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n for Placement' PENDING SIS INVESTIGATION/ THREAT ASSESSMENT I. Subject: (2 or 3 Days) 3 Day Review Action Taken on the Above Dale: Continue in Special Housing Unit Printed Name/Signature: Date Reviewed 07.19.2019 II. RECORD REVIEW. (TO be done weekly in the inmate's absence, beginning after the in-person 7
s documented here. Record Copy • Inmate Concerned (not necessary it placement is a result ot holdover status); Copy - Captain, Copy - Unit Manager. Copy - Operation Supervisor • Administrative Detention Unit: Copy — Psychology; Copy - Central Fine PDF Prescribed by P5270 (Replaces 8P-A0308 of JAN 88.) EFTA00110601 8P
ason for Iftecement PENDING SIS INVESTIGATION/ THREAT ASSESSMENT 1. Sutsect (2 or 3 Days) 3 Day Review Acton Taken on the Above Date Continue in Special Housing Unit Date Redo:mixt 07-19-2019 Pnnted Nameragnature: 11. RECORD REVIEW. (To be done weekly in the DATE ACTION TAKEN REMARKS SIGNATURE 07-23-2019
s documented here. Record Copy - Inmate Concerned (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 Fine PDF Prescribed by P5270 (Replaces 8P-A0308 of JAN 88.) EFTA00110614 8P
NG SIS INVESTIGATION/ THREAT ASSESSMENT L Subject (2 or 3 Days) 3 Day Review Date Reviewed 07-19-2019 Acton Taken on the Above Date Continue in Special Housing Unit P r. N rn nature: II. RECORD REVIEW. (To be done wieldy In the Inmates absence. beginning after the iniperson 7 day review. and continuing every
s documented here. Record Copy - Inmate Concerned (not necessary it placement is a result ot holdover status); Copy - Captain, Copy - Unit Manager. Copy - Operation Supervisor • Administrative Detention Unit: Copy — Psychology; Copy - Central Fike PDF Prescribed by P5270 (Replaces BP-A0308 of JAN 88.) EFTA00060708 8P
Race: WHITE Facility: NYM Encounter Date: 08/10/2019 07:25 Provider: RN Unit: Z04 Emergency Code - Resuscitation Event encounter performed at Special Housing Unit. SUBJECTIVE: Emergency Note Provider: RN Team Members: Provider fiQle RN Team/Code Leader Code Events: Tvoe Value Pate CPR Compressions
s dteumented here_ Record Copy - Inmate Concerned (not necessary if placement Is a result of holdover status); Copy - Captain; Copy • Unit Manager. Copy - Operation Supervisor f eaeysAdmintstratve Detention Unit Copy —Psychology: Copy - Central Fite PDF Prole Ned by P5270 (Replaces 8P-A0308 al JAN 88.) EFTA00047579 B
Entities connected to both Special Housing Unit and Copy - Operation Supervisor
Federal Bureau of Prisons
ORGANIZATIONLeon Black
PERSON
Julie K. Brown
PERSONCOMPLETED - CONTINUE PROCESSING
ORGANIZATIONNYM-NEW YORK MCC
ORGANIZATIONNext Review
ORGANIZATIONthe Reviewing Authority
ORGANIZATIONSpecial Housing Review Form
ORGANIZATIONUNT MGR
ORGANIZATIONPGM REVIEW
ORGANIZATIONthe Segregation Review
ORGANIZATIONR. PROTO
ORGANIZATIONMedical Staff
ORGANIZATIONActon Taken
LOCATIONNYM MED DY ST
ORGANIZATIONCARE1-MENTAL
ORGANIZATIONSHU Review
ORGANIZATIONOHO Report
ORGANIZATIONEl Continue
ORGANIZATIONthe Central File (Incident Report
ORGANIZATION