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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
ion HI must be signed by the prisoner. If prisoner 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. Prisone
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
on III must be signed by the prisoner. If prisoner 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. Prison
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
on III must be signed by the prisoner. If prisoner 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. Prison
Entities connected to both USMS Intake Officer and the Office of Interagency Medical Services
Prisoner Services Division
ORGANIZATION
Department of Justice
ORGANIZATIONDistrict File
ORGANIZATIONBooking Package
ORGANIZATIONMedical Insurance Information
ORGANIZATIONK Correctional
ORGANIZATIONLeon Black
PERSONthe United States Marshals Service
ORGANIZATIONFederal Bureau of Investigation - New York
ORGANIZATIONLocation/Facility of Arrest
ORGANIZATIONBROADWAY FBI NY
ORGANIZATIONLong Term Medical Conditions
ORGANIZATIONK Current
ORGANIZATIONK Eligible
ORGANIZATIONK Medical
ORGANIZATIONPrisoner Medical Records Release Form)-
ORGANIZATION
Julie K. Brown
PERSONAlbany
LOCATION
NEW YORK NY
LOCATION
Michael C.Green
PERSON