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BP-AQ2S2 APR 16 U.S. DEPARTMENT OF JUSTICE NEWYORK MGC _ (Institution) 763 18-054 EPSTEIN, JEFFREY EDWARD Reg. No. Régular Unit: auAT MGR Ei =" Ga Cell: Violation Date Time A or Reason: Rec'd: NA _ Rec'd: a Inmate Name: Team/caseworker, Admittance Date Time Nia NA Authorized: Ral.: Rel.: Pertinent Infarmation: Separation Information: ‘ 204- LAD Ni. Special Housing Unit Gell Number. pote Inmate Is In: - DS; iit AD Status s NIA ‘ ; Is Inmate on Medication: Medical Department Notified: ; "Out of cell time : | Medical Comments Staff Sign OG Signature Cate Shift Meals (| SH | Exercise ; [8 b/s | | ___fTotal minMrs) | Morn Day Eve 072020131 Mom | ¥ ‘a i | Day | o7-ze-2c1a| Eve , y | N a7-30-20'9] Mom | ¥ | 07-30-2019 Day y i “ON. [Ret o7-3o2019 | Eve y No ” ge and page "07-31-2019 | Morn yw “97-31-2019 Day _ ¥ + jeesoorse of p2ie0 Sea Ind page or.ai-paia| Eve ¥ 8-01-2018 Mom = | ¥ 1-01-2019, Day y | 4 | Ret See 2nd page ae-ai-ao1a | Eve Ly No 08-02-2019] Morn ¥ 3-02-2019} Day ¥ y [No f ~ ofao Ses ond page oe-o22019| Eve ¥ di No 08-03-2019 Marn | ¥ 08-03-2018 | Day | ¥ oe-oa2c19| Eve y | N [Ne EXPLANATORYNOTES:Pertinent Info: Le., Epileptic; Diabetic; Suicidal’ Assaultive: etc. Meals/SH: Shower - Yes (¥}; No (N); Refused (R)Out-of-Cell Time: {LL) Law Library,(Lv} Legal Visit, (U) Unit Team, (P} Psyehotogy, (E) Education, {H) Haircut, (C} Chapel, (R) Recreation, 06 Property Issue, (V) Visit, (M) Medical, (C) Court, (0} Other — Yes (Y) if applicable / Enter Actual Time Period Start and End {.e., 0930 -— 1030 hrs) In Cut of Cell Time Bonk. Medical: Medical providers will sign the segregation log each shift and the record sheet each time the inmate is seen by a medical provider, Ata minimum, the record sheet must be signed at least once each day by the medical provider. Comments: .¢., Conduct, Attitude, etc, Additional comments on reverse side must include date, signature, and title. O1C Signature: O1C must sign all record sheets each shift. (OIC - Unit Officer} POF Prescribed by P5270 This form replaces BP-292(52) dated AUG 2041. DOJ-OGR-00024611