Prepare the health information.

Print this sheet and complete it off the site. Jail411 does not collect or transmit health information. This is an independent preparation worksheet, not an official LASD form.

Fax numbers & full process →

JAIL411 · PREPARATION WORKSHEET

Custody health summary

Independent worksheet, not an official LASD form. For urgent medical concerns call (213) 893-5544, available 24/7. A fax does not replace an urgent call.

Booked name, date of birth and booking number

Current facility and housing, if known

Sender name, relationship and callback number

Treating physician / psychiatrist and contact information

Diagnoses and current concerns

Medications, doses, schedule and pharmacy

Allergies, adverse reactions and medicines that did not work

Recent self-harm risks or other urgent concerns

Date/time sent, fax used and follow-up record

Include relevant health information, not charge details. Confirm the receiving fax and keep a copy and transmission confirmation. Use the healthcare guide for hours, fax routes, consent and follow-up.
www.jail411.com/directory/california/los-angeles-county/healthcare/