Preventive Health Care
Federal Bureau of Prisons
Clinical Practice Guidelines

April 2013

Clinical guidelines are made available to the public for informational purposes only. The
Federal Bureau of Prisons (BOP) does not warrant these guidelines for any other purpose, and
assumes no responsibility for any injury or damage resulting from the reliance thereof. Proper
medical practice necessitates that all cases are evaluated on an individual basis and that treatment
decisions are patient specific. Consult the BOP Clinical Practice Guidelines Web page to
determine the date of the most recent update to this document:
http://www.bop.gov/news/medresources.jsp

Federal Bureau of Prisons
Clinical Practice Guidelines

Preventive Health Care
April 2013

What’s New in the Document?
April 2013 Revisions:
In this new version of the Preventive Health Care guidelines, Appendix 7 has been added with four
Preventive Health forms that are also available on Sallyport:

•
•
•
•

BP-A0891:
BP-A0890:
BP-A0889:
BP-A0892:

Preventive Health Summary – Males (BP-S891.060: Instructions)
Preventive Health Summary – Females (BP-S890.060: Instructions)
Preventive Health Risk Assessment Tool – Males
Preventive Health Risk Assessment Tool – Females

Other revisions since the April 2007 version of the BOP Clinical Practice Guidelines for Preventive
Health Care are outlined below—including those in the July 2012, July 2011, December 2010, and April
2009 versions. Except where otherwise noted, these changes were primarily based on updated guidance
from the U.S. Preventive Services Task Force (USPSTF).

July 2012 Revisions:
Mammogram screening: Biennial mammogram screening is recommended from age 40 years for women
with increased risk for breast cancer, and from ages 50 through 74 years for women with average risk.
Osteoporosis screening: The following intervals are recommended for bone mineral density (BMD)
screening in women:
• Normal BMD (T score of 1.00 or higher) or mild osteopenia (T score of 1.01 to -1.49)  screen every
15 years
• Moderate osteopenia (T score of -1.50 to -1.99) on BMD testing  screen every 5 years
• Advanced osteopenia (T score of -2.00 to -2.49) on BMD testing  screen every year
Cervical cancer screening: Recommendations for cervical cancer screening are as follows:
• Women ages 21–65 years  screen every 3 years with cytology (Pap smear), without human
papillomavirus (HPV) testing
• Women ages 30–65 years  screen with cytology every 3 years or combination of cytology and HPV
testing every 5 years
Tdap vaccine: It is recommended that pregnant women receive a tetanus, diphtheria, and acellular
pertussis (Tdap) booster, preferably after 20 weeks of gestation, to protect infants from pertussis via
transfer of protective maternal antibodies. It is also recommended that all inmates who have never
received the Tdap vaccine be administered a one-time Tdap dose at the baseline visit.
Hepatitits B vaccine: Hepatitis B vaccination is recommended for adults with diabetes who are younger
than age 60 years.
Oral cancer screening: It is recommended that clinicians conduct oral cancer screening by directly
inspecting and palpating the oral cavity in adults age > 55 who have a history of HPV, sun exposure,
alcohol and tobacco use.

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Clinical Practice Guidelines

Preventive Health Care
April 2013

July 2011 Revisions:
•

Osteoporosis screening: Recommendations for screening have been extended to women younger
than age 65 whose fracture risk is equal to or greater than that of a 65-year-old white woman who has
no additional risk factors.

•

MMR vaccine: It is recommended that a pregnancy test be given at intake to women of childbearing age who report never having received the MMR vaccine as an adult, prior to administering
the vaccine.

•

Tdap vaccine: There is no longer an upper age limit for the use of the Tdap (Tetanus-DiptheriaPertussis) vaccine.

December 2010 Revisions:
• Diabetes screening: Hemoglobin A1C testing now may be used for both screening and diagnosing
diabetes, with a cut point of >6.5% being diagnostic for diabetes. The BOP recommendations have
been changed to align with the American Diabetes Association’s Standards of Medical Care in
Diabetes – 2010.
•

Hepatitis B screening: Several different screening strategies have been recommended, depending
upon the clinical context and goal for screening, such as pre-vaccination screening and screening to
detect chronic HBV. Various serologic markers, alone or in combination, have been proposed for this
purpose, including: anti-HBc alone or in combination with HBsAg, and HBsAg alone or in
combination with anti-HBs. For the purpose of screening federal inmates for HBV infection, the
combination of HBsAg and anti-HBs should be performed. Additional HBV serologic tests may be
warranted depending on the inmate’s medical history. The BOP recommendations have been
changed to align with the latest recommendations from the Centers for Disease Control and

Prevention.
•

Folic acid: All females of child-bearing age should be counseled to consider taking folic acid, which
they can purchase as an OTC drug through the commissary.

•

Vision acuity in older adults: Vision screening in older adults is not effective in identifying
common pathologies and is not routinely recommended.

April 2009 Revisions:
•

HIV screening: Routinely encourage HIV testing for all sentenced inmates who have not been
previously tested in the BOP.

•

Colorectal cancer screening: BOP and USPSTF recommend fecal occult blood testing (FOBT) for
average risk persons, beginning at age 50. It is emphasized that three FOBTs annually are necessary
to achieve adequate sensitivity for cancer screening. Routine screening for colorectal cancer
screening should cease at age 75. Updated American Cancer Society/American Gastroenterological
Association guidelines for screening persons who are at increased risk for colorectal cancer are
included in the current document.

•

Diabetes screening: The USPSTF has concluded that there is only one group of asymptomatic,
individuals for whom routine diabetes screening is warranted: those with a blood pressure greater
than 135/80 (treated or untreated). Screening should also be performed as clinically warranted,
including for hyperlipidemia, cardiovascular disease, peripheral vascular disease, history of
gestational diabetes, or history of polycystic ovary disease.

•

Blood pressure screening: Inmates with borderline blood pressure elevations (systolic
120–139; diastolic 80–90) should be screened annually.

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Clinical Practice Guidelines

Preventive Health Care
April 2013

•

Screening for lipid disorders: Routine screening of average-risk women is no longer recommended.

•

Aspirin for CVD prevention: Risk-based guidance is provided on whether or not to recommend
aspirin, based on the risk of CVD in men and the risk of stroke in women, as compared against the
risk of gastrointestinal hemorrhage. For men, calculate the 10-year risk of CVD every 5 years,
beginning at age 45. For women, calculate the 10-year risk of stroke every 5 years, beginning at
age 55. Links to risk calculators are provided in this document. (Please see the BOP Management of
Diabetes Clinical Practice Guidelines for recommendations about treating diabetic inmates with
aspirin.)
Risk Level at Which Prevented CVD Events (“Benefit”) Exceed GI Harms
Men: 10-year CHD risk
Age 45–59 years >4%
Age 60–69 years >9%
Age 70–79 years >12%

Women: 10-year stroke risk
Age 55–59 years >3%
Age 60–69 years >8%
Age 70–79 years >11%

•

Pneumococcal vaccine is no longer recommended routinely for Native Americans/Alaskan Natives.
Pneumococcal vaccine is now recommended for inmates with asthma, cerebrospinal fluid leaks, or
chronic alcoholism, and those who are long-term care residents. For inmates with newly diagnosed
HIV-infection, pneumococcal vaccine should be administered as close as possible to the time of
diagnosis.

•

Meningococcal vaccine is recommended for inmates with asplenia, i.e., sickle cell disease.

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Federal Bureau of Prisons
Clinical Practice Guidelines

Preventive Health Care
April 2013

Table of Contents
1. Purpose .................................................................................................................................6
2. Preventive Health Care Overview .......................................................................................6
3. Preventive Health Care Scope of Services ...........................................................................6
Intake ...................................................................................................................6
Prevention Baseline Visit .....................................................................................7
Prevention Periodic Visits ...................................................................................8
4. Preventive Health Care Delivery .........................................................................................9
5. Preventive Health Care Program Evaluation ......................................................................9

Appendices
Appendix 1. Preventive Health Care – Intake Parameters................................................... 10
Appendix 2. Federal Bureau of Prisons – Preventive Health Care Scope of Services
for Sentenced Inmates ....................................................................................... 11
Appendix 3. Preventive Health Care Guidelines by Disease State ....................................... 13
A. Infectious Disease Screening ........................................................................ 13
Hepatitis B Viral Infection ......................................................................... 13
Hepatitis C Viral Infection ......................................................................... 13
HIV-1........................................................................................................ 13
HIV-2........................................................................................................ 14
Sexually Transmitted Diseases .................................................................. 14
Tuberculosis .............................................................................................. 14
B. Cancer Screening ......................................................................................... 15
Breast Cancer ............................................................................................ 15
Cervical Cancer ......................................................................................... 15
Ovarian Cancer ......................................................................................... 15
Oral Cancer ............................................................................................... 15
Prostate Cancer ......................................................................................... 15
Colorectal Cancer ...................................................................................... 15

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April 2013

C. Chronic Diseases/Lifestyle ........................................................................... 18
Abdominal Aortic Aneurysm ..................................................................... 18
Aspirin for CHD & Stroke Risk ................................................................. 18
Diabetes Mellitus ...................................................................................... 18
Hypertension ............................................................................................. 18
Lipids ........................................................................................................ 18
Obesity ...................................................................................................... 19
Folic Acid ................................................................................................. 19
Substance Abuse ....................................................................................... 19
D. Sensory Screening ........................................................................................ 19
Vision ....................................................................................................... 19
Hearing ..................................................................................................... 19
E. Immunizations .............................................................................................. 20
Hepatitis A ................................................................................................ 20
Hepatitis B ................................................................................................ 20
Influenza ................................................................................................... 21
Measles-Mumps- Rubella (MMR) ............................................................. 21
Meningococcal .......................................................................................... 21
Pneumococcal ........................................................................................... 22
Tetanus- Diphtheria-Pertussis .................................................................... 22
Appendix 4a. Inmate Fact Sheet – Preventive Health Program for Women ....................... 23
Appendix 4b. Inmate Fact Sheet – Preventive Health Program for Men ............................ 24
Appendix 5. Staff Roles for Preventive Health Care Delivery.............................................. 25
Appendix 6. Selected Preventive Health Care References .................................................... 26
Appendix 7. Preventive Health Forms .................................................................................. 31

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Federal Bureau of Prisons
Clinical Practice Guidelines

Preventive Health Care
April 2013

1. Purpose
The Federal Bureau of Prisons (BOP) clinical practice guidelines for preventive health care
outline health maintenance recommendations for federal inmates.
These preventive health guidelines do not cover diagnostic testing or medical treatments that
might be indicated by a patient’s signs and symptoms. These guidelines also do not preclude
patient-specific screenings based on medical histories and evaluations.

2. Preventive Health Care Overview
Based on the recommendations of the U.S. Preventive Services Task Force (USPSTF), the BOP
defines a scope of preventive health care services for inmates that incorporates targeted patient
counseling and immunizations, as well as screening for infectious diseases, cancer, and chronic
diseases. The BOP preventive health care program deviates from USPSTF recommendations
only when the risk characteristics of the BOP inmate population suggest an alternative approach.
The BOP preventive health care program includes the following components:
•

A health care delivery system that uses a multi-disciplinary team approach, with specific
duties assigned to each team member.

•

An emphasis on the inmate’s responsibility for improving his or her own health status and
seeking preventive services.

•

Prioritization of inmates who are at high risk for specific health problems.

•

Recognition that routine physical examinations are not a recommended component of a
preventive health care program.

3. Preventive Health Care Scope of Services
Intake
Newly incarcerated inmates are screened for conditions that warrant prompt intervention:
contagious diseases, active substance abuse, chronic diseases, and mental illness. Intake
screening and prevention parameters are outlined in Appendix 1 (Preventive Health Care –
Intake Parameters) and are governed by current BOP policy.
•

Tuberculosis (TB):
►

►

►

Symptom screening for TB disease should be considered a public health priority and
should be conducted universally, by a trained health care provider, for all newly
incarcerated inmates.
Tuberculin skin testing should be performed on all inmates within 48 hours of intake,
except for those with documentation of a prior positive TST (in millimeters), those who
have a credible history of being treated for latent TB infection or active TB disease, or
those who report history of a severe reaction to a TST (e.g., swollen, blistering).
Chest radiographs should be performed for inmates with a positive TST. All HIVinfected inmates should have a CXR performed at intake, in addition to their intake TB
symptom screen and TST. Routine screening chest radiographs are also now

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Clinical Practice Guidelines

Preventive Health Care
April 2013

recommended for foreign-born inmates who have been in the United States for one year
or less and have no documentation of a chest radiograph obtained in the U.S. This
screening guideline also applies to inmates who have been out of the U.S. or Canada for
six months or more prior to incarceration in the Bureau of Prisons.
In facilities that house inmates with a high incidence of TB, it may be appropriate to
conduct routine CXR screening of all inmates entering the prison. Decisions about the
use of routine CXR screening should be made in consultation with the Warden and the
HSD staff from the Regional and Central Offices.
•

Sexually transmitted disease (STD): Screening for STDs is based on age, gender, and
patient-specific risk factors (see Appendix 1).
►

►

•

Female inmates: Syphilis screening should be conducted universally. Chlamydia
screening should be conducted for all women less than age 25, and for other women with
identified risk factors.
Male inmates: Syphilis screening should be provided if the inmate reports risk factors
for syphilis. However, Clinical Directors should consider universal syphilis screening for
males if the inmate population is drawn from communities where syphilis is
hyperendemic, e.g., certain large urban areas.

