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Page 1223 Page 1 of 1 BP-A295.052 SPECIAL HOUSING UNIT REVIEW U.S. DEPARTMENT OF JUSTICE Bia FEDERAL BUREAU OF PRISONS Institution: NEW YORK MCC Inmate Name: EPSTEIN, JEFFREY EDWARD Date Entered Special Housing: 07-29-2019 I. Subject: (2 or 3 Days) | Register Number: frowase Reason for Placement: ~ PENDING DHO FOR CODE 228 SELF-MUTILATION Date Reviewed 08-01-2019 3 Day Review Action Taken on the Above Date: Continue in Special Housing Unit Printed Name/Signature: (DMG), (BNF KC) Wy (To be done weekly in the inmate's absence, beginning after the in-person 7 day review, and continuing every week between each in-person 30 day review.) DATE ACTION TAKEN "REMARKS SIGNATURE bi6); (oF WC} 08-05-2019 | Continue in Special Housing Unit IH. Subject: (7 or 30 Days) Review By (SRO): | Reviewing Authority: 7 Day Review BMG (DTC) Date inmate appeared for a Special Housing Review: Or Date inmate waived right to appear: 08-05-2019 041-01-111 Has been seen daily by Medical Staff: | Yes; LJ No Has been seen daily by responsible officer designated by Warden: 7] Yes; L] No Has received prescribed weekly exercise: MV] Yes; LJ No Proper documentation and justification in the Central File (Incident Report, DHO Report, copies of Special Housing Review Form): wd Yes; LJ No if no, why not? Is there a written psychiatric or psychological assessment on the inmate who has spent 30 days in a special housing status? M] Yes; C] No ls there an additional assessment for every one month interval thereafter? | Yes; C] No if no, why not? Action taken on the above date by the Segregation Review Official or the Reviewing Authority: LJ Released from Special Housing; A Continue in Special Housing Did inmate in Administrative Detention receive a written copy of staff's decision and the basis for the finding at each 30 day review? Vi Yes; CL] No if no, why not (Should be given provided institutional security not compromised)? Remarks: (Any change in the reason for placement is to be noted In this section. If the reason for placement changes, the inmate must receive a copy of this form): Date of Next Review: 08-12-2019 Printed Name and Signature of Segregation Review Official or the Reviewing Authority and Date Signed: b)(6}; (DIFC) Record Copy - Central File This form replaces BP-295(52) dated January 1988 file:///C:/temp/shu/Epstein-Reno763 18-054 SRO_20190729-20190810.html 8/13/2019 DOJ-OGR- 00025428