(and often terminal) needs are moved out of DOC custody into an appropriate level of care outside of the correctional system. CT DOC is a pioneer among correctional jurisdictions in the creation of this model. On‐Site Medical Care Intake – Jail CT DOC policy requires jail intake screening upon admission (Directive 8.1.7). In general, all intake screenings are completed in a timely manner with critical actions taken to address substance use withdrawal, refer for essential medications, and appropriately manage any mental health issues requiring immediate intervention. Referrals for treatment and ongoing care seem as though they are completed in a timely manner, and chart review showed follow‐up care was met 89% of the time. This is particularly important at the intake facilities. CT DOC should prioritize focusing on ensuring that the delivery of necessary medical care occurs. All patients identified with medical or psychiatric needs should have a plan of care that includes timely follow‐up, medication management, additional testing or diagnostics, as well as orders for interval of care follow‐up as it relates to best practice around their chronic condition levels of control (i.e., patients with poorly controlled disease will have a shorter interval to follow up then a person with well‐ controlled illness). CT DOC might consider a dedicated LEAN project focused on this patient flow issue and institute routine audits at each intake facility. Other areas of future attention at the intake stage are infectious disease screening and follow‐up (e.g. TB/STI) as well as Hepatitis A/B/C assessment and immunizations. CT DOC should work to align its policy and practice with the Connecticut Public Health Guidelines. Our inability to conduct in‐person or virtual site visits prevented a thorough assessment of privacy protections during the intake screening and assessment process. Privacy is of critical importance to the inmate/patient and lends credibility to the CT DOC health care services; In addition, health care practitioners are bound by patient privacy practice standards. Intake – Prison Despite the limited information available on this topic, it is our understanding the CT DOC practice is not to duplicate intake screening and/or assessment protocols following transfer from another system facility regardless of the time elapsed between system intake and the transfer. The only policy reviewed regarding intra‐facility transfers (Directive 8.1.7) states, “In the event of a referral from the admitting and processing staff member for an immediate screening and assessment, a qualified health services staff member shall promptly conduct an intake or transfer health screening and assessment.” This policy Recommendation 15 contemplates provider follow‐up on referrals. We were unable to secure any other policy related to CT DOC prison intake/transfer policy. The National Commission on Correctional Healthcare (NCCHC) Prison transfer standard (Prison: P‐E‐03) can inform the CT DOC transfer policy and ensure that health assessments are performed upon transfer. Regardless of the decision to implement a more detailed policy, CT DOC should consider policies and practices that will ensure inmates with risks are provided continuity of care coordination across settings. The EHR (discussed in detail later in the report) is a critical tool to identify patient movement and allow for continuity of care across the CT DOC system. The EHR ensures that a patient’s information and plan of care follows them and is available to their care team wherever they transfer within the facilities. It provides continuity of care documentation for all service lines, medical, behavioral health, and dental. The CT DOC EHR utilizes a “transfer encounter,” but it is not clear who is responsible for activating the patient in the new site and ensuring that all elements of care/diet/orders/referral are addressed in a timely way. We do know that pending orders could and occasionally are dropped in the transfer process. Initial Health Assessment CT DOC Policy (Directive 8.1.8.B) regarding Initial Health Assessment comports with NCCHC standards and most state penal codes that require a comprehensive health assessment be conducted within 14 days of incarceration. Yet, the chart review did not demonstrate a process for and documentation of Initial Health Assessments. We were advised by a Centricity training team member that Initial Health Assessments are not routinely done and only occur upon the recommendation of the nurse to a provider. It was difficult to assess the frequency and outcome of nurse‐to‐provider referrals due to provider tendency to incorrectly document such referrals in the EHR (i.e. they often do not correctly document these events as provider encounters). Health assessment is the central driver of the care model and ensures that all health care needs are assessed and documented and that a plan of care and follow‐up planning are clearly established. Assessments are conducted by a provider or a nurse if the provider has trained the nurse (NCCHC standard: When assessment is conducted by nurse, positive findings should be reviewed by provider). A behavioral health and/or physical health provider should perform the intake assessments to manage emergent and urgent medical, mental health, substance use, and dental needs. The lack of standardization of timely delivery of the