IMMIGRATION HEALTH SERVICE CORPS
Immigration Customs Enforcement

Stewart Detention Center

79 Holder Road

Lumpkin, GA 31815

(229)?83 8?1241

 

Report of Detainee Incident Segregation Review

 

Detainee Name: W43 or} 

Alien Number: @023 2?75

 

 

 

The abov?iaineent seen and or the above medical reco1d was evaluated by the USPHS medical staff on
(date) at (hour) (9 for an incident and or pre-segregation review.

 

The medical disposition of the detainee (select one):

I: Cleared for General Housing Unit (as per security)
Placed on Constant Watch (Suicide Precautions)
{B/Cleared for Special Housing Unit

Medical Observation in Short Stay Unit

Medically cleared after Use of Force

Off-site HOSpital

Other:

Comments: qu k0 Li [8-33 it} 

 

Kimbeew 

tint name of the Individual dompleting the Form
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IMMIGATION HEALTH SERVICE CORPS
STEWART CONTRACT DETENTION FACILITY
. 79 HOLDER ROAD LUMPKIN, GA 31815

SEGREGATION LOG

 

DETAINEE NAME: 5 ?Jamel-A Maggi?! 
ALIEN NUMBER: U20 1 L73

CELM COMMENTS ST LS
I #7 NEEDS (NEEDS, BEHAVIOR, REMOVED FROM SEG ET .

YIN
YorN
YorN
YorN
YorN
YorN
YorN
YorN
YorN
YorN
YorN
YorN
YorN
YorN
YorN
YorN
YorN
Yor


orN

YorN
YorN
YorN
YorN

orN
orN

Segregation start date: LI 27 1?1

 

 

 



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NOTE: Remove from Segregation Log book when detainee has been taken out of Segregation.
Place form in Medical Records inbox.



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IMMIGRATION HEALTH SERVICE CORPS

STEWART CONTRACT DETENTION FACILITY
79 HOLDER ROAD LUMPKIN, GA 318k5

SEGREGATION LOG

 

DETAINEE NAME:

ALIEN NUMBER:

EMONT NR


"3?1 WAUJZ. TQM



Segregation start dateMEDICAL COMM ENTS
NEEDS NEEDS, BEHAVIOR. REMOVED FROM SEG ETCUsual! :9 Pic/La 
or Uw?cd 
or 
or 

orN
orN
orN
orN
orN
orN
orN
orN
orN
orN
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orN
orN



NOTE: Remove from Segregation Log book when detainee has been taken out of Segregation.
Place form in Medicai Records inbox.

   



 

Jam'07