USM form 552 is to be retained in the prisoner's files Section I - IBMS Prison( IaforrinatIon I. Prisoner Name (Iasi. Fin'. P11) le t 45 7S/414 Je Fgr 3. Di irks Nam( 4 Oi nal Section II - Prisoner Personal Data Aad Medical Information 6. Oak Of Birth IMosDay/Yrl SI.? 8. Mediesi Insurance