BOP Program Statement 6270.02 § 5

OR TREATMENT COMPLETE REFERRAL (413) REQUESTS

All transfer requests for medical, surgical, or psychiatric re-designations will be completed in the

Electronic Health Record (EHR) on a Re-Designation Referral Request (770) or on a Treatment

Complete Referral Request (413) unless the inmate is in community custody, then a medical BP-

A0770, Medical/Surgical and Psychiatric Referral Request (770) will be used.

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 The determination as to whether an inmate is approved for re-designation depends on the 770

or 413 being completed thoroughly. If a 770 or 413 request does not include the necessary

information for OMDT to make a determination, OMDT will defer the request and the

institution will be responsible for submitting a new request with the required documentation.

 Institutions are responsible for scheduling and continuing all medically necessary treatment

and ongoing medical care for inmates who have been approved for re-designation by OMDT,

but who have not physically transferred to the receiving facility. Failure to provide necessary

treatment while awaiting physical transfer after re-designation could result in a delay in care.

a. Re-Designation Referral Request (770). A 770 provides all the designation, transportation,

and security information required to complete a designation. It is used in the following

circumstances:

 Re-designation to a higher level of medical or mental health care (i.e., Medical Care

Level 3 facility, MRC, or Mental Health Care Level 4 facility).

 To request a transfer of a Medical Care Level 3 or 4 inmate to another Medical Care

Level 3 or 4 facility, or to request transfer from a Medical Care Level 4 to a Medical Care

Level 3 facility.

 Emergency referral requests.

The Clinical Director, Chief Psychologist, and HSA will ensure all essential medical, surgical, or

psychiatric information is documented on the 770 to assist OMDT and the receiving MRC in

processing transfers.

 The institution provider or staff member will initiate the 770 with input from other

providers involved with the inmate’s care (e.g., Advanced Practice Providers,

Psychologists, Medical Officers, Nurses, Physical Therapists, Consultant Physicians).

 The Clinical Director and HSA must review the 770, authorize the transmission of the

request, and notify the institution Warden a request for transfer has been submitted.

 The 770 is electronically sent to OMDT in the EHR for initial review.

Procedures for review of Medical 770 requests.

 Care Level 3 requests are assigned to the Regional Medical Director (RMD) for their

concurrence or disapproval. The 770 is then assigned to the OMDT Medical Designator

for a final review and determination. If the OMDT Medical Designator and the RMD

have differing recommendations, the 770 will be electronically sent to the CHP in the

EHR for final determination.

 Care Level 4 requests are reviewed by the assigned Medical Designator. The Medical

Designator may approve the request; however, all recommendations for disapproval are

referred to the CHP for final determination.

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 All determinations are based on a thorough review of clinical information, and the

inmate’s EHR.

 When there are dissenting recommendations, OMDT will facilitate a meeting attended by

the CHP, RMD, Chief, OMDT, and Medical Designator to discuss complicated requests

containing refusals of care, non-compliance, end of life, or other relevant clinical issues.

 The Medical Designator, in consultation with the CHP, may change the urgency of the

request.

Procedures for review of Mental Health 770 requests.

 Care Level 4 requests are reviewed by the assigned Medical Designator and sent to the

Bureau Chief Psychiatrist for final determination.

 All determinations are based on a thorough review of clinical and psychiatric

information, as well as the inmate’s EHR.

 The Medical Designator, in consultation with the Chief Psychiatrist may change the

urgency of the request.

If an inmate is approved for medical re-designation, the Medical Designator will select the most

appropriate Care Level 3 facility or MRC based on the following:

 Inmate’s medical needs

 Security/custody level

 Central Inmate Monitoring System (CIMS) considerations (e.g., separatees)

 Custodial concerns

 Care Level 3/MRC bed space availability

 Proximity to the inmate’s primary residence. A facility as close to or, to the extent

practicable, within 500 driving miles of the inmate’s primary residence will be chosen.

