGRAM

Prison Health Services has established a CQI program using a streamlined version of the
QI implementation process as outlined by JCAHO. This process is applicable to
correctional health services due to its flexibility approach and methodology for the
following reasons:
Facility can develop a CQI plan reflective of the unique needs and established
systems of the healthcare services unit.
Implementation is easy even if healthcare staff may not have had experience in
healthcare CQI.
A logical “starting point” for staff to address and resolve problems is provided.
A continuous process for monitoring healthcare activities is provided even when
there are staffing changes over time.
COMPONENTS OF THE CQI PROGRAM
RISK MANAGEMENT – The nature of the correctional setting makes correctional
facilities more at risk that the average business for various health concerns. A
comprehensive CQI program should include a risk management component designed to
protect the financial assets of an organization by assuring appropriate insurance coverage,
reducing the liability when an adverse event occurs, and preventing the occurrence of
events that lead to increased liability. The risk management component of CQI program
should be implemented to assist in the prevention of loss.
CLINICAL RISK MANAGEMENT – The concept of risk management should be
applied to the clinical setting. In the clinical setting, risk management activities should
focus on the identification of clinical events, which have or may have the potential of
placing the patient, healthcare provider, or the facility at risk. The identified risk areas
should be investigated and analyzed to develop policies and procedures that reduce risk
and maintain a safe clinical environment.
ENVIRONMENTAL RISK MANAGEMENT – The CQI program should include a
component addressing safety. A safety program is intended to provide a safe
environment for inmates, employees and visitors. The safety program should be based on
systematic monitoring and evaluation of the environment. All appropriate individuals
should be informed of all accidents, injuries and potential hazards. This information can
be used when determining area for evaluation. The CQI committee must work constantly
to maintain a safe environment and reduce the risk of accidental injuries. An effective
safely program will assist in the prevention of injuries, reducing the demand for health
services, employee compensation claims, and accidents that can be attributed to the
organization; and therefore, contribute to the organization’s cost containment efforts by
reducing medical expenditures and protecting the organization against possible litigation.
The safety program should contain the following elements:

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ƒ
ƒ
ƒ

Identification, development, implementation and review of safety policies and
procedures.
A system for reporting and investigation all incidents that involve inmate,
personnel, or visitor; occupational illness; or property damage.
Documentation and summarization of all reports and follow-up action.

INFECTION CONTROL – The next component of the CQI program is infection
control. Correctional facilities must have infection control policies and procedures for the
surveillance, identification, treatment, documentation, and communication of infectious
diseases. The primary functions of the infection control program are:
ƒ
ƒ
ƒ

Management of communicable diseases surveillance and treatment.
Reporting of communicable diseases and conditions.
Collection, reporting and evaluation of epidemiological data for trends and
analysis.

UTILIZATION MANAGEMENT – Utilization management is the component of the
CQI program that focuses on managing the utilization of healthcare resources in a costeffective manner while maintaining the delivery of quality healthcare services. Utilization
looks at the process through which healthcare services are delivered. Statistical data is
collected on a routine basis and is used to detect potential problems. Any deviation in a
pattern or trend may warrant further evaluation.
INMATE GRIEVANCES – In the correctional setting the inmate is the customer of the
healthcare services provided. While it is realized that many grievances may be derived
from unrealistic expectations, the grievances should be reviewed to identify potential
problem areas and to determine if a pattern exists.
CONTINUOUS QUALITY MONITORING – A unit based CQI program is one which
provides for monitoring, evaluation and evaluation and improvement of the healthcare
services by the healthcare providers who deliver the care. The primary assumption
behind a unit-based program is that the healthcare providers who deliver the care are in
the best position to monitor the delivery of the healthcare services. Prison Health Services
has defined specific areas necessary for the success of unit based programs.
ƒ
ƒ
ƒ

Special Inmate Events
Health Record Audits
Focused Studies

PHYSICIAN HEALTH RECORD AUDITS – On a monthly basis the quality
assurance nurse reviews the care provided by to inmates. Health records are chosen at
random to insure that the care that has been provided is acceptable and appropriate.

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EMERGENCY PLAN
The responsible health authority and the facility administrator will approve the healthcare
aspects of the facility’s Emergency Plan, which is used in the case of an internal or
external disaster.
Prison Health Service’s portion of the Emergency Plan is practiced at least annually.
All healthcare service personnel are to be familiar with the healthcare unit’s
responsibilities and response procedures in the event of an emergency.
Each PHS medical unit will establish a site specific Emergency Plan for the medical unit
that addresses at least the following:
a. The triaging process
b. Locations identified where care will be provided.
c. Procedures and location on call list of health personnel who are to be
called in
d. Phone numbers for ambulance and hospitals
e. Evacuation plan for inmates should this become necessary
f. Specific roles for healthcare personnel
g. Back up plan
Each facility will develop a system for separate emergency supplies, which are stored in a
location known to all healthcare staff and are regularly checked for completeness and for
expiration dates on all items.
All healthcare service personnel will be oriented to the Emergency Plan during their
initial new employee Sheriff’s Orientation and annually during the annual drill.
Following the annual Emergency Plan drill, a critique will be completed and documented
to identify any weakness or improvements needed in the Emergency Plan.
INFECTION CONTROL PROGRAM
Prison Health Services maintains an Infection Control Program at each facility.
This program includes, but is not limited to, concurrent surveillance of inmates and staff,
prevention techniques, and treating and reporting infections in accordance with state and
local laws.
An Infection Control Committee is established at each facility with membership
consisting of the Health Services Administrator, the responsible physician, and other
professionals on staff and/or from within the community or the facility.
Surveillance will include, but is not be limited to the following:
a. During the initial health screening, the nurse will observe and make
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inquiry into the possibility that the patient has signs and symptoms of
infectious and/or communicable diseases.
b. Any inmate suspected of having an infectious communicable disease will
be housed in isolation; the responsible physician will be notified.
c. All new employees will be tested for TB or provided evidence of testing
within the past year. Each employee will be re-tested annually or semiannually and results will be documented in the employee’s file.
Reporting to the appropriate parties:
a. The nurse who first identifies a potential infectious disease will
communicate in the manner determined by the Health Services
Administrator or designee.
b. The Health Services Administrator or designee will assume responsibility
for reporting to the appropriate health authority (i.e. Public Health
Department) any inmate having a reportable communicable disease such
as hepatitis or a sexually transmitted disease, or a widespread
documentation of diarrhea, staph infections, or varicella.
c. The kitchen will be informed if disposable trays are required.
Other measures to prevent the spread of infectious diseases will include:
a. All staff will be constantly attentive to good hand washing technique and
other Universal Precautions. Hand washing supplies are readily available
in all clinical areas.
b. The medical staff will reinforce hygiene with food handlers, correctional
staff, etc. whenever possible.
c. Regular in-service programs on infection control will be conducted at least
annually.
d. All reusable instruments including dental tools and instruments will be
chemically disinfected before handling and then autoclaved.
e. Upon discharge from medical isolation, the medical cell will be
thoroughly disinfected by the designated inmate worker who will follow
strict universal isolation precautions.
f. All sharps and bio-hazardous waste is disposed of in appropriate containers
and is picked up by a contacted bio-hazardous company.
g. Appropriate measures are to be taken with contaminated linens and trash.
h. Any condition resulting in the spread of infection will be addressed
immediately by the Health Services Administrator, the responsible
physician, and the facility administrator.
TB Skin Tests:
a. All inmates will be tested for TB during the receiving screening.
b. Inmates known to be positive will be referred to TB clinic.
c. All TB skin tests will be read by a qualified healthcare professional within
48-72 hours.
d. All test results will be documented in the inmate’s health record in
millimeters (mm) of induration. + PPD = 10mm or greater.
e. Positive skin tests, or those inmates who report they have tested positive to
the skin test in the past, will have the following:
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1. Interview the patient regarding past exposures and previous nonreactive test.
2. Assess for any signs and symptoms.
3. Document findings in the health record and record test results in mm.
4. Schedule for a chest x-ray.
5. If the inmate is symptomatic, or the healthcare professional suspects
he/she is positive, the inmate will be moved to an area where
respiratory isolation can be implemented, preferably with negative
pressure air flow.
6. If X-ray is positive, the inmate will remain in respiratory isolation until
see by the physician.
7. The physician will write orders for treatment and will determine when
the patient can be released from isolation.
8. If the inmate was previously housed with other inmates, a list of
inmates who have been exposed should be re-tested and/or reported to
the local health authority.
RPR testing
a. All high risk inmates, including known drug users, prostitutes, and those
who were previously living in an area known to be high risk, may be
offered an RPR test during the receiving screening.
b. Other inmates have the RPR test performed during the Health
Assessment if indicated.
c. Positive results (1:1 or greater) will be handled as follows:
1. Interview the inmate to gather information on previous history and
treatment
2. Assess for signs and symptoms
3. Document findings in the health record
4. Schedule the patient to be seen by the physician, physician assistant, or
nurse practitioner.
5. Transcribe and carry out medical orders to treat the patient.
6. Report the incident to the appropriate public health authority.
HIV testing
a. HIV testing may be offered to inmates at the time of Health Assessment.
b. Pre and post-test counseling may be provided by qualified healthcare
personnel.
c. When test results are positive and the patient is not already being treated,
the patient is scheduled for the next physician’s sick call.
d. Mental health referral may be made for all newly diagnosed HIV+
inmates.
e. Make a referral to local providers as early as possible to ensure continued
care for the inmate upon release.

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STANDARD PRECAUTIONS (AKA: Universal Precautions)
Since medical history and examination cannot reliably identify all individuals infected
with HIV or HepB or other blood-borne pathogens, standard precautions should be used
consistently. This is of particular importance in emergent situations where the risk of
blood exposure is increased and the infection status of the individual is unknown.
Standard precautions apply to:
ƒ Blood
ƒ Tissue
ƒ Body fluids containing visible blood
ƒ Semen
ƒ Vaginal Secretions
ƒ Cerebrospinal Fluid
ƒ Synovial Fluid
ƒ Pleural Fluid
ƒ Pericardial Fluid
ƒ Amniotic Fluid
ƒ Saliva in dentistry
Standard precautions do not apply to the following unless they contain visible blood:
ƒ Sweat
ƒ Tears
ƒ Nasal Secretions
ƒ Sputum
ƒ Urine
ƒ Vomit
ƒ Saliva
ƒ Breast Milk
HAND WASHING
Hand washing is the single most important procedure for preventing nosocomial
infections. It is defined as a vigorous rubbing together of all surfaces of lathered hands,
followed by rinsing under a stream of water. Hand washing can be classified as
mechanical or chemical depending on whether plain soap, detergents or antimicrobialcontaining products are used.
Hand washing indications – personnel should always wash their hands: before
performing invasive procedures; before and after taking care of inmates; before and after
touching wounds; after exposure to bodily fluids; and between contacts with inmates.

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PERSONAL PROTECTIVE EQUIPMENT
Healthcare personnel should wear personal protective equipment when there is a
possibility of body fluid exposure. The protective equipment should be kept in medical
areas where the most frequent need arises, generally the treatment room.
Protective equipment including, but not limited to the following, may be used as needed:
gowns, gloves, goggles or surgical mask with or without plastic shield, caps, booties,
one-way valves, or particulate respirators or facemasks.

GUIDELINES FOR PREVENTION OF TRANSMISSION OF THE HBV AND HIV
EXAMPLES OF RECOMMENDED USE OF PERSONAL PROTECTIVE EQUIPMENT

ACTIVITY

Spurting Blood
Minimal Bleeding
Emergency Childbirth
Code
Blood Drawing
Starting IV
Endotrachial Intubation
Oral/Nasal Suctioning
Handling/Cleaning
Contaminated Instruments
Measuring Blood Pressure
Measuring Temperature
Giving an Injection

GLOVES

GOWN

MASK

Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes

Yes
No
Yes
Yes
No
No
No
No
Yes*

Yes
No
Yes
Yes
No
No
PR
PR
No

GOGGLE

Yes
No
Yes
Yes
No
No
Yes*
Yes*
No

CAPS/BOOTIES

Yes*
No
Yes*
Yes*
No
No
No
No
No

No
No
Yes

No
No
No

No
No
No

No
No
No

No
No
No

*If splashing is likely.
PR: Particulate Respirator is recommended whenever sputum exposure is likely. A fluid resistant surgical mast is
not sufficient.

ENVIRONMENTAL HEALTH AND SAFETY
The facility administrative staff in conjunction with the Health Services Administrator
and the Medical Director develops Polices and Procedures to assure a safe, sanitary
environment, for inmates and staff.
Regularly scheduled environmental inspections are conducted with written reports
submitted to the Health Services Administrator and the facility administrator.
The Health Services Administrator will ensure that regularly scheduled environmental
inspections are completed on at least a monthly basis.

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The Health Services Administrator will keep written reports of the results of these
inspections on file.
Identified problems will be addressed in Administrative Meetings with the facility
administrator or designee and in Continuous Quality Improvement meetings when
appropriate.
Immediate corrective action will be taken when an unsafe or unsanitary condition is
noted.
At a minimum, areas that are included in the environmental inspection are:
a. Inmate housing
b. Kitchen and laundry
c. Healthcare Unit
d. Housekeeping
e. Risk exposure areas including electrical outlets, fire retardant equipment,
and barber and beauty shops
f. Ventilation systems
g. Appropriate personal protective equipment

KITCHEN SANITATION AND FOOD HANDLERS
Inmates and staff working in food services must submit to a pre-assignment physical
examination to ensure freedom of illnesses transmissible by food.
The Health Services Administrator or designee will work cooperatively with the
correctional authority responsible for food service to ensure that inspections are
conducted and that corrective actions are taken when problem areas are identified.
All inmate kitchen workers are medically screened prior to beginning work in the food
service area and are re-examined on an annual basis.
A Medical Clearance Form is completed for each inmate who is being considered for
assignment to the food service area prior to their beginning work and annually. The
original is forwarded for the inmate’s classification file, and a copy may be filed in the
medical record.
The food service supervisor is responsible for monitoring the health and cleanliness of
inmate kitchen workers on a daily basis. The food service supervisor or designee will
maintain documentation of these daily checks. Daily screening will include determining
if the inmate is free from diarrhea, skin infections, and other illnesses that are
transmissible by food or utensils.
Inmates who have diarrhea, skin infections, runny nose, and other illnesses transmissible
by food or utensils will not be cleared to work in the food service area. Inmates who are
already assigned to the food service area who develop any of these conditions will be
relieved of their duties until such time as they are medically cleared to return to work.
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All inmate and civilian kitchen workers who prepare or serve food are required to wear
hair covers and gloves.

ECTOPARASITE CONTROL
The physician establishes and approves ectoparasitic control procedures that are used to
treat inmates found to have ectoparasites including procedures for disinfecting of clothing
and bedding.
All inmates are evaluated for the presence of ectoparasites during the receiving screening
and anytime thereafter that it is indicated.
Prior to choosing treatment, consideration is given to the individual inmate regarding the
presence of any open wounds, allergies, seizure disorders, pregnancy, respiratory
ailments, or other conditions that may contraindicate use of the established treatment
procedure.
It is the policy of Prison Health Services that each inmate is to be evaluated individually
in regard to the need for ectoparasite treatment and that all inmates are not routinely
treated upon admission.
Each newly admitted inmate will be evaluated for the presence of ectoparasites at
the time of the health screening.
Inmates found to have ectoparasitic infestations will be instructed that all articles
of clothing, bedding, and towels must be bagged and appropriately marked for
disinfection.
The patient should be instructed to take a shower, using hot water and soap.
The treatment prescribed by the physician is then carried out.
For body infestation, the lotion ordered by the physician is applied from the neck
down on the whole body, except for the head and face and is generally left on for
a prescribed period time before being removed by thorough washing in the
shower or bath.
For head and pubic infestations, the prescribed agent is given to the inmate to
apply liberally to the affected areas and the inmate is given specific instructions
regarding how long the solution is to remain on prior to rinsing.
The inmate’s clothing and bedding should be bagged up by the inmate and
marked for delousing. The housing cell will also be disinfected and the inmate is
issued new clothing and bedding.

