Office of Information Governance and Privacy
U.S. Department of Homeland Security
500 12th St., SW
Washington, D.C. 20536

U.S. Immigration
and Customs
Enforcement

May 5, 2020
Daniel McGrath
American Oversight
1030 15th Street NW, B255
Washington, DC 20005
RE:

American Oversight. v ICE et al., 1:19-cv-01817-RCL
ICE FOIA Case Number 2019-ICLI-00051
Supplemental Production

Dear Mr. McGrath:
This letter is a supplemental response to your Freedom of Information Act (FOIA) request to
U.S. Immigration and Customs Enforcement (ICE), dated February 8, 2019, for all records
pertaining to Jeffry Hernandez Rodriguez aka Roy Alexander Hernandez Rodriguez aka Roxsana
Hernandez and Mergensana Amar.
ICE has considered your request under both the FOIA, 5 U.S.C. ? 552.
For this production, ICE reviewed 101 pages of potentially responsive records. Of those 101
pages, ICE determined that 19 pages were nonresponsive or duplicative and 181 pages were
responsive. This production consists of 82 pages. These documents have been Bates numbered
2019-ICLI-00051 1701 through 2019-ICLI-00051 1782.
Please note, the remaining responsive pages have been referred to other agencies and/or
components for direct response to you.
ICE has applied Exemption 5 to protect from disclosure intra-agency documents that contain the
recommendations, opinions, and conclusions of agency employees. The disclosure of these
communications would discourage the expression of candid opinions and inhibit the free and
frank exchange of information and opinions among agency personnel on important agency
decision-making by having a chilling effect on the agency's deliberative process.
FOIA Exemption 5 protects from disclosure those inter- or intra-agency documents that are
normally privileged in the civil discovery context. The three most frequently invoked privileges
are the deliberative process privilege, the attorney work-product privilege, and the attorney-client
privilege. After carefully reviewing the responsive documents, I have determined that portions
www.ice.gov

VERSIGHT



ICE FOIA Number 2019-ICLI-00051

Page 2 of 3

of the responsive documents qualify for protection under the deliberative process privilege, the
attorney-client privilege, and the attorney work-product privilege. The deliberative process
privilege protects the integrity of the deliberative or decision-making processes within the
agency by exempting from mandatory disclosure opinions, conclusions, and recommendations
included within inter-agency or intra-agency memoranda or letters. The release of this internal
information would discourage the expression of candid opinions and inhibit the free and frank
exchange of information among agency personnel. The attorney work-product privilege protects
documents and other memoranda prepared by an attorney in contemplation of litigation. The
attorney-client privilege protects confidential communications between an attorney and his client
relating to a legal matter for which the client has sought professional advice. It applies to facts
divulged by a client to his attorney, and encompasses any opinions given by an attorney to his
client based upon, and thus reflecting, those facts, as well as communications between attorneys
that reflect client-supplied information. The attorney-client privilege is not limited to the context
of litigation.
ICE has applied FOIA Exemptions 6 and 7(C) to protect from disclosure the names, e-mail
addresses, and phone numbers of DHS employees contained within the documents.
FOIA Exemption 6 exempts from disclosure personnel or medical files and similar files the
release of which would cause a clearly unwarranted invasion of personal privacy. This requires a
balancing of the public's right to disclosure against the individual's right to privacy. The privacy
interests of the individuals in the records you have requested outweigh any minimal public
interest in disclosure of the information. Any private interest you may have in that information
does not factor into the aforementioned balancing test.
FOIA Exemption 7(C) protects records or information compiled for law enforcement purposes
that could reasonably be expected to constitute an unwarranted invasion of personal privacy.
This exemption takes particular note of the strong interests of individuals, whether they are
suspects, witnesses, or investigators, in not being unwarrantably associated with alleged criminal
activity. That interest extends to persons who are not only the subjects of the investigation, but
those who may have their privacy invaded by having their identities and information about them
revealed in connection with an investigation. Based upon the traditional recognition of strong
privacy interest in law enforcement records, categorical withholding of information that
identifies third parties in law enforcement records is ordinarily appropriate. As such, I have
determined that the privacy interest in the identities of individuals in the records you have
requested clearly outweigh any minimal public interest in disclosure of the information. Please
note that any private interest you may have in that information does not factor into this
determination.
ICE has applied FOIA Exemption 7(E) to protect from disclosure internal agency case numbers
contained within the document.
FOIA Exemption 7(E) protects records compiled for law enforcement purposes, the release of
which would disclose techniques and/or procedures for law enforcement investigations or
prosecutions, or would disclose guidelines for law enforcement investigations or prosecutions if
such disclosure could reasonably be expected to risk circumvention of the law. I have

AMERICAN

PVERSIGHT



ICE FOIA Number 2019-ICLI-00051

Page 3 of 3

determined that disclosure of certain law enforcement sensitive information contained within the
responsive records could reasonably be expected to risk circumvention of the law. Additionally,
the techniques and procedures at issue are not well known to the public.
If you have you any questions about this matter, please contact Assistant U.S. Attorney Benton
Peterson at Benton.Peterson@usdoj.gov or 202-252-2534.
Sincerely,

Fernando Pineiro Jr.
Acting FOIA Officer

Enclosure(s): 82 page(s)
cc:
Benton Peterson
Assistant U.S. Attorney
CWA Building 501 3rd Street, NW
Washington DC 20001

PVERSIGHT



U.S. Customs and
Border Protection
720 E. San Ysidro Blvd.
San Ysidro, CA 92173

DATE: 05/11/2018
Mobile Medical Group, Inc.
,h,,.:::
,- I
5030 Camino de la Siest:11
San Diego, CA 92108
Phone (619) 260-6300

"-l
(b..:..a
)(--'
6)-'-'
; (--'
b)-'(7..:..a
)(--'
C)'---------'I
PHYSICIAN ASSIST ANT
LIC# b)(6); (b)(?)(C)

PA-C

D

!<b)(6): ( b )(7)(C)
CA UC b)(6);
DEA b)(6):

l

l(b)(6); (b)(?)(C)
PA-C
PHYSICIAN ASSISTANT
LIC# b)(6); (b)(?)(C)

DEA~---~

IM.D.

DETAINEE INFORMATION:

LAST NAME: HERNANDEZ RODRIGU~
FIRST NAME: ROY ALEXANDER
DOB: 02/18/1985
A# 206418141
..,....PATIENT IS MEOICALL Y CLEARED FOR TRANSPORT AND INCARCERATION.....,..

SIGNED: _______________________

_

AME CAN

pVERSIGHT

DHS-ICE-19-0196, 19-0197-G-000001
2019 -ICLl-00051 1701



..

' .

Deta~nee Assessment

U.S. Customs and
Border Protection
Assessment for Transport, Escort, and Detent ion
Detainee Information

. ..

Date of Assessment: 05 /11/2018
Gender: M
Age: 33
Weight: 160 lbs

A Number (if any): 20641 814 1
Name: HERNANDEZ RODRIGUEZ ' ROY ALEXANDER
Date of Birth: 02/18/1985
Height: 68 inches

Guidelines

. .

Complete this assessment for all deta inees in CBP custody, including U.S. Citizens, to evaluate each detainee's
safety, whether they may be considered an at-risk deta inee or at risk of posing a thre at to others, known or
reported medical or mental health issues and level of risk to themselves, other detainees, and staff based on the
information available at the time of the assessment. Assessments of an individual may change.
Any newly available information that could effect this assessment must be recorded herein .

., o .. o v .o

Does the detainee appear to have or have they identified as
having a mental, physical, or developmental disability?
Has the detainee self-identified as gay, lesbian, bisexual,
ransgender, intersex , or gender nonconforming?

?

l2Sl

I&)

?

Has the deta inee self-identified as having previously
experienced sexual victimization?

?

~

'\

Has the detainee stated concerns about his or her safety?

(8)

TRAN~G-ENDER

~rf.s~~r
,

?

Does the detainee appear to have physical or psycholog ical
medica l needs?
re there indications that the detainee requires, or have they
indicat ed they are on medication?
Does the detainee appear to be under the in fluence of an illicit
ubstance?

D

::: '

:,.,.

?

I&)

?

I&)

Is the detainee pregnant or nursing?

?

181

Is the detainee able bodied?

l2Sl ?

Is the detainee blind, deaf, or mute?

?

...
... .
~

. : ...

~

igJ

ot..t;,:.;::
,~
t!\ o"'! ,

,1 .

Page 1 of

2'

..; . o

... ..

(08/2 6/2016 )

AMcRI

PVERSIGHT

.'

DHS-ICE-19-0196, 19-0197-G-000002
2019-ICLl-00051 1702



Has the detainee been previously incarcerated or detained?

D

[8]

Does the detainee have any prior history for sex offenses?

D

18!

Does the detainee have any prior history of violent offenses?

D

~

Does the detainee have any signs of gang affiliation?

D

IBl

...
o I

Evaluating the totality of the circumstances, is this detainee
at a high risk for sexual abuse?

D

~

Evaluating the totality of the circumstances, is this detainee
at a hlgh risk of belng abusive to others?

D

~

D
D

Prosecution
Notice To Appear

(gj

Expedited Removal

D
D

ithdrawal of application
Isa Waiver Program Refusal/Removal

o io

!Bl
~

D
IBl

~I

ER/CF

~

Other Removal Proceedings
(e .. Reinstatement, Landing revocation, GMR, etc.)

D

IE)

Outstanding Warrant/Extradition

D

~

Unknown at time of assessment

D

IE)

Notes :

(b )(6);
?)(C)

l...----------------------1(b)(

l l f;)

(b)(6);
(b)(?)(C)

Date/Time

Page 2 of 2
(08/26/2016)

AMcHI

pVERSIGHT

DHS-ICE-19-0196, 19-0197-G-000003
2019-ICLl-0005 1 1703



-..:.'(:
~

.

I'-,

DEPA. MENT OF HOMELAND SECURITY
U.S. Customs and Border Protection

.

Discretionary Authortty Checklist for Allen Applicants
Appllcant's Name: ROY ALEXANDER HERNANDEZ RODRIGUEZ
Date of Birth:

02/18/1985

Citizenship:

HONDURAS

!fb1,(7){E)

I

~ kb)(6);

Port:

SAN YSIDRO, CA

Date of Action:

05/09/2018

Passport/ A#:

1) Identity I Citizenship:

/ 206418141

2) Age, Health and Notoriety of Applicant:

Identity sufficiently detem,ined:

YesOONoD
Yes [!]No ?

Citizenship sufficiently determined:

Are age or health relevant factors?

YesDNo~

Is the applicant e public figure?
Congrssslonal or media Interest?

Yes ? Nol!l
Yss ? No[!]

:! .'

ooNOTH: Discretiona:ry
established.

should

authority

generally

not

be exercised

if

identity

or citirenship

can not be

REMARKS (to Include onaln desUnatfon and Intended lenath of stavl:
FROM HONDURAS TO U.S. FOR AN INDEFINTE STAY

4) Database

3) Intended Purpose of Entry:

quertqs,:r ._
:..

Medical:
Pleasure:
Business/Official:
Other:

,

o t

(b)( 6); Subject Qu~ry):.

Yes ? Nol!l
YesDNoOO
Yes ? Nol!l
YesDNol!l
YesOONoD

Emergency:

(b )(7 ,(Match to subject):
)(E) ?(b )(6);

I

fb)(7)(E)

I ,"..

I

l(b)(7)( Super query);..:
... NOTE: In the
1nadm1ssibil.1ty.

remarks section
belolf,
indicate
The auer.1.ea listed
in number

REMARKS (to Include

l(b)( 6);

Kb
)(7)( E)

j l(b)( 6); (b)( 7")(C);

the

speciEic

4 represent

vlolat.1on (s'J.or .g'rounds for
the mininazm queries
that 8hould

I If aoollcable~

POSl!lNEG ?
POS ? NEGlil
POSl!lNEG ?

POS ? NEGl!l
POSl!lNEG ?
POSl!lNEG ?

be conducted.

.

I

5) Previous lmmlgraUon VlolatJons or lnadmlsslblllty:

6) Nature of lnadmlsslblllty:
-,

PreviousImmigration Violation(s):
PreviousInadmissibility:
PreviousBeneficiaryof DlscreUon:

Yesl!lNoD
YesOONoD
Yes D No l!l

;

Minor/ Technical : ..:
Criminal:
;r, .-:..:.
National / Homeland Security

Yesl!lNoD
YesDNol!l
YesONol!l

REMARKS:
PreviousImmigration Violations or Inadmissibility: ER'D FOR 5 YEARS ON 01/2:)/2014 HOUSTON

AML--{CAN

pVERSIGHT

LAW ENFORCEMENT SENSITIVE-FOR OFFICIAL USE ONLY

(Last Updated 05/08)
DHS-ICE-19-0196, 19-0197-G-000004

2019-ICLl-00051-1704

:i' ...



7) Thr eat posed to the Unit ed States:
b)(7)(E)

**NOTE : Discretio
na ry au thority
t h e Un ited
S t ate s.
REMARKS :

should

generally

not

if

be exercised

a thr e a t i s po s e d to

I

Likely to Add to Illegal Population

8) Other Factors to Consider:

Yes ? No!El
YesONo@
YesONo@
YesONo@

Legitimate reason for entering the United States :
Documentary (Passport / Visa) deficiency only:
Credible claim of official misinformation :
Relationship to a U.S. employer or resident:
Intent to circumvent admiss ibility requirements :
Misrepresentations made during processing :
Minor children accompanying or already in the United States:
Unaware of visa voidance or consequences of VWP overstay:
Relief available through the parole or wa iver process :

Yes ? No!EI
Yes ? No!El
Yes O No@
Yes O No!EJ
YesONo!El

REMARKS .
212 (a) (7) (A) (i) (I) of the Immigration and Nationality Act, a

Examining CBP Officer :

(b )(6);
l(b)(6); (b)(7)(C) I CBP OFFICER (b)(7)(C)

Applicable Ground(s) of Inadmissibility :

I 212 la) (7)

Applicable Discretionary Action(s):
Withdrawal of Application for Adm ission:
Parole to Depart Foreign / Voluntary
Return:
Humanitarian Parole:
Waiver of Passport Requirement:
Waiver of Non-Immigrant Visa
Requirement:
Classification :
Waiver of Immigrant Visa Requirement:
Waiver of processing fee (if applicable):
Deferred Inspection:

Ar-?.l~

CAN

pVERSIGHT

(A) (i)

m of the lmmior:
:-.:.-.

