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Arizona Department of Corrections, Rehabilitation & ReentryMedical Services DivisionMedical Services Technical ManualUpdated: June 3, 2021Grant Phillips MD, Medical DirectorDateLarry Gann, Assistant DirectorDate1
MEDICAL SERVICESCONTRACT MONITORINGBUREAU TECHNICALMANUALARIZONA DEPARTMENT OFCORRECTIONSREHABILITATION &REENTRYOPR:MSCMB Assistant DirectorSUPERSEDES: 08/15/2018EFFECTIVE DATE: 07/01/2019REPLACEMENT PAGE REVISIONDATE: N/AINTRODUCTIONPURPOSE: This Medical Services Contract Monitoring Bureau (MSCMB) Technical Manual was created toprovide technical and professional guidance for the delivery of quality health care within the ArizonaDepartment of Corrections Rehabilitation & Reentry facilities or their supporting non-ADCRR organizations.RESPONSIBILITY: It is the responsibility of the ADCRR Health Services Contract Vendor, with oversightmonitoring by MSCMB, to ensure that adequate Dental, Medical, Mental Health, Nursing, Pharmaceutical,Medical Records, Laboratory, and X-ray services are available to the inmate population incarcerated within theArizona Department of Corrections Rehabilitation & Reentry.2
Table of ContentsOPR:Arizona Department of CorrectionsRehabilitation & ReentryMedical Services Technical ManualSUPERSEDES: 08/15/2018EFFECTIVE DATE: 07/01/2019Chapter 1, Sec. 1.0Guiding Doctrines and Philosophies . 9Chapter 1, Sec. 2.0Authority and Accountability . 11Chapter 1, Sec. 3.0Communications, Meetings and Reports . 15Chapter 1, Sec. 4.0Policy Administration (Policy and Procedures) . 18Chapter 1, Sec. 5.0Quality Improvement of Health Services . 20Chapter 1, Sec. 5.1Peer Review of Professional Activities . 27Chapter 1 Sec. 6.0Incident Command System (ICS) . 29Chapter 1, Sec. 6.1Urgent Notification List . 33Chapter 1, Sec. 6.2Emergency Medical Supplies . 34Chapter 1, Sec. 7.0Confidentiality . 36Chapter 1, Sec. 8.0.Medical Grievance System . 38Chapter 2, Sec. 1.0.Resource Administration . 40Chapter 2, Sec. 2.0Pharmacy Inventory Control . 42Chapter 2, Sec. 3.0.Chapter 2, Sec. 4.0Medical Sharp and Tool Control . 45Budget and Inventory Control . 52Chapter 2, Sec. 5.0Infection Control . 53Chapter 2, Sec. 6.0Environmental Health. 54Chapter 2, Sec. 7.0Chapter 2, Sec. 8.0Kitchen Sanitation . 55Ectoparasite Control and Treatment Procedures . 56Chapter 3, Sec. 1.0Responsible Authorities & Staff Administration. 58Chapter 3, Sec. 2.0Chapter 3, Sec. 3.0Staffing Patterns . 60Credentialing Responsibilities . 61Chapter 3, Sec. 4.0Orientation and Education for Health Services Staff . 63Chapter 3, Sec. 4.1Medication Administration Training . 65Chapter 3, Sec. 5.0Chapter 3, Sec. 6.0Clinic Space, Equipment, and Supplies . 66Student and Extern Clinical Rotation Programs . 68Chapter 3, Sec. 7.0Inmate Workers . 71Chapter 3, Sec. 8.0Training for Correctional Officers. 73Chapter 4, Sec. 1.0Chapter 4, Sec. 1.1Pharmacy Administration . 74Pharmaceutical Dispensing Procedures . 77Chapter 4, Sec. 1.2Pharmacy Medications Issued to Clinic Stock . 83Chapter 4, Sec. 1.3After Hours Pharmacy Support and Clinic Stock Medication Storage Area . 863
