EFTA00036573.pdf

Page 1 of 1 BP-A295.052 SPECIAL HOUSING UNIT REVIEW APRIL 1994 Inmate Name: EPSTEIN, JEFFREY EDWARD Date Entered Special Housing: 07-29-2019 Register Number 76318-064 U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS Reason for Placement: PENDING DHO FOR CODE 228 SELF-MUTILATION Institution: NEW YORK MCC I. Sutract (2 Cr 3 Days) 3 Day Review Action Taken on the Above Date: Continue in Special Housing Unit Printed Name/Signature: Date Reviewed 08-01-2019 H. RECORD REVIEW. (To be done weekly in the ornate's absence, beginning after the unperson 7 day review, and continuing every week between each in -person 30 day review.) DATE ACTION TAKEN REMARKS SIGNATURE 08-05-2019 Continue in Special Housing Unit it Subsea: (7 or 30 Days) 7 Day Review Review 8y (SRO): Reviewing Authority: Date inmate appeared for a Special Housing Review. 08-05-2019 Or Date inmate waived right to appear: 01-01-111 Has been seen daily by Medical Staff. HAS been seen daily by responsible officer designated by Warden g Yes: q No Has received prescribed weekly exercise: WI Yet E Na Proper documentation and justification in the Central File (Incident Report OHO Report, Copies of Special Housing Review Form) g Yes: q No if no, why not? Is there a written psychiatric or psychological assessment on the inmate who has Spent 30 days in a special housing status? 1_.] Yes: q No Is there an additional assessment for every one month interval thereafter? P1 Yes: E NO if no. why not? P1 Yes: El No Action taken on the above date by the Segregation Review Official or the Reviewing Authority: I;s71 COntinbe in Special Housing iJ Released from Special Housing; Did inmate in Administrative Detention receive a written copy of stairs decision and the basis for the finding at each 30 day review? g Yes; q No if no. why not (Should be given provided institutional woody not compromised)? Remarks: (Any change in the reason for placement is bo be noted in this section. If the reason for placement changes the inmate must receive a copy of this form): Date of Next Resew: 08-12-2019 PriAtti Name and Signature of Segregation Renew Maud or the Reviewing Authority and Cobs Sigred. Record Copy - Central File That form replaces 8P-295(52) dated January 1988 file:///C:ftemp/shu/Epstein-Reno76318-054_SRO_20190729-20190810.html 8/13/2019 EFTA00036573