Immunizations: Immunizations ordinarily are not recommended at the time of intake,
except for the measles-mumps-rubella (MMR) vaccine for all women of child-bearing age
who report that they have never received the vaccine as an adult. In such cases, the women
should first be tested for pregnancy.

Prevention Baseline Visit
A prevention baseline visit should be conducted for all sentenced inmates within six months of
incarceration. At the discretion of the Clinical Director and Health Services Administrator, the
prevention baseline visit may be either incorporated into the intake physical examination or
scheduled later as a separate visit.
The primary purpose of the prevention baseline visit is to assess the inmate’s risk factors and
identify the need for and frequency of recommended preventive health measures, as outlined in
Appendix 2 (Preventive Health Care Scope of Services) and Appendix 3 (Preventive Health Care
Guidelines by Disease State). All inmates should be advised of the preventive health
measures that are provided by the BOP, as well as their responsibility for seeking these
services. A plan should be developed with the inmate for accessing recommended preventive
health services.
The following preventive measures should be provided in accordance with the specific
indications outlined in Appendix 2:
•

Completing a preventive health risk assessment and developing a plan with the inmate for
delivery of follow-up preventive health services.

•

Immunizing against tetanus-diphtheria-pertussis, pneumococcal pneumonia, hepatitis A,
hepatitis B, measles-mumps-rubella, and influenza (as seasonally appropriate).

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Clinical Practice Guidelines

Preventive Health Care
April 2013

•

HIV testing should be offered to all sentenced inmates, regardless of risk factor history. HIV
testing for sentenced inmates with HIV risk factors is considered mandatory per BOP policy.

•

Screening for HBV and HCV infections in asymptomatic inmates is based on the presence of
risk factors or upon inmate request.

Prevention Periodic Visits
Periodic visits to review the inmate’s need for and receipt of preventive health care services are
recommended at least at the following intervals:
•

Every three years, for sentenced inmates under age 50 (with the exception of annual
tuberculin skin tests, annual influenza vaccinations for certain inmates, and annual
audiograms for inmates at occupational risk).

•

Annually, for inmates 50 years of age and older.

The frequency of monitoring inmates should be patient-specific, and adjusted as clinically
necessary to monitor significant changes in a parameter such as weight or blood pressure.
The following screening parameters should be included in periodic preventive health care visits,
as outlined in Appendix 2 (Preventive Health Care Scope of Services) and Appendix 3
(Preventive Health Care Guidelines by Disease State):
•

Counsel regarding nutrition, exercise, substance abuse, and infectious disease transmission.

•

Measure weight and BMI (schedule reevaluation based on trend).

•

Measure blood pressure (schedule reevaluation based on trend).

•

Screen for latent TB infection with annual tuberculin skin test (unless previously positive).

•

Screen for hearing loss with annual audiograms for those at occupational risk.

•

Screen for breast, cervical, and colon cancers per established parameters and clinical
indications.

•

Screen for cardiovascular risk (aspirin need), diabetes, and hypercholesterolemia per criteria.

•

Screen for osteoporosis in females 65 years of age and older, and in younger women whose
fracture risk is equal to or greater than that of a 65-year-old white woman who has no
additional risk factors.

•

Screen for oral cancer screening by directly inspecting and palpating the oral cavity in adults
who are older than 55 have a history of HPV, sun exposure, alcohol, and tobacco use.

•

Screen for abdominal aortic aneurysms in male smokers 65 to 75 years of age.

Universal screening for certain diseases (e.g., glaucoma, ovarian and prostate cancer) is not
recommended, due to a lack of evidenced-based data. However, screening for these diseases
may be indicated for certain inmates, based on specific risk factors or clinical concerns.
Decisions regarding screening for such conditions should be patient-specific.

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Clinical Practice Guidelines

Preventive Health Care
April 2013

4. Preventive Health Care Delivery
The delivery of preventive health care services is a shared responsibility between the inmate and
the BOP health care team.
•

Inmates should be provided information on available preventive services, as outlined on the
Inmate Fact Sheets (see Appendices 4a and 4b), and should be counseled about their
responsibility to seek these services.

•

All members of the health care team should take part in preventive health care in some
capacity, under the collaborative leadership of the Health Services Administrator and the
Clinical Director. Specific assignments are determined locally, based on staffing mix, staff
skill sets, and logistical factors. Appendix 5 (Staff Roles for Preventive Health Care
Delivery) outlines how different categories of staff can be utilized in implementing the
preventive health program.

•

Additionally, inmate education and preventive services can be delivered, in part, through
ancillary means such as group counseling, educational videotapes, and health fairs conducted
by volunteers and community-based organizations.

5. Preventive Health Care Program Evaluation
Health Services Administrators, Clinical Directors, and Director of Nursing (at MRCs) should
develop local protocol outlining the implementation of their preventive healthcare program. The
preventive health care programs should be evaluated through the local IOP programs. Applicable
evaluation strategies include, but are not limited to:
•

Assessing process measures such as the proportion of inmates who were eligible for a
certain health screen and were screened, e.g., proportion of eligible, female inmates who are
screened for breast cancer within the recommended time frames.

•

Assessing outcome measures such as the proportion of asymptomatic inmates who were
screened for a certain condition and were diagnosed with it, e.g., proportion of those
screened with a fasting blood glucose who were diagnosed with diabetes.

•

Conducting case studies of inmates who were priority candidates for preventive services,
i.e., inmates who were at high risk for a certain condition, but were not evaluated for the
condition.

•

Conducting case studies of inmates who were diagnosed clinically, rather than by
preventive screening, or who had a negative clinical outcome related to a preventive
measure that was not conducted, e.g., an inmate with hypertension who suffered a
myocardial infarction and in the process was diagnosed with diabetes (even though the
individual should have been a candidate for an earlier diabetes screening).

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Clinical Practice Guidelines

Preventive Health Care
April 2013

Appendix 1. Preventive Health Care – Intake Parameters
All Inmates
Detoxification

Assess need for detoxification at intake health screen.

TB Symptom Screen

At intake, a health care professional should ask all inmates about a history
of tuberculosis and presence of the following symptoms:
• Blood tinged sputum
• Night sweats
• Weight loss
• Fever
• Cough
Inmates who have symptoms suggestive of TB disease should receive a
thorough medical evaluation, including a TST, a chest radiograph, and, if
indicated, a sputum examination. If TB is suspected, they should be
immediately told to wear a surgical mask and placed in a low traffic area
until they can be isolated in an airborne infection isolation (AII) room.

Tuberculin Skin Test
(TST)

Place TST within 48 hours of intake for all inmates except those with a
credible history of being treated for latent TB infection (TLTBI) or TB
disease, or a history of severe reaction to tuberculin. Ignore BCG history.
Consider 2-step test for inmates who are foreign-born.

Chest Radiograph
(CXR)

Obtain intake screening CXR for HIV-infected inmates. Also obtain
screening CXR for foreign-born inmates who have been in the United
States for one year or less, and for whom there is no documentation of a
chest radiograph obtained in the U.S. This screening guideline also
applies to inmates who have been out of the U.S. or Canada for six months
or more prior to incarceration in the BOP.

Vision

Visual acuity testing with a Snellen eye chart at the intake physical.

Female Inmates
Syphilis

RPR for all females.

Chlamydia

Nucleic acid amplification test (NAAT) from urine or cervical swab for
females who fall into any of the following categories:
• Are age 25 and under.
• Have HIV infection.
• Have a history of syphilis, gonorrhea, or chlamydia.

Cervical Cancer

PAP smear at intake physical.

MMR Vaccine

Measles-mumps-rubella (MMR) vaccine at intake for all child-bearing age
women who report never having received MMR as an adult. The women
should be tested for pregnancy prior to administering the vaccine.

Male Inmates
Syphilis*

RPR for all males who fall into any of the following categories:
• Have had sex with another man.
• Are HIV infected.
• Have a history of syphilis, gonorrhea, or chlamydia.

* Consider universal syphilis screening for male inmates from endemic areas.

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Federal Bureau of Prisons
Clinical Practice Guidelines

Preventive Health Care
April 2013

Appendix 2. Federal Bureau of Prisons – Preventive Health Care Scope of Services for Sentenced Inmates
This 2-page chart provides an overview of preventive health services to be offered to sentenced inmates, based on age, sex, and identified risk factors. This chart does not include
intake preventive health measures (see Appendix 1 for these). An asterisk (*) in this table indicates that more detail on risk factors and specific screening tests can be obtained
from Appendix 3. These guidelines do not cover testing indicated by clinical signs and symptoms; nor do they preclude patient-specific screening based on medical history and
evaluation.

Screening

Recommended Age Groups
15

20

25

30

35

40

45

50

55

60

65

Prevention
Visit

Prevention baseline visit: Within 6 months of intake.
Periodic prevention visit: Under age 50, every 3 years; Age 50+, annually.
Every 3 years

Hepatitis B
Viral
Infection

Every year

Review risk factors and needed screening tests; provide inmate counseling; obtain blood
pressure and weight. If BMI is 30 kg/m2 or greater, provide nutrition/exercise counseling.
Calculate BMI: http://www.cdc.gov/healthyweight/assessing/bmi/index.html

HBsAg and anti-HBs. Risk-factor based*: Hepatitis B vaccination recommended for
adults with diabetes younger than age 60. Ever injected illegal drugs, received tattoos or
body piercings while in jail, history of STD, males who have had sex w/ males, HIV or
HCV infection, from high-risk country, on chronic hemodialysis or immunosuppressants,
etc.
Anti-HCV. Risk-factor based*: Ever injected illegal drugs, received tattoos or body
piercings while in jail, HIV or HBV infection, blood transfusion (before 1992), ever on
hemodialysis, etc.

Risk-factor based

Hepatitis C
Viral
Infection
HIV
Infection

Risk-factor based
Offer HIV testing to all sentenced inmates. HIV testing is
mandatory for sentenced inmates with HIV risk factors.

TB

Breast
Cancer

Colorectal
Cancer

High risk:
every
2 years
Every
3 years

Mammogram. High risk (see Appendix 3): Biennial mammogram screening
beginning at age 40. Avg risk: Biennial mammogram screening from ages 50 to 74.

Average risk:
every 2 years

Pap smear. Age 21-65: At intake & every 3 years – Pap smear without HPV testing.
Ages 30–65: At intake & every 5 years if screened with combination of Pap smear and
HPV testing.

Every 3 years (with HPV testing,
extend screening to every 5 years)

Risk-factor based

HIV EIA. Risk factors*: Injected illegal drugs, unprotected sex w/ multiple partners or w/
persons at risk for HIV, males who have had sex w/ males, history of STD, from
sub-Saharan/W. Africa, hemophiliac, received blood products (1977–85), etc.
Annual TST unless documented prior TST(+). CXRs (see Appendix 3 for detail):
Baseline CXR only: If TST (+). Semi-annual CXR indefinitely: If HIV (+) and either
TST (+) or a close contact to an active TB case (regardless of TST result), and have not
completed TLTBI. Semi-annual CXR x 2 years: If HIV (-) & TST (+) and either recent
TST convertor or close contact of an active TB case and have not completed TLTBI.

Annual tuberculin skin test (TST);
chest x-ray (CXR) only for specific groups.

Cervical
Cancer

Tests / Schedule/ Risk Factors

70

Annual FOBT (x3)

Fecal occult blood test (FOBT), 3 consecutive. Average risk: Annually, begin at age
50. Three tests are required for adequate sensitivity. Stop routine screening at age 75.
Higher risk: Follow American Cancer Society recommendations (see Appendix 3).

(continued on next page)

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Federal Bureau of Prisons
Clinical Practice Guidelines

Preventive Health Care
April 2013

Appendix 2. Federal Bureau of PrisonsCPreventive Health Care Scope of Services for Sentenced Inmates (continued from previous page)
Screening
Aspirin for
CVD Risk
Factors

15

20

25

30

35

40

45

50

55

60

65

70

Calculate 10-year CVD
risk every 5 years.

