Q&A Attachment 12a - 2024 HSR Reports.xls

XLS spreadsheet 832 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

This is a Health Services Report (HSR) for the Idaho Department of Correction (IDOC) facility, documenting medical and mental health service metrics for the 2024 calendar year. The report tracks monthly performance data across multiple service categories including population information, screenings, medical provider encounters, telemedicine, nurse sick call encounters, mental health services, dental services, segregation procedures, and infirmary care. The average daily population for the facility ranged from 571 to 580 residents throughout 2024, with an annual average of 575.67. Key performance metrics include 3,531 clinical visits with midlevel providers, 263 physician encounters, 13,219 health services requests submitted, 5,423 sick call visits completed, 1,557 dental appointments completed, and 500 psychiatrist visits. Mental health services encompassed 29 initial psychiatric evaluations, 12 suicide risk assessments, and 736 psychiatric midlevel visits. The report utilizes data extracted from the eOMIS system and includes quarterly and year-to-date totals alongside monthly breakdowns.

The HSR document serves as a comprehensive performance tracking mechanism for the IDOC facilities and is designed to monitor compliance with contracted medical and mental health service delivery standards. The data reflects service utilization patterns across multiple clinical disciplines, including physicians, midlevel providers, nurses, mental health professionals, and dental hygienists. Segregation procedures accounted for 410 medical and mental health intake screens and 3,512 welfare checks throughout 2024. The report indicates zero infirmary bed capacity and admissions during the reporting period, suggesting reliance on alternative care arrangements. This HSR template supports the IDOC's ability to evaluate contractor performance against established clinical metrics and service delivery requirements under the medical and mental health services contract.

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Q&A Attachment 12b - 2025 HSR Reports.xlsx	XLSX spreadsheet	Jul 13, 2026
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Amendment 1 - RFP 1301 - Administrative Document.docx	DOCX document	Jul 13, 2026

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Jan

	Site Name:	0			Site Number:	0			Name of Preparer			MONTHLY CHRONIC DISEASE PROGRAM REPORT
						Current	Last Mo.									Site:		0
	Month/Year	Dec-99			Avg. Daily Census Current	0	0		Reviewer							Month/Year:
	RDU/SCREENS/ASSESSMENTS	Current	Last Mo.		ONSITE SPECIALTY CARE	Current	Last Mo.		TRANSPORTS	Current	Last Mo.	CLASS I		Number of Offenders		TOTAL NUMBER OF CHRONIC DISEASE VISITS
0	0	0	0	35	0	0	0	61	0	0	0	(One CDP DX)		Current	Last Mo.	Diagnosis:		Number of Visits
0	0	0	0	36	0	0	0	62	0	0	0	93	Class I (one CDP DX) 1 Diagnosis	0				Current	Last Mo.
0	0	0	0	37	0	0	0	63	0	0	0					113	Autoimmune Diseases	0
0	0	0	0	38	0	0	0									114	Cardiac/Vascular	0
0	0	0	0	39	0	0	0		OFFSITE ACTIVITY	Current	Last Mo.					115	Endocrine Disease/Disorder	0
0	0	0	0	40	0	0	0	64	0	0	0	CLASS II		Number of Offenders		116	Diabetes	0
7	0	0	0	41	0	0	0	65	0	0	0	(Multiple CDP DX)		Current	Last Mo.	117	Gender Dysphoria	0
8	0	0	0						Average Hospital Length of Stay	0	0	0	0	0		118	Hematology	0
					MENTAL HEALTH	Current	Last Mo.	66	0	0	0	0	0	0		119	HIV	0
	TRANSFER SCREENS	Current	Last Mo.	42	0	0	0	67	0	0	0	0	0	0		120	LTBI Treatment	0
9	0	0	0	43	0	0	0	68	0	0	0	0	0	0		121	Liver Disease (Non HCV)	0
10	0	0	0		Total MH Appts Completed	0	0					0	0	0		122	Hepatitis C	0
11	0	0	0	44	0	0	0		WORKMAN'S COMP	Current	Last Mo.		Total Class II Offenders	0		123	Neurological Disease/Disorder	0
				45	0	0	0	69	0	0						124	Oncology	0
	CLINICAL VISITS	Current	Last Mo.	46	0	0	0	70	0	0						125	Pulmonary Disease	0
12	0	0	0									CLASS III		Number of Offenders		126	Renal Disease	0
13	0	0	0		PHARMACY	Current	Last Mo.		FEMALE OFFENDERS	Current	Last Mo.	0		Current	Last Mo.		Total Number of Visits	0	0
14	0	0	0	47	0	0	0	71	0	0		0	0	0
15	0	0	0		% on Prescription Medication	0%	0%	72	0	0		0	0	0		125	Offenders in Chronic Disease Program	0
16	0	0	0	48	0	0	0	73	0	0			Total Class III Offenders	0
17	0	0	0		% on Psychotropic Medication	0%	0%	74	0	0
18	0	0	0	49	0	0	0	75	0	0						HIV/AIDS		Number of Offenders
19	0	0	0					76	0	0		TOTAL CHRONIC DISEASE BY DIAGNOSIS				127	0	0
20	0	0	0		ANCILLARY SERVICES	Current	Last Mo.							Current	Last Mo.	127	0	0
21	0	0	0	50	0	0	0		DENTAL	Current	Last Mo.	101	Autoimmune Diseases	0		127	0	0
				51	0	0	0	77	0	0		102	Cardiac/Vascular	0		127	0	0
	INFIRMARY	Current	Last Mo.					78	0	0		103	Endocrine Disease/Disorder	0		127	0	0
22	0	0	0		INFECTIOUS DISEASES	Current	Last Mo.	79	0	0		104	Diabetes	0		127	0	0
23	0	0	0	52	0	0	0	80	0	0		105	Gender Dysphoria	0
24	0	0	0	53	0	0	0	81	0	0		106	Hematology	0
25	0	0	0	54	0	0	0					107	LTBI Treatment	0
26	0	0	0	55	0	0	0		OPTOMETRY	Current	Last Mo.	108	Liver Disease (Non HCV)	0
27	0	0	0					82	0	0		109	0	0
28	0	0	0		OFFENDER DEATHS	Current	Last Mo.	83	0	0		110	Oncology	0
				56	0	0	0	84	0	0		111	Pulmonary Disease	0
	EXTENDED CARE INFIRMARY	Current	Last Mo.	57	0	0	0					112	Renal Disease	0
29	0	0	0	58	0	0	0		COMMUNITY RELEASE CENTERS	Current	Last Mo.		Total	0
30	0	0	0					85	0	0
31	0	0	0		POST PHYSICALS	Current	Last Mo.	86	0	0
32	0	0	0	59	0	0	0	87	0	0
33	0	0	0	60	0	0	0	88	0	0
34	0	0	0					89	0	0
								90	0	0
								91	0	0
								92	0	0

&L&"Arial,Bold"CORIZON&C&"Arial,Bold"HEALTH SERVICES REPORT &R&8Revised 022714 Riley, Karen the proposed new HSR would allow for tracking of every months' stats YTD. Unsure why this current "monthly" summary breakout would need to be added on the report

ICIO

DEFINITIONS			SITE NAME & NUMBER: ICIO ID0002
			Year: 2024
HEALTH SERVICES REPORT - MEDICAL			HEALTH SERVICES REPORT - MEDICAL
EACH SITE WILL COMPLETE THIS REPORT	Definitions	Reports / Inputs / Pathway	EACH SITE WILL COMPLETE THIS REPORT	Jan	Feb	Mar	Apr	May	Jun	July	Aug	Sept	Oct	Nov	Dec	Q1	Q2	Q3	Q4	YTD TOTAL	YTD AVE
POPULATION INFORMATION			POPULATION INFORMATION
Avg Daily Population	# of residents/patient who reside in facility in a given month	Monthly Average Daily Population Report	Avg Daily Population	578	572	574	573	572	571	577	578	576	578	580	579	574.6666666667	572	577	579		575.6666666667
SCREENINGS			SCREENINGS