Yes O NolBI
Yes O NolBI

Yes ? NolBI
Yes ? NolBI
Yes ? NolEJ

YesO NolBI
Yes O NolBI
Yes O No lBI

alitv Act a

J
oI

Length of parole s~ught:

days

Length of parole sought:
Period of admission sought:

days
days

Period of admission sought:

days

Deferral Period and Location: __

LAW ENFORCEMENT SENSIT IVE-FOR OFFICIAL USE ONLY

days ,

(Last Updated 05/08)
DHS-ICE-19-0196, 19-0197-G-000005

2019-ICLl-00051 1705
>

I
.,,



(b)(6); (b)(7)(C)
Superv iso ry CBP Offi ce r:

(b)( 6);
/ L \/

"'7 \/

SCBPO .
,-.. ,

Reco mm end atio n:
Approve [El Disapprove D
Ju st ifi cat ion for reco mm endati o n (to include alte rnatives if dl saoor ova l is recom mende d:
212 (a) (7) (A) (i) (I) of the Immigration and Nationality Act, a

..

Reviewi ng 2nd Line Manager (GS13 o r Above) :

I i (b)(6): (b)(7)(C)

.. (b)(6);
(b)(7)(C)

~ Branch Chief

Deci sio n:
Approved [El Disapproved D
Ju stifica ti o n fo r decisio n {t o Inclu de fi nal dis pos ition if disaooroved ):
212 (a) (7) (A) (i) (I) of the Immigration and Nationality Act , a

:o .o:1..,

AMc {ICAN

PVERSIGHT

LAW ENFORCEMENT SENSITIVE-FOR OFFICIAL USE ONLY

(Last Updated 05/08)
DHS-ICE-19-0196, 19-0197-G-000006

2019-ICLl-00051 1706



Record of Sworn t,tatement in Proceedings
under Section 235(b)(1) of the Act

U.S. Departm ent ofHomdnnd Srcurity

Office: SAN YSIDRO,

l<b)(?)<Eb

~(h \ (R\.

C:ilcNo:
0 6 18 141
Event Number :,,. o ,_,

CA, POE

Statement by: HERNANDEZ RODRIGUEZ,

ROY ALEXANDER

In the case of: ROY ALEXANDER HERNANDEZ RODRIGUEZ
Dute ofHirth: 02/18/1985
At: SAN YSIDRO,

Gender (circle on

CA (SYS)

Bcforc:](b )(6); (b )(7)( C)

~~C )~~~~~ f--- --;a-;-...,.,...,;-:------=

I

In the SPANISH

Date: May 11,

o

GBP'emale

2 018

CB
=P--=OF=-=Fc..=I
=CE
=R"----------

--

(NarncandTotlc)

lm1fiagc. lnterprctcrl.._
(b--')..,_
(6....)"-;_ .,________

Employed by..:D
:.:H
:::..:
S::..;
/c_C
=:B=-P=--- ----

I nm nn oflicer of the United Stales Department of Homeland Sceuriiy. I am authorized to administer the immigrnt ion
laws und to take sworn statements. l wunt to take ynur sworn statement regarding your application for admission to the
United Stutes. Before 1 take your stntcment, I also wont to explain your rights. and the pu.rpose and consequences or this
interview.
' l .
You do not appear 10 be admissible or to hove the required legal papers authorizing your admission to the United Stntes.
This muy result in yllur being denied nclmission :ind immediately returned 10 your home country without o henring. )fa
decision is made to refuse your admission into the Uni1ed States. you mny be imrnedintely removed from this country, und if
so, you may be bnrrcd from reentry for u period of 5 years or longer.
This mny be your only opportunity to present information 10 me nnd the Dcpnrtrncnt of Homeland Security to mnkc a
decision. It is very important that you tell me the truth. If you lie or give misinformntion, you mny be subject to criminnl or
civil penalties. or barred from receiving immigrotion benefits or relief now or in the future.
Exccpl ns I will explain to you, you arc not entitled to a hearing or review.
U.S. law provides protection to certnin persons who foce persecution. hann or torture upon return to their home country.
If you fcnr or hove II concern about being removed from the United SUltesor nhout being sent home. you should tell me
so during this interview bccuust: you may not hnvc another chnnce. You will hnve the.oppnrtunity to speak privately
and confidentinlly to another officer nbout your fcnr or concern. That officer will determine ii' you should remain in the
United States and not be removed bconusc of that fonr.
Until a decision is rcnchcd in your case, you will remain in the custody of the Department of Homeland Security.
Any stntcmcnt you mnkc may be used against you in this or nny wbscqut:n l adminislmtivc p~occecling.
Q:

A:

Q:

Do you understand
Yes.

A:

Do you have
No .

Q:
A:

Are you willing
Yes.

Q: Do you s wear
complete?
A:
Yes.
Q;

A:
Q:

A:

what

I have

said

to you?

any questions?
to answer
or affirm

my questio

th at

all

n s at

sta t ements

this

time?

you are

about

to make are

true

and

What is your true and correct
name?
Roy Alexand er HERNANDEZRodriguez
What is your da te of birth?
The 18th oE rebruary
198 5 .

. . . (CONTINUED ON I - 831)

Pa ge I of_S_

AMr ~ICAN

pVERSIGHT

1-8(,7 A (08/0 I /07)

d

DHS-ICE-19-0196, 19-0197-G-000007
2019-ICLl-00051 1707



Co ntinuat ion Page for For-n1_ I_._8_6
_7_A
__

U.S. Depa rtment of Homeland Secur ity

Alien's Name
HERNANDEZ
Q:

A:
Q:

A:
Q:
A:

Q:
A:

Q:

File Number A206 418 141
ROY ALEXANDER kb)(7)( E)
(b)(6);
Event No: k'b)(R):(hV 7V ( l:

RODRIGUEZ,

Have you ever used any other
name or date
Yes, Roxana Elizabeth
HERNANDEZ Rodriguez.
What city,
Comaygua,

state
and country
Honduras .

Of what country
Honduras.

are

Of what country
Honduras.

is

A:

What city,
state
Honduras .

Q:
A:

Of what country
Honduras.

you

is

you

born

_

Date
May 11,

2018

birth?

in?

a citizen?

your

and

were

of

__

mother

country

your

a citizen?
was

father

your

mother

born

in?

a citizen?

,,

A:

Q:

What city,
Honduras

Q:
A:

Where do your parents
My parents
are dead.

Q:

Where else
do you
I have my s i sters

A:

Q:
A:

Q:
A:

Q:
A:

Q:
A:

stat

e and

country

hav e fam i ly living
in Honduras
.

When did you leave
I left
Comayagua,

have

y our home?
Honduras
in

residency

When did you le a ve your
I left
in April
2018.

in

any

in

home

in

I

Why did you leave
your home
(CONTINUED ON NEXT PAGE)

April

other

How we re you able
to leave
and
A:
I left
by car from Honduras
to
Once in Mexico we traveled
by bus
While
in Tapachula
F I heard
about
United
States fo }GBPZ)( )
by train
and bus until
we arrived

...

fath e r bo r n in?

Honduras?

Honduras

Q:

Q:

your

live?

Where do you live?
I am l i ving in Comayagua,

Do you
No.

was

in

2018.

country?

Honduras?

where did you travel?
Guatemala.
In Guatemala,
we crossed
a river
into Mexico.
to Tap a chula,
Chiapas
where we stayed
for five
days.
W
a caravan
of immigrants
who were going
to travel
to the
I left
Tapachula,
Chiapas
with
the caravan.
We traveled
to Tijuana
.
Honduras?

o
Signature

b)(6); (b)(7)(C)

ITitle
CBP OFFICER

2
_ __

V
f Qllll 1-83 1 Cq ntinu atinn Page (Rev. 0ll/0 1/0 7)

pVERSIGHT

L00
05~

of _ _ 5_ _ Pages

DHS-ICE-19-0196, 19-0197-G-000008



Conti nuation Page for Form

U.S. Department of Homeland Securi ty
Alien's Name
HERNANDEZ RODRIGUEZ,

File Number A206 418 141 ., Date
May 11,
ROY ALEXANDER l<b)(7)( E)
Event No : 1,,_""''. ,,_,,"7
, ,r-,.

I

tried

I left
because
to k ill
me

Q:
A:

When did you
April
2018.

Q:
A:

Where have you been
We have been staying

Q:
A:

On what day d i d you attempt
Yesterday
(05/10/2018).

Q:
A:

How did you attempt
to enter
the
From the shelter
we came here.

Q:
A:

What documents
My identification

A:

Q:
A:

What did
Kb)(7)( E)

I

my life
was
was afraid

arrive

you

did

staying
since
at House of

state

United

St ates?

and

United

United

States?

States?
when you

when you

en~~:fd

applied

for

the

admission?

to

the

primary

officer

l(b)(7)( E)
'---------~-

that

lor did

someone

I

Do you know kb)( 7)( E)
I means to ask for li eip

Q:

Were you
No.

you

ana

any

told

one

I

protection.

I

to l(b )(7)( E)

told

Did you pay
No.
were
No.

the

officer

Q:
A:

A:

enter

primary

No,

Q:

raped

to Tijuana?

the

ilbH Zl, El

Q:

to

arriving
immigration.

to the officer
Mexico .

Q:

A:

of Maras

Tijuana?

A:

A:

2018

j

A:

speak

by the Maras gang.
A group
and I left
Honduras.

you present
papers
from

tell

Did you specifically
on your behalf?
I asked .

Q:

to

threatened
for my life

I- 8 67 A

for

any

on how you

had

reason?
to answer

the

questions

you

w~r ,e asked?

(b)(7)( E)

Q:
A:

...

Do you
No .

ask

for

help

in

Honduras?

(CONTINUED ON NEXT PAGE}
Till e

Signature

b)(6); (b)(7)(C)

CBP Ol!'FICRR

3
_ __

of _ _ 5 _

Pages

Forni 1.831 Continuntion Page (Rev. 08/0 l /07)

PVERSIGHT

DHS-ICE-19-0196, 19-0197-G-000009
2019-ICLl -00051 1709



Continuation Page for Form _I_-_ 8_ 6_ 7_A_ _____ __ _

U.S. Department of Home land Secur ity

Alien's Name
HERNANDEZ

File Number A206 418 141

Date
May 11,

ROY ALEXANDER Kb)(7)( E)
lth \fl'l\.
I
Event No: l(b)(6); (b)( 7)(C);

RODRIGUEZ,

2018

(b )(7)( E)

I
Q:
A:

Where was your destination
in the United
i(b)(6): (b)(7)( C)
To be with my brother

States?

Q:
A:

Do you have the phone number
No, I have a phone number.

for

Q: Do you
States?
A : No.

or

have

Q : Do you
Immigration
A:
No.

have any
Service?

you

ever

and address

had

legal

applications

entry

documents

or petitions

pending

Have you ever lived
Yes, 2 years
illegally

Q:

Have you ever been arrested
in
Yes, 3 to 4 times by the Dallas

Q:
A:

Dallas,

point
to

Texas.

of

contact

enter

with

or

United

in

the

United

reside

in

the

States

Citizenship

States?

United

and

...

Q:
A:
A:

the

Iin

Have you ever been
Yes, two times.

in

the United
in Dallas,

removed

or

States
Texas.

before?

the United
Police.
deported

States

from

the

or

any

United

other
States

country?
before?

b)(7)(E)

Q:
A:

If tr avelling
in a group,
where
I joined
a caravan
of Hondurans

Q:
the

How did
caravan?

~~at::

you

join

RGn1~%)Tapa chula

Q: Did you pay
you pay?
A:
No.

cara v an,

the
I

a smuggler

heard

I

did you meet
in Tapachula,
how did

from

during

Q:
Did you seek legal
representation
entering
the Port of entry?
A:
No .
.. . {CONTINUED ON NEXT PAGE)

you

a friend

your

know about
about

up?
'.~ .
the

a caravan

travel

into

the

( talked

to

a lawyer

United

or

caravan
that

was

States

lawyer

and where
going
and

if

to

did

you meet

the

United

so bow much did

representative)

before

ITitle

b)(6) ; (b)( 7)(C)

Signature

or group
Chiapas.

CBP OPPICER

f
-

4
_ __

of ___ 5 _ Pages

fo rm 1-831 Continuation Page (Rev. 08/01/07 )

I

pVERSIGHT

DHS-ICE-19-0196, 19-0197-G-000010
2019-ICLl-00051 1710



Continuation Page for Form _ r_-_8_6_7_A___

U.S. Department of nomeland Security
Alien 's Name
HERNANDEZ RODRIGUEZ,

Q:
A:

Q:
A:

File Number A206 418 141
Date
ROY ALEXANDER ilth\/~\. /h\/ 7 \/r.\. /h\/7\/ ~\
I.
May 11,
Event No: l(b)(6): (b)(7)(C): I

Have you made payments
No.
Were you
No.

advised

by

to

a lawyer

or

a lawyer/lawyer

future

payments

representative

to

for

lawyer(s)?

seek

asylwn

_ _

2018

in the

United

States?

(b)(7)(E)

Q:

Do you

A:

No.

have

any questions

Signature

or

is

there

anything

else

you would

like

to

add?

Title

b)(6); (b)(7)( C)

CBP OFFICBR

I

F rm 1-831 Con\i111101
ion Page (Rev. 08/01/07)

PVERSIGHT

~

4~
2019-ICLl-00051 1711

r

LJ t/2
- s__of _

_

s_ Pages

DHS-ICE-19-0196, 19-0197-G-000011



Jurat for Record of Sworn Statementin
Proceedingsunder Section 235(b)(l) of the Act

U.S. Department orl-lomtland Security

r)(

l{b)(7)(E)

Q: Why did yo u leave yo ur home co untr y or countr y of Inst re5idcncc?
,1

7)( E)

b)(7)( E)

Q. Do you hove any questions or is there anything else yo u wou ld like to add?
A . NO

r

:

o\1

I hove rend (or hnve had read 10 me) this statement, consisting or&ges
(inc luding this page) .
state thllt my answers arc true and correct to the best of my knowledge and that this statement is a full,
true and correct reco rd of my intcrrogn tion on the date indicated by the above n11mcdofficer of the
Depnrlmcnt of I lomclnnd Sccu rity." ljhnve initinlcd cnch pngc of this stntcmen l (nnd the
correc tions noted on pagc(s)

VL ),

Signature:._)<J....;.._
_ ~..,_..,,~
......._'/"'---

ROY ALE~E;

-

--

--

-

HERNANDEZRODRIGUEZ

Sworn and subscr ib ed to befo re me al SAN YSIDRO PORT OF ENTRY
on May 11, 2018

(b)(6); (b)(7)(C)

b)(6); (b)(7)(C)
CBP OFFICER
Witn essed by ~
: =======:;.;::;:=

(b )(6);
(b)(7)(C)

:::;:;;====

==

= :::!....- --

-

-

-

--=--

--

-

C P OFFICER

'' .

