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UNCLASSIFIEDIILAW ENFORCEMENT SENSITIVE (When Completed) <br />Does the facility participate in the NMCC? <br />C` Yes (' No <br />Does the facility have an onsite pharmacy? <br />(' Yes (1 No <br />Does the facility document prisoner health care grievances? <br />(' Yes i No <br />Response to Medical, Mental and Dental Health Needs <br />Are all prisoners who require health care beyond the capacity of the facility transferred to a facility where such care is <br />available? <br />(~ Yes (' No <br />Are facility staff CPR/First Aid certified? <br />(' Yes C' No <br />With the exception of emergencies, does the facility use POD Medical Management to request approval for outside <br />medical services? <br />(' Yes (- No <br />Does the facility immediately notify the district in the event of a USMS prisoner medical emergency? <br />(' Yes (' No <br />Suicide Prevention <br />Does the facility have a suicide prevention program? <br />C es (- No <br />Does the facility document staff training for prisoner suicide prevention? <br />C` Yes i No <br />Does the facility have procedures for identifying prisoners at risk for suicide? <br />(' Yes C' No <br />Does the facility have procedures for monitoring prisoners at risk for suicide? <br />(' Yes C` No <br />How often are welfare inspections conducted on suicidal prisoners? <br />elect... <br />Does the facility report suicidal gestures, remarks, tendencies and attempts to the USMS? <br />(~ Yes C No <br />Does the facility provide mental health services to suicidal prisoners? <br />(' Yes C' No <br />Does the facility report restrictive housing of suicidal prisoners to the USMS? <br />( Yes (' No <br />NOTICE This document Is intended FOR OFFICIAL USE ONLY and may contain LAW ENFORCEMENT SENSITIVE OR CONFIDENTIAL information <br />which is for the sole use of the intended recipieni(s). Any unauthorized review, use, disclosure. or distribution is prohibited. If you are not the intended <br />recipient, please contact the sender and destroy all copies of this document. Any Protected Health Information contained in this document is to be used <br />only to aid in providing healthcare services to federal prisoners. Any other use is a violation of Federal HIPAA Law and/or the Privacy Act and will be <br />reported as such. <br />UNCLASSIFIED//LAW ENFORCEMENT SENSITIVE (When Completed) <br />Page 10 of 22 <br />Form USM -218 <br />Rev. 07/21 <br />