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Current National Threat Level is elevated

The threat level in the airline sector is High or Orange.

Forms

Below are the forms used by DIHS.


Form Description Form ID / Link

Clinic Forms
Problem List DIHS-001
Authorization for Release of Confidential Health Information DIHS-003
Pre & Post HIV Test Counseling and Consent Form DIHS-075
Doctor's Orders SF-508
Nursing Notes SF-510
Vital Signs Record SF-511
Request for Administration of Anesthesia and for Performance of Operations and Other Procedures SF-522
Medical Summary of Federal Prisoner/Alien In Transit USM-553
Progress Notes SF-600
Medical Consent Form DIHS-793
Intake Screening Form DIHS-795A
General Medical Encounter Form DIHS-Medical
Physical Examination Form DIHS-795B
Body Diagram Form DIHS-802
Treatment Authorization & Consultation Form DIHS-812
Detainee Special Needs Form DIHS-819
Refusal Form DIHS-820
Medical /Psychiatric Alert DIHS-834
Suicide Observation Checklist DIHS-835
Input/Output Flow Sheet DIHS-836
SSU Admission and Discharge Form DIHS-837
SSU Discharge Summary DIHS-837-A
Generic Flow Sheet DIHS-838
Hunger Strike Monitoring Form DIHS-839
Medication Profile (Use CIPS generated form where available) DIHS-840
Detainee Medical Status DIHS-841
Chronic Disease Clinic Inital Baseline Medical Data NCCHC-Baseline
Chronic Disease Clinic Follow-up NCCHC-Follow-up
Mental Health Encounter DIHS-843-E
Consent to Receive Psychiatric Medications DIHS-844
Prenatal Care History and Physical Exam Form DIHS-846
Post-Restraints Observation Report DIHS-867
Medical Observation of Detainee in Restraints DIHS-869
DIHS Incident Reporting Form DIHS-Incident Report
Report of Root Cause Analysis Form DIHS-RCA Form

Dental Forms
Dental Examination Form SF-603
Dental Clinical Record Form SF-521
Dental Treatment Continuation Form DIHS-Form
Dental Screening Form DIHS-English
DIHS-Spanish

Pediatric Forms
Pediatric Physical Assessment Form 2 to 4 weeks DIHS-851
Pediatric Physical Assessment Form 2 months old DIHS-852
Pediatric Physical Assessment Form 4 months old DIHS-853
Pediatric Physical Assessment Form 6 months old DIHS-854
Pediatric Physical Assessment Form 9 months old DIHS-855
Pediatric Physical Assessment Form 12 months old DIHS-856
Pediatric Physical Assessment Form 15 months old DIHS-857
Pediatric Physical Assessment Form 18-23 months DIHS-858
Pediatric Physical Assessment Form 2 years old DIHS-859
Pediatric Physical Assessment Form 3 years old DIHS-860
Pediatric Physical Assessment Form 4 years old DIHS-861
Pediatric Physical Assessment Form 5 years old DIHS-862
Pediatric Physical Assessment Form 6 years old DIHS-863
Pediatric Physical Assessment Form 7 years old DIHS-864
Pediatric Physical Assessment Form 8 years old DIHS-865
Pediatric Physical Assessment Form 10 years old DIHS-866
Juvenile Transfer/Release Summary DIHS-845

Infectious Disease Reporting Forms
DIHS TB Case and Suspect Report and International Referral Form DIHS-TB
DIHS TB Case and Suspect Report and International Referral Form Instructions DIHS-TB Inst.
DIHS Infections Disease Report Form DIHS-ID
DIHS Infections Disease Report Instructions DIHS-ID Inst.
TB Medical Hold Request Form DIHS-TB Hold
TB Release Medical Hold Form DIHS-TB Release