BP-AD292 APR 16 U.S. DEPARTMENT OF JUSTICE a NEW YORK MCG (Institution) Inmate Name: EPSTEIN, JEFFREY EDWARD Reg, No,_76318-054 Team/caseworker, Regular Unit: SUNT MGR. | Cell: 5 Violation Date Time PENDING CLASSIFICATION 5 or Reason: cid: 2019-07-29 Roca: 1221 Admittance Date Time Authorized: = Rel.: Rel.: Pertinent Information: NA Separation Information: N/A Special Housing Unit Cell Number: 204-206LAD Inmate Is In: Ds: AD AD Status Y Is Inmate on Medication: Medical Department Notified: Out of cell time Medical Date Shift Meals SH | Exercise Comments Staff Sign OIC Signature | 8 | o 7S | (Total min/hrs) | oe-o4-2019, Morn | ¥ ce morenre| Day Ty 1] | | | | ve-04-2019/ Eve || ral | | | | a A ( 06-05-2019 Morn | ¥ as w052019| Day | | y | | a mesma] Eve 1 iv | 1 | | ft 06-06-2019 Morn | ¥ a 06-06-2019 Day | | ¥ | a 06.06.2019 | Eve Y No eee A ee 06:07-2019 | Morn Y —_—_— sor208) Day || — 06.07.2019 | Eve Y | No EE eee 06-08-2019 | Morn Y 06-08-2013 | Day I | ¥ 06-08-2019 | Eve | y | 06-09-2019 Morn Y 06-08-2019 | Day T Ty 06-09-2019 | Eve Y 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. EFTA00036581