Chapter 4, Sec. 1.4Pharmacy Security . 90Chapter 4, Sec. 1.5Chapter 4, Sec. 1.6Post-Exposure Prophylaxis for Employees . 92Non-Formulary Drug Requests . 93Chapter 4, Sec. 1.7Compounding and Prepackaging . 95Chapter 4, Sec. 1.8Drug Utilization Review/Evaluation . 96Chapter 4, Sec. 1.9Chapter 4, Sec. 1.10Drug Recalls . 98Special Pharmacy Issues. 99Chapter 4, Sec. 1.11Psychotropic Medications . 100Chapter 4, Sec. 1.12Methadone Use . 102Chapter 4, Sec. 2.0Chapter 4, Sec. 3.0Laboratory Procedures. 103Radiologic Imaging Procedures . 105Chapter 5, Sec. 1.0Inmate Access To Health Care . 108Chapter 5, Sec. 1.1Transportation of Inmate-Patients . 110Chapter 5, Sec. 1.2Chapter 5, Sec. 1.2.1Special Handling Intake/Medication Issues Intake/Gender Dysphoria Issues . 113Paper Health Records – Transfer Process of Released Offenders . 118Chapter 5, Sec. 1.2.2Transfer inmates to ICE. 122Chapter 5, Sec. 1.3Continuous Progress Notes (SOAPE) . 124Chapter 5, Sec. 1.4Chapter 5, Sec. 1.5Treatment Plans . 127Nursing Assessment and Protocols . 129Chapter 5, Sec. 2.0Intake & Return to Custody. 131Chapter 5, Sec. 2.1Intake at Non-Reception Facility. 135Chapter 5, Sec. 3.0Non-Emergency Health Issues . 137Chapter 5, Sec. 3.1Routine Appointments Health Needs Request (HNR) . 140Chapter 5, Sec. 3.2Inmate Access to Appointment Locations . 143Chapter 5, Sec. 4.0Routine Appointments -Recording . 146Chapter 5, Sec. 5.0Chapter 5, Sec. 5.1Continuity of Care Upon Transfer . 148Chronic Condition Care (Monitored Conditions) . 152Chapter 5, Sec. 5.2Security of Accountability of Paper Health Records. 154Chapter 5, Sec. 5.3Chapter 5, Sec. 6.0Organization of the Health Record . 156Medication Delivery (Keep On Person) . 165Chapter 5, Sec. 6.1Transfer Medications . 168Chapter 5, Sec. 6.2Outside, Intake and Transfer Medication orders . 170Chapter 5, Sec. 6.3Chapter 5, Sec. 6.4Adverse Drug Reactions . 172Medication Administration . 173Chapter 5, Sec. 6.5Narcotics Accountability . 176Chapter 5, Sec. 6.6Medication Error Reporting . 178Chapter 5, Sec. 7.0Chapter 5, Sec. 7.1Clinical Follow Up Requirements . 180Missed Appointments . 182Chapter 5, Sec. 7.2Appointment or Treatment Refusals . 183Chapter 5, Sec. 8.0Health Services Fees. 185Chapter 5, Sec. 9.0Oral Health Care Services . 1884
Chapter 6, Sec. 1.0Health Education and Promotion. 189Chapter 6, Sec. 2.0Chapter 6, Sec. 3.0Tobacco Use . 190Exercise . 191Chapter 6, Sec. 4.0Personal Hygiene . 192Chapter 6, Sec. 4.1Self-Catheterization and Colostomy Care . 194Chapter 7, Sec. 1.0Chapter 7, Sec. 1.1Facility Capabilities Supporting Special Needs and Services . 195Alcohol & Substance Abuse . 197Chapter 7, Sec. 1.2Sun Exposure Protection . 199Chapter 7, Sec. 1.3Therapeutic Diets. 200Chapter 7, Sec. 1.4Chapter 7, Sec. 1.5The Pregnant Inmate. 202Tuberculosis Screening & Management. 