DOJ-OGR-00025241.pdf

Page 997 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: _______ 5UNT MGR (b)(6); (b)(7)(C) XT (b)(6); (b)(7)(C) Cell: 5 Violation or Reason: N/A Date Rec'd: N/A Admittance Authorized: N/A Date Rel.: N/A Pertinent Information: N/A Separation Information: N/A Special Housing Unit Cell Number: Z04-206LAD Inmate Is In: N/A DS: N/A AD Status Is Inmate on Medication: N/A Medical Department Notified: N/A Date Shift Meals SH Exercise Out of cell time (Total min/hrs) Comments Medical Staff Sign OIC Signature 08-04-2019 Morn Y Y 08-04-2019 Day Y Y 08-04-2019 Eve Y Y 08-05-2019 Morn Y Y 08-05-2019 Day Y Y 08-05-2019 Eve Y Y 08-06-2019 Morn Y Y 08-06-2019 Day Y Y 08-06-2019 Eve Y No 08-07-2019 Morn Y Y 08-07-2019 Day Y Y 08-07-2019 Eve Y No 08-08-2019 Morn Y Y 08-08-2019 Day Y Y 08-08-2019 Eve Y Y 08-09-2019 Morn Y Y 08-09-2019 Day Y Y 08-09-2019 Eve Y Y Morn Day Eve 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 Time (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-00025241