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BP-A0292 APH 16 U.S. DEPARTMENT OF JUSTICE SPECIAL HOUSING UNIT RECORD FEDERAL BUREAU OF PRISONS NEW YORK MCC EPSTEIN, JEFFREY EDWARD 76318-054 Inmate Name: Reg, No. Teancaseworker Regular Unit: SUNT NS T Cal: a Violation a Date Time or Reason, Rec'd: NIA _ Rec'd: NA Admittance Date Time Authorized: bial Rel. en Rel.: puis NIA Pertinent Information: Separation Information: Me ‘O4- Special Housing Unit Cell Number; Seidialpiet os inmate Is in: we DS: Ne AD Status Is inmate on Medication: Bi Medical Department Notified: . i d x | i r Out of cell time | | Medical Date | Shift | _“ea's, _ | SH | Exercise Staff Sign OIC Signature B | BLS] | 24 __ {Total min/hrs) Pons ¥ pe-oa-zoia| Morn 08.04.2019 | Day ¥ ' 03-04-2019 | Eve ¥ 18-05-2019] Mom | ¥_ oaos01a| Day | | ¥ 085-2019) Eve ‘ ia 08-08-2018] Morn E | 08-86-2019 | Day | fang-2ais] Eve ¥ No 08-07-2019 Mom | ¥ a6-072019[ Day ry os-o7-2018 | Eve ¥ No 08-08-2019} Marn ¥ | 08-08-2019 Day | y | oe-oe-anis| Eve ¥ if 08-05-2049 j Morn ¥ I 08-09-2018 Day ¥ neae-2019 | Eve ¥ Morn Day | Eve EXPLANATORYNOTES:Pertinent (nfo: ie., Epileptic; Diabetic; Suicidal; Assaultive, etc. Meals/SH: Shower - Yes (Y}; No (N); Refused (Rj)OutofCell Time; {LL} Law Library,{LV) Legal Visit, (U} Unit Team, {P} Psychology, (E} Education, (H) Haircut, (C) Chapel, (R} Recreation, (<) Property Issue, (V) Visit, (M) Medical, (C) Court, (0) Other— Yes (Y) if applicable / Enter Actual Time Perlod Start and End (Le., 0930 — 1030 hrs} in Gut of Cell Time Block. Medical: Medical providers will sign ihe segregation log each shift and ihe record sheet each time the Inmate is seen by a medical provider. At a minimum, the record sheet must be signed at least once each day by the medical provider. Comments: ie., Canduct, Attitude, etc. Additional comments on reverse side rust include date, signature, and title. O/C Signature: OIC must sign all record sheets each shift, (OIC - Unit Officer) PDF Prescribed by P5270 This form replaces BP-292(52) dated AUG 2011. DOJ-OGR-00024613