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Page 3127 BP-A0292 aERe U.S. DEPARTMENT OF JUSTICE SPECIAL HOUSING UNIT RECORD FEDERAL BUREAU OF PRISONS Er 500 . {Insttution) 7 054 Inmate Name: EPSTEIN, JEFFREY EDWARD Reg. No. 6318-0 D} . tT ss UNASSIGNED ADMISSION Reguiar Unit: A&C NIT MANAGER 7 elt A&O Date Time Violation NiA a. N/A or Reason: Rec'd: _ Rec'd: Admittance Date Time NiA NIA Authorized: Rei.: Rel.: Pertinant Information: Separation Information: ne : A Special Housing Unit Cell Number, 208-124LA0 Inmate Is tn: Ne DS: be AO Status N Is Inmate on Medication: Medical Departmant Notified: Date Shift SH C vil Ole Signature peT ols| ‘otal minis: sla Tee iA Madical Staff Sign a7-142018| Mom | ¥ ae somtee || Lele ea a Oc 07-16-2019 | Mom = mere] Mom ~~ | _ {if Eve | See 2nd page Sea 2nd page OF-17-2019 eS on eT = orerel Day | | vy | | w [rt | See 2nd page Of-Te-2019 Day | | ¥ went won Iv] | | | wool Pe EXPLANATORYNOTES:Pertinent info: ie. Epttentic; Diabetic: Suicidal; Assauttlve; 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, (G} Court, (0) Other ~ Yas (¥) if applicable / Enter Actual Time Period Start and End {i.e., 0930 — 1030 hrs) in Out of Cell Time Block. 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 minimurn, 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: OlC 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-00026767