Healthcare Provider's Certification Form

A Healthcare Provider’s Certification Form must:

a) Be completed for all individuals serving Work Release, Work Furlough, or Weekender sentences for more than 24 hours

b) Be completed less than 45 days before incarceration to assess whether the person is medically fit to serve time in the Maricopa County jails

c) Include Current PPD (within six months), or a negative chest x-ray with a negative symptom assessment

This must be completed less than 45 days before incarceration. You must obtain a Tuberculin Skin Test, or Chest X-Ray as indicated in the form. It typically takes 72 hours to get test back, so allow for plenty of time. You must bring the completed form with you to jail.

Click here for a downloadable copy of the instructions and form.

Jail Information

 

You must bring the following items with you when you report to the jail:

·          The Confinement Order as issued by the court.

·          A government issued picture identification, such as a driver’s license.

·          A completed Healthcare Provider's Certification Form.

·          If you have prescription medication(s) that you must take, it must be in the original pharmacy container with your name on it and a quantity sufficient for your stay in jail.

·          Any necessary medical device(s), such as C-PAP machine, prosthesis, etc.

If you fail to bring your confinement order or proper identification you may be refused for intake. You will be required to return to the court for an amended order of confinement for a later date / time. Do not confuse the court minute entries for the Confinement Order, they are not the same. If you have been sentenced to more than 24 hours of Weekender, Work Release or Work Furlough you must have a Health Care Provider’s Certification Form completed no more than forty-five (45) days prior to your reporting. This form will be given to you by the court at the time of your sentencing and is also available on the MCSO website. A TB test is required to be completed and takes a minimum of two (2) days to complete. Failure to complete any portion of the form or failure to bring the form with you may cause you to be removed from the Work Furlough / Work Release program and you will be kept in full-custody for the duration of your sentence.

 Once you have begun your work hours, you may bring back the following items on your first day out;

Work Release: Prescription eyeglasses, one (1) jacket or sweater, one (1) plastic flashlight (C-size batteries maximum), one (1) watch, one (1) wedding ring, one (1) wallet with driver’s license or identification card, one (1) paperback book or magazine, one (1) non-electric clock, approved prescription medication, two (2) towels, up to $40 in cash, and up to $5.00 in quarters for use of the laundry machines.

 Any item not on this list is considered contraband and will not be accepted at the jail.

The jail has shower facilities and laundry machines. You may bring in contact lenses, but must buy the solution from the inmate canteen. Combination padlocks may be purchased from the inmate canteen for lockers. You cannot bring in an outside padlock.

Cell phones are not allowed and will be impounded. Jackets or sweaters cannot have hoods. Towels, clocks, flashlights, and books or magazines will remain at the facility during release times.

All of the following clothing items are unauthorized.

·          Sleeveless shirts

·          Tank tops

·          Tube tops

·          Low cut shorts

·          Bathing suits

·          Shirts exposing the stomach

·          Clothing with unacceptable language or gang affiliations printed on it

·          See-through clothing

·          Flip flops (shoes)

·          Sandals

·          Steel-toed boots

 The Inmate Rules and Regulations prohibit the use of drugs or alcohol within the jail environment; Rules Violation(s) 028: Being Intoxicated, and 032: Refusing to Submit to Any Drug Test, Failure to Produce a Sample, or Having Positive Test Results.

If you are sentenced to Work Release or Work Furlough and you report to the jail with alcohol or drugs in your system you will be accepted into the jail, issued a disciplinary action report for violation of the inmate rules, and placed into full-custody for the duration of your sentence. You will not be eligible for either Work Release or Work Furlough and the sentencing court will be notified.