♂

Tests / Schedule / Risk Factors
Males, ages 45–79: Calculate 10-year CVD risk every 5 years. Risk calculator:
http://www.mcw.edu/calculators/CoronaryHeartDiseaseRisk.htm Females, ages 55–79:
Calculate 10-year risk of stroke. Risk calculator:
http://www.westernstroke.org/index.php?header_name=stroke_tools.gif&main=stroke_tools.php

Calculate 10-year
stroke risk q 5 yrs.

♀

Recommend aspirin 81 mg daily if risk exceeds the following:*
Men, if 10-year CVD risk: Ages 45–59 (>4%); ages 60–69 (>9%); ages70–79 (>12%)
Female, if 10-yr stroke risk: Ages 55–59 (>3%); ages 60–69 (>8%); ages 70–79(>11%)
For patients with diabetes, see BOP Management of Diabetes Clinical Practice Guidelines.

Diabetes
(Type II)
Hearing
Lipid
Disorders

High risk (BP>135/80): Every 3 years

♂

If occupational risk: Baseline & annual
Annual
Risk-factor based
Average risk: Every 5 years
Average risk: No routine screening

♀
Risk-factor based
Substance
Abuse
Folic Acid

Vaccine

Risk-factor based
Women of child-bearing age

Fasting serum glucose or hemoglobin A1C. High Risk: Screen every 3 years if blood
pressure is >135/80 (treated or untreated).
Occupational Risk: Annual audiogram. Age 65+: Ask about hearing annually.
Avg-risk males: Beginning at age 35, screen every 5 years (total chol & HDL).
Avg-risk females: No routine screening.
If DM, CVD, or PVD: Beginning at age 20, perform lipoprotein analysis annually.
If other risk factors (has relative with CVD disease–male under age 50 or female under age
60; or has multiple CVD risk factors, e.g., tobacco & hypertension): Beginning at age 20,
screen every 5 years (total chol & HDL).
Assessment of substance abuse history (including tobacco): Provide substance abuse
counseling and referral as needed.
Women capable of pregnancy: Recommend 400–800 g daily, OTC through commissary.

Vaccine/Indications

TetanusDiptheriaPertussis
Influenza

Booster every 10 years: Administer a one-time Tdap dose instead of the Td dose; thereafter, Td boosters every 10 years.
If incomplete or unknown vaccination history: Administer 3-dose series, including a one-time dose of Tdap (preferably as the initial dose) and 2 doses of Td.
For wound management, see BOP guidelines on Medical Management of Exposures. For issues related to pregnancy, see Appendix 3.
Age 50 or older or if risk factors: Administer annually. See Appendix 3 for list of risk factors.
Pneumococcal Age 65 or older: Administer once.* Risk-factor based*: Administer once regardless of age for certain chronic medical conditions such as chronic lung disease
(including asthma), chronic CVD, immunocompromising conditions, chemotherapy or long-term systemic corticosteroids, diabetes mellitus, chronic liver diseases,
cirrhosis, chronic renal failure or nephrotic syndrome, functional or anatomic asplenia, cochlear implants, CSF leaks, chronic alcoholism, or in long term care.
For certain risk factors: Repeat in 5 years (see Appendix 3 for list of risk factors).
Hepatitis A
Risk-factor based*: Men who have sex with men, users of injection illegal drugs, liver disease or cirrhosis, recipients of clotting factor concentrates.
Hepatitis B
Risk-factor based*: Recommended for adults with diabetes younger than age 60. Other clinical conditions include cirrhosis or liver disease, HIV infection (with
HBV risk factors), HCV infection (prioritized for those with evidence of liver disease), injection drug use, men who have sex with men, recent history of an STD,
inmate workers at risk for bloodborne pathogen exposure, hemodialysis patients, end-stage renal disease, post-exposure prophylaxis, contacts to inmates with
acute hepatitis.
MMR
If born after 1956, previously vaccinated, but no history of MMR as an adult: Administer 1 dose (booster). If born after 1956 and vaccination history is
incomplete/unknown: Administer 2-dose series. Women of childbearing age without evidence of immunity are high priority for MMR vaccine, but should
first be tested for pregnancy.
* See Appendix 3 for more complete information.
Abbreviations:

♂=male, ♀=female, Anti-HCV=HCV antibody, BMI=body mass index, chol=cholesterol, CVD=cardiovascular disease, DM=diabetes mellitus, EIA=enzyme immunoassay,
HBV=hepatitis B virus, HBsAg=hepatitis B surface antigen, HCV=hepatitis C virus, NAAT=nucleic acid amplification test, PVD=peripheral vascular disease, STD=sexually
transmitted disease, TLTBI=treatment of latent TB infection

12

Federal Bureau of Prisons
Clinical Practice Guidelines

Preventive Health Care
April 2013

Appendix 3. Preventive Health Care Guidelines by Disease State
Throughout most of this chart, recommendations regarding health screenings and vaccinations are
displayed in the third column. These recommendations are based on age, sex, and the risk factors that
are listed in the middle column. The first column indicates: the disease or condition, whether the
recommendation applies to all inmates or only those who are sentenced (unless modified in the middle
column), and the source of the recommendation.
Source Abbreviations: ACS=American Cancer Society, ACIP=Advisory Committee on Immunization Practices,
ADA=American Diabetes Association, BOP=Bureau of Prisons, CDC=Centers for Disease Control and Prevention,
CDC-DQ=CDC Division of Global Migration and Quarantine, USPSTF=United States Preventive Services Task Force,
AGA = American Gastroenterological Association

A. Infectious Disease Screening
Disease/Source
Hepatitis B Viral
Infection
Sentenced
BOP, CDC

Risk Factors Indicating Screening
•
•
•
•
•
•
•
•
•
•

•
Hepatitis C Viral
Infection
Sentenced
BOP, CDC

HIV-1
Sentenced
BOP, Federal Law

ever injected illegal drugs and shared equipment
received tattoos or body piercings while in jail or prison
males who have had sex with another man
history of chlamydia, gonorrhea, or syphilis
HIV infected
HCV infected
from high risk country in Africa, Eastern Europe,
Western Pacific, or Asia (except Japan)
history of percutaneous exposure to blood
on chronic hemodialysis and failed to develop antibodies
after 2 series of vaccinations (screen monthly) (all)
planned immunosuppressant therapy, e.g.
chemotherapy, anti-tumor necrosis factor alfa agents,
organ transplant recipient
pregnancy (all)

Screening Test/Guideline
HBsAg and anti-HBs
At baseline prevention
visit: If HBV risk factors are
identified, HBsAg and
anti-HBs testing is
recommended. If inmate is
pregnant, test for HBsAg
immediately.

•
•
•
•
•
•
•

ever injected illegal drugs and shared equipment
received tattoos or body piercings while in jail or prison
HIV infected
HBV infected (chronic)
received blood transfusion/organ transplant before 1992
received clotting factor transfusion prior to 1987
percutaneous exposure to blood (all)
• ever on hemodialysis (if currently, screen semiannually)

Anti-HCV

HIV risk factors:
• ever injected illegal drugs and shared equipment
• males who have had sex with another man
• had unprotected intercourse with a person with known
or suspected HIV infection or multiple sexual partners
• history of chlamydia, gonorrhea, or syphilis
• from a high risk country (in Sub-Saharan or West Africa)
• hemophiliac or received blood products (1977–1985)
• percutaneous exposure to blood (all)
• diagnosis of active TB (all)
• pregnancy (all)

HIV-1 EIA

(Appendix 3 continues on next page.)

13

At baseline prevention
visit: If HCV risk factors are
identified, recommend
testing for anti-HCV.

Routinely encourage HIV
testing for all sentenced
inmates who have not been
previously tested in the
BOP. HIV testing of
sentenced inmates with HIV
risk factors is considered
mandatory per BOP policy.

Federal Bureau of Prisons
Clinical Practice Guidelines

Preventive Health Care
April 2013

A. Infectious Disease Screening (continued)

Disease/Source
HIV-2
Sentenced
CDC

Sexually
Transmitted
Diseases
(Chlamydia &
Syphilis)
All
BOP, USPSTF

Risk Factors Indicating Screening

Screening Test/Guideline

• from African countries where HIV-2 prevalence
is >1%: Cape Verde, Côte d´Ivoire, Gambia,
Guinea-Bissau, Mali, Mauritania, Nigeria, and
Sierra Leone
• from other West African countries reporting
HIV-2: Benin, Burkina Faso, Ghana, Guinea,
Liberia, Niger, Sao Tome, Senegal, and Togo
• from other African nations reporting HIV-2 at
>1%: Angola & Mozambique
• have been sex partners or needle-sharing partners
of a person from West Africa or a person known to
have HIV-2 infection
• received transfusions in West Africa

HIV-2 EIA

• All females .............................................................
• All females who: ....................................................
► are age 25 or under and/or
► have HIV infection and/or
► have history of syphilis, gonorrhea, or chlamydia
• All males who: .......................................................
► have had sex with another man and/or
► have HIV infection and/or
► history of syphilis, gonorrhea, or chlamydia
Note:

• RPR: At intake physical
• Chlamydia: At intake
physical (NAAT urine or
cervical swab)

For inmates with these risk
factors, also test for HIV-2.

• RPR: At intake physical

Routine gonorrhea screening is not recommended
unless symptoms of gonorrhea are present, or unless
syphilis or chlamydia have been diagnosed.

Tuberculosis
All
CDC, BOP

• All inmates .............................................................

• Intake TB symptom
screen

• All inmates except those with:.............................
► history of tx of latent TB infection (TLTBI) or
active TB
► documented TST positive (in millimeters)
► history of severe reaction to tuberculin

• Tuberculin skin test (TST)
within 48 hrs of intake

• Foreign born (with above exceptions) ...................

• Consider 2-step TST

• Foreign born living in U.S. less than 1 year & no
history of CXR in U.S.; or U.S. born and has
lived outside of U.S. or Canada for the
previous 6 months ................................................

• CXR: At intake

• HIV seropositive ....................................................
► and history of positive TST and has not
completed TLTBI, or a contact of TB case
and refusing TLTBI (regardless of TST result) ..
• All inmates with baseline negative TST ..............
• Documented HIV (-) TST converter refusing
TLTBI ......................................................................
(Appendix 3 continues on next page.)

14

• CXR: At intake
• CXR: Every 6 mos
indefinitely

• TST: Annually
• CXR: Every 6 mos for 2 yrs

Federal Bureau of Prisons
Clinical Practice Guidelines

Preventive Health Care
April 2013

B. Cancer Screening
Disease/Source

Risk Factors Indicating Screening

Screening Test/Guideline

Breast Cancer

• All females .............................................................

Sentenced

• Average-risk females, ages 50–74.......................

• Clinical breast exam:
Offer annually
• Mammogram: Every 2 yrs

BOP, USPSTF, ACA

• Risk-factor based, beginning age 40: .................
► 2 first-degree relatives with breast or ovarian
cancer
► relative with breast cancer before age 50
► relative with two cancers (breast and ovarian or
two independent breast cancers)
► female with male relative with breast cancer

• Mammogram: Every 2 yrs

The USPSTF recommends that women whose family history is associated with an
increased risk for deleterious mutations in BRCA1 or BRCA2 genes be referred for
genetic counseling and evaluation for BRCA testing. Certain women of Jewish heritage
may be at increased risk. Both maternal and paternal family histories are important. See
USPSTF recommendations, which are available at:
http://www.ahrq.gov/clinic/uspstf05/brcagen/brcagenrs.htm#clinical

Cervical Cancer
Sentenced

All females (who have a cervix):
• Age 21–65 (Pap smear only) ................................

• At intake physical, then
every 3 years

BOP, ACS

• Ages 30–65 (Pap smear & HPV test) ...................

Ovarian Cancer

The United States Preventive Services Task Force recommends against routine
screening for ovarian cancer, finding that there is no evidence that any screening
test (including CA-125, ultrasound, or pelvic examination) reduces mortality from
ovarian cancer.

USPSTF

Oral Cancer
USPSTF

Prostate Cancer
USPSTF

Colorectal Cancer
Sentenced
USPSTF, ACS, AGA

• At intake physical, then
every 5 years

The United States Preventive Services Task Force recommends that clinicians
conduct oral cancer screening by directly inspecting and palpating the oral cavity in
adults who have a history of HPV, sun exposure, alcohol and tobacco use.
The United States Preventive Services Task Force has found insufficient evidence to
recommend for or against routine screening for prostate cancer by prostate surface
antigen or digital rectal exam. Decisions about screening should be made case-bycase, with the inmate. Prostate cancer screening should not be done for men over
age 75.
Average risk .............................................................
Increased risk:
Follow guidance on next page if …

•
•
•
•

history of polyps at prior colonoscopy
history of colorectal cancer
family history
genetic predisposition
• inflammatory bowel disease
(Colorectal Screening Guidelines begin
on next page of Appendix 3.)
(Appendix 3 continues on next page.)