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The inmate is instructed to return to the medical unit in seventy-two (72) hours for
a follow-up visit.
Physical findings and delousing instructions are documented in the medical record
at the time of treatment. The inmate’s condition and response to treatment is
documented in the medical record when he is re-evaluated at seventy-two (72)
hours.
BIOHAZARDOUS WASTE PLAN
The purpose of the biohazardous waste plan is to provide for the proper management of
biochemical waste in a manner that is consistent with federal and state regulations.
Biomedical Waste – Biomedical waste is defined as any solid or liquid wastes
that may present a threat of infection to humans. Examples of biochemical waste
include:
Non-liquid tissue and body parts
Laboratory and veterinary waste which contain human disease causing agents
Discarded sharps
Blood and body fluids
Used, absorbent material saturated with blood, dried blood, body fluids,
excretions or secretions, contaminated with blood
Disposable devices that may have been contaminated with blood, body fluids
or blood contaminated excretions and secretions.
Other contaminated solid waste materials, which represent a significant risk
because they are generated in medical facilities which care for persons
suffering from diseases requiring strict isolation.
Segregation and Handling – Biomedical waste is identified, segregated from all
other solid wastes and placed in to the appropriate biomedical waste receptacle at
the point of origin. Point of origin is defined as the room or area where the
biomedical waste is generated.
SHARPS – Sharps are discarded directly into leak-proof, puncture-resistant
containers that have been designed for this purpose.
NON-SHARPS – All non-sharp biomedical waste are discarded directly into
red impermeable bags located in the health services area.
Co-Mixing – Do not co-mix biomedical waste with hazardous waste.
Labeling – Because treatment and disposal of biomedical waste occurs off-site,
all packages containing biomedical waste are labeled with:
Facility name and address
Date
“Biohazard, Biohazardous Waste, Infectious Waste, or Infectious Substance”
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On-Site Storage – All on-site storage of biomedical waste is in a
designated area, away from general traffic flow patterns and is accessible to
authorized personnel only. Storage of biomedical waste shall not be for a period
greater than 30 days.
Off-Site Transport – Biomedical waste is collected and transported for
incineration.
Cleaning Solutions – Surfaces contaminated with spilled or leaked biomedical
waste shall be cleaned with a solution of industrial strength detergent to remove
visible soil before being disinfected with a 1:10 solution of bleach.
Records – All biomedical waste management records, including the
documentation provided by the transporter, shall be maintained for a minimum of
three years and will be made available for inspection, upon request. The records
will be stored on-site.
Employee Training – All employees who are involved in the handling, disposal
and/or management of biomedical waste shall receive training on the policy and
procedure prior to initiating their duties and on an annual basis thereafter.
OSHA HAZARD COMMUNICATION
About 32 million workers are potentially exposed to one or more chemical hazards.
There are an estimated 575,000 existing chemical products, and hundreds of new ones are
being introduced annually. Chemical exposure may cause or contribute to many serious
health effects such as heart ailments, kidney and lung damage, sterility, cancer, burns,
and rashes. Some chemicals may also be safety hazards and have the potential to cause
fires and explosions and other serious accidents.
The Occupational Safety and Health Administration (OSHA) issued, in 1983; a rule
called “Hazard Communication” that applies to employers in the manufacturing sector of
industry. The scope of the rule was expanded 1987 to include employers in the nonmanufacturing sector. The basic goal of the standard is to ensure that employers and
employees know about chemical hazards and how to protect themselves. This
knowledge, in turn, should help to reduce the incidence of chemical source illness and
injury.
The Hazard Communication Standard establishes uniform requirements to assure that the
hazards of all chemicals used in the workplace are evaluated and that the resultant hazard
information and recommended protective measures are provided to employers and
potentially exposed employees.
PHS complies with the Hazard Communication Standard by complying with all
directives from the Alameda County Sheriff’s Office with regard to hazardous materials.
MSDS sheets are displayed throughout the jail for use as needed. Containers are labeled.
Employees participate in OSHA training.
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SAFE LIFTING & CARRYING

Plan To Prevent Injury
Use a cart or trolley when possible
Break down large or heavy loads
Seek help if necessary
Check your route is clear
Take extra care with awkward tasks

Lift The Load Safely
Stand close to it with feet apart
Bend your knees, not your back
Grip the load firmly
Lift with your legs

Carry It Carefully
Hold it close to your body
Look where you are walking
Take extra care carrying up and down stairs
Don’t twist our body, move your feet to turn
Push carts in-line with your direction of travel (not across at 90º)

Put It Down Properly
Bend your knees to lower the load
Don’t trap your fingers or toes
Put it down first, then slide it into place
Don’t over-reach or stretch

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TUBERCULOSIS REVIEW

TUBERCULOSIS (TB) DEFINED:
Tuberculosis is a disease caused by the bacterium Mycobacterium Tuberculosis,
frequently called Tubercle Bacilli. TB can occur anywhere in the body but is most
common in the lungs and larynx.
TUBERCULOSIS TRANSMISSION:
TB is spread through the air by tiny airborne particles called “droplet nuclei” which
contain Tubercle Bacilli. Individuals produce “droplet nuclei” when they talk, sing,
cough and sneeze. The droplet nuclei may remain suspended in the air and may be
inhaled by others if the area is not properly vented to the outside. If an individual has
infectious (active) TB of the lung or larynx the droplet nuclei may contain tubercle
bacilli.
WHAT IS TB INFECTION:
When an individual breathes in air contaminated with tubercle bacilli the bacteria will
multiple to some degree before the individual’s immune system obtains control of the
growth. At this point, the individual has been exposed to TB and is considered to have
the TB infection. However, this does not mean that the individual is infectious and can
transmit TB to others. Once an individual has TB infection, the tubercle bacilli may
remain dormant (inactive), or they may become active and cause clinical disease
(infectious TB) at some point in the future.
A person who has TB infection without active disease:
cannot spread TB infection to others,
is not considered a case of TB
usually has a negative x-ray and does not have symptoms of TB, but
does have tubercle bacilli and may develop the disease at any point in the future.
TB DISEASE:
Once exposed, an individual may develop active disease. This can happen at the time of
exposure or many years later. When the immune system is suppressed, the risk of
developing TB increases. Factors, which suppress the immune system, include HIV
infection, chemotherapy, and malnutrition and drug and alcohol abuse.

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TB SYMPTOMS:
As previously stated, TB can occur anywhere in the body. The symptoms vary
depending on the location of the disease. General symptoms of TB disease include:
lethargy
weakness
weight loss
loss of appetite
fever
night sweats
The most common location of TB is in one or both lungs. TB of the lungs is called
“Primary TB.” The symptoms of “Primary TB” include:
persistent cough
chest pain
hemoptysis
TB CONTROL:
The Mantoux skin test is the standard method of identifying individuals infected with
Tubercle Bacilli. Injecting a purified portion of the dead Tubercle Bacilli into the
superficial layers of the skin performs the skin test. The test is interpreted in 48-72 hours.
A positive test results in a firm or hard swelling which can be felt by gently rubbing the
injection site. The firm, or indurated, area is measured in millimeters (mm). The
reddened area at the injection site is not included in the measurement. A 5-10 mm or
greater reaction is considered to be a positive reaction, depending on a prescribed set of
criteria.
Individuals who have a positive skin test for TB should have a x-ray to be certain they do
not have active TB. An individual who has a positive skin test and a negative chest xray, in most cases has been exposed to TB but does not have active or infectious TB. The
exception would be an individual who is experiencing symptoms.
Individuals working in the correctional environment and having direct contact with the
inmate population should be tested for TB prior to employment. Employees are tested
for TB annually or by chest x-ray annually with history of + PPD.
TB THERAPY:
Preventive therapy substantially reduces the risk of developing clinically active TB in
infected individuals. All individuals who have a positive skin test for TB should be
considered for preventative therapy when active disease has been ruled out. The current
preventative therapy regiment is 6 to 12 months Isoniazid and Vitamin B 6. Patients
must be monitored monthly for symptoms of drug toxicity as sell as to ensure
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compliance. If the medication is not taken as prescribed, the tubercle bacilli may become
resistant to the medication, and therefore, the medication is ineffective.

CONTACT INVESTIGATION:
Whenever a case of TB is suspected or diagnosed, all close contacts should be tested.
However, individuals with a documented history of a positive skin test will not need to be
re-tested. Close contacts include anyone who has shared air in an enclosed environment
with a potentially infectious individual. Close contacts many include cellmates, pod
mates, and health and correctional staff working in the area.

RULE OUT TB:
Inmates placed in the Outpatient Housing Unit (OPHU) for “Rule-out TB” may not be
released from the unit until they have been cleared and released by the TB nurse. Specific
protocols apply and need to be explicitly followed when determining the status of a
potential Tuberculosis case.

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HOW TO REPORT INMATE INCIDENTS

Incident reporting is a critical step in successful risk management programs. We rely
heavily on this communication tool to alert us to the potential claims and lawsuits against
the Company. Incident reporting is also key to prevention. By tracking and trending
incidents with potential for injury to patients, we can evaluate our processes and
implement corrective action measures as necessary. However, we can only do this
effectively with your help.
An incident is defined as any unplanned or unexpected occurrence in the health services
department or area that is not consistent with the routine care of a patient. The Prison
Health Services, Inc.’s Incident Report form is available for your. An inmate incident
should be reported to the nursing supervisor or designee as soon as possible (ASAP). An
actual injury need not have occurred. The potential for injury is sufficient for an
occurrence to be considered an incident. Therefore, we have developed the following list
of types of incidents that you are required to report through our incident reporting system:
WHAT TO REPORT:
All deaths
Acute neurological deficits/injuries
Delays in treatment or diagnosis
Unplanned hospitalizations due to:
Cardio/respiratory arrests
Repeat visits to the ER for the same complaint or condition
Seizures
Suicide attempts
Head injuries
Detoxification
Miscarriages
Infections/sepsis
Significant injuries such as:
Amputations
Loss of use of limb(s)
Spinal cord injuries
Visual/hearing impairment
Reproduction organ loss/impairment/burns (2nd and 3rd degree)
Medication errors

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WHAT TO DO FOLLOWING AN INMATE INCIDENT:
1.

Notify the Nursing Supervisor as soon as possible.
We consider an urgent matter to be a serious injury (i.e., death, amputation,
neurological injury, etc.) or receipt of a lawsuit or claim. All other types of
incidents do not require such prompt notification.

2.

Complete the Incident Report. When you are ready to complete the incident
report, notice that in bold letters at the top of the report it states:
CONFIDENTIAL: THIS FORM IS NOT PART OF THE MEDICAL RECORD.
This is extremely important. As you will note, it also says at the top of the form
that this document is privileged and confidential, for use by legal counsel, and
may not be released without the consent of PHS’ general counsel. For that
reason, we ask that you do not keep a copy of the form at the site. If anyone
requests a copy of the incident report form, you must contact PHS’ general
counsel for authorization.
The employee involved in responding to, observing or discovering the incident
must complete the incident report form.
In completing the incident report, keep the description of the incident brief and
concise. You will notice that our form provides only four lines to describe the
incident, which has occurred. If more room is needed, continue on the back. The
purpose of this form is to let us know that a particular incident has occurred and
generally what treatment was provided (e.g., transfer to the hospital.) Details
about the incident itself, assuming that it was a medical emergency of some sort,
will be contained in the medical record.

3.

Do not make reference to the existence of the incident report in the progress
notes in the medical record. Doing so may result in waiving any legal
protection we may have available to us.

4.

Sign the form and give it to the Nursing Supervisor or your supervisor for
review. The supervisor will forward the original to the Health Services
Administrator (HSA) or designee.

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HOW TO REPORT AN OCCUPATIONAL EXPOSURE OR INJURY

Incident reporting is a critical step in successful risk management programs. We rely
heavily on this communication to alert us to occupational hazards present in the
workplace, i.e., exposure to chemicals, bodily fluids, or physical plant hazards. Incident
reporting is also key to prevention. By tracking and trending incidents with potential
injury to staff, we can evaluate our processes and implement corrective action measures
as necessary. However, we can only do this effectively with your help.
WHAT TO INJURIES TO REPORT:
Any occupational incident resulting in employee injury.
Any occupation-related injury or illness, i.e., needle stick, exposure to
chemicals, exposure to bodily fluids, or an injury that you consider to be
occupational in nature.
WHAT TO DO FOLLOWING AN OCCUPATIONAL INJURY OR EXPOSURE:
1. Notify the Nursing Supervisor/your supervisor as soon as possible. Do not
delay reporting an occupational exposure or injury/illness. Nursing
supervisor/your supervisor notifies HR or designee to facilitate prompt
completion of appropriate Workers Compensation Claim documents.
2. If a needle stick or occupational exposure to blood and body fluids, follow the
PHS Needle Stick Policy.
3. Attend an Occupational Medical Provider clinic for PHS Workers Compensation
injuries. See www.mywcinfo.com for a current listing of providers in a
geographic area convenient for you.

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PHS NEEDLE STICK AND OCCUPATIONAL EXPOSURE
TO BLOOD AND BODY FLUIDS POLICY
POLICY:
It is the intent of Prison Health Services, Inc. to protect it’s
Healthcare Providers as much as possible from exposure to blood or body fluids
parenterally. All exposures to blood and body fluids must be reported to your
immediate supervisor for incident reporting, the completion of Worker
Compensation reports and the post exposure evaluation and prophylaxis.
PROCEDURE:
Whenever any employee is exposed to blood or other
Potentially infectious fluids the employee will:
1. As soon as possible, following the incident, thoroughly wash the area in
Running water with soap. Eyes will be washed with an appropriate eyewash
or potable water for 15 minutes. Bleach or other suitable veridical may be
used for non-mucus membrane exposures.
2. The exposure will be immediately reported to the immediate supervisor.
3. An incident report form will be completed, and the time the employee was
sent off site for treatment will be noted on the incident report.
4. The employee will immediately be referred to a local treating facility so that
the employee will receive treatment within 2 hours of such stick for
evaluation, counseling, and possible institution of post exposure prophylaxis
(PEP). Baseline evaluation of the employee should include HIV, HCV,
VDRL/RPR, HbsAg, and/or HBV.
5. Another staff member will review the source patient’s medical record for any
evidence of HIV, HCV, and/or HBV with immediate notification to the
supervisor.
6. Whatever available medical information regarding the source patient will be
sent with the employee to the local healthcare provider.
7. If the source patient’s HIV, HCV and HBV status is unknown, a blood sample
will be requested for HIV, HCV and HBV.
8. The results of these blood tests will be shared with the employee and the
employee’s healthcare provider.
9. Initiating PEP should be decided on a case by case basis by the injured staff
member and the treatment facility based on the exposure risk and the
likelihood of HIV infection in the known or possible source patients. If
additional information becomes available, decisions about PEP can be
modified.
10. The employee should follow the site Worker’s Compensation Policy and have
follow up counseling and medical evaluation, including HIV antibody tests at
baseline and periodically for at least six months post exposure (e.g., 6 weeks,
12 weeks, and 6 months), and should observe precautions to prevent possible
secondary transmission.
11. The designated Worker Compensation provider will provide immunizations,
medication, counseling (to include methods of preventing secondary
transmission of HIV, HCV, syphilis and/pr HBV) and follow-up lab tests.

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DEFINITIONS:
1.
Healthcare Provider – all employees, members of the medical and dental
Staff of the facility, and contracted professional personnel.
2.
Isg – Immune Serum Globulin
3.
HBIG – Hepatitis B Immune Globulin
4.
HBsAg – Hepatitis B Surface Antigen
5.
HbsAb – Hepatitis B Surface Antibody
6.
HBVac – Hepatitis B Vaccine
7.
HCV – Hepatitis C Virus
8.
Baseline blood work for Hepatitis B consists of testing for Hepatitis B
Surface Antigen (HbsAg) and Hepatitis B Surface Antibody (HbsAb).
9.
An occupational exposure that may place a worker at risk for HIV, HCV
and/or HBV infection is defined as a percutaneous injury, or contact of
skin with blood, tissues or other body fluids to which Universal
Precautions apply including:
a)
Semen, vaginal secretions, cerebrospinal, synovial, pleural,
peritoneal, pericardial and amniotic fluids
b)
Laboratory specimens that may contain HIV, HCV and/or HBV.
10.
Percutaneous injury – a needle stick or cut, with a sharp object.
11.
Skin contact – when the exposed skin is happed, abraded or affected with
dermatitis or the contact is prolonged or involving an extensive area.

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WORKERS COMPENSATION REPORTING OF INJURIES OR ILLNESS
All employee injuries, including needle sticks, at work must be reported to the PHS
administrator or Supervisor and called in ASAP by the supervisor or PHS administrator
to the worker’s compensation carrier1-800#, and specifying PHS. DO NOT report
employee injuries using the inmate incident report form.
If injury is a needle stick, follow the needle stick policy.
A Supervisor’s Accident Investigation Report shall be completed by
Supervisor and forwarded to Human Resources or designee.
The HSA must be informed of the injuries.
PHS needs to be notified immediately if an employee misses time from work
due to their injuries/illness. Human Resources shall prepare a PAF placing
that employee on leave if they are absent longer than 3 days.
When reporting the injury please make sure the correct site number is given
(052 Santa Rita/Glenn Dyer).
All surgeries or extenuating circumstances involving the claims should be
processed and approved by the PHS corporate office. This is only to
minimize confusion in the process and also maintain manageability within
the program.
The Worker’s Compensation Insurance Company for Prison Health Services
and America Service Group is posted.
The medical providers for Occupational Medicine, Physical Therapy &
Rehabilitation Services are posted and are listed on the workers’
compensation website.

Toll-free Claims Reporting Quick Reference Sheet for Worker’s Compensation
Claims. Thank you for your prompt claims reporting!
To report a worker’s compensation claims quickly and efficiently, please have
the following information ready when for toll-free claims reporting
service. This is a general listing for your quick reference. Additional
information may be requested based on state requirements.
Policy Information:
Insured Name (Prison Health Services, Inc., America Service Group)
Policy number (if known)

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Claimant Information:
Employee name
Social security number
Address and home phone number
Spouse’s name
Number of dependents
Date of hire
Gross pay per week
Accident Information:
Exact date and time of injury
Exact location or site code where injury occurred
Specific description of injury (i.e., employee slipped and fell on wet floor)
Name of any witnesses of the stated injury
Safeguards or safety equipment provided to prevent injuries (where
applicable)
Name and address of claimant’s physician
Name and address of hospital

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SUPERVISOR’S ACCIDENT INVESTIGATION
REPORT

Employee Name: ____________________ Date of Accident: ______________________
Location of Accident: ________________ Time of Accident: ______________________
Occupation of Employee: _____________ Injury: _______________________________
Witness: ________________________________________________________________
Employee’s description of accident: __________________________________________
_____________________________________________________________________________________

_______________________________________________________________________
What acts failures to act and/or conditions contributed most directly to this accident?
________________________________________________________________________
________________________________________________________________________
Why did the above acts and/or conditions occur? ________________________________
________________________________________________________________________
________________________________________________________________________
What is the plan of action to prevent recurrence? ________________________________
________________________________________________________________________
________________________________________________________________________
Supervisor’s Comments:____________________________________________________
________________________________________________________________________
Investigated by: _____________________ Date: ________________________________
Reviewed by: ______________________ Date: ________________________________

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INMATE HEALTH SERVICES

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RECEIVING SCREENING
The receiving screening is intended to identify any potential critical needs among
arrestees arriving at the jail. It is a process of structured inquiry and observation
designed to prevent newly arrived inmates who pose a threat to their own or others’
health or safety from being admitted to the jail’s general population and to get them
medical care. It occurs upon the inmate’s admission (booking) to the facility and
must be performed on all new arrivals to the jail system. Receiving screening must be
considered using a form and language fully understood by the detainee who may not
speak English and/or have a mental or physical impairment (e.g., speech, hearing, and
sight). AT&T language line is available for translation services. The receiving
screening findings are recorded on a form approved by the health authority.
Inmates who are transferred from another institution within the same correctional system
accompanied by their initial health screening forms and a copy or summary of their
medical record from the transferring institution may not need a new initial screening
to be conducted. However, the medical information must still be reviewed and
verified to ensure continuity of care.
It is extremely important for screeners to explore fully the inmate’s suicide and alcohol
and other drug (AOD) withdrawal potential. Reviewing with an inmate any history of
suicidal behavior, and visually observing the inmate’s behavior (delusions,
hallucinations, communication difficulties, speech and posture, impaired level of
consciousness, disorganization, memory defects, depression, or evidence of selfmutilations) are required. This approach, coupled with training staff in aspects of
mental health and chemical dependency should enable staff members to intervene
early to treat withdrawal and to prevent most suicides.
Particular attention should be paid to descriptions of signs of trauma. All staff members
should be reminded of their responsibility for reporting suspected abuse of inmates to
the appropriate authorities. Inmates arriving with signs of recent trauma should be
referred to the medical staff immediately for observation and treatment.
Prison Health Services’ policy and procedures require that receiving screening is
performed by health trained or qualified healthcare personnel on all inmates upon
their arrival at the jail system. Persons who are unconscious, semiconscious, bleeding,
mentally unstable, or otherwise urgently in need of medical attention are referred for
emergency care. If they are referred to a community hospital, their admission or
return to jail is dependent upon written medical clearance.
ORAL SCREENING
Oral screening is preformed on inmates when complaint is received from or voiced by the
inmate during the Receiving Screening process, and on all inmates during the Health
Assessment.
A dentist licensed in the state of the facility provides necessary dental care to patients.
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Each inmate receives dental care/hygiene items at the time of admission to the facility
and dental instructions during Health Assessment.
Acute dental problems are referred to the dentist as soon as they are
identified.
The Health Assessment includes a dental screen.
An inmate may receive dental hygiene instructions and dental health
education during their initial intake process.
INFORMATION ON HEALTH SERVICES
Prison Health Services requires that all inmates be informed of the scope of care available
and mechanism for accessing health services both verbally and in writing.
Verbal notification will be given to all inmates and will be documented on the Receiving
Screening form. Additional verbal notification is given to the inmate at the Health
Assessment.
The procedure for assessing health services is provided in writing in the Inmate
Handbook provided by the Alameda County Sheriff’s Office. The method for obtaining
routine and emergency healthcare services are prominently posted in reception areas and
housing units in bilingual signage.
The facility or Prison Health Services will provide interpretation services as needed to
assist in information exchange between inmates and medical personnel.
The nurse completing the Receiving Screening verbally informs all inmates
of available healthcare during intake screening.
Bilingual signs are posted in the receiving areas and in the housing units
explaining how to access emergency and routine medical care.
The inmate requesting routine or non-emergent healthcare will fill out the
Sick Call slips, date and sign it, and return it to the sick call box located
in the dining area of the housing unit.
All inmates are to have access to Sick Call Slips on a daily basis. Sick Call
Slips are placed in the sick call box located in the housing unit dining area
and each inmate has the opportunity to present completed forms on a daily
basis.
HEALTH ASSESSMENT
All newly committed inmates are required to have a Health Assessment (H&P)
completed by qualified health staff within fourteen (14) days at jails. The Health
Assessment consists of a complete medical history and physical examination.