Intake Screens-RDU	# of residents who come through RDU in a given month	Run Nurse Intake Screening Report in eOMIS	Intake Screens-RDU	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Mental Health Screens-RDU	# of residents who have a mental health screen performed in RDU	Run Nurse Intake Screening Report in eOMIS	Mental Health Screens-RDU	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Dental Intake Screen-RDU	# of residents who have a dental screen performed in RDU	Run Dental Initial Intake Exam in eOMIS	Dental Intake Screen-RDU	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Transfer Screens In	# of residents transferred In to your facility (to include from RDU to ISCI)	Run Nurse Transfer Receiving Report in eOMIS	Transfer Screens In	42	39	27	42	37	38	34	35	43	42	34	25	438	117	112	101	768	36.5
Transfer Screens Out	# of residents transferred Out from your facility	Run Nurse Transfer Sending Report in eOMIS	Transfer Screens Out	29	23	15	26	19	17	24	29	19	35	21	23	280	62	72	79	493	23.3333333333
Transfer Mental Health Screens	# of residents transferred IN who received a MH screen		Transfer Mental Health Screens	42	39	27	42	37	38	34	35	43	42	34	25	438	117	112	101	768	36.5
Number of TB Screens-RDU	# of TB Screens planted	Run Pentaho Idaho RDU Audit and filter as necessary	Number of TB Screens-RDU	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Parole/Full Term Release Date Screen			Parole/Full Term Release Date Screen													0	0	0	0	0	0
MEDICAL PROVIDERS ENCOUNTERS			MEDICAL PROVIDERS ENCOUNTERS
Clinical Visits-Physicians	# of physician encounters	Run Encounter Search by physician(s) for your facility	Clinical Visits-Physicians	8	9	8	6	9	13	8	8	6	6	7	56	144	28	22	69	263	12
Clinical Visits-Midlevel	# of midlevel encounters	Run Encounter Search by midlevel(s) for your facility	Clinical Visits-Midlevel	114	140	239	162	218	160	163	228	159	207	128	94	2012	540	550	429	3531	167.6666666667
Health Assessments-RDU	# of health assessments completed in RDU	Run Practitioner Health Assessment - Initial for your facility	Health Assessments-RDU	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Periodic Health Exams Completed	# of periodic health exams completed (annual exams)	Run Practitioner Health Assessment - Periodic for your facility	Periodic Health Exams Completed													0	0	0	0	0	0
# of Medical Provider encounter refusals			# of Medical Provider encounter refusals													0	0	0	0	0	0
TELEMEDICINE ENCOUNTERS (SEE TELEHMED LOG)			TELEMEDICINE ENCOUNTERS (SEE TELEHMED LOG)													0					0
NURSE SICK CALL ENCOUNTERS			NURSE SICK CALL ENCOUNTERS
Health Services Requests submitted -RDU	# of HSR's submitted while in RDU	Provide number from sick call log	Health Services Requests submitted -RDU	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Sick Call seen - RDU	# of residents seen for sick call while in RDU	Provide number from sick call log	Sick Call seen - RDU	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Medical Health Services Requests Submitted	# of HSR's submitted for your facility for GP	Provide number from sick call log	Health Services Requests Submitted	293	414	614	619	659	602	656	679	648	719	665	702	7270	1880	1983	2086	13219	605.8333333333
Sick Call seen - Medical	# of residents seen for sick call for GP	Provide number from sick call log	Sick Call seen - Medical	131	174	236	281	257	261	251	307	291	284	252	257	2982	799	849	793	5423	248.5
Total # Nurse Sick Call encounters completed (autocalculated)			Total # Nurse Sick Call encounters completed (autocalculated)													0	0	0	0	0	0
# of referrals to Medical provider/Mid-level after seen by nursing sick call			# of referrals to Medical provider/Mid-level after seen by nursing sick call													0	0	0	0	0	0
# of referrals to Mental Health after seen by nursing sick call			# of referrals to Mental Health after seen by nursing sick call													0	0	0	0	0	0
# of referrals to Dental after seen by nursing sick call			# of referrals to Dental after seen by nursing sick call													0	0	0	0	0	0
# of Nurse Sick Call refusals			# of Nurse Sick Call refusals													0	0	0	0	0	0
OTHER NURSING ENCOUNTERS			OTHER NURSING ENCOUNTERS
Number of Lab Draws-RDU	# of lab draws completed while in RDU	Pentaho Report - Idaho RDU Audit (filter by completed)	Number of Lab Draws-RDU	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Number of lab Draws-Medical			Number of lab Draws-Medical													0	0	0	0	0	0
Clinical Visits RN/LPN/CMS			Clinical Visits RN/LPN/CMS													0	0	0	0	0	0
# of post use of force exams completed			# of post use of force exams completed													0	0	0	0	0	0
# of return from off-site assessments completed			# of return from off-site assessments completed													0	0	0	0	0	0
MENTAL HEALTH ENCOUNTERS			MENTAL HEALTH ENCOUNTERS
Initial Psychiatric provider Evaluations	# of initial psychiatric evaluations completed	Run Mental Health Psychiatrist Initial Psych Eval in eOMIS	Initial Psychiatric provider Evaluations	1	2	2	1	1	1	5	0	0	2	0	2	17	3	5	4	29	7.25
Psychiatrist Visits Completed	# of psychiatric visits completed	Run Mental Health Psychiatric Scheduled and Unscheduled by physician(s) for your facility in eOMIS	Psychiatrist Visits Completed	52	55	81	48	52	56	0	0	0	0	0	0	344	156	0	0	500	250
Psychiatric Midlevel Visits Completed	# of midlevel psychiatric visits completed	Run Mental Health Psychiatric Scheduled and Unscheduled by midlevel(s) for your facility in eOMIS	Psychiatric Midlevel Visits Completed	0	0	0	0	0	1	69	59	56	67	70	46	368	1	184	183	736	184
Suicide Risk Assessments Completed	# of suicide risk assessments completed	Run Mental Health Clinician SRA Initial in eOMIS	Suicide Risk Assessments Completed	1	0	1	0	1	0	4	0	0	0	0	0	7	1	4	0	12	4
Resident Placed on Suicide Watch	# of residents placed on suicide watch		Resident Placed on Suicide Watch													0	0	0	0	0	0
Total # of Mental Health encounter refusals			Total # of Mental Health encounter refusals													0	0	0	0	0	0
TELEPSYCH ENCOUNTERS (SEE TELEPysch LOGS)			TELEPSYCH ENCOUNTERS (SEE TELEPysch LOGS)													0
DENTAL ENCOUNTERS			DENTAL ENCOUNTERS
Dental HSR's Received	# of HSR's received for dental services	Provide number from sick call log	Dental HSR's Received	55	74	111	85	95	104	106	119	121	125	105	87	1187	284	346	317	2134	533.5
Dental Appts Completed	# of completed dental encounters completed	Run Dental Sick Call Scheduled by provider(s) for your facility	Dental Appts Completed	83	48	106	80	61	59	75	84	78	73	71	79	897	200	237	223	1557	389.25
Dental Prosthesis-in process			Dental Prosthesis-in process													0	0	0	0	0	0
