SOP 210.02-att-4: Statement of Medical Withdrawal from 90-Day Inmate Boot Camp Program
Summary
This form documents the medical removal of an inmate from the 90-day Inmate Boot Camp Program. It is completed by the Medical Section and Warden or designee to record the reasons for medical withdrawal and is maintained in the inmate's case history file for record-keeping purposes.
Key Topics
- boot camp
- medical withdrawal
- inmate removal
- medical section
- program termination
- 90-day program
- inmate records
- case history
Full Text
Attachment 4
SOP IIB12-0002
(210.02)
(07/16/15)
INMATE BOOT CAMP PROGRAM
STATEMENT OF MEDICAL WITHDRAWAL FROM 90-DAY PROGRAM
__________________________________
PRISON
Inmate: _____________________________________DATE: ____________________
STATE ID#:__________________________________DOB:______________________
The above named inmate has been removed from the 90-day Inmate Boot
Camp Program by the Medical Section for the following reasons:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_____________________________________ __________________________
Medical Date
_____________________________________ _________________________
Warden/Designee Date
RETENTION SCHEDULE:
Upon completion of this form, it will be placed in the inmate/probationer's
case history file.