AMl:::

Pnge ~

1-8670 (08/0 lifJ7)

of_l _

pVERSIGHT

DHS-ICE-19-0196, 19-0197-G-000012
2019-ICLl-00051 1712



Notice and Orde r of Expedited Removal

U .S. Departm ent uf Home land Security

DETERMINATION OF TNADMJSSIBILTTY
Event

Number

File No:

: !fhV ~ \. fh\f7Vr'\.

A206

Date: May

418
11,

141
2010

In the Matter of: ROY ALEXANDER HERNANDEZ RODRIGUEZ
Pursuant to section 235(6)( I) of the Immigration and Nationality Act (Act), (8 U.S.C. 1225(6)( I)), the
Department of Homeland Security has determined that you are inadmissible to the United Slates under
section(s) 2 I2(u) D (6)(C)(i); D (6)(C)(ii); Jll (7)(A)(i)(l); D (7)(A)(i)(l(); D (7)(B)(i)(l): and/or D (7)(B)(i)(II)
of the Act, as amended, and therefore are subject to removal, in that:
1) You are

not

a citizen

2) You are

a native

or

national

of Honduras

3) On or about May 9, 2018,
Mexico at the San Ysidro,

of

citizen

the

You are an immigrant
not in possession
pennit,
border
crossing
card,
or other
Immigration
and Nationality
Act .

...

(CONTINUED ON I - 831)

States.

of Hondura~.

yo u applied
for
Port of Entry.

4)

United

admission

into

the
1

United

States

from

o

of a valid
unexpired
valid
entry
document

immigrant
visa,
reentry
as required
by the

b)(6); (b)(?)(C)
!(b)(6): (b)(7)(C) !
CBP OFFICER

1ccr

Nome nnd title ofimmigrution onicw (Print)

ORDER OF REMOVAL
UNDER SECT ION 235(b)(l) OF THE ACT

Based upon the determination set forth above and evidence presented duri~1g)nspectionor examination pursuant
to section 235 of the Act, and by the authority contained in section 235(b)( l) of the Act, you are found to be
inadmissible as charged and ordered removed from the United States.

Signatureof immigrationoniccr

Name nnd title of immigrationoniccr (Print)

Nnmcand 1i1lcofsupcrv,~or(l'rinl)

Signature of supervisor, ifnvuilablc

D Check here if supervisory concurrence was obtained by telephone or other q1eans (no supervisor on duty).
CERT lFICATE OF SERVICE

I personally served the original of this notice upon the above-named person. on _ _ __

______

_

(Dale)

Signmurcof immigrntion officer

A

,AI\J

pVERSIGHT

Form 1-860(Rev. 08/01/07)

DHS-ICE-19-0196, 19-0197-G-000013
2019-ICLl-0005 1 1713



 ?50?th

19-0197-G-000014
2019-ICLI-00051 1714



Contin uation Page for Form _ I_-_8_6_0__

U.S. Department of Homeland Security

File Number A206

Alien's Name

ROY ALEXANDER HERNANDEZ RODRIGUEZ

!rh\/f\\.

Event

418

141

/h\/ 7 \/ (' \. /h\/ 7 \/ ~ \

No:

1/h\/f\\.

!

__

_

Date
May 11,

2018

/h\/7\/('\.

ON THE BASIS OF THE FOREGOING, IT IS CHARGED THAT YOU ARE SUBJECT TO REMOVAL FROM THE UNITED
STATES PURSUANT TO THE FOLLOWING PROVISION(S ) OF LAW:
'

===============================================-===========================--------=
-------212(a) (7) (A) (i) (I) of the Immigration
and Nationality
Act (Act),
as
who , at the time of application
for admission,
is not in possession
immigrant
visa,
reentry
permit,
border
crossing
card,
or other
valid
by the Act,
and a valid
unexpired
passport,
or other
suitable
travel
of identity
and nationality
as required
under
the regulations
.issued
under
sect i on 211(a)
of the Act.

Signature

,
(b)(6); (b)(7)(C)

amended,
as an immigrant
of a valid
unexpired
entry
document
required
document,
or document
by the Attorney
General

I

Title
CBP OFFICER

I

___2

of __ 2 _

Pages

rorm 1-831 Continuation Page (Rev. 08/01/07)

pVERSIGHT

DHS-ICE-19-0196, 19-0197-G-000015
2019-ICLl-00051 1715



Page 1716
Withhe ld pursuant to exe mption
(b )(7 )(E )

of t he Freedom of Informat ion and Privacy Act

Ar-?.l~

CAN

pVERSIGHT

DHS-ICE-19-0196, 19-0197-G-000016



Page1717
Withheld pursuant to exemption
(b )(7)(E)
of the Freedom of Informat ion and Privacy Act

AML--{CAN

pVERSIGHT

DHS-ICE-19-0196, 19-0197-G-000017



o Non Profit Organization
o o Referral Service

List of Pro Bono LegalService Providers

.o o Private Attorney

http://www.just ice.gov/ eoi r/list-p ro-bo no-legal-service-prov iders

I I

Updated April 2018

I

CALIFORNIA

I acknowledge
receiptof thisnotmcatlon--41--4--~----(AJlen's
Signature)

AMER

Disclaimer,
As required by 8 C.F.R. ? 1003. 61, tho Executive Offi ce for Im migration Review (EOIR), Office of t he Director, Office of
Lego! Access Programs , maintains u 11st of organizatio ns nnd attorneys qualified under the regulati ons who provide pro bono or free
lega l servi ces. Tho i nformation posted 011 this list is provided to EOIR by th e Providers. EOlR docs not ondorso any of t hose orgnniza
tions or attorneys. Additionally, EOIR does not participate in, nor is it responsible for, the representation
dooisions or performa nce of
these organiza ti o ns or attorneys.

pVERSIGHT

DHS-ICE-19-0196, 19-0197-G-000018
2019-ICLl-00051 1718

\



~
o Non Prom O'lilnlutlon
o o ReferrilI Service
ooo PrlvioteAnom~

List of Pro Bono Legal Service Providers
http://www.justice.gov/

Updated April 2018

eolr/Jist-pro-bo no-lega I-service-providers

Adelanto Immigration Court
EsperanzaImmigrant RightsProjecto

El Rescateo

Catholic Charities of Los Angeles
1530 James M Wood Blvd
Los Angeles, CA 90015
Tel: {213) 251-3505

1501 West 8th St. Suite 100
Los Angeles, CA 90017
Tel: (213) 387-3284

Fa,c:(213) 487-0986
www .espera nza-la.or11

o Bond hearings
o Removal proceedjngs'
o ICE paroled request
Human RightsFirst..

o Mon-Fri 8:30am-5:30pm
o Serving counties of Los Angeles, Orange, Riverside, .
San Bernardino, Ventura, Kern, & Santa Barbara
o Assist In various forms of immigration rellef, victims

333 South Hope Stfeet,dl2nd Floor

Los Angeles, CA 90071
Tel: (213) 294-2648
Laprobono@hu man rlghtsfl rst.org
of crime
o Reduced fee, nomlnal fee, or pro bono depending on www.humanrightsfirst.org
need and grant avallablllty
o Represents Indigent indlylduals seekingasylum.
o Languages: Spanish or interpeter services
..
:)i. ~ol P
o . .
o Asylum applicants should call and leave a message.
I
,J
., , .
No w~lk~ins.
1
o Represents detained and non-detained Individuals
before the Los Angeles and Adelanto Immigration
Angeles Asylum Office.
courts, as well as th.e
o Languages: Spanish, others as needed .

~cs

o-_r. -

-~! : \ ,. ~
~ o , '. I

~

.-t1r,

,.

or

,.,, nquind by 8 C.F.JL !I IQO;J,61, tbo E.x"""tl" Ofllco for lmm.lsru,tloo Jlmow (EOUt), omoeof tho Dlrocb>r, Office
11ad 11ttome711q11111lliedundor tho' ro11,ulaUons who provldo pro boao or free
LoQal Acoll4HIIIProgl"IIms mtalatalna II Ult of o~nlution1
nnrlc.e11.The lnfoma ?tion pom,,d on tbl ? Ila: Is provldtd to EOIJl by the Prvvldon. EOIR dots not endorse any ortheu orsa11la1"6111
tlons or 11ftome711.Addltlon? lly, 1:0IR don not parUclpate In, nor Is It reapo11slbla for, the repro's,entation declslons or parfor1111IIC4I of
.
thasa 011111nlmtions or attDme)"ll.
Dl1dalmpr1

AMf-~

o'

PVERSIGHT

DHS-ICE-19-0196, 19-0197-G-000019
2019-ICLl-00051 . 1719



19\
o Non Profl t Orsanlzatlon

... Prtwte AnO('T\ey

List of Pro Bono LegalService Prqviders
http://www.justice

Updated April 2018

,gov/eolr/I lst-pro-bono-lega 1-service-provid ers

Imperial Immigration Court

1501 West 8th St. Suite 100
Los Angeles, CA 90017
(213) 387-3284
o Bond hearings
o Removal proceedings
o ICE paroled request

omco rorl..isnlgaUon B.mow (EOIR), Office orthu Dinldx>r,Offlc,u of
Aa ruqulnod by 8 C.F.R. I 1003 .6l, the bec:wve
uisal Accea J'l"OAramo maJnlulno ? IIo of organ.lulion1 and ?tto:noaya q111Ufted under the regulationo who provide pro bono or mo
legal ..,..,,.lcea. Tbe ln(onr111tton palled on thl ? Ult 11provl.dad to EOIR. by the Providen. EOIR doe a not undono any of these orgaoiaattons or attol"'lleya Addtuonally, EOIJl dooa not partidp ?to ID, Dor h It re11ponatble for, the 1'8prnunbrtlon decl1lon11 or performance of
Oladafmpn

AMf-q

theta oiganlmlioD!i or anz>ra")"II,

PVERSIGHT

DHS-ICE-19-0196, 19-0197-G-000020
2019-ICLl-00051 1720

.1



o Non Pront Or11nl1allon
oo Referral5eMa

o o o Prlvate Attornev

Updated April 2018

List of Pro Bono Legal Service Providers
http://www.J

ust lee .gov/ eo i r/llst-pro-bono-lega

I-service-provide rs

Los Angeles Detained Immigration Court
EsperanzaImmigrant RightsProjecto

Public Counselo

Catholic Charities of Los Angeles

610 S Ardmore Avenue

1530 James M Wood Blvd

Los Angeles, CA 90005

Los Angeles, CA 90015

Tel: (213) 385-2977

Tel: (213) 251-3505

Fax: (213) 385-9089

Fax: (213) 487-0986

www.publlccounse_l.org/practlce_areas/lm

www.esperanza-la .org

hts

m lgra nt_rlg

Human RightsFi~o -o
o Mon-Fri 8:30am-5:30pm

,, ,.

333 South Hope Street; 42nd Floor
o Serving counties of Los Angeles, Orange, Riverside,
San Bernardino, Ventura, Kern, & Santa Barbara

Los Angeles, CA 90071
Tel: (213) 294-"2648 . .

of crime

La probono@hu mall ri~~tsfi rst.o rg
www .human rlghtsflrsto rg ..

o Reduced fee, nominal fee, or pro bone depending on

o Represents indigent .lndivlduals seekingasylum

o Assist in various forms of Immigration

relief, victims

need and grant avallabllity
o Languages: Spanish or lnterpeter

o Asyl1:1mapplicants , should call and leave a message.

services

1---------------------4
CHIRLA- Coalition for Humane Immigrant

No walk-Ins
Rightso

,.
o Represents detaln .ed and non-detained

the LA and Adelant~ immigration
2533 W. Third Street, Suite 101
Los Angeles, CA 90057

Individuals at

courts, and the LA

.
J .~, t! .
Office.
Asyl~ m.
as needed.
others
o Languages: Spanish,

Tel: (213) 353-1333
Fax: (213) 353-1344

Asian Americans AdvancingJustice - LosAngeleso

www .chlr1a.org

. .l .

.
o Consultations on Tuesdays, Thursdays and Saturadays 1145 Wilshire Blvd
CA 90017
Los Angeles,
at 8am
,.
.
.

o Languages: Spanish

Tel: (888) 349-9695
ildva ncingjustlce-la ..9rg
'

1501 West 8th St. Suite 100

. I.

If detained, call between 9am-12pm,
{714) 909-2668

M-F :

"' ..

(213) 387-3284
g_s....If not ~etained, call,betwe~n 10am-3pm,
____
gs_a_n_d_b_o_n_d_h_e_a_r_ln_
__
_p_ro_c_e_ed_l_n
...o_R_e_m_o_v_a_l
English / Other: 88~~3.4~-969S
Chinese/-9:t(.fEURUtJ

fr,

Khmer/~
Korean/.GBP,&
Tagalog/

"'!-F:

_ll1': 800-520-2356

l~~fll~ ,., ~ .ei: 800-867.3126
800-867 -3640
OI ~Jl S~tJ ~ 77~:

Paano na!l:llp 1~ayo matutulungan:

855-300-

2552
Thai/ li'iil.:in1tm1l.lt11~i~dl~:800-914-9583
Vietnamese/ C)n s11.glup d&: 800-267 -7395
B.m ..w (EOJRJ, Offlco orlbo Dtred:llr, Offlco or
Aa reqttlred by 8 C.F.ll. I 1003 .6l, lbo Executi..., OfD.ce lvrlmmls;n,t.lon
Prosn, 111111111fnlalns a JIit of orgaAls.ltoa ? and llttonle)"I quallll.ed under the reg11.lat1001 who pnntde pro bono or rreo
Le&al Acce11111
Jeaal 1enicea. The 1nrorau1tio11 posted on this lh1t la pivvtded tD EOIR by the Proriders. EOik 4....,. aot aodor? o IIDYorthaH orpnlmor
In, nor 111it rNpOnable for, the "pl'etant11UD11 docl1ioa1 or pmormaneo
tlana or 11tlon1.eyri. AddltJon11lly, EOIR doH not p11rtldpah
the .. 011111ntmdon1 Ol'ottomeya.

