BP-AD292 APR 16 SPECIAL HOUSING UNIT RECORD U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS Inmate Name: EPSTEIN, JEFFREY EDWARD NEW YORK MCC (Institution) Reg. No. 76318-054 Roguar unt: SUNT MC? oy. 5 Teamicaseworker. Violation Date Time or Reason:__~ Rec'd: NA Rec'd: NIA Admittance Date , Time Authorized:_’A Rel.: NA Rel.: NA Pertinent Information: NWA Separation Information: NA Special Housing Unit Cell Number: 204-206LAD Inmate Is In: WA Ds: WA AD Status Is Inmate on Medication: NIA Medica! Department Notified: WA . Out of cell time Medical Date Shift Meals SH | Exercise Comments Staff Sign OIC Signature |B) 0. S| {Total min/hrs) | oe-o4-2019, Morn | ¥ 0s.042018 | Day Y es ee ee ee o6-04-2019' Eve || Ty | | | a 06-05-2019 Morn | ¥ 06-05-2019| Eve | | Ty! | | 06-06-2019 | Morn Y F 4 06-06-2019| Day | | ¥ SS 06-06-2019 | Eve ¥ No a ee 06-07-2019 Morn | y ——— 0607-2019| Day | | oy a oe 06.07.2019 | Eve Y | No ee 06-08-2019 | Morn Y = 06-08-2093) Day Y me 06-08-2019 | Eve Y a 06-09-2019 Morn | ¥ = oe 06-08-2013 Day Y a 06.09-2019 | Eve | y | SS ee 0 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. EFTA00036598