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The Health Assessment will be documented on the form approved by the health authority,
which has and will become part of the permanent medical record.
Only an appropriately trained registered nurse, physician assistant, nurse practitioner, or
physician performs physical examination.
The dentist will provide in-service training to all nursing staff who assigned to perform
health assessments. The Health Assessment includes a dental screen.
Re-admitted inmates who have received a health appraisal within the last three months
(90 days) and their receiving screening shows no changes in their health status may only
require that their results be reviewed, and tests and examinations updated as needed.
The medical history and physical examination provides the beginning
database for the total comprehensive plan of care which is delivered
according to the philosophy and objectives of Prison Health Services. The goal
is to prevent deterioration of inmate’s health during incarceration and to
improve vital functions whenever possible.
The health evaluation may include the following:
a. Review of the receiving screening form
b. Collection of additional data to complete the medical, dental, and
psychiatric histories
c. Testing for communicable diseases, such as syphilis and tuberculosis
d. HIV testing may be offered to inmates who have related symptoms, highrisk behaviors or have requested a test. Informed consent is required.
e. Recording height, weight, and vital signs.
f. Physical examination of all major body systems that including mental
status and dental screening
g. Completion of other clinically indicated tests and examinations
h. Review of all laboratory tests and referral to the physician when indicated
i. Initiation of appropriate treatment when indicated or ordered by the
physician.
j. Make referrals for follow-up as needed.
k. Provide patient education.
Health appraisals are updated on an annual basis with elements
being repeated based upon the age, sex and the health need of the inmate.

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MENTAL HEALTH OBSERVATION TRAINING for clinical staff performing
health assessments and physical examinations (H&P’s).
Prepared and presented by Criminal Justice Mental Health

Orientation (Person/Place/Time)
o Does the person know who he or she is? Have them state their name.
o Does the person know where he or she is? Have them tell you.
o Does the person know the time, day, year, month?
o Note: Most people will know who they are. Not knowing where they are
and what the time, day, month year, etc can mean various things:
dementia, delirium, confused thinking. If the patient answers, re: bizarre,
it can indicate psychosis.
Appearance and attitude (Motor Behavior/Manner)
o Observe the general appearance: neat clean, dirty, malodorous, unkempt,
etc.
o What is their attitude? Cooperative, hostile, mute, scared, nervous, etc.
o Observe any unusual behaviors, movements, gestures.
Affect & Mood
o Affect is the outward expression of how a person feels. Does their
expression look sad, happy, flat, etc
o Mood is what they report about how they feel. If you ask them how are
they feeling? When asked they report they fell angry, fearful, worried, sad
etc.
Emotional Response to Incarceration
o How are they handling being arrested and housed in jail?
o Are they adjusting? What are their concerns?
Content of Thought
o Are they having any delusional thoughts (believing false ideas) such as
they are being poisoned, they are the king of England, people can read
their minds.
o Are they experiencing any hallucinations? Hearing things that are not
really there; seeing things that are not really there? Etc.
History of Suicide, Present Thoughts of Suicide
o Do they have thoughts about harming themselves now?
o Have they felt suicidal in the past and/or made suicide attempts? in
custody attempts?
o Has anyone in their family attempted or committed suicide?
o Do they feel depressed, hopeless now?
o Do they have any plan to hurt themselves in custody?

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Record the patient's sex, age, race, and ethnic background. Document the patient's
nutritional status by observing the patient's current body weight and appearance.
Remember recording the exact time and date of this interview is important, especially
since the mental status can change over time such as in delirium.
Recall how the patient first appeared upon entering the office for the interview. Note
whether this posture has changed. Note whether the patient appears more relaxed. Record
the patient's posture and motor activity. If nervousness was evident earlier, note whether
the patient still seems nervous. Record notes on grooming and hygiene. Most of these
documentations on appearance should be a mere transfer from mind to paper because
mental notes of the actual observations were made when the patient was first
encountered. Record whether the patient has maintained eye contact throughout the
interview or if he or she has avoided eye contact as much as possible, scanning the room
or staring at the floor or the ceiling.
Attitude toward the examiner
Next, record the patient's facial expressions and attitude toward the examiner. Note
whether the patient appeared interested during the interview or, perhaps, if the patient
appeared bored. Record whether the patient is hostile and defensive or friendly and
cooperative. Note whether the patient seems guarded and whether the patient seems
relaxed with the interview process or seems uncomfortable. This part of the examination
is based solely on observations made by the health care professional.

Mood
The mood of the patient is defined as "sustained emotion that the patient is experiencing."
Ask questions such as "How do you feel most days?" to trigger a response. Helpful
answers include those that specifically describe the patient's mood, such as "depressed,"
"anxious," "good," and "tired." Elicited responses that are less helpful in determining a
patient's mood adequately include "OK," "rough," and "don't know." These responses
require further questioning for clarification.
Establishing accurate information pertaining to the length of a particular mood, if the
mood has been reactive or not, and if the mood has been stable or unstable also is helpful.
Affect
A patient's affect is defined in the following terms: expansive (contagious), euthymic
(normal), constricted (limited variation), blunted (minimal variation), and flat (no
variation). A patient whose mood could be defined as expansive may be so cheerful and
full of laughter that it is difficult to refrain from smiling while conducting the interview.
A patient's affect is determined by the observations made by the interviewer during the
course of the interview.
Speech
Document information on all aspects of the patient's speech, including quality, quantity,
rate, and volume of speech during the interview. Paying attention to patients' responses to
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determine how to rate their speech is important. Some things to keep in mind during the
interview are whether patients raise their voice when responding, whether the replies to
questions are one-word answers or elaborative, and how fast or slow they are speaking.
Thought process
Record the patient's thought process information. The process of thoughts can be
described with the following terms: looseness of association (irrelevance), flight of ideas
(change topics), racing (rapid thoughts), tangential (departure from topic with no return),
circumstantial (being vague, ie, "beating around the bush"), word salad (nonsensical
responses, ie, jabberwocky), derailment (extreme irrelevance), neologism (creating new
words), clanging (rhyming words), punning (talking in riddles), thought blocking (speech
is halted), and poverty (limited content).
Throughout the interview, very specific questions will be asked regarding the patient's
history. Note whether the patient responds directly to the questions. For example, when
asking for a date, note whether the response given is about the patient's favorite color.
Document whether the patient deviates from the subject at hand and has to be guided
back to the topic more than once. Take all of these things in to account when
documenting the patient's thought process.
Thought content
To determine whether or not a patient is experiencing hallucinations, ask some of the
following questions. "Do you hear voices when no one else is around?" "Can you see
things that no one else can see?" "Do you have other unexplained sensations such as
smells, sounds, or feelings?"
Importantly, always ask about command-type hallucinations and inquire what the patient
will do in response to these commanding hallucinations. For example, ask "When the
voices tell you do something, do you obey their instructions or ignore them?" Types of
hallucinations include auditory (hearing things), visual (seeing things), gustatory (tasting
things), tactile (feeling sensations), and olfactory (smelling things).
To determine if a patient is having delusions, ask some of the following questions. "Do
you have any thoughts that other people think are strange?" "Do you have any special
powers or abilities?" "Does the television or radio give you special messages?" Types of
delusions include grandiose (delusions of grandeur), religious (delusions of special status
with God), persecution (belief that someone wants to cause them harm), erotomanic
(belief that someone famous is in love with them), jealousy (belief that everyone wants
what they have), thought insertion (belief that someone is putting ideas or thoughts into
their mind), and ideas of reference (belief that everything refers to them).
Aspects of thought content are as follows:
Obsession and compulsions: Ask the following questions to determine if a patient
has any obsessions or compulsions. "Are you afraid of dirt?" "Do you wash your
hands often or count things over and over?" "Do you perform specific acts to
reduce certain thoughts?" Signs of ritualistic type behaviors should be explored
further to determine the severity of the obsession or compulsion.
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Phobias: Determine if patients have any fears that cause them to avoid certain
situations. The following are some possible questions to ask. "Do you have any
fears, including fear of animals, needles, heights, snakes, public speaking, or
crowds?"
Suicidal ideation or intent: Inquiring about suicidal ideation at each visit is
always important. In addition, the interviewer should inquire about past acts of
self-harm or violence. Ask the following types of questions when determining
suicidal ideation or intent. "Do you have any thoughts of wanting to harm or kill
yourself?" "Do you have any thoughts that you would be better off dead?" If the
reply is positive for these thoughts, inquire about specific plans, suicide notes,
family history (anniversary reaction), and impulse control. Also, ask how the
patient views suicide to determine if a suicidal gesture or act is ego-syntonic or
ego-dystonic. Next, determine if the patient will contract for safety. For homicidal
ideation, make similar inquiries.
Homicidal ideation or intent: Inquiring about homicidal ideation or intent during
each patient interview also is important. Ask the following types of questions to
help determine homicidal ideation or intent. "Do you have any thoughts of
wanting to hurt anyone?" "Do you have any feelings or thoughts that you wish
someone were dead?" If the reply to one of these questions is positive, ask the
patient if he or she has any specific plans to injure someone and how he or she
plans to control these feelings if they occur again.
Sensorium and cognition: Perform the Folstein Mini-Mental State Examination.
Consciousness: Levels of consciousness are determined by the interviewer and are
rated as (1) coma, characterized by unresponsiveness; (2) stuporous, characterized
by response to pain; (3) lethargic, characterized by drowsiness; and (4) alert,
characterized by full awareness.
Orientation: To elicit responses concerning orientation, ask the patient questions,
as follows. "What is your full name?" (ie, person). "Do you know where you are?"
(ie, place). "What is the month, date, year, day of the week, and time?" (ie, time).
"Do you know why you are here?" (ie, situation).
Concentration and attention: Ask the patient to subtract 7 from 100, then to repeat
the task from that response. This is known as "serial 7s." Next, ask the patient to
spell the word "world" forward and backward.
Reading and writing: Ask the patient to write a simple sentence (noun/verb).
Then, ask patient to read a sentence (eg, "Close your eyes."). This part of the
MSE evaluates the patient's ability to sequence.
Visuospatial ability: Have the patient draw interlocking pentagons in order to
determine constructional apraxia.
Memory: To evaluate a patient's memory, have them respond to the following
prompts. "What was the name of your first grade teacher?" (ie, for remote
memory). "What did you eat for dinner last night?" (ie, for recent memory).
"Repeat these 3 words: 'pen,' 'chair,' 'flag.' " (ie, for immediate memory). Tell the
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patient to remember these words. Then, after 5 minutes, have the patient repeat
the words.
Abstract thought: Assess the patient's ability to determine similarities. Ask the
patient how 2 items are alike. For example, an apple and an orange (good
response is "fruit"; poor response is "round"), a fly and a tree (good response is
"alive"; poor response is "nothing"), or a train and a car (good response is "modes
of transportation"). Assess the patient's ability to understand proverbs. Ask the
patient the meaning of certain proverbial phrases. Examples include the
following. "A bird in the hand is worth 2 in the bush" (good response is "be
grateful for what you already have"; poor response is "one bird in the hand").
"Don't cry over spilled milk" (good response is "don't get upset over the little
things"; poor response is "spilling milk is bad").
General fund of knowledge: Test the patient's knowledge by asking a question
such as, "How many nickels are in $1.15?" or asking the patient to list the last 5
presidents of the United States or to list 5 major US cities. Obviously, a higher
number of correct answers is better; however, the interviewer always should take
into consideration the patient's educational background and other training in
evaluating answers and assigning scores.
Intelligence: Based on the information provided by the patient throughout the
interview, estimate the patient's intelligence quotient (ie, below average, average,
above average).
Insight
Assess the patients' understanding of the illness. To assess patients' insight to their illness,
the interviewer may ask patients if they need help or if they believe their feelings or
conditions are normal.
Judgment
Estimate the patient's judgment based on the history or on an imaginary scenario. To
elicit responses that evaluate a patient's judgment adequately, ask the following question.
"What would you do if you smelled smoke in a crowded theater?" (good response is "call
911" or "get help"; poor response is "do nothing" or "light a cigarette").
Impulsivity
Estimate the degree of the patient's impulse control. Ask the patient about doing things
without thinking or planning. Ask about hobbies such as coin collecting, golf, skydiving,
or rock climbing.
Reliability
Estimate the patient's reliability. Determine if the patient seems reliable, unreliable, or if
it is difficult to determine. This determination requires collateral information of an
accurate assessment, diagnosis, and treatment.

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SICK CALL
The backbone of any correctional health delivery system is its sick call process. Every
jail and prison should have a mechanism in place that enables all inmates, including those
in segregation, to request health services daily. PHS utilizes a written request system
using medical request forms coupled with staff rounds of inmates in administrative
segregation.
Regardless of which sick call procedure is used, it is important to ensure:
inmates have an opportunity to make their health needs known on a
daily basis.
access is directly controlled by healthcare staff and not by correctional
staff (which in a written request system, includes health staff only picking
up the medical request form AKA: sick call slips).
healthcare staff review (triage) all forms received daily and determine the
appropriate disposition (e.g., “inmate to be seen immediately” or scheduled
for next sick call” or “referred to dental department”.)
inmate is notified of the healthcare unit’s response to their requests as
appropriate.
Correctional facilities that have a written request system often use a multiple copy form.
The yellow copy is returned to the inmate after his/her sick call visit. Thus latter step is
important. Inmates frequently submit multiple requests for the same problem to the
healthcare staff.
Sick call occurs when an inmate reports for and receives appropriate care. It is held in a
clinical setting where adequate equipment and supplies are available. Nurses, physician
assistants or other qualified health professionals, conduct sick call at least five days per
week. Sick is available on the weekends when necessary. Additionally, while the
frequency of physician clinics is dependent on institutional size and inmate needs,
clinician sick call may be held five times per week.
Inmate requests for non-emergency care should be processed within 24 hours and they
should be scheduled for sick call or referred as required. Nurses or physician extenders
usually see the patient first to gather additional information, take vital signs and/or
provide care within the scope of their licenses. Based on their review, they determine
whether the inmate needs to be referred to a physician or another clinician.

NURSE SICK CALL SYSTEM – PROVIDER OVERVIEW
Inmates seeking medical attention fill out a Prison Health Services Medical
Request Form. The housing unit nurse retrieves these forms daily.
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The Housing Unit Nurse reviews the Prison Health Services Medical Request
Form and determines if the request is an emergency or routine.
The Housing Unit Nurse documents the disposition on the Prison Health
Services Medical Request Form) i.e., Nurse Sick Call, Clinician Sick Call,
Dental, or Mental Health Clinic. All routine requests will be referred to Nurse
Sick Call.
All emergency requests (chest pain, SOB, etc.) will be evaluated as soon as
possible.
Upon seeing the inmate, the Housing Unit Nurse will sign, date, and time the
request and give the yellow copy to the patient.
Referrals for Mental Health and/or Dental services are delivered via mail
boxes which are monitored by the intended recipient services.
For those requests being referred to Nurse Sick Call, they should be addressed
as soon as possible. The Sick Call nurse (who documents in the inmate’s
health record on Progress Notes using the SOAP charting format. It is
important that the nurse document times as well as dates when charting SOAP
notes.
PHS employs a priority system categorizing receiving screeners as a Number
1, 2, or 3. During the nursing sick call orientation sessions the procedures
pertaining to this system will be explained and used.
Nurses have access to a clinician on-call or on-site for consultation and review
of sick call.

EMERGENCY SERVICES
Prison Health Services staff responds to medical emergencies whenever a health staff
member or a correctional staff member identifies an urgent medical need.
Nursing staff will respond to emergency calls within a few minutes by reporting to the
area of the medical emergency with necessary emergency equipment and supplies for
evaluation and possible treatment.
Emergency equipment and supplies area regularly maintained and accessible to
healthcare staff at all times.
The patient will be stabilized on-site and then transferred to an appropriate healthcare
unit if deemed necessary.
The on-call practitioner will be notified immediately, if possible, or soon after the
incident.
The practitioner in charge will determine if the patient needs to be transported to a local
emergency room. If no practitioner available, then the nurse in charge will determine
based upon practitioner input and/or nursing assessment whether the patient needs to be
transported. Correctional staff will be notified of this need so as to assure that an
ambulance has been called and arrangements made for a deputy to escort the patient.
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A list of names and telephone numbers of persons to be called in event of an emergency
are readily available to healthcare staff at all times.
All healthcare staff personnel are oriented to Emergency Services at the time of their
initial orientation as a new employee. Annual training is conducted as part of the inservice training program for all health service staff.
Emergency drugs, equipment, and supplies are readily available at all times and are
replenished after each use and checked on a regular basis.
Ambulances are accessed through the appropriate Ambulance Company. The phone
number is listed on the Emergency form at each site.
The correctional facility supervisor will be contacted and informed of any medical
emergency.
In most cases decisions regarding the need for emergency transportation are made by
medical staff.
Whenever possible, the physician on call should be notified prior to transporting the
patient to the hospital. However, in the event of a life-threatening emergency, the patient
is sent to the hospital in the most expedient way possible and this may require notifying
the physician after the patient has been transported.

