Exhibit A — USA v. Edwards et al (Dkt. 153.1)

Summary

Exhibit A, Document 153-1, filed 04/26/24 in United States v. Edwards et al., No. 6:22-cr-00201 (M.D. Fla.): a two-page checklist of the medical information needed to transport a defendant, headed with the form USM 553 and a medical summary. It asks for items such as diagnosis, current medications, allergies, tuberculosis clearance, mobility, weight and ability to handle daily activities. Further sections cover medical devices, dialysis, seizures, wheelchair use, oxygen therapy, suicide watch and any hospitalization in the last 30 days. The page names no person and records no patient data.

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Record facts

Full text

EXHIBIT A  
The Medical Information required to transport the Defendant includes: 
USM 553 with medical summary to include: 
•
Medical Diagnosis
•
Current Medication(s)
•
Food/Medication Allergies
•
Current TB clearance (date & result)
•
Ambulatory status
o Walk independently?
o Climb stairs independently?
o Currently using any assistive devices? Will they be sent with?
•
Current weight
•
Independent with Activities of Daily Living (ADLs: eating, bathing, dressing,
toileting)?
•
Behavioral issues
•
Any other information that would be helping in the transportation and care of
this inmate
Additional information 
•
Any medical devices?
o Cardiac monitors, CPAPs, wound vacs, PICC lines, prosthetics,
colostomies, catheters, etc
•
Dialysis info
o Access site
o Schedule
o 1-2 weeks of dialysis run sheets or contact info of where these can be
requested from
•
Seizure info:
o Date of last seizure, if within the last 4 weeks
▪
Type, duration, rescue meds if required, etc
o Any changes to seizure medication in the last 4 weeks
•
Wheelchair info
o Does the prisoner have their own wheelchair, if so, Is it powered or
manual
o Is the prisoner able to transfer themselves in/out of wheelchair
•
Oxygen therapy
o How many LPM
o Is it continuous
Case 6:22-cr-00201-AGM-LHP     Document 153-1     Filed 04/26/24     Page 1 of 2 PageID
711

2 
o What route
o Does the inmate have their own concentrator, if so need make/Model
•
Suicidal
o Is the prisoner currently on suicide watch, mental health observations,
or other continuous observation
o If not currently on any type of watch, when was last watch (if
applicable)
o What suicidal or self-harm tendencies does the prisoner have
•
Recent Hospitalization
o If the inmate has been in the hospital in the last 30 days, please provide
hospital discharge paperwork that includes any test results, physician
notes, etc. The patient version of a discharge summary does not suffice.
Case 6:22-cr-00201-AGM-LHP     Document 153-1     Filed 04/26/24     Page 2 of 2 PageID
712

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gov.uscourts.flmd.408844.153.1.pdf

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gov.uscourts.flmd.408844.153.1.pdf

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