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Section 14

OP-140106

OP-140107

  • - "Worksheet for Monthly Medical Activity Report"

OP-140108

  • - "ODOC Authorization for Release of Protected Health Information"
  • - "Revocation of Authorization for Release of Protected Health Information"
  • - "ODOC Health Record Locator Card"
  • - "ODOC Authorization for Release of Protected Health Information for the Release of Psychiatric/Psychological Records"
  • - "Accounting Of Disclosure Log"
  • - "Acknowledgement of Request for Protected Health Information" 
  • - "Request for Correction/Amendment of Protected Health Information" 

OP-140111

OP-140112

OP-140113

OP-140114

  • - "Medical/Mental Health Screening"
  • - "Initial Intake and Routine Physical Examination"
  • - "Initial Physical Examination and Laboratory Requirements - Male"
  • - "Initial Physical Examination and Laboratory Requirements - Female"

OP-140115

  • - "Periodic Physical Examination and Laboratory Requirements Male"
  • - "Periodic Physical Examination and Laboratory Requirements Female"

OP-140116

  • - "Employee Medical Screening Form/Employee Post-Offer Screening and Examination Report Results"
  • - "Medical Clearance for Respirator Use" 
  • - "OSHA Respirator Medical Evaluation Questionnaire"

OP-140117

OP-140118

  • - "Daily/Monthly AED/Narcan Inspection Log"
  • - "Non-Medical Facility Staff Administration and Access to Naloxone" (Narcan)
  • - "Oklahoma Department of Corrections Probation and Parole Officer (PPO) Office of Fugitive Apprehension and Investigations (OFI) Security Threats Intelligence (STI) Administration and Access to Naloxone (Narcan)"

OP-140119

OP-140121

  • - "Health Care Leave Request" 
  • - "Rules for Health Care Leave and Medication" 
  • - "Affidavit for Financial Responsibility for Medical. Mental Health, Dental and/or Vision Care" 
  • - "Record of Treatment by Community Health Care Provider" 
  • - "After Clinic Hours-Transfer to ER" 

OP-140124

  • - “Periodontal Charting” 
  • - “Review for Partial Dentures” 
  • - “Endodontic and Orthodontic Consent” 
  • - “Request for Dental Exception (Dentures)”

OP-140125

OP-140127

  • - "Mental Health Unit, Intermediate Housing Care Unit or Habilitation Program Referral Form"
  • - "Evaluation Summary"
  • - “Oklahoma Department of Corrections Mental Health Unit Intake”

OP-140129

OP-140130

OP-140132

OP-140133

  • - "Orthoses, Prostheses and Other Aids to Impairment Appliance Record"

OP-140137

  • - "Severity Classification of Common Chronic Illness"
  • - "Chronic Illness Management Guidelines-Routine and Annual Treatment Guidelines"

OP-140138

  • - “Living Will/Advance Directive for Health Care” 
  • - “Notification of Activation for a Living Will/Advance Directive and/or DNR” 
  • - “Do Not Resuscitate (DNR) Consent Form”

OP-140140

  • - "Mental Health Administration and Organization" 

OP-140141

  • - "Authorization for Application of Therapeutic Five Point Restraints”
  • - "Restraint Medical Flow sheet”
  • - "Physical Restraint Log "
  • - “Certification Checklist for Safe/Therapeutic Seclusion/Restraint Cell”
  • - "Therapeutic Seclusion Watch Log"
  • - "Therapeutic Seclusion Conditions/Precautions" 
  • - "Procedures for Four/Five Point Therapeutic Restraints" 

OP-140142

  • - "Provider Peer Review Criteria" 
  • - "Qualified Mental Health Professional Peer Review Criteria"

OP-140146

OP-140147

  • - "Male to Female Hormonal Therapy Risk and Information Form" 
  • - "Female to Male Hormonal Therapy Risk and Information Form"
  • - "Request for Gender Dysphoria (GD) Evaluation/Treatment"
  • - “Referral for Gender Associated Results”

OP-140201

  • - "Mental Health Service Levels Classification System Criteria" 
  • - "Mental Health or Mental Status Review"
  • - “Mental Health Assessment for Segregation Housing”
  • - "Abnormal Involuntary Movement Scale"
  • - "Facility Needs Assessment and Strategic Plan Format"

OP-140301

OP-140652

  • - "ODOC Involuntary Medication Report"
  • - "ODOC Notice of Hearing to Consider Recommendation of Involuntary Administration of Psychotropic Medication"
  • - "ODOC Medication Review Committee Report"
  • - "ODOC Involuntary Medication Hearing - Staff Representative Fact Sheet"
  • - "ODOC Involuntary Medication Appeal Request"
  • - "ODOC Involuntary Medication Appeal Decision"

OP-140701

  • - "Consent for Medical, Dental and Mental Health Treatment" 
  • - "Vaccine Administration Consent/Refusal Form" 
  • - "Neuroleptic's Informed Consent"
  • - "Informed Consent for Telemedicine Services"
  • - "Consent for Pain Treatment with Controlled Substances; Inmate Agreement"