so NUMBER DATE BOOKED CURRENT CLASS PAGE 07/10/2015 I MEDIUM 1 Booklng Sheet STATUS Waller County Sheriffs Office 95 $20,513 (DO NOT INCLUDE PAROLE 1 701 Calvit. Hempstead, TX 77445 979-826?8282 NAME SID JAIL ID I BOOKING NUMBER BLAND, SANDRA ANNETTE - 3038* if ALIAS NAME-SI FBI IMAGE BLAND, SANDRA I SEX I ETHNICITY DATE OF BIRTH AGE NON HISPANIC 02/07/1987 28 HEIGHTALF WEIGHT HAIR EYES BUILD COMPLEXION SOCIAL SECURITY NO 3 6 FT. 0 I 175 BLK BRO OBR SEARS AMPUTATIONS TATTOO ON BACK ADDRESS PHONE PLACE OF BIRTH CHICAGO. IL UNITED STATES EMERGENCY CONTACT NAME EMERGENCY CONTACT ADDRESS a PHONE PHONE NUMBERS CALLED AT BOOKING ADDITIONAL IMAGE 95 2 RELATIONSHIP . Lu ARRESTING AGENCY ARRESTING OFFICER ARREST DATE I ARREST TIME ARREST LOCATION . DEPARTMENT OF 2547. ENCINIA. BRIAN 07/1012015 4:27 PM . U, SAFETY VEHICLE MODEL 7 LICENSENO STATE VEHICLE TOTALJED MAKE I HYUNDAI AZERA CROWN BODY SHOP DEPOSIT AMT QTY I ITEM DESCRIPTION 5 LOCATION I BINIBOX $30 1 SANDALSMULTI COLOR Property Bin6 - - -- -- I DRESS BLK BRA BLU 7 1 Bm (I CURRENT BALANCE 5 1 I $.00 i UNDERWARE THUMB PRINT 7 1 I CIRCLE BANDROPE BELT.HAIR I Property I Bin6 I I certify that this is a correct Iist of I pm I I items removed from my . I possession at the time I was 1 1 PIERCING-BELOW BELT Property 6 I placed in jail I 1 4? TX DL 1 Property 8m 6 4 END OF LIST DATE ELSA CHARGES HOLD REASON I I OFFENSE I ISSUING I BONDING I BOND I BOND I FINE I DISP REFERENCE No. AUTHORITY STATUS I AMOUNT TYPE WARRANTL ASSAULT PUBLIC DISTRICT Not Set ESSION- I . SERVANT VIEW I . SO 026981 DOB 02/07/1987 Desc Suicide Questionnaire Black Female Suicide Assessment BLAND, SANDRA ANNETTE Booked 07/10/2015 8:15 PM 1. Does arresting No 12- HaVe YOU had officer or any other thoughts of killing person believe that yourself in the last the inmate is at risk? year? 2. Any current medical yes 13. Are you thinking NO problems, recent about killing hospitalizations or yourself today? serious injuries or withdrawal concerns? INMATE STATES SHE HAS EPILEPSY 3. If female are you No 14. Have you ever Yes pregnant? attempted suicide? it When? Why? How? IN TAKING PILLS 4. Medications? Yes 15. Have y0u Yes experienced a recent KEPPRA loss? GOD MOTHER PASSED IN LATE 2014 5. Have you ever No 16. Does the individual N0 received services for seem: confused, mental health or pre-occupied, mental retardation? hopeless, sad, paranoid, 6. Do you receive a No 17. Is this person's NO social security speech: rapid, hard check? to understand, hesitant, or childlike? 7. Have you ever been NO 18. Observed to be None (NO) in special under the influence education? of: Alcohol? Drugs? Withdrawals? 8. Do you have any NO 19. Observed to have No previous military visible signs of harm service? cuts on arms, etc.): 9. Do you hear any N0 20. Does the screener N0 noises or voices that suspect mental other people don't illness/mental seem to hear? retardation? 