204Chapter 7, Sec. 1.6Suicide or Mental Health Watch . 208Chapter 7, Sec. 1.6.1Hunger Strike Clinical Support . 210Chapter 7, Sec. 1.7Chapter 7, Sec. 1.8ADA Eligible Inmate Management . 213Clinical Staffing of Special Problems . 216Chapter 7, Sec. 1.9Special Needs Considerations and Orders (SNO) . 218Chapter 7, Sec. 2.0Outside (Specialty) Care and Clinics . 221Chapter 7, Sec. 3.0Chapter 7, Sec. 4.0Outside Hospitalization . 224Infirmary (IPC) . 227Chapter 7, Sec. 5.0Emergency Medical Transportation Services . 231Chapter 7, Sec. 6.0Segregation (lockdown status) . 233Chapter 7, Sec. 7.0Management of Terminal Illness . 236Chapter 7, Sec. 7.1Inmate Mortality . 239Chapter 7, Sec. 7.2Paper Health Records Transfer Process – Deceased Inmates . 241Chapter 7, Sec. 7.3Hospice Services Support Organization . 242Chapter 7, Sec. 8Chapter 7, Sec. 9.0Medical ACIS Entries. 245Medical Classification Scores . 247Chapter 7, Sec. 10.0Sexual Assault . 248Chapter 7, Sec. 11.0Chapter 8, Sec. 1.0Orthotic and Prosthetic Aids . 249Establishment of Health Record . 252Chapter 8, Sec. 2.0Consent to Treat/ Informed Consent . 254Chapter 8, Sec. 2.1Release of Medical Information . 255Chapter 8, Sec. 2.2Chapter 8, Sec. 2.3HIPPA Ruling. 261Request for Medical Records from outside Healthcare Practitioner/Provider . 262Chapter 8, Sec. 3.0Retention of Paper Health Records . 263Chapter 8, Sec. 4.0Inmate Access to Health Record Information . 265Chapter 8, Sec. 4.1Chapter 9, Sec. 1.0Release of Information . 268Discharge Planning. 271Chapter 9, Sec. 2.0Medical Research . 273Chapter 9, Sec. 3.0Access to Custody Information . 275Chapter 9, Sec. 4.0Restraints and Medical Seclusion . 2765
Chapter 9, Sec. 5.0Forensic Examinations and Information. 278Chapter 9, Sec. 6.0Appendix AExecutions . 280Statistics and Reporting Requirements . 281Appendix BDental Technical Manual . 282Appendix C, Sec. 1.0Chronic Illnesses (Monitored Illnesses) . 283Appendix C, Sec. 2.0Appendix D, Sec. 1.0Clinical Practice Guidelines for the Prevention and Treatment for Viral Hepatitis C 284Communicable Disease Definitions . 293Appendix D, Sec. 2.0Tuberculosis Screening/ Contract Investigation . 296Appendix E, Sec. 1.0Emergency Response Orders . 300Appendix E, Sec. 2.0Appendix E, Sec. 3.0Nursing Encounter Tools (NETs) Symptom and Intervention Guide . 307Nursing Assessment Protocols (Private Prisons). 311PROTOCOL 1 --- OTC MEDICATIONS FOR SYMPTOMATIC COMPLAINTS . 312PROTOCOL 2 --- ALLERGIC REACTIONS . 313PROTOCOL 3 --- CONDITIONS RELATED TO HEAT . 313PROTOCOL 4 --- OPEN WOUNDS (e.g., Abrasions, Lacerations, Punctures, Avulsions, Amputations) 314PROTOCOL 5 --- HYPERTENSION. 315PROTOCOL 6 --- PEPPER SPRAY, MACE, TEAR GAS EXPOSURE . 316PROTOCOL 7 --- BURNS . 316PROTOCOL 8 --- SEIZURES . 317PROTOCOL 9 --- INHALATION INJURIES . 318PROTOCOL 10 --- SNAKE BITES . 318PROTOCOL 11 --- SPIDER, SCORPION, & INSECT BITES/STINGS . 318PROTOCOL 12 --- TOOTHACHE / DENTAL ABSCESS . 320PROTOCOL 13 --- SORE THROAT . 