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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
(2 Or 3 Days) 3 Day Review Action Taken on the Above Date Continue In Special Housing Unit Date Reviewed 07.19.2019 Pelted Name/Signature -St IL RECORD REVIEW. (To be done weekly in U'- absence, beginning after the in.person 7 day review. and continuing every week between each in-person 30 day review.) D
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
or 3 Days) 3 Day Review Acton Taken on ine AbOve Date: Continue In Special Housing Unit Printed Name/Signature: =MEI Date Reviewed 07.19.2019 IL RECORD REVIEW. (To be done weekly in the inmate's absence, beginning after the in.person 7 day review. and continuing every week between each in-person 30 day rev
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
L (2 or 3 Days) 3 Day Review Action Taken on um Above Deb: Continue In Special Housing Unit mead NameisIgnalaret Data Ftedavrad 07-19-2019 IL RECORD REVIEW. (To be done wedge? M the train's abloom% begin:AM° after the N-omen 7 day review. and conertuing every week between each in-person 30 day antaw.)
Entities connected to both Special Housing Unit and IL RECORD REVIEW
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
ORGANIZATIONthe Segregation Review
ORGANIZATIONPGM REVIEW
ORGANIZATIONUNT MGR
ORGANIZATIONActon Taken
LOCATIONR. PROTO
ORGANIZATIONMedical Staff
ORGANIZATIONNYM MED DY ST
ORGANIZATIONCopy - Operation Supervisor
ORGANIZATIONSHU Review
ORGANIZATIONOHO Report
ORGANIZATIONCARE1-MENTAL
ORGANIZATIONEl Continue
ORGANIZATION