Exhibit 14 - MMS Report.xlsx

XLSX spreadsheet 101 KB Posted Jul 13, 2026

Attached to: Medical and Mental Health Services
Solicitation number: 1301
Issued by: Idaho

About this file

Written by GovTribe AI · Aug 31, 2026

Exhibit 14 is a Monthly Medical Statistical Report template prepared for the Idaho Department of Correction's 2026 fiscal year tracking. The report is designed to collect comprehensive demographic and health data across all IDOC facilities statewide, organized by month from January through December 2026 with columns for yearly totals and monthly averages. The template captures population statistics segmented by age groups, including total population counts and breakdowns for individuals aged 80 and above, 70-79, 60-69, and 50-59, providing the baseline data structure necessary for monitoring inmate health demographics and service delivery metrics across the department's facilities.

This reporting framework supports the Idaho Department of Correction's Medical and Mental Health Services RFP by establishing standardized data collection protocols for measuring and tracking the inmate population characteristics that directly impact medical and mental health service requirements and resource allocation. The monthly statistical format enables performance monitoring, trend analysis, and capacity planning throughout the contract period, facilitating compliance tracking and evaluation of contractor performance against service delivery standards across all departmental facilities.

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Q&A Attachment 12b - 2025 HSR Reports.xlsx	XLSX spreadsheet	Jul 13, 2026
Consolidated Offeror Questions.docx	DOCX document	Jul 13, 2026
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Q&A Attachment 12a - 2024 HSR Reports.xls	XLS spreadsheet	Jul 13, 2026
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Amendment 1 - RFP 1301 - Administrative Document.docx	DOCX document	Jul 13, 2026

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Summary 2026

Site Name:	Preparer:
Site Number:	Reviewer

	Monthly Medical Statistical Report includes, but is not limited to the following:	Jan-26	Feb-26	Mar-26	Apr-26	May-26	Jun-26	Jul-26	Aug-26	Sep-26	Oct-26	Nov-26	Dec-26	Yearly Total	Monthly Avg
1	Population (Total)	1444													1444
2	Age 80 and above
3	Age 70-79
4	Age 60-69
5	Age 50-59
6	Age <49
7	Intake Screen - RDU
8	Mental Health Screen - RDU
9	Health Assessments - RDU
10	Lab draws - RDU
11	Positive PPD or QFT - RDU
12	Dental Screens - RDU
13	Sick Call Visits - RDU
14	MOUD Continuation - RDU
15	Transfer Screens OUT
16	Transfer Screens IN
17	Transfer Mental Health Screens
18	Discharges
19	Health Services Requests Submitted
20	Sick Call - Medical
21	Sick Call - RHU
22	Clinical Visits - Physician
23	Clinical Visits - Midlevel
24	Clinical Visits - RN
25	Clinical Visits - LPN/CMS
26	Emergency Response/Man-Down Events
27	Use of Force Incidents Resulting in Injury
28	Annual TB Screens
29	Periodic Health Exams Completed
30	Deaf
31	Blind
32	RHU Medical Intake Screen
33	RHU MH Intake Screen
34	RHU Welfare Checks
35	RHU Sick Call
36	Optometry HSR's Received
37	Optometry - Vision (HSR Request)
38	Optometry DEE/Other (Referral)
39	Orthotic/Prosthetic Visits Completed
40	Physical Therapy Visits Completed
41	Ultrasounds
42	Residents on Dialysis
43	Dialysis Treatments/Runs
44	Nephrologist Visits
45	Specialty Provider Consultation-onsite
46	X-Rays
47	Lab draws
48	Medical Diets
49	Diets approved within 5 business days
50	Wound Care
51	My Wound Care Doctor (or similar)
52	MOUD Treatment Initiation
53	IDOC Staff Immunizations TB/Hep A&B
54	Infusions
55	Psychiatrist Visits Completed
56	Psychiatric Midlevel Visits Completed
57	Suicide Risk Assess. Completed
58	Suicide Watch
59	Suicide Attempts
60	Residents on Prescription Medication
61	Residents on Psychotropic Medication
62	Number of Non-Formulary Prescriptions
63	Number of NF approved in 24 hours
64	HIV Medication
65	HCV Medication
66	LTBI Medication
67	Biologic Medication
68	Long Acting Antipsychotic Medication
69	Medication Related DOR's (custody)
70	New TB - Positive PPD or QFT diagnosis
71	New RPR diagnosis
72	New HBV diagnosis
73	New HCV diagnosis
74	New HIV diagnosis
75	Death-onsite
76	Death-offsite
77	Suicides
78	Total Scheduled Offsite Specialist visits
79	Audiology
80	Cardiology
81	Dermatology
82	Endocrinology
83	ENT
84	Gastroenterology
85	General Surgery
86	Gynecology
87	Hematology
88	Internal Medicine
89	Maternal Fetal Medicine
90	Nephrology
91	Neurology/Neurosurgery
92	Oncology
93	Ophthalmology
94	Oral Surgeon
95	Orthopedic
96	Outpatient Surgery
97	Podiatry
98	Pulmonology
99	Urology
100	Other off-site specialty consults
101	# of Off-site Specialty Care refusals
102	Total Scheduled Offsite Diagnostics
103	Ultrasounds
104	MRIs
105	CT Scans
106	Other Diagnostics
107	# of Off-site Specialty Diagnostics refusals
108	Unscheduled Emergency Department Visits
109	Unscheduled Urgent Specialist Visit (Other)
110	Hospital Admissions - Planned
111	Hospital Admissions - Unplanned
112	Hospital Days
113	Pregnant Offenders
114	OB Appointments
115	Live Births
116	Miscarriage/stillbirth
117	MOUD Continuation
118	Dental HSR's Received
119	Dental Treatment Provided
120	Dental Prosthesis-in process
121	Hygienist Appointments
122	Annual Dental Assessments
123	Total enrolled in Chronic Disease Program
124	Autoimmune Diseases
125	Cardiac/Vascular
126	Endocrine Disease/Disorder
127	Diabetes
128	Gender Dysphoria
129	Hematology
130	HIV
131	LTBI Treatment
132	Liver Disease (Non HCV)
133	Hepatitis C
134	Neurological Disease/Disorder
135	Oncology
136	Current Chemo/Radiation
137	Pulmonary Disease
138	Renal Disease
139	Other CDP
140	Number of Civil Commits
141	Civil Commit Weekly Rounds
142	Man-Down drills
143	Disaster drills
144	Number of Infirmary Beds
145	Admissions to Infirmary
146	Transfer To LTC (Lower LOC)
147	Discharges to GP (Lowest LOC)
148	Number of LTC Beds
149	Admissions to LTC
150	Transfer to Infirmary (Higher LOC)
151	Discharge to GP (Lowest LOC)
152	Medical Observation (<23 hours)
153	Med Obs admitted
154	Med Obs DC'd to GP
155	Number of Medical Annex (Equivalent) beds
156	Admissions to MA/Equiv housing

