Name 4. District / 2. USMS Prisoner 5. CustodyDate (Mo/Day/Yr) 1111.0q Seel inn II - Prisoner Personal Data And Medical In formation 6. Date of Birt (M Day/Yr) 7. Social Security No. 8. Medical Insurance Information A) Insurance Company Name B) Policy Number C) Medicare /Medicaid Coverage? El Yes 9.