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Control Number: <br />411.06.03.001 <br />Version: <br />7.0 <br />Title: <br />Co-Pay for Medical Services <br /> <br />Page Number: <br />5 of 5 <br /> <br />Idaho Department of Correction <br />• Eyeglasses provided once every two years by prescription <br />o In the event glasses are broken, lost, or misplaced before the two year <br />timeframe is completed, the inmate will be subject to a $2 co-pay for an <br />optometry visit and $2 co-pay to replace the lost or broken glasses. <br />Inmate Worker Work-Related Injuries <br />Inmates injured while working at a facility (kitchen worker, CI, janitor, maintenance, etc.) <br />are allowed one initial visit and one follow up visit at no charge for the work injury. A <br />medical provider must order further visits to be exempt from a co-pay charge. <br />6. Health Services Request Co-Pay Form <br />An inmate must complete a health services request co-pay form before each visit for health <br />care services except as exempted above. <br />An inmate may submit up to three health service requests with one issue per request per <br />day. <br />7. Assessing the Medical Co-Pay Fee <br />Upon completion of the four-part NCR health services request co-pay form, the original (first <br />page) is kept by the health care professional. The second and third pages go to fiscal for <br />charging the medical co-pay fee. The fourth page is kept by the inmate. The third page is <br />returned to the inmate by institutional mail once charges are documented. <br />8. Inmate Concerns <br />An inmate who thinks a medical co-pay fee was unfairly charged may file a concern form <br />seeking resolution. <br />9. Compliance <br />Compliance with this SOP and all related Department -approved protocols will be monitored <br />by the health services director, or designee, by using various sources to includ e: this SOP, <br />clinical practice guidelines, routine reports, program reviews, and record reviews. <br />The health services director, or designee, must conduct two audits a year (or more <br />frequently as desired based on prior audit results). The audits must consist of monitoring <br />applicable contract medical provider and IDOC policy and procedures, applicable NCCHC <br />standards, and the review of a minimum of fifteen individual records. <br />DEFINITIONS <br />None <br />REFERENCES <br />None <br /> <br />– End of Document – <br />