EFTA00036584.pdf

Type: pdf
Source set: data-set-8
Extracted text

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