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I71.2 Attachment A Effective: 1/4/2012 Reviewed: 10/15 TDC HEALTH SERVICES DIVISION DIRECTIVE TO PHYSICIANS Directive made this day of (month, year). I, PATIENT FIRST NAME PATIENT MIDDLE UNIT PATIENT
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How to fill out TDCJ Health Services Division:

01
First, gather all the necessary information and documents. This may include personal identification, medical history, and any relevant medical records.
02
Visit the TDCJ Health Services Division website or contact their office to obtain the specific forms and instructions for filling out the required paperwork.
03
Carefully read through the instructions and guidelines provided. Make sure you understand the information being requested and any specific requirements for completing the forms.
04
Begin filling out the forms accurately and completely. Provide all the required information, ensuring that you double-check its accuracy before submitting.
05
If there are sections or questions that you are unsure about, seek clarification either from the TDCJ Health Services Division or from a trusted healthcare professional.
06
Attach any supporting documents, such as medical records or referrals, as requested by the forms.
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Review the completed forms and ensure that all the necessary fields have been filled out properly.
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If submitting the forms online, follow the instructions for submitting electronically. If mailing or delivering the forms in person, ensure they are properly packaged and addressed.
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Keep copies of all the completed forms and supporting documents for your records.
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Submit the forms and keep track of their delivery or receipt, ensuring that they have been successfully received by the TDCJ Health Services Division.

Who needs TDCJ Health Services Division:

01
Inmates within the Texas Department of Criminal Justice (TDCJ) system who require medical attention, treatment, or healthcare services.
02
TDCJ staff members who may need to access medical services or seek medical advice.
03
Individuals who have concerns or questions regarding the healthcare or medical services provided within the TDCJ system.
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The TDCJ Health Services Division is responsible for providing medical care and services to incarcerated individuals within the Texas Department of Criminal Justice.
Health care providers and medical staff within the TDCJ are required to file reports and documentation with the Health Services Division.
To fill out the TDCJ Health Services Division reports, health care providers must accurately document the medical care and services provided to incarcerated individuals.
The purpose of the TDCJ Health Services Division is to ensure that incarcerated individuals receive adequate medical care and treatment while in custody.
Information such as medical diagnoses, treatments, medications, and referrals must be accurately reported on the TDCJ Health Services Division forms.
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2012 declarants I-71 lifesustaining TDCJ HSA-58 MRN INIT declarant providers willfully sustaining artificially revoke irreversible determines withheld incurable prolonged Attachment revoked refusal PHYSICIANS DIRECTIVE voluntarily

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