DOC ADMISSION / DISCHARGE REPORT

PLEASE PRINT FULL NAME:

ID

/ DATE:
LAST NAME / FIRST NAME / MIDDLE NAME / TIME:
FROM UNIT AND ASSIGNMENT: / TO UNIT AND ASSIGNMENT: /

CODE:

MSP: / MSP: / DOC
Unit / LHU-1 LHU-2 HSU 1HSU-2 MHTUHSU-2UAUA/DRUBUB/DRUB MHTUUCUC/DRUDMDIUMDIU/MASC HOLDINFIRMARYDairyWRCDOC Lewistown InfirmaryDETENTIONPHC-CDPHC-DDBMPBIPSMPISO / Unit / LHU-1LHU-2HSU 1HSU-2 MHTUHSU-2UAUA/DRUBUB/DRUB MHTUUCUC/DRUDMDIUMDIU/MASC HOLDINFIRMARYDairyWRCDOC Lewistown InfirmaryDETENTIONPHC-CDPHC-DDBMPBIPSMPISO / MSP
Assignment / Assignment / MWP
MWP: / ICP - Intensive Challenge Program / MWP: / BASC-Blgs Ass. and Snctn CtrICP - Intensive Challenge Program
Pod / InfirmaryIntakeA-PODB-PODC-PODD-PODE-PODF-PODG-PODH-PodDETENTIONPHC/CDPHC/DD Cell Bed / Pod / InfirmaryIntakeA-PODB-PODC-PODD-PODE-PODF-PODG-PODH-PodDETENTIONPHC/CDPHC/DD Cell Bed / RPC
Regional Prison: / CCC-SHELBYDCCF-GLENDIVEGFRP-Great FallsOther - / Regional Prison: / CCC-SHELBYDCCF-GLENDIVEGFRP-Great FallsOther - / CD**
Pod / A-PODB-PODC-PODD-PODE-PODF-PODG-PODS DORMBookingMedicalSMU-Special Mgmt UnitCACBCCCDHC1-Holding Cell 1HC2-Holding Cell 2SR-Safe RoomPHCPHC-1PHC-2DetentionPHC-CDPHC-DD / Pod / A-PODB-PODC-PODD-PODE-PODF-PODG-PODS DORMBookingMedicalSMU-Special Mgmt UnitCACBCCCDHC1-Holding Cell 1HC2-Holding Cell 2SR-Safe RoomPHCPHC-1PHC-2 DetentionPHC-CDPHC-DD / DD**
MASC / 9011 - Assessment9012 - Jail Hold9013 - Sanction9014 - Diversion9015 - MASC-Hold to MDIU9016 - MASC-Hold to CCC New InmateProb ViolProb Viol w/ New SentP V / MASC / 9011 - Assessment9012 - Jail Hold9013 - Sanction9014 - Diversion9015 - MASC-Hold to MDIU9016 - MASC-Hold to CCC
Hospital / Anaconda HospitalBillings - DeaconessBillings - St. Vincent'sCommunity - MissoulaDeer Lodge Medical CenterFort Harrison - HelenaGlendive Medical CenterGreat Falls - Benefis EastGreat Falls - Benefis WestShelby - Marias Health CareSt. James - ButteSt. Patrick's - MissoulaOther - / Hospital / Anaconda HospitalBillings - DeaconessBillings - St. Vincent'sCommunity - MissoulaDeer Lodge Medical CenterFort Harrison - HelenaGlendive Medical CenterGreat Falls - Benefis EastGreat Falls - Benefis WestShelby - Marias Health CareSt. James - ButteSt. Patrick's - MissoulaOther -Anaconda HospitalBillings - DeaconessBillings - St. Vincent'sCommunity - MissoulaFort Harrison - HelenaGlendive Medical CenterGreat Falls - Benefis EastGreat Falls - Benefis WestPowell County-Deer LodgeShelby - Marias Health CareSt. James - ButteSt. Patrick's - MissoulaOther - / HOLD
Cond. Release / Vio.5001 - Anaconda5002 - Billings5003 - Bozeman5004 - Butte5005 - Cut Bank5006 - Dillon5007 - Glasgow5008 - Glendive5009 - Great Falls5010 - Hamilton5011 - Hardin5012 - Havre5013 - Helena5014 - Kalispell5015 - Lewistown5016 - Libby5017 - Livingston5018 - Miles City5019 - Missoula5020 - Polson5021 - Shelby5022 - Sidney5023 - Th. Falls5101 - Out of State / Conditional Release / 5001 - Anaconda5002 - Billings5003 - Bozeman5004 - Butte5005 - Cut Bank5006 - Dillon5007 - Glasgow5008 - Glendive5009 - Great Falls5010 - Hamilton5011 - Hardin5012 - Havre5013 - Helena5014 - Kalispell5015 - Lewistown5016 - Libby5017 - Livingston5018 - Miles City5019 - Missoula5020 - Polson5021 - Shelby5022 - Sidney5023 - Th. Falls5101 - Out of State
OLTC / BedsideCourtFederal CourtFire CrewFuneralIAD - CourtUS ImmigrationOther - / OLTC / BedsideCourtFederal CourtFire CrewFuneralIAD - CourtUS ImmigrationOther - / CUSTODY:
