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Healthcare Records

Table of Contents  MSRM 140106.01

In the event that the EHR is not operational, a paper format system will be used.  Healthcare record forms for services normally documented in the EHR, will be available at each facility for staff use.
The following forms are available electronically for use.

EHR Forms Only

  • Facesheet
  • Infirmary Daily Shift Assessment - RN
  • Infirmary Shift Note - LPN
  • Medical Lay-In/Restrictions
  • Medical Progress Note - NARRATIVE (Same as progress note 140106B)
  • Medical Progress Note - SOAP (Same as progress note 140106B)
  • Mental Health Evaluation for Lower Security
  • Mental Health Intake Record Review
  • Mental Health Progress Note Narrative (Same as progress note 140106B)
  • Mental Health Progress Note SOAP (Same as progress note 140106B)
  • Mental Health Provider Note
  • Notification of Hospital Admission to Local Hospital
  • Offender Discipline Recommendations
  • Optometric Progress Note - Narrative
  • Providers Infirmary Admission Assessment
  • Providers Infirmary Assessment Note
  • Psychopharmacological Medication Screening and Management
  • Periodic Physical Examination (Non-Chronic Clinic)
  • Segregated Housing Unit (SHU) Medical Record Review
  • Telepsychiatry/Psychiatry Note

Chronic Clinic

Communicable Disease / Tuberculosis


Consents and Refusals


Hepatitis C


Living Will/Advance Directive/DNR

Laboratory, Radiology, and Optometric Services


Mental Health


Offender Death

Outside Referral

Palliative Care

Peer Review


Protected Health Information