DIKfglmcto

AMER

PVERSIGHT

DHS-ICE-19-0196, 19-0197-G-000021
2019-ICLl-00051 . 1721



o Non Profit Oraan!tatlon

.. RefetralSer.1ce
... Prmle Attorney

Updated April 2018

List of Pro Bono Legal Servic.e Pr~"Vi1;iers
eolr /list-pro-bo no-I ega1-serv_ice-provlde rs .

http://www.justice.gov/

Los Angeles Immigration Court .
....,

Kids In Need of Defense (KIND)o

PublicCounselo

888 West 6th Street, #900
Los Angeles, CA 90017
Infolosa nge les@supportklnd .o rg

610 S Ardmore Avenue .
Los Angeles, CA 90bo~ .

. .. .

i nfolosa ngel es@supportkind.o rg

Tel: (213) 385-2977 .
Fax: (213) 385-9089 .
www.publ lccou nseforg/practlce_a reas/1mm lgra nt_rlg
.. .'
hts .

www.supportklnd.org

International Institute of Los Anseleso

o KINDonly represents minors and unnacompanied

435 S. Boyle Avenue
Los Angeles, CA 90~.3 _(

Tel: (213) 274-0170

children

o KINDayuda a menores de edad y nlno/as noacompanados
---------1
t---------------Immigrant Defenders Law Centero
634

s.Sprlns St, 10th floor

Tel: (323) 264-6217r ;.; .'
Fax: (323) 264-6418.
.

Robert Foss, Division Qlrector
www.iilosangeles.~rg .

Los Angeles, CA 90014
o ' i _ 'j

~';
r'.

o Asylum cases, deportation defense, children's cases
El Rescateo

Tel: (213) 634-0999
Fax: (213) 634-0999
lnfo@lmmdef.org

1501 West 8th St. Sult~ .100

www.lmmdef.org

CA 90017
Los Aflgeles,
, o . , .. ;
o
L
o Unaccompanied minors only
o Languages: Spanish
- Coalition for Humane Immigrant Rightso
CHIRLA

(213) 387-3284

I

-1

o Re'!)~_val proceed1 .~ -~nd bond hearings

2533 W, Third Street, Suite 101
Los Angeles, CA 90057
Tel: (213) 353-1333
Fax: (213) 353-1344
www.chlrla.org
o Consultations on Tuesdays, Thursdays and Saturadays
at8am

o Languages:Spanish

.-..,

~.
. ,... .....

AM[.

or

tho Dir,11:lnr, Office of
Review (EOIR),omco
Lepl Accou Programs maJatalns a llat of <>1"8Dllhatlonsand attonle)'S quallftud undor du, .-ragulatlon1 who p"'vtdo pro bono or free
lapl Nrvlllltl. Tho ldonn ?tlon pelted on Ulla Uat Is P"'oldod to EOUt by the Providen. E:OlH. d~u not .ondoru any ofthoN Or&? Dim-
deol ? h;oao or performance of
t10n1 or 11.ttoniayaAddltlonally, KOIH. doa1 not p11rtidpat. l11,11orIs It re? ponrdble for, the repreunlntioa

Pl.11dalmcr1 Aa nqulrod by 8 C.F.B..I 100:J.6a. the I.xeeuUvo omce for I mmlgntloa

t hou OIJlllnlmtlon li or attorneys.

PVERSIGHT

DHS-ICE-19-0196, 19-0197-G-000022
2019-ICLl-00051 1722



o Non Profit ?'1:1 nl HI la n

... Prmte Attorney

Updated Aprfl 2018

List of Pro Bono LegalService Providers

o o ReferraI Service

http://www.Justice.gov/

eol r/11st-pro-bo no-lega I-service-provide rs

.....

Human RightsFirst..

:o,

. .. ,

" '

Esperanza Immigrant Rights Projecto

333 South Hope Street, 42nd Floor
Catholic Charities o_f i.os Angeles
1530 James M Woo ,d Blvd
.
Los Angeles, CA 90015
.. .

Los Angeles, CA 90071
Tel: (213) 294-2648

~

Tel: (213) 251-3505

i, :

www. hu manrightsfirst.o rg

Fax: (213) 487--0986 -

o Represents detained and non-detained Individuals
before the Los Angeles and Adelanto immigration

www.esperanza-la.org

o Represents Indigent lndlvlduals seekingasylum.

o Mon-Fri 8:30am-5:30pm

o Languages: Spanish, others as needed.
o Asylum applicants should call and leave a message.
No walk-ins .

San Bernardino, Ventura, Kern, & Santa Barbara
o Assist in various forms of Immigration rel~ef, victims
; '.o:~:.'.
of crime
o Reduced fee, nominal fee, or pro bone depending on
need and grant avallab1l1ty
o Languages: Spanl~.~oor interpeter services

:l . , ..
'.!.. I;;!;,
~-

-. .

(\ ~ ~

. .I

,, ,

Jlorio;w (Ef?lll), Office of tho Dlred.-T, Office of
AJ, req111nd by 8 C.l' .R.. I 1003.61, tho Exoca,tiT9 Ofllca for hnmlrUon
and attDrn&y? qua JIBad 11ndeT the 1'9811liiltgns who pl"Ovldepl"Obong or
Pn>p m ? mah,tnlns a llllt of orsanlutlona
Loaal ACQQSII
I ? proold.d tg EO[R. by the Prvridvrs. EOIR. dges not endgrse any of th&aa orsanlulepl Rrv1ce ?o Tba information pond Qn tlll ? 11111:
deelslons OT P41rforma11eeof
Uon, or attorneys. Addltlonally, EOllt does not partidpate In, nol' ls It raspoallble ror, the ntpnontlltfon
.
these orsanlml!on moratt11n11,7u.

J>b,d9lmpr1

AM[H

PVERSIGHT

f"o

DHS-ICE-19-0196, 19-0197-G-000023
2019-ICLl-00051 1723



~
o Non Profit O'1:.tnlz.itlon
o o ReferraI Semce
ou PrlYate Attomry

List of Pro Bono Legal Service Providers

Updated April 2018

http://www.justice.gov/eolr/llst-pro-bono-legal-servlce-provlder1

Otay Mesa Immigration Court
Casa Comella Law Centero

El Rescateo

2760 Fifth Avenue, Suite 200
San Diego, CA 92103
Tel: (619) 231-7788
Fax: (619) 231-7784
LawCenter@CasaCorneIla.org
www.casacorne Ila.o rg

1501 West 8th St. Suite 100
Los Angeles, CA 90017,
(213) 387-3284
. r.

o Bond hearings
o Removal proceedings
o ICEparoled request

o Asylum, victims of serious crime
ABA Immigration Justice Projecto

Jewish Family Service_of San Dleg;oo

2727 Camino del Rio South, Suite 223

8788 Balboa Avenue ...

San Diego, CA 92108

San Diego, CA 92123

Tel: (619) 255-8810

: (858) 637-3365

Fax: (619) 255-8792
contact@a baIJp.o rg

Fu:: (858) 637-301!. -~'-'
lmmlgratlon@jfssd:P.rs

S
f d rg/ . I
//
services/I h
http://www.americanbar.org/groups/publlc
ttp: www.J ss .o site Page erver 7pagename=pro
.
.
.
.
f
mmlgrat1on/projects lnittatlves/imm1gratlonjustlce_p
grams re ugee main \ .
- _ .
roJect_ljp_of_san_dlego.html
o Please call for apP,oi~,ment
o Services limited to San Diego, CA
o Office Is not open to the public, please call for
appointment

--------------------

o Sef\'.lcesinclude: l:)ionfl:Hearlngs, Removal Defense,
Cancellation of Removal, Asylum, Adjustment of Status
o lanuuages: Spani!l_h, Arabic, Multilingual
Interpretation May be Available

-r:-, - .

R.r,1...., .(ll,OIR), Office or the Dil'Cldur, Offlco of
AJJn,qulrYd by 8 C.F.R.. I 1003.61, th& becutlve Office forimmiptloa
Lepl AOC&""Pn,gnu:01 mlllntaln1 a lill of orpnJu.tio1u aad att.DrDll)'IIqliaUftad under the i-eguleUons who provlde pro bono or fna
lepl serrii=es. The ldonn11tion pod'lld on this lid: I? provided to aont by the Prmdan . EOIR does not end on, 1117of these orpnhaUoq11or att.omeya. Additionally, EOIR doH not parttc::lpat-e 111,qor I ? It N,rpooidbla for, the repre ? ontatloA dechlnoa or penor1111ne.e of
.
thoto orgaAl111tion1 or an.on"Yl'.

Dl!dplmcn

AMER

PVERSIGHT

DHS-ICE-19-0196, 19-0197-G-000024
2019-ICLl-00051 - 1724

!.



o Non Profit ora~nlutlon
o o Referril I SerAce

List of Pro Bono Legal Service Providers
http://www.justice.gov/eolr/list-pro-bono-lega

ooo Private Anomey

Updated Aprll 2018

I-service-providers

San Diego Immigration Court ..
ABA Immigration Justice Projecto

Casa Comella Law Centero

2727 Camino del Rio South, Suite 223

2760 Fifth Avenue, .Suite 200

San Diego, CA 92108

San Diego, CA 92103

Tel: (619) 255-8817

Tel: (619) 231-7788

Fax: (619) 25S-8792

Fax:(619) 231-7784

o Services limited to San Diego, CA

LawCente r@CasaCornella.org

o Office Is not open to the public, please call for

www .casacornel ia.org

appointment
o Offer legal orientations to Individuals ln removal
proceedings at the San Diego Immigration Court,
Wednesdays 8:30 amo 10:00 am (English and Espanol).

o Asylum, unacompanted minors, victims of serious
, .
crime
1
. . . o .:..

call for more information.

LegalAid Societyof San Dle10o

Jewish Family Serviceof San Diegoo

110 South Euclid Avenue
San Diego, CA 92114

8788 BalboaAvenu.e
San Diego,CA 92123

Tel: (877) 534-2524

Tel: (858) 637-3365

Fax: (619) 263-5697

Fax: (858) 637-301~

"' :.1.

.-

I.

www.lassd.org

Imm lgratlon@Jfssd.org

o Free legal services

OoJ
.,
ite/PageServer?pagename=pro
http://www.jfssd.org/s

o WIii not represent asylum cases

grams_refugee_maJn . : ..

o Non-detained

representation

L---=--

.........

,

'

only

-----------------1

o langues : Spanish

I

- ,

o Ple.1secall for appointment
:, . '
o Services Include: B_on ,d Hearings, Removal Defense,
Cancellatlon of Reniov .al, Asylum, Adjustment of Status

o languages: Spanish, Arabic, multilingual
Interpretation

may ;be available

.

,,, .

Dl,s:l11lmer1 ~ req11iredby 8 C.P.R..I IQOJ.61, t.b, Ex,ieuu..-. omc. ror.I~mlanitJon R?'l'iew (EOIB.), omeeoft.bu LltndDr, Office or
Legal Accea ProgJII ma m11!ntalns a 11stof orwin.tudoao and attm,,0711 quallft?d under lhe regulationo .. ho provide pro bona or free
lepl nmcu. Tho information posted 011 t.bla HIii:111pnwtded to EOIR. by t.be Providerri. EOIR daeu not eador10 aay ort.bHe orpolmtio111 or 11ttora8J"II.Addttionally, EOIR doe ? nat parUdpato In, nor 111It r?11ponatble for, t.be repNnntlltlon dechioaa or pmorm11m::eof

AMER

t.b"" D'5"nlmtlon s or llftoraeya.

PVERSIGHT

DHS-ICE-19-0196, 19-0197-G-000025
2019-ICLl-00051 1725
, 1, .,, ;



o Non Profit Orgilnlratlon
oo Referrill Service
ooo Prl\lll!e Attorney

List of Pro Bono Legal Service Providers
http://www.justice.go\//

Updated April 2018

rovlde rs
eoir /list-pro-be no- lega 1-serJlce~j:)

San Francisco Immigration Court
Immigration Law Clinic

Asian Law caucuso

U.C. DavtsSchool

of Lawo

55 Columbus Ave.
One Shields Ave Tff.30
Davis, _CA 95616-5201 .
,. '
(530) 752-6942

San Francisco, CA 94111
(415) 896-1701

(415) 896-1702
www .adv anclngjustice-a lc.o rg

o Holly Cooper, Associate Director and Amagda Perez,
Staff Attorney

o Specialize in cr1mlnal removal defense
o Rarely take asylum cases

o Serving Northern and Central California

Mandarin, cantonese, Vletnamese, Hindi
o languages:
---t
__________________
.,_
Asian Padflc Islander Legal Outreacho

o Detained and non-detained cases
.
o Mon-Fri, 9am-Sprif .-'1o.o. .
o languages: Spanish,.-ltallan.
La Raza Centro Le~~Io

1121 Mission Street
San Francisco, CA 94103

474 Valencia St., Ste.. 2~5

(415) 567-6255

San Fianclsco, CA

Fax: (415) 567-6248

Tel: (415) 575-3500 ., .

www.apllegaloutreach.org
Asytum Program of the San Francisco Lawyers'

Fa,c:(415) 255-759~

Committee for Civil Rl1htso

rel.arg
WW\,\',,I

o o.'

.
~,io.)
:J..... .. .

'j

131 Steuart Street, Ste. 400

o Non-detained only .

San Francisco, CA 94105
Tel: (415) 543-9444

o languages: Spanish

..

'

Social Justice Collaborativeo

.. . .

Fax: (415) 543-0296
lnfo@lccr.com

420 3rd Street, Suite.130 .

www.lccr.com

Oakland, CA 94607 ~. ....
Tel: (510) 992-3964 .
't

.': -

..._
Asylum
o ______

_____________
.......,..
Only

--1

Fax: (510) 255-5200
offlce@socialjustic~coJl~boratlve.org

.~oratlve. org
(!~

WWW :~o~laljustlcesi

1 '. _..

o Consultations by,Appointment Only
'

o I

o

o lar~ages - Spa~ish, Tamil
o De'portatlon defe.nse priority

.t .

. .

