EFTA00036598.pdf

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 Rog. No. 76318.054 Teamtaseworker Regular Unit 5UNT MGR Celt 5 Violation Date Time or Reason: N/A Reed: N/A ReCd: NA Admittance Date Time N/A N/A N/A Authorized: Rel.: Rel: Pertinent Information: NIA Separation Information: NIA Special Housing Unit Cell Number: Z04.206LAD Inmate Is In: Is Inmate on Medication: NIA Date Shift Meals SH Exercise Out of cell time (total) Comments Medical Staff Sign OIC Signature 8 D S 06-04-2019 Morn Y M- 08-04-2019 Day y = 0604-2019 Eve y = 1:6454019 Morn v 0605.2019 Day y 06-05.2019 Eve r CO.013.2019 Mom y 03-013.2019 Day Y 06-062019 0507.2019 Eve Morn y y No M. ME Ce07.2019 Day v 0807.2019 Eve I r No —.-- ceoe-zors Mom v 126-08-2019 Day v 06.0112019 Eve r Il 013-09•2019Morn v I . 126-08.2019 Day v 06.09.2019 Eve y M. — Morn \ Day Eve NIA Medical Department Notified: N/A DS: N/A AD Status EXPLANATORYNOTES:Pertinent Info: i e.. Epileptic; Diabetic; Suicidal; Assaultive: etc. Meals/SH: Shower - Yes (Y): No (N); Refused (R)Out•of -Cell Time: (LL) Law Ubrary,(LV) Legal Visit, (U) Unit Team. (P) Psychology. (E) Education, (H) Haircut, (C) Chapel, (R) Recreation, (X) Property Issue. (V) (M) Medical. (C) Court, (O) Other - Yes (Y) if applicable / Enter Actual Time Period Stan and End (i.e., 0930 -1030 Irs) 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. EFTA00036598