i rn araans ADMINISTRATIVE DETENTION ORDER By DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS —_—_———— NEW YORK MCC Instituten - 07-16-2019 15: TO: Special Housing Unit Officer DaterTine: 215s FROM: 7. LIEUTENANT (Name/Title) SUBJECT: Placementot________ [MM og ion. Aoministrative Detention {a) 1s 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: | hereby requestplacementin Administrative Detention for my own protection. Inmate Signature/Register No.: ee eeeeeFeeEeeSeSeSSeSSSSSSFSSSSSSFsFse Staff Witness Printed Name Signature: ———SSeeSeSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSee —_____[2) Since a serious sweat exits to II ste @s perceived by staff, although person has not requested admission; referral of the necessary information w lorwarded for an appropriate hearing by the SRO. fe) ts pending transfer or is in holdover status during transfer. ) Is pending classification; or {g) __!s terminating confinement in Disciplinary Segregation and has been ordered into Administrative Detention by the [i designee. it is this Correctional ma decision based on all the circumstances that the above named 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/time) Staff Witness Signature/Printed Nam ..... 1 lb 19 Supervisor 24 hour review of placement: Signature/Printed name. * 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 Fite Prescribed by P5270 (Replaces BP-A0308 of JAN 88.) POF EFTA00110614

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Baas ADMINISTRATIVE DETENTION ORDER HB. DEPARTMENT OF susTICE FEDERAL BUREAU OF PRISONS ———— NEW YORK MCC instituson Date/Time: 07-16-2019 15:50 TO: FROM: | (NamefTie) SuBvECT: Piacementot______ MMMM eg. No___ Min administrative Detention (2) Is pending an investigation for @ violation of Bureau regulations; —¥__(0) Is pending an Sis investigation. {¢) ts pending investigation or trial for a criminal act: (8) 's 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 [IEEE safety 2s 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 [IN designee. itis this Comectona! [NMININNIN cecision based on all the circumstances that the above named IMM continued presence in the general Population poses @ serious threat to life, property, self, staff, other inmates, or to the secunity 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) rere StaffWitness Signature/Printed Name. Date Supervisor 24 hour review of placement: Signature/Printed marme * 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.) EFTA00110615

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/ -_ NYMHJ 535.03 * PAGE 001 OF 001 ; REGNO: NAME. : RSP..: PHONE : PROJ REL METHOD: UNKNOWN PROJ REL DATE..: UNKNOWN PAR ELIG DATE..: PAR HEAR DATE..: NYM-NEW YORK MCC PAX: INMATE PROFILE REG FUNCTION: PRT DOB/AGE.: R/@VETH.: MILEAGE, : a FBI NO..: INS NO..: SSN...2.3 PSYCH: NO DETAINER: OFFN/CHG RMKS: TITLE: 21 USC: 846 OFFN/CHG RMKS: TITLE: FACL CATEGORY --2ee- NYM ADM-REL A-PRE NYM CALLOUTS NYM CARE LEVEL NYM COR COUNSL NYM CMC NYM CASEWORKER NYM CUSTODY NYM DRUG PGMS NYM EDUC INFO NYM FIN RESP NYM LEVEL NYM MED DY ST NYM NYM NYM NYM NYM NYM NYM CARE1-MH UNT 7S UNT 7 IN NR WAIT GED UNK UNASSG UNASSG SECOND RSP S4N UNIT 7 WAITNG LST CIM COMP WRK DETAIL UNASSG Go000 21 USC: COURT SDNY SEPARATION NOT MED CL PGM REVIEW OCT QUARTERS 612-7921, RELIGION OWN 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 / 50 W/M/H 11 MILES 88869JA1 108649131 NO CMC..: EFF DATE TIME 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 1718 0731 1343 1414 osss 1415 1718 1102 1718 1718 1718 1718 1043 1001 1718 1718 1050 1110 1718 WALSH: YES YES EFTA00110616