01:!ildalmen All n,qulnd b:r8 C.F.B.. S 1003-61, th"

AM~~

Offieo for.lmmlsnU011 Jlmew (XOIK), Office orth,. Dlredor, Office or
Enoutln
ma.lnlllin.a o lilt or 01"8Dnhalion1 and atton.eyw q1111Uliadunder !he ....,au lat.tons wbo provide pro bono or fne
Lepl Aeoess Propmo
lepl Al'Ylcea. The in format.Ion polled on this lllll:la proYidtd to iOIR by .the Pro\'ldeni. EOIR doH not endorve 11ny oftheae organlaideelslo= or performaa.ce of
tlon11 or attor,,.uyw, Addltli111.alt,, EOIR don 11.otparUdpalD In, nor I~ It reaponslbl, for, !Jie ~pn,sent.Uon
.
..:. .::.: . '
,. .
thu ?e o,ganlmttollli or ?ttomll)'II.

pVERSIGHT

.,..
,Y.,;...
DHS-ICE-19-0196, 19-0197-G-000026
2019-ICLl-00051 1726

l. : -J: .
. '



o Non Proflt orsanlHtlon
oo Refe1nlSe/V1ce
oo o Private Altoml!'f

Listof Pro Bono LegalSetvice Providers
no-lega 1-se~lc~~p rovlde rs

http://www .justice.gov/eolr/list-pro-b~

Community LegalServicesin East Palo Alto
(CLSEPA)o

Kids In Need of Defense (KIND)o
San Francisco Office

1861 Bay Road
East Palo Alto, CA 94303

200 Pine St, 3rd floor
San Francisco, CA 94104

Tel: (650) 326-6440
Fax: (866) 688-5204
lmmlgration@clse pa.org

Tel: (415) 694-7389 .
Fax: (415} 956-902~.
Infos anfrancisco@~'u P~.ortkind.o rg
www.supportkind.org .
'-~-' ) .~ .

www.clsepa.org

Updated April 2018

o Residents of San Mateo and Santa Clara counties only o KIND only represents minors and unnacompanled
children
o No collect calls
ayuda a me_(,oi.e.s de edad y nlno/as'noo Kll'{D_.
o Languages: Spanish
;,.
acon:ipanados
Center of Northern
Resource
Central American
Centro Legal de la Razao

California*
3400 E. 12th Street
Oakland, CA 94601

.
3101 Mission St, Suite 101

Tel: (510) 437-1554

San Francisco, CA 9:tl.10

Fax: (510) 437-9164
lnfo@centrolegal.org

Tel : (415) 642-4400~ ,....
Fax: (415) 824-280~ .. .

www .centrolega I.org
-----=---=-----------------t
.....

carecen@carecensf.org

..,

carecensf.org
I

oo

.'.' ,o

' I'.'o~

o Asylum, TPS, Naturalization, DACA, U Visas
o Cancellation of r~rnoval, SUS,Family Petitions
o U~i~ations - 9th ~i~t~lt appeals
.
o BIA appeals

i

I,. ,11: o

R .....I~o--(.EOIK), Office or tho
N roq uirod by 8 C, F. R..11100:J.61, tho I.xecuttV11Offli>e r~r I 111mJsnaU011
tho rei;ulatlont wflo pravlde
11lilt of ol'gjlla.liattona and 1ttan1eyw qualified u11d11r
ma.111'1111111&
Lopl Al!C8SSPf'l>W9.m11
lopl serri.,_. Thu Information po8'ed on thla lilt ii praridad to EOIR by the Praridon. EOIR don not endona any
for, the r'opruentBtloa dedtlons
tloa1 or llttDrueys. Addtt.lonally, .EOIJl doa? not partidp11ta In, nor It It ,-poalllble
tll"e orga11lmdom 1 or attoruey..

Dlad.glmers

AMER

.

PVERSIGHT

Dil'llc:IDr,Offlc. of
pro booo or frea
of these orga11l11111or perform1111iceof

DHS-ICE-19-0196, 19-0197-G-000027

2019-ICLl-00051 1727



U.S. DEPARTMENT OF HOMELAND SECURITY

NOTICE TO ALIEN ORDERED REMOVED /DEPARTURE VERIFICATION
(b )(6); (b )(7)(C);

b)(6):
b)(6); (b)(7)(C);
Event

,

..

No:

,_ ,

fL

'\I

~

.A-File No:
Date :

\ I r-" \

.- .

Alien's name:

Roy Alexander

_2_0_6_4_1e_1_4_1
__

__

__

_

os1111201a

HERNANDEZ RODRIGUEZ

You have been found to be inadmissible to the United States under the provision's of s.ect ion 212(a) of the Immigration
and Nationality Act (Act) or deportable under the provisions of section 237 of the Act as a Visa Waiver Pilot Program
vio lator. In accordance with the provisions of section 212(a)(9) of the Act , you are prohibited from entering, attempting to
enter, or being in the United States
For a period of 5 years from the date of your departure from the United States as a consequence of your having been
found inadmissible as an arriving alien in proceedings under section 235(b )(1) or 240 of the Act.

D
D

For a period of 10 years from the date of your departure from the United States as a consequence of your having
been ordered removed in proceedings under any section of the Act other than section 235(b)(1) or 240, or of being
ordered excluded under section 236 of the Act in proceedings commenced prior to April 1, 1997 .

IR] For a period

of 20 years from the date of your departure from the United States as a consequence of being found
inadmissible and being previously excluded , deported , or removed from the United States.

D

At any time because in addition to being found inadmissib le, you have been convicted of a crime designated as an
aggravated felony.
After your removal has been effected, you must request and obtain perm ission from the Secretary of Homeland Security
to reapp ly for admission to the United States during the period indicated. You must obtain such permission before
commencing your trave l to the United States. Application forms for request ing permission to reapply for admission may be
obtained by contacting any United States Consulate or U.S . Department of Homeland Security office . Refer to the above
file number when requesting forms or information.
WARNING FOR ALL REMOVED ALIENS: It is a crime under TIUe 8 United States Code, Section ?1326, for an alienwho has beenremoved
from tho UnitedStates to enter, attempt to enter, or be found in tho United States without the Secretary of HomelandSecurity'sexpress
consent. Dependingon the circumstancesof the removal , conviction for this crime can result in Imprisonmentof a periodof from 2 to 20
years and/or a fine up to $250,000.

SPECIALNOTICETOSEX OFFENDERS: FederalLaw requires a convicted sex offender, including an alien who has beenremoved from or
otherwise departed the United States and subsequently returns, to rogister In each JurisdictionIn tho UnitedStates In which he or she
resides, Is employed, or Is a student. Vlolatlon of this requirement can result In prosecutlorJ.and Imp risonment for up to 10 years under
itlA 1A llnltAd States Code Section 2250.
.o .
- b)(6); (b)(7)( C)
l(b )(6):
I
SAN 'l_SIDRO, CALIFORNIA

-

-

~aming)

..

CSP OFFICER

.-

(Title of officer) -

II ,

.
.
Verification

I
Departure Date

"

(Location of OHS Office)
-,

.

of Removal

(Complete this section for file copy orily)

I

Port of Departure

I

Title of Officer

Signature of Verifying Officer

(b)(6); (b)(7)(C)

Photograph of Alien

Ba*4ke

>srHh

Jer

(Signature'of alien hose fingerpnnand photograph appear above)

A~

Page 1 of 1

OHS Fori:iit 296 (1/12)

pVERSIGHT

rint)

DHS-ICE-19-0196, 19-0197-G-000028
2019-ICLl-00051 1728



U.S. DEPARTMENT OF HOMELAND SECURITY

NOTICE TO ALIEN ORDERED REMOVED /DEPARTURE VERIFICATION
l..(b-)(-6)-; (-b-)(7-)-(C-);-(b- )(_7_
)( E~
)I

Vb
)(6): (b)(7)(C):
Alien's name:

~b)(6): (b)(7)(C):

I

A-File No: 206us1u

-- -- -------

I

Roy Alexander

Date: 0s/111201a
IJRRNANDBZ ROORIGUBZ

You have been found to be Inadmissible to the United States under the provisions of section 212(a) of the Immigration
and Nationality Act (Act) or deportable under the provisions of section 237 of the Act as a Visa Waiver Pilot Program
violator . In accordance with the provisions of section 212{a)(9) of the Act , you are prohibited from entering , attempting to
enter, or being in the United States
For a period of 5 years from the date of your departure from the United States as a consequence of your having been
found inadmiss ible as an arriving alien in proceedings under section 235(b)(1) or 240 of the Act.

D
D

For a period of 1O years from the date of your departure from the United States as a consequence of your having
been ordered removed in proceedings under any section of the Act other than section 235(b)(1) or 240, or of being
ordered excluded under section 236 of the Act in proceed ings commenced prior to April 1, 1997.

~ For a period of 20 years from the date of your departure from the United States as a consequence of being found

inadmissible and being previously excluded , deported , or removed from the United States .

D

At any time because in addition to being found inadmissib le, you have been co~~icted of a crime designated as an
aggravated felony.
After your removal has been effected , you must request and obtain permission from the Secretary of Homeland Security
to reapply for admission to the United States during the period indicated . You must obtain such permission before
comme ncing your travel to the United States . Appl ication forms for requesting permiss ion to reapply for admission may be
obtai ned by contacting any United States Consulate or U.S. Department of Homeland Security office . Refer to the above
file number when requesting forms or information .

-

WARNING FOR ALL REMOVED ALIENS: It ls a crime underTillo 8 Unltod States Codo, Sectio n 1326, for an allon who has boon removed
from the Unllod States to en tor, attempt to enter, or bo found in tho Unltod States without the Secrotary of Homeland Security's oxpress
consent. Dopondlng on the ci rcumstances of tho remova l, co nviction for this crime can result in lmprlsonmon l of a period of from 2 to 20
'
yoars and/or a flno up to $250 ,000.
~ t:'
.....

-

SPECIAL NOTICE TO SEX OF FENDER S: Federal Law requires a convicted sex offendor, Including an allen who has boon removed from o r
otherwise departod the United States and subsequon tly returns, to roglstor In each Jurlsdlctton .Jntho Unltod States In which ho or she
resides, Is omployed, or Is a student. Vio lation of this roquiremont can result In prosocutlon and Imprisonme nt for up to 10 yoars under
T.'" - ?" , ,_,._..,c::,-o--,.._..,_"-. lion 2250.
. ' .

(b)(6); (b)(7)( C)

I
lf h \( R\.
CBP OPPICBR

-

.varning)

, SAN YSIDRO, CALIFORNIA

(Location or DHS Office)

(Tille or officer)

V II
I

Verification of Removal

I

o1

(Complete this sect ion for file copy only )
Departure Dat e

I

Man ~~r of Departure

'Port of Departu re

Signature of Verify ing Officer

I

TiU~ of Officer

Photograph of Alien

b)(6); (b)(7)(C)

A

Page 1 of 1

DHS Foll{1 l--296(1/ 12)

pVERSIGHT

int)

DHS-ICE-19-0196,
19-0197-G-000029
.
2019-ICLl-00051 1729



Notice and Order of Expedited Removal

U.S. Department ofllomelantl Securit y

DETERMINATION OF INADMISSlBILlTY
Event

Number

I.

~b)(6); (b)(7)(C); (b)(7)(E)

In the Matter of:

ROY ALEXANDER

HERNANDEZ

File No: A206 418 141

kb)(6) ; (b)(7)(C);

Date: May 11,

2018

RODRIGUEZ

(8

Pursuant to section 235(b)(l) of the Immigrati on and Natio nality Act (Act);
U.s.c: 1.22S(b)(l)) , the
Department of Hom eland Security has determined that you are inadmi ssi ble to the United Sta tes under
section(s) 212(a) D (6)(C)(i); ? (6)(C){ii); ii (7)(A)(i)( I); ? (7)(A)(i)(II); ? (7)(8)(i)(I); and/or ? (7)(B)(i)(ll)
of the Act, as amended, and therefor e are subject to remova l, in that:
1)

You are

not

2)

You are

a native

3)

On or about
May 9, 2018,
Mexico at the San Ysidro,

4)

You are an immigrant
not in possession
permit,
border
crossing
card,
or other
Immigration
and Nationality
Act .

...

a citizen
of

or

national

Honduras

of

citizen

the

United

of

Honduras.

you applied
for
Port
of Entry.

States.

admission

of a valid
valid
entry

into

the

unexpired
documeri"t

United

States

immigrant
as required

from

visa,
reentry
by the

(CONTINUED ON I-831)

b)(6); (b)(7)(C)

l(b)(6);
~
.esp OFFICER
Name and title of immigrati on officer (Print)

o
ORDER OF REMOVAL
UNDER SECTION 235(b)(l) OF THE AEURT
Based upon the determination set forth above and evidence presented dur ing inspection or exa minati on pursuant
to section 235 of the Act, and by the auth ority con tained in section 235(b)(l) _of the Act, you are found to be
inadmissible as charged and ordered removed from the Unite d States.

Sig.na1urcof immigration officer

Name and title of immigrati on officer (Print)

Name and title of supervisor (Print)

D

Signatu re of supervisor, 1favnilable

Check here if supervisory concurrence was obt aine d by telephone or other ,ineans (no supervisor on duty).

