DOJ-OGR-00025349.pdf

Page 1127 BP-A0292 APR 16 SPECIAL HOUSING UNIT RECORD U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS NEW YORK MCC (Institution) Inmate Name: EPSTEIN, JEFFREY EDWARD Reg. No. 76318-054 Team/caseworker: UNASSIGNED ADMISSION A&ON: (b)(6); (b)(7)(C) Regular Unit: UNIT MANAGER (b)(6); (b)(7)(C) Cell: A&O Violation or Reason: PENDING CLASSIFICATION Date Rec'd: 2019-07-07 Time Rec'd: 19:20 Admittance Authorized: (b)(6); (b)(7)(C) Date Rel.: Pertinent Information: N/A Separation Information: N/A Special Housing Unit Cell Number: Z05-124LAD Inmate Is In: DS: AD AD Status Is Inmate on Medication: N Medical Department Notified: Y Date Shift Meals SH Exercise Out of cell time (Total min/hrs) Comments Medical Staff Sign OIC Signature Morn B D S Day Eve 07-08-2019 Morn Y (b)(6); (b)(7)(C) Day Eve Morn Day Eve Morn Day Eve 07-11-2019 Morn Y 07-11-2019 Day Y N Ref See 2nd page (b)(6); (b)(7)(C) 07-11-2019 Eve Y 07-12-2019 Morn Y 07-12-2019 Day Y See 2nd page (b)(6); (b)(7)(C) 07-12-2019 Eve Y 07-13-2019 Morn Y 07-13-2019 Day Y 07-13-2019 Eve Y EXPLANATORY NOTES: Pertinent Info: i.e., Epileptic; Diabetic; Suicidal; Assaultive; 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, (C) Court, (O) Other - Yes (Y) if applicable / Enter Actual Time Period Start and End (i.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 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: 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-00025349