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Page 3125 ee U.S, DEPARTMENT OF JUSTICE SNe NEWYORRMGC Inmate Name: EPSTEIN, JEFFREY EDWARD | Reg. No. 76318-054 f Tear ese UNASSIGNED ADMISSION Regular Unit sais Violation Date Time AYA or Reason: we acd: nes _ Reed: Date Time Admittance NIA NIA Authonzed: Rel.: Rel: Pertinent Information: ON Separation Information: NI = A NIA Special Housing Unit Cell Number. Z08-124LAD Inmate ts In: Bi Os: AD Status Is Inmate on Medication: oi Medical Department Notified: ni ; —— je bat a [ane | E aie hea OIC Signet ate i xarcise Staff Sign gnature | OTS | otal minors ani SA ! | 7 aEETT Tye || 07-11.209) Eve rt iy 074220191 Mom mune nor O7-13-2019 7 ro ST ee EXPLANATORYNOTES Pertinent Info: Le., Epieptic; Diabetic; Suicidal: Assauttive; etc. Meals/SH: Shower - Yes (7); No (N}; Refused {RjyOut-o-Ce Time: {LL} Law Library.(LV) Legal Visit, (U) Unit Team, (P} Psychology. (E) Education, {H) Hatreut, (C} Chapel, {R) Recreation, (X} Property Issue, (V} Visit, (M) Medical, (C) Court, (0) Other — Yas (Y) if applicable / Enter Actua! Time Period Start and End {.e., 0930 — 1030 hrs) in Gut of Cell Time Block. Soe 2nd page See 2nd page Medical: Medical providers will sign the segregation log each shift and the record sheet each time the inmate is seen by a medical provider. Ata minimum, the record sheet must be signed at least once aach day by tha medical provider. Comments: ie., Conduct, Atitude, ete. 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-00026765