_x000D_&1#&"Calibri"&10&K000000 IDOC Data Sensitivity Classification - L3 Restricted

Environment Survey

Facility:
Performed By: Date Completed:
	Yes	No	N/A
Medical & dental areas, and hallways are clean & free of physical safety hazards	x
Linen carts are covered, unless in separate clean room	x
Ice scoop kept on clean surface and use of gloves when using scoop	x
Wet-floors signs used when floors are being cleaned	x
Pt. exam tables & chairs are in good condition, tables papered between patients	x
PPE is readily available to staff in patient care areas	x
Counters are clean & free of spills	x
Hand washing facilities with liquid soap, towels, & water are readily available	x
Eye wash station(s) is in readily accessible area and functioning	x
Electrical cords show no signs of damage	x
Inspect for evidence of insects or rodents	x
Fire extinguishers available with current inspection (Medical areas)	x
Signage posted for X-ray radiation warning	x
Signage posted for exits per Fire Regulations	x
Daily temp logs of all refrigerators with medications	x
No food is stored in med refrigerator	x
Multi-dose vials are dated and initialed when opened	x
Negative pressure rooms are tested daily when occupied, monthly when unoccupied	x
Storage items are on shelf above floor & at least 18 inches below sprinkler heads	x
O2 tanks secured in carriers or behind chains	x
O2 tank gauges in working order	x
EKG machines in working order	x
Daily battery log checks on all AEDs	x
Emergency Response Bag(s)	x
Disaster Bag(s)	x
Weekly Blood Glucose Monitor Calibration logs complete	x
Sterilizer(s)/autoclave(s) in working order	x
Weekly spore count logs for dental &/or medical autoclave complete	x
Adequate supply of internal & external strips for sterilization	x
Sharps containers are available in all areas where disposable sharps are used	x
Sharps containers do not exceed the maximum fill line (3/4 full if not marked)	x
Bio-Hazard containers are available in all medical and dental areas	x
Bio-hazard containers (full) are secured for pick up & disposal	x
Biohazard is routinely collected and disposed of by certified biohazard waste company	x
Chemicals safely stored in original containers or have approved labels	x
MSDS available on ALL chemicals in unit (include janitorial supplies, alcohol, etc.)	x

&18Medical Environment Surveillance

_x000D_&1#&"Calibri"&10&K000000 IDOC Data Sensitivity Classification - L3 Restricted

Concern & Grievance Stats

Contractor Name

Site Name:

