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17 <br />ORANGE COUNTY JAIL <br />SICK CALL REQUEST <br />CC: <br />Date: Time: .am/pm <br />Officer Name __ <br />Medical Offsftc Notified: yes ` no _ Dale/'t'ime Nvtificd <br />Inmate Transported to Hospital: yes _ no __ <br />Subjective: <br />Objective: T- P-_R- <br />B/P-_ <br />Name: <br />DOB: <br />SS#: <br />W t- <br />Allergies <br />AsscssrricnC 1. S. <br />2. _ (. <br />3. ~_ 7. <br />4. 8. <br />Plan: 1. <br />h <br />3. <br />4. <br />S. <br />medication ordered <br />R`IC [or I:/U <br />RTC pm <br />!sent to ER <br />-sent for Xtay <br />-return tv jail area <br />-jail medical supervision recommended <br />^rcfcrto dental <br />-refer to psych <br />_uutsielc referral: <br />where' <br />ATTACHMENT #1 <br />