BP-A0292

APR 16

# SPECIAL HOUSING UNIT RECORD

U.S. DEPARTMENT OF JUSTICE

FEDERAL BUREAU OF PRISONS

NEW YORK MCC
(Institution)
Inmate Name: EPSTEIN, JEFFREY EDWARD
Reg. No.: 76318-054
Team/caseworker: UNASSIGNED ADMISSION
Regular Unit: A&O <empty> UNIT MANAGER <empty> Cell: A&O
Violation or Reason: PENDING CLASSIFICATION
Date: 2019-07-07
Time: 19:20
Rec'd: <empty>
Admittance Authorized: <empty>
Date: <empty>
Time: <empty>
Rel.: <empty>
Pertinent Information: N/A
Separation Information: N/A
Special Housing Unit Cell Number: Z05-124LAD
Inmate Is In: <empty>
DS: <empty>
AD: <empty>
AD Status: <empty>
Is Inmate on Medication: N
Medical Department Notified: Y

# SPECIAL HOUSING UNIT RECORD (cont.)

<table><tr><th rowspan="2">Date</th><th rowspan="2">Shift</th><th colspan="3">Meals</th><th rowspan="2">SH</th><th rowspan="2">Exercise</th><th rowspan="2">Out of cell time

(Total min/hrs)</th><th rowspan="2">Comments</th><th rowspan="2">Medical
Staff Sign</th><th rowspan="2">OIC Signature</th></tr><tr><td>B</td><td>D</td><td>S</td></tr><tr><td></td><td>Morn</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td>Day</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td>Eve</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td>"</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>07-08-2019</td><td>Morn</td><td>Y</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td>Day</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td>Eve</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td>Morn</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td>Day</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td>Eve</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td>Morn</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td>Day</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td>Eve</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>07-11-2019</td><td>Morn</td><td>Y</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>07-11-2019</td><td>Day</td><td></td><td>Y</td><td></td><td>N</td><td>Ref</td><td></td><td>See 2nd page</td><td></td><td></td></tr><tr><td>07-11-2019</td><td>Eve</td><td></td><td></td><td>Y</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>07-12-2019</td><td>Morn</td><td>Y</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>07-12-2019</td><td>Day</td><td></td><td>Y</td><td></td><td></td><td></td><td></td><td>See 2nd page</td><td></td><td></td></tr><tr><td>07-12-2019</td><td>Eve</td><td></td><td></td><td>Y</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>07-13-2019</td><td>Morn</td><td>Y</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>07-13-2019</td><td>Day</td><td></td><td>Y</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>07-13-2019</td><td>Eve</td><td></td><td></td><td>Y</td><td></td><td></td><td></td><td></td><td></td><td></td></tr></table>

# SPECIAL HOUSING UNIT RECORD (cont.)

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, (O) 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.

EFTA00037712

Day shift comments:
Health: Voices no medical complaints.

07-11-2019

07-12-2019

Day shift comments:
Health: Voices no medical complaints.

EFTA00037713