arr ry CoE Sey: . _ @# AR S ft AMSKCHLOBSERVATION LOGY oa yl RA name £ Psfein . recistranione: 262 |€—OS4 LEASE RETURN LOG TO PSYCHOLOGY AFTER THE CUSERVATION HAS ENDED. TRANK YOU. 4 a wn re "\ ove, ri > Be AZe WAP is, ¢€y | ITEMS ALLOWED: Regular Clothes 2_ Safety Toothbrush | Mewspaper/Magazine . | Books (softcover only} Safety Pen and Paper - -_Toilet Paper ¢ j i _Lega! Mail,‘ _____ Other SW Blanket & SW Mattress must be used even on Psych . Observations. {f nothing is checked with 2 silver marker, only a Suicide Simock and Suicide Blanket are allowed. SDNY_00010977 EFTA00034435

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Name of Inmate On Suicide Watch or Psych Observation: r= 7 an Registration #: 1£—OX EATING/SHOWER CHART lL lh a SHOWER SHOWER mie t+} rte ee a rae oe a a ee ee ee 4) || a en ae ae a Zn rs ee VA a ee a a rs eee ee a rs es rs eee ee a PE ee ee PE! PET as ee FOE ee: 2 A DOES ee SG EOE ee ee eR) MAE Please check the appropriate box if the person on” Suicide Watch/Psych Observation actually éats his meal. Do not check the box if hevust r received it,. but did not eat it. Place a check in the “Liquids” box each time the person drinks. Thank you. CONFIDENTIAL | SONY 00010978 EFTA00034436

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