15

Fecal occult blood test:
Annually beginning at age 50.
Stop routine screening at
age 75. Provide guiac-based
test cards to use with 3
consecutive stools and return
to clinic. Do not rehydrate
specimen. If positive, do
colonoscopy.
Note: It is necessary to test 3
stools each year to achieve
adequate sensitivity.

Federal Bureau of Prisons
Clinical Practice Guidelines

Preventive Health Care
April 2013

B. Cancer Screening (continued)

Colorectal Screening Guidelines: Increased Risk and High Risk
Guidelines for Screening and Surveillance for the Early Detection of Colorectal
Adenomas and Cancer in Individuals at Increased Risk or High Risk (AGA/ACS, 2008)

Increased Risk: Patients with History of Polyps at Prior Colonoscopy
Risk Category

Age to Begin

Recommendation/Comment

Patients with small rectal
hyperplastic polyps

Same as those with
average risk

Colonoscopy or other screening options at same
regular intervals as for those at average risk. Those
with hyperplastic polyposis syndrome are at
increased risk for adenomatous polyps and cancer,
and should have more intensive follow-up.

People with 1 or 2 small
(<1 cm) tubular
adenomas with
low-grade dysplasia

5–10 years after the
polyps are removed

Colonoscopy: Time between tests should be based
on other factors such as prior colonoscopy findings,
family history, and patient and doctor preferences.

People with 3 to 10
adenomas, or a large
(>1 cm) adenoma, or any
adenomas with
high-grade dysplasia or
villous features

3 years after the polyps
are removed

Colonoscopy: Adenomas must have been
completely removed. If colonoscopy is normal or
shows only 1 or 2 small tubular adenomas with
low-grade dysplasia, future colonoscopies can be
done every 5 years.

People with more than 10 Within 3 years after the
adenomas on a single
polyps are removed
exam

Colonoscopy: Consider possibility of genetic
syndrome (such as FAP or HNPCC).

Patients with sessile
adenomas that are
removed in pieces

Colonoscopy: If entire adenoma has been
removed, further testing should be based on
physician’s judgment.

2–6 months after
adenoma removal

Increased Risk: Patients with Colorectal Cancer
Risk Category

Age to Begin

Recommendation/Comment

People diagnosed with
colon or rectal cancer

At time of colorectal
surgery, or can be 3–6
months later if person
doesn’t have cancer
spread that can't be
removed

Colonoscopy to view entire colon and remove all
polyps. If the tumor presses on the colon/rectum
and prevents colonoscopy, CT colonoscopy (with IV
contrast) or DCBE may be done to look at the rest of
the colon.

People who have had
colon or rectal cancer
removed by surgery

Within 1 year after cancer
resection (or 1 year after
colonoscopy to make sure
the rest of the
colon/rectum was clear)

Colonoscopy: If normal, repeat exam in 3 years. If
normal then, repeat exam every 5 years. Time
between tests may be shorter if polyps are found or
there is reason to suspect HNPCC. After low
anterior resection for rectal cancer, exams of the
rectum may be done every 3–6 months for the first
2–3 years to look for signs of recurrence.

(Colorectal Screening Guidelines continue on next page of Appendix 3.)

16

Federal Bureau of Prisons
Clinical Practice Guidelines

Preventive Health Care
April 2013

B. Cancer Screening (Colorectal Screening Guidelines, continued)

Increased Risk: Patients with a Family History
Risk Category

Age to Begin

Recommendation/Comment

Colorectal cancer or adenomatous
polyps in any first-degree relative
before age 60, or in 2 or more
first-degree relatives at any age (if
not a hereditary syndrome)

Age 40, or 10 years before the
youngest case in the immediate
family, whichever is earlier

Colonoscopy: Every 5 years

Colorectal cancer or adenomatous
polyps in any first-degree relative
aged 60 or higher, or in at least 2
second-degree relatives at any
age

Age 40

Fecal occult blood test: 3 times
annually.

High Risk
Risk Category

Age to Begin

Recommendation/Comment

Familial adenomatous polyposis
(FAP) diagnosed by genetic
testing, or suspected FAP without
genetic testing

Age 10 to 12

Yearly flexible sigmoidoscopy
to look for signs of FAP. Provide
counseling to consider genetic
testing if it hasn’t been done. If
genetic test is positive, removal of
colon (colectomy) should be
considered.

Hereditary non-polyposis colon
cancer (HNPCC), or increased risk
of HNPCC based on family history
without genetic testing

Age 20 to 25, or 10 years before
the youngest case in the
immediate family

Colonoscopy every 1–2 years;
counseling to consider genetic
testing if it hasn’t been done.
Genetic testing should be offered
to first-degree relatives of people
found by genetic tests to have
HNPCC mutations. It should also
be offered if 1 of the first 3 of the
modified Bethesda criteria1 is met.

Inflammatory bowel disease:
• Chronic ulcerative colitis
• Crohn’s disease

Cancer risk begins to be
significant 8 years after the onset
of pancolitis (involvement of entire
large intestine), or 12–15 years
after the onset of left-sided colitis

Colonoscopy every 1–2 years
with biopsies for dysplasia. These
patients are best referred to a
center with experience in the
surveillance and management of
inflammatory bowel disease.

Abbreviations: DCBE = double-contrast barium enema; FAP = familial adenomatous polyposis;
HPNCC = hereditary nonpolyposis colon cancer; CTC = computed tomographic colonoscopy
1

The Bethesda criteria can be found in the American Cancer Society "Can Colorectal Cancer Be Prevented?"
available at:
http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_Can_colon_and_rectum_cancer_be_prevented.asp?sitearea=

Reference: American Cancer Society [homepage on the internet]. Detailed guide: colon and rectum cancer. Can
colorectal polyps and cancer be found early? Revised 3/5/2008. Available from:
http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_Can_colon_and_rectum_cancer_be_found_early.asp
(General guidelines resume on next page of Appendix 3.)

17

Federal Bureau of Prisons
Clinical Practice Guidelines

Preventive Health Care
April 2013

C. Chronic Diseases/Lifestyle
Disease/Source
Abdominal Aortic
Aneurysm
Sentenced

Risk Factors Indicating Screening

Screening Test/Guideline

At risk: Men, ages 65–75, with a history of smoking.

Abdominal
ultrasonography: Once

Screen for abdominal aortic aneurysm (AAA);
surgically repair large AAAs (5.5 cm or more).

USPSTF

Aspirin for CHD & Males ages 45–79: Calculate CHD risk every 5 years using risk calculator:
http://www.mcw.edu/calculators/CoronaryHeartDiseaseRisk.htm
Stroke Risk
Females ages 55–79: Calculate risk of stroke every 5 years using stroke calculator:
Sentenced

http://www.westernstroke.org/index.php?header_name=stroke_tools.gif&main=stroke_tools.php

USPSTF

If risk of adverse cardiovascular event exceeds risk of gastrointestinal bleed,
then recommend that inmate take aspirin 81 mg every day.*
* For patients with diabetes, see the BOP Management of Diabetes Clinical Practice Guideline.

Risk Level at Which CVD Events Prevented (“Benefit”) Exceeds GI Harms:
Men: 10-Year CHD Risk

Diabetes Mellitus
Sentenced
ADA, BOP, USPSTF

Hypertension
Sentenced
BOP, USPSTF

Lipids
Sentenced
USPSTF

Women: 10-Year Stroke Risk

Ages 45–59

>4%

Ages 55–59

>3%

Ages 60–69

>9%

Ages 60–69

>8%

Ages 70–79

>12%

Ages 70–79

>11%

Risk-factor based: If blood pressure is >135/80 or if
otherwise clinically indicated.

Fasting serum glucose or
hemoglobin A1C: Every 3
years

The BOP recommends the use of serum glucose testing or A1C for initial screening
and diagnosis. When fasting serum glucose values are borderline high, a fasting
plasma glucose should be obtained.
Based on age:
• Under age 50 ..........................................................
• Age 50 and over.......................................................
• Borderline blood pressure elevations
(systolic 120-139; diastolic 80-90) ........................
• If diabetes, CVD or peripheral vascular disease,
beginning at age 20 .................................................
• If risk factors: First-degree relative with CVD
(male before age 50, female before age 60)
or tobacco use and hypertension, beginning at
age 20 ......................................................................
• Average risk men: Beginning at age 35................
• Average risk women: .............................................
If lipid levels are close to warranting therapy, then
shorten intervals between screenings.
(Appendix 3 continues on next page.)

18

Blood pressure:
• At least every 3 yrs
• At least annually

• At least annually
Fasting lipoproteinanalysis:

• Annually
Total cholesterol & HDL:

• At least every 5 years
• Every 5 years

• Screening not indicated at
any age

Federal Bureau of Prisons
Clinical Practice Guidelines

Preventive Health Care
April 2013

C. Chronic Diseases/Lifestyle (continued)

Disease/Source
Obesity
Sentenced
USPSTF

Risk Factors Indicating Screening
Calculate Body Mass Index (BMI), utilizing calculator at
http://www.cdc.gov/healthyweight/assessing/bmi/index.html
• Under age 50 ...............................................................
• Age 50 and older.........................................................

Screening
Test/Guideline
Height/ weight/
body mass index
• Every 3 years
• Every year

Nutrition/exercise counseling for BMI of 30 or greater.
Osteoporosis
Sentenced
USPSTF, Surgeon
General Report

• Women age 65 and older, and younger women whose
fracture risk is equal to or greater than that of a 65-yearold white woman who has no additional risk factors.
• Risk factor based: Women age 60–64 with body weight
less than 70 kilograms and no current use of estrogen.
Repeat BMD screening as clinically indicated. The
following intervals are recommended:
• Normal BMD (T score of 1.00 or higher) or mild
osteopenia (T score of 1.01 to -1.49)  screen every
15 years
• Moderate osteopenia (T score of -1.50 to -1.99) 
screen every 5 years
• Advanced osteopenia (T score of -2.00 to -2.49) 
screen every year

• Women of child-bearing age: Supplements containing
400–800 g of folic acid in the periconceptual period
Sentenced women
reduce the risk for neural tube defects.
Folic Acid

USPSTF

Substance
Abuse
BOP

• All inmates: At intake assess for substance abuse
history and need for detoxification. Provide counseling
and referral to BOP substance abuse and smoking
cessation programs, as indicated.

Bone mineral
density screening
(BMD)
The most commonly
recommended test is
dual x-ray
absorptiometry
(DXA).

Counsel inmate
Recommend OTC
purchase through
commissary.
Substance abuse
history at intake

D. Sensory Screening
Disease/Source

Risk Factors Indicating Screening

Screening
Test/Guideline

• All inmates

Snellen at intake
physical
Note: Vision acuity
testing is not effective
in identifying common
age-related
pathologies.

Hearing

• Age 65 and older.........................................................

Sentenced

• Occupational risk (any age) .......................................

• Ask about hearing
annually
• Audiogram
annually

Vision
Sentenced
USPSTF

USPSTF, BOP
(Appendix 3 continues on next page.)

19

Federal Bureau of Prisons
Clinical Practice Guidelines

Preventive Health Care
April 2013

E. Immunizations
For more specific information about immunizations and contraindications, see CDC adult immunization
recommendations at http://www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm.
For information about pregnant women, refer to the current adult immunization schedule (see link above).

Vaccine/Source
Hepatitis A
Sentenced
CDC, BOP, ACIP

Risk Factor

Guideline

Risk-factor based:
• Men who have sex with men
• Users of injection illegal drugs
• Liver disease or cirrhosis
• Recipients of clotting factor
concentrates
For foreign born inmates, consider prescreening for hepatitis A immunity prior
to vaccination.

Hepatitis B
Sentenced
BOP, CDC, ACIP,
USPSTF

Risk-factor based:
• Diabetic adults younger than age 60
• Hemodialysis patients
• End-stage renal disease (hemodialysis
anticipated)
• Inmate workers at risk for bloodborne
pathogen exposure
• HIV infected (with risk factors for
acquiring HBV)
• HCV infection (prioritized for those with
evidence of liver disease)
• Cirrhosis or liver disease
• Injection drug use
• Men who have sex with men
• History of syphilis, gonorrhea, or
chlamydia in last 6 months
• Post-exposure prophylaxis
• Contacts to inmates with acute
hepatitis

At baseline prevention visit:
If patient has risk factors for
hepatitis A, start two-dose series;
administer 2nd dose at least 6
months after 1st dose.
The two available single antigen
vaccines (Vaqta® and Havrix®) can
be used interchangeably.
For candidates for both vaccines,
the combined hepatitis A and
hepatitis B vaccine (Twinrix®) can
be used. Administer 3 doses at 0,
1, and 6 months; or alternatively,
use a 4-dose schedule,
administered on days 0, 7 and 21–
30, followed by a booster dose at
month 12.
At baseline prevention visit:
If patient has risk factors for
hepatitis B, start 3-dose series. The
2nd dose is given 1–2 months after
the 1st dose. The 3rd dose is given
4–6 weeks after the 2nd dose (or
thereafter).
For candidates for both vaccines,
the combined hepatitis A and
hepatitis B vaccine (Twinrix®) can
be used. Administer 3 doses at 0,
1, and 6 months; or alternatively,
use a 4-dose schedule,
administered on days 0, 7 and 21–
30, followed by a booster dose at
month 12.