Hygienist HSR's Received	# of HSR's received for hygenist services	Provide number from sick call log	Hygienist HSR's Received	24	30	36	22	45	29	28	41	30	35	33	36	389	96	99	104	688	172
Hygienist Appointments Completed	# of completed hygenist encounters completed	Run Dental Sick Call Scheduled by hygenist(s) for your facility	Hygienist Appointments Completed	11	24	23	15	20	18	15	16	21	25	19	18	225	53	52	62	392	98
MISCELLANEOUS VISITS AND DIAGNOSIS			MISCELLANEOUS VISITS AND DIAGNOSIS
RN Hours-Nampa-CRC			RN Hours-Nampa-CRC													0	0	0	0	0	0
Provider Hours-Nampa-CRC			Provider Hours-Nampa-CRC													0	0	0	0	0	0
RN Hours-Treasure Valley-CRC			RN Hours-Treasure Valley-CRC													0	0	0	0	0	0
Provider Hours-Treasure Valley-CRC			Provider Hours-Treasure Valley-CRC													0	0	0	0	0	0
RN Hours-East Boise-CRC			RN Hours-East Boise-CRC													0	0	0	0	0	0
Providers Hours-East Boise-CRC			Providers Hours-East Boise-CRC													0	0	0	0	0	0
RN Hours-Idaho Falls-CRC			RN Hours-Idaho Falls-CRC													0	0	0	0	0	0
Provider Hours-Idaho Falls-CRC			Provider Hours-Idaho Falls-CRC													0	0	0	0	0	0
Class I (one CDP DX) 1 Diagnosis			Class I (one CDP DX) 1 Diagnosis													0	0	0	0	0	0
Class II (Multiple CDP DX) 2 Diagnosis			Class II (Multiple CDP DX) 2 Diagnosis													0	0	0	0	0	0
Class II (Multiple CDP DX) 3 Diagnosis			Class II (Multiple CDP DX) 3 Diagnosis													0	0	0	0	0	0
Class II (Multiple CDP DX) 4 Diagnosis			Class II (Multiple CDP DX) 4 Diagnosis													0	0	0	0	0	0
Class II (Multiple CDP DX) 5 Diagnosis			Class II (Multiple CDP DX) 5 Diagnosis													0	0	0	0	0	0
Class II (Multiple CDP DX) 6 Diagnosis			Class II (Multiple CDP DX) 6 Diagnosis													0	0	0	0	0	0
Class III (High Acuity) Chemo			Class III (High Acuity) Chemo													0	0	0	0	0	0
Class III (High Acuity) Dialysis			Class III (High Acuity) Dialysis													0	0	0	0	0	0
SEGREGATION			SEGREGATION
Segregation Medical Intake Screen	# of medical intake screens for segregation residents	Run Nursing Segregation Intake in eOMIS	Segregation Medical Intake Screen	22	10	18	25	30	11	19	27	30	12	12	14	230	66	76	38	410	19.1666666667
Segregation MH Intake Screen	# of mental health intake screens for segregation residents	Run Nursing Segregation Intake in eOMIS	Segregation MH Intake Screen	22	10	18	25	30	11	19	27	30	12	12	14	230	66	76	38	410	19.1666666667
Segregation Welfare Checks	# of welfare checks completed for segregation residents	Run Nursing Segregation Rounds in eOMIS	Segregation Welfare Checks	194	145	213	175	216	81	223	236	312	117	55	65	2032	472	771	237	3512	169.3333333333
Segregation Sick Call HSR's			Segregation Sick Call													0	0	0	0	0	0
INFIRMARY CARE			INFIRMARY CARE
Number of Infirmary Beds	# of beds	Report number of beds in your infirmary	Number of Infirmary Beds	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Admissions to Infirmary	# of admission to infirmary	Run Practitioner Infirmary Admission in eOMIS	Admissions to Infirmary	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Discharges from Infirmary	# of discharge from infirmary	Run Practitioner Infirmary Discharge in eOMIS	Discharges from Infirmary	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Medical Observation (<23 hours)	# of residents who received 23 hour observation	Provide number from infirmary log	Medical Observation (<23 hours)	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Infirmary Care Days			Infirmary Care Days													0	0	0	0	0	0
Infirmary Average Length of stay			Infirmary Average Length of stay													0	0	0	0	0	0
Infirmary Rounds	# of provider infirmary rounds	Run Practitioner Infirmary Rounds in eOMIS	Infirmary Rounds	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Number of Extended Care Infirmary Beds	# of LTC beds in your facility	Report # of LTC beds	Number of Extended Care Infirmary Beds	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Admissions to Extended Care Infirmary	# of admissions to LTC	Provide number from LTC log	Admissions to Extended Care Infirmary	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Discharges from Extended Care Infirmary	# of discharges from LTC	Run Practitioner LTC Discharge in eOMIS	Discharges from Extended Care Infirmary	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Extended Care Infirmary Care Days			Extended Care Infirmary Care Days													0	0	0	0	0	0
Extended Care Average Length of Stay			Extended Care Average Length of Stay													0	0	0	0	0	0
Extended Care Infirmary Rounds	# of provider LTC rounds	Run Practitioner LTC Rounds in eOMIS	Extended Care Infirmary Rounds	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
ON-SITE SPECIALTY VISITS			ON-SITE SPECIALTY VISITS
Residents Receiving X-rays			Residents Receiving X-rays													0	0	0	0	0	0
Orthotic/Prosthetic Visits Completed			Orthotic/Prosthetic Visits Completed													0	0	0	0	0	0
Physical Therapy Visits Completed			Physical Therapy Visits Completed													0	0	0	0	0	0
Ultrasounds			Ultrasounds													0	0	0	0	0	0
Dialysis Treatments/ Runs			Dialysis Treatments/ Runs													0	0	0	0	0	0
Dialysis Provider Visits			Dialysis Provider Visits													0	0	0	0	0	0
Specialty Provider Consultation-onsite			Specialty Provider Consultation-onsite													0	0	0	0	0	0
OPTICAL APPOINTMENTS			OPTICAL APPOINTMENTS
Optical HSR's Received	# of HSR's received for optical services	Provide number from sick call log	Optical HSR's Received	14	9	25	15	39	28	34	24	22	30	41	27	308	82	80	98	568	25.6666666667
Optical HSR's Referred to Optometrist			Optical HSR's Referred to Optometrist													0	0	0	0	0	0
Optical Visits Completed	# of completed dental encounters completed	Run Practitioner Optometry by provider(s) for your facility	Optical Visits Completed	0	20	13	13	0	31	21	15	26	4	13	15	171	44	62	32	309	17.1
Optical Outstanding HSR's	# of optical appointments waiting to be seen	Count the number of outstanding optical HSR's for your facility	Optical Outstanding HSR's	1	2	12	30	0	1	0	0	2	0	0	0
NUTRITIONAL SERVICES			NUTRITIONAL SERVICES
Medical Diets	# of residents on a medical diet	Access the Medical Diet Authorization Log and report total medical diets.	Medical Diets	11	10	13	11	14	12	18	16	14	14	16	22	171	37	48	52	308	14.25
MEDICATION			MEDICATION
Residents on Prescription Medication	# of residents who received a prescription medication	Obtain number from pharmacy provider	Residents on Prescription Medication	255	261	264	271	280	284	273	282	301	296	295	302	3364	835	856	893	5948	1487
