BP-A0292
APR 16 U.S. DEPARTMENT OF JUSTICE
SPECIAL HOUSING UNIT RECORD FEDERAL BUREAU OF PRISONS
NEW YORK MCC
(Institution)
76318.054
Inmate Name: EPSTEIN, JEFFREY EDWARD Reg. No.
Unit: 5UNT MGR. 5
Tearn/caseworker. Regular
Violation Date Time
PENDING CLASSIFICATION 2019-07-29 12:21
or Reason: Redd: Redd:
Admittance Date Time
Authorized: Rel.: Ret.:
N/A
Pertinent Informabon:
SeparationInformation: Nth
Z04.206LAD AD
Special Housing Unit Cell Numbs: Inmate Is In: DS: AD Status
Y
Is Inmate on Medication: Y Medical Department Notified:
Out of cell time Medical
Date Shift Meals SH Examise Staff Sign OIC Signature
B D S (Total minfirs) Comments
OB-04-2019 Mum Y
CS-04-2019 Day y
osea-2019 Eve y
1:6454019 mom y
06-05.2019 Day y
oseszoia Eve y
CO.011.2019 Mom y
03-011.2019 Day Y
06-062019 Eve y No
Ce07.2019 Morn y
IS07.2019 Day v
Ce07.2019 Eve y No
osee-zoia Mom y
CO-08-2019 Day v
osee-zoia Eve y
126-094019 Mom y
CO494019 Day y
06-08-2019 Eve y
Morn
Day
Eve
EXPLANATORYNOTES:Pertlnent Info: i e.. Epileptic. Diabetic; Suicidal; Assaultive: etc. Meas/SH: Shower - Yes (t): 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 Pedod Start 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 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.
EFTA00036581