For foreign born inmates, consider prescreening for hepatitis B immunity prior
to vaccination.
(Appendix 3 continues on next page.)

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Federal Bureau of Prisons
Clinical Practice Guidelines

Preventive Health Care
April 2013

E. Immunizations (continued)

Vaccine/Source

Risk Factor

Influenza

• Age 50 or older

All

• Medical risk factors

ACIP, CDC

Guideline

►

Chronic disorders of the cardiovascular or
pulmonary systems, including asthma

►

Chronic metabolic diseases, including
diabetes mellitus, renal or hepatic
dysfunction, hemoglobinopathies
Immunocompromising conditions,
including HIV
Asplenia, including sickle cell disease
Any condition that compromises
respiratory function, e.g., cognitive
dysfunction, spinal cord injury, or seizure
disorder

►

►
►

►

Annually. Inmates age 50 and
older, and those who are younger
with risk factors should receive
annual influenza vaccine.

Pregnancy (during flu season)

• Occupational/Residential risk
factors:
►
►

Measles-MumpsRubella (MMR)
ACIP, CDC-DQ

Inmate health care workers
Residents of long term care facilities

• Women of child-bearing age (All) .......
• If born after 1956 and previously
vaccinated (Sentenced).......................
• If incomplete or unknown
vaccination history and born after
1956 (Sentenced) .................................

• At intake: Administer 1 dose.
Test for pregnancy prior to
vaccinating.
• At prevention baseline visit:
Administer 1 booster dose.
• At prevention baseline visit:
Administer initial dose of two-dose
series; then give 2nd dose 4–8
weeks later.

Notes:
(1) HIV infection is not a contraindication to MMR, except for those who are severely
immunocompromised, i.e., CD4+ T-cell count <200 cells/mm3.
(2) MMR is contraindicated during pregnancy.

Meningococcal
All

Anatomic or functional asplenia,
including sickle cell disease (age 55 and
under only)

Administer meningocccal conjugate
vaccine (one-time only).

ACIP, CDC
(Appendix 3 continues on next page.)

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Federal Bureau of Prisons
Clinical Practice Guidelines

Preventive Health Care
April 2013

E. Immunizations (continued)

Vaccine/Source
Pneumococcal
Sentenced
ACIP

Risk Factor

Guideline

• Age 65 and over ..................................
• Risk-factor based ...............................
►
►
►
►
►

►

►

►

►
►
►
►

Chronic lung disease (including asthma)
Chronic cardiovascular diseases
Diabetes mellitus
Chronic liver diseases, cirrhosis
Chronic renal failure or nephrotic
syndrome*
Functional or anatomic asplenia (e.g.,
sickle cell disease or splenectomy)*
Immunocompromising conditions (e.g.,
congenital immunodeficiency, HIV
infection, leukemia, lymphoma, multiple
myeloma, Hodgkins disease, generalized
malignancy, or organ transplantation)*

* For inmates with asterisked conditions,
give one-time revaccination after 5
years.
Notes:
(1) Administer pneumococcal vaccine as
soon as possible after HIV-infection is
diagnosed.

Chemotherapy with alkylating agents,
antimetabolites, or long-term systemic
corticosteroids*
Cochlear implants
Cerebrospinal fluid leaks
Chronic alcoholism
Long term care residents

(2) Routine use of pneumococcal
vaccine is no longer recommended for
Alaska Native or American Indian
persons younger than 65 years unless
they have other qualifying medical
conditions.
(3) Pneumococcal vaccine can be
administered to pregnant women with
risk factors.
To protect against pertussis, a one-time
Tdap dose should replace a single dose
of Td for adults ages 19 and older, who
have not received a dose of Tdap
previously (either as a booster dose or
part of a vaccine series).

TetanusDiphtheriaPertussis
Sentenced
ACIP, CDC-DQ,
USPSTF

• Administer once*
• Administer once, regardless of
age. For patients who are age 65
or older, administer a one-time
re-vaccination if the person was
vaccinated 5 years or more ago,
and was less than age 65 when
initially vaccinated.

• If never has had a Tdap vaccine ........

• If incomplete or unknown
vaccination history .............................

• At prevention baseline visit:
Administer a one-time Tdap dose
instead of the Td dose. Thereafter, a
Td booster should be administered
every 10 years.

• At prevention baseline visit:
Administer a 3-dose tetanusdiphtheria-pertussis series, including a
one-time dose of Tdap (preferably as
the initial dose) and 2 doses of Td.
Administer the first 2 doses at least 4
weeks apart, and the 3rd dose 6–12
months after the 2nd dose. Thereafter,
a Td booster should be administered
every 10 years.

Note: Pregnant women in need of vaccine may receive Td in the 2nd or 3rd trimester. It
is recommended that pregnant women receive a tetanus, diphtheria, and acellular
pertussis (Tdap) booster, preferably after 20 weeks of gestation, to protect infants
from pertussis via transfer of protective maternal antibodies.

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Federal Bureau of Prisons
Clinical Practice Guidelines

Preventive Health Care
April 2013

Appendix 4a. Inmate Fact Sheet – Preventive Health Program for Women
Initial Preventive Health Screening
You will receive the following preventive health screening shortly after you enter federal prison:
TB Skin Test........ To test for exposure to TB, unless your medical record shows a previous positive TB
skin test.
Chest X-Ray ........ If you have a positive TB skin test, if you are foreign-born or have recently been
outside the U.S., or you have HIV infection.
Chlamydia Test ... If you are age 25 or less, have HIV infection, or have a history of sexually transmitted
diseases such as syphilis, gonorrhea, or chlamydia.
Syphilis Test ....... At your intake physical exam.
PAP Smear .......... To test for cervical cancer or other conditions, at your intake physical exam.
MMR Vaccine ...... To protect against measles, mumps, and rubella; given if you are of child-bearing
age, have no record of vaccination, and have first been tested to see if you are
pregnant.
Your health care provider may recommend additional health screens (tests) based on your medical
history and physical examination.

Routine Preventive Health Screening for Sentenced Inmates
The following preventive health tests are routinely provided for sentenced inmates:
Viral Hepatitis ..... If you are at risk for hepatitis B or hepatitis C viral infections, or if you report that you
had a prior infection.
HIV ....................... Recommended for all sentenced inmates.
TB Skin Test........ Every year, unless your record shows a positive test in the past.
Breast Cancer ..... Mammogram every 2 years, beginning at age 50; beginning at age 40, if there is a
history of breast cancer in your family. Annual breast exam upon request.
Pap Smear........... Every 3 years, if you are age 21 to 29.
Every 3–5 years (with an HPV test), if you are age 30 or older.
Colon Cancer ...... Testing for blood in your stool every year, beginning at age 50; colonoscopy if you
are at higher risk for colon cancer.
Diabetes .............. If your blood pressure is greater than 135/80.
Cholesterol ......... Beginning at age 20, but only if you have risk factors.
In addition, vaccinations are provided as recommended by health authorities. Based on your age and
specific needs, other preventive health services may be made available to you. You can also request a
preventive health visit to review needed services: every three years (if you are under age 50) or every
year (if you are age 50 and over).

Take care of yourself while you are in prison!
•
•
•
•
•
•
•
•

Exercise regularly.
Eat a healthy diet (low fat, more fruits and vegetables).
Take medications and supplements recommended by your doctor.
Don’t use tobacco or illegal drugs.
Don’t have sexual contact with others while in prison.
Don’t get a tattoo while in prison.
Don’t share personal items (razors, toothbrushes, towels).
Wash your hands regularly.

23

Federal Bureau of Prisons
Clinical Practice Guidelines

Preventive Health Care
April 2013

Appendix 4b. Inmate Fact Sheet – Preventive Health Program for Men
Initial Preventive Health Screening
You will receive the following preventive health screening shortly after you enter federal prison:
TB Skin Test........ To test for exposure to TB, unless your medical record shows a previous positive
TB skin test.
Chest X-Ray ........ If you have a positive TB skin test, if you are foreign-born or have recently been
outside the U.S., or if you have HIV infection.
Syphilis Test ....... At your intake physical exam if you have HIV infection, or if you have a history of
sexually transmitted diseases such as syphilis, gonorrhea, or chlamydia.
Your health care provider may recommend additional health screens (tests) based on your medical
history and physical examination.

Routine Preventive Health Screening for Sentenced Inmates
The following preventive health tests are routinely provided for sentenced inmates:
Viral Hepatitis ..... If you are at risk for hepatitis B or hepatitis C viral infections, or if you report that
you had a prior infection.
HIV ....................... Recommended for all sentenced inmates.
TB Skin Test........ t Every year, unless you had a positive test in the past.
Colon Cancer ...... Testing for blood in your stool every year, beginning at age 50; colonoscopy if you
are at higher risk for colon cancer.
Diabetes .............. If your blood pressure is greater than 135/80.
Cholesterol ......... Beginning at age 35, screen every 5 years (sooner if you are at risk).
In addition, vaccinations are provided as recommended by health authorities. Based on your age and
specific needs, other preventive health services may be made available to you. You can also request a
preventive health visit to review needed services: every three years (if you are under age 50) or every
year (if you are age 50 and over).

Take care of yourself while you are in prison!
•
•
•
•
•
•
•
•

Exercise regularly.
Eat a healthy diet (low fat, more fruits and vegetables).
Take medications as recommended by your doctor.
Don’t use tobacco or illegal drugs.
Don’t have sexual contact with others while in prison.
Don’t get a tattoo while in prison.
Don’t share personal items (razors, toothbrushes, towels).
Wash your hands regularly.

24

Federal Bureau of Prisons
Clinical Practice Guidelines

Preventive Health Care
April 2013

Appendix 5. Staff Roles for Preventive Health Care Delivery
Primary Care Provider Teams will be responsible for providing preventive health care services in each
facility. Roles and responsibilities for specific aspects of preventive health care will vary, based on
staffing in each facility and adaptations required to maintain clinic operations. The most efficient and
cost-effective way to implement the preventive health care guidelines is to assign appropriate
responsibilities to each health care professional team member. All team members should be oriented
to the guidelines in this document.

Clerical Staff
Possible tasks include pulling and filing medical records, scheduling appointments, preparing lab slips,
and auditing records.

Nursing Staff
Emphasis on preventive health care may involve an expanded role for nurses in each facility,
depending on their availability.
Preparation for Preventive Health Visits: In advance of the visit, a thorough chart review should be
conducted to determine what tests and evaluations are indicated by the inmate’s age, sex, and risk
factors. Laboratory tests and evaluations can be ordered prior to the visit (utilizing standing orders), to
maximize clinic efficiency.
Preventive Health Visits: Nursing functions can include interviewing inmates, assessing risk factors,
recommending and ordering (with standing orders) specific health screens and interventions,
instructing inmates about prevention measures, administering immunizations, and providing health
education.
Preventive Health Follow-Up: Abnormal results shall be reviewed and referred to the MLP or
physician for follow-up.

Mid-Level Practitioners
MLPs are responsible for: ensuring that their patients have been offered preventive services;
counseling inmates on serious health conditions that require treatment; following-up on abnormal
results; and developing a treatment plan.

Physicians
Physicians are responsible for developing a treatment planCparticularly for complicated patientsCand
for mentoring and advising MLPs on specific patients.

Clinical Director
The Clinical Director is responsible for serving as a role model and leader in delivering preventive
health services; providing standing orders for nurses; providing staff education; developing IOP
measures; and working with the Health Services Administrator to ensure that adequate staffing,
supplies, and materials are available for successful implementation of the program.

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Clinical Practice Guidelines

Preventive Health Care
April 2013

Appendix 6. Selected Preventive Health Care References
U.S. Preventive Services Task Force (USPSTF): Topic Index: A–Z. Available from:
http://www.uspreventiveservicestaskforce.org/uspstopics.htm. A PDA program is available, the
Electronic Preventive Services Selector. To download, go to http://pda.ahrqgov. More detailed
publications of the USPSTF are referenced below under the relevant topic.

A. Physical Examinations – Historic Reference
American Medical Association, Council on Scientific Affairs. Medical evaluations of
healthy persons. JAMA. 1983;249:1626–1633.