320PROTOCOL 14 --- ACUTE ANXIETY . 321PROTOCOL 15 --- COMMON COLD . 321PROTOCOL 16 --- CONSTIPATION . 321PROTOCOL 17 --- DIARRHEA, ACUTE ONSET . 321PROTOCOL 18 --- EARACHE . 322PROTOCOL 19 --- EYE EXAMINATIONS / EYE WEAR . 322PROTOCOL 20 --- HEADACHE . 323PROTOCOL 21 --- HEARING LOSS . 323PROTOCOL 22 --- IMPACTED CERUMEN . 324PROTOCOL 23 --- HIV TEST REQUEST (Patient HNR) . 324PROTOCOL 24 --- MINOR SPRAINS AND CONTUSIONS . 324PROTOCOL 25 --- NAUSEA AND VOMITING . 325PROTOCOL 26 --- MEDICATION ORDERS ON TRANSFER OF PATIENT . 325PROTOCOL 27 --- CONTACT W/ PRACTITIONERS ON URGENT NOTIFICATION LIST . 326PROTOCOL 28 --- MEDICAL ICE . 3266
PROTOCOL 32 --- INDICATIONS FOR C-SPINE AND SPINE BOARD PRECAUTIONS . 326PROTOCOL 34 --- ATHLETE’S FOOT (TINEA PEDIS) or JOCK ITCH (TINEA CRURIS) . 328PROTOCOL 35 --- LICE (PEDICULOSIS) AND SCABIES . 328PROTOCOL 36 --- VACCINATIONS . 329PROTOCOL 36A --- TETANUS AND DIPHTHERIA (Td) VACCINE . 330PROTOCOL 37 --- TUBERCULOSIS . 330PROTOCOL 38 --- WAIVERS AND SPECIAL NEED ORDERS . 332PROTOCOL 39 --- KITCHEN CLEARANCE . 332PROTOCOL 40 --- DISRUPTION OF HEALTH CARE SERVICES. 333PROTOCOL 41 --- MONITORED CONDITIONS . 333PROTOCOL 42 --- EYE INJURIES / RED EYE . 334Appendix E, Sec. 4.0Treatment Guidelines . 335Appendix E, Sec. 4.1Appendix E, Sec. 4.2Cardiovascular Risk Factors . 338Contemporary Management of Angina . 339Appendix E, Sec. 4.3Guidelines for the Evaluation and Management of Chronic Stable Angina. 343Appendix E, Sec. 4.4Guidelines for the Evaluation and Management of Unstable Angina . 344Appendix E, Sec. 5.0Appendix E, Sec. 6.0Guidelines for the evaluation and treatment of chronic Asthma . 345Guidelines: Evaluation and Treatment of Chronic Obstructive Pulmonary Disease(COPD . 348Appendix E, Sec. 6.1Appendix E, Sec. 7.0Differentiating between COPD and Asthma . 349MSCMB Diabetes Management Policy . 351Appendix E, Sec. 7.1Guidelines for the Evalualtion and Mnaagement of Type 1 Diabetes . 355Appendix E, Sec. 7.2Pharmacological Therapy Guidelines for Hyperglycemia in Type 2 Diabetes . 356Appendix E, Sec. 7.3Appendix E, Sec. 7.4Diabetes Tables Lifestyle Modifications . 357Diagnosis of Gestational Diabetes Mellitus (GDM) . 358Appendix E, Sec. 8.0Guidelines for the Evaluation and Treatment for Naïve HIV . 359Appendix E, Sec. 8.1Treatment Guidelines for the Initiation of ART in the Chronically Infected HIV patient361Appendix E, Sec. 9.0Classification Management of Hypertension . 364Appendix E, Sec. 9.1Hypertension Guidelines . 372Appendix E, Sec. 9.2Hypertension Flow Charts . 374Appendix E, Sec. 10.0Anti-Epilepsy Drugs (AEDs) . 376Appendix E, Sec. 10.1Guidelines for the Evaluation and Management of Seizure Disorders. 378Appendix E, Sec. 11.0Appendix E, Sec. 11.1Clinical Opiate Withdrawal Scale (COWS) . 380Clinical Institute Withdrawal Assessment-Alcohol revised (CIWA- r) . 382Appendix E, Sec. 11.2Benzodiazepine Withdrawal Scale for Corrections (BWS-C). 384Appendix E, Sec. 12.0Guidelines for the Evaluation and Treatment of Cataracts . 385Appendix E, Sec. 13.0Substance Abuse. 386Appendix E, Sec. 14.0Substance Withdrawal . 388Appendix E, Sec. 15.0Treatment Guidelines for Myasthenia Gravis . 391Appendix E, Sec. 16.0Management of Patients with Multiple Sclerosis . 3937
