2-05/030.00 Medical Screening Form

The yellow “Los Angeles County Unified Medical Screening Form” SH-R-422 (REV. 3- 29-11) shall be completed for any person who is in the custody of the Sheriff.

A yellow “Medical Screening Form” shall be transported to the Inmate Reception Center (IRC) / Century Regional Detention Facility (CRDF) with each new inmate booking. Court Services Transportation Bureau (CST) will not transport any new bookings without this form in their possession. Ensure that all boxes on the form are checked individually. Marking one box and drawing a line through the rest is unacceptable. If the form has a “YES” answer to any question there must be a Watch Sergeant’s signature, employee number, date and time at the bottom of the second page. Additionally, all “YES” answers on the “Medical Screening Form” shall be examined to ensure full compliance with the form’s instructions for “YES” answers.

New Bookings from Outside Agencies

In all cases, a yellow “Medical Screening Form” shall be received for each new booking accepted. CST Deputies transporting new bookings and Court Services lockup Deputies receiving the new bookings shall follow these guidelines:

• When an outside agency uses our form as their standard medical screening form or books at IRC/CRDF or Sheriff Station jails:
  • The “Arresting Deputy’s/Officer’s Observations” section is completed.
  • The “Jailer’s Assessment” section is completed.
  • The “Outside Agency Medical Declaration” section is not required.
• When an outside agency does not use our medical screening form:
  • The “Outside Agency Medical Declaration” section shall be filled out by the agency.
  • If there is a “NO” answer on the declaration, attach their medical screening form to the booking packet.
  • If there is a “YES” answer on the declaration:
    • If the agency uses their own form, attach a copy of their form to our form.
    • If the agency does not have a medical screening form, they must complete the “Arresting Deputy’s/Officer’s Observations” section on the Sheriff’s form and the receiving Deputy must complete the “Jailer’s Assessment” section.

New Bookings from Sheriff’s Stations

In all cases, a yellow “Medical Screening Form” shall be received for each new booking accepted. The declaration section does not apply. CST or Court Services lockup Deputies who accept the new bookings shall ensure the following:

• The “Arresting Deputy’s/Officer’s Observations” section is completed.
• The “Jailer’s Assessment” section is completed.

Court Remands

When persons are remanded into our custodyat any court facility, the bailiff shall complete the “Medical Screening Form” and provide it to lockup personnel. The “Outside Agency Medical Declaration” section does not apply.

Handling and Disposition of the Form

The original “Medical Screening Form” shall be removed from all other paperwork for inmates remanded to the Sheriff’s Department. The forms shall be attached to a separate transmittal. The number of new bookings and the number of forms must be the same.

When the new bookings have reached their destination, the transmittal of original “Medical Screening Forms” shall be delivered along with the new bookings to the receiving Deputy at the location. The receiving Deputy shall sign the transmittal in the “Received by” box. The transporting Deputy shall retain a copy of the signed transmittal, and at the end of the day, turn in all Medical Screening Form transmittals to the CST Watch Sergeant.

Any change in an inmate’s medical condition from the time the form was completed until the inmate boards the bus, must be reflected in additional paperwork, along with any medical treatment forms.

Handling of Inmates That Require Medication

When inmates require HIV/AIDS medication, the handling Deputy shall follow the procedures outlined in the Court Services Division Manual, 2-05/060.10 - Handling of HIV/Aids Positive Inmates Requiring Medication. Any medication in their possession or property shall be sent with their property to IRC/CRDF at the time the inmate is transported.

Intoxication Assessment Form

Inmates identified as chronic alcoholics with Post Alcohol Syndrome are considered to have medical problems. Receiving Deputies shall ensure that a copy of any applicable “Intoxication Assessment Sheets” (Sundance Procedures) is attached to the “Medical Screening Form.”

Inmate Releases

The handling Deputy shall attach the “Medical Screening Form” to the booking packet when releasing inmates.

Branch Supervisors shall ensure that all personnel are aware of this order and trained in the procedures for completing and processing the new “Medical Screening Form.”