B. Behavioral Counseling
U.S. Preventive Services Task Force. Behavioral counseling in primary care to promote a
healthy diet: recommendations and rationale. Am J Prev Med. 2003;24(1):93–100.
Available from: http://www.ahrq.gov/clinic/3rduspstf/diet/dietrr.pdf
U.S. Preventive Services Task Force. Behavioral Counseling in Primary Care to Promote
Physical Activity: Recommendations and Rationale. Rockville, MD: Agency for Healthcare
Research and Quality; 2002. Available from:
http://www.ahrq.gov/clinic/3rduspstf/physactivity/physactrr.htm

U.S. Preventive Services Task Force. Counseling to Prevent Tobacco Use and
Tobacco-Related Diseases: Recommendation Statement. Rockville, MD: Agency for
Healthcare Research and Quality; 2003. Available from:
http://www.ahrq.gov/clinic/3rduspstf/tobacccoun/tobcounrs.htm

C. Infectious Disease Screening
Hepatitis (Viral)
Centers for Disease Control and Prevention. A comprehensive immunization strategy to
eliminate transmission of hepatitis B virus infection in the United States: recommendations
of the Advisory Committee on Immunization Practices (ACIP) part II: immunization of
adults. MMWR. 2006;55(RR-16):1–40.
Centers for Disease Control and Prevention. Prevention and control of infections with
hepatitis viruses in correctional settings. MMWR. 2003;52(RR01):1–33. Available from:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5201a1.htm

U.S. Preventive Services Task Force. Screening for Hepatitis B Infection: Recommendation
Statement. Rockville, MD: Agency for Healthcare Research and Quality; 2004. Available
from: http://www.ahrq.gov/clinic/3rduspstf/hepbscr/hepbrs.htm
U.S. Preventive Services Task Force. Screening for hepatitis C in adults: recommendation
statement. Ann Intern Med. 2004;140:462–464. Available from:
http://www.ahrq.gov/clinic/3rduspstf/hepcscr/hepcrs.pdf

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Clinical Practice Guidelines

Preventive Health Care
April 2013

HIV
Centers for Disease Control and Prevention [homepage on the Internet]. HIV/AIDS.
Accessed April 14, 2009. Available from: http://www.cdc.gov/hiv/
Centers for Disease Control and Prevention. Revised recommendations for HIV testing of
adults, adolescents, and pregnant women in health-care settings. MMWR.
2006;55(RR14):1–17. Available from:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm

Federal Bureau of Prisons. Clinical Practice Guidelines: Medical Management of
Exposures: HIV, HBC, HCV, Human Bites, and Sexual Assaults. Washington, DC: Federal
Bureau of Prisons; 2009. Available from: http://www.bop.gov/news/medresources.jsp
Sexually Transmitted Diseases
Centers for Disease Control and Prevention (2005). Program and Operations Guide for STD
Prevention: Medical and Laboratory Services. Available from:
http://www.cdc.gov/std/program/med&lab.pdf

Centers for Disease Control and Prevention. Sexually transmitted diseases treatment
guidelines, 2006. MMWR. 2006;55(RR-11). Available from:
http://www.cdc.gov/std/treatment/

Federal Bureau of Prisons. Clinical Practice Guidelines: STD Treatment Tables.
Washington, DC: Federal Bureau of Prisons; 2011. Available from:
http://www.bop.gov/news/medresources.jsp

Tuberculosis
American Thoracic Society and Centers for Disease Control and Prevention. Treatment of
tuberculosis. MMWR. 2003;52(RR11):1–77. Available from:
http://www.cdc.gov/MMWR/preview/MMWRhtml/rr5211a1.htm

Centers for Disease Control and Prevention. Prevention and control of tuberculosis in
correctional and detention facilities: recommendations from CDC. MMWR. 2006;55(No.
RR-09). Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5509a1.htm
Federal Bureau of Prisons. Clinical Practice Guidelines: Management of Tuberculosis.
Washington, DC: Federal Bureau of Prisons; 2010. Available from:
http://www.bop.gov/news/medresources.jsp

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Clinical Practice Guidelines

Preventive Health Care
April 2013

D. Cancer Screening
American Cancer Society [homepage on the internet]. American Cancer Society Guidelines
for the Early Detection of Cancer. Revised 3/5/2008. Accessed April 14, 2009. Available
from: http://www.cancer.org/docroot/ped/content/ped_2_3x_acs_cancer_detection_guidelines_36.asp
Breast Cancer
American Cancer Society [homepage on the internet]. Detailed Guide: Breast Cancer. Can
Breast Cancer Be Found Early? Revised 9/4/2008. Accessed April 14, 2009. Available
from:
http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_Can_breast_cancer_be_found_early_5.asp

U.S. Preventive Services Task Force. Screening for Breast Cancer. Rockville, MD: Agency
for Healthcare Research and Quality; 2009. Available from:
http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm
U.S. Preventive Services Task Force. Genetic Risk Assessment and BRCA Mutation Testing
for Breast and Ovarian Cancer Susceptibility. Rockville, MD: Agency for Healthcare
Research and Quality; 2005. Available from: http://www.ahrq.gov/clinic/uspstf/uspsbrgen.htm
Cervical Cancer
U.S. Preventive Services Task Force. Screening for Cervical Cancer. Rockville, MD:
Agency for Healthcare Research and Quality; 2012. Available from:
http://www.uspreventiveservicestaskforce.org/uspstf/uspscerv.htm
Colorectal Cancer
American Cancer Society [homepage on the Internet]. Detailed Guide: Colon and Rectum
Cancer. Can Colorectal Polyps and Cancer be Found Early? Revised 3/5/2008. Accessed
April 1, 2009. Available from:
http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_Can_colon_and_rectum_cancer_be_found
_early.asp?sitearea

U.S. Preventive Services Task Force. Screening for Colorectal Cancer. Rockville, MD:
Agency for Healthcare Research and Quality; 2008. Available from:
http://www.ahrq.gov/CLINIC/USPSTF/uspscolo.htm

Ovarian Cancer
U.S. Preventive Services Task Force. Screening for Ovarian Cancer. Rockville, MD:
Agency for Healthcare Research and Quality; 2004. Available from:
http://www.ahrq.gov/Clinic/uspstf/uspsovar.htm

U.S. Preventive Services Task Force. Genetic Risk Assessment and BRCA Mutation Testing
for Breast and Ovarian Cancer Susceptibility. Rockville, MD: Agency for Healthcare
Research and Quality; 2005. Available from:
http://www.ahrq.gov/CLINIC/USPSTF/uspsbrgen.htm

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Federal Bureau of Prisons
Clinical Practice Guidelines

Preventive Health Care
April 2013

Prostate Cancer
U.S. Preventive Services Task Force. Screening for Prostate Cancer. Rockville, MD:
Agency for Healthcare Research and Quality; 2008. Available from:
http://www.ahrq.gov/CLINIC/USPSTF/uspsprca.htm

E. Chronic Disease Screening and Prevention
Abdominal Aortic Aneurysm
U.S. Preventive Services Task Force. Screening for Abdominal Aortic Aneurysm:
Recommendation Stataement. Rockville, MD: Agency for Healthcare Research and Quality;
2005. Available from: http://www.ahrq.gov/clinic/uspstf05/aaascr/aaars.htm
Cardiovascular Risk: Aspirin for Primary Prevention
U.S. Preventive Services Task Force. Aspirin for the Prevention of Cardiovascular Disease.
Rockville, MD: Agency for Healthcare Research and Quality; 2009. Available from:
http://www.ahrq.gov/clinic/USpstf/uspsasmi.htm

CVD 10-year risk calculator: http://www.mcw.edu/calculators/CoronaryHeartDiseaseRisk.htm
Stroke 10-year risk calculator:
http://www.westernstroke.org/index.php?header_name=stroke_tools.gif&main=stroke_tools.php

Diabetes
U.S. Preventive Services Task Force. Screening for Type 2 Diabetes Mellitus in Adults.
Rockville, MD: Agency for Healthcare Research and Quality; 2008. Available from:
http://www.ahrq.gov/CLINIC/USPSTF/uspsdiab.htm

Federal Bureau of Prisons. Clinical Practice Guidelines: Management of Diabetes.
Washington, DC: Federal Bureau of Prisons; 2012. Available from:
http://www.bop.gov/news/medresources.jsp
American Diabetes Association. Standards of medical care in diabetes—2010. Diabetes
Care. 2010;33(suppl 1):S11–S61. Available from:
http://care.diabetesjournals.org/content/33/Supplement_1/S11.full
Folic Acid Supplements
U.S. Preventive Services Task Force. Folic Acid for the Prevention of Neural Tube Defects
Recommendation Statement. Rockville, MD: Agency for Healthcare Research and Quality;
May 2009. Available from: http://www.ahrq.gov/clinic/uspstf09/folicacid/folicacidrs.htm
Hypertension
Federal Bureau of Prisons. Clinical Practice Guidelines: Hypertension. Washington, DC:
Federal Bureau of Prisons; 2004. Available from: http://www.bop.gov/news/medresources.jsp
U.S. Preventive Services Task Force. Screening for High Blood Pressure. Rockville, MD:
Agency for Healthcare Research and Quality; 2007. Available from:
http://www.ahrq.gov/CLINIC/USPSTF/uspshype.htm

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Federal Bureau of Prisons
Clinical Practice Guidelines

Preventive Health Care
April 2013

Lipids
Federal Bureau of Prisons. Clinical Practice Guidelines: Management of Lipid Disorders.
Washington, DC: Federal Bureau of Prisons; 2006. Available from:
http://www.bop.gov/news/medresources.jsp

U.S. Preventive Services Task Force. Screening for Lipid Disorders. Rockville, MD:
Agency for Healthcare Research and Quality; 2008. Available from:
http://www.ahrq.gov/CLINIC/uspstf/uspschol.htm

Obesity
Centers for Disease Control and Prevention [homepage on the Internet]. Body Mass Index
Calculator. Accessed April 20, 2009. Available from:
http://www.cdc.gov/healthyweight/assessing/bmi/index.html
U.S. Preventive Services Task Force. Screening for Obesity in Adults. Rockville, MD:
Agency for Healthcare Research and Quality; 2003. Available from:
http://www.ahrq.gov/clinic/uspstf/uspsobes.htm
Osteoporosis
Gourlay, Margaret L. Bone-density testing interval and transition to osteoporosis in older
women. N Engl J Med. 2012;366:225–233.
Raisz LG. Clinical practice. Screening for osteoporosis. N Engl J Med. 2005;353:164–171.
U.S. Department of Health and Human Services. Bone Health and Osteoporosis: A Report
of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services,
Office of the Surgeon General; 2004. Available from:
http://www.surgeongeneral.gov/library/bonehealth/content.html

U.S. Preventive Services Task Force. Screening for osteoporosis: U.S. preventive services
task force recommendation statement. Ann Intern Med. 2011;154(5):356–364. Available
from: http://www.annals.org/content/154/5/356/suppl/DC1 and
http://www.guideline.gov/content.aspx?id=25316

Visual Acuity in Older Adults
U.S. Preventive Services Task Force. Screening for Impaired Visual Acuity in Older Adults
recommendation Statement. Rockville, MD: Agency for Healthcare Research and Quality;
July 2009. Available from: http://www.ahrq.gov/clinic/uspstf09/visualscr/viseldrs.htm

F. Immunizations
Centers for Disease Control and Prevention. Division of Global Migration and Quarantine [homepage
on the Internet]. Technical Instructions to Panel Physicians. Revised October 29, 2008. Accessed
April 20, 2009. Available from: http://www.cdc.gov/ncpdcid/dgmq/index-new-sites.html
Centers for Disease Control and Prevention [homepage on the internet]. Adult Immunization
Schedule. Accessed April 20, 2009. Available from:
http://www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm.

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Federal Bureau of Prisons
Clinical Practice Guidelines

Preventive Health Care
April 2013

Appendix 7. Preventive Health Forms
This Appendix contains the following forms, which are also available on Sallyport:
•

BP-A0891: Preventive Health Summary – Males (BP-S891.060: Instructions) = 2 pages

•

BP-A0890: Preventive Health Summary – Females (BP-S890.060: Instructions) = 2 pages

•

BP-A0889: Preventive Health Risk Assessment Tool – Males = 2 pages

•

BP-A0892: Preventive Health Risk Assessment Tool – Females = 3 pages

31

PREVENTIVE HEALTH SUMMARY – MALES

BP- A0891

U.S. DEPARTMENT OF JUSTICE

CATEGORY

Updated April 2013

FEDERAL BUREAU OF PRISONS

REVISION HPC IN AUG 2012

Prevention Visits

Baseline visit:
 Within 6 months of intake or intake physical examination.
Periodic visit:
 Age < 50: Every 3 years.
 Age 50 and older: Every year. Review risk factors and needed screening tests; provide
counseling, obtain vital signs and WT.
 If BMI >30 kg/m2: Counsel about diet /exercise.

