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Custody Division Manual / Volume 6 - Station Jail Manual

6-03/030.00 Los Angeles County Unified Arrestee Medical Screening Form (SH-R-422)


6-03/020.00 Probable Cause Declaration (PCD)
6-03/040.00 Intoxication Observation Sheet (SH-R-445)

The Los Angeles County Unified Arrestee Medical Screening (SH-R-422) form shall be initiated by the arresting deputy/officer or booking officer. This form shall be completed for every person who is arrested by Sheriff's Department personnel or booked into a Sheriff's Department station/facility by an outside law enforcement agency. The form shall be filled out in its entirety. Each box shall be checked off, do not check the first box and draw a line through the rest of the form.

The SH-R-422 form is divided into three sections:

  • Arrestee Questionnaire
  • Arresting Deputy/Officer Observation
    • allows for medical screening of the arrestee by the booking deputy/officer
  • Jailer Observations
    • allows for medical screening of the arrestee by the jailer.

ARRESTING (BOOKING) DEPUTY/OFFICER

The arresting deputy/officer shall complete the Arrestee Questionnaire and the Arresting Deputy's/Officer's Observation section of the form. The arresting deputy/officer shall include their name, employee/ID number, date, and time the form was filled out at the end of each section. If the arrestee refuses to answer the questions in the "Arrestee Questionnaire" section, the arresting deputy/officer or booking officer shall mark the "Refuse" box for each question not answered.

In addition, if the arrestee refuses to sign the form, the arresting deputy/officer or booking officer shall write "Refused" in the indicated area and include their name, employee number, date, and time.

Personnel shall complete a Behavioral Observation and Mental Health Referral (SH-J-407) for all inmates for whom there is an answer in the affirmative to any of the following questions:

  • Arrestee Questionnaire - question: Do you feel suicidal or feel like hurting yourself?
  • Arresting Deputy/Officer Observations - question: Did the arrestee threaten suicide or attempt "suicide by cop" during their arrest?
  • Jailer Observations - question: Does the arrestee's behavior or statements suggest a risk of suicide? Examples: severe depression, crying, withdrawal, silence, history of previous suicide attempt such as self-inflicted injuries. Does the arrestee display any of the following behaviors? Examples: responding to something that is not there, withdrawn, bizarre beliefs, rambling nonsensically, overly suspicious, combative without apparent provocation.

Sheriff's station personnel shall ensure that any inmate who displays obvious suicidal ideation or exhibits unusual behavior that clearly manifest self-injurious behavior or other clear indication of mental health crisis shall be transported to the Inmate Reception Center (IRC), Century Regional Detention Facility (CRDF), or a medical facility as soon as practicable. Pending transport, such inmates shall be under unobstructed visual observation or a suicide resistant location with safety checks every 15 minutes.

JAILER

The jailer shall complete the Jailer Observation section and must sign the form in the indicated space.

WATCH SERGEANT

Watch sergeants shall review and sign all SH-R-422 forms.

RETENTION OF THE FORM

The original form must accompany the arrestee whenever he/she is transferred; therefore, if the arrestee is:

  • Transferred, the original form shall accompany the inmate. Copies of the original shall be made for the booking packet and station URN file
  • Released from the station, the original form shall be included in the station URN file.

When an inmate is transferred to another Sheriff’s Department facility, the transporting deputy shall separate the original form from any other accompanying paperwork. The original form shall be presented separately to the person receiving the inmate. Personnel receiving the transferred inmate shall ensure there is an original form for each inmate received.