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UNCLASSIFIED//LAW ENFORCEMENT SENStTIVE (When Completed) <br />Medical Staff lnformation (Annotate number of authorized and filled positions per facility's staffing plan) <br />Authorized Filled <br />Physician <br />Physician's Assistant <br />Nurse Practitioner <br />Registered Nurse <br />Licensed Practical Nurse <br />Mental Health Professional <br />Other Medical Staff <br />Contraband <br />List facility's total number of contraband incidents since last USMS DFR (if applicable) <br />D or Alcohol or Alcohol hernalia <br />Wea <br />Electronic Devices <br />ToolElectronic Device <br />lncidents <br />List facility's total number of incidents since last USMS DFR (if applicabte) <br />Suicides Suicide Esca <br />Ph Assaults on Prisoners icalAssaults on Staff <br />Health Care Grievances Natural Deaths Sexual Assaults on Prisoners <br />SexualAssaults on Staff Homicides Riots/Disturbances <br />Overdose Deaths Overdoses Use of Force Excessive Use of Force <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. lf you are not the intended <br />recipient, please conlact the sender and destroy all copies of lhis document. Any Prolected Health lnformation coniained 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 HIPM Law and/or the privacy Act and will be <br />reported as such. <br />UNCLASSIFIED//LAW ENFORCEMENT SENSITIVE (When Completed) <br />Form USM-218 <br />Page 3 of 22 Rev. 07/21 <br />A