BP-AD292 APR 16 U.S. DEPARTMENT OF JUSTICE SPECIAL HOUSING UNIT RECORD FEDERAL BUREAU OF PRISONS a NEW YORK MCC (Institution) Inmate Name; EPSTEIN, JEFFREY EDWARD Reg. No. 76318-054 Teamicaseworker: Regular Unit: 5UNT MGR. N. REID EXT 6421/6301 Cell: 5 Violation ; Date Time : or Reason:____ Rec'd: N/A _ Rec'd: N/A Admittance , Date Time ; Authorizea:_N/A Rel.: NA Rel.: NYA NIA Pertinent Information: Separation Information: WA Z04-206LAD NA NA Special Housing Unit Cell Number: Inmate Is In: DS: AD Status Is Inmate on Medication: NWA Medica! Department Notified: NWA Out of cell time Medical Date Shift Meals SH | Exercise Comments Staff Sign OIC Signature B D'S {Total min/hrs) o6-o4-2019, Morn | ¥ 06-04-2019 | Eve Y 06-05-2019 06-05-2019 | Day Y 06-05-2019 06-06-2019 06-06-2019 | Day Y 06-06-2019 06-07-2019 06-07-2019 | Day Y 06-07-2019 | Eve Y No 06-08-2019 | Morn Y 06-08-2019 | Day Y 06-08-2019 | Eve Y 06-09-2019 06-09-2019 06-09-2019 Morn Day Eve A Be Be 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. EFTA00143155