SOP_NUMBER: 210.02-att-4
TITLE: Statement of Medical Withdrawal from 90-Day Inmate Boot Camp Program
REFERENCE_CODE: IIB12-0002
DIVISION: Facilities
TOPIC_AREA: 210 Policy-Probation Boot Camp
EFFECTIVE_DATE: 2015-07-16
WORD_COUNT: 66
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/106057
URL: https://gps.press/sop-data/210.02-att-4/

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

ATTACHMENTS:
  1. Inmate Boot Camp Program - Statement of Voluntary Withdrawal from 90-Day Program
     URL: https://gps.press/sop-data/210.02-att-1/
  2. Statement of Withdrawal from 90-Day Program by the Parole Board
     URL: https://gps.press/sop-data/210.02-att-2/
  3. Statement of Disciplinary Withdrawal from 90-Day Inmate Boot Camp Program
     URL: https://gps.press/sop-data/210.02-att-3/
  4. Statement of Medical Withdrawal from 90-Day Inmate Boot Camp Program
     URL: https://gps.press/sop-data/210.02-att-4/

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FULL TEXT:
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**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.

```