i rn span ADMINISTRATIVE DETENTION ORDER U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS NEW YORK MCC Insttuton - 07-16-2019 15: TO: Special Housing Unit Officer DaterTine: 215s Frou: (Name/Title) SUBJECT : Pecenentot___ Reg.No____ in. Administrative Detention {a) ts pending an investigation for a violation of Bureau regulations; —¥__(b) Is pending an SiS investigation. ——_—[¢)_!s pending investigation or trial for a criminal act; ——__(@)_ Is to be admitted to Administrative Detention {1) Since the inmate has requested admission for protection: I hereby requestplacementin Administrative Detention for my own protection. Inmate Signature/Register No.: SSS Staff Witness Printed Name Signature: ess —__[2) Since a serious threat exists to individual's safety as perceived by staff, although person has not requested admission; referral of the necessary information will be forwarded for an appropriate hearing by the SRO. fe) ts pending transfer or is in holdover status during transfer. ) Is pending classification; or (g) Is terminating confinement in Disciplinary Segregation and has been ordered into Administrative Detention by the Warden's designee. itis this Correctional Supervisors decision based on all the circumstances that the above named inmate's continued presence in the general population poses a serious threat to life, property, self, staff, other inmates, or to the security or orderly running of the institution because* PENDING SIS INVESTIGATION’ THREAT ASSESSMENT ~ Therefore, the above named inmate |s to be placed in Administrative Detention until further notice. The inmate received a copy of this Order on (date / ime) Staff Witness Signature/P rinted Name, fF Date 7 /b /9 Supervisor 24 hour review of placement: Signature/Printed name. * In the case of DHO action, reference to that orderis sufficient. in other cases, the Correctional supervisor will make an independent review and decision, which is documented here. Record Copy - Inmate Concemed (not necessary if placement is a result of holdover status): Copy - Captain; Copy - Unit Manager, Copy - Operation Supervisor - Administrative Detention Unit; Copy - Psychology; Copy - Central Fite Prescribed by P5270 (Replaces BP-A0308 of JAN 88.) POF EFTA00110601

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BP A908 ADMINISTRATIVE DETENTION ORDER U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS ———— NEW YORK MCC instituson Date/Time: 07-16-2019 15:50 TO: FROM: . (Name/Title) SUBJECT : Placement of PF /Reg.No___ Min Acministrative Detention (a) ts pending an investigation for a violation of Bureau regulations; —¥__(0) Is pending an Sis investigation. {¢) ts pending investigation or trial for a criminal act: (4) Is tobe admitted to Administrative Detention (1) Since the inmate has requested admission for protection; | hereby request placement in Administrative Detention for my own protection. Inmate Signature/Register No.: Staff Witness Printed Name Signature: (2) Since a sericus threat exists to individuat's safety as perceived by staff, although person has not requested admission; referral of the necessary information will be forwarded for an appropriate hearing by the SRO. {e) _|s pending transfer or is in holdover status during transfer. © |s pending classification; or (9) 's terminating confinement in Disciplinary Segregation and has been ordered into Administrative Detention by the Warden's designee. tis this Correctional Supervisors decision based on all the circumstances that the above named inmate's continued presence in the general Population poses @ serious threat to life, property, self, staff, other inmates, or to the security or orderly running of the institution because* PENDING SIS INVESTIGATION/ THREAT ASSESSMENT Therefore, the above named inmate is to be placed in Administrative Detention until further notice. The inmate received a copy of this Order on (date / time) TTT ee SSSSSSSSSSSSSSSSSSSSSSSSSSSse StaffWitness Signature/Printed Name. te Supervisor 24 hour review of placement; Signature/Printed mame * In the case of DHO action, reference to that order is sufficient. in other cases, the Correctional supervisor will make an independent review and decision, which is documented here. Record Copy - Inmate Concemed (not necessary if placement is a result of holdover status); Copy - Captain; Copy - Unit Manager, Copy - Operation Supervisor ~ Administrative Detention Unit; Copy — Psychology: Copy - Central File POF Prescribed by P5270 (Replaces BP-A0308 of JAN 88.) EFTA00110602

