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is <br />ORANGE COUNTY.JAIL <br />SICK CALL REQUEST <br />cc: <br />Date: Time: .am/pm <br />Oflicct Narnc __ <br />Medical OCfsite Noti6cd: yes ~ no _ Uate/ i"ime Notified <br />Inmate Transported to Hospital: yes _ no __ <br />Subjective: <br />Objective: T- P-_R-_B/P- Wt- Allergies <br />AsscssrticnG 1. S. <br />2. _ C,. <br />.3. ~^_ 7, <br />4. R. <br />Plan: 1. <br />2. <br />.3. <br />4. <br />S. <br />mcdicatinn ordered <br />RTC for P/U <br />_RTC prn <br />-sent to ER <br />-sent for Xray <br />Provider Sivnahirc: <br />Name: <br />DOB: <br />SS#: <br />-return to jail area <br />-jail medical supervision recommended <br />-refer to dental <br />_rc(cr to psych <br />-outside referral: <br />where: <br />ATTACHMENT #1 <br />Tlalr Tirnr ~m/nm <br />