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Page 2694 areas | U.S. DEPARTMENT OF JUSTICE or ORK MCE (Institution) 18-054 inmate Name: EPSTEIN, JEFFREY EDWARD Reg. No. 76318 Violation Date fA, or Reason. . Ree'd:___ Time Admitlance Gate NYA : NIA Authorized: Rel: : NIA Pertinent Information: : N Separation Information: i A 05-124LAD . NIA ; Ni Special Housing Unit Ceil Number. an) inmate Is In. DS: AD Status N/A Is Inmate on Medication: Medical Department Notified: N/A Meals Men Olc Signature re] 0 | natu Date Comments Staff Sign ig m x is d. an bid 07-11-2018 rw Gy | [e|_|p | Sa A ee EXPLANATORY NOTES:Pertinent Info: ie., Epileptic; Diabetic; Suicidal; Assauitive; etc. Maalsf$H: Shower - Yes (7); No {N); Refused (RyOut-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, (¥} Visit, (M) Medical, (C) Court, (0) Other — Yes (¥) if applicable / Enter Actual Time Period Start and End f.¢., 0930 - 1030 hes) in Out of Cell Time Block. ort 1-2019 Puon | | = joa | | Medical Medical providers will sign the segregation log each shift and the recerd 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., Conduct, Attitude, etc. Additional comments on reverse side must include date, signature, and title. O'G Signature: O'C must sign all record sheets gach shift. (CIC - Unit Officer) PDF Prescribed by P5270 This form replaces BP-202(52) dated AUG 2011. DOJ-OGR-00026350