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U NCLASSI FIEDI/LAW ENFORCEMENT SENSITIVE (When Completed) <br />Does the facility participate in the NMCC? <br />CYes CNo <br />Does the facility have an onsite pharmacy? <br />CYes CNo <br />Does the facility document prisoner health care grievances? <br />CYes CNo <br />Response to Medical, Mental and Dental Heatth Needs <br />Are all prisoners <br />available? <br />CYes CNo <br />who require health care beyond the capacity of the facility transfe rred to a facility where such care is <br />Are facility staff CPR/First Aid certified? <br />CYes CNo <br />With the exception of emergencies, does the facility use POD Medical Management to request approval for outside <br />medical services? <br />CYes CNo <br />Does the facility immediately notify the district in the event of a USMS prisoner medical emergency? <br />CYes CNo <br />Suicide Prevention <br />Does the facility have a suicide prevention program? <br />CYes fNo <br />Does the facility document staff training for prisoner suicide prevention? <br />CYes CNo <br />Does the facility have procedures for identifying prisoners at risk for suicide? <br />CYes CNo <br />Does the facility have procedures for monitoring prisoners at risk for suicide? <br />CYes CNo <br />How often are welfare inspections conducted on suicidal prisoners? <br />Select. <br />Does the facility report suicidal gestures, remarks, tendencies and attempts to the USMS? <br />fYes CNo <br />Does the facility provide mental health services to suicidal prisoners? <br />(t Yes C No <br />Does the facility report restrictive housing of suicidal prisoners to the USMS? <br />CYes CNo <br />NOTICE: This document is lntended FoR oFFlclAL usE ONLY and may contain LAW ENFORCEMENT SENS|TIVE oR CONFIDENTTAL information <br />which is for the sole use of the intended recipient(s). Any unauthorized review, use, dlsclosure, ordlslribution is prohibited. lf you are not the intended <br />recipient, please contact the sender and destroy all copies of this document. Any Protected Health lnformation contained in this document is to be used <br />only t0 aid in providing healthcare services to federal prisoners, Any other use is a violation of Federal HIPM Law and/or the privacy Act and will be <br />reporled as such. <br />UNCLASSI FIED//LAW ENFORC EM ENT SENS|TIVE (When Compteted) <br />Form USM-218 <br />Page 1A of 22 Rev. 0Zl21