10. Have you ever been NO 21. If yes, when was a MA depressed? magistrate notified? Date/Time How? Written/Electronic 11. Do you feel this way No 22. Additional now? Comments Screening Officer: MAGNUS. ELSA Screening Date/Time: 07/10/2015 8:18 PM Comment: Reviewing Officer: PAGE I 2 Primed on 7 20/5 at 8.56:0} PM SO 026981 BLAND, SANDRA ANNETTE DOB 02/07/1987 Desc Black Female 175 Booked 07/10/2015 8:15 PM Medical Intake 07/10/2015 8:17 PM Officer MAGNUS, ELSA Badge EM3679 Insurance N0 Carrier Policy Comment TB Test Date by Test Results Date Test Read by Reaction X-Rays Ordered by X-Ray Results Treatment for TB Given No Intake Questionnaire 1. Allergies? No 8. Alcoholism? N0 15. OtherConditions? NO 2. Asthma? N0 9. Mental Illness? No 16. 3. HeartTrouble? N0 10. Venereal Disease? No 17. Recent Injuries: 4. Hypertension? N0 11. Tuberculosis? N0 18. Treatment-Recent Injury: 5. Diabetes? No 12. Attempted Suicide? N0 19. Special Needs: 6. Epilepsy? Yes 13. Communicable N0 20. Pregnant? N0 Diseases? INMATE STATES SHE HAS EPILEPSY 7. Drug Addiction? No 14. Hepatitis? NO Printed on 7/13/2015 at 4.5653 PM Page 1 of 1 WALLER COUNTY OFFICE INMATE INVENTORY CHECK-IN SHEET SOEI: BOOKIN DATE: 7 '5 BOOKIN TIME: LAST NAME: FIRST NAME: 5 and Ira, MIDDLE NAME: an nc'H-e, AGE: RACE: SEX: DOB: a 1 - ?31 ASSIGNED INVENTORY CHECK LIST CHECK OFF INVENTORY BY PLACING A CHECK IN THE SPACE PROVIDED AFTER EACH ITEM INMATE RECEIVED ITEMS NOT RECEIVED SHOULD BE LEFT BLANK. INMATES WILL BE HELD RESPONSIBLE FOE EACH ITEM SIGNS OUT CHECK IN DATE: '1 lo I5 CHECK OUT DATE: 1 PAIR OF ORANGE SHOES $2.00 1 PAIR OF ORANGE SHOES $2.00 1 PAIR OF ORANGE PANTS $8.00 1 PAIR OF ORANGE PANTS $8.00 1ORANGE SHIRT $6.00 SHIRT $6.00 1 PAIR OF WHITE BOXERS $2.00 1 PAIR OF WHITE BOXERS $2.00 I 1 PAIR OR ORANGE SHORTS $8.00 I 1 PAIR OR ORANGE SHORTS $8.00 j; 1 ORANGE S600 i 1 ORANGE T-SHIRT $6.00 1 MATTRESS $40.00 1 MATTRESS $40.00 1 BEDSHEET $6.00 1 BEDSHEET $6.00 1 BLANKET 52.00 I 1 BLANKET $2.00 1 TOWEL 51000 i 1 TOWEL $10.00 OTHER THAN NORMAL USE, ITEMS DESTROYED OR DAMAGED MUST BE PAID FOR BEFORE YOU ARE RELEASED FROM THIS FACILITY. THE REPLACEMENT COST FOR EACH ITEM IS LISTED ABOVE. MA. INMATE SIGNATURE RECEIVING INMATE SIGNATURE DEPARTURE JAILER SIGNATURE JAILER SIGNATURE FROM: WALL-ER COUNTY DEPARTMENT DATE: I AIL DIVISION 701 CALV IT STREET TEXAS 77445 (979) 826?8282 TO: DR. SUBIECT: REQUEST OF COPES OE MEDICL RECORI S. REQUEST THAT COPE-S OF THE. RECORDS ON THE FOLLOW-TKO BE OR EAXED TO THE ADDRESS LISTED BELOW. THE END NEDUAL IS NOW INCARCERATED AT THE WALLER COUNTY I AIL ARE FOR OF RECORDS ARE NEEDED. mums Winn/not I, SOE: 033qu I:in 51g 340609 03(08?4575. RECORDS ML 813 NEEDED ACCORDING TO THE DATES OF CARE ILLNESS RECERES. .3 ANY ADDITIONAL ON THE PURPOSE OF REQUEST ARE AS FOLLOW S: REQUEST RECORD TO BE RELEASED TO THE FOLLOWWG: WALLER COUNTY SEE-REE TT MI). GIL-BEEN BERRY - REEDICAL DEPARTMENT 701 CALVIT STREET PIE-WSTEAD, TEXAS 77445 979?826-8282. EXT. 404?4 979?826-7781 THAT THE ABOVE FOR COPIES OF MY MEDICAL BE ACCOMPLISI-IED IN AN ACCURATE AND TLMELY MANNOR POOR TI-IE OF OF MY MEDICAL NEEDS. I NATURE. DATE: '1 '0 L5 NAME BLAND, SANDRA A ARREST REPORT WaIIer County Sheriffs Office 701 CaIvit. Hempstead. TX 77445 979-826-8282 NNETTE - SO NUMBER 026981 ARRESTING AGENCSI JAIL IDIBOOKING No 332038 1 DEPARTMENT OF PUBLIC SAFETY ALIAS BLAND, SAN DRA 5 -VIEW 1 SERVANT 13990063 I DISTRICT PID OTHER ID TYPE OTHER ID NO SID RACE SEX ETHNICITY DATE OF BIRTH AGE DL I ID NO STATE TYPE FBI NON HISPANIC 02/07/1987 28 - TX 3 CLASS HEIGHT WEIGHT HAIR EYES BUILD COMPLEXION SOCIAL SECURITY NO I MARITAL STATUS 6 FT. 0 IN. 