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Correctional Managed Health Care

Policy Manual

Correctional Managed Health Care Policy Manual
Policy # Effective Date Title Format
  09/29/2021 Table of Contents PDF
    Disclaimer PDF
    Transmittal Memos and Signature Pages HTML
    Policy Review Schedules:  
         Policy Review for January PDF
         Policy Review for April PDF
         Policy Review for July PDF
         Policy Review for October PDF
A-01.1 03/07/2017 Access to Care PDF
A-02.1 03/17/2016 Responsible Health Authority PDF
A-02.2 03/17/2016 Treatment of Injuries Incurred in the Line of Duty PDF
A-03.1 03/17/2016 Medical Autonomy PDF
A-04.1 03/17/2016 Administrative Meetings PDF
A-04.2 02/25/2019 Health Services Statistical Report PDF
A-05.1 10/27/2020 Correctional Managed Health Care Policies PDF
A-06.1 01/04/2012 Quality Improvement/Quality Management Program PDF
A-06.2 05/20/2016 Professional and Vocational Nurse Peer Review Process PDF
A-07.1 05/25/2017 Emergency Plans and Drills PDF
  05/25/2017      Attachment A: Disaster Drill Evaluation Form PDF
A-08.1 05/28/2019 Decision Making for Serious Mentally Ill Patients PDF
  05/28/2019      Attachment A: Mental Health Disciplinary Review Form PDF
A-08.2 11/05/2019 Transfers of Offenders with Acute Conditions PDF
  10/27/2020      Attachment A: Approved Medical Transportation Criteria PDF
A-08.3 08/28/2019 Referral of Offenders to the Development Disabilities Program (DDP) PDF
A-08.4 08/23/2018 Offender Medical and Mental Health Classification PDF
  11/05/2019      Attachment A: Guidelines for Completing the Health Summary for Classification Form PDF
A-08.5 08/23/2016 Coordination with Windham School System PDF
A-08.6 08/23/2018 Medically Recommended Intensive Supervision Screening PDF
  05/02/2013      Attachment A: MRIS Screening Form PDF
  03/07/2017      Attachment B: MRIS Medical Summary PDF
A-08.7 08/16/2017 PULHES System of Offender Medical and Mental Health Classification PDF
  09/22/2014      Attachment A: PULHES Background and Information PDF
  08/23/2016      Attachment B: Guidelines For Coding PUHLES PDF
A-08.8 08/17/2021 Medical Pass PDF
A-08.9 08/17/2021 The Chronic Mentally Ill Treatment Program (CMI-TP) PDF
A-08.10 02/25/2019 The Program for Aggressive Mentally Ill Offender (PAMIO) PDF
A-09.1 04/2007 Privacy of Care PDF
A-10.1 11/05/2019 Notification Requirements Regarding Critically Ill Offenders PDF
A-11.1 11/22/2021 Procedure to be Followed in Cases of Offender Death PDF
  05/20/2016      Attachment A: Initial Notification to Health Services of Offender Death PDF
  05/20/2016      Attachment B: Deaths in Custody – Death Report for Bureau of Justice Statistics PDF
  05/20/2016      Attachment C: Offender Death Summary PDF
A-11.2 05/12/2014 Pronouncement of Death by Licensed Nurses PDF
A-12.1 10/2021 Grievance Mechanism PDF
  09/03/2019      Attachment A: Getting Medical Treatment – English PDF
  09/03/2019      Attachment B: Getting Medical Treatment – Spanish PDF
  10/2021      Attachment C: Informal Resolution Process PDF
A-12.2 06/01/2009 Patient Liaison Program PDF
A-13.1 11/19/2018 Provider Peer Review PDF


Infection Control Policy

C-18.1 03/17/2016 Licensure and Credential Verification PDF
C-19.1 03/17/2016 Continuing Education/Staff Development PDF
C-19.2 07/2015 Correctional Managed Health Care Reference Materials PDF
  05/20/2016      Attachment A: Sample Correctional Managed Health Care Bookshelf PDF
C-20.1 07/08/2015 Training for Correctional Officers PDF
C-22.1 08/17/2021 Offender Workers PDF
C-23.1 08/23/2016 Position Descriptions PDF
C-24.1 12/11/2014 Staffing Levels PDF
C-25.1 10/30/2013 Orientation Training for Health Services Staff PDF
D-27.1 03/17/2016 Pharmaceuticals PDF
D-27.2 05/28/2019 Heat Stress (formerly B-15.2) PDF
