EFTA00106310.pdf

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IA-y -" vmck Jeep - c.6 5\e"\ 1 --4:`:ii5er, \e cat 4 \sn ii S ic-e--9\191.9 -7W6, EFTA00106335 I I • N. 1 1 1 1 1--) 'F• 52- • , 1 - • • - • • • • (f\ DLA .7;P e ; Name of Inmate On Suicide Watch or Psych Observation: e .-79.at-4147 1 S 5 0 Registration #: 7-6 7/0* EATING/SHOWER CHART EFTA00106336 Name of Inmate On Suicide Watch or Psych Observation: e ".7942.-64i7 Registration B: 76 EATING/SHOWER CHART DATE BREAKFAST LUNCH DINNER LIQUIDS OFFERED SHOWER RECEIVED SHOWER ( fi /L7C ./iVi% 7 6  r"------;— v --------  J.--- / n Lo•e'- ..i/Witil 7/ (9'  .V4/ / Please check the appropriate box if the person on Suicide Watch/Psych Observation actually eats his meal. Do not check the box if he just received it, but did not eat it. Place a check in the "Liquids" box each time the person drinks. Thank you. EFTA00106337