Laserfiche WebLink
a h are <br />your independent healthcare choice. <br />Intake Screening Form in TechCareO <br />'^y RECkP164G XAE08TA ..........�"rt,. <br />Patient DOE, JANE s: 02510761805067f29d89d-tang:31d6(1234) AdStlenallnlo. <br />008: 4/8/1990 (Age=26) Sex: Female Race: <br />p[OHSRE <br />Housing: SSN: -' X DEN— <br />NOT AYAR/IBLE <br />Status: ACTIVE Booking Date: 4/8/2015 3:50:25 PM <br />eP 120 ,'.86 TEDP 98.6 PULSE T5 . RESP 18 Seel 96 85 126. PAm� tttinl 6�., ,Htlwsneat 10 M 1d9 <br />ON5 ItA .NAP 9].]l yl <br />4 T x gaga a Rewe a Ta ae aw R6s . R s mm+ <br />-911 <br />In n <br />We*t <br />.9ryo! Drasase <br />Fdns Pasde <br />Qsxea <br />+� <br />' <br />L. <br />i <br />_. _ <br />i Ones NePea: <br />i Alva fkxoy W Mown <br />I <br />7 <br />i. <br />i Screenen: All questions in this form most be addressed. For question with a single checkbox; <br />by leaving the the kbox unselected, you are documenting your conclusion that all parameter <br />of the question are false. By selecting the checkbox. you are admowledging a positive <br />rnsporre to the item and further documentation must be provided in the corresponding <br />`y questions and teq boxes. <br />i <br />I ARRESTING OFFICER QUESTIONS -Saler and Document all Mat apply <br />4 <br />Is the arresting officer aware of any of Me follovdng7: <br />Ye b <br />NA <br />OMa Hkwxed0u9r m;ivtd <br />�] �j <br />t7J <br />Cmbarce. Aaalvev6amwry <br />'� � <br />� 1- <br />I <br />Trtnmesbv Mebcd Po-xdadh6w <br />by <br />_ <br />©. ® <br />n <br />Proactive Health Assessment upon Intake <br />A beneficial feature of NaphCare's Intake Screening process for the SAI is that we perform the Health <br />Assessment up front, during intake. By performing this assessment at intake, we can identify urgent <br />medical and mental health issues upon an inmate's arrival. This not only reduces costs for emergency <br />and hospital transportation, but it also reduces the inmate movement required to provide the health <br />assessment at 14 days. We propose to continue this model for the SAI as we have seen positive results <br />in doing so — Our Proactive Care Model has significantly reduced ER trips by 98% for the SAI. <br />Mental Health Screening <br />This screening is NCCHC compliant and was created to be proactive in identifying and prioritizing <br />inmates in need of mental health services. The following is a description of each section of the screening <br />and the information it obtains: <br />Inmate Medical Services <br />City of Santa Ana <br />25F-25 <br />RFP No. 17-051 <br />26 <br />