CERTIFICATE OF SERVICE
I perso nally served the original of th is notice upon the above -named perso n-o n __

_ _______

_

(O3te)
Signature of imm igration officer

A

l~1AI\J

pVERSIGHT

Form 1-860 (Rev 08/0 1/07)

DHS-ICE-19-0196, 19-0197-G-000030
2019-ICLl-00051 1730



.-

-

(rumeuBJS
t,U9/N)

. :;I '"f ' 0 5 >;,;/ -\f'~ 0 t{) uo1i~ou

st\AJO~l809J e6p1tMOIDf~I

AMERICAN

PVERSIGHT

DHS-ICE-19-0196, 19-0197-G-000031
2019-ICLl-00051 1731



Continuation Page for Form _I _-_8_6_o___

U.S. Department of Homeland Security

_ _

Fi IP hl11mher ""> ni; 41 R 1 41
Date
(b)(6); (b)(7)(C); (b)(7)( E)
I May 11, 2018
Event No: lfh\f~\. fh\f7\fr'\.
ON THE BASIS OF THE FOREGOING, IT IS CHARGED THAT YOU ARE SUBJECT TO REMOVAL FROM THE UNITED
STATES PURSUANT TO THE FOLLOWING PROVISION (S) OF LAW:
, , ,

Alien's Name

ROY ALEXANDER HERNANDEZ RODRIGUEZ

===:=============------------------======--==============
====------- --------====---=======-212(a) (7) (A) (i) (I) of the Ill1Illigration
and Nationality
Act (Act),
as
who, at the time of application
for admission,
is not in possession
immigrant
visa,
reentry
permit,
border
crossing
card,
or other
valid
by the Act,
and a valid
unexpired
passport,
or other
suitable
travel
of identity
and nationality
as required
under
the regulations
issued
under
section
211(a)
of the Act.

amended,
as an immigrant
of a valid
unexpired
entry
document
required
document,
or document
by the Attorney
General

C'

Signature

b)(6) ; (b)(7)(C)

I

Title
CBP OPPICER

y

__ 2 _ of __ 2 _

Pages

Form 1-831 Continuation Page (Rev.08 /0 1/07)

pVERSIGHT

DHS-ICE-19-0196, 19-0197-G-000032
2019-ICLl-00051 1732



Page I 6f2

0

Targeling Framewor k

!<
b)(7)( E)

ALIEN fllE f Re<onl : 206418141
EID Even l Id:

kh\/

7 \/ C:\
Date of Birth: 021181198.5
Citit.en$h ip: HONOURAS

Namo: HERNANDEZ RODRIGUEZ, ROY ALEXANDEURR
P~ea of Wrth : HONOURA.S

NO Pl
Encounter. 05/09/2011

l<b
)(7)( E) I

Encounter: 01112/20 15

!(b)(7)( E)

Encounter: 03./07/2014

I

I

E,,eow,t.e.r. 0112l/20 1'

Kb)(7)( EI

l(b)(7)( E) I

Al

P \Jl<GBP2tn
(fGBP)
~ I \.:it1 I

DHS-ICE-19-0196, 19-0197-G-000033

2019 ICll 00051 1733

1s11012018



Page 2 of2

Encoun ter: 05114/2009

l(b)(7)( E)

I

NO PHOTO

Eneoun ter : 10!06/2005

l(b)(7)( E)

I

E.ncoun lc-r. OA./2512009

~b)(?)(E)

I

DHS-ICE-19-0196, 19-0197-G-000034
2019-ICLl-00051 1734

5/10 /20 18



Page 1 of 6

Targeting Framework

HERNANDEZ RODRIGUEZ , ROY ALEXANDER
last modified by

l(b)(6); (b)(?)(C)

Presented As:
False Claim :
Gender :
Race :
Hair Color :
Height :
Complexion :
Inspection Date/Date of Entry :
Co-Traveler:
CBP Status:
Desc ripti on :

10511112018 01 18

No Documents
None
Male
WHITE
BROWN
5ft Bin
LIGHT BROWN
05/09/20 18 10:30
No

Perso n Typ e: UNDOCUMENTED ARRIV ING
ALIEN
Citizenship : HONDURAS
Place of Bi rth : HONDURAS , HOND URAS
NT:~=~ f~~~~(b )(?)(C)
Date Of Birth :
Typ e: MOTHER
Name: kb)(6); (b)(7)(C)
Date Of Birth :
Ali as: HERNAND EZ, JEFREN RODRIGUEZ

[Back t o Top]
Assoc iat ion:
Marital Status :
Hispanic:
Eye Colo r:
Weight :
Classification :
Person Role :
Gang Affi li ation :
Smugg led Cos t :

SINGLE
Y
BROWN
160 (lbs)
N/A - Not Applicab le
Principal

Date Of Birth: 02/18/1985

Citizenship : HO NDURAS
POB Country :
Citizens hi p : HONDURAS
POB Country :
Date Of Birth :

SSN :
Alias: HERNA NDEZ, JEFFRY
SSN:
A li as: HERNANDEZ, JEFREN
SSN:
Alias: HERNANDEZ-RODRIGUEZ , JEIFRI

Cit izenship:
Date Of Birth: 09/ 22/ 1987
Citizensh ip :
Date Of Birth:
Citizenship:
Date Of Birth: 02/ 13/ 1985

SSN:
Al ias : HERNAN DEZRODRIGUEZ, JEIFR I ALEXAN DER
SSN:
Alias: HERNANDEZRODRIGU EZ , YENFRI
SSN :

Citizenship :
Date Of Birt h :

Apprehens ion: SUBJECT APPREHENDE D
Ub )( 6 ) : ( b )( 7 )( C ) :

l

Incid ent ID: !rhVR).
I
EID Ev ent: !rhVR). fh )f7 )( C:) I
Charging Docum ent : R-84 - Final D1spos1tion Report

Cit izensh ip :
Date Of Birth : 07/01/1985
Citizenship:

kh)f 7 V

Sub j ect: !th \f ~ \ I
Civilian ID: 178725158
Arrest Date: 05/09/2018 17:33

(b)(6); (b)(?)(C); (b)(?)(E)

A~./

pv ~~~+ T--------------~
2019-ICU-000511735

DHS-ICE-19-0196, 19-0197-G-000035

5/ 10/201 8



Page 2 of 6

Targeting Framework
b)(6); (b )(7)(C); (b )(7)( E)
ALIEN FILE# Record2:

206418141

Disposition
last modlf,ed by

l(b)( 6); (b)( 7)(C)

Disposition Category: REFUSED
ClsposlUon: FXPEDIIED

NotlflcaUon to the TTRT and JTTF:
Deferred Port:

No

rb )(?)( E)
In Lieu of ER/CF:
Report Date:
Report Time:
Charge: Sec212(a)(7)(A)(i)(l)-lmmigrant w/out Docs
Charge: 8 USC 1182-Alien inadmissibility under sedion 212
AllegaUon Text: You are not a citizen or national cf the United States.
#
You are a nati11eof Honduras citizen of Honduras.
#
On or about May 9, 2018, you applied for admiHion into the United States
from Mexico at the San Ysidro, Port of Entry.
#
You are an immigrant not in possessionof a 11alidunexpired immigrant 11isa,
reentry pennit. border crossing card, or other valid entry document as required
by the lmmlgralion and Nationality Act.

tJ

LocaUon
~ 05109/2018 17 23

las/ mod,F,ed bykb)(6) ; (b)(?)(C)

Address: U.S. Address
OHS CUSTODY
UNITED STATES OF AMERICA
Latitude Declmal:
Longitude Declmal:
Property Type: MONEY (in possession)
Value: 6.00
Descrtptlon: $6.00 USD

Unit of Cunency:

United Slates Dollar

?!(b )(7)( E)
las/ modified by

Kb)(6); (b)( ?)(C)

tS/1112018 02:0B

I

l(b)( 6); (b)( ?)(C); (b)( ?)( E)
Last Responsa: (2018-05-11 02:08:14.0)i(.i...\{j::n,1...\,7 \,r-\
Lvascreated successfully
Status: SA - SUSPECT, ALIEN
Query NoUflcatlon: 1 - NOTIFICATION TO
RECORD OWNER
Lookout Level: 0
Primary Action: 4 - REFER TO INS
SECONDARY
Category Subject:
Subject:
Primary Stop Data: 05/10/2019
Primary Start Date: 05/11/2018
Site:
Exel us Ion:
Armed and Dangerous: No
Entry Date:
! ON 05,,vi""'-'!<.LM.......UO!..!lo!,IL~.!....!.>ol!...!A:!...._~
Remar1t: !(b)(6).
CITIZEN OF HONDURA
e
INTO THE U.S. FROM MJ!:Tirr.n~~:T"'.,..,., _ ____.
PEDESTRAIN. SERVED AN 1-860 (ER/CF) TAKEN
INTO DHS CUSTODY PENDING ER/CF
!(b)(3) Unspecified Statut e

Officer: j(b)( 6); (b)( ?)(C)

A~"~

pv~ ~ l--S---------------.

2019-ICLl-00051 1736

DHS-ICE-19-0196, 19-0197-G-000036

5/10/2018



Page 3 of 6

Targeting Framework

CJ Narrative
Croilted by!r h\f ~\ - (b){7\/C)
last 111od1fi1Jd (b)(6): (b)(7)(C)

by

lo,91201 B 11 22
05111/2018 01.18

ON 05/09/2018, SUBJECT JS A CITIZEN OF HONDURAS kb)(3) Unspecified Statute
INTO THE U.S. FROM MEXICO VIA SYS POE PEDESTRAIN. SERVED AN 1-860
ER/CF TAKEN INTO DHS CUSTODY PENDING ER/C~ )(3) Unspecified
b)(3) Unspecified
. . .

I

.....
-

ltinerary:AUTO-GENERATED

~-;_-

-_-

.__-_..

..:....:;___;__

las/modlfiedby!( b)( 6 ); (b)(?)(C)

ITINERARY

__I
-..

..

.

--- -

.

0:111/201801

19

Land f>edeatrfan Conveyance

I 0511112018 oug

last modified b;,fo )( 6 ). (b )( 7 )( C )

(Back to Top]

Encounter Cate: 05/09/2018 10:30 LOCAL
TIME
Remari<a: AFOOT VIA SYS POE PED WE.ST

Custody Log
l8St n1odd1edoy 111
...\/

1:>\ . /1... \/ "7 \/ I" \

I 0511112018 02 16
Custody CurrenUy In Port:

Priority:

SAN YSIDRO,
CA. 2504

Custody Time In : 05/09/2018
Custody Time Out ;
14:20 LOCAL
TIME
Custody Status: CURRENTl. Y
Transfer To:
IN
CUSTODY
Secured Holding Location: CELL 9
Baggage Che~k Number: 7732863/ 64
Secured Holding Location Time In: 05/10/2018
secured Holding Location Time Out:
13:44 LOCAL
TIME
Responsible Party: SYS/ AEU / MC
Terminal Number.
Riek Level Reaeon:
Risk Level: LOW
Safe/Sanitary Condition: Yes
Water AccH?lble: Yes
Room Temperature Reason:
Room Temperature: 66-80 F
Degrees
ICE Declined to Celaln:

-

'i

Secondary Check(s)
Conduc19'd By
(b)(6); (b)(7)(C)

Cell

WELFARE CHECK

CELL 9

WELFARE CHECK

CEU. 9

05111/2018 01 :36

WELFARE CHECK

CEU. 9

05111/2018 01 :17

WELFARE CHECK

CEU. 9

05111/2018 00:57

WELFARE CHECK

CEU. 9

05111/2018 00:45

WELFARE CHECK

CELL 9

05111/2018 00:25

WELFARE CHECK

CELL 9

05111/2018 00:11

Arv1-nr:AN

pv E~
-~~
~

Date/Time

Chea Type

v-- ------------------

2019-IGI 1-000511737

0511 I /2018 02:21

DHS-ICE-19-0196, 19-0197-G-000037

.........
-n ........
.,~

5/10/2018



Page 4 of 6

Targeting Framework
(b )(6); (b )(7)(C)

'NELFARE CHECK
OTHER CHECK
Notes: CELL TEMPERATURE 70.9
'NELFARE CHECK

CELL g

CELL 9

05110/2018 23:24

'NELFARE CHECK

CELL 9

05110/2018 22:59

05110/2018 23:48

'NELFARE CHECK
CELL 9
05110/2018 22:42
HOT MEAL OFFERED
Noles: MEAL GIVEN, FEMALES AND CHILDREN HAD CHOICE OF CHICKEN NUGGETS OR CHICKEN SANDWICH
WITH JUICE AND VEGETABLES. MALE AOUL TS CHICKEN SANDIMCH WITH VEGETABLES AND JUICE.
'NELFARE CHECK
CELL 9
(b)( 6); (b)( ?)(C)
05110/2018 22:15
'NELFARE CHECK

CELL 9

05110/2018 21 :56

'NELFARE CHECK

CELL 9

05110/201 B 21 :44

'NELFARE CHECK

CELL 9

05110/201 B 21 :27

'NELFARE CHECK

CELL 9

05110/2018 21 :06

'NELFARE CHECK

CELL 9

05110/2018 20:48

'NELFARE CHECK

CELL 9

05110/2018 20:37

'NELFARE CHECK

CELL 9

05110/2018 20:19

'NELFARE CHECK

CELL 9

05110/2018 20:08

'NELFARE CHECK

CELL 9

05110/2018 19:52

'NELFARE CHECK

CELL 9

05/10/2018 19:44

'NELFARE CHECK

CELL 9

os,1012018 19:30

'NELFARE CHECK

CELL9

05/10/2018 19:12

'NELFARE CHECK

CELL 9

05/10/2018 18:49

WELFARE CHECK

CELL 9

WELFARE CHECK

CELL

9

0511012018 18:07

WELFARE CHECK

CELL 9

05110/2018 17:48

WELFARE CHECK

CELL 9

05110/2018 17:35

Vo/ELFARECHECK

CELl 9

05110/'2018 17: 18

Vo/ELFARECHECK

CELL 9

05110/2018 16:53

WELFARE CHECK

CELL 11

05110/2018 16:23

1/,,'ELFARECHECK

CELL 11

05110/2018 15:51

MEAL OFFERED

CELL 11

05/10/2018 15:41

b)(6) ; (b)(7)( C)

05110/2018 18:28

No/es: Meal$ (Hot burrilo or sanwich and juice) 111erved
between @ 1130 1JOOh11u,sCell cieaned by Job Options
'NELFARE CHECK
CELL 11
b)(6); (b)(7)( C)
05/10/2018 15:11

WELFARE CHECK

CELL 11

05/10/2018 14:52

WELFARE CHECK

CELL 11

05/10/2018 14:27

WELFARE CHECK

CELL 11

05/10/2018 13:58

WELFARE CHECK

CELL 11

05110/201 B 13:26

WELFARE CHECK

CELL 11

05110/2018 13: 1B

WELFARE CHECK

CELL 11

05110/2018 13:02

CELL 11
WELFARE CHECK
OTHER CHECK
Noles: Fluke 5111Temperature Meter readingal 0930-~h,....,r....,.:
1.,,.,0_.6_-=--------~
\f,,'ELFARE CHECK
CELL 11 (b)(6); (b)(7)(C)

OS/10/2018 12:55

05110/201812:30

'NELFARE CHECK

CELL 11

05/10/201812:15

WELFARE CHECK

CELL 11

05110/201 B 11 :49

WELFARE CHECK

CELL 11

05/10/2018 11:41

WELFARE CHECK

CELL 11

05110/2018 11 :31

DHS-ICE-19-0196, 19-0197-G-000038
2019-ICLl-00051 1738

5/10/2018



Page S of 6

Targeting Framework

(b)(6); (b)(7)(C)

05/10/201811:14

VVELFARECHECK

CELL 11

VVELFARE CHECK

CELL 11

05/10/2018 10:48

MEAL OFFERED
VVELFARE CHECK
HOT MEAL OFFERED

CELL 11

05110/2018 10:34

Notes: Meal provided.Adults burrito. ci1ildren cereal withmilk

(b)(6); (b)(7)(C)

