EFTA00143155.pdf

BP.A0292 APR 16 SPECIAL HOUSING UNIT RECORD U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS Inmate Name: EPSTEIN, JEFFREY EDWARD NEW YORK MCC (Institution) 76318454 Reg. No. Teamtaseworker Regular Und. • 5UNT MGR. N. REID EXT 6421/6301 5 Cell' Violation Date Time N/A N/A N/A or Reason: Reed: ReCd: Admittance Date Time N/A N/A N/A Authorized: Rel.: Rel.: Pertinent Information: NIA Separation Information: Nth Special Housing Unit Cell Number: Z04.2061/0 Inmate Is In: Is Inmate on Medication: Nth Date 0344-2019 Shift Meals SH Exercise Out of cell time (Total minfirs) Comments Medical Staff Sign OIC Signature B D S Morn Y 06.04-2019 Day Y 0344-2019 Eve I I C6454019 mem y 06454019 Day y 06454019 Eve Y 06064019 Mom y 06064019 Day Y 06462019 Eve Y No 26474319 Morn y C6474319 26474019 Day y EVe Y No ceee-zais Mom Y 26464019 Day Y 0646-2019 Eve Y I:842' 2012 Morn Y 08062019 Day Y 06462019 Eve y Morn Day Eve N/A Medical Department Notified: N/A DS: NIA AD Status EXPLANATORYNOTES:Peninent Info: i e., Epileptic; Diabetic; Suicidal; Assaultive: etc. Meals/SH: Shower - Yes (Y): No (N); Refused (R)Out•of -Cell Time: (LL) Law Ubrary,(LV) Legal Visit, (U) Unit Team. (P) Psychology. (E) Education. (H) Haircut, (C) Chapel, (R) Recreation, (X) Property Issue. (V) (M) Medical. (C) Court, (0) Other - Yes (Y) if applicable Enter Actual Time Period Stan and End (.e., 0930 - 1030 hrs) in Out of Cell Time Block. Medical: Medical providers will sign the segregation log each shift and the record sheet each time the inmate is seen by a medical provider. At a minimum. the record sheet must be signed al 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: OIC must sign all record sheets each shift. (OIC • Unit Officer) PDF Prescribed by P5270 This (can replaces BP•292(52) dated AUG 2011. EFTA00143155