Laserfiche WebLink
UNCLASSIFIEDULAW ENFORCEMENT SENSITIVE (When Completed) <br />Infectious Disease <br />Does the facility have written plan to address the management and reporting of infectious and communicable diseases? <br />C" Yes C' No <br />Does the plan include: <br />HIV? <br />Yes <br />C' No <br />Tuberculosis? <br />C" Yes <br />C' No <br />Hepatitis? <br />("' Yes <br />(" No <br />Influenza? <br />C` Yes <br />(" No <br />Chlamydia? <br />C` Yes <br />C' No <br />COVID? <br />C' Yes <br />C, No <br />Ebola? <br />C` Yes <br />C' No <br />HPV? <br />t"` Yes <br />C" No <br />Salmonella? <br />C` Yes <br />C` No <br />Scabies? <br />C Yes <br />C No <br />Zika? <br />C Yes <br />C No <br />E. coli? <br />C" Yes <br />C' No <br />Chicken Pox? <br />C Yes <br />C' No <br />Does the facility report all cases of infectious and communicable diseases to the CDC? <br />r Yes r No <br />Does the facility report all cases of infectious and communicable diseases to the LISMS? <br />r Yes C' No <br />Does the facility have an infectious and communicable disease policy or procedures to: <br />Identify prisoners with infectious and communicable diseases? C' Yes C No <br />Treat prisoners with infectious and communicable diseases? C Yes C No <br />Quarantine prisoners with infectious and communicable diseases? C' Yes C No <br />Has the facility tested communication with local and federal health authorities? <br />C" Yes C' No <br />Does the facility maintain adequate PPE for all staff in the event of a pandemic? <br />C' Yes C` No <br />Does the facility maintain adequate PPE for all prisoners in the event of a pandemic? <br />C' Yes C' No <br />NOTICE: This document is intended FOR OFFICIAL USE ONLY and may contain LAW ENFORCEMENT SENSITIVE OR CONFIDENTIAL information <br />which 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 win be <br />reported as such. <br />UNCLASSIFIEDIILAW ENFORCEMENT SENSITIVE (When Completed) <br />Page 15 of 27 <br />Form USM-218 <br />Rev. 02125 <br />