WRITTEN AND VERBAL/TELEPHONE ORDERS
Clinical treatment is performed pursuant to written or verbal/telephone orders signed by
personnel who are authorized by state practice laws within the state where the facility is
located to write medical orders.
Physicians, physician assistants, nurse practitioners, psychiatrists, and dentist are
generally the individuals who are authorized to write medical orders. The physician will
follow state law regarding whose orders require co-signature.
Verbal/telephone orders are signed in accordance with state law and accreditation
standards:
All orders for medical treatment are written on the physician order sheet.
All medical orders include the date, time, location, inmate’s name, date of
birth, PFN, diagnosis, and known allergies. If the patient has no allergies
NKDA is to be written on the order sheet.
All medication orders require, in addition to the above requirements: name
of the drug, the dosage, the route, frequency, and duration.
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All medical orders are noted and signed off along with print/stamp on
both copies with the date and time by a licensed nurse in red ink.
All medical orders if V.O or T.O. must be written V.O or T.O. Dr.________/
Nurse signature, title, print/stamp, date, and time noted the order. Do not
write “per protocol” medical orders.

NURSING ASSESSMENT PROTOCOLS/STANDARDIZED PROCEDURES
Nursing Assessment protocols are developed by the Medical Director and the Director of
Nursing or supervisor of the nursing staff.
The Nursing Protocol manual is reviewed periodically by the Medical Director and the
Director of Nursing.
Assessment protocols shall be appropriate for the level of skill and preparation of the
nursing personnel who will carry it out. Each assessment protocol is in compliance with
the California State Nursing Practice Act.
Assessment protocols do not include any prescription medication use with the exception
of those covering emergency or life-threatening situations.
Treatment with prescription medication is only initiated upon the written, verbal, or
telephone order of a licensed clinician.
Standing orders are not used. Standing orders are defined as a written order that
provides the same course of treatment for each patient suspected of having a given
condition and that specify the use and amount of prescription medications.
Nurse practitioners and physician assistants may practice as mandated by their respective
state boards and approved by the responsible physician.
Prison Health Services has developed Nursing Assessment Protocols
under the guidance of the Corporate Medical Director who serves as
reference for the responsible site physician.
The Medical Director will review the protocols, make any adjustments that
he/she feels are necessary and signs off on the manual.
The medical director will review, and when appropriate, revise
the Nursing Assessment Protocols.
The protocols include over the counter medications (OTC). When OTC
medications are administered per protocol the nurse needs the name of the
responsible physician or nurse practitioner on the order.
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Administration of OTC’s by health personnel are to be documented in the
Medication Administration Record (MAR).

HEALTH EVALUATION OF INMATES IN SEGREGATION
Healthcare staff will evaluate all inmates who are segregated from the general population
at least daily.
The purpose of these evaluations is to monitor the health status of segregated inmates and
to ensure that individuals in segregation have access to health services.
All medical complaints, treatments rendered, or changes in condition are noted in the
individual patient health record.
The assessment rounds are to be documented and maintained in the files of the healthcare
unit.
Corrections staff notify health care staff of the placement of an inmatepatient in segregation.
A designated health staff member will conduct medical rounds and document
on segregated inmates daily.
The medical rounds will include at least the following:
a.
b.
c.

Observation of each inmate to determine obvious medical problems
Notation of any changes in the inmate’s attitude and outlook
Identification of any cuts, bruises or other injuries indicating trauma

Delivery of medications or other treatments that have been ordered by the
practitioner will continue as ordered for any patient who is placed in
segregation.

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MEDICATION ADMINISTRATION

Administration and Storage of Medications:
PHS staff responsibilities in the administration of medication include these actions:
1.

Obtaining the medication order from the physicians.

2.

Ordering the prescription from the pharmacy.

3.

Administering the medication.

4.

Documenting the administration of the medication or the refusal of
medication on the appropriate form.

Medications must be kept safely locked, forms must be completed, and administration of
the medication must be documented. Medications must be given in a safe manner while
protecting the dignity and confidentiality of the patient.
General Guidelines in Medication Administration:
Always ask questions if you don’t understand the order or something doesn’t make sense.
Wash hands before handling medications. It is particularly important to wash your
hands:
- After using the toilet.
- Before handling food or medication.
- After handling food or medication.
- After using a Kleenex or handkerchief.
Maintain safety and accuracy. Work efficiently. Mistakes happen most often when you
are in a hurry, distracted, or failing to document at the time of medication administration.
Concentrate on your work.
- Do not allow yourself to be interrupted.
- Ensure that you have good lighting.
- Check and re-check, remember the order may have changed.
Read the entire medication label three times.
- Prior to taking the medication out of the package.
- Prior to administering the medication.
- Prior to documenting the administration of the medication.
Remember the importance of the five “rights” of medication administration.
- Right patient (confirm identification by checking wrist-band)
- Right medication.
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-

Right dose.
Right time.
Right route.

Read the entire label for specific instructions about the medication such as:
- Give with water.
- Give with food.
- Avoid working with machines or driving.
- Avoid alcohol.
- Avoid sunlight.
Additional “Do’s”
- Do give the task your full attention.
- Do check the ID of the inmate before administering medication.
- Do remain with the inmate until the medication has been taken.
- Do prepare medications for only one inmate at a time.
- Do document immediately after giving the medication.
Additional “Don’ts”
- Don’t give a medication if you can’t clearly read the label.
- Don’t give a medication from another patient’s medications.
- Don’t give medications out to more than one inmate at a time.
- Don’t hide a medication error.
- Don’t change anything about a medication without a doctor’s order.
Do NOT give medications when:
There is no written order.
The label on the medication is illegible; the pharmacist must replace it.
The inmate exhibits a significant change in status:
- Difficulty breathing
- Change in level of consciousness
- Seizures
- Other changes that may be threatening to the patient’s health
The patient refuses to take the medication. Attempt to find out why the patient is
refusing the medication then report it to the practitioner who prescribed the
medication.
The patient has an allergic reaction to the medication. Common allergic reactions
include rash, hives and difficulty breathing.

Routes of Administration:
Oral:
The most common route of administration may be in the form of tablet,
capsule, or liquid.
Do not crush, dissolve, or split the dose without specific instructions to do so.
Do not empty the contents of a capsule prior to administration.
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Do not dilute or mix liquid medications without specific instructions to do so.
Liquid Medications:
Never pour ahead of time.
Shake the bottle well before pouring.
Hold the medicine cup at your eye level to measure correct dose.
If a liquid and a pill are to be given at the same time, give the pill first and
follow it with the liquid.
Never mix different liquids in the same cup.
If the liquid medication required refrigeration, return it to the refrigerator
immediately after use.
Never mix partially used bottles of medication even if they are the same
medication as potency and dosage may not be identical.
Sublingual:
g
Only medication clearly ordered to be given sublingually should be.
Instruct the patient to place the medicine under their tongue and wait for it
to dissolve.
Pulmonary
y Inhalant Medications:
These medications are in a sealed container under pressure.
Pressing down on the inhaler to release a measured administration
dose.
Topical Medications:
Respect the privacy of the patient by finding a private place.
Wash hands prior to using.
Wear gloves when administering.

Storage of Medications:
General Guidelines:
All medications must be stored in the original container with the original
label.
Internal, external and indictable medications must be stored separately.
Care must be taken so that label remains affixed and legible.
Do not store large quantities of drugs – a thirty- (30) day supply is
maximum.
All medications must be stored away from food and toxic materials.
Store all medications away from excessive heat, light and moisture.
Maintain a sufficient storage space and adequate lighting.
Controlled Substances:

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Federal drug control agencies have identified some medications as being more
likely to be abused. These medications are grouped in six
categories called schedules according to their potential for abuse.
These medications must be double locked at all times. They should also be
counted by two licensed nurses at each change of shift to ensure that all
medications can be accounted for.

Refusal of Medications:
If a patient refuses a medication, try to determine the reason for the refusal. Among the
reasons the patient refuse are:
An unpleasant side effect.
Dislike of the taste, smell or feel of the medication.
Difficulty swallowing the medication.
For some reason the patient is afraid of the medication.
The patient doesn’t understand the reason for taking the medication.
It is part of the patient’s non-compliant behavior.
Document on the medication administration record (MAR) that the patient has refused
the dose of medication. Have the inmate sign a release of responsibility form.
Report the inmate’s refusal of medication to the practitioner and schedule that patient to
return to the practitioner for further evaluation.
Medication Errors:
All medication errors must be reported when they are discovered or as soon as possible
thereafter to the nursing supervisor.
A medication error has occurred if:
Wrong patient was given the medication.
Wrong drug was given to the patient.
Wrong dose was given to the patient.
Medication was given at the wrong time.
Medication was not given at the time ordered.
Medication was administered by the wrong route.

Medication errors should be reported on an incident report form and should include:
Who the patient(s) and staff were who were involved;
What type of error was made;
When the error occurred;
The effect of the error on the patient if known; and
The corrective action(s) taken by supervisor and/or physician as appropriate.
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Medication Administration in Corrections:
It is a nursing responsibility to ensure that the patient has swallowed their
medication. The “cheeking”, “hoarding”, “pawning” and “switching”
medication with another inmate may ultimately result in death.
Do not allow multiple inmates to obtain medications at the same time.
Do not allow inmates access to your medication supplies or your cart.
Check arm band on each inmate before administering medications. No
identification means no medication given. (NO ID ≠ NO MEDS).

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SPECIAL NEEDS AND SERVICES

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MENTAL HEALTH SERVICES

MENTAL HEALTH EVALUATIONS
Mental Health Records are subject to special Federal and California State Confidentiality
laws. All mental health services at Santa Rita Jail/Glenn Dyer Detention Facility are now
provided by Criminal Justice Mental Health (CJMH), a division of Alameda County
Behavior Health Care Services. At intake, or at the first screening interview, a brief
mental health history will be obtained. All inmates who report or who are known to have
a history of mental care will be referred to CJMH for further evaluation and services as
appropriate. Anyone whom the screening nurse believes to be in need of mental health
services will be referred for mental health evaluation. CJMH will determine the need and
extent of services required. Those inmates requiring intense services beyond the
capability of CJMH will be referred to an acute care facility.
FORCED PSYCHOTROPIC MEDICATIONS
It is PHS policy not to use forced medications. PHS staff does not participate in the
administration of forced medications.

CHEMICAL RESTRAINTS
It is PHS policy not to use Chemical Restraints.

SUICIDE PREVENTION PROGRAM
The PHS Medical Department and CJMH will follow the facility’s collaborative plan for
suicide prevention. CJMH trains corrections personnel on suicide prevention.
The plan will include, at a minimum, the following components:
1.
2.
3.
4.
5.
6
7.
8.
9.
10.
11.
12.

Identification
Training
Assessment
Monitoring
Housing
Referral
Communication
Intervention
Notification
Reporting
Review
Critical incident debriefing

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Every effort will be made to prevent suicidal gestures and attempts in the facility through
surveillance and vigilant monitoring on the part of all health personnel and correctional
personnel.
1.

Identification:
a. The receiving screening is the first opportunity for assessing each inmate’s
potential for suicide by asking specific questions regarding current suicidal
ideation’s and history previous attempts.
b. If the is assessed as being at risk for suicide, the receiving nurse will notify the
appropriate corrections staff member and arrange for housing that affords suicide
watch for the inmate.
c. The nurse will follow-up to ensure that appropriate housing and watch have been
initiated.
d. Patients who are assessed as being at risk for suicide at a later time by health or
correctional staff will be relocated to a housing area that affords suicide watch.
e. All inmates who are identified as being at risk for suicide will be referred to the
psychiatrist or mental health professional for evaluation as soon as possible.

2.

Training
a. Healthcare personnel and correctional staff will be trained in all aspects of suicide
prevention including the knowledge that a patient is particularly susceptible to
becoming suicidal upon admission, after adjudication, upon return from court,
following bad news about a family member or significant other, after suffering from
some type of humiliation or rejection and when previous depression appears to be
receding.
b. All staff is initially trained regarding recognition of verbal or behavioral signs of
suicidal ideation during their orientation program. Additional training will be
provided annually.
c. The following signs and symptoms of suicidal ideation should be reviewed at all
training:
1. Despair/hopelessness
2. Poor self image/feelings of inadequacy
3. Great concern regarding “What will happen to me”
4. Past history of suicidal attempt
5. Verbalization of a suicide plan
6. Extreme restlessness exhibited by such behavior as continuous pacing
7. Loss of interest in personal hygiene and daily activities
8. Visitation refusals that previously were accepted.
9. Depressed state indicated by crying, withdrawal, insomnia, lethargy,
indifference to surroundings and other people.
10. Sudden drastic changes in eating or sleeping habits.
11. Hallucinations, delusions, or other manifestations of loss of touch with reality.
12. Sudden marked improvement in mood following period of obvious depression.

3.

Assessment and referral
a. Immediately following recognition that a patient is at risk for suicide, placement in
housing area (i.e., safety cell) that affords the closest monitoring is appropriate until

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the patient can be further assessed by the mental health professional or psychiatrist.
b. Upon assessment by a mental health professional, the appropriate level of suicide
precautions will be ordered.
c. If the facility is not equipped with housing and/or staff to maintain the patient’s
safety while he/she is suicidal, transfer should be arranged to the closest facility that
can offer adequate protection for the patient.
4.

Monitoring
a. 15 minute Watch – This requires 15-minute interval observations. This watch
requires the patient be within full sight of the correctional officer when the
15-minute checks are done. Documentation on the Isolation Observation Log (IOL)
is required.
b. CJMH mental health staff continue to monitor patient as needed and determine
when a patient is removed from suicide watch.

5.

Housing
a. Medical/mental health staff will follow the facility’s plan for where inmates who
are on suicide precautions are to be housed.
b. Once an inmate is identified as being at risk for suicide, he/she should not be
housed elsewhere or left alone.
c. Rooms that are used for suicide watch should be made as suicide proof as possible.

6.

Referrals
All inmates identified, as being suicidal will be evaluated by a mental health
professional at the earliest possible time.

7.

Communication
Daily communication made between designated healthcare and corrections
staff is important to monitor the status of any inmate who is on suicide precautions.

8.

Intervention
Any time a suicide attempt is identified, it is treated as a medical emergency and
medical staff responds immediately. In the event of a hanging attempt, the body is
supported while the patient is gently brought to the ground. As with any medical
emergency, the ABC’s are of utmost importance. Every effort should be made to
stabilize and/or resuscitate a patient who has attempted suicide while emergency
medical support is summoned for immediate transport if necessary.

9.

Notification
All suicide attempts are reported immediately by the healthcare staff to the Mental
Health Services Administrator or designee, Health Services Administrator, the Medical
Director and the shift supervisor for corrections and medical. The Mental Health
Administrator or designee will ensure that the facility administrator and the responsible
physician is informed.

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10.

Reporting
Medical staff and mental health staff will participate, as appropriate, in completing all
reporting activities surrounding any suicide attempt or completion as required by the
facility

11.

Review
As defined in the facility’s suicide plan, appropriate medical personnel and mental
health staff will participate in review of suicides or attempted suicide.

12.

Critical Incident Debriefing
The CJMH offers counseling and debriefing with mental health
professionals who have been affected by a suicide or suicide attempt.

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ASSESSMENT OF SUICIDE POTENTIAL
1.

Has the detainee sustained a recent loss (loved one, friend, home, job) or a series of losses?

2.

Is detainee depressed?

3.

Does he/she have a religious and/or philosophical background that supports suicide?

4.

Does he/she believe suicide is an acceptable release (from jail, life)?

5.

Is he/she socially isolated from others detainees and staff (without friends and other social
support systems)?

6.

Is this the first time in jail?

7.

Does he/she seem overly embarrassed, ashamed or guilty about the crime committed?

8.

Has detainee been previously treated for mental illness, emotional disturbance?

9.

Does detainee have a history of self-destructive acts?

10. Has a member of his/her family attempted suicide?
11. Does he/she think about suicide at this time?
12. Is he/she psychotic?
13. Is he/she hearing voices telling him to kill himself?
14. Has detainee-expressed wish to die or failed to perform life-saving acts?
15. Does detainee have terminal medical condition?
16. Does detainee talk or think about giving possessions away or writing a will?
17. Does detainee talk about a particular method/plan for killing himself?
18. Is that method/plan available?
19. Has there been an unexplained, marked improvement in mood?
NOTES: This list provides a method of organizing information regarding suicide potential. It is arranged
so that, generally speaking, the questions towards the end of the list indicate a need for greater concern than
the ones at the beginning. The more “Yes” marks there are the higher the potential for suicide. These
guidelines are provided to assist in assessment, but the final determination is to be based on the judgment of
the personnel in the situation.