Residents on Psychotropic Medication	# of residents who received a psychotropic medication	Obtain number from pharmacy provider	Residents on Psychotropic Medication													0	0	0	0	0	0
Number of Non-Formulary Prescriptions	# of resident who received a non-formulary prescription	Obtain number from pharmacy provider	Number of Non-Formulary Prescriptions													0	0	0	0	0	0
Residents on emergency psychotropic medication			Residents on emergency psychotropic medication													0	0	0	0	0	0
Residents on non-emergency Involuntary Medication			Residents on non-emergency Involuntary Medication													0	0	0	0	0	0
Total # of Treatment Review Committee (non-emergency involuntary medications)			Total # of Treatment Review Committee (non-emergency involuntary medications)													0	0	0	0	0	0
INFECTION CONTROL			INFECTION CONTROL
Number on LTBI Treatment/Meds	# of residents on LTBI treatment/meds	Chronic disease log / nurse	Number on LTBI Treatment/Meds	0	0	0	0	1	0	1	1	2	1	2	2	10	1	4	5	20	1.4285714286
New TB Positive Tests	# of PPD's positive tests		New TB Positive Tests													0	0	0	0	0	0
Active MRSA Cases	# of active MRSA cases	Provided by BioReference	Active MRSA Cases													0	0	0	0	0	0
# of Hepatitis A with active HCV (positive RNA test)			# of Hepatitis A with active HCV (positive RNA test)													0	0	0	0	0	0
# of Hepatitis B with active HCV (positive RNA test)			# of Hepatitis B with active HCV (positive RNA test)													0	0	0	0	0	0
# of new intakes with history of HCV (untreated or unknown treatment)			# of new intakes with history of HCV (untreated or unknown treatment)													0	0	0	0	0	0
# of active HCV (positive RNA) NOT currently on treatment			# of active HCV (positive RNA) NOT currently on treatment													0	0	0	0	0	0
# of Residents with HCV actively on treatment			# of Residents with HCV actively on treatment													0	0	0	0	0	0
# of Current month new positive HIV tests			# of Current month new positive HIV tests													0	0	0	0	0	0
# of HIV			# of HIV													0	0	0	0	0	0
# of patients on HIV meds during the month			# of patients on HIV meds during the month													0	0	0	0	0	0
PPDs			PPDs
# of initial PPDs placed			# of initial PPDs placed													0	0	0	0	0	0
# of initial PPDs read			# of initial PPDs read													0	0	0	0	0	0
percentage . Read divided by placed (AUTOCALC)			percentage . Read divided by placed (AUTOCALC)													0	0	0	0	0	0
Annual TB Screens/Plant	# of annual TB tests planted or screens completed (birth month)		Annual TB Screens													0	0	0	0	0	0
Annual PPDs placed			Annual PPDs placed													0	0	0	0	0	0
Annual PPDs read			Annual PPDs read													0	0	0	0	0	0
percentage . Annual Read divided by placed (AUTOCALC)			percentage . Annual Read divided by placed (AUTOCALC)													0	0	0	0	0	0
EMERGENCY MEDICAL SERVICES			EMERGENCY MEDICAL SERVICES
Medical Emergency responses within the facility			Medical Emergency responses within the facility													0	0	0	0	0	0
Naloxone deployments within the facility (given by medical staff)			Naloxone deployments within the facility (given by medical staff)													0	0	0	0	0	0
TRANSPORTS			TRANSPORTS
Ambulance emergency responses within the facility			Ambulance emergency responses within the facility													0	0	0	0	0	0
Medical Transports Scheduled	# of scheduled medical transports	Obtain from scheduler	Medical Transports Scheduled	7	6	0	10	2	0	4	5	5	0	0	2	41	12	14	2	69	5.125
Medical Transports Unscheduled	# of unscheduled medical transports	Obtain from scheduler	Medical Transports Unscheduled	2	1	5	3	2	0	0	0	1	1	0	2	8	5	1	3	17	2.125
Total IDOC Man Hours-Unscheduled			Total Man Hours-Unscheduled													0	0	0	0	0	0
HOSPITALIZATION			HOSPITALIZATION
# of hospital admissions	# of admissions to a hospital	Provided by UM Team	# of hospital admissions	1	0	0	1	0	0	0	0	1	0	0	0	3	1	1	0	5	1
# of inpatient hospital days			# of inpatient hospital days													0	0	0	0	0	0
# of Observation only patients			# of Observation only patients													0	0	0	0	0	0
OFF-SITE SPECIALITY CONSULTATIONS			OFF-SITE SPECIALITY CONSULTATIONS
Audiology			Audiology													0	0	0	0	0	0
Cardiology			Cardiology													0	0	0	0	0	0
Dermatology			Dermatology													0	0	0	0	0	0
Endocrinology			Endocrinology													0	0	0	0	0	0
ENT			ENT													0	0	0	0	0	0
Gastroenterology			Gastroenterology													0	0	0	0	0	0
General Surgery			General Surgery													0	0	0	0	0	0
Gynecology			Gynecology													0	0	0	0	0	0
Hematology			Hematology													0	0	0	0	0	0
Internal Medicine			Internal Medicine													0	0	0	0	0	0
Maternal Fetal Medicine			Maternal Fetal Medicine													0	0	0	0	0	0
Nephrology			Nephrology													0	0	0	0	0	0
Neurology/Neruosurgery			Neurology/Neruosurgery													0	0	0	0	0	0
Oncology			Oncology													0	0	0	0	0	0
Ophthalmology			Ophthalmology													0	0	0	0	0	0
Oral Surgeon			Oral Surgeon													0	0	0	0	0	0
Orthopedic			Orthopedic													0	0	0	0	0	0
Outpatient Surgery			Outpatient Surgery													0	0	0	0	0	0
Podiatry			Podiatry													0	0	0	0	0	0
Pulmonology			Pulmonology													0	0	0	0	0	0
Urology			Urology													0	0	0	0	0	0
Other off-site specialty consults			Other off-site specialty consults													0	0	0	0	0	0
# of Off-site Specialty Care refusals			# of Off-site Specialty Care refusals													0	0	0	0	0	0
SPECIALTY DIAGNOSTICS - OFF SITE			SPECIALTY DIAGNOSTICS - OFF SITE
Ultrasounds			Ultrasounds													0	0	0	0	0	0
MRIs			MRIs													0	0	0	0	0	0
CT Scans			CT Scans													0	0	0	0	0	0
Other Diagnostics			Other Diagnostics													0	0	0	0	0	0
# of Off-site Specialty Diagnostics refusals			# of Off-site Specialty Diagnostics refusals													0	0	0	0	0	0
Residents WORKMAN'S COMP			Residents WORKMAN'S COMP
Total Residents under Workman's Comp.	# of residents who have an open Workman's Comp case	Scheduler should have this number	Total Residents under Workman's Comp.	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Total Workman's Comp Appts-offsite	# of offsite appointments related to Workman's Comp case	Scheduler should have this number	Total Workman's Comp Appts-offsite	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
WOMEN'S HEALTH			WOMEN'S HEALTH
Pregnant Residents	# of residents who are pregnant	Chronic disease log / nurse	Pregnant Residents	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
