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Page 1117 BP-A0292 APR 16 U.S. DEPARTMENT OF JUSTICE SPECIAL HOUSING UNIT RECORD SEnEHAl BUREAU ORPRISGNS ee NEW YORK MCC (Institution) 76318-054 Inmate Name: EPSTEIN, JEFFREY EDWARD 5UNT MGR) Team/caseworker: Regular Unit: Violation Date Time PENDING CLASSIFICATION 9019-07-29 acta 12:21 or Reason: Rec'd: Admittance Authorized: Date Time Rel.: Rel.: N/A Pertinent Information: Separation Information: Special Housing Unit Cell Number: corel Inmate Is In: DS: val AD Status ae Is Inmate on Medication: Medical Department Notified: ; Meal Out of cell time Medical Date Shift _Meals _| SH | Exercise Comments Staff Sign OIC Signature D#S (Total min/hrs) by6); (bE? HC} 08-04-2019 | Morn Y 08-04-2019 Day Y 08-04-2019) Eve ¥ 08-05-2019 Morn | ¥ 08-05-2019 | Day Y 08-05-2019 Eve ij 08-06-2019 Morn Y 08-06-2019 | Day ¥ 08-06-2019 | Eve ¥ No 08-07-2019 | Morn ¥ 08-07-2019 | Day Y 08-07-2019 Eve ¥ No 08-08-2019 | Morn Y 08-08-2019 | Day 1 | 08-08-2019 Eve ¥ 08-09-2019 | Morn ¥ “08-09-2019 Day Y 08-09-2019 | Eve y Morn Day Eve ee EXPLANATORYNOTES:Pertinent Info: i.e., Epileptic; Diabetic; Suicidal; Assaultive; etc. Meals/SH: Shower - Yes (Y); No (N); Refused (R)Out-of-Cell Time: (LL) Law Library,(LV) Legal Visit, (U) Unit Team, (P) Psychology, (E) Education, (H) Haircut, (C) Chapel, (R) Recreation, (X) Property Issue, (V/) Visit, (M) Medical, (C) Court, (0) Other — Yes (Y) if applicable / Enter Actual Time Period Start and End (i.e., 0930 — 1030 hrs) in Out of Cell Time Block. Medical: Medical providers will sign the segregation log each shift and the 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: i.e., Conduct, Attitude, etc. Additional comments on reverse side must include date, signature, and title. OIC 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- 00025339