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UNCLASSTFTED/LAW ENFORCEMENT SENSITIVE (When Gompleted) <br />lf 'No', when were results Provided? <br />months days <br />Do all prisoners undergo mental health screening during the initial intake process? <br />CYes CNo <br />lf 'No', how long after intake does the mental health screening occur? <br />months days <br />Do all prisoners undergo dental health screening during the initial intake process? <br />CYes CNo <br />lf 'No', how long after intake does the dental health screening occur? <br />months days <br />Are all medical screening results reviewed by a physician? <br />CYes CNo <br />How tong after intake does this occur? <br />months days <br />Are medical screening records maintained for every prisoner? <br />CYes CNo <br />Medlcal, Dental, and Mental Health <br />Does the facili$ have a medical unil stalfed 24ft? <br />CYes CNo <br />Does the facility employ an on-site mental health professional? <br />CYes CNo <br />Are prisoners with mental health issues identified as part of the vulnerable population? <br />CYes CNo <br />Are prisoners with mental health issues referred to qualified mental health professionals? <br />CYes CNo <br />Routine, Chronic, and Emergency Health Services <br />Are all prisoners made aware of the process for requesting health care services? <br />CYes CNo <br />Does the facility have a policy or procedures for identifuing medical emergencies? <br />CYes CNo <br />Does the facility provide access to prescription medication? <br />CYes CNo <br />NOTTCE: This document is intended FOR OFFICIAL USE ONLY and may contain LAW ENFORCEMENT SENSITIVE OR CONFIDENTIAL informalion <br />which is for the sole use of the intended recipient(s). Any unauthorized revierv, use. disclosure, or distribulion is prohibited. It you are not the intended <br />i",ipi"nf. pt"6" conlact the sender ancl destroy iti copies of this document. Any Protected Health lnformation contained in this document is to be used <br />onifto iiO in providing healthcare seryices to federal prisoners. Any olher use is a violation of Federal HIPM Law and/or lhe Privacy Act and will be <br />reported as such. <br />UNCLASSIFIEDT/LAW ENFORCEMENT SENSITIVE (When Gompleted) <br />Form usM_218 <br />Page I of 22 Rev. 07121