"County Jail/Detention Center Intakes" - Illinois

County Jail/Detention Center Intakes is a legal document that was released by the Illinois Department of Corrections - a government authority operating within Illinois.

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COUNTY JAIL/DETENTION CENTER INTAKES
Offender Name: _____________________________
IDOC#: ___________
(last, first)
Date COVID-19 Test Administered: _________________
(Must be administered 72 hours in advance of transfer)
COVID-19 Test Results received on:
_________________
☐ Positive
☐ Negative
☐ Inconclusive
(Date)
(Test results must be from a confirmatory PCR test - Rapid test shall not be utilized. Offenders with positive or inconclusive results
shall not be transferred to IDOC.)
TCO Notified by 3:00 p.m. prior to date of transfer by:
__________________________________________________
(County Representative Name)
DOC 0521, Custodial Transfer Summary Completed?
(Written proof of temperature check by trained healthcare provider on day of transfer must be documented under the medical document section for additional
medical documents provided)
No
Yes
If Yes, Date Completed: ________________
Offender has been quarantined for ___________
days prior to transfer.
Offender received 1st Dose of Vaccine on
______________________
Vaccine Brand
_________________________________
<select brand>
Offender received 2nd Dose of Vaccine on
Vaccine Brand
______________________
_________________________________
<select brand>
Offender refused Vaccine on
______________________
Date: ___________________
Form Completed By: ________________________________
COUNTY JAIL/DETENTION CENTER INTAKES
Offender Name: _____________________________
IDOC#: ___________
(last, first)
Date COVID-19 Test Administered: _________________
(Must be administered 72 hours in advance of transfer)
COVID-19 Test Results received on:
_________________
☐ Positive
☐ Negative
☐ Inconclusive
(Date)
(Test results must be from a confirmatory PCR test - Rapid test shall not be utilized. Offenders with positive or inconclusive results
shall not be transferred to IDOC.)
TCO Notified by 3:00 p.m. prior to date of transfer by:
__________________________________________________
(County Representative Name)
DOC 0521, Custodial Transfer Summary Completed?
(Written proof of temperature check by trained healthcare provider on day of transfer must be documented under the medical document section for additional
medical documents provided)
No
Yes
If Yes, Date Completed: ________________
Offender has been quarantined for ___________
days prior to transfer.
Offender received 1st Dose of Vaccine on
______________________
Vaccine Brand
_________________________________
<select brand>
Offender received 2nd Dose of Vaccine on
Vaccine Brand
______________________
_________________________________
<select brand>
Offender refused Vaccine on
______________________
Date: ___________________
Form Completed By: ________________________________