Form USM-553, Prisoner in Transit Summary
BOX 1: Self-explanatory. Note that Designated To refers to the prisoners final permanent designated facility and not any
intermediate facilities that the prisoner may transit through.
BOX 2: Self-explanatory.
BOX 3: The goal of this section is to identify recent medical conditions or changes in medical conditions that might impact the
transfer of a prisoner. Positive responses in this section should be further explained in BOX 7 (COMMENTS). For female
prisoners, determination of pregnancy status is dependent on the policies in place at the sending facility. JPATS does not require
a urine or blood pregnancy testing results as confirmation.
BOX 4: This section must be completed for those prisoners who will be transported by air. A documented history of either Sickle
Cell Disease or Sickle Cell Trait is sufficient. Hemoglobin electrophoresis results are not required to confirm diagnosis. The
JPATS Sickle Cell clearance is a separate document that must be attached to the USM-553 if indicated.
BOX 5: Self-explanatory.
BOX 6 (a&b): Self-explanatory. Note that medications listed should correlate with the medical problems that are listed. If more
space is needed use of the back of the document or a separate sheet of paper is allowed.
BOX 7: This space is available for any other pertinent information that the transporting medical personnel and the receiving
facility should be aware of.
BOX 8: Signing this section means that the designated health authority at the sending facility has assessed this prisoner and
deemed the prisoner medically cleared for transport.