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PATIENT INFORMATION FACT SHEET – SUICIDE PREVENTION

“Your Brother’s Keeper”
WHAT IS SUICIDE PREVENTION?
• Suicide Prevention is keeping someone from dying by their own hand.
• It is everyone’s job.
• It means:
o knowing the warning signals of suicide.
o putting your own feelings aside to try to save another’s life.
o knowing the facts.
o listening to others.
WHAT SHOULD I DO IF I THINK SOMEONE MAY BE SUICIDAL?
Do not be afraid to ask the person, “Are you thinking about suicide?”
Stay with the person and ask someone to go for help.
Do not worry about risking a friendship if you truly feel someone is
suicidal.
Ask for help from staff if the person talks about suicide or makes
statements related to
death.
Ask for help from staff if someone you know:
¾ has had something very stressful happen such as a death in the
family, relationship break-up, or receiving bad news regarding their
case or sentence.
¾ is giving away their possessions along with suddenly acting as if
they feel better.
¾ seems to have lost interest in things they usually enjoyed.
Take all threats seriously. Most everyone that attempts suicide or commits
suicide has given some warning.
WHAT SHOULD I DO IF I AM THINKING ABOUT SUICIDE?
Ask for help. Suicide is final. It is often a reaction to a temporary problem.
Be aware of the warning signs.
Ask questions of your health care provider.
Ask for help if you:
¾ have lost interest in things you usually enjoyed.
¾ are having overwhelming feelings of shame, guilt, helplessness and
hopelessness.
¾ are thinking about your own death.
¾ have had a very stressful thing happen to you.
EMERGENCY! TELL A CORRECTIONAL OFFICER OR DEPUTY TO CALL
MEDICAL IF:
You are having suicidal thoughts.
You are concerned that someone you know may be suicidal.
© Prison Health Services, Inc. 2008 All rights reserved.
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INTOXICATION AND WITHDRAWAL
Significant percentages of inmates admitted to correctional facilities have a history of
alcohol or other drug abuse. Newly admitted individuals may enter intoxicated or
develop symptoms of alcohol or other drug withdrawal. Alcohol withdrawal is the
abstinence syndrome with the highest mortality rate, although opiate and tranquilizer
withdrawal is life threatening.
The treatment of most non-threatening withdrawal consists of the amelioration of
symptoms and can be managed in the convalescent or outpatient setting. All individuals
experiencing withdrawal symptoms should be closely monitored for the development of
potential life threatening symptoms.
Prison Health Services policies, procedures and protocols address inmates under the
influence of alcohol and other drugs or those undergoing withdrawal. The PHS polices
address the treatment and observation of individuals manifesting mild or moderate
symptoms of intoxication or withdrawal. Individuals at risk for progression to more
severe levels of intoxication or withdrawal are kept under observation. Inmates
experiencing severe intoxication or withdrawal are immediately transferred to a licensed
acute care facility. Medical detoxification is done only under medical supervision in
accordance with local, state and federal laws. Alcohol and drug abuse records are subject
to special Federal and California State Confidentiality Laws.

PRENATAL CARE
All pregnant inmates receive timely and appropriate prenatal care by qualified healthcare
practitioners. Individuals who specialize in obstetrical care will provide on-site or offsite prenatal care.
Prenatal care will be scheduled on a regular basis and will include examinations, advice
on appropriate levels of activity, safety precautions, nutritional guidance, and counseling.
If the inmate states she is pregnant or that she has missed two periods, urine for
pregnancy testing will be collected at the time of receiving screening, or at the
time the inmate informs a medical staff member of this information.
Pregnant inmates should ideally be followed during their pregnancy by the
women’s health practitioner.
Documentation should include prenatal history in which the following are
addressed:
a. Medical, surgical, and obstetrical history
b. Family and social history
c. High risk factors including drug, tobacco, and alcohol use, infectious
diseases, past obstetrical complications, and chronic medical conditions.

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While the pregnant inmate is incarcerated, the following care are provided as
appropriate:
a. Routine urine testing for ketones & protein, vital signs, fundal height,
and fetal heart tones should be assessed at prenatal care visit
b. Vitamin with iron supplements are provided
c. Special diets with increased calories are provided
d. All staff will observe for signs of toxemia, including fever,
hypertension, abdominal pain, uterine cramps, vaginal bleeding, severe
headaches, visual changes, edema, or decreased in fetal movements.
e. Methadone maintenance treatment is provided for prenatal inmates who
have been on methadone maintenance or who are addicted to opioids.

SEXUAL ASSAULT
Immediate response to an act of sexual assault is of utmost importance. Most
jurisdictions define a sexual assault as a sexual act that is coercive or assaultive in nature
and where there is the use or the threat of force.
Victims of sexual assault are assessed, medically stabilized, and referred to CJMH for
mental health services as needed. Appropriate testing for sexually transmitted diseases
are ordered.

SPECIAL NEEDS TREATMENT PLANS
The special needs program serves a broad range of health conditions and problems that
require health personnel to design a program tailored to the individual inmate’s needs.
Chronic illnesses require care and treatment over a long period of time and usually are
not curable. The goal is to restore and maintain inmate health to the extent possible.
Examples of chronic illnesses monitored include, but are not limited to asthma, diabetes,
hypertension, HIV, and seizures.
Communicable diseases include those that are sexually transmitted (e.g., syphilis,
gonorrhea, chlamydia, HIV), transmitted through the respiratory system
(e.g. tuberculosis), or via infected blood (e.g., hepatitis).
Physical handicaps refer to mobility impairments or physical disabilities that limit an
individual’s normal function. These include, but are not limited to amputation,
paraplegia, visual impairments, hearing impairments, or speech impairments.
Frail elderly inmates frequently suffer from chronic conditions that impair their ability to
function (e.g., dress, and feed, use toilet) to the extent that they require special nursing
care.

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Terminally ill inmates (those with a life expectancy of less than one year due to illness)
may require special health services to provide comfort, relief from pain, and special
counseling and support in anticipation of death.
Criminal Justice Mental Health (CJMH) provides services to inmates with special mental
health needs, i.e., self-mutilators, the aggressive or severely mentally ill, suicidal inmates,
and sex offenders.
Developmentally disabled inmates may be in need of rehabilitation planning, assistance
in accepting the limitations of their conditions, and special attention to their physical
safety in the corrections environment.
A special needs treatment plan may be prepared on an individual basis. A treatment plan
is a series of written statements specifying the particular course of therapy and the roles
of qualified health care personnel in carrying it out. It is individualized, typically
multidisciplinary, and based on an assessment of the patient’s needs, a statement of short
and long-term goals as well as the methods by which these goals will be pursued. When
clinically indicated, the treatment plan gives inmates access to the range of support and
rehabilitative services (such as physical therapy, individual or group counseling, and selfhelp groups) that the treating practitioner deems appropriate.
Individuals with special needs are followed during their incarceration. Regularly
scheduled chronic care clinics are a good way to ensure continuity of care. Regularly
scheduled chronic care clinics at SRJ include Asthma, Diabetes, HIV, Hypertension, and
Seizure. A master problem list that includes conditions, treatments, and known drug
allergies may be helpful.

OUTPATIENT HOUSING UNIT (OPHU) – A Medical Observation Unit
An Outpatient Housing Unit (previously called the “infirmary”) is an area within the
confinement facility accommodating two or more inmates for a period of 24 hours.
Expressly set up and operated for the purpose of caring for patients who are not in need
of hospitalization or placement in a licensed nursing care facility. Patients are placed in
the OPHU with an illness or disorder that requires nursing care and/or limited
observation/management by a clinician. The level of health care services does not
ordinarily exceed that which is provided by a home health care agency. A Licensed
Registered Nurse (RN) is available in the OPHU twenty-four (24) hours per day, seven
(7) days per week.
The number of patients, their levels of acuity determines the number of assigned
healthcare personnel, and the level of care required for each patient. Being within sight or
hearing of a registered nurse means that the inmate/patient can readily gain the person’s
attention. Call lights and buzzer systems are useful ways of ensuring this. All patients
are within sight and sound of a health professional and the OPHU has within each patient
room a call alarm button to notify and summon staff for assistance if the patient is
experiences a medical or mental health problem.

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To maintain and improve the quality of care in this setting begins with the assignment of
responsibility to one physician. Depending upon the size of the out patient housing unit,
this physician may be employed part or full-time. A full-time staff physician is assigned
to the OPHU to provide primary care medical services to the non-pregnant patients
housed in the unit. He/she provides supervision of all aspects of clinical and
administrative operations within the unit.
Nursing care policies and procedures are consistent with professionally recognized
standards of nursing practice and in accordance with the nursing practice act and
licensing requirements of the State of California. Policies and procedures are developed
on the basis of current scientific knowledge and current clinical practices.
The inmate’s Outpatient Housing Unit health record includes admitting notes, a discharge
plan including a summary if the patient has been discharged, and complete
documentation of the care and treatment given. The OPHU record becomes part of the
inmate’s medical record file when he/she is discharged from the unit.

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CONFIDENTIALITY AND HEALTH RECORDS

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CONFIDENTIALITY OF INMATE HEALTH INFORMATION

Original health record(s) or portions of the health record(s) should not be removed from
the facility, except as permitted by PHS policy or required by law. The health record is
the official business record of the clinical care provided to the patient. The health record
folder is the physical property of the facility, however the information enclosed belongs
to the inmate. The inmate controls disclosure of that information unless otherwise
required or permitted by law. Health information used or disclosed in violation of Federal
or State regulations may result in fines assessed to the facility and/or the individual
responsible. Fines for negligent disclosures may range from $1,000 to $25,000. Licensed
health care professionals who knowingly and willingly make disclosures in violation for
financial gain may fined from $5,000 to $250,000.
CONFIDENTIALITY includes:
Conversations concerning a patient should be in private areas, not in a public area or in
the presence of other inmates.
Converse only with those who have a need to know.
Converse only about the current subject requiring attention.
Keep the medical information in the health record confidential.
Do not permit non-medical personnel to read the medical record with you, i.e. over
your shoulder.
For security reasons, do not discuss or confirm who may or may not be confined within
the facility, either with anyone outside the facility or with anyone inquiring from
outside the facility. Refer that type of inquiry to the correctional authority.
Refer immediate health-issue calls from next-of-kin to the nursing supervisor, charge
nurse, or AHSA for attention, i.e. pharmaceutical lists, incoming information from
family to facilitate care of patient.
SHARING OF MEDICAL / MENTAL / CUSTODIAL INFORMATION is permitted
within the facility for the purpose of continuing care and treatment of the patient.
Medical information may be accessed as needed by PHS staff.
Facility mental health practitioners can review medical information.
Copies of mental health progress notes are in the health record for review as needed.
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Medical providers may request to review custodial records in order to facilitate
treatment of the patient.
Correctional personnel may obtain limited confidential information relevant to
appropriately responding to the specific needs of the individual patient, i.e. chronic
conditions, special needs, or physical limitations.
Correctional personnel may obtain limited confidential information when the either
safe operation of the jail or the safety and welfare of inmates, custody staff, or
staff is in question.
Medical transfer summaries are provided to correctional facilities and transportation
officials as required by statute. Clarification or additional information may be
provided as needed.
DISCLOSURE OF CONFIDENTIAL INFORMATION requires a valid
authorization for disclosure signed by the patient or legal healthcare representative
unless otherwise permitted by law. Federal and State regulations governing medical,
psychiatric and drug & alcohol records are very complex. Refer all requests for protected
health information to the Health Information Services Department (HISD), i.e. court
orders, subpoenas, attorneys, SSI, insurance companies, medical care providers,
correctional facilities, probation officers, treatment programs, and individual patients.
DISCLOSURES NOT REQUIRING VALID SIGNED AUTHORIZATION:
Any reporting required by statute, i.e. public health reporting, imminent danger to
public or an individual.
Any requests from Coroner
Any requests from a Hospital Emergency Department providing care for a lifethreatening event of a patient.
Medical transfer summaries for transportation of inmate to a different facility.
Refer to Health Information Services Department.
OUR REQUESTS FOR PROTECTED HEALTH INFORMATION to other outside
health providers: ‘Authorizations for Disclosure and Use of Protected Health
Information’ forms are available in Health Information Services Department (HISD) for
the purpose of obtaining confidential health information from outside medical providers.
These forms must be completely filled out with the specific information needed, the
purpose of the request, the exact name and location of the provider/agency, and the
inmate’s initials, signature, and date. Per PHS policy, authorizations are to be signed by
the clinician.

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The Record That Defends Its Friends:

GUIDELINES FOR DOCUMENTATION
THE INMATES’S NAME MUST APPEAR ON EVERY PAGE.
RECORD THE TIME, DATE, AND LOCATION OF ALL ENTRIES.
SIGN AND PRINT OR STAMP EVERY ENTRY THAT YOU MAKE, AND
INCLUDE YOUR PROFESSIONAL TITLE.
MAKE ALL ENTRIES PERMANENT. USE BLACK INK.
NEVER USE A PENCIL!
MAKE GOOD ENTRIES THE FIRST TIME AROUND. ENTRIES SHOULD
BE ACCURATE, TIMELY, OBJECTIVE, SPECIFIC, CONCISE,
CONSISTENT, COMPREHENSIVE, LOGICAL, LEGIBLE, CLEAR,
DESCRIPTIVE, AND REFLECTIVE OF THOUGHT PROCESSES AS YOU
ARE MAKING THEM.
BE SPECIFIC.
BE OBJECTIVE. AVOID TENTATIVE PHRASES SUCH AS “APPEARS TO
BE”, “LOOKS LIKE IT MIGHT”, ETC.
BE COMPLETE:
Document everything significant to the inmate’s condition and course of
treatment (physical, psychological and emotional status; deviations from previous
status reports) is recorded. When in doubt, write it down!
Be careful to document any deviation from standard treatment and the reason
why. A plaintiff’s attorney can find a dozen “expert” witnesses to testify, “That is
not the way you normally treat this condition.”
Enter any unusual occurrence, such as a fall, with the responsive or remedial steps
taken and the inmate’s condition. However, do not enter “INCIDENT REPORT
FILED”. This immediately notifies a plaintiff’s attorney that vulnerable party
may exist in the facility. Do not file any incident report in the record.
MAKE ALL ENTRIES PROMPTLY
ABBREVIATE CORRECTLY AND WRITE LEGIBLY

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MAKE ENTRIES CONTINUOUS
Make Entries Consistent, And Avoid Contradictions
Make and Sign Your Own Entries (An order in two different types of
handwriting is NOT GOOD)
COUNTERSIGN CAREFULLY
PROVIDE AND DOCUMENT INMATE EDUCATION
The topics discussed
A statement of the inmate’s understanding
If written materials were provided
DOCUMENT INFORMED CONSENT WHENEVER APPLICABLE
DOCUMENT INMATE REFUSALS
If the inmate refuses to sign use the Release of Responsibility form. The
healthcare provider should document “Inmate Refuses to Sign” in the progress
notes. The healthcare provider and a witness sign the form.
MAKE CORRECTIONS AND AMENDMENTS CAREFULLY
When changes in the record are absolutely necessary, utilize the following procedures:
Draw a single, thin pen line through each line of the entry making sure the
inaccurate material is still legible.
Date and initial change.
Add a note in the margin stating why the entry has been replaced.
Fit the change into the correct chronological order, if possible.
Make sure to indicate which entry the correction is replacing.
Cross reference amendments to the record.
In some situations it may be wise to have the corrected notation witnessed by a
colleague.
DOCUMENT ON ORIGINALS - DO NOT DOCUMENT ON FAXES OR
COPIES
DELETIONS ARE A PROSECUTOR’S PLAYGROUND
Never delete material on the record by scratching out, using “white out”, and
obliterating with a felt tip marker, typing XXXXXs, tearing off the page, etc. These
are examples of mutilating the record.
AVOID OMISSIONS
AVOID TIME GAPS
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TAMPERING CAN BE FATAL
AVOID EXTRANEOUS REMARKS
JOUSTING IS DEADLY
Jousting is arguing, complaining, belittling, criticizing or blaming others to defend
oneself. In the record, jousting is deadly not only because it can provide a plaintiff
with a powerful “expert” witness against the facility and the joustee, but as one
experienced attorney put it, “Jousting is about the only thing that will guarantee a
lawsuit and raise the amounts awarded sky high.”
MAKE SURE THE RECORD PROVES YOU WERE THERE!
DISPLAY YOUR THOUGHT PROCESSES
The medical record sets forth the healthcare professional’s reasoning,
especially if it leads to important treatment decisions. If the record shows that
all available evidence was prudently weighed and a decision – even one with
clinical risk to the inmate – was carefully made, the situation is defensible and
exposure to legal risk will be minimized.
PROGRESS NOTES REQUIRE SPECIAL ATTENTION
MAKE SURE THE HEALTH CARE RECORD IS COMPLETE
Healthcare professionals in ambulatory settings are responsible for ensuring
continuity of care and facilitating inmate compliance with self-care regimens.
Consequently, the ambulatory care record must additionally demonstrate that:
Screening and testing are sensitive enough to detect the onset of acute episodes of
illness, which may warrant hospitalization.
Healthcare professionals have devised follow-up plans, which anticipate inmates
further needs.
Inmate education has been provided and inmate is willing and able to contribute to
his or his own care.
LATE ENTRIES
Progress notes written out of chronological order are considered to be late entries.
Each late entry must be appropriately labeled “Late Entry”.
It is unacceptable to add information to a previously written progress note.
A late entry should not be written on a new form and added to the appropriate place.
The late entry should refer to the date and time the original note was actually written
and the date and time the events took place.

“IF IT WAS NOT DOCUMENTED, IT DIDN’T HAPPEN!”

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Prison Health Services
POLICY ON DOCUMENTATION
Title:

DOCUMENTATION

Policy:

Employees are expected to complete all medical documents in accordance
with PHS policies and procedures and with all accreditation standards and
requirements.

Statement:

Records and forms must be completed in a standardized and uniform
fashion. This includes but is not limited to the following requirements:

1.

All entries must include place, date, time and be legible. All entries must include
signature and title.

2.

Per PHS policy, all signatures must be accompanied by printed or stamped
identification of the signature.

3.

A progress note must record all encounters. Documentation of patients note seen
and why they were not seen must be recorded on the progress note.

4.

All forms must be completely filled out and each item addressed (i.e., transfers,
public health, H&Ps, sick call requests, chronic care screeners). Special care
must be taken with multiple forms – press hard for legibility.

5.

All documents in the record must include the inmate’s name, PFN number,
housing unit, date of birth, allergies, and sex.

6.

Master Problem List must be filled out completely with each problem, date of
onset, treatment plan, status of each problem, any allergies, and initials of the
health professional entering the data.

7.

Progress notes must be in SOAP format.

8.

All finding, diagnoses, treatments, dispositions must be recorded.

9.

Reports of labs, x-rays, diagnostic studies and immunization records ordered
must be in the patient’s record.

10.

Results of internal and external consultations must be completed and recorded.

11.

Patients with major medical problems (i.e., infirmary patients) require a recorded
treatment plan.

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12.

All physician orders must include all identifying information listed above and the
status of the patient’s allergies. Orders must be legible and include start and stop
dates. Special attention must be taken to prevent error, misreading, improper
abbreviations and prescribing non-formulary items without prior approval.

13.

All verbal/telephone orders must be signed within 72 hours.

14.

Any encounter that generates a physician’s order must be crossed-referenced to a
progress note, written by the provider or the person taking the verbal/telephone
order. The progress note must refer to the physician’s order and the reason for the
order.