Tuberculin Skin Test

TST annually unless documented prior TST (+/mm) or documented history of TB.

Chest X-Ray

Baseline CXR only if TST (+), foreign-born, or have recently been outside the U.S.
Semi-annual CXR indefinitely if HIV (+) and either TST (+) or a close contact to an active TB
case.
Average risk: Annual FOBT x 3 at age 50–70 years.
High risk: Periodic colonoscopy determination per risk factors.

Colon Cancer
Diabetes

Risk-factor based: BP >135/80, blood glucose >110 mg/dl, or clinically indicated.
Perform: Fasting plasma glucose or hemoglobin A1C every 3 years.

Cholesterol

Average risk: Begin at age 35, every 5 years (Fasting Lipid profile).
High risk: Begin at age >20, every year (Fasting Lipid profile).

CVD Risk

Ages 45–79: Calculate risk of stroke every 5 years. If >6%, discuss ASA use.

Abdominal Aortic
Aneurysm (AAA)

At risk: Ages 65–75, with a history of smoking.
Abdominal ultrasonography once.
Surgically repair large AAAs (5.5 cm or more).

Hearing Test

Age > 65: Ask about hearing every year.
Occupational risk: Annual audiogram.

Oral Cancer

Cancer screening: Examination of head, neck, and oral cavity. Risk factors include tobacco,
alcohol, ≥ 55 years, HPV, and sun exposure. Biopsy if lesions not resolved in 7–10 days.

Substance Abuse

All inmates: History of substance abuse at intake. Assess for detoxification; assess for need
for referral for counseling.

VACCINE

PHC-AUG 2012

SCREENING T EST

PHC- AUG 2012

Tetanus

Booster every 10 years: Admin Tdap x1
and then Td booster every 10 years.
Unknown history: 3-dose series with
initial Tdap dose.

Gonorrhea/
Chlamydia

If age 25 or less, have HIV infection, or
history of sexually transmitted diseases
such as syphilis, gonorrhea, or
chlamydia

MMR

Born in >1956: Admin 1 dose.
Unknown history: Admin 2 doses.

Syphilis (RPR)

All sentenced inmates.

Pneumococcal

Age >65: Admin 1 dose.
Risk-factor based: Admin 1 dose and
repeat in 5 years.

HIV EIA

All sentenced inmates.

Hepatitis A

Risk-factor based: Men having sex with
men, injecting illegal drugs, liver disease,
clotting factor.

HBsAg

At risk for Hepatitis B or prior infection.
Pre-vaccination.

Hepatitis B

Risk-factor based: Diabetes & age <60,
liver diseases, HIV, HCV, injection drug
use, men having sex with men, STD,
exposures, ESRD, acute hepatitis.

HCV EIA

At risk for Hepatitis C or prior infection.

Influenza

Immunize every year if age >50 or
medical risk factors.

BP- S891.060

INSTRUCTIONS FOR PREVENTIVE HEALTH SUMMARY – MALES

U.S. DEPARTMENT OF JUSTICE

Updated April 2013

FEDERAL BUREAU OF PRISONS

The Preventive Health Summary for males (BP- A0891) and females (BP- A0890) are tools to track preventive
health interventions and record preventive health visits, screening tests, tuberculin skin tests, and
immunizations. Screening and intervention should be documented within the medical record.
A prevention baseline visit should be conducted for all sentenced inmates within six months of
incarceration. At the discretion of the Clinical Director and Health Services Administrator, the prevention
baseline visit may be either incorporated into the intake physical examination or scheduled later as a separate
visit.
Preventive Health Program Overview: Consult the BOP Clinical Practice Guidelines on Preventive Health
Care for specific recommendations about age- and risk-based counseling, screening, and immunizations.
Intake/Intake History and Physical: All inmates should be screened for TB symptoms (tuberculin skintested, unless contraindicated), and screened for syphilis, gonorrhea, and chlamydia (if risk factors).
Prevention Baseline Visit: Preventive health assessment should take place during intake/intake history and
physical or within 6 months of incarceration. Indicate on the Summary if the inmate is at high risk for specific
conditions, using “Y” (yes) or “N” (no). Based upon risk assessment, determine a plan for preventative health
services and implement counseling, referral, screening for infectious diseases, chronic diseases and cancer,
and administer immunizations.
Periodic Prevention Visits: Conduct every three years for sentenced inmates under age 50, and every year
beginning at age 50. Review the plan for preventive health services. Routine evaluations include: weight,
BMI, vital signs, and age/risk-based screenings. Assure provision of annual tuberculin skin tests, influenza
vaccination (if indicated), and audiograms (if occupational risk).

PREVENTIVE HEALTH SUMMARY – FEMALES

BP- A0890

U.S. DEPARTMENT OF JUSTICE

CATEGORY
Prevention Visits

Pap Smear/HPV

FEDERAL BUREAU OF PRISONS

REVISION HPC IN AUG 2012

Tuberculin Skin Test
Chest X-Ray
Mammogram

Updated April 2013

Baseline visit:
 Within 6 months of intake or intake physical examination.
Periodic visit:
 Age < 50: Every 3 years.
 Age 50 and older: Every year. Review risk factors and needed screening tests; provide
counseling, obtain vital signs and WT.
 If BMI >30 kg/m2: Counsel about diet /exercise.
TST annually unless documented prior TST (+/mm) or documented history of TB.
Baseline CXR only if TST (+), foreign-born, or have recently been outside the U.S.
Semi-annual CXR indefinitely if HIV (+) and either TST (+) or a close contact to an active TB case.
Average risk: Biennial ages 50–74.
High risk: Biennial beginning at age 40.
Pap smear: Intake, then every 3 years for ages 21–65.
OR

Colon Cancer
Diabetes
Cholesterol
CVD Risk
Osteoporosis

Hearing Test
Oral Cancer
Substance Abuse

VACCINE
Tetanus

MMR
Pneumococcal

Hepatitis A

Hepatitis B

Influenza

Pap smear & HPV: Intake, then every 5 years for ages 30–65.
Average risk: Annual FOBT x 3 at age 50–70 years.
High risk: Periodic colonoscopy determination per risk factors.
Risk-factor based: BP >135/80, blood glucose >110 mg/dl, or clinically indicated.
Perform: Fasting plasma glucose or hemoglobin A1C every 3 years.
Average risk: Not indicated at any age.
High risk: Begin at age >20, every year (Fasting Lipid profile).
Ages 55–79: Calculate risk of stroke every 5 years. If >6%, discuss ASA use.
Ages >65 and younger women age 60–64 & weight <70 kg:
BMD screening for DXA needs — Normal T scoreevery 15 years;
moderate osteopeniaevery 5 years; advanced osteopeniaevery year.
Age > 65: Ask about hearing every year.
Occupational risk: Annual audiogram.
Cancer screening: Examination of head, neck, and oral cavity. Risk factors include tobacco, alcohol,
≥ 55 years, HPV, and sun exposure. Biopsy if lesions not resolved in 7–10 days.
All inmates: History of substance abuse at intake. Assess for detoxification; assess for need for
referral for counseling.

PHC-AUG 2012
Booster every 10 years: Admin Tdap x1
and then Td booster every 10 years.
Unknown history: 3-dose series with initial
Tdap dose.
Born in >1956: Admin 1 dose.
Unknown history: Admin 2 doses.
Age >65: Admin 1 dose.
Risk-factor based: Admin 1 dose and
repeat in 5 years.
Risk-factor based: Sex with men who
have sex with men, injecting illegal drugs,
liver disease, clotting factor.
Risk-factor based: Diabetes & age <60,
liver diseases, HIV, HCV, injection drug
use, sex with men who have sex with
men, STD, exposures, ESRD, acute
hepatitis.
Immunize every year if age >50 or
medical risk factors.

SCREENING T EST
Gonorrhea/
Chlamydia

PHC- AUG 2012

Syphilis (RPR)

If age 25 or less, have HIV infection, or
history of sexually transmitted diseases
such as syphilis, gonorrhea, or
chlamydia
All sentenced inmates.

HIV EIA

All sentenced inmates.

HBsAg

At risk for Hepatitis B or prior infection.
Pre-vaccination.

HCV EIA

At risk for Hepatitis C or prior infection.

BP- S890.060

INSTRUCTIONS FOR PREVENTIVE HEALTH SUMMARY – FEMALES

U.S. DEPARTMENT OF JUSTICE

Updated April 2013

FEDERAL BUREAU OF PRISONS

The Preventive Health Summary for males (BP- A0891) and females (BP- A0890) are tools to track preventive
health interventions and record preventive health visits, screening tests, tuberculin skin tests, and
immunizations. Screening and intervention should be documented within the medical record.
A prevention baseline visit should be conducted for all sentenced inmates within six months of
incarceration. At the discretion of the Clinical Director and Health Services Administrator, the prevention
baseline visit may be either incorporated into the intake physical examination or scheduled later as a separate
visit.
Preventive Health Program Overview: Consult the BOP Clinical Practice Guidelines on Preventive Health
Care for specific recommendations about age- and risk-based counseling, screening, and immunizations.
Intake/Intake History and Physical: All inmates should be screened for TB symptoms (tuberculin skintested, unless contraindicated), and screened for syphilis, gonorrhea, and chlamydia (if risk factors).
Prevention Baseline Visit: Preventive health assessment should take place during intake/intake history and
physical or within 6 months of incarceration. Indicate on the Summary if the inmate is at high risk for specific
conditions, using “Y” (yes) or “N” (no). Based upon risk assessment, determine a plan for preventative health
services and implement counseling, referral, screening for infectious diseases, chronic diseases and cancer,
and administer immunizations.
Periodic Prevention Visits: Conduct every three years for sentenced inmates under age 50, and every year
beginning at age 50. Review the plan for preventive health services. Routine evaluations include: weight,
BMI, vital signs, and age/risk-based screenings. Assure provision of annual tuberculin skin tests, influenza
vaccination (if indicated), and audiograms (if occupational risk).

Preventive Health Risk Assessment Tool – Males

BP- A0889

U.S. DEPARTMENT OF JUSTICE

Updated April 2013

FEDERAL BUREAU OF PRISONS

The Preventive Health Risk Assessment Tool is utilized to systematically determine recommended preventive health services for sentenced
BOP inmates. It is designed to be administered at the Baseline Prevention Visit. The necessary health information can be obtained either
by inmate interview and/or by medical record review.
 The inmate has been advised of the preventive health measures that are provided by the BOP, as well as his responsibility for
seeking these services.
I. Cancer and Chronic Diseases Screening
INDICATE () INMATE’ S RISK FACTORS:

Risk Status and Recommendations
INDICATE () RISK STATUS:

RECOMMEND/ORDER ():

Colon Cancer





 None checked = Average Risk.
Fecal occult blood tests annually, ages
50-75.
 Any checked = Increased Risk.
Begin screening for colonoscopy per BOP
Clinical Practice Guidelines (CPG).

 Fecal occult blood test x3

 Fasting lipoprotein
analysis: Annually

 First-degree relative with CVD (male before age 50)

 Any high-risk factors checked: Begin
screening at age 20.
 None checked = Average Risk for Men.
Begin screening at age 35

 Tobacco use and hypertension

 Current chol, TG, HDL, LDL:_________
_________________________________

 Refer to BOP CPG.

 At risk: The BOP recommends use of
serum glucose testing or A1C for initial
screening and diagnosis.
 Current glucose, A1C: ______________

 Fasting serum glucose
and hemoglobin A1C
every 3 years

 At risk: If risk of adverse cardiovascular
event > risk of GI bleeding, recommend
inmate take aspirin 81 mg daily.

 ASA 81mg daily

History of polyps at prior colonoscopy
History of colorectal cancer
Family history of colon cancer or adenomas
Known or suspected: Familial adenomatous polyposis and
hereditary non-polyposis
 Inflammatory bowel disease

 Colonoscopy

Lipid Disorders
 Diabetes
 Existing cardiovascular disease

 Total chol., TG, HDL, LDL
at least every 5 years

Diabetes
 Blood pressure >135/80 (treated/untreated)
 Otherwise clinically indicated
Aspirin for CHD
 Men ages 45–79: Calculate CHD risk every 5 years using
risk calculator:
http://www.mcw.edu/calculators/CoronaryHeartDiseaseRis
k.htm
Check() if risk exceeds average 10-Year CHD Risk for
men: Age 45-59 ≥4%; Age 60-69 ≥9%; Age 70-79 ≥12%

 For patients with diabetes, see the BOP
Management of Diabetes CPG.

Hypertension
  Under age 50  Age 50 and over
 Borderline BP elevations (>120-139/80-90)

 If age <50, measure BP.
 If age >50 / borderline BP, measure BP.

 At least every 3 years
 At least annually

 At risk: Perform audiogram and may
consider safety equipment.

