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UNCLASSIFIEDULAW ENFORCEMENT SENSITIVE (When Completed) <br />Medical Staff Information (Annotate number of authorized and filled positions per facility's staffing plan) <br />Authorized Filled <br />Physician <br />Physician's Assistant <br />Nurse Practitioner <br />Registered Nurse <br />Licensed Practical Nurse L <br />Mental Health Professional ---� <br />Other Medical Staff <br />Contraband <br />List facility's total number of contraband incidents since last USMS DFR (if applicable), <br />Drugs or Alcohol <br />I I <br />Electronic Device Accessory <br />Incidents <br />Drugs or Alcohol Paraphernalia <br />Weapon <br />List facility's total number of incidents since last USMS DFR (if applicable). <br />Suicides Suicide Attempts <br />Escape Attempts Physical Assaults on Prisoners <br />Health Care Grievances Natural Deaths <br />Electronic Devices <br />Tool <br />Escapes <br />Physical Assaults on Staff <br />Sexual Assaults on Prisoners <br />Sexual Assaults on Staff Homicides Riots/Disturbances <br />[Overdose Deaths Overdoses Use of Force Excessive Use of Force <br />NOTICE: This document is intended FOR OFFICIAL USE ONLY and may contain LAW ENFORCEMENT SENSITIVE OR CONFIDENTIAL information <br />Mich is for the sole use of the intended recipient(s), Any unauthorized review, use, disclosure, or distribution is prohibited. If you are not the intended <br />recipient, please contact the sender and destroy all copies of this document. Any Protected Health Information contained in this document is to be used <br />only to aid in providing healthcare services to federal prisoners. Any other use is a violation of Federal HIPAA Law and/or the Privacy Act and will be <br />reported as such. <br />UNCLASSIFIEDULAW ENFORCEMENT SENSITIVE (When Completed) <br />Page 4 of 27 <br />Form USM-2i8 <br />Rev. 02/25 <br />