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UNCLASSIFIEDIILAW ENFORCEMENT SENSITIVE (When Completed) <br />Medical Staff Information (Annotate number of authorized and filled positions per facility's staffing plan) <br />Authorized Filled <br />Physician F <br />Physician's Assistant <br />Nurse Practitioner F <br />Registered Nurse <br />Licensed Practical Nurse <br />Mental Health Professional E7 <br />Other Medical Staff <br />Contraband <br />List facility's total number of contraband incidents since last USMS DFR (if applicable). <br />Drugs or Alcohol Drugs or Alcohol Paraphernalia Electronic Devices <br />I - -7 [ .1 <br />Electronic Device Accessory Weapon Tool _ <br />Incidents <br />List facility's total number of incidents since last USMS DFR (if applicable). <br />Suicides Suicide Attempts Escapes <br />Escape Attempts Physical Assaults on Prisoners Physical Assaults on Staff <br />Health Care Grievances Natural Deaths Sexual Assaults on Prisoners <br />Sexual Assaults on Staff Homicides Riots/Disturbances <br />F F <br />Overdose Deaths Overdoses Use of Force Excessive Use of Force <br />F7-- 17 -_ <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 recipient{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 coples 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 />UNCLASSIFIEDIILAW ENFORCEMENT SENSITIVE (When Completed) <br />Form USM -218 <br />Page 3 of 22 Rev 07121 <br />