MSH-WS / MSH-WS / MIN 2
Pre-Release / Pre-Release / Inmate Worker / MIN 1
6461-Gt Falls Transition Ctr. (Male)6461A-Gt Falls Transition Center-Aftercare6463-Missoula Corr. Services (Male)6465-Butte Comm. Cor. (Male)6464-Billings Alpha House (Male)6469-Helena Pre-Release(Male)6474-Gallatin Co Pre Release (Bozeman Male)6466-Butte Comm. Cor. (Female)6463-Missoula Corr. Services (Female)6461-Gt Falls Trans. Ctr. (Female)6476-PASSAGES Pre-Release (Female)Other - / 6461-Gt Falls Transition Ctr. (Male)6461A-Gt Falls Transition Center-Aftercare6463-Missoula Corr. Services (Male)6465-Butte Comm. Cor. (Male)6464-Billings Alpha House (Male)6469-Helena Pre-Release(Male)6474-Gallatin Co Pre Release (Bozeman Male)6466-Butte Comm. Cor. (Female)6463-Missoula Corr. Services (Female)6461-Gt Falls Trans. Ctr. (Female)6476-PASSAGES Pre-Release (Female)Other - / MED 2
ISP / 7102 - Billings7106 - Bozeman7107 - Butte7108 - Glendive7103 - Great Falls7104 - Kalispell7105 - MissoulaOther- / ISP / 7102 - Billings7106 - Bozeman7107 - Butte7108 - Glendive7103 - Great Falls7104 - Kalispell7105 - MissoulaOther / MED 1
TSCTC-Trainee Probation / TSCTC-TraineeProbation / CLOSE
Treatment Programs9502-WATCH Warm Springs9503-WATCH Glendive9041-PASSAGES ASC9043-PASSAGES Sanction9044-PASSAGE Revocation9045-Passages ASC Hold 6475-PASSAGE ADT6467-Connections Corrections-BUTTE6473-Connections Corrections-Warm SpringsELKHORN-METH-BOULDER (F)MCDC Montana Chemical Dep CenterNEXUS-METH-LEWISTOWN (M) / Treatment Programs9502-WATCH Warm Springs9503-WATCH Glendive9041-PASSAGES ASC9043-PASSAGES Sanction9044-PASSAGE Revocation9045-Passages ASC Hold 6475-PASSAGE ADT6467-Connections Corrections-BUTTE6473-Connections Corrections-Warm SpringsELKHORN-METH-BOULDER (F)MCDC Montana Chemical Dep CenterNEXUS-METH-LEWISTOWN (M) / MAX
Transfer / Transfer / AD SEG
Escape Apprehended State: / Escape Apprehended State:
Parole Violator New ConvictionTechnical Violation / Release / ParoleProbationDischargeDisch - Bal SSDisch-Bal SS- RemainBondCommutation of SentenceDeathDiversionFederal JurisdictionNew Court OrderOther State Jurisdiction / REST
AD SEG
Probation Violator RDSRSSw/ New Sentence
STARTCenterRevocationSanctionMASC DiversionMASC HoldAdmin TransfersMental HealthInmate Worker New InmateP VProb Viol w/ New SentProb ViolPrRel ViolCond Release / START Center RevocationSanctionMASC DiversionMASC HoldAdmin TransfersMental HealthInmate WorkerNew InmateP VProb Viol w/ New SentProb ViolPrRel ViolCond Release
In Transit / In Transit
New Inmate
10-Day Furlough / 10-Day Furlough
Other / Community Worker (Fire Crew)Community Worker (Truck) / Other / Community Worker (Fire Crew)Community Worker (Truck)
**Notify the Infirmary and Mental Health when PHC , DD or CD

Health Services clearance

/ Yes No (If No, attach Special Needs Treatment Plan)
COMMENTS:
STAFF MEMBER’S NAME / SIGNATURE: / L LAMBERTSON / /
It is mandatory that all ADR’s are turned into the Placement/Movement Office when a move is made. All ADR’s are filled out by the sending unit with the exception of a jail hold & Infirmary, which will be filled out by the receiving unit. Information must be complete with housing unit and job assignment number and including title.
cc:RECORDS – WHITEMINI FILE – CANARYREV. 1/12