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

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

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