  10/27/2020      Attachment A: Drugs Associated With Heat Stress PDF
  05/30/2018      Attachment B: Comorbidities That May Affect Heat Tolerance PDF
D-27.3 02/25/2019 Photosensitivity PDF
D-28.1 08/23/2016 Clinic Space, Equipment, and Supplies PDF
D-28.2 07/2015 Sharp, Needle and Syringe Control PDF
D-28.3 07/08/2015 Facility Repairs and Renovations PDF
D-28.4 01/04/2012 First Aid Kits PDF
D-28.5 08/23/2016 Equipment, Supplies and Inventory PDF
D-29.1 10/1995 Access to Diagnostic Services PDF
D-30.1 03/07/2017 Hospital and Specialized Ambulatory Care PDF
D-30.2 10/1995 Scheduling Approved Consultations to Specialty Health Services PDF
E-31.1 03/17/2016 Information on Health Care Services PDF
E-31.2 08/16/2017 Organ or Tissue Donation PDF
  02/12/2014      Attachment A: Donor Information Sheet PDF
  05/02/2013      Attachment B: Retraction of Tissue and Organ Donor Status PDF
E-31.3 03/08/2018 Obtaining Community Hospital Offender Information PDF
E-31.4 05/20/2016 Management of Offenders Who Have Received Solid Organ Transplants PDF
E-32.1 09/03/2019 Receiving, Transfer and Continuity of Care Screening PDF
  08/28/2019      Attachment A: CMC Intake History & Health Screening Form PDF
  06/2015      Attachment B: SAFPF Detoxification Medications List PDF
E-34.1 05/28/2019 Health Appraisal of Incoming Inmates PDF
E-34.2 08/28/2019 Periodic Physical Examinations PDF
E-34.3 03/17/2016 Use of Force Procedures PDF
E-34.4 07/08/2015 Reporting Suspected Abuse PDF
E-34.5 08/17/2021 Chemical Agents and the Use of Force Contraindication List PDF
E-35.1 11/05/2019 Mental Health Appraisal for Incoming Offenders PDF
E-35.2 05/28/2019 Mental Health Evaluation PDF
E-36.1 08/17/2021 Dental Treatment Levels of Care and Appendix I, II, and Dental Sealants PDF
E-36.2 04/03/2018 Inprocessing Offenders – Dental Examination, Classification, Education and Treatment PDF
E-36.3 01/04/2012 Recording and Scheduling Dental Patient Visits PDF
E-36.4 05/25/2017 Dental Prosthodontic Services PDF
  01/04/2012      Attachment A: Medically Necessary Dental Prosthetics Referral Form PDF
  01/04/2012      Attachment B: Completed Dental Prosthesis Requisition Form PDF
E-36.5 01/04/2012 Dental Utilization/Quality Review Committee PDF
E-36.6 01/04/2012 Periodontal Disease Program PDF
E-36.7 10/2021 Dental Clinic Operations Reporting PDF
E-36.8 08/23/2018 Dental Comprehensive Treatment Plan (DCTP) PDF
E-37.1 11/19/2018 Daily Processing of Health Complaints and Sick Call PDF
  05/25/2017      Attachment A: Sick Call Procedure For Offenders Unable To Write PDF
E-37.2 01/04/2012 Guidelines for Clipper Shave Pass PDF
E-37.3 05/20/2016 Medical Lay-Ins PDF
E-37.4 05/28/2019 Lockdown Procedures PDF
E-37.5 05/20/2016 Interpreter Services – Monolingual Spanish-Speaking Offenders PDF
E-37.6 01/04/2012 Cosmetic Surgery PDF
E-39.1 04/07/2017 Health Evaluation and Documentation Offenders in Segregation – Restrictive Housing PDF
E-39.2 11/19/2018 Alternative Meal Service PDF
E-40.1 08/28/2019 Direct Medical Orders PDF
E-41.1 08/23/2016 Emergency Services PDF
E-41.2 08/23/2016 Emergency Response During Hours of Operation PDF
  02/25/2019      Attachment A: Inventory List PDF
E-42.1 08/23/2018 Offender Transport and Transfer PDF
E-42.2 03/08/2018 Missed Clinic Appointment PDF
  01/2012      Attachment A: SLC Missed Appointment Audit/Survey PDF
E-42.3 11/14/2017 Transportation of Infirmary and Inpatient Mental Health Offenders PDF
  06/17/2016      Attachment A: Authorization to Leave the Inpatient or Sheltered Housing Setting PDF
E-42.4 03/18/2015 Medical Holds PDF
E-43.1 11/22/2021 Delegation to Advanced Practice Registered Nurses and Physician Assistants PDF
  10/2021      Attachment A: Prescriptive Authority Agreement PDF
  10/30/2013      Attachment B: Alternative Physician Supervision Log PDF
