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Manual of Policies and Procedures / Cerritos Station's Unit Orders / Cerritos Station Unit Orders / Unit Order 2016

16-003 Protected Health Information (PHI) Form


16-002 Inmate Safety Checks Quarterly Audit
16-004 Desk Operations

                                                                                                                                                                                                                                                                                                                                                       

Los Angeles County Sheriff’s Department

STATION ORDER

Cerritos Station

 

STATION ORDER NUMBER:  16-003                                                       

Subject: Protected Health Information (PHI) Form

Effective Date:

05/10/16

Last Date Revised:

 

Last Date Reviewed:

03/10/2020

Next Review Date:

03/10/2021

 

PURPOSE: 

The purpose of this order is to ensure that Department personnel are utilizing the Los Angeles Sheriff’s Department Medical Services "Authorization to Use and Disclose Protected Health Information” (PHI) form.  This form shall be completed when obtaining a medical booking clearance (“okay to book”) for prisoners in custody who will be transported to Inmate Reception Center (IRC) or Los Angeles County Medical Center (LCMC) regarding an ongoing medical condition requiring continuity of care.  Such medical conditions may include but are not limited to hypertension, diabetes, fractures, wound care, cancer, epilepsy, etc.      

SCOPE OF ORDER:

This directive applies to deputy personnel and station jailers.

ORDER:

When a prisoner is transported to a medical facility for a medical booking clearance regarding an ongoing medical condition that will require transport to IRC or LCMC for continuity of care, deputy personnel shall complete a PHI form.  The prisoner’s name, booking number, and date of birth shall be written in the designated spaces in the upper left hand corner of the PHI form.  The name, address, and phone number of the medical facility shall be indicated in the designated spaces on the PHI form.  The prisoner shall sign and print his/her name, along with the date, in the designated spaces at the bottom of the PHI form.  If medical personnel are hesitant to provide the prisoner’s medical information with the prisoner’s consent, deputy personnel shall offer to have it sealed in a manila envelope for LASD Medical Services Staff to open.  The envelope shall have the LASD “Confidential Medical Records” cover sheet affixed to it. 

Medical personnel are not required to provide the requested information.  If it is explained that the information is sought to provide continuity of care when the inmate is transported to a jail medical facility, medical personnel may be more inclined to provide the information.

Station jail personnel shall ensure that each prisoner requiring and receiving a medical booking clearance under the above conditions has a completed PHI form submitted with the booking packet.