| Term 
 
        | Inmate initiated health care visits meeting the guidelines set henceforth require a co-payment of _______ and inmate initiated emergency visits outside the normal sick call by procedures system shall be subject to a ________ dollar co-payment. |  | Definition 
 
        | five (5) dollar   and   seven (7) dollar |  | 
        |  | 
        
        | Term 
 
        | Inmates who are declaring an emergency accrue a co-pay if they are screened and determined to be an emergency. T/F |  | Definition 
 
        | False - they will not accrue a co-pay |  | 
        |  | 
        
        | Term 
 
        | Facilities accredited by NCCHC and/or ACA operating 24 hours/7 days a week, must have Sick Call requests reviewed and triaged _____. |  | Definition 
 | 
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        | Term 
 
        | Facilities that are NOT accredited and do NOT have daily medical coverage will conduct Sick Call reviews and triage |  | Definition 
 
        | on a day when a RN is present at the facility |  | 
        |  | 
        
        | Term 
 
        | In facilities with 7-day nursing care, inmates in segregation will receive a visit ____ from a trained or licensed healthcare staff member (RN, LPN, CHAII, NAII) to assure health and well-being are maintained. |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | For units without 7-day nursing care, inmates in segregation will receive a visit _______ from a trained or licensed healthcare staff member |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | Medical Segregation Screening should be completed by licensed nurse or provider at the time of placement into segregation, or within ___? |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | is defined as threat to life and/or limb |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | If inmate declares an emergency and it is determined  by the nurse not to be an emergency, the inmate will be told to |  | Definition 
 
        | Submit a Sick Call request |  | 
        |  | 
        
        | Term 
 
        | If further evaluation and/or treatment are delivered and the situation is not a valid emergency, the applicable co-payment _____ will be charged. |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | Possible blood-borne pathogen exposure Staff member will be referred to the closest major hospital emergency department and/or the closest approved Comp Care Facility for treatment. T/F
 |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | Health Services staff may not provide emergency medical treatment to DOC employees whenever necessary to protect life or limb and relieve undue suffering using standing orders from Emergency Protocols for urgent care only. T/F |  | Definition 
 
        | False nursing staff may assist |  | 
        |  | 
        
        | Term 
 
        | Health services staff may be requested by facilities to assess employees after an incident or accident at the facility and stabilize with first aid, which may be recorded on _______? |  | Definition 
 
        | on the DOC-WC-4 "Employees Initial Report of Injury" (worker's compensation form) |  | 
        |  | 
        
        | Term 
 
        | Co-payment fees deducted will never take the inmates trust fund account balance below |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | When deposits are made into the inmates account, no more than ______ of a deposit will be taken to pay a co-payment balance. |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | Sick Call Encounters Incurring No Charge - |  | Definition 
 
        | Dental examinations instituted by the DOP Health Services staff, One (1) inmate-initiated sick call visit for the same chief complaint, that inmate has been seen for within last fourteen (14) calendar days
 Up to two (2) visits initiated by a health care provider for follow-up care for the original chief complaint, with the nurse or next level of provider
 Emergency care to include inmates on outside job assignments that are directed by their State of North Carolina supervisors to an emergency room or urgent care provider for evaluation of a potentially life or limb threatening injury, allergy, or illness
 Work related incidents, provided Form DC-193 is completed                          and submitted at the time of the visit
 |  | 
        |  | 
        
        | Term 
 
        | Inmates who are declaring an emergency accrue ______ if they are screened and determined NOT  to be an emergency if no treatment is provided |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | Nutritionally balanced loaf-style form                                of nourishment utilized for inmates on segregation status that display disruptive behavior known as |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | Custody Unit Manager or OIC will notify Medical immediately when a Special Management Meal is approved True or False
 |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | If the inmate is not on a therapeutic diet, then a medical provider or nurse may be the approving medical authority for placing an inmate on a Special Management Meal. T/F
 |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | Medical staff making medical determination will also review the inmate’s Mental Health grade, and if listed as _____, must notify the facility’s psychological staff that the inmate is subject to being placed on the Special Management Meal diet |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | Every ______ days inmates admitted to the Palliative Care Units (PCU) must be evaluated by a Palliative Care provider and recertified that they continue to meet the criteria. |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | This is to provide interdisciplinary and comfort oriented care for seriously ill dying inmates, that allows these inmates to live their final days with dignity, the highest level of function possible, and the least amount of adverse symptoms. |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | This factor relates to general physical function. It is impacted by medical, dental, and mental health conditions which do not fall under other specific factors of the system. |  | Definition 
 
