BP-AD292 APR 16 U.S. DEPARTMENT OF JUSTICE SPECIAL HATERS LST RECOM FEDERAL BUREAU OF PRISONS NEW YORK MCC (Institution) Inmate Name; EPSTEIN, JEFFREY EDWARD Reg. No. 76318-054 RO SUNT MGR. cell: 5 UNASSIGNED ADMISSION Teamicaseworker. Regular Unit: Violation Date Time PENDING CLASSIFICATION . or Reason: 1d: 2019-07-10 Rec'd: 15:26 Admittance Date Time Authorized: = Rel.: Rel.: Pertinent Information: NWA Separation Information: NA Special Housing Unit Cell Number: HO1-001L Inmate Is In: DS: AD AD Status Is Inmate on Medication: Medica! Department Notified: | cup | Out of cell time Medical Date Shit | Meals | SH_| Exercise Comments Staff Sign OIC Signature | (8) DS) {Total min/hrs) | o7-21-2019, Morn | ¥ mares Day || es ee marane|Eve | || y| | Le 07-22-2019 Morn | ¥ 07-22-2019 | Day Y Y | No 01:00 o7-22-2019' Eve | | ral | Morn Day Eve Morn | Day Eve Morn ’ Day Eve Morn Day Eve 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 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, (0) 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. EFTA00036584