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/ NYMHJ 535.03 * PAGE 001 OF 001 NYM-NEW YORK MCC REGNO: NAME. : RSP..: PHONE : sameeren PF. PROJ REL METHOD: KNOWN PROJ REL DATE..: PAR ELIG DATE..: PAR HEAR DATE.. UNKNOWN OFFN/CHG RMKS: TITLE: 21 USC: 846 21 USC: OFFN/CHG RMKS: TITLE: FACL CATEGORY --2f*e- NYM ADM-REL A-PRE NYM CALLOUTS NYM CARE LEVEL CARE1-MH NYM COR COUNSL UNT 75S NYM CMC NYM CASEWORKER UNT 7 NYM CUSTODY IN NYM DRUG PGMS NR WAIT NYM EDUC INFO GED UNK NYM FIN RESP UNASSG NYM LEVEL UNASSG NYM MED DY ST NYM NYM NYM NYM NYM NYM NYM SECOND RSP S4N UNIT 7 WAITNG LST CIM COMP WRK DETAIL UNASSG Go0000 COURT SDNY SEPARATION NOT MED CL PGM REVIEW OCT QUARTERS 612-792 RELIGION OWN INMATE PROFILE REG FUNCTION: PRT DOB/AGE.: R/S/ETH. : MILEAGE. : ax: FBI NO..: INS NO..: SSN.....: PSYCH: NO DETAINER : 841 CURRENT ASSIGNMENT - - - - PRE-SENT ADMIT, ADULT COURT USM SOUTHERN DISTRICT CARE1-MENTAL HEALTH VACANT SEPARATION IN CUSTODY NRES DRUG TMT WAITING GED STATUS UNKNOWN FINANC RESP-UNASSIGNED UNASSIGNED NOT MEDICALLY CLEARED OCTOBER PROGRAM REVIEW HOUSE G/RANGE 12/BED 792L RELIGION UNKNOWN USM NYS 54N NEW YORK, NY UNT MGR. R. PROTO EXT 6393 CIM PACKET COMPLETE UNASSIGNED WORK DETAIL TRANSACTION SUCCESSFULLY COMPLETED * 07-16-2019 15:47:57 03-10-1969 / SO W/M/H 11 MILES 88869JA1 108649131 WALSH: YES NO CMC. .: EFF DATE 08-01-2018 07-16-2019 09-12-2018 11-24-2018 11-23-2018 11-24-2018 08-01-2018 08-02-2018 08-01-2018 08-01-2018 08-01-2018 08-01-2018 10-29-2019 11-23-2018 08-01-2018 08-01-2018 08-04-2018 03-07-2019 08-01-2018 TIME 1718 0731 1343 1414 osss 1415 1718 1102 1718 1718 1718 1718 1043 1001 1718 1718 1050 1110 1718 EFTA00110603

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PP41 oo NYMH} 535.01 PAGE 001 OF 001 * INMATE LOAD DATA * Page | of 1 07-16-2019 15:48:27 RSP OF: NYM-NEW YORK MCC DOBC(AGE): 03-10-1969(50) RACE....: WHITE FBI NO..: 888699A1 SEX.....2 MALE INS NO..! ETHNIC HISPANIC ssn.....: HEIGHT..: 5 06 DNA.....: NYMO6201 WEIGHT 180 HAIR....: BLACK EYES....: BROWN CITIZENSHIP....: CMC.....: YES BIRTH PLACE....: NEW YORK MILEAGE.: 11 MILES Lecac resrpence: BRONX, NEW YORK 10460 G0005 TRANSACTION SUCCESSFULLY COMPLETED - CONTINUE PROCESSING IF DESIRED https://bop.tcp.doj.gov:9049/SENTR Y/J1PP030.do 7/16/2019 EFTA00110604

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PD15 Page | of | - lan NYMGS * INMATE DISCIPLINE DATA * 07-16-2019 PAGE 001 OF O01 * CHRONOLOGICAL DISCIPLINARY RECORD bal 23:36:10 recrsTer no: voc. : FUNCTION...: [OIS FORMAT: [CHRONO LIMIT TO [__ MOS PRIOR TO [07-16-2019 RSP OF: NYM-NEW YORK MCC G5401 DISCIPLINE DATA DOES NOT EXIST FOR THIS INMATE https://bop.tcp.doj.gov:9049/SENTRY/J1PPDS0.do 7/16/2019 EFTA00110605

