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BP-A082
APR 16
U.S. DEPARTMENT OF JUSTICE
FEDERAL BUREAU OF PRISONS
SPECIAL HOUSING UNIT RECORD
NEW YORK MCC
(Institution)
Reg. No. 76318-054
Inmate Name: EPSTEIN, JEFFREY EDWARD
Team/caseworker UNASSIGNED ADMISSION
Regular Unit: A&C
UNIT MANAGER
Cell: A&O
Violation or Reason: N/A
Date Rec'd: N/A
Date Rel.: N/A
Time Rec'd: N/A
Time Rel.: N/A
Admittance Authorized: N/A
Pertinent Information: N/A
Separation Information: N/A
Inmate Is In: N/A
DS: N/A
AD Status
Special Housing Unit Cell Number: Z05-124LAD
Is Inmate on Medication: N/A
Medical Department Notified: N/A
Date Shift Meals SH Exercise Out of cell time (Total min/hrs) Comments Medical Staff Sign OIC Signature
B D S
Morn
Day
Eve
07-08-2019 Morn Y
Day
Eve
Morn
Day
Eve
Morn
Day
Eve
07-11-2019 Morn Y
07-11-2019 Day Y N Ref See 2nd page
07-11-2019 Eve Y
07-12-2019 Morn Y
07-12-2019 Day Y
07-12-2019 Eve Y
07-13-2019 Morn Y
07-13-2019 Day Y
07-13-2019 Eve
EXPLANATORY NOTES: Pertinent Info: I.e., Epileptic; Diabetic; Suicidal; Assaultive; etc. Meals/SH: Shower - Yes (Y); 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 Period 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)
Prescribed by P5270 This form replaces BP-292(52) dated AUG 2011.
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DOJ-OGR-00026350