# of pregnant Residents on MAT	# of residents who are receiving MAT	Provided by pharmacy provider	# of pregnant Residents on MAT	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Live Births	# of residents who gave live birth	Offsite log	Live Births	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Miscarriage/stillbirth	# of residents who had a miscarriage/stillbirth	Offsite log	Miscarriage/stillbirth	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
OB Appointments Completed			OB Appointments Completed													0	0	0	0	0	0
mammograms completed			mammograms completed													0	0	0	0	0	0
PAP smears completed			PAP smears completed													0	0	0	0	0	0
SUBSTANCE ABUSE			SUBSTANCE ABUSE
Unique Residents on CIWA/COWS Protocol			Unique Residents on CIWA/COWS Protocol													0	0	0	0	0	0
Unique Residents on MAT			Unique Residents on MAT													0	0	0	0	0	0
CHRONIC CARE DIAGNOSIS			CHRONIC CARE DIAGNOSIS
Autoimmune Diseases	# of residents with this diagnosis	Chronic care database on the M Drive	Autoimmune Diseases	1	1	1	4	4	6	5	5	5	5	5	5	47	14	15	15	91	3.9166666667
Cardiac/Vascular	# of residents with this diagnosis	Chronic care database on the M Drive	Cardiac/Vascular	81	87	89	86	92	94	100	101	105	113	110	118	1176	272	306	341	2095	98
Chemo	# of residents with this diagnosis	Chronic care database on the M Drive	Chemo	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Diabetes	# of residents with this diagnosis	Chronic care database on the M Drive	Diabetes	11	11	12	12	14	16	17	19	20	18	22	24	196	42	56	64	358	16.3333333333
Dialysis	# of residents with this diagnosis	Chronic care database on the M Drive	Dialysis	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Endocrine Disease/Disorder	# of residents with this diagnosis	Chronic care database on the M Drive	Endocrine Disease/Disorder	14	14	14	13	13	12	12	13	13	13	13	14	158	38	38	40	274	13.1666666667
Gender Dysphoria	# of residents with this diagnosis	Chronic care database on the M Drive	Gender Dysphoria	2	2	2	2	2	2	2	2	2	2	2	2	24	6	6	6	42	2
Hematology	# of residents with this diagnosis	Chronic care database on the M Drive	Hematology	0	0	0	0	0	1	2	2	2	2	2	2	13	1	6	6	26	1.8571428571
LTBI Treatment	# of residents with this diagnosis	Chronic care database on the M Drive	LTBI Treatment	0	0	0	0	1	0	1	1	2	1	2	2	10	1	4	5	20	1.4285714286
Liver Disease (Non HCV)	# of residents with this diagnosis	Chronic care database on the M Drive	Liver Disease (Non HCV)	1	1	2	3	3	3	3	3	2	2	2	2	27	9	8	6	50	2.25
Neurological Disease/Disorder	# of residents with this diagnosis	Chronic care database on the M Drive	Neurological Disease/Disorder	4	4	3	2	2	1	1	1	2	1	1	2	24	5	4	4	37	2
Oncology	# of residents with this diagnosis	Chronic care database on the M Drive	Oncology	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Pulmonary Disease	# of residents with this diagnosis	Chronic care database on the M Drive	Pulmonary Disease	12	12	11	13	13	14	14	14	17	24	22	23	189	40	45	69	343	15.75
Renal Disease	# of residents with this diagnosis	Chronic care database on the M Drive	Renal Disease	2	1	1	1	1	1	1	1	1	2	2	2	16	3	3	6	28	1.3333333333
HIV/AIDS/HCV			HIV/AIDS													0					0
Total Number of Residents with Hep C Dx	# of residents with Hep C Dx	Chronic disease log / nurse	Total Number of Residents with Hep C Dx	9	12	10	8	7	9	8	6	3	3	3	3	31	24	17	9	81	6.75
Residents on Hep C Treatment	# of residents receiving Hep C treatment	Chronic disease log / nurse	Residents on Hep C Treatment	3	4	6	7	7	4	2	2	2	2	0	0	39	18	6	2	65	3.9
Total Number of Residents with HIV Dx	# of residents with HIV Dx	Chronic disease log / nurse	Total Number of Residents with HIV Dx	1	1	1	1	1	1	1	0	0	0	0	0	7	3	1	0	11	1
Total Number of Residents w/new HIV Dx	# of residents with new HIV Dx	Chronic disease log / nurse	Total Number of Residents w/new HIV Dx	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Residents on HIV Treatment	# of residents receiving HIV treatment	Chronic disease log / nurse	Residents on HIV Treatment	1	1	1	1	1	1	1	0	0	0	0	0	7	3	1	0	11	1
Total Number of Residents with AIDS Dx	# of residents with AIDS Dx	Chronic disease log / nurse	Total Number of Residents with AIDS Dx	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
CHRONIC CARE ENCOUNTERS			CHRONIC CARE ENCOUNTERS
Autoimmune Diseases			Autoimmune Diseases													0	0	0	0	0	0
Cardiac/Vascular			Cardiac/Vascular													0	0	0	0	0	0
Endocrine Disease/Disorder			Endocrine Disease/Disorder													0	0	0	0	0	0
Diabetes			Diabetes													0	0	0	0	0	0
Gender Dysphoria			Gender Dysphoria													0	0	0	0	0	0
Hematology			Hematology													0	0	0	0	0	0
LTBI Treatment			LTBI Treatment													0	0	0	0	0	0
Liver Disease (Non HCV)			Liver Disease (Non HCV)													0	0	0	0	0	0
Hepatitis C			Hepatitis C													0	0	0	0	0	0
Neurological Disease/Disorder			Neurological Disease/Disorder													0	0	0	0	0	0
Oncology			Oncology													0	0	0	0	0	0
Pulmonary Disease			Pulmonary Disease													0	0	0	0	0	0
Renal Disease			Renal Disease													0	0	0	0	0	0
GRIEVANCES (see Centurion Grievance Roll Up Report)			GRIEVANCES (see Centurion Grievance Roll Up Report)
OCCURRENCE/SENTINEL EVENTS (also send oSEL report)	# of occurrenc sentinel events also send osel report		OCCURRENCE/SENTINEL EVENTS (also send oSEL report)
Number of Suicide Attempts	# of suicide attempts	Get number from MH Clinical Supervisor	Number of Suicide Attempts	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Offender Death-onsite	# of offender death onsite	Get number from HSA	Offender Death-onsite	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Offender Death-offsite	# of offender death offsite	Get number from HSA	Offender Death-offsite	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Suicides	# of suicides	Get number from HSA	Suicides	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
MISCELLANOUS NCCHC REQUIREMENTS			MISCELLANOUS NCCHC REQUIREMENTS
# of Man-Down events - day			# of Man-Down events - day													0	0	0	0	0	0
# of Man-Down events - evening			# of Man-Down events - evening													0	0	0	0	0	0
# of Man-Down events -night			# of Man-Down events -night													0	0	0	0	0	0
# of Disaster drills			# of Disaster drills													0	0	0	0	0	0
STAFF REQUIREMENTS			STAFF REQUIREMENTS
Post Physicals Completed			Post Physicals Completed													0	0	0	0	0	0
# of IDOC Staff Immunizations Clinics Offered (Hep A&B and TB)	# of immunization clinics offered to IDOC Staff this month	Get number from HSA	IDOC Staff Immunizations TB/Hep A&B	0	0	0	2	0	0	0	0	0	0	0	0	0	2	0	0	2	2
Training Hours for Healthcare Staff	3	0	Training Hours for Healthcare Staff													0	0	0	0	0	0