175 BLK BRO DBR SCARS MARKS TATTOOS AMPUTATIONS TATBACK PLACE OF BIRTH OCCUPATION EMPLOYER CHICAGO. IL I L, ADDRESS PHONE EMERGENCY CONTACT NAME RELATIONSHIP EMERGENCY CONTACT ADDRESS 8. PHONE LLI PHONE ARRESTING AGENCY I ARRESTING OFFICER 2547 SAFETY ENCINIA. BRIAN ARREST DATE ARREST TIME COMPLAINTANT I5 07/10/2015 4:27 PM lat-I ARREST LOCATION FM 1098 WITNESSIES) I OTHER OFFICERS VEH YR 2006 LIC MAKE MODEL COLOR HYUNDAI AZERA SILVER CROWN BODY SHOP LIJ VEHICLE STORED AT CHARGES I I I I BOND I BOND i BOND FINE WARRANTIREF. HOLD REASON i OFFENSE CODE ISSUING AUTHORITY STATUS i AMOUNT i TYPE AMOUNT ASSAULTPUBUC Not Set 4 END OF LIST WALLER COUNTY DEPARTMENT SHERIFF R. G. SMITH 701 Calvit Street - Hempstead. Texas 77445 (979)826-8282 (979)826-7781fax Female Inmate Intake Form This questionnaire is to be completed by EACH Female inmate that gets booked in at the Waller County Jail facility, Pregnancy Screening is required by Texas Commission on Jail Standards, and shall be followed. - This questionnaire is then to be sent to Medical for entry into the female inmate?s medical Please Print Clearly: Date ofBirth: 941 18?! I) At this time, are you pregnant? YES MAYBE lF YES: a) Has this been. veri?ed by a doctor? YES No Date oflast menstrual cycle? (approx) c) How many weeks are you currently? d) What is your expected delivery date? e) When was your LAST Prenatal Appointment? When is your NEXT Prenatal Appointment? g) Are you HIGH RISK per your doctor? YES NO Who is your Obstetrician? Location? 2) Have you recently given birth months ago)? YES lF YES: 21) How long ago was the birth? ES b) Birth Method? C-Section Vaginal c) Any complications? 3) Are you CURRENTLY on any medication? (Please have your medications brought from home) 4) Are you CURRENTLY under care of MHMR/l?exana? IF YES: a) Are you on medication? YES NO b) When is your next appointment? c) What was iagnos with? Inmate Signature: Date: PRIMARY SECURITY LEVEL ASSESSMENT Inmate Name: mi lumntell'): Circle Whether Override or Security Designation Was Recommended: YES Written of Override: Circle The Recommended SecurigI Designation: LUW MEDIUM MINIMUM LOW MINIMUM MEDIUM HIGH CLOSE CUSTODY Assessment Staff Member and Date Assessment Completed: 3 . 0 Supervisory Review Of Override: Ciltle Whether Override Oi'Security Designation Was Approved or Disappruved VERY 110W MINIMUM (lf'DlSAl?l?llOVED' is circled, provide a wn'ttcn explanation) DISAPPRUVED A Written Exglanation of Circle Final Security Designation: HIGH CLOSE CUSTODY MEDIUM LOW MEDIUM MINIMUM LUW MINIMUM VERY LOW MINIMUM Signature Of Supervisor and Date Of Override Review: Recommended Housing Assignment: I I THIS RELEASE IS POR TEE CONIL TONY OP THE CARE. AGENCIES ONLY AND CAN ONLY BE USED IN CONNECTION WITH HER TIES UNDER TITLE 7, CHAPTER 614, HEALTH AND SAFTY CODE- AGENCY MAY NEE-D OTHER RELEASE. FORMS FOR RELEASE OF LNTORMATION ANY OTI-ER IVE) UAL OR ENTITY. l?l MYNAME-IS: L?tte. SOS: a 1" '1 3'7 I AUTHORIZE WALLER COUNTY IAH. TO RELEASE THE FOLLOWTNG LATORITLATION AEOUT ITNITLAL THO SE THAT APPLY) - MCARCERATION EMTLOYTVTENT HISTORY RENTAL BEA TH TNEO ADDRES OCIAL HISTORY OTHER CRBEEAL RECORD TNPORBLATION ALL TEL-ALT IS LISTED BTOPCNLATION CAN BE USED FOIL HE. PURPOSE THOSE THAT APPLY) LEARN AB OUT MY