## SPECIAL HOUSING UNIT RECORD

## U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS

|                                                                        |       |       |        |   |    |          |                  |                       | NEW YORK MCC |         |               |           |  |
|------------------------------------------------------------------------|-------|-------|--------|---|----|----------|------------------|-----------------------|--------------|---------|---------------|-----------|--|
|                                                                        |       |       |        |   |    |          |                  |                       |              |         | (Institution) |           |  |
| Rog. No. 76318.054<br>Inmate Name: EPSTEIN, JEFFREY EDWARD             |       |       |        |   |    |          |                  |                       |              |         |               |           |  |
| Teamtaseworker                                                         |       |       |        |   |    |          |                  | Regular Unit 5UNT MGR |              |         | Celt 5        |           |  |
| Violation                                                              |       |       |        |   |    |          |                  | Date                  | N/A          |         | Time          |           |  |
| N/A<br>or Reason:                                                      |       |       |        |   |    |          |                  | Reed:                 |              |         | ReCd:         | NA        |  |
|                                                                        |       |       |        |   |    |          |                  |                       |              |         |               |           |  |
| Admittance<br>N/A<br>Authorized:                                       |       |       |        |   |    |          |                  | Date<br>Rel.:         | N/A          |         | Time<br>Rel:  | N/A       |  |
|                                                                        |       |       |        |   |    |          |                  |                       |              |         |               |           |  |
| Pertinent Information: NIA                                             |       |       |        |   |    |          |                  |                       |              |         |               |           |  |
| Separation Information: NIA                                            |       |       |        |   |    |          |                  |                       |              |         |               |           |  |
| Special Housing Unit Cell Number: Z04.206LAD                           |       |       |        |   |    |          | Inmate Is In:    |                       | NIA          | DS:     | N/A           | AD Status |  |
| N/A<br>Is Inmate on Medication:<br>NIA<br>Medical Department Notified: |       |       |        |   |    |          |                  |                       |              |         |               |           |  |
| Date                                                                   | Shift | Meals |        |   | SH | Exercise | Out of cell time |                       |              | Medical |               |           |  |
|                                                                        |       | 8     | D<br>S |   |    | (total)  |                  | Comments              | Staff Sign   |         | OIC Signature |           |  |
| 06-04-2019 Morn                                                        |       | Y     |        |   |    |          |                  |                       |              |         | M             |           |  |
| 08-04-2019 Day                                                         |       |       | y      |   |    |          |                  |                       |              |         | =             |           |  |
| 0604-2019 Eve                                                          |       |       |        | y |    |          |                  |                       |              |         | =             |           |  |
| 1:6454019 Morn                                                         |       | v     |        |   |    |          |                  |                       |              |         |               |           |  |
| 0605.2019 Day                                                          |       |       | y      |   |    |          |                  |                       |              |         |               |           |  |
| 06-05.2019 Eve                                                         |       |       |        | r |    |          |                  |                       |              |         |               |           |  |
| CO.013.2019 Mom                                                        |       | y     |        |   |    |          |                  |                       |              |         |               |           |  |
| 03-013.2019 Day                                                        |       |       |        |   |    |          |                  |                       |              |         |               |           |  |
| 06-062019                                                              | Eve   |       | Y      |   |    |          |                  |                       |              |         |               |           |  |
|                                                                        |       |       |        | y |    | No       |                  |                       |              |         | M.            |           |  |
| 0507.2019                                                              | Morn  | y     |        |   |    |          |                  |                       |              |         |               | ME        |  |
| Ce07.2019 Day                                                          |       |       | v      |   |    |          |                  |                       |              |         |               |           |  |
| 0807.2019 Eve                                                          |       |       |        | r |    | No       |                  |                       |              |         | —.--          |           |  |
| ceoe-zors Mom                                                          |       | v     | I      |   |    |          |                  |                       |              |         |               |           |  |
| 126-08-2019 Day                                                        |       |       | v      |   |    |          |                  |                       |              |         |               |           |  |
| 06.0112019 Eve                                                         |       |       |        | r |    |          |                  |                       |              |         |               | I<br>l    |  |
| 013-09•2019                                                            | Morn  | v     |        |   |    |          |                  |                       |              |         | I             |           |  |
| 126-08.2019 Day                                                        |       |       | v      |   |    |          |                  |                       |              |         |               |           |  |
| 06.09.2019 Eve                                                         |       |       |        | y |    |          |                  |                       |              |         | M.            | —         |  |
|                                                                        |       |       |        |   |    |          |                  |                       | \            |         |               |           |  |
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|                                                                        | 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 Ubrary,(LV) Legal Visit, (U) Unit Team. (P) Psychology. (E) Education, (H) Haircut, (C) Chapel, (R) Recreation, (X) Property Issue. (V) (M) Medical. (C) Court, (O) Other - Yes (Y) if applicable / Enter Actual Time Period Stan and End (i.e., 0930 -1030 Irs) 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)