15.

Medication administration must have documentation of the names of the
personnel administering or delivering the medication.

16.

Consent for medical service forms or release of responsibility forms must be
obtained and completed.

17.

All medical records must be kept in the medical records department. Records
must be removed from the medical records department consistent with record
policies and procedures.

Revised/Effective Date: 4/6/04

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PROBLEM ORIENTED PROGRESS NOTES

Problem oriented progress notes are written to match each problem documented on the
Master Problem List and organized in a narrative form using the SOAP format. When
writing a progress note, a separate SOAP note is needed for each problem. Different
problems are better addressed in separate progress notes.

ADVANTAGES OF PROBLEM ORIENTED PROGRESS NOTES
FOCUSES ON THE INMATE AND THEIR PROBLEMS
FOCUSES ON THE TOTAL INMATE BY INCORPORATING EMOTIONAL
AND SOCIAL ASPECTS OF CARE ALONG WITH THE PHYSICAL
COMPONENTS.
PROVIDES FOR CLEARER COMMUNICATION ABOUT THE INMATE
BETWEEN ALL HEALTH TEAM MEMBERS.
PROVIDES FOR MEANINGFUL EVALUATION OF THE EFFECTIVENESS
OF CARE.
PROVIDES A FEEDBACK SYSTEM FOR MONITORINIG QUALITY OF
CARE.
ADVANTAGES OF SOAP CHARTING
ORGANIZES DOCUMENTATION IN A CONCISE LOGICAL MANNER
ACCORDING TO INMATE PROBLEMS.
ELIMINATES UNNECESSARY VERBIAGE.
INMATE FOCUSED.
PROVIDES FOR CLEARER COMMUNICATION WITH OTHER HEALTH
CARE TEAM MEMBERS.
PROVIDES FOR AN ON-GOING EVALUATION OF INMATE’S PROGRESS.

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THE SOAP FORMAT
S – Subjective
The inmate’s self proclaimed symptoms and own description of the problem not
perceptible to an observer.
Examples: Nausea, headache, cramps, and pain.
O – Objective
Clinical findings, observations and factual data.
Examples: Vital signs, observations, and assessment findings.
Anatomical system charting is useful in the objective portion of a SOAP
note.
A – Assessment
Conclusions about the health condition based on the subjective and objective data.
Nursing diagnoses may be used.
Examples: Nursing diagnoses; constipation related to immobility.
P – Plan
Nursing interventions may be diagnostic (observe for increased drainage), therapeutic
(implemented bowel program per protocol), or educational (instruct in finger stick
process). The plan should include implementation of the interventions, evaluation,
how the plan worked, and revision, changes to the plan if required. Inmate education
may also be included in this section of the progress notes.
Examples: Referred to physician; instructed to increase fluids, and return
to clinic in one week.

NOTE: RNs use SOAP format documentation. LVN’s use SOI method (subjective,
objective, and impression).

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MARs
A correct MAR needs to show the following:
All documentation must be legible
1. Inmate name (correct name, not an alias)
2. Inmate PFN
3. Inmate location (within facility)
4. Facility name
5. Allergies to medications
6. Diagnosis
7. Month and year of MAR
8. Initials of person taking off order(s)
9. Start and stop date for each medication
10. Name of prescribing clinician for each order
11. Medication ordered, including dose and route
12. Time(s) medication is to be given
13. Lines to delineate start and stop of medication, yellow out section upon
completion or discontinuation of medication
14. Identification of initials of person giving medication(s) (signature and
stamp/print)
15. Initials of person giving medication(s), be sure to circle if not given and document
reason on back of MAR
16. Document on MAR when medication is given, not before
17. Document on originals only – do NOT document on faxes or copies

Any Order Written on a Physician’s Order Sheet
All documentation must be legible
ALL CLINICIANS
AND LICENSED
NURSES

Medications,
Treatments,
or
Medication
renewals

Clinicians use SOAP
notes
RN’s use SOAP notes
LVN’s use SOI notes
Sign name & Title
Print/Stamp name

Order must be
justified in
progress
notes

NO EXCEPTIONS

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MILITARY TIME USEAGE
All charting or documentation done by PHS staff is done in military time. Below is the
break down of military time which starts after 12 noon.
1 or 0100 or 1300 hours

7 or 0700 or 1900 hours

2 or 0200 or 1400 hours

8 or 0800 or 2000 hours

3 or 0300 or 1500 hours

9 or 0900 or 2100 hours

4 or 0400 or 1600 hours

10 or 1000 or 2200 hours

5 or 0500 or 1700 hours

11 or 1100 or 2300 hours

6 or 0600 or 1800 hours

12 or 1200 or 2400 hours

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NURSING DIAGNOSIS

Nursing diagnosis provides a useful mechanism for structuring nursing knowledge in an
attempt to define the unique role and domain of nursing. PHS mandates that nursing staff
practice within the constraints of their licensure. This would imply that nurses do not
utilize or make medical diagnoses.
Nursing diagnosis can provide a solution to the quest of nursing because it serves to:
Define nursing in its present state
Classify the domain of nursing
Differentiate nursing from medicine
Identify nursing knowledge for students.
The Concept of Nursing Diagnosis
The word diagnosis evokes many responses in nurses – some positive, some negative.
Because nurses have historically linked the word diagnosis exclusively with medicine,
some may tend to overlook the fact that teachers diagnose teaming disabilities,
hairdressers diagnose hair problems, and mechanics diagnose automotive disorders. In
addition, many nurses were taught to avoid making definitive statements when
documenting and were advised to use terms such as “seems to be” or “appears to be.”
This socialization process rewarded nurse for not diagnosing.
A nursing diagnosis is a statement that describes the human response (health state or
actual/potential altered interaction pattern) of an individual or group which the nurse can
legally identify and for which the nurse can order the definitive interventions to maintain
the health state or to reduce, eliminate, or prevent alterations.
For a comprehensive list of nursing diagnoses, please refer to professional nursing
literature and reference texts.

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THE USE OF NAMES IN ORDER TO COMMUNICATE LETTERS

Procedure Name:

Verbal communication with PFN Identification

Purpose:

To ensure accurate identification of inmate information.

Procedure:

The following phonetic alphabet is used for clarification of verbal
communication of PFN numbers:

Letters used:
A – Adam

N – Nora

B – Boy

O – Ocean

C – Charles

P – Paul

D – David

Q – Queen

E – Edward

R – Robert

F – Frank

S – Sam

G – George

T – Tom

H – Henry

U – Union

I – Ida

V – Victor

J – John

W – William

K – King

X – X-ray

L – Lincoln

Y – Yellow

M – Mary

Z – Zebra

Numbers used:
1,2,3,4,5,6,7,8,9,0

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COMMONLY USED ABBREVIATIONS

COMPUTER QUERY ABBREVIATIONS
JQCN.Last Name then Enter (Finds Complete Name, Date of Birth, PFN#)
JQCN.Last Name.I then Enter (Finds Inactive Name, Date of Birth, PFN#)
JPQN.Last Name.First Name then Enter (Finds Complete Name, Date of Birth, PFN#)
JPQS.PFN# then Enter (Finds All Aliases, Date of Birth)
JQCD.PFN# then Enter (Finds Active/Inactive, Receiving Date, Release Date)
JPQP.PFN# then Enter (Finds Address, Social Security #)
JQLA then Enter (Finds location)
JQLA.SPOD# then Enter (Finds Everyone in POD)
JASA then Enter (To Book Appointments)
JUMR.PFN# (Finds PPD & CxR information)
JUSA then Enter (to Correct/Cancl appointments)
JASD then Enter (To Enter a Diet)
JQSD. Diet Code or PFN then Enter (Query diet record)
JUSD.PFN then Enter (Update or Delete diet record)
JQMG.PFN# then Enter (Finds Appointments)
JQMN.Last Name or First Name then Enter (Finds Movement History)
JAMR then Enter PFN# (Finds Sex, Date of Birth, Medical Record Number)
EMPLOYEE USER ID = your 3 initials and the 4 last numbers of your social security
number in all lower case (small letters)
TO LOGON: type cesn (or alaco) (space) user ID
TO LOGOFF: type cesf (space) logoff
Passwords chosen by the individual employee are restricted to only lower case letters or
numbers.
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COMMON ADMINISTRATIVE COMMUNICATIVE ABBREVIATIONS
PFN – Prisoner file number (ID#)

SO – Sheriff’s Office

DOB – Date of birth

CDC – CA Department of Corrections

NIC – Not in custody

USM – US Marshall Service

OTA – Out to appointment

DOJ – Department of Justice

OTC – Out to court

ACSO – Alameda County SO

SRJ – Santa Rita Jail

SOlD15 – SRJ HU1 PodD Cell15

GDDF (NCJ) – Glenn Dyer (North County) NOlE05 – GDDF Flr1 PodE Cell5
SEEN
REFUSED
COMPUTER CODES – CHART LOCATOR SYSTEM

AS – ACTIVE SRJ
IS –

INACTIVE SRJ

AN – ACTIVE GDDF (NCJ)
IN –

INACTIVE GDDF

IF –

OFF-SITE STORAGE CHART

CS –

CONFIDENTIAL SRJ

CN – CONFIDENTIAL GDDF
COMMONLY USED OTHER FACILITY ABBREVIATIONS

VSPW – Valley State Prison for Women

Names by county (i.e., Santa Cruz)

SQ – San Quentin State Prison

DVI – Deuell Vocational Institute

FCI – DUBLIN (Federal Correctional Institute at Camp Parks, Dublin)
CDC – California Department of Corrections (PRISONS)
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FINDING HEALTH INFORMATION:
CHARTS, SCREENERS, AND LOOSE FILING PAPERS
Health Information Services Department consists of two medical record rooms, one
known as Active and one known as Inactive.
The Active Room contains active shelving, prenatal shelf, clerks’ analysis shelves, MD
signing shelves, returns shelves, Outpatient Housing Unit (OPHU) Discharge shelf, and
small computer room. Blank forms, labeled boxes for returning loose filing paper, mail
boxes, fax machine, and bins for scheduling clinics are located in this room. The Active
room also in the location for the court order and +PPD logs. (PPD readings from nurses
are usually kept in PHS administration.)
The Inactive Room contains inactive shelving, screener boxes labeled by month, and
copies of screeners labeled by month. Often there will be baskets in the inactive room
hallway with charts specifically pulled for a variety of reasons, such as: Annual H&Ps,
Accreditation Audits, Quality Assurance Audits, etc.
In these rooms, charts are most likely found on inactive file shelving, active file shelving,
clerk analysis shelves, and MD signature shelves. Screeners are most likely found in
boxes labeled by month or in the “Charts –to-be-made” cue. Loose filing paper with
medical record numbers are most likely found on clerks’ desks or in the sorter. Each
clerk has an assigned number of terminal digits. In your daily work situation, all nurses
are expected to look in all of these locations first before requesting assistance from health
information personnel.
All nurses, medical assistants, and lab technicians are expected to find a chart, a screener,
and/or loose paper filing if they need it. The health information staff is willing to help
find charts once the nurse has tried all obvious locations.
Screeners without medical record numbers are kept in strict alphabetical order within
the month of booking.
Screeners that are in cue for medical record number assignment are loosely by letters
in “Charts-to-be-made” cue.
New booking screeners may be on clerks’ desks waiting to be matched with
preexisting chart folder or may be waiting to be matched with chart ordered from
off-site storage.
Loose filing paper with medical record numbers may be on clerks’ desks or in the
sorter.
Charts may be found on inactive or active shelving. They may be found on clerks’
analysis shelves or MD signing shelves. All of these areas are filed in strict
terminal digit filing.
Returning or arriving loose filing paper needs to go to the appropriately labeled boxes
and bins. PLEASE, MAKE SURE TO PLACE LOOSE FILING (screeners, orders, etc.)
IN THE CORRECT BOX. This saves time and enables these items to be found in a timely
manner.

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Court Orders are logged in logbook and matched with chart if possible for the housing
unit nurse. All court orders must be addressed appropriately, completed (with written
court order response if required), and returned directly to Health Information Supervisor
(Supervisor In-Box or Office only).

Terminal Digit Filing System Instructions
The filing system used at Santa Rita and at Glenn Dyer is terminal digit. The system
uses a color-coded system in conjunction with a medical record number that consists of
three pairs of numbers connected with dashes (i.e. 12-06-45). These are not to be
confused with a Date of Birth (i.e. 12/6/45).
The color coding is as follows:
Zero = Red, One = Gray, Two = Blue, Three = Orange, Four = Purple, Five =
Black, Six = Yellow, Seven = Brown, Eight = Pink, and Nine = Green.
Looking at the vertical numbering on the side of the folder, if the chart number is 0306-12; you start with the 12, which are the bottom pair of two numbers, then 06,
and finishing with 03, the top two numbers.
Using the color-coded system, in looking for 03-06-12, first, you would look for the
bottom pair of numbers, a blue sticker signifying 2, and then a gray signifying 1.
Then you would look for the middle pair of numbers, red signifying 0 (the first
number of the middle pair). At this point you have to complete the middle pair
06, and then look finally for the top pair 03.

CHART ORDER
A standardized source oriented chart order is used to maintain a standardized order within
an inmate’s health record.
See enclosed sample of chart order.

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CHART ORDER - PRISON HEALTH SERVICES – ALAMEDA COUNTY JAILS
LEFT SIDE
MASTER PROBLEM LIST
DISEASE CODE SHEET (JUMR screen)
ANY OF THE FOLLOWING IN REVERSE CHRONOLOGICAL ORDER:
Court Orders and/or Subpoenas
Authorizations for Release of Information
Records received from other facilities
Requests for Health Information
Other Correspondence
*HIV Consent (place on top of Master Problem List only when all appropriate signatures
are not completed, after completion file on right in consents)
TAB ORDER FOR RIGHT SIDE OF CHART:
CURRENT ADMISSION ONLY (right side of chart):
PRENATAL (Green)
METHADONE (Brown)
INFIRMARY (Blue)
LAB/X-RAY (Yellow)
OUTSIDE HOSPITAL (Purple)
NEW ADMISSIONS (Pink)
NON-ADMISSION SENSITIVE (at bottom of right side of chart):
DENTAL (Red)
MENTAL (Grey)
ASSEMBLY NOTES:
All documents (except Prenatal Tab section) are affixed to chart in their respective sections in
REVERSE CHRONOLOGICAL ORDER, oldest date first moving forward to more recent dates.
When the patient is released from the facility (NIC = not in custody), a blue paper is placed on
top of that admission with the NIC date and clerk ID on the lower right corner and all Tabs are
removed except for Dental and Mental. (Tab removal is new as of 1/28/03)
When a subsequent volume is created (ex: VOL II of II) the Dental (red) and Mental (grey)
sections are moved to the current volume being created. All coding and allergy labels need to be
added to new folder.
If 295.0 coding is present, this indicates the presence of a separate Psychiatric Volume.
295.0 is a Historical system and is not currently used by HISD.
If 39.95 coding is present, this indicates the presence of a separate Dialysis Volume. If not
already made, a Dialysis volume needs to be made for every Dialysis patient.
An in-custody death chart is coded 798.2 and update to/filed in SRJ CS.
Refer to “John/Jane Sample.”
**Chart Order as of 2009

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CHART ORDER – PRISON HEALTH SERVICES – ALAMEDA COUNTY JAILS
RIGHT SIDE
BLUE SHEET (dated and initialed to close admission/incarceration)
TRANSFER SHEET TO OTHER FACILITY
Peapods (Chronological order OK in Prenatal Section only)
PHYSICIANS ORDERS
OB/GYN H&P (on prenatal progress note)
PROGRESS NOTES
Progress notes, copies of labs and studies, and internal consults –
INTERNAL CONSULTATIONS
stamped “prenatal”
PRE-NATAL TAB (Green)
Prenatal Counseling, Social Services, and Education
Prenatal Records
METHADONE TAB (Brown)
Prenatal Methadone Counseling
Prenatal Methadone Records
INFIRMARY TAB (Blue)
Infirmary discharge plan
Outpatient Housing Unit Records
Physician’s orders
FLOW SHEETS: HIV or any CCC Flow Sheet
Provider Notes (stamped as such)
CIWA-Ar RECORD
Infirmary nursing progress notes
COWS RECORD
Intake/output record
WEIGHT RECORD
Neurological assessment
Vital signs flow chart
BLOOD PRESSURE RECORD
Infirmary record (opens each infirmary admission)
WOUND TREATMENT RECORD
DIABETIC RECORD
NOTE: Multiple Infirmary
HISTORY AND PHYSICAL
admissions/discharges
are placed in
FORMULARY EXCEPTION REQUEST
METHADONE ADMINISTRATION RECORD
h
l i l d
All
/l b
d
MEDICATION RECORD (MAR)
LAB/X-RAY TAB (Yellow)
Labs, X-Rays, Ultrasound Reports, Morbidity Reports
GYN LAB ASSESSMENT
ER Room Referral
PPD REPORT/INH EVALUATION
ER Referral to Hospital
OUTSIDE HOSPITAL TAB (Purple)
Hospital Records
Utilization
Outside Hospital Records
ER or Outpatient Consultation Referral
DIET SHEET
DETAIL OFFICE SPECIAL REQUESTS
PERSONAL PROPERTY RECEIPT
SICK CALL REQUESTS
METHADONE VERIFICATION FORM
KITCHEN ASSESSMENTS
RELEASES OF RESPONSIBILITY
CONSENTS
TRANSFER FORMS FROM OTHER AGENCIES/FACILITIES
RECEIVING SCREENER (Opens the chart/current admission)
NEW ADMISSIONS TAB (Pink)
BLUE SHEET OVER ANY PREVIOUS ADMISSIONS
DENTAL TAB (Red)
Dental Records
MENTAL TAB (Grey)
Mental Health Records
CONFIDENTIAL ENVELOPE (HIV Antibody Test)