05110/201809:46

WELFARE CHECK

CELL 11

WELFARE CHECK

CELL 11

05110/201809:01

OTHER CHECK

CELL 11

05/1012018 08:38

Notes: 70
VVELFARE CHECK

CELL 11

05110/201B 08:32

WELFARE CHECK

CEL.1.11

05110/201B 08:01

VVELFARE CHECK

CELL 11

05110/201B 07:40

VVELFARE CHECK

CELL 11

05110/2018 07:21

WELFARE CHECK

CEL.1.11

05110/2018 06:50

WELFARE CHECK

CELL 11

05110/2018 06:27

VVELFARE CHECK

CELL 11

05110/2018 05:59

b)(6); (b)(7)(C)

05110/201B 05:41

VVELFARE CHECK

CELL 11

VVELFARE CHECK

CELL 11

05/10/2018 05:23

VVELFARE CHECK

CELL 11

05/10/2018 05:05

WELFARE CHECK

CELL 11

05110/201B 04:45

VVELFARE CHECK

CELL 11

0511012018 04:36

SHOWER OFFERED
HOT MEAL OFFEREO
VVELFARE CHECK

CEL.1.11

05110/2018 04:06

CEL.1.11

05110/201B 04:06

Notes: 70 Temp
VVELFARE CHECK

CEL.1.11

05110/201B 03:47

WELFARE CHECK

CELL 11

05110/2018 03:34

VVELFARE CHECK

CELL 11

05/10/2018 03:15

VVELFARE CHECK

CELL 11

05/10/2018 02:54

VVELFARE CHECK

CELL 11

05/10/2018 02:20

WELFARE CHECK

CELL 11

05110/2018 01 :SJ

VVELFARE CHECK

CELL 11

05110/2018 01:21

VVELFARE CHECK

CELL 11

VVELFARE CHECK

CELL 11

05110/2018 00:41

VVELFARE CHECK

CELL 11

05/10/2018 00:19

WELFARE CHECK

CELL 11

WELFARE CHECK

CELL 11

05/09/2018 23:37

VVELFARE CHECK

CELL 11

05/09/2018 23:13

VVELFARE CHECK

CELL 11

05109/2018 22:59

OTHER CHECK

CELL 11

05/0912018 22:24

b)(6); (b)(7)(C)

b)(6); (b)(7)(C)

Notes: CELL TEMPERATURES ARE BETWEEN 71-73 DEGREES.
CELL 11
VVELFARE CHECK
l(b)(6); (b)(7)(C)
MEAL OFFEREO

CEL.1.11

051101201801 :OD

05/10/2018 00:04

05/09/2018 22:23
05109/2018 22:19

Noles: MEALOFFERED. WAS GIVEN A CHICKEN c: NDWlCH OR CHICKEN NUGGETS, VEGGIE PACK, AND JUICE.
(b)(6); (b)(7)(C)
05109/2018 21 :47
WELFARE CHECK
CELL 11
VVELFARE CHECK

A~

CELL 11

P Vi~~~--s- T----------------L-'-.

-'--i-''-'---'--~-

05/09/2018 21 :23

DHS-ICE-19-0196, 19-0197-G-000039

...,...,---.,.---,,.--.---.--22{0341-9-9--HIG~L:= 1/4 -l-90~00~6t41-41+733f9~-------_JIoo. 5/10/2018



Targeting Framework

A~AL

If""'/\

Page 6 of 6

(b)(6); (b)(7)(C)

05/09/2018 20:54

WELFARE CHECK

CELL 11

WELFARE CHECK

CELL 11

05/09/2018 20:34

WELFARE CHECK

CELL 11

0S/09/2018 20:16

WELFARE CHECK

CELL 11

05/09/2018 19:52

WELFARE CHECK

CELL 11

05/09/2018 19:24

WELFARE CHECK

CELL 11

05/09/2018 19:04

WELFARE CHECK

CELL 11

0S/09/2018 18:42

1/'JELFARECHECK

CELL 11

05/09/2018 18:21

WELFARE CHECK

CELL 11

05/09/2018 18:03

WELFARE CHECK

CELL 2

05/09/2018 17:37

1\1

\ 0v._____________

DHS-ICE-19-0196, 19-0197-G-000040
2'-l.lOL+;
19::1=--1-1..IC
.....
L1-=1.I-O.M.10Ll,,l.;05J.-11-11~74~o,._
________

_.V1012018



J
._;.~ - DEPARTMENT OF HOMELAND SECURI

1 ...

NOTICE TO ALIEN ORDERED REMOVED/DEPARTURE VERIFICATION
A-File No: 206 418 141
Date: 01/ 2 4/2014
Alien's name : JEIFRI

ALEXANDER HERNANDEZ-RODRIGUEZ

You have been found to be inadmissible to the United States under the provisions of section 212(a) of the Immigrat ion
and Nationality Act (Act) or deportable under the provisions of section 237 of the Act as a Visa Waiver Pilot Program
violator. In accordance vJittrthe provisions of section 212(a)(9) of the Act, you are prohibited from entering , attempting to
enter , or being in the United States

181For a period of 5 years from the date of your departure

from the United States as a consequence of your having been
found inadmissible as an arriving alien in proceedings under section 235(b)(1) or 240 of the Act.

D

For a period of 10 years from the date of your departure from the United States as a consequence of your having
been ordered removed in proceedings under any section of the Act other than section 235(b)(1) or 240 , or of being
ordered excluded under section 236 of the Act in proceedings commenced prior to April 1, 1997 .

D

For a period of 20 years from the date of your departure from the United States as a consequence of being found
inadmissible and being previous ly excluded, deported, or removed from the United States .

D

At any time because in addition to being found inadmissible, you have been convicted of a crime designated as an
aggravated felony .

After your removal has been effected , you must request and obtain permission from the Secretary of Homeland Security
to reapply for admission to the United States during the period indicated . You must obtain such permission before
commencing your travel to the United States . Application forms for requesting permission to reapply for admission may be
obtained by contacting any United States Consulate or U.S. Department of Homeland Security office . Refer to the above
file number when requesting forms or information .
WARNING FOR ALL REMOVED ALIENS: It is a crime under Title 8 United States Code, Section 1326, for an alien who has been removed
from the United States t.o enter , attempt to enter, or be found In the United States without tho Secretary of Homeland Security's express
consent. Depending on the circumstances of the removal, conviction for this crime can result in Imprisonment of a period of from 2 to 20
years and/o r a fine up to $250,000.

SPECIAL NOTICE TO SEX OFFENDERS:FederalLaw requires a convictedsex offender, including an alien who has been removedfrom or
otherwisedeparted the United States and subsequentlyreturns,to register In each jurisdiction in the United States in which he or she
resides, is employed,or Is a student. Violation of this requirement can result in prosecutionand imprisonmentfor up to 10 years under
Tille 18 United States Code, Section 2250.

(b)(6); (b)(7)( C)

LAREDO
, TEXAS

BORDER PATROLAGENT
(Signature of officer serving warning)

(Location of OHS Office)

(Title of officer)

Verification of Removal
(Complete this section for file copy only)
D
i---..........c_..........._1---'-t

b)( ;

Title of Officer

Right Index Finger

Photograph of Alien

b)(6) ;
b)(7)(C)

(s .,.._____

_, taking fingerprint)

Page 1 of 1
DHS-ICE-19-0196, 19-0197-G-000041

2019-ICLl-00051 1741



Notice and Order of Expedited Removal

U.S. Department or Homeland Security

DETERMINAT ION OF INADMISSIBILITY Event

No:kb)(6); (b)(7)(C);

File No: A206 418 141
Date: January

Inth eMatterof

24 , 2014

JEIFRI ALEXANDERHERNANDEZ-RODRIGUEZ
AKA: HERNANDEZ, JEFREN

Pursuant to section 235(b)(I) of the Immigration and Nationality Act (Act) , (8 U.S.C. 1225(b)(t)) , the
Department of Hom eland Security has detennined that yo u are inadmissible to the United States under
section(s) 2 12(a) D (6)(C)(i); D (6)(C)(i i); !RI(7)(A)( i)(l); D (7)(A)(i)(II); ? (7)(8)(i)(I) ; and/or D (7)(8)(i)(II)
of the Act, as amended , and the refo re are subject to removal , in that:
1.
You are an immigrant
not in possession
of a valid
unexpired
immigrant
visa,
reentry
permit,
border crossing
card,
or other valid
entry document required
by t he Immigration
and Nationa lity
Act; To wit: you were app rehended
within
1 00 air miles
of the
international
boundary of the United States
of America and Mex ic o within
14 days of having
illegally
entered
the U.S. by crossing
the Rio Grande River in the Southern
District
of
Texas.
You illegally
entered
with the intent
to re si de and seek employment
in the Uni ted
States.
You were not inspected
or admitted
by an Immigration
Officer
at a port of entry
designated
by th e Attorney
General.

~b)(6); (b)(7)(C)
Border

Patrol

l(b)(6);

Agent

Signalun: of immigration officer

Name nnd title of immigration officer (Print)

ORDER OF REMOVAL
UNDER SECTION 23S(b)(l) OF THE ACT
Based upon the detennination set forth above and evidence pre sented during inspection or examinat ion pursuant
to section 235 of the Act, and by the au thority contained in sect ion 235(b)(I) of the Act, you are found to be
inadmi ssib le as charged and ordered removed from the United States.
fb)(6) ; (b)(7)(C)
Border

Patrol

Agent
Signature ofimmi ra1ion officer

Name nnd title of immigration officer (Print)

(b)(6);
(b)(7)(C)

l(b)(6); (b)(7)(C)
ACTING PATROL AGENT IN CHARGE
Name and title or supervisor (Print)

D

Signarun: or su

sor, if available

Check here if supervisory conc urrence was obtained by telephone or other means (no superv isor on duty).

CERTIFICATE OF SERVICE
I personally served the origina l of this notice upon the above-named person on
l{b)(6);

GAi\

- --

-~.L.
GBP=b.=-l/,__
J,-:1-f_,
'{'---- (Date)

I

Signature ol 1mmigrchonnflicer

pvEHSIGH

DHS-ICE-19-0196, 19-0197-G-000042
Fonn 1-860 (Rev. 08/01/07)
2019-ICLl-00051 1742



u ..::5.DEPARTMENT OF HOMELAND SECURI 1 1
NOTICE TO ALIEN ORDERED REMOVED /DEPARTURE VERIFICATION
A-File No: 206 418 141
Date : 01/24/2014
Alien's name : JEIFRI

ALEXANDER HERNANDEZ- RODRIGUEZ

You have been found to be inadmissible to the United States under the provisions of section 212(a) of the Immigration
and Nationality Act (Act) or deportable under the provisions of section 237 of the Act as a Visa Wa iver Pilot Program
violator. In accordance with the provisions of section 212(a )(9) of the Act , you are proh ibited from entering , attempting to
enter , or being in the United States

(g!

For a period of 5 years from the date of your departure from the United States as a consequence of your having been
found inadmissible as an arriving alien in proceedings under section 235(b) (1) or 240 of the Act.

D

For a period of 10 years from the date of your departure from the United States as a consequence of your having
been ordered removed in proceedings under any section of the Act other than sect.ion 235 (b)(1) or 240, or of being
ordered excluded under section 236 of the Act in proceedings commenced prior to April 1, 1997.

D

For a period of 20 years from the date of you r departure from the United States as a consequence of being found
inadmissible and being previously excluded , deported , or removed from the United States .

D

At any time because in addition to be ing found inadmissible, you have been convicted of a crime designated as an
aggravated felony .

Afte r your remova l has been effected , you must request and obta in permiss ion from the Secretary of Homeland Security
to reapp ly for admission to the United States during the period indicated. You must obtain such permiss ion before
commencing your travel to the United States . Application forms for requesting permiss ion to reapply for admiss ion may be
obtained by contacting any United States Consulate or U.S. Depa rtment of Home land Security office. Refer to the above
file number when requesting forms or information.
WARN ING FOR AL L REMOVED ALIENS: It is a crime under Title 8 United States Code, Section 1326 , for an alien who has been removed
from the United States to enter, attempt to enter , or be found in the United States witho ut the Secretary of Homeland Security's express
consent Depending on the circumstances of the removal , conviction for this crime can result in imprisonment of a period of from 2 to 20
years andlor a fine up to $250,000.

SPECIAL NOTICE TO SEX OFFENDERS: Federal Law requires a convicted sex offender, including an alien wh o has been removed f rom or
otherwise departed the United States and subsequently returns , to register in each jurisdiction in tlile United States in which he or she
resides, is employed, or is a stude nt Violation of this requ irement can result in prosecution and imprisonment for up to 1Oyears under
Title 18 United States Code, Section 2250.

(b)(6); (b)(7)(C)
(Signa ure o o cer serving warning)

BORDER PATROL AGENT

LAREDO, TEXAS

(Title of officer)

(Location of OHS Office)

Verification of Removal
(Complete this section for file copy only)
Departure Date

I

Port of Departure

I

Signature of Verifying Officer

I Manner of Departure

Title of Officer

Right Index Finger

Photograph of Alien

d~

Y' /--eJc YJ0. h
5"
(Signature of alien whose fingerprint anphotog raph appear above)

-;Tr>

l(b)(6);
th \/7\f

('~

I

.

