BP-A0292
APR IS U.S. DEPARTMENT OF JUSTICE
SPECIAL HOUSING UNIT RECORD FEDERAL BUREAU OF PRISONS
NEW YORK MCC
(Institution)
Rog. No. 76318.054
Inmate Name: EPSTEIN, JEFFREY EDWARD
UNASSIGNED ADMISSION 5UNT MGR. 5
Teamtaseworker Regular Unit Cell'
Violation Date Time
PENDING CLASSIFICATION 15:26
or Reason: 2019-07-10 ReCd:
Reed:
AdmMance Date Time
Authorized: Rel.: Rel.:
N/A
Pertinent Information:
Separation Information: Nth
H01•001L AD
Special Housing Unit Cell Number: Inmate Is In: DS: AD Status
Is Inmate on Medication: N Medical Department Notified:
Out of cell time Medical
Date Shift Meals SH Exercise Staff Sign OIC Signature
B D S (total) Comments
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
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