ATE-EDS ECIDE ON WHAT CARE INEED WHO CA RP, '50. ME DECIDE HOW CARE WELL BE GWEN OTHER (LIST) ALL THAT IS LISTED THIS INFORMATION CAN BE RELEASED TO BESIDE ANY THAT COUNTY STAPP COUNTY DOCTOR COUNTY MENTAL HEALTH AND MENTAL RETARDATION CENTERS COUNTY SUPERVISION AND CORRECTIONS COUNTY EMS PERS ONEL ROOM OP THE HOSPITAL. WALLER CO UNTY USES WTEXAS DEPARTMENT OP HEALTH - DEPARTLENT OP TUSTICE DEPARTMENT OP THIHAL HEALTH AND MENTAL RETARDATION DEPARTMENT OP HUT-LAN SERVICES COUNCEL ON OPPENDERS WITH MENTAL IMPAIRMENTS . HEALTH AND MENTAL RETARDATION CENTER OP WALLER COUNTY ANY COUNTY OR STATE LAW EMORCEMENT CENTER I AM BEMG TRANSPERPCED TO IAUTHORIZE THE, INTIALED BESIDE TO SHARE THE WI 1H EACH OTHER YES THIS CONSENT EXPIRES UPON MY RELEASE PROM WALLER COUNTY JAIL. UNDERSTANT THAT I CAN MY PERMISSION AT ANY GIVEN TIME EY THE MEDICAL STAPR IN WRITING, EXCEPT TO THE EXTENT THAT AN-AGENCY HAS ALREADY TAKEN ACTION RELIANCE ON THIS CONSENT. IALSO UNDERSTAND THAT WITH OUT THIS CONSENT MY OP BETWEEN AGENCIES WILL BE PORPETTED UNLESS REQUIRED BY LAW. I UNDERSTAND THAT I HAVE THE RIGHT TO RECEIVE A COPY OP THIS POR ML I I 15 SIGNATURE OP INMATE OR LEGALLY AUTHORIZED REPRESENTNB SIGNATURE OF INMATE REFUSING TO SIGN CONSENT a" DATE PYHSICIAN SIGNATURE ATE WALLER COUNTY OFFICE 701 CALVIT, HEMPSTEAD, TEXAS 77445 PHONE: (979) 826-8282 FAX: (979) 826-7781 SHERIFF R. GLENN SMITH CHIEF JAILER J. HESTER ASST. CHIEF JAILER L. RECEIPT OF INMATE RULES AND REGULATIONS I HAVE BEEN PROVIDED A PRINTED COPY OF THE WALLER COUNTY AND I FULLY UNDERSTAND THAT I MAY BE SUBJECT TO DISCIPLINARY ACTION IF I VIOLATE A RULE REGULATION. DATE: 7/10/15 8/ INMATE SIGNATURE: BOOKING .IAILERS SIGNATURE: CLASSIFICATION NOTICE NAME: (last) ?ab-Jud, (?rst) We Sandra. (middle) a? i Doe. 1h 31 RACE: 5 SEX: Issrv: ?alga? Pinion; Servth - You have been placed in the following classi?cation: ASH, 3C1 5 This classi?cation is determined by: currentfpast convictions; current/past institutional behWnding charges or holds in other jurisdictions (if any); sentenced or unsentenced; and/or any other information that may be deemed appropriate :with regard to your personal security or the security of the facility. NOTE: Your classi?cation can change when: charges are altered or reduced; you are sentenced; due to administrative hearings; due to regular periodic review; and other reasons recommended by the jail staff. Appeal Prooass: any inmate dissatis?ed with his or her classi?cation must appeal his her classi?cation, in writing. writing. within ten (10) days ofthe primary classi?cation or reclassi?cation by addressing his/her appeal as APPEAL OF CLASSIFICATION and directing it to: the Sheriff or his designee. Classi?ed by: .mag?mi I Data?7!! Comments by staff: Booking-Dateer . Known Yes;I fast/Present 1 Serious Inst. Yesl Behavior I High iAssaumve i i Problems No I Felony 4 IConvidions/NQLD tune?: a Yes' Offense .zsape i 2 ?ssaultive 1' gist?), CIOSE Custody rem-?Y N0 liSegurg) :Prior Yes: igfoan'cme Knewn Yesi - Medium EConvidions Not ?fggisaagr . ASIUBSC I Problems . . . . - - - . . . . . .- iEsc-ape [History 4 lisezure) No Medium more Yes; 5 Prior Felony Convictions i yrs) No' . .5 .. gOverride Reason: :Deiainer Yes Medium i lvvarrants or PIE-Sentence i iPending I l' ICharges Known Yes F5 Felony or I Minimum . Pre?sentence . Inst. Behavior iHigh Risk: (Check) Special Condition: (check) Probtems No Assaultive Protective Custody Escape El Medical No . 