# of participants	1	0	# of participants													0	0	0	0	0	0

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Kerrie checking to see if live versus stillborn could be captured

IMSI

DEFINITIONS			SITE NAME & NUMBER: IMSI
			Year: 2024
HEALTH SERVICES REPORT - MEDICAL			HEALTH SERVICES REPORT - MEDICAL
EACH SITE WILL COMPLETE THIS REPORT	Definitions	Reports / Inputs / Pathway	EACH SITE WILL COMPLETE THIS REPORT	Jan	Feb	Mar	April	May	Jun	July	August	Sept	Oct	Nov	Dec	Q1	Q2	Q3	Q4	YTD TOTAL	YTD AVE
POPULATION INFORMATION			POPULATION INFORMATION
Avg Daily Population	# of residents/patient who reside in facility in a given month	Monthly Average Daily Population Report	Avg Daily Population	532	535	531	530	528	510	508	515	510	495	494	478	532.667	522.667	511.000	489.000		513.8333333333
SCREENINGS			SCREENINGS
Intake Screens-RDU	# of residents who come through RDU in a given month	Run Nurse Intake Screening Report in eOMIS	Intake Screens-RDU	0	0	0	0	3	0	0	0	0	0	7	0	0	3	0	7	10	5
Mental Health Screens-RDU	# of residents who have a mental health screen performed in RDU	Run Nurse Intake Screening Report in eOMIS	Mental Health Screens-RDU	0	0	0	0	3	0	0	0	0	0	7	0	0	3	0	7	10	5
Dental Intake Screen-RDU	# of residents who have a dental screen performed in RDU	Run Dental Initial Intake Exam in eOMIS	Dental Intake Screen-RDU	0	0	0	0	3	0	0	0	0	0	7	0	0	3	0	7	10	5
Transfer Screens In	# of residents transferred In to your facility (to include from RDU to ISCI)	Run Nurse Transfer Receiving Report in eOMIS	Transfer Screens In	55	58	59	32	66	51	43	62	45	63	74	37	172	149	150	174	645	161.25
Transfer Screens Out	# of residents transferred Out from your facility	Run Nurse Transfer Sending Report in eOMIS	Transfer Screens Out	29	30	57	25	65	45	30	40	34	55	92	50	116	135	104	197	552	138
Transfer Mental Health Screens	# of residents transferred IN who received a MH screen		Transfer Mental Health Screens	55	58	59	32	66	51	43	62	45	63	74	37	172	149	150	174	645	161.25
Number of TB Screens-RDU	# of TB Screens planted	Run Pentaho Idaho RDU Audit and filter as necessary	Number of TB Screens-RDU	0	0	0	0	3	0	0	0	0	0	7	0	0	3	0	7	10	5
MEDICAL PROVIDERS ENCOUNTERS			MEDICAL PROVIDERS ENCOUNTERS
Clinical Visits-Physicians	# of physician encounters	Run Encounter Search by physician(s) for your facility	Clinical Visits-Physicians	42	48	44	38	56	42	15	0	0	0		0	134	136	15	0	285	95
Clinical Visits-Midlevel	# of midlevel encounters	Run Encounter Search by midlevel(s) for your facility	Clinical Visits-Midlevel	116	204	133	82	108	99	331	202	129	414	431	272	453	289	662	1117	2521	630.25
Health Assessments-RDU	# of health assessments completed in RDU	Run Practitioner Health Assessment - Initial for your facility	Health Assessments-RDU	0	0	0	0	3	0	0	0	0	0	7	0	0	3	0	7	10	5
Periodic Health Exams Completed	# of periodic health exams completed (annual exams)	Run Practitioner Health Assessment - Periodic for your facility	Periodic Health Exams Completed													0	0	0	0	0	0
# of Medical Provider encounter refusals			# of Medical Provider encounter refusals													0	0	0	0	0	0
TELEMEDICINE ENCOUNTERS (SEE TELEHMED LOG)			TELEMEDICINE ENCOUNTERS (SEE TELEHMED LOG)	0		25	9	43	28	48	25	47	36	25	37	25	80	120	98	323	80.75
NURSE SICK CALL ENCOUNTERS			NURSE SICK CALL ENCOUNTERS													0
Health Services Requests submitted -RDU	# of HSR's submitted while in RDU	Provide number from sick call log	Health Services Requests submitted -RDU	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Sick Call seen - RDU	# of residents seen for sick call while in RDU	Provide number from sick call log	Sick Call seen - RDU	0	0	0	0	0	0	0	0	0	0	7	0	0	0	0	7	7	7
Medical Health Services Requests Submitted	# of HSR's submitted for your facility for GP	Provide number from sick call log	Health Services Requests Submitted	686	699	983	1087	1227	1176	1340	1215	1282	1239	1053	1028	2368	3490	3837	3320	13015	3253.75
Sick Call seen - Medical	# of residents seen for sick call for GP	Provide number from sick call log	Sick Call seen - Medical	240	280	414	380	397	334	407	427	354	498	356	381	934	1111	1188	1235	4468	1117
Total # Nurse Sick Call encounters completed (autocalculated)			Total # Nurse Sick Call encounters completed (autocalculated)	240	280	414	380	397	334	407	427	354	498	356	381	934	1111	1188	1235	4468	1117
# of referrals to Medical provider/Mid-level after seen by nursing sick call			# of referrals to Medical provider/Mid-level after seen by nursing sick call													0	0	0	0	0	0
# of referrals to Mental Health after seen by nursing sick call			# of referrals to Mental Health after seen by nursing sick call													0	0	0	0	0	0
# of referrals to Dental after seen by nursing sick call			# of referrals to Dental after seen by nursing sick call													0	0	0	0	0	0
# of Nurse Sick Call refusals			# of Nurse Sick Call refusals													0	0	0	0	0	0
OTHER NURSING ENCOUNTERS			OTHER NURSING ENCOUNTERS				\
Number of Lab Draws-RDU	# of lab draws completed while in RDU	Pentaho Report - Idaho RDU Audit (filter by completed)	Number of Lab Draws-RDU	0	0	0	0	2	0	0	0	0	0	7	0	0	2	0	7	9	4.5
Number of lab Draws-Medical			Number of lab Draws-Medical													0	0	0	0	0	0
Clinical Visits RN/LPN/CMS			Clinical Visits RN/LPN/CMS													0	0	0	0	0	0
# of post use of force exams completed			# of post use of force exams completed													0	0	0	0	0	0
# of return from off-site assessments completed			# of return from off-site assessments completed													0	0	0	0	0	0
MENTAL HEALTH ENCOUNTERS			MENTAL HEALTH ENCOUNTERS
Initial Psychiatric provider Evaluations	# of initial psychiatric evaluations completed	Run Mental Health Psychiatrist Initial Psych Eval in eOMIS	Initial Psychiatric provider Evaluations	3	2	2	8	4	4	5	2	5	2	2	4	7	16	12	8	43	10.75
Psychiatrist Visits Completed	# of psychiatric visits completed	Run Mental Health Psychiatric Scheduled and Unscheduled by physician(s) for your facility in eOMIS	Psychiatrist Visits Completed	70	80	74	67	77	70	94	76	74	65	79	73	224	214	244	217	899	224.75
Psychiatric Midlevel Visits Completed	# of midlevel psychiatric visits completed	Run Mental Health Psychiatric Scheduled and Unscheduled by midlevel(s) for your facility in eOMIS	Psychiatric Midlevel Visits Completed	68	76	83	74	95	110	76	99	101	115	67	77	227	279	276	259	1041	260.25
Suicide Risk Assessments Completed	# of suicide risk assessments completed	Run Mental Health Clinician SRA Initial in eOMIS	Suicide Risk Assessments Completed	165	146	168	112	164	151	161	175	130	163	128	141	479	427	466	432	1804	451
