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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
a Special Housing Review: REMARKS Review By (SRO): SIGNATURE Reviewing Authority: Or Dale inmate waived right to appear. Has been seen daily by Medical Stall. O Yes: O No Has been seen daily by responsible officer designated by Warden: O yes: O No Has received prescribed weekly exorcise: K Yot O No
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
Special Housing Review: REMARKS Review fly (SRO): SIGNATURE Reviewing Authority: Or Dale inmate warted right to appear': Has been seen daily by Medical Stall. K Yes; K No Has been seen daily by timpani/le officer designated by Warden: K Yes: K NO Has receMid prescribed weekly exercise: K Yes: K No
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
w By (SRO): Reviewing Authority: Date inmate appeared for a Special Housing Review; Or Date inmate waived right to appear: Has been seen daily by Medical Stall. K Yes: K No Has teen seen daily W response. officer designated by Warden: K Y0E K No Has received presented weekly exercise: K Yea: K No Pro
Entities connected to both Special Housing Unit and Medical Stall
Federal Bureau of Prisons
ORGANIZATIONLeon Black
PERSON
Julie K. Brown
PERSONNYM-NEW YORK MCC
ORGANIZATIONCOMPLETED - CONTINUE PROCESSING
ORGANIZATIONNext Review
ORGANIZATIONthe Reviewing Authority
ORGANIZATIONSpecial Housing Review Form
ORGANIZATIONUNT MGR
ORGANIZATIONMedical Staff
ORGANIZATIONPGM REVIEW
ORGANIZATIONR. PROTO
ORGANIZATIONOHO Report
ORGANIZATIONActon Taken
LOCATIONEl Continue
ORGANIZATIONR/S/ETH
ORGANIZATIONCARE1-MENTAL
ORGANIZATIONNYM MED DY ST
ORGANIZATIONSHU Review
ORGANIZATIONCopy - Operation Supervisor
ORGANIZATION