DOJ-OGR-00025335.pdf

Page 1113 Page 1 of 1 BP-A295.052 APRIL 1994 SPECIAL HOUSING UNIT REVIEW U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS Inmate Name: EPSTEIN, JEFFREY EDWARD Register Number: 76318-054 Unit: 5 Institution: NEW YORK MCC Date Entered Special Housing: 07-29-2019 Reason for Placement: PENDING DHO FOR CODE 228 SELF-MUTILATION I. Subject: (2 or 3 Days) 3 Day Review Date Reviewed 08-01-2019 Action Taken on the Above Date: Continue in Special Housing Unit Printed Name/Signature: (b)(6); (b)(7)(C) II. RECORD REVIEW. (To be done weekly in the inmate's absence, beginning after the in-person 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 (b)(6); (b)(7)(C) III. Subject: (7 or 30 Days) 7 Day Review Date inmate appeared for a Special Housing Review: 08-05-2019 Review By (SRO): (b)(6); (b)(7)(C) Reviewing Authority: Or Date inmate waived right to appear: 01-01-111 Has been seen daily by Medical Staff: Yes; No Has been seen daily by responsible officer designated by Warden: Yes; No Has received prescribed weekly exercise: Yes; No Proper documentation and justification in the Central File (Incident Report, DHO Report, copies of Special Housing Review Form): Yes; No Is there a written psychiatric or psychological assessment on the inmate who has spent 30 days in a special housing status? Yes; No Is there an additional assessment for every one month interval thereafter? Yes; No Action taken on the above date by the Segregation Review Official or the Reviewing Authority: Released from Special Housing; Continue in Special Housing Did inmate in Administrative Detention receive a written copy of staff's decision and the basis for the finding at each 30 day review? Yes; No if no, why not (Should be given provided institutional security not compromised)? Remarks: (Any change in the reason for placement is to be noted in this section. If the reason for placement changes, the inmate must receive a copy of this form): Date of Next Review: 08-12-2019 Printed Name and Signature of Segregation Review Official or the Reviewing Authority and Date Signed: (b)(6); (b)(7)(C) Record Copy - Central File This form replaces BP-295(52) dated January 1988 file:///C:/temp/shu/Epstein-Rend76318-054_SRO_20190729-20190810.html 8/13/2019 DOJ-OGR-00025335