Resident Placed on Suicide Watch	# of residents placed on suicide watch		Resident Placed on Suicide Watch													0	0	0	0	0	0
Total # of Mental Health encounter refusals			Total # of Mental Health encounter refusals													0	0	0	0	0	0
TELEPSYCH ENCOUNTERS (SEE TELEPysch LOGS)			TELEPSYCH ENCOUNTERS (SEE TELEPysch LOGS)																	0	0
DENTAL ENCOUNTERS			DENTAL ENCOUNTERS
Dental HSR's Received	# of HSR's received for dental services	Provide number from sick call log	Dental HSR's Received	43	72	78	53	84	73	70	47	91	74	103	111	193	210	208	288	899	224.75
Dental Appts Completed	# of completed dental encounters completed	Run Dental Sick Call Scheduled by provider(s) for your facility	Dental Appts Completed	105	86	72	76	71	115	117	74	105	75	83	76	263	262	296	234	1055	263.75
Dental Prosthesis-in process			Dental Prosthesis-in process													0	0	0	0	0	0
Hygienist HSR's Received	# of HSR's received for hygenist services	Provide number from sick call log	Hygienist HSR's Received	5	9	19	9	17	16	8	5	1	4	3	7	33	42	14	14	103	25.75
Hygienist Appointments Completed	# of completed hygenist encounters completed	Run Dental Sick Call Scheduled by hygenist(s) for your facility	Hygienist Appointments Completed	13	11	13	9	24	15	34	18	19	10	8	10	37	48	71	28	184	46
MISCELLANEOUS VISITS AND DIAGNOSIS			MISCELLANEOUS VISITS AND DIAGNOSIS													0	0	0	0	0	0
RN Hours-Nampa-CRC			RN Hours-Nampa-CRC													0	0	0	0	0	0
Provider Hours-Nampa-CRC			Provider Hours-Nampa-CRC													0	0	0	0	0	0
RN Hours-Treasure Valley-CRC			RN Hours-Treasure Valley-CRC													0	0	0	0	0	0
Provider Hours-Treasure Valley-CRC			Provider Hours-Treasure Valley-CRC													0	0	0	0	0	0
RN Hours-East Boise-CRC			RN Hours-East Boise-CRC													0	0	0	0	0	0
Providers Hours-East Boise-CRC			Providers Hours-East Boise-CRC													0	0	0	0	0	0
RN Hours-Idaho Falls-CRC			RN Hours-Idaho Falls-CRC													0	0	0	0	0	0
Provider Hours-Idaho Falls-CRC			Provider Hours-Idaho Falls-CRC													0	0	0	0	0	0
Class I (one CDP DX) 1 Diagnosis			Class I (one CDP DX) 1 Diagnosis													0	0	0	0	0	0
Class II (Multiple CDP DX) 2 Diagnosis			Class II (Multiple CDP DX) 2 Diagnosis													0	0	0	0	0	0
Class II (Multiple CDP DX) 3 Diagnosis			Class II (Multiple CDP DX) 3 Diagnosis													0	0	0	0	0	0
Class II (Multiple CDP DX) 4 Diagnosis			Class II (Multiple CDP DX) 4 Diagnosis													0	0	0	0	0	0
Class II (Multiple CDP DX) 5 Diagnosis			Class II (Multiple CDP DX) 5 Diagnosis													0	0	0	0	0	0
Class II (Multiple CDP DX) 6 Diagnosis			Class II (Multiple CDP DX) 6 Diagnosis													0	0	0	0	0	0
Class III (High Acuity) Chemo			Class III (High Acuity) Chemo													0	0	0	0	0	0
Class III (High Acuity) Dialysis			Class III (High Acuity) Dialysis	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
SEGREGATION			SEGREGATION
Segregation Medical Intake Screen	# of medical intake screens for segregation residents	Run Nursing Segregation Intake in eOMIS	Segregation Medical Intake Screen	21	29	18	39	21	21	14	23	44	27	34	42	68	81	81	103	333	83.25
Segregation MH Intake Screen	# of mental health intake screens for segregation residents	Run Nursing Segregation Intake in eOMIS	Segregation MH Intake Screen	21	29	18	39	21	21	14	23	44	27	34	42	68	81	81	103	333	83.25
Segregation Welfare Checks	# of welfare checks completed for segregation residents	Run Nursing Segregation Rounds in eOMIS	Segregation Welfare Checks	2096	1264	1694	1293	1540	1057	1425	959	701	1133	1400	1698	5054	3890	3085	4231	16260	4065
Segregation Sick Call HSR's			Segregation Sick Call													0	0	0	0	0	0
INFIRMARY CARE			INFIRMARY CARE
Number of Infirmary Beds	# of beds	Report number of beds in your infirmary	Number of Infirmary Beds	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Admissions to Infirmary	# of admission to infirmary	Run Practitioner Infirmary Admission in eOMIS	Admissions to Infirmary	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Discharges from Infirmary	# of discharge from infirmary	Run Practitioner Infirmary Discharge in eOMIS	Discharges from Infirmary	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Medical Observation (<23 hours)	# of residents who received 23 hour observation	Provide number from infirmary log	Medical Observation (<23 hours)	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Infirmary Care Days			Infirmary Care Days													0	0	0	0	0	0
Infirmary Average Length of stay			Infirmary Average Length of stay													0	0	0	0	0	0
Infirmary Rounds	# of provider infirmary rounds	Run Practitioner Infirmary Rounds in eOMIS	Infirmary Rounds	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Number of Extended Care Infirmary Beds	# of LTC beds in your facility	Report # of LTC beds	Number of Extended Care Infirmary Beds	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Admissions to Extended Care Infirmary	# of admissions to LTC	Provide number from LTC log	Admissions to Extended Care Infirmary	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Discharges from Extended Care Infirmary	# of discharges from LTC	Run Practitioner LTC Discharge in eOMIS	Discharges from Extended Care Infirmary	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Extended Care Infirmary Care Days			Extended Care Infirmary Care Days													0	0	0	0	0	0
Extended Care Average Length of Stay			Extended Care Average Length of Stay													0	0	0	0	0	0
Extended Care Infirmary Rounds	# of provider LTC rounds	Run Practitioner LTC Rounds in eOMIS	Extended Care Infirmary Rounds	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
ON-SITE SPECIALTY VISITS			ON-SITE SPECIALTY VISITS													0	0	0	0	0	0
Residents Receiving X-rays			Residents Receiving X-rays													0	0	0	0	0	0
Orthotic/Prosthetic Visits Completed			Orthotic/Prosthetic Visits Completed													0	0	0	0	0	0
Physical Therapy Visits Completed			Physical Therapy Visits Completed													0	0	0	0	0	0
Ultrasounds			Ultrasounds													0	0	0	0	0	0
Dialysis Treatments/ Runs			Dialysis Treatments/ Runs													0	0	0	0	0	0
Dialysis Provider Visits			Dialysis Provider Visits													0	0	0	0	0	0
Specialty Provider Consultation-onsite			Specialty Provider Consultation-onsite													0	0	0	0	0	0
OPTICAL APPOINTMENTS			OPTICAL APPOINTMENTS
Optical HSR's Received	# of HSR's received for optical services	Provide number from sick call log	Optical HSR's Received	12	7	12	8	25	21	9	7	8	8	12	8	31	54	24	28	137	34.25
Optical HSR's Referred to Optometrist			Optical HSR's Referred to Optometrist													0	0	0	0	0	0
