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Page 1127 BP-A0292 APR 16 U.S. DEPARTMENT OF JUSTICE SPECIAL HOUSING UNIT RECORD FEDERAL BUREAU OF PRISONS (Institution) Inmate Name: EPSTEIN, JEFFREY EDWARD Reg. No. eee Team/caseworker: UNASSIGNED ADMISGKON Regular Unit: sill WOK Cell: AES Vicsaion PENDING CLASSIFICATION Pale ine or Reason: Rec'd: i ia _ Rec'd: eee Admittance — Date Time byHG); (DTC) Authorized: Rel.: Rel.: Pertinent Information: a Separation Information: Li Special Housing Unit Cell Number: ee Inmate Is In: DS: Be AD Status Is Inmate on Medication: N Medical Department Notified: Out of cell time Medical Date Shift | Meals. SH | Exercise —— Staff Sign OIC Signature B/D |S (Total min/hrs) pelle Morn Day Eve 07-08-2019] Morn | y b)(6); (DIF KC) Day Eve Morn Day Eve Morn Day Eve 07-11-2019 Morn Y 07-11-2019 | Day Y N Ref See 2nd page 07-11-2019 | Eve ¥ | 07-12-2019 | Morn ¥ “07-12-2019 Day ¥ See 2nd page o7-12-2019| Eve ¥ 07-13-2019] Morn | ¥ 07-13-2019 | Day y 07-13-2019 | Eve Y 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, (O) 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-00025349