BP.A0292
APR 16 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
5UNT MGR 5
Teamtaseworker Regular Unit Celt
Violation Date Time
N/A N/A NA
or Reason: Reed: ReCd:
Admittance Date Time
N/A N/A N/A
Authorized: Rel.: Rel:
NIA
Pertinent Information:
Separation Information: NIA
Z04.206LAD NIA N/A
Special Housing Unit Cell Number: Inmate Is In: DS: AD Status
N/A
Is Inmate on Medication: NIA Medical Department Notified:
Out of cell time Medical
Date Shift Meals SH Exercise Staff Sign OIC Signature
8 D S (total) Comments
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 Eve y No M.
0507.2019 Morn y
ME
Ce07.2019 Day v
0807.2019 Eve r No —.--
I
ceoe-zors Mom v
Day
126-08-2019 v
06.0112019 Eve r I l
013-09•2019 Morn v I .
126-08.2019 Day v
06.09.2019 Eve y M. —
\
Morn
Day
Eve
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