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PP41 oo NYMH} 535.01 PAGE 001 OF 001 * INMATE LOAD DATA REG NO: ST vnc: * Page | of 1 07-16-2019 15:48:27 RSP OF: NYM-NEW YORK MCC DOBCAGE): 03-10-1969(50) RACE....: WHITE FBI NO..: 888693A1 SEX.....2 MALE INS NO..: ETHNIC HISPANIC SSN.....: 108649131 HEIGHT 5 06 DNA.....: NYMO6201 WEIGHT 180 HAIR....: BLACK EYES....: BROWN CITIZENSHIP. ...: CMC... : YES BIRTH PLACE....: NEW YORK MILEAGE.: 11 MILES LEGAL RESIDENCE: BRONX, NEW YORK 10460 G0005 TRANSACTION SUCCESSFULLY COMPLETED - CONTINUE PROCESSING IF DESIRED https://bop.tcp.doj.gov:9049/SENTR Y/J1 PP030.do 7/16/2019 EFTA00110617

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PDIS5 . Page | of | - lan NYMGS * INMATE DISCIPLINE DATA * 07-16-2019 PAGE 001 OF O01 * CHRONOLOGICAL DISCIPLINARY RECORD bal 23:36:10 ReGIsTeR NO: [A vovc..: 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.tep.doj.gov:9049/SENTR Y/J1PPD50.do 7/16/2019 EFTA00110618

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PDIS5 Page 1 of 1 o fan NYMGS * INMATE DISCIPLINE DATA * 07-16-2019 PAGE 001 OF 001 * PENDING REPORTS * 23:36:32 FUNCTION...: [prs 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 EFTA00110619

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Bureau of Prisons **SENSITIVE BUT UNCLASSIFIED” Psychology Services SHU Review inmate Name: AN Reg #: aa Date of Birth: 03/10/1969 Sex: M Facility NYM Unit Team: 7 Date: 07/18/2019 07:19 Provider: 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 [JIE 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 Ire may suffer from a ps: ical disorder requiring additional psychological services. This SHU review is also not a risk assessment of an 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 IE. EEE PAO/Chief Psychologist on 07/18/2019 12:26 Generated 07/18/2019 12:26 by I. ME Pho/chief§——-_Bureau of Prisons - NYM Pagetof 1 EFTA00110620

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BP-A295.052 SPECIAL HOUSING UNIT REVIEW wm. DEPARTMENT OF JUSTICE APRIL 1904 FEDERAL BUREAU OF PRISONS Institution: NEW YORK MCC 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 il, RECORD REVIEW. (To be done weekly in iif 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 Statt: _[_lyes;_[_]No Has been seen dally by responsible officer designated by Warden: __[_lyes:_[_]No Has received prescribed weekly exercise: oO Yes: D0 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]y¥es; C)no Is there an additional assessment for every one month interval thereafter? C1) ves; CI) No if no, why not? Action taken on the above date by the Segregation Review Official or the Reviewing Authority: (Released trom Specie! Housing: —_[_] Continue in Special Housing Did inmate in Administrative Detention receive a written copy of staff's decision and the basis for the finding at each 30 day review? oO Yes; & No if no, why not (Should be given provided institutional security not compromised)? ee EEE EEE 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): ee 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 EFTA00110621

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8P-A205.052 SPECIAL HOUSING UNIT REVIEW BB. DEPARTMENT OF JUSTICE APRIL. 1994 FEDERAL BUREAU OF PRISONS il, RECORD REVIEW. (To be done weekly in the 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 Administrative Detention receive a written copy off decision and the basis for the finding at each 30 day review? Yves; C)no 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 EFTA00110622

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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 Tara |ConmminSpectliouneue | CC 07-02019|Contiuein Special Housing nt | —s—s—~‘~*~*‘~sr LC °V—'_ ee 1. Subject: (7 or 30 Days) Review By (SRO): 7 Day Review | fC Date inmate appeared for @ 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 written copy ot Il] decision and the basis for the finding at each 30 day review? Myes; Cn 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: 2 ee oy Record Copy - Central File ‘This form replaces BP-295(52) dated January 1968 Page | of 1 8/6/2019 EFTA00110623

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ght weigh S ros?! 180 BLACK 180 BLACK BROWN Paciiicy NYM BROWN 180 ix Weight 180 Weight 180 Hate BLACK tye BROWN Peat lity NYM tye BROWN Facility NYM kye BROWN Pacility NYM EFTA00110624

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EFTA00110625