BOP Program Statement 6090.04 § 8

a. Form Language. All official forms filed in the record will be in English. Form versions

available on Sallyport in other languages will be for reference only.

b. Outpatient Forms. All forms used in the outpatient record (with the exception of outside

consultant forms) will have Health Services Division, Chief of Health Information, approval to

provide a systematic, integrated record and eliminate unapproved forms from being used in health

record. The Chief of Health Information will receive all requests for revised or new forms from

the field. Forms will be submitted in final format to the Forms Manager, Policy and Information

Management Branch. Once approved, the form will be incorporated into the appropriate health

record filing format.

c. Inpatient Forms. Inpatient forms at Medical Referral Cente rs will be handled locally. See

Appendix D for the discharged chart order. Forms generated for ancillary services (physical

therapy, radiation therapy, social work, etc.) at Medical Referral Centers that are also used in

outpatient settings are authorized to be handled locally. Copies of any new and updated Medical

Referral Center forms will be sent to the Chief of Health Information for informational purposes.

d. Availability. Bureau forms are available on Sallyport.

P6090.04 3/2/2015 14

9. ADVANCE DIRECTIVES

An advance directive is “a written document, such as a living will that states the patient’s

preferences for care. It also can be in the form of a durable power of attorney for healthcare in

which the patient names another person to make medical decision on his or her behalf in the event

he or she is incapacitated” (LaTour and Eichenwald-Maki 2006). Laws governing advanced

directives are state-specific. There is no standard Bureau advance directive form. Advance

directives are state-driven.

Ordinarily, an inmate will initiate and provide the advance directive to HIM staff to file/scan into

the record. The HSA will be responsible for providing the form if the inmate cannot obtain the

form on his/her own. An alert will be placed on the EHR notifying staff o f the document’s

existence.

Advanced directives may be changed or rescinded. Health Services staff must ensure when an

inmate updates or rescinds an advanced directive, this information is filed in the document

manager and the alert updated or removed.

Any time an inmate with an advance directive is admitted to an outside healthcare facility, a copy

of the advance directive will accompany the patient to inform the receiving facility of its existence.