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In the reason for placement Is to be noted m this section. If the reason for placement changes, the inmate must receive a copy of Cis form): Date of Next Review 0740-2019 Rented Name and Senature of aegis° Official or the Reviewing Authoaty and Date Signed. Record Copy • Central Ftie This form replaces B
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
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'
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
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 of Next Review. 07.23.2019 lion Review Official Or the Reviewing Authority and Date Signed. This form replaces BP-295(52) dated January 1988 Page I of 1 7/19/20
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 Next Review and Medical Stall
Special Housing Unit
ORGANIZATIONthe Reviewing Authority
ORGANIZATIONSpecial Housing Review Form
ORGANIZATIONLeon Black
PERSONMedical Staff
ORGANIZATIONFederal Bureau of Prisons
ORGANIZATIONCOMPLETED - CONTINUE PROCESSING
ORGANIZATION
Julie K. Brown
PERSONActon Taken
LOCATIONOHO Report
ORGANIZATIONUNT MGR
ORGANIZATIONCopy - Operation Supervisor
ORGANIZATIONR. PROTO
ORGANIZATIONEl Continue
ORGANIZATIONNYM-NEW YORK MCC
ORGANIZATIONPGM REVIEW
ORGANIZATIONSHU Review
ORGANIZATIONNYM CALLOUTS
PERSONCARE1-MENTAL
ORGANIZATIONNYM MED DY ST
ORGANIZATION