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GLOSSARY OF TERMS

ADMINISTRATION OF MEDICATION is the act in which a singe dose of identified
drug is given to a patient.
ADMINISTRATIVE MEETING of the jail are meetings of the health staff, security
personnel; and administration, as appropriate.
ADMINISTRATIVE SEGREGATION: see Segregation
ALCOHOL DETOXIFICAION: See Detoxification.
ANNUAL STATISTICAL REPORT is a compilation of information concerning the
number of inmates receiving health services by category of service, as well as other
relevant information (e.g., operative procedures, referrals to specialists, ambulance
services).
ASSESSMENT PROTOCOLS are written instructions or guidelines that specify the
steps to be taken in appraising a patient’s physical status. Assessment protocols should
not include any directions regarding dosages of prescription medication except for those
covering emergency, life-threatening situations (e.g., nitroglycerin, epinephrine).
CHEMICAL DEPENDENCY refers to the state of physiological and/or psychological
dependence of alcohol, opium derivatives, synthetic drugs with morphine-like properties
(opiates), stimulants, and depressants.
CHRONIC ILLNESS requires care and treatment over a long period of time and usually
is not cured (e.g., asthma, heart disease, diabetes, hypertension, and chronic obstructive
pulmonary disease).
CLINIC CARE is medical service rendered to an ambulatory patient with healthcare
complaints that are evaluated and treated at sick call or by special appointment.
CLINICAL ENCOUNTER refers to any health encounter with a qualified health
professional where some type of diagnostic test or treatment is provided.
COMMUNICABLE DISEASES include those diseases that are sexually transmitted
(e.g., syphilis, gonorrhea, chlamydia, HIV), transmitted through the respiratory system
(e.g., tuberculosis), or via infected blood (e.g., hepatitis).
CORRECTIONAL HEALTH COORDINATOR is an individual who coordinates the
health delivery services under the joint supervision of the responsible physician and the
jail administrator in jails without any full-time qualified healthcare personnel. This
individual is trained in limited aspects of health care, as determined by the responsible
physician, and may include correctional officers and other personnel.
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CRITICAL INCIDENT DEBRIEFING is a process whereby individuals are provided
an opportunity to express their thoughts and feelings about a critical incident (e.g., a
serious injury/death of a staff member or inmate), develop an understanding of critical
stress symptoms, and develop ways of dealing with those symptoms. Critical incident
stress is a normal reaction to an abnormal event that causes individuals to experience
unusually strong emotional reactions. Absent the opportunity for debriefing, critical
incident stress has the potential for interfering with an individual's ability to function now
or some time in the future.
A DEA CONTROLLED SUBSTANCE is a drug regulated by the Drug Enforcement
Administration under the authority of the Federal Controlled Substances Act.
The DENTAL EXAMINATION should include the taking or reviewing of the patient’s
dental history; charting of teeth; examination of the hard and soft tissue of the oral cavity
with a mouth mirror, explorer and adequate illumination. X-ray studies for diagnostic
purposes should be taken if necessary.
DENTAL SCREENING: See ORAL SCREENING.
DETOXIFICATION refers to the process by which an individual is gradually
withdrawn from a drug to which the person is physically dependent and/or the treatment
of the condition which results from the withdrawal of the drug (the abstinence syndrome).
This process is usually accomplished by the administration of decreasing doses of the
drug upon which the person is physiologically dependent, one that is cross-tolerant to it,
or a drug that has been demonstrated to be effective on the basis of medical research.
DIASTER PLAN: See EMERGENCY PLAN
DISPENSING OF MEDICATION refers to the distribution of one or more doses of a
prescribed medication in containers that are correctly labeled with the name of the
patient; the contents of the container and all other vital information needed to facilitate
correct drug administration.
DISTRIBUTION OF MEDICATION is the system of delivering, storing, and
accounting for drugs from the source of supply to the nursing station or point where they
are administered to the patient.
DOCUMENTED HEALTH REQUESTS health requests include such examples as (1)
the recording on the request slip of the action taken regarding triaging and the filing of
such slips in the patient’s medical record, and (2) the use of a log to record the request
and its disposition.
DRUG DETOXIFICATION: See DETOXIFICATION.
ECTOPARASITES are animals or insects, such as pediculosis and scabies that are skin
infestations. They are communicable and may lead to secondary infections.

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EMERGENCY CARE (MEDICAL, DENTAL, AND MENTAL HEALTH) is care for an

acute illness or unexpected healthcare needs that cannot be deferred until the next
scheduled sick call or clinic.
EMERGENCY PLAN is the plan developed to respond to manmade or natural, internal
or external disasters. Health aspects of an emergency plan, among other items, include
the triaging process, outlining where care can be provided, and laying out a backup plan.
FORMULARY is a written list of prescribed and non-prescribed medication stocked
within the facility.
FRAIL ELDERLY inmates are those who frequently suffer from chronic conditions and
that impair their ability to function (e.g., dress, fed, and toilet) to the extent that they
require special nursing care.
HEALTH ADMINISTRATOR is a person who by education (RN, MPH, MHA, or a
related discipline), experience, or certification (e.g., CCHP, Fellow in the American
College of Healthcare Executives) is capable of assuming responsibility for arranging for
all levels of healthcare and providing quality and accessibility of all services provided to
inmates.
HEALTH ASSESSMENT is the process whereby the health status of an individual is
evaluated. The responsible physician defines the extent of the health appraisal, including
medical examination, but include at least the items noted in standard J-33.
HEALTH AUTHORITY is the individual to whom has been delegated the
responsibility for the facility’s healthcare services, including arrangements for all levels
of healthcare and the ensuring of quality and accessibility or all health services provided
to inmates.
HEALTHCARE is the sum of all actions taken, preventive and therapeutic, to provide
for the physical and mental well being of a population. Healthcare, among other aspects,
includes medical, psychiatric, and dental services, personal hygiene, dietary and food
services, and environmental conditions.
HEALTH SERVICES STAFF are qualified healthcare personnel and all personnel
without healthcare licenses who are trained in some aspects of healthcare delivery (e.g.,
health services administrators, nursing assistants, record administrators, laboratory and
clerical workers).
INFORMED CONSENT is the agreement by the patient to a treatment, examination, or
procedure after the patient receives the material facts regarding the nature or,
consequences of, risks of, and alternatives to the proposed treatment, examination, or
procedure. The right to refuse treatment is inherent in this concept.
INITIAL HEALTH SCREENING: See RECEIVING SCREENING.
INTERNAL QUALITY IMPROVEMENT: See MONITORING OF SERVICES
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KEEP-ON-PERSON (KOP) refers to an inmate keeping his medication on his person.
LARGE-MUSCLE ACTIVITY are those activities involving large muscle groups such
as walking, jogging in place, basketball, Ping-Pong, and isometrics.
A LICENSED NURSING FACILITY provides long term or rehabilitative care to
patients with chronic physical or mental disabilities.
MEDICAL PREVENTIVE MAINTENANCE: See PREVENTIVE MAINTENANCE.
MEDICAL RESTRAINTS: See RESTRAINTS.
MEDICATION ACCOUNTING is the system of recording, summarizing, analyzing,
verifying, and reporting medication usage.
MONITORING OF SERVICES is the process for ensuring that all providers are
rendering high-quality healthcare services in the facility. On-site observation and review
(e.g., sturdy of inmates’ complaints about care; review of health records, pharmaceutical
process, standing orders, and performance of care) accomplish the monitoring.
MORTALITY REVIEW is a process that involves physicians, nurses and others
seeking to determine in the case of death if there was a pattern of symptoms that might
have resulted in earlier diagnosis and intervention. Additionally, the review examines
events immediately surrounding a death to determine if appropriate interventions were
undertaken. Each inmate death should be compared with other inmate deaths to
determine if there is an emerging pattern.
NURSING PROTOCOLS: See ASSESSMENT PROTOCOLS.
OPIATES are derivatives of opium, (e.g., morphine and codeine), and synthetic drugs
with morphine-like properties.
ORAL HYGIENE by standard definition includes clinical procedures taken to protect
the health of the mouth and chewing apparatus, minimum compliance is met by
instruction in proper brushing of teeth.
ORAL SCREENING is a visual observation of the teeth and gums performed by a
dentist or healthcare personnel who are properly trained and designated by the dentist.
ORTHOSES as specialized mechanical devices used to support or supplement weakened
or abnormal joints or limbs, such as braces, foot inserts, or hand splints.
OUTPATIENT HOUSING UNIT is a medical observation unit.
OUTPATIENT HOUSING UNIT CARE is defined as care by or under the supervision
of a registered nurse for an illness or diagnosis that requires limited observation and/or
management but does not require admission to a licenses hospital or nursing care facility.
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PHYSICAL HANDICAPS refer to physical disabilities that limit a person’s normal
functioning, including mobility impairments, visual impairments, hearing impairments,
and speech impairments.
POLICY is a facility’s official position on a particular issue related to an organization’s
operations.
PROCEDURE describes in detail, sometimes in sequence, how a policy is to be carried
out.
PREVENTIVE MAINTENANCE refers to health promotion and disease prevention.
This includes the provision of individual or group health education and medical services,
such as inoculations and immunizations provided to take advance measures against
disease, and instruction in self-care for chronic conditions.
PROTHESES are artificial devices to replace missing body parts or compensate for
defective bodily functions. Examples are items such as artificial limbs, eyeglasses, and
full and partial plates.
PSYCHIATRIC PERSONNEL or psychiatric services staff are psychiatrists, general
family physicians with psychiatric orientation, psychologists, psychiatric nurses and
social workers.
QUALIFED HEALTH PERSONNEL are physicians, dentists, and other professional
and technical workers who by state law engage in activities that support, complement, or
supplement the functions of physicians and/or dentists, and who are licenses, registered,
or certified as is appropriate to their qualifications to practice; further, they practice only
within their license, certification, or registration.
QUALIFIED MENTAL HEALTH PERSONNEL include physicians, nurses,
physician assistants, and other who by virtue of their education, credentials, and
experience are permitted by law to evaluate and care for mental health needs of patients.
QUALIFIED IMPROVEMENT COMMITTEE is a multi-disciplinary group of health
providers working at the facility (the responsible physician and representatives of other
departments) who meet on a fixed schedule to monitor and evaluate the healthcare
services provided.
QUALIFIED IMPROVEMENT PROGRAMS ensure the quality and consistency of
the health services provided in the facility, usually through periodic review of patients’
charts and ongoing monitoring of clinical services.
RECEIVING SCREENING is a system of structured inquiry and observation designed
to prevent newly arrived inmates who pose a health or safety threat to themselves or
others from being admitted to the facility’s general population, and to identify those
newly admitted inmates in need of medical care. This process is also referred to as
INTIAL HEALTH SCREENING.
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RESPONSIBLE PHYSICIAN is an individual physician who supervises medical
judgments regarding the care provided to inmates at a specific facility.
RESTRAINTS are physical and chemical devices used to limit patient activity as a part
of healthcare treatment. The kinds of restraints that are medically appropriate for the
general population within the jurisdiction may likewise be used for medically restraining
incarcerated individuals (e.g., leather or canvas hand and leg restraints, chemical
restraints, and straightjackets).
SEGREGATION (Administrative Segregation) refers to inmates isolated from the
general population and who receive services and activities apart from other inmates.
SELF-CARE is defined as care for a condition that can be treated by the patient; it may
include over-the-counter-type medications.
SELF-MEDICATION programs permit responsible patients to carry and administer
their own medications (e.g., “keep-on-person” programs).
SICK CALL is the system through which each inmate reports for and receives
appropriate medical services for non-emergency illness and injury. Some people refer to
sick call as a CLINIC VISIT.
SPECIAL MENTAL HEALTH NEEDS patients include self-mutilators, the aggressive
mentally ill, suicidal inmates, and sex offenders.
SPECIAL NEEDS CARE refers to care developed for patients with certain medical
conditions that dictate a need for close medical supervision (e.g., seizure disorder,
diabetes, potential suicide, pregnancy, chemical dependency, and psychosis).
STANDARD PRECAUTIONS are recommendations by the Centers for Disease
Control and Prevention (CDC) and the Occupation Safety and Health Administration
(OSHA) that require healthcare workers to consider all patients as potentially infected
with blood borne pathogens and to follow infection control precautions intended to
minimize the risk of exposure to blood and certain other body fluids of patients. Also
known as Universal Precautions.
STATISTICAL REPORTS summarize and monitor trends of inmates receiving health
services by category of care, operative procedures, referrals to specialists, positive testing
for HIV and tuberculosis infections, and emergency services provided patients.
TERMINALLY ILL patients are those with a life expectancy of less than one year due
to illness and who may require special health services to provide comfort, relief from
pain, and special counseling and support in anticipation of death.
THERAPEUTIC SECLUSION refers to the placement and retention (by qualified
healthcare personnel) of an inmate/patient in a bare room for the purpose of containing a

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clinical situation (e.g., extreme agitation, threatening or assaultive behavior) that may
result in a state of emergency.
TREATMENT PLAN is a series of written statements that specify the particular course
of therapy and the roles of medical and non-medical personnel in carrying out the current
course of therapy. It is individualized and based on assessment of the individual patient’s
need, and includes a statement of the short and long-term goals and the methods by which
the goals will be pursued.
TREAMENT PROTOCOL is pre-established written orders that specify the steps to be
taken in appraising a patient’s physical status. Treatment protocols do not have any
directions regarding danger of prescription medications.
TRIAGE is the sorting out and classification of patient-inmate health complaints to
determine priority of need and proper place of healthcare.
UNIVERSAL PRECAUTIONS: See STANDARD PRECAUTIONS
VERIFICATION OF CREDENTIALS may consist of copies of current credentials,
letters from the state licensing or certifying bodies regarding the status of credentials for
currently employed personnel, or personal observation of the document by an
authenticating employee or similar means.

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EMPLOYEE RIGHTS AND RESPONSIBILITIES

1.

FIT Test (face mask) – One time.

2.

Sheriff’s Orientation – New Employee & Annual.

3.

TB Testing – Annual.

4.

CPR and Professional License – Every Two years (Licensed
personnel). You are required to provide PHS with a copy of your
current CPR card and current license (and DEA registration as
appropriate).

5.

Continuing Education Units (CEU’s) –
Keep current with files located in the administrative office (filed in
alphabetical order and by shift).
ƒ Personnel with inmate contact - ACA Accreditation requires 40
hours and NCCHC Accreditation requires 12 hours. Examples
of professional skill maintenance and enhancement activities
you may document: all-staff meetings, PHS sponsored CEU
participation, outside educational activities, classes taken for
college credit, lectures attended, etc. A minimum orientation of
40 hours is completed before taking an individual job
assignment per ACA.
ƒ Other personnel – NCCHC Accreditation requires 12 hours of
training time documentation. 40 hours of orientation is
completed before taking an individual job assignment per ACA.

6.

PRN Nurses – Turn in availability for scheduling in accordance with
Collective Bargaining Agreement.

7.

Swiping In and Out on the Time Clock – For Accuracy

8.

Keep track of your sick time and paid vacation time. Vacations must
be approved in advance. Payment slips must be completed by
employee and signed by supervisor for all sick time, holidays, and
vacations.

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9.

If you are injured on the job – notify your supervisor immediately.
Follow Needle Stick Policy as required. Workers compensation
injuries must be reported immediately or ASAP to your supervisor
and/or PHS administrator.

10.

If you are absent or late – notify your supervisor.

11.

Employees are expected to be awake and alert at all times. Sleeping is
NOT allowed on the job site, while working, and/or while on a break.
Sleeping while on duty compromises care.

12.

Telephones and computers are to be used for official PHS and
Sheriff’s Office business use only. Internet use (including browsing,
checking your personal email account, streaming radio, and streaming
video) is not authorized unless required to complete your PHS job
duties.

13.

PHS provides equal employment opportunities to all qualified
employees and applicants for employment without regard to race,
color, religion, sex, age, or national origin and extends to the disabled,
disabled veterans, and veterans of the Vietnam era. Equal employment
relates to all phases of employment, including but not limited to
recruiting, placement, upgrading, demotion, transfer, termination,
rates of pay or other forms of compensation, selection for training,
educational assistance and use of all facilities and participation in
company-sponsored employee activities.

14.

Anyone who uses language or displays conduct (including any form
of harassment) which reflects negatively on any race, color, religion,
age, national origin, the disabled or veterans, including veterans of the
Vietnam era may be subject to disciplinary actions up to and including
discharge.

15.

Employees must abide by the standards, rules, and regulations set
forth in the PHS Business Ethics Manual and the Employee
Handbook.

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SCENARIOS

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SCENARIO I:

REVIEW FREQUENTLY USED FORMS
(See Section 10)

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SCENARIO II:

HEALTH RECORD SCAVENGER HUNT

Finding a Health Record in Terminal Digit Filing
Finding a Screeners
Finding Loose Filing Paper
Rules: The trainer (i.e. Quality Coordinator or Supervisor of Health Information) will
remind new employee of what possible areas a chart, screener, or loose filing may be
filed and/or placed. In order to ensure a successful experience, the trainer should make
sure that items for the test are placed available before the scenario begins.
You must find all charts, screeners, and loose filing paper without assistance. They may
be in any location in any of the medical record rooms. Your skills in alphabetical order
and terminal digit order will be utilized. Make sure that you study terminal digit and how
to find a chart before your scavenger hunt begins.
Three charts (pre-selected specially for training purposes) will be chosen for
new employee to find.
Five screeners (recently chosen by trainer) will be chosen for new employee
to find.
Three pieces of loose paper (recently chosen by trainer) will be chosen for
new employee to find.
Any employee who has completed this exercise shall be considered capable of finding
any loose filing papers, screeners, and charts for themselves. In the daily work
environment, an employee must look first in all the obvious locations in medical records.
For this test, you must find everything without assistance.
Find the following charts.
1. Active _________________
2. Inactive _________________
3. MD (other) _________________
Find the following screeners (full name and date of screening provided).
1. Screener box _____________________________________
2. Charts-to-be-made cue ______________________________________
3. MRN# and not opened ______________________________________
4. IF (off-site) MRN# and chart not received yet ______________________________
5. Other ____________________________________
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Find the following loose filing papers (name and medical record number or screening
date given).
1. MAR _________________________________
2. Clinician’s order _________________________________
3. Other _________________________________

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ACKNOWLEDGMENT OF ABILITY TO LOCATE HEALTH RECORDS
Upon completion of the Medical Record Scavenger Hunt, the new employee has
demonstrated knowledge of locating health records, screeners, and loose filing. The
following documentation must be completed.
On ______________, ______________________________ has completed this Scenario.
(Date)
(Print name of new employee)

Medical Record Scavenger Hunt for finding loose paper, screeners, and charts with
100% accuracy.

__________________________________
New employee signature

___________________________
Print name

___________________________________
Trainer signature

______________
Date

(Orientation Instructions: The signature portion of this scenario is combined with closing
signature pages of new employee orientation packet.)