 Annual audiogram
 Recommend safety equip.

 At risk: Screen for AAA with abdominal
ultrasonography.

 Abdominal
ultrasonography
 Consider surgical repair if
indicated (> 5.5 cm)

 At risk: Screen for oral cancer.

 Ongoing

Hearing
 Age 65 and older
 Occupational risk
Abdominal Aortic Aneurysm (AAA)
 At risk: Men, ages 65–75, who have a history of smoking

Oral Cancer
 Risk factors: >55 years of age; history of HPV, sun
exposure, and alcohol/tobacco abuse
Substance Abuse
 Assess at intake: Substance abuse history?  At risk: Provide counseling and referral
Need for detoxification?
to BOP substance abuse and smoking
cessation programs, as indicated.
Patient Information

Comments:

Inmate Name:
Reg. No.:
DOB:
WT:

BMI:

 Refer for substance abuse counseling
and treatment
 Refer for smoking cessation counseling

BP/P:

Ordering Clinician Signature:
Date:

Page 1 of 2

BP- A0889

Preventive Health Risk Assessment Tool – Males

U.S. DEPARTMENT OF JUSTICE

Updated April 2013

FEDERAL BUREAU OF PRISONS

II. Bloodborne Pathogen Screening and Immunizations
Circle Y (yes) for conditions that apply.
Circle N (no) for those that do not
apply. Order screening test or
immunization for all “Y” items.

SCREENING
HIV

Hep
A

Hep
B

IMMUNIZATION/ORDER
Hep
C

Tdap

Td

Influenza

Pneu

Hep
A

Hep
B

MMR

MMR
Y
N

Born in the United States after 1956,
with history of previous MMR vaccine.

Yes

Age>50 or
risk factors:
1 dose

1 dose

Y
N

Incomplete or unknown MMR history.
And/or born outside U.S.

Yes

Age>50 or
risk factors:
1 dose

2
doses

Tetanus
1 dose

Yes

Age>50 or
risk factors:
1 dose

Y
N

Tdap given previously, but no dose
indicated. (Continue with Td booster
every 10 years.)

Y
N

Last tetanus shot > 10 years. (Give
Tdap as initial dose and then repeat
with Td booster every 10 years.)

Y
N

Incomplete/unknown history. (Give
3-dose series: 1 dose Tdap & then two
doses Td to complete series.)

Yes

Illegal injection drugs, unprotected sex
w/ multiple partners, men having sex
w/ men, sex w/HIV+, hx of STDs,
active TB, from W. Africa, hemophiliac,
received blood products 1977–85.

Yes

Yes

Yes

Yes

Age>50 or
risk factors:
1 dose

2-dose
series,
if not
immune
(if HIV+)

3-dose
series,
if not
immune
(if HIV+)

Yes

Yes

Yes

Yes

Age>50 or
risk factors:
1 dose

2-dose
series,
if not
immune

3-dose
series,
if not
immune

2-dose
series
if not
immune

3-dose
series
if not
immune

1 dose

1st
dose

Age>50 or
risk factors:
1 dose
2nd
Age>50 or
and 3rd risk factors:
doses
1 dose

HIV
Y
N

Hepatitis A & B
Y
N

Has diabetes age <60, injected legal
drugs, received tattoos/body piercing in
jail, HIV +, HCV+, recent hx STD, I/M
workers at risk, ESRD, post-exposure
prophylaxis.

Pneumonia
Y
N

Age >65, lung disease, asthma, CVD,
immunocompromised, diabetes, liver
disease, renal failure, Asplenia, ETOH
hx, long-term care. May repeat Q 5
years.

Age>50 or
risk factors:
1 dose

Yes

1-dose;
repeat in
5 years
if risk
factors

Hepatitis C
Y
N

Injected illegal drugs, tattoos or body
piercings while in jail, HIV+, HBV+,
blood transfusion <1992, and
hemodialysis.

Yes

Yes

Yes

Age>50 or
risk factors:
1 dose

Yes

Tuberculosis
Y
N

Tuberculin skin test (+).

Age>50 or
risk factors:
1 dose

Yes

Patient Information

CHECK BELOW TO INDICATE IF SCREENING/IMMUNIZATION IS INDICATED.
ORDER IF CHECKED AT LEAST ONCE ABOVE.

Inmate Name:
HIV

Reg. No.:
DOB:

Hep
A

Hep
B

Hep C

Date:
Ordering Clinician Signature:

Page 2 of 2

Tdap

Td

Influenza

Pneu

Hep A

Hep
B

MMR

BP- A0892

Preventive Health Risk Assessment Tool – Females

U.S. DEPARTMENT OF JUSTICE

Updated April 2013

FEDERAL BUREAU OF PRISONS

The Preventive Health Risk Assessment Tool is utilized to systematically determine recommended preventive health services for sentenced
BOP inmates. It is designed to be administered at the Baseline Prevention Visit. The necessary health information can be obtained either
by inmate interview and/or by medical record review.
 The inmate has been advised of the preventive health measures that are provided by the BOP, as well as her responsibility for
seeking these services.
I. Cancer and Chronic Diseases Screening

Risk Status and Recommendations

INDICATE () INMATE’ S RISK FACTORS:

INDICATE () RISK STATUS:

RECOMMEND/ORDER ():

Breast Cancer





Two 1st-degree relatives with breast or ovarian cancer
Relative with breast cancer before age 50
Relative with 2 cancers (breast and/or ovarian)
Female with male relative with breast cancer

 Any checked = Increased Risk.
Begin mammogram at age 40.
 None checked = Average Risk.
Mammograms for all females ages 50–74.

 Mammogram every
2 years

 Ages 21–65: Pap smear only

 At intake PE, then every
3 years
 At intake PE, then every
3–5 years

Cervical Cancer
 All females (who have a cervix)

OR

 Ages 30–65: Pap smear & HPV test
Colon Cancer





History of polyps at prior colonoscopy
History of colorectal cancer
Family history, genetic predisposition
Known or suspected: Familial adenomatous polyposis and
hereditary non-polyposis
 Inflammatory bowel disease

 None checked = Average Risk.
Fecal occult blood tests annually, ages
50-75.
 Any checked = Increased Risk.
Begin screening for colonoscopy per BOP
Clinical Practice Guidelines (CPG).

 Fecal occult blood test x3

 Any high-risk factors checked: Begin
screening at age 20.
 None checked = No routine screening
recommended.
 Current chol, TG, HDL, LDL:_________
_________________________________

 Fasting lipoprotein
analysis: Annually

 At risk: Serum glucose testing or
hemoglobin A1C for initial screening and
diagnosis.
 Current glucose, A1C: ______________

 Fasting serum glucose
and hemoglobin A1C
every 3 years

 Colonoscopy

Lipid Disorders
 Diabetes
 Existing cardiovascular disease
 First-degree relative with CVD (female before age 60)
 Tobacco use and hypertension

 Total chol., TG, HDL, LDL
at least every 5 years
 Refer to BOP CPG.

Diabetes
 Blood pressure >135/80 (treated/untreated)
 Otherwise clinically indicated
Aspirin for Stroke
 Females ages 55–79: Calculate risk of stroke every 5 years  At risk: If risk of adverse cardiovascular
event > risk of GI bleeding, recommend
using stroke calculator:
http://www.westernstroke.org/index.php?header_name=str
inmate take aspirin 81 mg daily.
oke_tools.gif&main=stroke_tools.php
 For patients with diabetes, see the BOP
Management of Diabetes CPG.
Check() if risk exceeds average 10-year Stroke Risk
for women: Age 55-59 ≥3%; Age 60-69 ≥8%; Age 70-79
≥11%

 ASA 81mg daily

Hypertension
  Under age 50  Age 50 and over
 Borderline BP elevations (>120-139/80-90)

 If age <50, measure BP
 If age >50 / borderline BP, measure BP

 At least every 3 years
 At least annually

 At risk: Perform audiogram and consider
safety equipment; ask about hearing
annually

 Annual audiogram
 Recommend safety equip.

 At risk: Screen for oral cancer.

 Ongoing

Hearing
 Age 65 and older
 Occupational risk
Oral Cancer
 Risk factors: >55 years of age; history of HPV, sun
exposure, and alcohol/tobacco abuse

Page 1 of 3

Preventive Health Risk Assessment Tool – Females

BP- A0892

U.S. DEPARTMENT OF JUSTICE

Updated April 2013

FEDERAL BUREAU OF PRISONS

Osteoporosis
 Age 65 and older, and younger women w/ Fx risk
 Age 60-64 w/ < 70 Kg and no current estrogen tx

Screening results:
 Normal-moderate BMD (T score 1.00–1.49)  Screen Q 15 years
 Moderate BMD (T score 1.50–1.99)
 Screen Q 5 years
 Advanced BMD (T score 2.0–2.49)
 Screen annually

Substance Abuse
 Assess at intake: Substance abuse history?
Need for detoxification?
Patient Information

 At risk: Provide counseling and referral
to BOP substance abuse and smoking
cessation programs, as indicated.

 Refer for substance abuse counseling
and treatment
 Refer for smoking cessation counseling

Comments:

Inmate Name:
Ordering Clinician Signature:

Reg. No.:
DOB:

Date:
WT:

BMI:

BP/P:

Page 2 of 3

BP- A0892

Preventive Health Risk Assessment Tool – Females

U.S. DEPARTMENT OF JUSTICE

Updated April 2013

FEDERAL BUREAU OF PRISONS

II. Bloodborne Pathogen Screening and Immunizations
Circle Y (yes) for conditions that apply.
Circle N (no) for those that do not
apply. Order screening test or
immunization for all “Y” items.

SCREENING
HIV

Hep
A

Hep
B

IMMUNIZATION/ORDER
Hep
C

Tdap

Td

Influenza

Pneu

Hep
A

Hep
B

MMR

MMR
Y
N

Born in the United States after 1956,
with history of previous MMR vaccine.

Yes

Y
N

Incomplete or unknown MMR history.
And/or born outside U.S.

Yes

Y
N

Women of child bearing age w/o
evidence of MMR immunity. (Give only
after negative serum pregnancy test.)

Yes

Age>50 or
risk factors:
1 dose
Age>50 or
risk factors:
1 dose
Age>50 or
risk factors:
1 dose

1 dose

2
doses
2
doses

Tetanus
1 dose

Yes

Age>50 or
risk factors:
1 dose

Y
N

Tdap given previously, but no dose
indicated. (Continue with Td booster
every 10 years.)

Y
N

Last tetanus shot > 10 years. (Give
Tdap as initial dose and then repeat
with Td booster every 10 years.)

Y
N

Incomplete/unknown history. (Give
3-dose series: 1 dose Tdap & then two
doses Td to complete series.)

Yes

Illegal injection drugs, unprotected sex
w/ multiple partners, sex w/known
HIV+, hx of STDs, pregnancy, active
TB, from W. Africa, hemophiliac,
received blood products 1977–85.

Yes

Yes

Yes

Yes

Age>50 or
risk factors:
1 dose

2-dose
series,
if not
immune
(if HIV+)

3-dose
series,
if not
immune
(if HIV+)

Yes

Yes

Yes

Yes

Age>50 or
risk factors:
1 dose

2-dose
series,
if not
immune

3-dose
series,
if not
immune

2-dose
series
if not
immune

3-dose
series
if not
immune

1 dose

1st
dose

Age>50 or
risk factors:
1 dose
2nd
Age>50 or
and 3rd risk factors:
doses
1 dose

HIV
Y
N

Hepatitis A & B
Y
N

Has diabetes age <60, injected legal
drugs, received tattoos/body piercing in
jail, HIV +, HCV+, recent hx STD, I/M
workers at risk, ESRD, post-exposure
prophylaxis.

Pneumonia
Y
N

Age >65, lung disease, asthma, CVD,
immunocompromised, diabetes, liver
disease, renal failure, Asplenia, ETOH
hx, long-term care. May repeat Q 5
years.

Age>50 or
risk factors:
1 dose

Yes

1-dose;
repeat in
5 years
if risk
factors

Hepatitis C
Y
N

Injected illegal drugs, tattoos or body
piercings while in jail, HIV+, HBV+,
blood transfusion <1992, and
hemodialysis.

Yes

Yes

Yes

Age>50 or
risk factors:
1 dose

Yes

Tuberculosis
Y
N

Tuberculin skin test (+).

Age>50 or
risk factors:
1 dose

Yes

Patient Information

CHECK BELOW TO INDICATE IF SCREENING/IMMUNIZATION IS INDICATED.
ORDER IF CHECKED AT LEAST ONCE ABOVE.

Inmate Name:
HIV
Reg. No.:
DOB:

Hep
A

Hep
B

Hep C

Date:
Ordering Clinician Signature:

Page 3 of 3

Tdap

Td

Influenza

Pneu

Hep A

Hep
B

MMR