SPAM
APR 16 U.S. DEPARTMENT OF JUSTICE
SPECIAL HOUSING UNIT RECORD FEDERAL BUREAU OF PRISONS
NEW YORK MCC
(Institution)
Reg. ese. 76318.054
Inmate Name: EPSTEIN, JEFFREY EDWARD
UNASSIGNED ADMISSION . Ma:M. UNIT MANAGER Cell' MO
Teamtaseworker Regular UM'
Violation Date Time
PENDING CLASSIFICATION 2019-07-07 Real: 19:20
or Reason: Reed:
AdmMance Date Time
Authorized: Rel.: Rel.:
N/A
Pertinent Information:
Separation Information: NIA
Z05-124 LAD AD
Special Housing Unit Cell Number: Inmate Is In: DS: AD Status
Is Inmate on Medication: N Medical Department Notified:
Out of cell lime Medical
Date Shift Meals SH Exercise Staff Sign OIC Signature
B D S (total) Comments
Morn
Day
Eve
0745.2019 Morn v
Day
Eve
Morn
Day
Eve
Morn
Day
Eve
07.114019 Mom Y
07.11.2019 Day Y N Ref See 2nd page
07.11.2019 Eve y
07.124019 MOM Y
07.124019 Day y an 2nd page
07.124019 Eve y
a .-
07.114019 Morn v
07.134019 Day v
07.11.2019 Eve v
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)
Visit. (M) Medical. (C) Court, (O) Other - Yes (Y) if applicable / Enter Actual Time Period Stan and End (i.e., 0930 -1030 hrs) in OW 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 tom replaces BP•292(52) dated AUG 2011.
EFTA00036587
Day shift comments:
07-11-2019 Health: Voices no medical complaints.
Day shift comments:
07-12-2019 Health: Voices no medical complaints.
EFTA00036588