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PDIS5 Page | of 1 o rm NYMGS * INMATE DISCIPLINE DATA * 07-16-2019 PAGE 001 OF 001 * PENDING REPORTS * 23:36:32 REGISTER NO: (QM nave..: FUNCTION...: [DIS FORMAT: |PENDING LIMIT TO [__ MOS PRIOR TO [07-16-2019 RSP OF: NYM-NEW YORK MCC 65401 DISCIPLINE DATA DOES NOT EXIST FOR THIS INMATE https://bop.tep.doj.gov:9049/SENTRY/J1PPD50.do 7/16/2019 EFTA00110606

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Bureau of Prisons **SENSITIVE BUT UNCLASSIFIED” Psychology Services SHU Review Inmate Name: Py Reg: a Date of Birth: 03/10/1969 Sex: Unit Team: 7 Date: 07/18/2019 07:19 Placed in SHU: 07/16/2019 Type: SHU Status: ADMIN.DETENTION Threat to Self: Low Basis of Review: Inmate was interviewed Adjustment: Satisfactory, segregation not detrimental Mental Status: No significant mental health issues. Threat to Others: Low Comments Monthly SHU Review Note Note: This SHU review is a brief evaluation of this inmate's current mental status in SHU. Although an inmate may exhibit adequate adjustment to his SHU confinement and a lack of acute distress at this current time, it does not preclude the fact s/he may suffer from a psychological disorder requiring additional psychological services, This SHU review is also not a risk assessment of an inmate's potential for violent behaviors. Rather, it is an assessment of whether the inmate exhibits any aggressive or violent behaviors at the time of the SHU review. Subjective/Objective data: Inmate displayed no evidence of depression or suicidality and appeared to be adequately adjusting to SHU placement. This adjustment was determined by clinical presentation, his self report and Unit personnel statements. Assessment/Plan: Inmate is currently psychologically stable. He has been instructed to contact Psychology Department staff for support should he request, or be in need of mental health services. Unit staff are aware of the referral process. Inmate will be seen on an as needed basis or monthly for SHU reviews. Completed by (EEEEEEBPh0/Chief Psychologist on 07/18/2019 12:26 Generated 07/18/2019 12:26 by Miller, Elissa PhD/Chief Bureau of Prisons - NYM Pagetof 1 EFTA00110607

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BP-A295,052 SPECIAL HOUSING UNIT REVIEW U.S. DEPARTMENT OF JUSTICE APRIL 1904 FEDERAL BUREAU OF PRISONS Date Entered Special Housing: 07-16-2019 |. Subject: (2 or 3 Days) 3 Day Review Action Taken on the Above Date: Continue in Special Housing Unit Printed Name/Signature: ll, RECORD REVIEW. (To be done weekly in the inmate's absence, beginning after the in-person 7 day review, and continuing every week between each in-person 30 day review.) SIGNATURE 07-19-2019 Mil, Subject: (7 of 30 Days) Date inmate appeared for a Special Housing Review: Or Date inmate waived right to appear: Has been seen daily by Medical Stat: [_lyes; [_]No Has been seen dally by responsible officer designated by Warden: _[_lyes:_[_]No Has received prescribed weekly exercise: oO Yes: 0 No Proper documentation and justification in the Central File (Incident Report, DHO Report, copies of Special Housing Review Form): Oo Yes; oO No if no, why not? Is there a written psychiatric or psychological assessment on the inmate who has spent 30 days in a special housing status? C] yes; Clo Is there an additional assessment for every one month interval thereafter? Dyes; C\no if no, why not? Action taken on the above date by the Segregation Review Official or the Reviewing Authority: [CT Released trom Specie! Housing: —[_] Continue in Special Housing Did inmate in Administrative Detention receive a waitien copy of staff's decision and the basis for the finding at each 30day review? L]ves; []no if no, why not (Should be given provided institutional security not compromised)? dat Remarks: (Any change in the reason for placement is to be noted in this section. If the reason for placement changes, the inmate must receive a Copy of this form): a Date of Next Review: 07-23-2019 ‘Segregation Review Official or the Reviewing Authority and Date Signed: This form replaces BP-295(52) dated January 1988 Page | of 1 7/19/2019 EFTA00110608