E-44.1 11/22/2021 Continuity of Care PDF
E-44.2 01/08/2016 Examination of Offenders by Private Practitioners PDF
  01/08/2016      Attachment A: Request and Consent for Examination by Private Practitioner PDF
F-46.1 03/17/2016 Health Education and Promotion PDF
F-47.1 08/16/2017 Therapeutic Diets and Food Allergies PDF
  10/2012      Attachment A: Counseling Sheet for Therapeutic Diet Refusal PDF
F-48.1 05/20/2016 Exercise Program PDF
F-49.1 09/22/2014 Personal Hygiene PDF
F-50.1 12/11/2014 Tobacco Free Environment PDF
G-51.1 03/07/2017 Offenders with Special Needs PDF
G-51.2 03/07/2017 Admission to A Geriatric Center PDF
G-51.3 03/08/2018 Admission Health Appraisals for Offenders with Physical Disabilities PDF
  03/18/2015      Attachment A: Speech Pathology Referral Criteria for TDCJ and Speech Pathology Referral Process PDF
  03/18/2015      Attachment B: Level of Care Assessment PDF
G-51.4 03/17/2016 Wheelchair Repair and Maintenance PDF
G-51.5 03/08/2018 Certified American Sign Language (ASL) Interpreter Services PDF
G-51.6 05/28/2019 Referral of an Offender for Admission Into a Behavioral Health Facility PDF
G-51.7 08/17/2021 Behavioral Health Treatment for Substance Abuse Felony Punishment Facility Offenders PDF
G-51.8 03/17/2016 Care of Offenders With Terminal Conditions PDF
  09/22/2014      Attachment A: Consent to Hospice Care PDF
  09/22/2014      Attachment B: Hospice Guidelines PDF
G-51.9 05/20/2016 Wheelchair Use PDF
  05/20/2016      Attachment A: Special Wheelchair Committee - Treatment Plan of Offender Refusing to Walk PDF
  05/2017      Attachment B: Special Wheelchair Committee Treatment Plan Form PDF
G-51.10 05/28/2019 Chronic Care Program PDF
G-51.11 01/10/2017 Treatment of Offenders With Intersex Conditions, Gender Identity Disorder or Gender Dysphoria, Formerly Known as Gender Identity Disorder PDF
  08/05/2014 G-51.11 Revision Explanation PDF
  01/10/2017      Attachment A: Consent Form for Therapy with Male Hormones PDF
  01/10/2017      Attachment B: Consent Form for Therapy with Female Hormones PDF
G-51.12 04/11/2019 Offenders with Special Needs who are Releasing from TDCJ PDF
G-51.13 10/27/2020 Admission to a Sheltered Housing PDF
G-52.1 08/23/2016 Infirmary Care PDF
G-52.2 08/17/2021 Chronic Mentally Ill - Sheltered Housing (CMI-SH) PDF
G-52.3 05/28/2019 Admission to the TDCJ Mental Health Therapeutic Diversion Program (MHTDP) PDF
G-52.4 10/27/2020 Seriously Mentally Ill – Sheltered Housing (SMI-SH) PDF
  06/14/2019 Attachment A - Seriously Mentally Ill – (SMI-SH) Referral Form PDF
G-53.1 08/16/2017 Suicide Prevention Plan PDF
  08/23/2018 Attachment A - Health Services Policy Facility Addendum PDF
G-53.3 12/12/2016 Management of Offenders Hunger-Strikes PDF
G-54.1 01/04/2012 Detoxification PDF
G-55.1 10/2021 Pregnant Offenders PDF
G-56.1 12/11/2014 Offenders with Substance Abuse Disorders PDF
G-57.1 08/28/2019 Sexual Assault/Sexual Abuse PDF
  09/01/2005      Attachment A: Penal Code, Chapter 22. – Assaultive Offenses PDF
  10/2021      Attachment B: Code of Criminal Procedure, Chapter 56. – Rights of Crime Victims, Subchapter A. – Crime Victims’ Rights PDF
G-59.2 03/07/2017 Optical Prostheses and Appliances PDF
  11/14/2017      Attachment A: CMHC Dispensing of Prescription Eyewear PDF
G-59.3 10/2021 Medical Prostheses and Orthotic Devices PDF
  09/2014      Attachment A: Medical Conditions Not Suitable for B&L Referral PDF
H-60.1 02/25/2019 Health Records – Organization, Maintenance and Governance PDF
  03/17/2016      H-60.1 Attachment A Outpatient Health Record Format PDF
  03/17/2016      H-60.1 Attachment B List of EHR Chart Sections PDF
  11/14/2017      H-60.1 Attachment C: Approved Abbreviations PDF
  08/23/2016      H-60.1 Attachment D: CMHC EHR Standard Operating Procedure – Change Sign User for Email PDF
