EFTA00036584.pdf

BP-A0292 APR IS 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 5 Teamtaseworker UNASSIGNED ADMISSION Regular Unit 5UNT MGR. Cell' Violation Date Time PENDING CLASSIFICATION 2019-07-10 15:26 or Reason: Reed: ReCd: AdmMance Date Time Authorized: Rel.: Rel.: Pertinent Information: N/A Separation Information: Nth Special Housing Unit Cell Number: H01•001L Inmate Is In: Is Inmate on Medication: N Date Shift Meals SH Exercise Out of cell time (total) Comments Medical Staff Sign OIC Signature B D S 07-21.2019 MOM Y 07-21.2019 Day y - 07-21.2019 Eve y 07.22.2019 Morn v 07,224019 Day y Y NO 01:00 07,22.2019 Eve y Mom Day Eve Morn Day Eve Mom Day Eve Morn Day Eve Morn Day Eve DS: AD AD Status Medical Department Notified: EXPLANATORYNOTES:Pertinent Info: i t. Epileptic; Diabetic; Suicidal; Assaultive: etc. Meals/SH: Shower - Yes (Y); No (N); Refused (R)Out•of 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 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 al 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 tom replaces BP•292(52) dated AUG 2011. EFTA00036584