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BP-A0292 APR 16 SPECIAL HOUSING UNIT RECORD U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS NEW YORK MCC (Institution) Inmate Name: EPSTEIN, JEFFREY EDWARD Reg, No. 76318-054 Teanveaseworker: UNASSIGNED ADMISSION Regular Unit: cialis MGR ES) ExT Call: . Violation Lie Bate Time or Reason: Rec'd: i _ Rec'd: pee Admittance Date nas Time a Authorized: Rel. : Rel. Pertinent Information: Separation Information: ie - N Special Housing Unit Gell Number: BeOS Inmate Is In: i DS: my AD Status a ' : NiA Is Inmate on Medication: Medical Department Notified: ; ets Out of cell time : [ Medical Date Shift | Meals | SH | Exercise ' Staff Sign Ol Signature Comments | {Total minfhrs) o7-2t-2019 | Morn ¥ OF-25 ani8 Day ¥ o7-21-2018| Eve 97-22-2019 | Morn 07.22.2019} Day if: 4 “oreazois| Eve ¥ Morn Morn Day ia \ Eve me EXPLANATORY NOTES:Pertinent Info: i.e., Epileptic; Diabetic: Suicidal: Time: (LL) Law Library, {LV} Legal Visit, fU) Unit Team, (P} Psycholegy, (E) Education, {H} Visit, (M} Medical, (C) Court, (0) Other — Yes (¥ Medical: Medical providers will sign the segregation the recard sheet must be signed at least once each side must include date, signature, and title. OIC Signature: O POF Prescribed by P4270 Assaullive; etc. Meals/SH: Shower - Yes (¥); No (N}, Refused {RyOut-of-Ceil Haircut, (C} Chapel, (R} Recreation, (4) Property Issue, {¥) ) if applicable / Enter Actual Time Period Start and End {i.e., 0930 — 1030 firs) in Out of Cell Time Block. jog each shift and the record sheet each time the inmate is seen by a medical provider. At a minimum, day by the medical provider. Comments: i.e., Conduct, Attitude, ete, Additional comments on reverse IC must sign all record sheets each shift. (CIC - Unit Officer) This form replaces BP-292(52) dated AUG 2011 DOJ-OGR-00024610