DOJ-OGR-00025341.pdf

Page 1119 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: _____________________________________ Regular Unit: _______ SUNT MGR EXT _______ Cell: 5 Violation or Reason: PENDING CLASSIFICATION Date: 2019-07-29 Time: 12:21 Admittance Authorized: (b)(6); (b)(7)(C) Date: _______ Time: _______ Pertinent Information: N/A Rel.: _______ Rel.: _______ Separation Information: N/A Special Housing Unit Cell Number: Z04-206LAD Inmate Is In: _______ DS: _______ AD _______ AD Status Is Inmate on Medication: Y 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 07-29-2019 Morn Y (b)(6); (b)(7)(C) Day 07-29-2019 Eve Y N 07-30-2019 Morn Y (b)(6); (b)(7)(C) Day Y N Ref See 2nd page 07-30-2019 Eve Y No 07-31-2019 Morn Y Day Y Y 06:30/07:30 O 02:00 See 2nd page 07-31-2019 Eve Y No 08-01-2019 Morn Y Day Y N Ref See 2nd page 08-01-2019 Eve Y No 08-02-2019 Morn Y Day Y Y No 01:00 See 2nd page 08-02-2019 Eve Y No 08-03-2019 Morn Y Day Y 08-03-2019 Eve Y N No 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. 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-00025341