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soner refuses to sign. note that in the signature block. All refusals should be immediately repotted to the Office of Interagency Medical Services. Prisoner Services Division. The completed USM Form 552 is to be retained in the prisoner's files. Section - USMS Prisoner In formation I. Prisoner Nam (Lass First, SD) :t SM
TTIC;N:;, smiko• ; 4 eustatiknoi by die USMS ionise Officer Sections ii AG ill are to be completed by the prisoner. Section may be completed by die USMS Intake Officer if the prisoner is unable • or unwilling, but Section HI must be signed by the prisoner. If prisoner refuses to sign. note that in the signature bl
soner refuses to sign, note that in the signature block. All refusals should be immediately reported to the Office of Interagency Medical Services, Prisoner Services Division. The completed Form USM-552 is to be retained in the prisoner's files. Section I - USMS Prisoner Information I. Prisoner Name (Last, First, MI) Ne
to me while in the custody of the United States Marshals Service, and for infectious disease clearances. Signature of Prisoner Date Signature of USMS Intake Officer Date Original—Prisoner File Copy to District File Copy Upon Transfer Form USM-552 Est. 6/98 SDNY_TN_00020917 EFTA00140914 Repository Inquir
soner refuses to sign, note that in the signature block. All refusals should be immediately reported to the Office of Interagency Medical Services, Prisoner Services Division. The completed Form USM-552 is to be retained in the prisoner's files. Section I - USMS Prisoner Information I. Prisoner Name (Last, First, MI) 11
to me while in the custody of the United States Marshals Service, and for infectious disease clearances. Signature of Prisoner Date Signature of USMS Intake Officer Date Original--Prisoner File Copy to District File Copy Upon Transfer Rem USM-552 Est. 6/98 SONY N1T_00000217 EFTA00140902 Message Detail
Entities connected to both Prisoner Services Division and USMS Intake Officer

Department of Justice
ORGANIZATIONthe Office of Interagency Medical Services
ORGANIZATIONDistrict File
ORGANIZATIONK Correctional
ORGANIZATIONBooking Package
ORGANIZATIONMedical Insurance Information
ORGANIZATIONthe United States Marshals Service
ORGANIZATIONLeon Black
PERSONK SAM
ORGANIZATIONK Separation
ORGANIZATIONNew York State Division of Criminal Justice Services
ORGANIZATION
Michael C.Green
PERSON
NEW YORK NY
LOCATIONAlbany
LOCATION
Julie K. Brown
PERSONFederal Bureau of Investigation - New York
ORGANIZATIONLocation/Facility of Arrest
ORGANIZATIONBROADWAY FBI NY
ORGANIZATIONLong Term Medical Conditions
ORGANIZATIONK Current
ORGANIZATION