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only. Begin calrics with Ms lumbar I Dad work up. Entries not completed will bo voided DISTRIBUTE: ORIORML-Callsal Tilt mord; COPY4- Inmate After UDC Action; COPY4- Lamm within 24 hours of Part I Prep • NOSOriWdbypS2M PDF yeti. ration. Replaces BegattlkliBlE(W05130f MAY04 EFTA00130119 Suicide Tim

And Time 7/23/2019 1:30 am 14. Incident Report Delivered to Above Inmate By (Type Name/Signature) 15. Date Incident Report Delivered 16. Time Repor 'ncident. Delivered Part II - Committee Action INCIDENT REPORT CDFRM FEDERAL BUREAU F PRISONS 17. Comments of Inmate to Committee Regarding Ab

th the number 1 and work up. Ent es not completed will be voided by staff. Distribute: Onginal-Central File Record; COPY-1-DHO: COPY-2-Inmate after UDC Action; COPY 3-Inmate within 24 hours of Part I Preparation PDF Prescribed by P5270 Replaces BP-A0288 of AUG EFTA00052851 Part III - Investigation 22

And Time 7/23/2019 1:30 am 14. Incident Report Delivered to Above Inmate By (Type Name/Signature) 15. Date Incident Report Delivered 16. Time Repor. ncident Delivered Part II - Committee Action 17. Comments of Inmate to Committee Regarding Above Incident LB. A. It is the finding of the commi

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7/23/2019 1:30 am 14. Incident Report Delivered to Above Inmate By (Type Name/Signature) 15. Date incident Report Delivered 16. Time jncident Repor Delivered INCIDENT REPORT CDFRM FEDERAL BUREAU OF PRISONS Part II - Committee Action 17. Comments of Inmate to Committee Regarding Above Incident