  08/23/2016      H-60.1 Attachment E: CMC Document Clarification PDF
  08/23/2016      H-60.1 Attachment F: CMHC EHR Standard Operating Procedure – Creating an Addendum Note PDF
  08/23/2016      H-60.1 Attachment G: Incomplete Chart Review PDF
H-60.2 05/28/2019 Inpatient Health Records PDF
  04/2013      Attachment A: History and Physical Examination PDF
  04/2013      Attachment B: Discharge Summary PDF
  04/2013      Attachment C: Approval To File an Incomplete Medical Record PDF
H-60.3 08/23/2016 Health Services Forms Control and Design PDF
H-60.4 04/07/217 Utilization of Electronic Health Record PDF
H-61.1 08/17/2021 Confidentiality and Release of Protected Health Information PDF
  07/2012      Attachment A: Affidavit of Personal Representative PDF
  01/2021      Authorization for the Use and Disclosure of Protected Health Information (PHI) - English Attachment B PDF
  01/2021      Authorization for the Use and Disclosure of Protected Health Information (PHI) - Spanish Attachment C PDF
  11/19/2008      Attachment D: Calculation of Costs for Patient Health Information (2/2005) Facilities PDF
  07/2012      Attachment E: Calculation of Costs for Patient Health Information (2/2005) Health Services Archives PDF
H-64.1 12/11/2014 Transfer of Health Records PDF
  10/2021      Attachment A: Breach of Confidentiality Incident Log PDF
  10/2021      Attachment B: Breach of Confidentiality Form PDF
H-65.1 11/22/2021 Retention/Destruction of Health Records PDF
I-66.1 11/14/2017 Medical Therapeutic Restraints PDF
  08/23/2016      Attachment A: Medical Therapeutic Restraint Flow Sheet PDF
I-66.2 11/19/2018 Therapeutic Restraint of Mental Health Patients PDF
I-66.3 11/19/2018 Therapeutic Seclusion of Mental Health Patients PDF
I-67.1 11/05/2019 Compelled Psychoactive Medication for Mental Illness PDF
  10/2012      Attachment A: Correctional Managed Health Care - Mental Health Services Certificate of Emergency Compelled Psychoactive Medication In A Mentally Ill Person PDF
  05/20/2016      Attachment B: Certificate of Non-Emergency Compelled Psychoactive Medication in a Mentally Ill Person PDF
I-68.1 03/17/2016 Blood and Urine Testing for Forensic Purposes PDF
I-68.2 03/07/2017 DNA Specimen Collection PDF
I-68.3 03/17/2016 Forensic Information PDF
I-68.4 01/04/2012 Medical Consultation for the Offender Drug Testing Program PDF
  01/04/2012      Attachment A: Offender Controlled Substance Testing Information Form PDF
  05/04/2018      Attachment B: Prescription Drugs Giving Positive Results for the T-cup Test PDF
I-69.1 01/04/2012 Participation in Executions PDF
I-70.1 08/28/2019 Informed Consent PDF
  09/24/2015      Attachment A: Request/Consent for Treatment or Services PDF
I-70.2 11/19/2018 Consent for Admission to a Behavioral Health Facility PDF
  02/25/2019      Attachment A: Voluntary Consent for Admission to a Behavioral Health Facility PDF
  11/19/2018      Attachment B: Psychiatric Involuntary Admission Review PDF
  11/19/2018      Attachment C: Involuntary Admission to a Behavioral Health Facility PDF
I-71.1 01/04/2012 Offender’s Right to Refuse Treatment, Department’s Right to Compel Treatment PDF
  08/07/2013      Attachment A: Request for Compelled Medical Treatment PDF
  08/07/2013      Attachment B: Refusal of Treatment or Services PDF
  08/16/2017      Attachment C: Instructions For Completing The Refusal Of Treatment Form PDF
I-71.2 07/08/2015 Patient Self-Determination Act, Natural Death Act, Advance Directives Act PDF
  01/04/2012      Attachment A: Directive To Physicians PDF
  07/01/2009      Attachment B: Standard Out-Of-Hospital Do-Not-Resuscitate Order PDF
  02/2012      Attachment C: Patient Information About Advance Directives PDF
I-72.1 01/08/2016 Biomedical Research PDF