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BP-A0292
APR 16
SPECIAL HOUSING UNIT RECORD
U.S. DEPARTMENT OF JUSTICE
FEDERAL BUREAU OF PRISONS
NEW YORK MCC
(Institution)
Inmate Name: EPSTEIN, JEFFREY EDWARD
Reg. No. 76318-054
Team/caseworker: ________________________ Regular Unit: 5UNT MGR. [Redacted (b)(6); (b)(7)(C)] EXT [Redacted (b)(6); (b)(7)(C)] Cell: 5
Violation
or Reason: PENDING CLASSIFICATION
Date Rec'd: 2019-07-29
Time Rec'd: 12:21
Admittance Authorized: [Redacted (b)(6); (b)(7)(C)]
Date Rel.: __________________
Time Rel.: __________________
Pertinent Information: N/A
Separation Information: N/A
Special Housing Unit Cell Number: Z04-206LAD
Inmate Is In: __________________ DS: __________________ AD _______________ AD Status
Is Inmate on Medication: Y
Medical Department Notified: Y
[GRID LOG]
Date | Shift | Meals B | Meals D | Meals S | SH | Exercise | Out of cell time (Total min/hrs) | Comments | Medical Staff Sign | OIC Signature
08-04-2019 | Morn | Y | | | | | | | [Redacted Block] | [Redacted Block]
08-04-2019 | Day | | Y | | | | | | [Redacted Block] | [Redacted Block]
08-04-2019 | Eve | | | Y | | | | | [Redacted Block] | [Redacted Block]
08-05-2019 | Morn | Y | | | | | | | [Redacted Block] | [Redacted Block]
08-05-2019 | Day | | Y | | | | | | [Redacted Block] | [Redacted Block]
08-05-2019 | Eve | | | Y | | | | | [Redacted Block] | [Redacted Block]
08-06-2019 | Morn | Y | | | | | | | [Redacted Block] | [Redacted Block]
08-06-2019 | Day | | Y | | | | | | [Redacted Block] | [Redacted Block]
08-06-2019 | Eve | | | Y | No | | | | [Redacted Block] | [Redacted Block]
08-07-2019 | Morn | Y | | | | | | | [Redacted Block] | [Redacted Block]
08-07-2019 | Day | | Y | | | | | | [Redacted Block] | [Redacted Block]
08-07-2019 | Eve | | | Y | No | | | | [Redacted Block] | [Redacted Block]
08-08-2019 | Morn | Y | | | | | | | [Redacted Block] | [Redacted Block]
08-08-2019 | Day | | Y | | | | | | [Redacted Block] | [Redacted Block]
08-08-2019 | Eve | | | Y | | | | | [Redacted Block] | [Redacted Block]
08-09-2019 | Morn | Y | | | | | | | [Redacted Block] | [Redacted Block]
08-09-2019 | Day | | Y | | | | | | [Redacted Block] | [Redacted Block]
08-09-2019 | Eve | | | Y | | | | | [Redacted Block] | [Redacted Block]
[Empty rows for Morn/Day/Eve follow]
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)
PDF Prescribed by P5270
This form replaces BP-292(52) dated AUG 2011.
DOJ-OGR-00025339
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