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BP-A295,052 SPECIAL HOUSING UNIT REVIEW U.S. DEPARTMENT OF JUSTICE APRIL 1994 FEDERAL BUREAU OF PRISONS 07-19-2019 fl, RECORD REVIEW. (To be done weekly in the inmate's absence, beginning after the in-person 7 day review, and continuing every week between each in-person 30 day review.) lil, Subject (7 oF 30 Days) 7 Day Review Date inmate appeared for e Special Housing Review: 07-23-2019 Has been seen daily by Medical Stat: YZ) ves; []No Has been seen daily by responsible officer designated by Warden: [] ves;__C]No Has received prescribed weekly exercise: Wyes: []No Proper documentation and justification in the Central Fe (Incident Report, OHO Report, copies of Special Housing Review Form): Yves; Ono if no, why not? Is there a written psychiatric or psychological assessment on the inmate who has spent 30 days in a specie! housing status? Yves; Ono Is there an additional assessment for every one month interval thereafter? VY yes; Ono if no, why not? Action teken on the above date by the Segregation Review Official or the Reviewing Authority: Cl Reteeses trom Specie! Housing: [) continue in Special Housing Did inmate in A¢ministrative Detention receive a written copy of staff's decision and the basis for the finding at each 30 day review? Myes; Ono if no, why not (Should be given provided institutional security not compromised)? oN —_— Remarks: (Any change in the reason for placement is to be noted in this section. If the reason for placement changes, the inmate must receive @ copy of this form): Date of Next Review: 07-30-2019 Printed Name and Signature of Seg! Official or the Reviewing Authority and Date Signed: Record Copy - Central File ‘This form replaces BP-295(52) dated January 1988 Page 1 of 1 7/23/2019 EFTA00110609

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BP-A295.052 SPECIAL HOUSING UNIT REVIEW U.S. DEPARTMENT OF JUSTICE APRIL 1994 FEDERAL BUREAU OF PRISONS Reason for Placement: PENDING SIS INVESTIGATION/ THREAT ASSESSMENT/COURTS SAY INMATE LT THREATEN ON . Date Entered Special Housing: 07-16-2019 1. Subject (2 or 3 Days) 3 Day Review Action Taken on the Above Date: Continue in Special Housing Unit Printed Name/Signature: li, RECORD REVIEW. (To be done weekly in the inmate's absence, beginning after the in-person 7 day review, and continuing every week between each in-person 30 day review.) oATe @723.20%0|Goninonin Special Housing une | 07-302019|[Continuein Special Housing unt | SSCS Ii, Subject: (7 or 30 Days) 7 Day Review Date inmate appeared for a Special Housing Review: 07-23-2019 Has been seen dally by Medical Stat yes: [)No Has been seen daily by responsible officer designated by Warden: ves; CN Has received prescribed weekly exercise: Myes; Ono Proper documentation and justification in the Central File (Incident Report, OHO Report, copies of Special Housing Review Form): Yves; No if no, why not? In thoro # written psychiatric o psychological assessment on the inmate who has spent 20 days in a speciat housing status? __ [¥] Yes: Ono Is there an additonal assessment for every one month interval thereafter? YZ) yes; No if no, why not? Action taken on the above date by the Segregation Review Official or the Reviewing Authority: (C)Reteased trom Speciat Housing; [YJ Continue in Special Housing Did inmate in Administrative Detention receive a writen copy of staff's decision and the basis for the finding at each 30 day review? [4] ves; Cine it no, why not (Should be given provided Institutional security not compromised)? a Remarks: (Any change in the reason for placement is to be noted in this section. If the reason for placement changes, the inmate must receive a copy of this form): eo Date of Next Review: 08-13-2019 Printed Name and Review Official or the Reviewing Authority and Date Signed: Record Copy - Central File ‘This form replaces BP-295(52) dated January 1968 Page | of 1 8/6/2019 EFTA00110610

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180 BLACK BROWN Paciiicy NYM tye BROWN Peat lity NYM tye BROWN Facility NYM kye BROWN Pacility NYM EFTA00110611

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EFTA00110612