EFTA00034392

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fitignariON.020, I NAME: PEG STRATIONef: OBSERVATION STARTED:_ 7 -2 qZL rt OBSERVATION ENDED: ____7 PLEASE RETURN LOG TO PSYCHOLOGY AFTER THE OBSERVATION HAS ENDED. ThANK YOU. ITEIVIS ALLOWED: Regular Clothes Safeh.. Toothbrush Newspaper/Magazine Books isoftcover only) Safety Pen and Paper Toile( Paper ; _--_Legal Mail Other SW Blanket & SW Matti ess . Observations. if nothing is checked with silver marker, only a Suicide Smock and Suicide Blanket are allowed. UUNI- lUtIN I IAL SDNY_00010893 EFTA00034392 Name of Inmate On Suicide Watch or Psych Observation: e . 19a--alli - j Registration #: EATING/SHOWER CHART DATE BREAKFAST LUNCH DINNER /9 8. 31VAI V LIQUIDS OFFERED SHOWER RECEIVED SHOWER C - Please check the appropriate box if the person on Suicide Watch/Psych Observation actually eats his meal. Do not check the box if heiust received it, but did not eat it. Place a check in the "Liquids" box each time the person drinks. Thank you. CONFIDENTIAL SDNY_00010894 EFTA00034393 5 utl___7313 -034 :2- 2.f- zoiq 2.:44/ gqs-v4 11,e p jpozrot 2j7MOSZY 00 ph. Accu ales. 0,erpotocvb1.7L Ps 1 --7'7‘tV-56 1)-Ce 0-4_-___S4eA' Zit/ ej_q -7 —3:1T El° J.Q.,1 5. to (....)(1_J--, E psf • .O.,341. t)opm Ti/111 GpS1- 6.!- L_PS e a.boo_‘ 01.e. 3;45:O, Tz://71 s yon 14,s 6eA loc,03 9,1 ••- p sl-4, _Of p qQCS 4'0 e 11.?,'2