Appendix E, Sec. 17.0Treatment Guidelines for Parkinson’s Disease . 395Appendix E, Sec. 18.0Appendix E, Sec. 19.0Evaluation and Management of Coccidioidomycosis (Valley Fever) . 396Management of End Stage Liver Disease. 398Appendix E, Sec. 20.0Evaluation and Management of Hyperlipidemia . 401Appendix E, Sec. 21.0Guidelines for Management of Chronic Kidney Disease (CKD) . 403Appendix E, Sec. 22.0Appendix E, Sec. 23.0Management of Coagulation Disorders . 405Guidelines for the Management of Warfarin Therapy . 407Appendix E, Sec. 24.0Management Guidelines for Hereditary Hemochromatosis . 410Appendix E, Sec. 25.0Treatment Guidelines for Rheumatoid Arthritis . 413Appendix E, Sec. 26.0Appendix E, Sec. 27.0Treatment Guidelines for Inflammatory bowel Disease . 416Management Guidelines for Systemic Lupus Erythematosus . 419Appendix E, Sec. 28.0Management Guidelines for Hyperthyroid Disorders . 422Appendix E, Sec. 29.0Treatment Guidelines for Sickle Cell Disease . 426Appendix E, Sec. 30.0Appendix E, Sec. 31.0Management Guidelines for Cystic Fibrosis . 434Treatment Guidelines Amendment Procedure . 436Appendix F, Sec. 1.0Forms and Stamps . 438Appendix G, Sec. 1.0Mental Health Services. 439Appendix H, Sec. 10Appendix I, Sec. 1.0Authorized Abbreviations . 440Approved Glossary . 4618
Guiding Doctrines andPhilosophiesArizona Department of CorrectionsRehabilitation & ReentryMedical Services Technical ManualChapter 1, Sec. 1.0REFERENCES:MSTMChapter 1Section 1.0.OPR:Medical Services ContractMonitoring Bureau AssistantDirectorMSMS Contract Monitoring BureauProgram Evaluation AdministratorAuth: rrSUPERSEDES: 08/15/2018EFFECTIVE DATE: 07/01/2019Guiding Doctrines and PhilosophiesNCCHC STANDARD P-A-01NCCHC STANDARD P-A-03PURPOSE: To provide grounding guidance for Medical Services Contract Monitoring Bureau and HealthServices Contract Vendor staff to ensure access to, and provision of, high quality and well organizedHealth Services to inmates that are incarcerated in facilities that are under the medical auspices of theArizona Department of Corrections Rehabilitation & Reentry.RESPONSIBILITY: It is the responsibility of the ADCRR Health Services Contract Vendor RegionalVP/Administrator, and Vendor Facility Health Administrators (with oversight monitoring by ADCRRMedical Services Contract Monitoring Bureau) to ensure that the communications regarding activitiesaffecting the delivery of
PURPOSE: This Medical Services Contract Monitoring Bureau (MSCMB) Technical Manual was created to provide technical and professional guidance for the delivery of quality health care within the Arizona Department of Corrections Rehabilitation & Reentry facilities or their supporting non-ADCRR organizations.
