Epstein Secrets

n a special housing states? ClYes; 0 No Is there an eitaltionai essesamertt for ovary one month interval thentediar7 O Yet CI No if no. why not? Acton taken on die above date by the Segregation Bedew OtEdat or the Redevitog Aalborg,: 0 RN-eased from Special Housing, ID Cangnue In Special &tang C4

s in a special housing status? Is there an additional assessment for every cne month interval thereafter? O Yes. O No dn.. why not? O Yes O No Acton taken on the above date by the Segregation Review ()Moat or the Reviewing Authority: K Re:eased from Special Housing. O Continue in Special Reusing

n 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) Date 01 Next Review 01.23-2019 Printed Name and Sign Segregation Renew Official or the Renewing Authority and Date Signed Record Copy - Central File This form repla

n a special hOuSelg status? K Yes: K No Is there an addmonal assessment for every one month interval thereafter? K Yes: K No if no. why not? Acton taken on the above date by the Segregation Review Official or the Reviewing Authority: K Released from Special Housing: K Conbnue vi Special Housin

ange in the reason for placement is to be noted in this What If Me reason for placement changes, the inmate must receive a copy &this form): Date of Next Review. 07.23.2019 Printed Name and Signe Segregation Review Official ea the Reviewing Authority and Date Signed. M. I Record Copy - Central File TN'

ys in a special housirg status, RI E No Is there an additional assessment tor every one month interval thereafter? Yes. —I No if no. why not, Acton taken on the above date by the Segregation Review Official or the Reyxweing Authority K Released from Special Housing, s, Continue in Special Hous

n the reason tor placement is to be noted in this section. t the reason for placement changes. the inmate must receive a copy of this form) Date of Next Review 07-25-2019 Pnnted Name and Signature of Segregation Review Official or the Reviewing Authority and Date Signed RICE, MARQUEA S Record Copy - Cent