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CLOSING

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PRISON HEALTH SERVICES
NEW EMPLOYEE ORIENTATION CHECKLIST
NAME: ____________________________ POSITION: ________________________
(please print)

DATE: _______________________ SITE/FACILITY: _________________________
Comprehensive Knowledge Base
Overview of Correctional Health Care
Inmate Health Services and Special Needs
Confidentiality of Health Information and Health Records
Location of time clock and associated employment forms
Obtaining and Returning Keys to security
Facility Orientation – Santa Rita / Glenn Dyer Detention Facility
PHS Policy and Procedure Manual
Nursing Assessment Protocols, Diet Manual, Chronic Care Manual (as appropriate)
Pharmacy Manual – Formulary/Non-Formulary Rx’s (as appropriate)
Chronic Care and Specialty Clinics
Communications, phones, and directory
Health (Medical) Records – Chart Order
Documentation Requirements - Signatures
Daily assignments and work schedules
Nursing and Clinician Sick Call
Badge, its visibility, and dress code
Outpatient Housing Unit/ITR/Booking Orientation
Review of the Frequently Used Forms
Laboratory orientation (including lab form completion)
Continuing Education and Training Requirements
Pill Call and Medication Administration
Meetings – Monthly – All Staff and/or Provider
Employee Rights and Responsibilities
Universal/Standard Precautions
Occupation Exposure and Needle Stick Policy
Use of Personal Protective Equipment
Bio-hazardous Waste Disposal
Emergency Services and Suicide Prevention
Other orientation: Security procedures and regulations (safety procedures), Supervision of inmates, Signs of
suicide risk and suicide precautions, Inmate rules and regulations, Key control, Rights and responsibilities of
inmates, Emergency plans, Professional communication (interpersonal skills, communication skills and
counseling techniques), Social/cultural lifestyles of the inmate population (Con Games), Cultural diversity,
Safety procedures, Contraband regulations, Hostage Survival, History of ACSO, Illness and Injury
Prevention, Fire Life Safety, ACSO Cardinal Sins, Sexual harassment and sexual misconduct awareness,
Appropriate conduct with inmates, and Ethics.

I have reviewed the above referenced information. I had the opportunity to ask questions
as needed to understand.

___________________________________ ___________________________________
New Employee Signature

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PRISON HEALTH SERVICES – CRIMINAL JUSTICE MENTAL HEALTH

MENTAL HEALTH OBSERVATION TRAINING*

NAME: ____________________________ POSITION: ________________________
(please print)

DATE: _______________________ SITE/FACILITY: _________________________

I have reviewed and have been trained in mental health observation. I have had the
opportunity to ask questions as needed to understand. I acknowledge receipt of the
Mental Health Observation Training handout prepared and presented by Criminal Justice
Mental Health.

___________________________________ ___________________________________
New Employee Signature

Witness/Orientation Instructor

*This training and signature is required for all RN’s hired. LVN’s may be given the same training in order
for them to have a knowledge-base in mental health observation.

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SIGNATURE / STAMP RECORD

Record / Chart Signature: _____________________________________
(occupational signature and title)

Print Name: ________________________________________________

Stamp Imprint: _____________________________________________

Mar Initial: ________________________________________________

Position / Shift Assigned: _____________________________________

Date of Information: _________________________________________
(today’s date)

Computer Access
If needed, see PHS Administrative staff or designee for user ID assignment and
password.

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POLICY ON DOCUMENTATION FOR PRISON HEALTH SERVICES
Title:

DOCUMENTATION

Policy:

Employees are expected to complete all medical documents in accordance with PHS
policies and procedures and with all accreditation standards and requirements.

Statement:

Records and forms must be completed in a standardized and uniform fashion. This
includes but is not limited to the following requirements:

¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾

¾
¾
¾
¾
¾

All entries must include place, date, time and be legible. All entries must include signature and
title.
Per PHS policy, all signatures must be accompanied by printed or stamped identification of the
signature.
A progress note must record all encounters. Documentation of patients note seen and why they
were not seen must be recorded on the progress note.
All forms must be completely filled out and each item addressed (i.e., transfers, public health,
H&Ps, sick call requests, chronic care screeners). Special care must be taken with multiple forms
– press hard for legibility.
All documents in the record must include the inmate’s name, PFN number, housing unit, date of
birth, allergies, and sex.
Master Problem List must be filled out completely with each problem, date of onset, treatment
plan, status of each problem, any allergies, and initials of the health professional entering the data.
Progress notes must be in SOAP format.
All finding, diagnoses, treatments, dispositions must be recorded.
Reports of labs, x-rays, diagnostic studies and immunization records ordered must be in the
patient’s record.
Results of internal and external consultations must be completed and recorded.
Patients with major medical problems (i.e., infirmary patients) require a recorded treatment plan.
All physician orders must include all identifying information listed above and the status of the
patient’s allergies. Orders must be legible and include start and stop dates. Special attention must
be taken to prevent error, misreading, improper abbreviations and prescribing non-formulary items
without prior approval.
All verbal/telephone orders must be signed within 72 hours.
Any encounter that generates a physician’s order must be crossed-referenced to a progress
note, written by the provider or the person taking the verbal/telephone order. The progress note
must refer to the physician’s order and the reason for the order.
Medication administration must have documentation of the names of the personnel administering
or delivering the medication.
Consent for medical service forms or release of responsibility forms must be obtained and
completed.
All medical records must be kept in the medical records department. Records must be removed
from the medical records department consistent with record policies and procedures.

Orientation Manual
Employee Signature: __________________________________________ Date: _________________
Print or Stamp Name: ________________________________________

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MANTOUX TUBERCULIN SKIN TEST VIDEO
I have viewed the above video as a review on TB Skin testing which includes:
1 – Administer a Tuberculin Skin Test
2 – Read a Tuberculin Skin Test
3 – Interpretation of the Tuberculin Skin Test

I have received the above referenced information. I have had the opportunity to
ask questions as needed to understand.

________________________
Date
______________________________
Signature

Orientation Manual

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______________________________
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COMPILED TRAINING TIME
Course Title

Orientation Manual

Hours

Signature

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Date

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ORIENTATION PROGRAM EVALUATION
NAME: __________________________
Instruction Key: 4 = Excellent,

1.

DATE: _____________________
3 = Good,

2 = Fair, 1 = Poor

Did the program meet your educational needs?

4

3

2

1

If no, what particular needs were not met? __________________________
____________________________________________________________
________________________________________________________________________

3.

Where the scenarios helpful as learning tools?

4

3

2

1

4.

How would you rate the program content?

4

3

2

1

5.

How would you rate the time allotted for the program?

4

3

2

1

6.

What did you enjoy most about the program? _________________________
__________________________________________________________________________
___________________________________________________________________________

7. What did you like least about the program? _____________________________
________________________________________________________________
________________________________________________________________
8.

Please provide any suggestions that you may have to improve the program.
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________

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Housing Unit Orientation Checklist
Each new employee is responsible for the items listed below.
Housing Unit Items to be Checked
and Inventory
Manuals – Nursing Protocols, PHS Policy & Procedure Manual, Pharmacy Formulary, Diet
Manual, and Chronic Care Manual
Pill Call, Sick Call, and documentation requirements
Emergency Services
AED Machine – under sink or standard location per site or area
Refrigerator Log – to be checked weekly and log completed
Emergency boxes – Grey (Pharmacy)
Orange (Nursing Supply) check monthly and sign and date card on top of box
Descending Count Logs – to be checked Tuesdays and kept updated (staple removal kit,
suture removal kit, Betadine bottle and alcohol bottle)
O2 Tank w/Log and Ambu-Bag – to be checked and logged on Tuesdays
Lab Supplies – in exam table drawers checked monthly
Wheelchair/gurney – either in each housing unit
1 pr crutches and 1 cane kept in bathroom
Signature/print/stamp name on all documents
AD-SEG Logs (i.e., HU 1, 2, 9, 24)– observations and documentation required daily
Blood Pressure Flow Sheets – kept up to date
Diabetic Finger Stick Flow Sheets – kept up to date
Master Problem List (kept updated)
Access to Health Care Signs (posted)
CPR mask on bulletin board
Check all open bottles for dates and initials (Normal Saline, Hydrogen Peroxide, Sterile
Water, Betadine, Alcohol, Podofolin, Insulin-in refrigerator). All open bottles expire after 30
days.

Date Housing Unit Orientation completed: ________________________
______________________________

_______________________________

New employee signature

Print/Stamp

I attest that the new employee named above has been oriented on all referenced activities,
documentation, and inventory requirements. He/she has had an opportunity to observe and to ask
questions as needed to understand obligations and requirements.

______________________________

_______________________________

Scheduling Nurse/Supervisor/Designee

Print/Stamp

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Prison Health Services, Inc.
New Employee Orientation
POST-TEST
Employee Name: __________________________________
(please print)

Date: ____________

Site Name: ______________________________
1. Prison Health Services, Inc. (PHS) is the industry leader of the correctional
managed healthcare industry. Since 1978, PHS has delivered value driven
healthcare to numerous jails, prisons, and juvenile facilities across the United
States.
a. True
b. False
2. “Privatization” of governmental functions or services has found growing favor at
all levels and has taken on many forms. One of the more unusual forms of
privatization involves the provision of healthcare services to inmates in prisons and
jails.
a. True
b. False
3. The benefits to healthcare contracting can generally be grouped into three
categories:
a. _________________________________________________
b. _________________________________________________
c. _________________________________________________
4. The terms “jail” and “prison” are largely interchangeable.
a. True
b. False
5. Which of the following best describes the comparison of “jails to prisons”?
a. Small to big
b. New to old
c. Short to long
d. Good to bad

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6. The term “standard precautions” are:
a. AKA “universal precautions”
b. Infection control precautions intended to minimize risk of exposure to
bodily fluids and blood borne pathogens
c. Recommended by CDC and OSHA for all health care workers
d. All of the above

7. Examples of contraband include, but are not limited to the following: needles,
syringes, Q-tips, tongue blades, alcohol wipes, any metal, and/or any glass.
a. True
b. False
8. Inmates working in the kitchen should not have:
a. Diarrhea
b. Skin infections
c. Runny nose
d. Hepatitis A or other infections transmissible by food or utensils
e. All of the above
9. Each site has an Emergency Plan. Emergency drills are executed:
a. Semiannually
b. Biannually
c. Annually
d. Quarterly
10. Which of the following is not reportable via an incident report?
a. Death of an inmate
b. Medication error
c. Employee injury
d. Injury of an inmate
11. Hand washing is considered the single most important procedure for preventing the
transmission of germs.
a. True
b. False
12. The results of TB skin tests are recorded in:
a. Millimeters
b. Centimeters
c. Inches
d. Meters

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13. Hazardous communication is accomplished by employee training and written
materials in Material Safety Data Sheets (MSDS) for all chemical substances. The
Sheriff’s Office maintains these sheets and has them prominently displayed
throughout the jail.
a. True
b. False
14. Examples of bio-hazardous waste include: body tissue, discarded sharps,
contaminated solid waste, blood, body fluids, absorbent materials saturated with
body fluids, and laboratory waste containing human disease causing agents.
a. True
b. False
15. The U.S. Supreme Court decisions in the 1970’s determined that the right to
adequate healthcare for inmates is protected by the 8th Amendment of the U.S.
Constitution.
a. True
b. False
16. Regarding the “Right to Refuse Treatment,” all of the following are true EXCEPT:
a. It is the responsibility of the healthcare staff to assure that inmates who
refuse medical treatment understand the purpose of the proposed care,
how the care will be provided, and the consequences and risk of their
refusal.
b. In situations where the inmate refuses care and refuses to sign a Release of
Responsibility Form (ROR), the nurse will document on the form and in a
progress note that the inmate has refused treatment and refused to sign the
release form. In addition, the nurse will obtain a witness signature
attesting to the inmate’s refusal to sign.
c. Inmates who refuse prescribed medication or treatment are not “entitled”
to further access to healthcare.
d. A refusal of care, which could endanger the patient, should be reported to
the medical director or designee for follow-up.
17. In the event of a medical emergency, as a good Samaritan, the on-site PHS
healthcare staff may provide healthcare services to correctional staff and visitors
within the facility to stabilize their health condition until EMS services arrive. PHS
healthcare personnel should not be involved in providing routine services to
anyone other than the inmate population.
a. True
b. False

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18. All staff should be concerned with minimizing exposure of self and others to
potentially dangerous situations and preventing accidents and injuries to staff and
inmates. Which of the following is not true regarding safety issues?
a. The healthcare service area must be locked when unoccupied.
b. Healthcare personnel are required to dress professionally. Revealing and
tight clothing should be worn ONLY in maximum-security setting.
c. Healthcare personnel must maintain control of all keys and equipment. All
keys must be returned before leaving the facility.
d. Never tell an inmate, his relatives, or others of an impending outside
medical appointment or trip.
19. Which of the following is true of a person who has TB infection without active
desease?
a. Is not considered a case of active TB
b. Usually has a negative CXR
c. May develop the disease at any point in the future
d. All of the above
20. The following are examples of personal protective equipment that may be used to
prevent the transmission of disease or germs: disposable gloves, gowns, masks,
goggles, caps, and/or booties.
a. True
b. False
21. In an effort to control massive lice outbreaks, all inmates upon intake into the
facility should receive prophylactic treatment for ectoparasites.
a. True
b. False
22. An employee safety manual including exposure categories and post-exposure
instructions (MSDS) is available on the unit.
a. True
b. False
23. Which of the following is not a sign of TB?
a. Weight gain
b. Lethargy
c. Night sweats
d. Fever
24. All inmates upon initial intake into the facility must receive an intake screening.
Which of the following would not be relevant to the screening?
a. Current medications
b. Previous suicidal history
c. Recent injuries
d. Reason(s) for arrest or incarceration

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25. PHS requires that all inmates be informed of the availability of healthcare and the
mechanism for accessing health services both verbally and in writing. Which of the
following is not true?
a. The nurse completing the Receiving Screening Form verbally informs all
inmates of available healthcare, during intake screening.
b. Any non-English/non-Spanish speaking inmates must rely on finding a
fellow inmate for language translation services.
c. Bilingual signs are posted in the receiving area and in the housing units
that explain how to access emergency and routine medical care.
d. The inmate requesting routine, non-emergent health care will fill out a
Sick Call Slip (Medical Request), date and sign it, and return it to
healthcare personnel for triage.
26. Correctional officers are responsible for ensuring that administered medications
are actually swallowed.
a. True
b. False
27. The special needs program serves a broad range of health conditions and problems
that require personnel to design a program tailored to the individual inmate’s
needs. Individuals are followed and scheduled for chronic care clinics per
procedure and/or as needed. All of the following illnesses should be followed
except:
a. Diabetes (DM)
b. HIV
c. Pregnant inmates
d. Hypertension (HTN)
e. Seizures (SZ)
28. Health records (medical records) should NEVER be removed from a facility or
system except in accordance with the institutional policies or as required by law.
a. True
b. False
29. All of the following are true regarding documentation in the inmate health record
EXCEPT:
a. Make all entries in pencil
b. The inmate’s name, PFN (ID), and location must appear on every page
c. The time and date of all entries must be included
d. Sign, print, and stamp every entry that author, including professional title
30. When documenting an inmate encounter in SOAP format, the nurse should include
a inmate’s complaints in the “A” section.
a. True
b. False

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31. Inmates should be assessed for suicide ideation upon intake into the facility.
a. True
b. False
32. Healthcare staff will evaluate all inmates who are segregated from the general
population as often as required by the facility but not less than three times per
week.
a. True
b. False
33. Which of the following is in exact alphabetical order?
a. Garcia, Jose; Garciapadilla, Manuel; Gardner, Michael; Gaines, Victor
b. Gonzalez, Juan H.; Gonzales, Juan L.; Lopez, Ricardo V.; Lopes, Richard
c. Miller, Joseph A; Miller, John A; McDonald, Lawrence; McDonald, Larry
d. Smit, Eduard A; Smith, Edward Allen; Smythe, Victor; Smythe, Valerie
34. Which of the following is an example of an inmate’s prisoner identification
(PFN)?
a. S06A15
b. UKA743
c. P47707
d. ATI846
e. Answers b and d
35. Which of the following is NOT an example of a medical record number?
a. 12-31-52
b. 11/24/63
c. 11-24-63
d. 09-08-03
36. Nurses, laboratory technicians, and medical assistants are trained and expected to
find a chart, a screener, or loose filing paper if they need it.
a. True
b. False
37. When you are looking for a chart, from left to right on the shelving, which of the
following Terminal Digit number sequences is in correct filing order?
a. 12-95-04; 08-95-08; 05-51-25; 11-24-25
b. 07-54-92; 08-54-92; 09-53-94; 08-53-94
c. 10-25-56; 11-25-56; 08-25-57; 09-25-56
d. 09-36-54; 08-37-54; 09-37-55; 10-36-57

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38. Which of the following are signs and symptoms of suicidal ideation?
a. Despair and hopelessness
b. Past history of suicidal attempt(s)
c. Verbalization of a suicide plan
d. Depression, withdrawal, lethargy, indifference to surroundings
e. Sudden improvement in mood following a period of depression
f. Loss of interest in personal hygiene and daily activities
g. All of the above
39. At facilities operated by the Alameda County Sheriff’s Office, mental health
services are provided by Criminal Justice Mental Health, an Alameda County
agency.
a. True
b. False
40. Alcohol withdrawal is the abstinence syndrome with the highest mortality rate.
a. True
b. False
41. Prenatal inmates are not provided healthcare by a qualified healthcare practitioner.
a. True
b. False
42. Confidentiality includes:
a. Conversing about inmate’s health in private areas and not in the presence
of other inmates
b. Conversing with only those who have a need to know
c. Not revealing who is in the jail or the dates and times of their
appointments for medical care
d. Sharing with Sheriff’s Office staff only that information for which there is
need to know.
e. All of the above
43. Unless otherwise required by law, a signed authorization for release of health
information is required before any inmate health information can be shared or
released.
a. True
b. False
44. In regard to an inmate’s health record, is this statement true? “If it was not
documented, it didn’t happen”
a. True
b. False

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New Employee Orientation
Post – Test Answer Key
1. True

23. A

2. True

24. D

3. Operational, Managerial, Financial

25. B

4. False

26. False

5. C

27. C

6. D

28. True

7. True

29. A

8. E

30. False

9. C

31. True

10. C

32. True

11. True

33. D

12. A

34. E

13. True

35. B

14. True

36. True

15. True

37. D

16. C

38. G

17. True

39. True

18. B

40. True

19. D

41. False

20. True

42. E

21. False

43. True

22. True

44. True

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FREQUENTLY USED FORMS
(SCENARIO I)

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