#iso request

ISOLATION FORM

ISOLATION FORM Patient name: Payton Lutz Age: 14 Isolation type: Solitary Duration: 72 hours Reason: Physically and verbally fighting with another patient even though patient knew it would cause her physical injury, not stopping when requested to by a member of staff, threatening to kill said patient Date issued: 06/11/2015 Requested by: Alton Greer

((on behalf of and with the consent of Em, given her hiatus))

ISOLATION FORM Patient name: Kara Stoyan Age: 18 Isolation type: Infirmary Isolation Duration: 36 hours Reason: Physical altercation with patient, Leah Jackson Date issued: 24 July 2014 (note: patient didn’t report until multiple days had passed) Requested by: Jack Emerson

ISOLATION FORM Patient name: Alice Deveraux  Age: 17 Isolation type: Infirmary Duration: 24 hours Reason: Out past curfew Date issued: 6-23-15 Requested by: Sebastian Hayle

ISOLATION FORM Patient name: Jace Colbert Age: 16 Isolation type: Infirmary Duration: 24 Hours Reason: Out past curfew Date issued: 6-23-15 Requested by: Sebastian Hayle

ISOLATION FORM Patient name: Camila Age: 17 Isolation type: Infirmary Duration: 48 hours Reason: Threat to a staff member/breaking curfew Date issued: 6/20/15 Requested by: Sebastian Hayle, Head Security

ISOLATION FORM Patient name: Cole Wallace Age: 17 Isolation type: Solitary Isolation Duration: 72 Hours Reason: Threatened to break staff member’s wrists Date issued: 4/25/2015 Requested by: Steven Waldec, Head of Security