Site Number

		INMATE CONCERN CATEGORIES	Jan-26	Feb-26	Mar-26	Apr-26	May-26	Jun-26	Jul-26	Aug-26	Sep-26	Oct-26	Nov-26	Dec-26	Yearly
Total	Monthly Average
	1	Medical Care													0	0.0	401.1428571
	2	Dental/Hygeine													0	0.0
	3	Mental Health													0	0.0
	4	Optometry													0	0.0
	5	Offsite care (consults, ED, etc.)													0	0.0
	6	Medication/Pill Call													0	0.0
	7	Requests for Aids/Supplies													0	0.0
	8	Medical Diets													0	0.0
	9	Staff Complaints													0	0.0
	10	Delay in care Provided													0	0.0
	11	Does Not Fit Any Category													0	0.0
	12														0	0.0
	13														0	0.0
	14														0	0.0
		TOTAL	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0

		INMATE GRIEVANCE CATEGORIES	Jan-26	Feb-26	Mar-26	Apr-26	May-26	Jun-26	Jul-26	Aug-26	Sep-26	Oct-26	Nov-26	Dec-26	Yearly
Total	Monthly Average
	I	Medical Care													0	0.0
	II	Dental/Hygeine													0	0.0
	III	Mental Health													0	0.0
	IV	Optometry													0	0.0
	V	Offsite care (consults, ED, etc.)													0	0.0
	VI	Medication/Pill Call													0	0.0
	VII	Requests for Aids/Supplies													0	0.0
	VIII	Medical Diets													0	0.0
	IX	Staff Complaints													0	0.0
	X	Delay in care Provided													0	0.0
	XI	Does Not Fit Any Category													0	0.0
		TOTAL	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0	0.0

_x000D_&1#&"Calibri"&10&K000000 IDOC Data Sensitivity Classification - L3 Restricted

Grievance Log

Site Name:
Site Number:
Resident Name	IDOC #	Date of Grievance	Date Received	Reporting Month	Grievance - Details	Grievance Category	Date of Response	Response - Details	Outcome	Staff Name

*GC = GRIEVANCE Categories
I	Medical Care
II	Dental/Hygiene
III	Mental Health
IV	Optometry
V	Offsite care (consults, ED, etc.)
VI	Medication/Pill Call
VII	Requests for Aids/Supplies
VIII	Medical Diets
IX	Staff Complaints
X	Delay in care Provided
XI	Does Not Fit Any Category

_x000D_&1#&"Calibri"&10&K000000 IDOC Data Sensitivity Classification - L3 Restricted

Staffing

SITE FTE STAFFING REPORT
Site Name:
Stats for Month/Year:	EXAMPLE

Position	Title	Req. by Contract	Operating FTE	Staff Name
HSA	HSA	1.0	1.0
DON	DON	1.0	1.0
AA	AA	1.0	1.0
Scheduler	Scheduler	1.0	1.0
Medical Records	Medical Records	1.0	1.0
Medical Records	Medical Records	1.0	1.0
Med Director	MD	0.4	0.4
SMD	MD	1.0	1.0
Mid Level Provider	PA-C	1.0	1.0
Mid Level Provider	NP	1.0	1.0
Psychiatrist	MD	0.2	0.2
Psychiatrist	MD	0.7	0.7
MH Mid Level Provider	NP	0.6	0.6
Dentist	DDS	1.0	1.0
Dental Hygienist	DH	0.4	0.4
Dental Assistant	DA	1.0	1.0
Optometrist	OD	0.1	0.1
X-Ray Tech	X-Ray Tech	0.5	0.5
Phlebotomist	Phlebotomist	1.0	1.0
RN	RN	1.0	1.0
RN	RN	1.0	1.0
RN	RN	1.0	1.0
RN	RN	1.0	1.0
RN	RN	1.0	1.0
RN	RN	1.0	1.0
RN	RN	1.0	1.0
RN	RN	1.0	1.0
RN	RN	1.0	1.0
RN	RN	1.0	1.0
RN	RN	0.6	0.6
LPN Pharmacy Manager	LPN	1.0	1.0
LPN	LPN	1.0	1.0
LPN	LPN	1.0	1.0
LPN	LPN	1.0	1.0
LPN	LPN	1.0	1.0
LPN	LPN	1.0	1.0
LPN	LPN	1.0	1.0
LPN	LPN	1.0	1.0
LPN	LPN	1.0	1.0
LPN	LPN	1.0	1.0
LPN	LPN	1.0	1.0
LPN	LPN	0.4	0.4
Pharmacy Tech	MA	1.0	1.0
Pharmacy Tech	MA	1.0	1.0
Pharmacy Tech	MA	1.0	1.0
Pharmacy Tech	MA	0.8	0.8
CAN	CNA	1.0	1.0
CNA	CNA	1.0	1.0
CNA	CNA	1.0	1.0
CNA	CNA	1.0	1.0
CNA	CNA	0.8	0.8
CNA	CNA	0.8	0.0
		46.2	45.5

_x000D_&1#&"Calibri"&10&K000000 IDOC Data Sensitivity Classification - L3 Restricted

File details come from the government source that posted it. Updated Aug 31, 2026.