SOP 208.01-att-1: Re-Assignment Review Form - Separate Housing re HIV Antibody

Division:
Facilities
Effective Date:
April 22, 2015
Reference Code:
IIA06-0001
Topic Area:
208 Policy-Facilities Care/Medical Management
PowerDMS:
View on PowerDMS
Length:
110 words

Summary

This form is used to document the review and decision-making process regarding whether an inmate with HIV should remain in separate housing or be reassigned to general population. The form captures recommendations from the Classification Committee, Warden/Superintendent, and Central Office Classification, along with documented reasons for housing decisions.

Key Topics

  • HIV housing
  • separate housing
  • inmate classification
  • housing assignment
  • re-assignment review
  • medical segregation
  • general population
  • classification committee
  • inmate housing decisions

Full Text

SOP IIA06-0001
(208.01)
ATTACHMENT 1
04/22/15

RE-ASSIGNMENT REVIEW FORM - SEPARATE HOUSING

FACILITY/CENTER: _________________________________________________ DATE OF REVIEW: ______________________

INMATE NAME: ______________________________________________ NUMBER: ________________________________

CLASSIFICATION COMMITTEE RECOMMENDATION: (Check appropriate block):

RECOMMEND GENERAL POPULATION: _________________ CONTINUE SEPARATE HOUSING: _________________

DOCUMENT SPECIFIC REASONS FOR CONTINUED SEPARATE HOUSING:
_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

Signed: _________________________________________________
Chairman, Classification Committee
******************

FINDINGS TO THE WARDEN/SUPERINTENDENT: YES: _______________ NO: ________________

WARDENS'/SUPERINTENDENT'S RECOMMENDATION: (Check appropriate block)

RETURN TO GENERAL POPULATION: ________________ CONTINUE SEPARATE HOUSING: ______________________

WARDEN'S /SUPERINTENDENT'’S COMMENTS: _____________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

Signed: ________________________________________________________
Warden or Superintendent

******************
FOR CENTRAL OFFICE CLASSIFICATION: Date of Review: ____________________________________________________

RETURN TO GENERAL POPULATION: ____________________ REMAIN IN SEPARATE HOUSING_________________
******************
DISTRIBUTION: 1 copy Central Office Classification
1 copy Inmate Administrative File
1 copy Inmate

RETENTION SCHEDULE:

Once completed, this form will be placed in the Inmate Case History file.

Attachments (1)

  1. Re-Assignment Review Form - Separate Housing re HIV Antibody (110 words)
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