OMDT will review the recommended mode of transportation on the 770. The mode of

transportation may be modified by OMDT after consultation with the referring Clinical Director

and the receiving MRC. The Clinical Director at the referring institution will determine the type

of health care provider, if necessary, to act as a medical escort staff.

 OMDT will send all approvals or disapprovals for transfer via email to the referring and

receiving institutions. The authorized transport date or denial comments, along with other

details, can be found in the applicable Bureau inmate management system.

 Once an appropriate bed is available and a transfer date identified by the receiving MRC,

OMDT will prepare a Transportation Authorization memorandum and route it via email

to the originator, as well as the receiving MRC.

 OMDT will verify all transfers and authorize the use of appropriate funds.

 The referring institution is responsible for all trip arrangements including any necessary

durable medical equipment required as well as custodial and medical escort staff.

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Emergency referrals will be referred to the most appropriate MRC based on:

 Available medical resources

 Proximity to the sending institution

 Security/custody needs

 Custodial concerns

 Bed space availability

b. Treatment Complete Referral Request (413). A 413 request serves as the notification that

medical or mental health treatment has been completed and provides all of the designation,

transportation, and security information required to complete a re-designation to a Medical Care

Level 1 or 2 facility or a Mental Health Care Level 1, 2, or 3 facility. MRCs and Care Level 3

institutions will be directed to complete a Medical 413 when NURAB determines treatment is

complete.

 413 requests must be completed in conjunction with Unit Team who will provide

pertinent custodial information:

 recommended facility

 current charge/offense

 additional Unit Team recommendations and special considerations

 The Clinical Director, Chief Psychologist, and HSA will ensure all essential medical,

surgical, or psychiatric information is documented on the 413 to assist OMDT and the

receiving institution in processing transfers. The 413 must document the following

information:

 the inmate’s current condition and treatment history

 reason for MRC/Care Level 3 designation (originally)

 course of treatment

 follow-up care required

 An institution provider or staff member will initiate the 413 with input from other

providers involved with the inmate’s care (e.g., Advanced Practice Providers,

Psychologists, Medical Officers, Nurses, Physical Therapists, Consultant Physicians).

 The Clinical Director and HSA must review the 413, sign the request for transfer, and

notify the institution Warden of the request for transfer.

The 413 is electronically sent to OMDT in the EHR for initial review.

Procedures for review of Medical 413 requests.

 Care Level 3 requests are reviewed by the assigned Medical Designator who may

approve the request; however, all recommendations for disapproval are referred to the

CHP for final determination.

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 Care Level 4 requests are first reviewed by the assigned Utilization Review Nurse

Consultant (URNC) for a determination, then electronically assigned to the Medical

Designator for a final review. If the Medical Designator and the URNC have differing

opinions, the CHP will make the final determination.

 When there are dissenting recommendations, OMDT will facilitate a meeting attended by

the CHP, URNC, Chief, OMDT, and Medical Designator to discuss complicated requests

containing refusals of care, non-compliance, or other relevant clinical issues.

If an inmate is approved for a treatment complete re-designation, the Medical Designator will

complete the designation to a Care Level 1 or Care Level 2 facility.

OMDT will send all approvals or disapprovals via email to the referring and receiving

institutions. Approval or denial comments, along with other details can be found in the applicable

Bureau inmate management system.

Procedures for review of Mental Health 413 requests.

 Care Level 4 requests are first reviewed by the assigned Medical Designator in

conjunction with the Mental Health Treatment Coordinator who will confirm the Mental

Health Care Level and provide a Care Level designation recommendation

If an inmate is approved for a treatment complete re-designation, the Medical Designator will

complete the designation to the appropriate facility.

OMDT will send all approvals or disapprovals via email to the referring and receiving

institutions. Approval or denial comments, along with other details can be found in the applicable

Bureau inmate management system.

For guidance regarding OMDT Redesignations, refer to the OMDT Redesignation Requests

Guide, which can be located on the Health Programs page under the Health Services Division of

the Bureau’s intranet site.