7 Juvenile i Surcudal I I Is Inmate I Family Ties Minimum Mental Handicap/Disabled Sentenced? 3 Gang Leader Cl Body Fluid watch Yes Yes .g ;o Other in Other 8 i Current Pal I I 0? Offense ?2011 Northpointe, Inc. This instrument may be used/copied in its manual version Misd- only. The instrument may not be modi?ed without express written consent of No Northpointe, Inc. Automation of the Instruments must be licensed by Northpolnte, Family Ties . ?221-4515. mPIOYmenVery Low WALLER COUNTY OFFICE JAIL DIVISION DISEASE SCREENING ISOLATION FORM Last Name: 5 First w??vm MW Temperature: 3? Tim"? j?piifzi Phone Numberls) Country ol' Residency: .lniler's Name: Fever of99.5? or Feeling Feverish Headache Stomach abdominal l?ain No No yes Yes Yes Diarrhea Exhaustion/intense Fatigue 1 oint l?ain Red(Conjunctivitis) No No, Ni; YES YES Yes Unexplai Bleeding (bleeding from mouth, nosebleed, bloody vomit, bloody/black diarri?nza, coughing hlood) Yes W?h Has the inmate had any of the following above today DR within the past 2 days? If yes please explain.. Yes ?No In the last 21 days, have you experienced any of the following? Have you been stuck with a needle used on a patient with a communicable disease? .. Yes Have you had body fluids of a patient with a communicable disease in your eyes, nose or n'louti'n? .. Yes Have you taken part in a burial or funeral rites or touched the body of someone who died with a communicabie disease? .. Yes Did you stay in a house with or have other casual contact with a patient: with a cormnunicabie disease? .. Yes HaVe you taken care of or come in contact with body fluids of a patient with a communicable disease 7? .. Yes lfyour answer was yes, did you always use a mask and gloves and other protection? .. Yes if you answered yes, please explain. WTEXAS Thxas Department of State Health Services ,ngf?j?iimm Correctional Tuberculosis Program Screening Facility Name: N650 Name: A agar/Ebola Employee Person completing form: i Film 3313 Print Name 1 Upon intake. all inmates should be screened for consistent with tuberculosis. Please ask all inmates during the intake process if they have any of the listed below. Persons with should receive a chest x-ray. regardless of tuberculin skin test result. inmates or employees with a dmm mu Luaq . a..an W. O. F. mEmemm? OFVCE A J. PRISOMQ INFORMATION I ELLIS 008203 07 198? - a; hmgi EASENCT MEMBEROELM A. IO A . - DATE- - - THE: (@937 LOCATIOM: t?M H398 PHVSICEL COMOITIOM 3 I ?7 ITIT POSSESSIOM O: EEISDMEE: EEC-JAE Iv vii?.343 MIPS - .ESTIM: OFFICER: 9' ?1 CHAAGE l? a? MEA-T I TATE L: PAC-I OF: MOMEER OFFENSE COURT CLASS CODE 1 an FoloL'c germ+ Waller i7/10/9013 i MailerWARRANT WEI L: EEIEF CAUSE In; Mm: DH REVERE: I EOEERW EMMA Tvga Balm/1+; [Iglor 01/05 Jana; {qny 66H Nair/0:31 :9 I {Vic/ca}: chm?. Me) ELM FORMATION .. i HAS THE DRIVING A MOTOR VEHICLE YES MO {3 COMMERCIAL VEHICLE YES [1 MO J3 FOR .2. VEHICLE YES MO - YES SEE BELOW - ?vEARa??b MAKE I . LP VIN: COLOR wwg?gm PM SIGNATURES: a DEPUTY OFFICER PRISONER a: PP, PERTY 4 744/?02?1! Mm? 10 TIME: JAILER RECEIVING 5v PROPERTY DATE: l?