        | P - Physical capacity or stamina |  | 
        |  | 
        
        | Term 
 
        | This factor relates to the hands, arms, shoulder girdle, and upper back in regard to strength, rage of motion, and general efficiency. |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | This spine factor relates to the feet, legs, pelvic girdle, lower back musculature, and lower back in regards to strength, range of motion, and general efficiency. |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | This factor relates to visual acuity, diseases, and defects of the eye. |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | This factor relates to visual acuity, disease, and defects of the eye. |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | This overall factor relates to institutional assignment and limitations affecting an inmate's ability to participate in jobs, programs, activities, and services |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | This factor relates to the designation as to whether special transportation requirements exist due to the inmate's health condition. |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | This factor relates to all dental or dental related health issues. |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | This factor relates to an individual's mental health status and the presence of any sign of mental illness |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | This factor relates to the extent of intellectual impairment or adaptive behavior deficit. |  | Definition 
 | 
        |  | 
        
        | Term 
 
        | PULHEATDMR stands for what? |  | Definition 
 
        | P-Physical capacity or strength U-Upper Extremities
 L-Lower Extremities
 H-Hearing and Ears
 E-Eyes
 A-Activity Grade
 T-Transportation
 D-Dental
 M-Mental Health
 R-Retardation
 |  | 
        |  | 
        
        | Term 
 
        | PULHEAT numerical system meanings for P 1-5 are |  | Definition 
 
        | P1 - Normal physical stamina P2 - Minimal physical stamina deficit
 P3 - Moderate physical stamina deficit
 P4 - Severe physical stamina deficit
 P5 - Pregnant inmate
 |  | 
        |  | 
        
        | Term 
 
        | PULHEAT numerical system meaning for U 1-4 are: |  | Definition 
 
        | U1 - No significant disability U2 - Minimal disability
 U3 - Moderate disability
 U4 - Severe disability
 |  | 
        |  | 
        
        | Term 
 
        | PULHEAT numerical system meaning for L 1-4 are: |  | Definition 
 
        | L1 - No significant disability L2 - Minimal disability
 L3 - Moderate disability
 L4 - Severe disability
 |  | 
        |  | 
        
        | Term 
 
        | PULHEAT numerical system meaning for H 1-4 are: |  | Definition 
 
        | H1 - no obvious loss of hearing H2 - Total unilateral hearing loss
 H3- Total hearing loss in one ear and moderate loss in the other
 H4 - Severe loss of hearing (Deaf)
 |  | 
        |  | 
        
        | Term 
 
        | PULHEAT numerical system meaning for E 1-4 are: |  | Definition 
 
        | E1 - No less that 20/50 corrected E2 - Vision in better eye is 20/50 and 20/200
 E3 - Better eye 20/200
 E4 - Less than 20/200 in better eye (blind)
 |  | 
        |  | 
        
        | Term 
 
        | PULHEAT numerical system meaning for A 1-5 are: |  | Definition 
 
        | A1 - Unrestricted Activity A2 - Minor restrictions (6-8 hr per day)
 A3 - Moderate restrictions (4-6 hrs per day)
 A4 - Severe restrictions (2-4 hrs per day)
 A5 - Extremely limited participation less than 2 hours per day.
 |  | 
        |  | 
        
        | Term 
 
        | PULHEAT numerical system meaning for T 1 and 5 are: |  | Definition 
 
        | T1 - No special transportation requirements T5 - Special transportation needs exist
 |  | 
        |  | 
        
        | Term 
 
        | PULHEAT numerical system meaning for D 1-4 are: |  | Definition 
 
        | D1 - No pressing dental requirements D2 - Need routine treatment
 D3 - need extensive dental treatment
 D4 - require immediate attention needed
 |  | 
        |  | 
        
        | Term 
 
        | PULHEAT numerical system meaning for M 1-5 are: |  | Definition 
 
        | M1 - no disorder or impairment M2 - Relatively mild impairment
 M3 -
 |  | 
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