Optical Visits Completed	# of completed dental encounters completed	Run Practitioner Optometry by provider(s) for your facility	Optical Visits Completed	23	10	11	5	23	30	9	26	0	34	15	16	44	58	35	65	202	50.5
Optical Outstanding HSR's	# of optical appointments waiting to be seen	Count the number of outstanding optical HSR's for your facility														0	0	0	0	0	0
NUTRITIONAL SERVICES			NUTRITIONAL SERVICES
Medical Diets	# of residents on a medical diet	Access the Medical Diet Authorization Log and report total medical diets.	Medical Diets	32	33	28	30	39	37	34	32	33	31	32	33	93	106	99	96	394	98.5
MEDICATION			MEDICATION
Residents on Prescription Medication	# of residents who received a prescription medication	Obtain number from pharmacy provider	Residents on Prescription Medication	377	374	384	387	387	387	377	381	380	380	382		1135	1161	1138	762	4196	1049
Residents on Psychotropic Medication	# of residents who received a psychotropic medication	Obtain number from pharmacy provider	Residents on Psychotropic Medication													0	0	0	0	0	0
Number of Non-Formulary Prescriptions	# of resident who received a non-formulary prescription	Obtain number from pharmacy provider	Number of Non-Formulary Prescriptions													0	0	0	0	0	0
Residents on emergency psychotropic medication			Residents on emergency psychotropic medication													0	0	0	0	0	0
Residents on non-emergency Involuntary Medication			Residents on non-emergency Involuntary Medication													0	0	0	0	0	0
Total # of Treatment Review Committee (non-emergency involuntary medications)			Total # of Treatment Review Committee (non-emergency involuntary medications)													0	0	0	0	0	0
INFECTION CONTROL			INFECTION CONTROL
Number on LTBI Treatment/Meds	# of residents on LTBI treatment/meds	Chronic disease log / nurse	Number on LTBI Treatment/Meds	2	0	1	1	2	2	2	2	2	2	2	0	3	5	6	4	18	4.5
New TB Positive Tests	# of PPD's positive tests		New TB Positive Tests													0	0	0	0	0	0
Active MRSA Cases	# of active MRSA cases	Provided by BioReference	Active MRSA Cases													0	0	0	0	0	0
# of Hepatitis A with active HCV (positive RNA test)			# of Hepatitis A with active HCV (positive RNA test)													0	0	0	0	0	0
# of Hepatitis B with active HCV (positive RNA test)			# of Hepatitis B with active HCV (positive RNA test)													0	0	0	0	0	0
# of new intakes with history of HCV (untreated or unknown treatment)			# of new intakes with history of HCV (untreated or unknown treatment)													0	0	0	0	0	0
# of active HCV (positive RNA) NOT currently on treatment			# of active HCV (positive RNA) NOT currently on treatment													0	0	0	0	0	0
# of Residents with HCV actively on treatment			# of Residents with HCV actively on treatment													0	0	0	0	0	0
# of Current month new positive HIV tests			# of Current month new positive HIV tests													0	0	0	0	0	0
# of HIV			# of HIV													0	0	0	0	0	0
# of patients on HIV meds during the month			# of patients on HIV meds during the month													0	0	0	0	0	0
PPDs			PPDs													0	0	0	0	0	0
# of initial PPDs placed			# of initial PPDs placed													0	0	0	0	0	0
# of initial PPDs read			# of initial PPDs read													0	0	0	0	0	0
percentage . Read divided by placed (AUTOCALC)			percentage . Read divided by placed (AUTOCALC)													0	0	0	0	0	0
Annual TB Screens/Plant	# of annual TB tests planted or screens completed (birth month)		Annual TB Screens													0	0	0	0	0	0
Annual PPDs placed			Annual PPDs placed													0	0	0	0	0	0
Annual PPDs read			Annual PPDs read													0	0	0	0	0	0
percentage . Annual Read divided by placed (AUTOCALC)			percentage . Annual Read divided by placed (AUTOCALC)													0	0	0	0	0	0
EMERGENCY MEDICAL SERVICES			EMERGENCY MEDICAL SERVICES													0	0	0	0	0	0
Medical Emergency responses within the facility			Medical Emergency responses within the facility													0	0	0	0	0	0
Naloxone deployments within the facility (given by medical staff)			Naloxone deployments within the facility (given by medical staff)													0	0	0	0	0	0
TRANSPORTS			TRANSPORTS
Ambulance emergency responses within the facility			Ambulance emergency responses within the facility													0	0	0	0	0	0
Medical Transports Scheduled	# of scheduled medical transports	Obtain from scheduler	Medical Transports Scheduled	20	29	20	26	13	15	41	36	30	33	34	36	69	54	107	103	333	83.25
Medical Transports Unscheduled	# of unscheduled medical transports	Obtain from scheduler	Medical Transports Unscheduled	0	0	1	1	2	1	0	0	1	0	1	1	1	4	1	2	8	2
Total IDOC Man Hours-Unscheduled			Total Man Hours-Unscheduled													0	0	0	0	0	0
HOSPITALIZATION			HOSPITALIZATION
# of hospital admissions	# of admissions to a hospital	Provided by UM Team	# of hospital admissions	3	2	0	0	1	4	2	1	1	1	1	0	5	5	4	2	16	4
# of inpatient hospital days			# of inpatient hospital days													0	0	0	0	0	0
# of Observation only patients			# of Observation only patients													0	0	0	0	0	0
OFF-SITE SPECIALITY CONSULTATIONS			OFF-SITE SPECIALITY CONSULTATIONS													0	0	0	0	0	0
Audiology			Audiology													0	0	0	0	0	0
Cardiology			Cardiology													0	0	0	0	0	0
Dermatology			Dermatology													0	0	0	0	0	0
Endocrinology			Endocrinology													0	0	0	0	0	0
ENT			ENT													0	0	0	0	0	0
Gastroenterology			Gastroenterology													0	0	0	0	0	0
General Surgery			General Surgery													0	0	0	0	0	0
Gynecology			Gynecology													0	0	0	0	0	0
Hematology			Hematology													0	0	0	0	0	0
Internal Medicine			Internal Medicine													0	0	0	0	0	0
Maternal Fetal Medicine			Maternal Fetal Medicine													0	0	0	0	0	0
Nephrology			Nephrology													0	0	0	0	0	0
Neurology/Neruosurgery			Neurology/Neruosurgery													0	0	0	0	0	0
Oncology			Oncology													0	0	0	0	0	0
Ophthalmology			Ophthalmology													0	0	0	0	0	0
Oral Surgeon			Oral Surgeon													0	0	0	0	0	0
Orthopedic			Orthopedic													0	0	0	0	0	0
Outpatient Surgery			Outpatient Surgery													0	0	0	0	0	0
Podiatry			Podiatry													0	0	0	0	0	0
Pulmonology			Pulmonology													0	0	0	0	0	0
Urology			Urology													0	0	0	0	0	0
Other off-site specialty consults			Other off-site specialty consults													0	0	0	0	0	0
# of Off-site Specialty Care refusals			# of Off-site Specialty Care refusals													0	0	0	0	0	0

This is the start of the file's text. The full file is on GovTribe.

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