The purpose of this order is to establish procedures for completing the Affordable Care Act (ACA) forms for inmates hospitalized over 24 hours.
This order shall apply to all personnel assigned to Pitchess Detention Center (PDC), North Facility.
When an inmate is hospitalized at a private hospital [REDACTED TEXT] for over 24 hours, deputies assigned to hospital security shall ensure the hospitalized inmate completes and signs an ACA Screening Form and a California Department of Health Care Services MC-306 Appointment of Representative form. If the inmate is over 65 years old, the inmate shall also complete a California Department of Health Care Services MC-210 Property Supplement form.
In the event the inmate refuses to sign the form, deputies assigned to hospital security shall complete the form with all known information, and write “inmate refused” on the top portion of the form.
The watch sergeant shall ensure the completed original forms are sent via county mail to the appropriate Access to Care personnel at Inmate Reception Center.
Desk personnel shall attach a copy of the forms, along with the date they were mailed, to the inmate hospital packet located in the watch sergeant’s office.