(Signature ofbfficial taking fingerprint)
Page 1 of 1
DHS-ICE-19-0196, 19-0197-G-000043

20 19-ICLl-0005 1 17 43



Notice and Order of Expedited Remova l

U .S. Depnrtmcnt of Home land Secu rity

DETERMINATION OF INADMISSIBILITYk ~b~)(_7)~(E~) -----~
File No:
Date:

A20 6 418
Janu ary

141
24 , 2014

In the Matter of JEIFRI

ALEXANDER HERNANDEZ- RODRIGUEZ
AKA: HERNANDEZ, JEFREN

Pursuant to section 235(b)(l) of the Immigration and Nat ionality Act (Act), (8 U.S.C. 1225(b)(l)) , the
Department of Homeland Security bas determined that yo u are inadmis:;ible to the United States under
section(s) 212(a) ? (6)(C)(i); ? (6)(C)(ii); 00 (7)(A)(i)(I); ? (7)(A)(i)(ll); O (7)(B)(i)(I); and/or ? (7)(B)(i)(ll)
of the Act, as amended, and therefore are subject to remov al, in that:
1 . You are an immigrant
not in possessi
on of a valid
unexpired
immigrant
visa,
reentry
permit,
border crossing
card , or other valid
entry document required
by the Immigration
and Nationality
Act; To wit: you were apprehended
within
100 air miles
of the
14 days of having
international
boundary of the United States
of America and Mexico within
illegal
l y entered
the U. S. by crossing
the Rio Grande River in the Southern
District
of
Texas.
You illega l ly entered
with the intent
to reside
and seek employment
in the Unit e d
States . You were not inspected
or admitted
by an Immigr a tion Officer
at a port of entry
designated
by the Attorney
General.

l(b)(6); (b)(7)(C)
Border

Patrol

Agent

Name nnd title of immigrationofficer (J>riot
)

ORDER OF REMOVAL
UNDER SECTION 235(b)(l) OF THE ACT
Based upon the determination set forth above and evidence presented during inspection or examination pursu ant
to section 235 oftbe Act, and by the authority conta ined in section 235(b)( l) of the Act, you are found to be
inadmissible as charged and ordered removed from the United States.

fb)(6); (b)(7)(C)
Border

Patro

I

(b)(6); (b)( 7)(C)

l Agent
:signature 01 1mm1gra1bno'fliccr

Nnme and title of immigrationofficer (Print)

l(b)( 6); (b)( 7)(C)

I

(b)(6);
(b)(7)(C)

ACTING PATROL AGENT IN CHARGE
Signature of suI,crvisor, if a\llrilablc

Nome and title of supervisor (Print)

D Check here if supervi sory concurrence

was obtained by telephone or other means (no supervisor on duty).

CERTIFICATE OF SERVICE
1 personally served the ori inal of this notice upon the above-named person on __
b)(6);

_

l....
~_a-''1,.,_W'""''l'/'----'(Da1c)

b )( 7) ( C)

p

Signamreofimmigmlion officer

l;iH I

DHS-ICE-19-0196, 19-0197-G-000044
Forni 1-860 (Rev. 08/0 1/0 7)
2019 -ICLl -00051 1744



,,...,,,
Record of Sworn Sta1...,mentin Proceedings
under Section 235(b)(l) of the Act

U.S. Dtpartmc111
or llomela11dSecurity

Offia::LARBDO SOOTB,

TX,

BORDER PATROL STATION'

FilcNo:A206 418 141
~b)(6); (b )(7)(C); (b )(7)( E)

SIB!l:mentby:-e:-==-----==~-==-==--,---------------------------

AXA: BBRHANPBZ, JBFRBN
ALBXANDKR HBRHAHDBZ-RODRICJIJBZ

In the case of: JBIFRI

Date ofBirth: 02/13/1.985

S

Female

Patrol

Agent

Gender (cin:lc:one):

At:J.AlUUJO
SOtJTR.TX. BORDER
PATROL
STATJ:ON

Dalc:January

24,

2014

>>order

Before:j(b )(6); (b )(7)(C)
(N'amellldt'~)

In the SPANISH

language. Ioterpn:ter_NO_HB
__ tl'_SBD
_____

~Employed by________

_

I am an officer of the Uni1edStates Departmentof Homeland Scanily. I am aulhorizedto administerthe immigration
laM end 10lalcesworn stalements. I want IDIBlccyour sworn stalement regardingyour 11pplication
for admissionto the
Unilcd Slalcs. Bc:fon:I IBlccyour statement. I also WllJ"ltto explain your righls, and !he pwpose and 00nscqucncesof this

interview.
You do not appearto be admissibleor to have the required legel ~ IWlhorizingyour admission to the Uniu:d Stales.
This may result in your being deniedadmission and immcdiaielyreturnedto your home 00untrywithout a hearing. If 11
decision is made to ref'we your admission into the Uniu:d Sllllcs,you may be immediatelyremoved from lhis 00untry,and if
so, you may be bam:dfrom reentry for IIperiodof 5 yearsor longer.
This may be your only opportunityto present informationto me and the Departmentof Homeland Securityto make a
decision. It i~veiy importantthalyou ti:11
me lhe innh. ICyou lie or give misinformation,you may be subjectto criminalor
civil penalties, or bam:dfrom receiving immigrationbenefi~ or reliernow or in the future.

Excepta I will explainto you, youaw not entitled IOa hearingor review.
U.S. law provide, protcaion to o:r1llinpawns who face persecution,hann or torture upon n:turn to their home country.
If you rear or have IIconcern about being removed from the Unilcd SlalCSor about being sent home, you should tell me
so during this interview becauseyou may not have anotherchance. You will have lhc opp:,rtunily to speak privllll:ly
1111d
confidentiallyto anolherofficer about your fear or oooccm. Thal officer will d:etcrmineiryou should remain in 1he
Unitl:d Stales and not be removed because of that fear.
or lhe Departmentof Homeland Security.
Until IIdeci5ionis reached in your c:asc,you will remain in lhc l:UStody
Any statement you make may be usedapinst you inlhis or any subsequent a.dministmive
pnx:ccding.

Q. Do you
A. Yes.
Q. You are
and do you
A. Yes.
Q. Do you

understand

what I have said

being processed
understand?
understand

to you?

for Expedited

the charges

against

Removal.

Has

you and that

this

been explained

you are being

to you

formally

deported?
A. Yes.
Q. Would you like

to speak to a consulate

officer?

A. No .
.. , (CONTINUED ON I-831)

Pagclof_3_

Arv

Vr'\

l-867A (0Mll/117)

'I

pVERSIGHT

DHS-ICE-19-0196, 19-0197-G-000045
2019-ICLl-00051 1745



U.S. Department or Homeland Security
Alien's Name

JBIPRI

IB67A

Continuation Page for Form
File Number

Date

ALBXANDERBERHJUmEZ-RODRICJtJBZ A206 418 141

January

24,

2014

Kb)(6); (b )(7)(C); (b )(7)( E)

Q. Are you willing
A. Yee.

Q. Do you swear
A. Yes.

to

answer

or affirm

my questions

that

all

at

this

statements

time?

you are

about

to make are

t%ue and complete?

Q. What is your true and complete
name?
A. Jaifri
llexander
BBRHANDBZ-Rodriguez.
Q. Have you ever

used

any other

names?

A. No.

Q. When and where ware you born?
A. I was horn on the 13th of P'abruary,
Q. What country
A. Mexico.

are

you a citizan

Q. What country
A. Mexico.

are

your parents

1985,

in

San Juan

Del Rio,

Quarataro,

Mexico.

of?

a citizen

of?

Q. DD you have any family resicling
in the Onitad States?
A. Yes, I. have brothers
but I dm,.'t Jen.ow where they live.

Q. Ara you in possession
of any ilmldgration
the United States
legally?
A. Ho.
Q. Do you have any petitions
A. No.
Q. How, when and where
A. I. crossed
the river
Q. Were you inspected

filed

documents

that

allow

you to enter

or remain

in

on your behalf?

did you enter the Onitad States?
(Rio Grande River) Thuraday
(1/23/2014)
by an immigration

officer

at a Port

near

Kuevo Laredo,

Mexico.

of Entry?

A. No.

Q. For what purpose

A. To live

did you come to the Onited
and work in Dallas,
Texas.

Q. Por what length
A. J'or three years

of ti.ma did you plan to stay
and then return
to Mexico.

g. Bad you entered
A. Yes.

the

Signature

trnitad

States

illegally

States?

in the onited

juut

before

States?

you were arrested?

( b)(6); ( b)(7)(C)
Bord.er

Pat.rel

___2

Agant

of ___ 3

Pages

DHS-ICE-19-0196, 19-0197-G-000046
2019-ICLl-00051 1746



U.S. Depar1meot of Homeland Security
Alien's Name

JEIFRI

File Number

Date

ALBXANDBRmraNANDBZ-RODRIGtJBZ JU06

418 141
tb )(6); (b )(?)(C); (b )(?)( E)

Q. Have you ever
A. Yee.

:been apprezumcsed

Q. How many times have you been
the United States
illegally?
A. This is my third
time.
Q. Have you ever

been

ordered

I867A

Continuation Page for Form

r,y any law euforcement

apprehended

January

o~x1cere

by the ll'rlitad

States

24,

2014

c.na un1tec:1 states?

1n

Border

Patrol

for

entering

removed?

A. Ho.
Q. Have you ever

lived

in

the

tJnited

States

before?

A. Yea.
Q. Would you be harmed er

face

persecution

if

you

are

returned

to

your

native

couotry?

A. Bo.

Q. Do you have

any questions

at

this

time?

A. No.

Signature

b)(6) ; (b)(?)( C)

rrit1e
Border

Pat.rol

__ 3 _

Age.1:1t.

of __

3_

Pages

DHS-ICE-19-0196, 19-0197-G-000047
2019-ICLl-00051 1747



14"".
U.S. Dcpartmrnt orUomdand Security

Jurat for Record""- Sworn Statement in
Proceedings under Section 235(b)(l) of the Act

Q: Why did you leave your home country or 00untryof Lastrcsidtnc:c?

A.TO LIVE AND WORlCIN THE llHITED STATES.

or beingremovedfrom lhe United Swes?

Q. Do you have any fear or a,no:m about beingn:tum.cdLOyour home~try
AHO.

Q. Wouldyou be harmed if you are n:tumcd to your home 00untryor co1mbyoGBP1astresidence?

Q. Do you have ll11Y
questionor is there anythingelse:you would like to add?

A.JIO.

I have read (or have had n:ad to me) this SUllement,oomisting of ~ages
(inc::lulfing
lhi.spage). I
swethalmy amwers aretr\lC and oom:a to die brn of my knowledge and thal this~ment is a full,
U\IC and QOITCC\
R'QJNof my inlmogatio11on the dale indiailed by 1heabovenamed offi~ of lhe
Departmentof HomelandSecurity. I have initialedach pageohhis slall!ment(and 1he
com:ctionsnotedon page(s)____
~

Signatu~: JBIFRI
BA:

BBRDHDBZ-RODRIGVEZ

ALBX.llmD
BBlUQNDBZ,

.n!PRZK

Swornand subscribedto befo~ me at uuumo SO'O'TB, TX, BOJWBR PATROL STATION
onJanuary 34, 3014
Kb)(6); (b)(7)(C)
Border

Patro1

Agent

(b)(6);
(b)(7)(C)

(b)(6); (b)(7)(C) S.-,nonllllllip,aaomWitnessed by: BPA
----<

1-867B (IIMI LV7)
DHS-ICE-19-0196, 19-0197-G-000048

2019-ICLl-00051 1748



Name:

HERNANDEZ-RODRJGUEZ,
JEIFRI ALEXANDER

Name:

HERNANDEZ-RODRJGUEZ,JErFRl ALEXANDER

Alias(s):

JEFREN HERNANDEZ

Alias(s):

JEFRENHERNANDEZ

Event#:

Kb)( 7)( E)

Event#:

NI:

206418141

NI:

20641814 1

DOB:

02/13/1985

DOB:

02/ 13/1985

COB:

MEXICO

COB:

MEXICO

l(b)( 7)( E)

Disposition: ExpeditedRemoval(1-860)

Disposition: ExpeditedRemoval(1-860)

Name:

HERNANDEZ-RODRJGUEZ,
JEIFRI ALEXANDER

Name:

HERNANDEZ-RODRIGUEZ,
JEIFRI ALEXANDER

Alias(s):

JEFRENHERNANDEZ

Alias(s):

JEFRENHERNANDEZ

Event#:

l(b )(7)( E)

Event#:

kb)( 7)(E)

Ni :

206418 141

Ni:

206418141

DOB:

02/13/1985

DOB:

02/13/1985

COB:

MEXICO

COB:

MEXICO

Disposition: ExpeditedRemoval (1-860)

Disposition: ExpeditedRemoval(1-860)

Name:

HERNANDEZ-RODRJGUEZ,
JEIFRJALEXANDER

Name:

HERNANDEZ-RODRJGUEZ,
JErFRJALEXANDER

Alias(s):

JEFRENHERNANDEZ

Alins(s):

JEFREN HERNANDEZ

Event#:

l(b )(7)( E)

Event #:

Kb)(7)( E)

Ni:

206418141

A#:

2064 18 141

DOB:

02/13/1985

DOB:

02/13/1985

COB:

MEXICO

COB:

MEXICO

Disposition: Expedited Removal (1-860)

Disposition: ExpeditedRemoval(1-860)

A~( '"i CAN

pVERSIGHT

DHS-ICE-19-0196, 19-0197-G-000049
2019-ICLl-00051 1749



l(b )(7)( E)

!(b)(7)( E)

Fi'st:Name
1.FAMILYNAME(~
1.et16s)
HERNANDEZ RODRIGUEZ, ROY ALEXANDER
4.Alias HERNANDEZ, JEFREN
HERNANDEZ, JEFFRY

7. BirthDate

Mldcle~

2.~
33

Event

No:

!<b )(6):

3. CCA..nby
ci Gtizenstip
HONDURAS

RODRIGUEZ
8. BirthPlace HONDURAS,

N / A,

HONDURAS

02/18/1985

9.Sex
Ii] Male
11.FileNumooA206 418

? Rmale

12

ecro

ER/CF

HONDURAS

(Explain)

DatePoste:i

141

Yes

14 Mede.al
Alert

13.0NS

D

10.(K/WA':GBPJvelJ
Yes
6'I No

0

Yes fKINo
15. lRANSFERDATE

(Expan)
MA .

FROM

TO

A
B
C
16.ADMITTED
BY:

19. RB.EASED
TO:

17.SEAROiB)IN BY:

20. RB..EASED
BY:

18.DATEADMITTED:

21.DATERB.EASED
:

24. Remarks: Subject

ID

22 Rt IndexPrint- In

23. Rt I.ndexPnnt. Qt

361342789

FORM 1.385 (08/01/07)
ALIENBOOt<ING
RC-CORO
UNITI:OSTATES
OEl'ARTMENTOF
HOMELANDSECURITY

AME-~CAN

pVERSIGHT

DHS-ICE-19-0196, 19-0197-G-000050
2019-ICLl-00051 1750



Page 1 01

,

U.S. DEPARTMENTOF HOMELAND SECURITY

FORM 1-218, RECORD OF PERSONS AND PROPERTY TRANSFERRED

Date of Transfer.

No M
1

Friday.May 11

1

From:

2018

Nameof Person

206418141 HERNANDEZRODRIGUEZ,ROY ALEXANDER

Sex Citlzen:lhlp
M

Birth DB1e

stal\ls

HONDURAS 02/18/1985 READY FOR TRANSPORT

Use a separate nne for eael't person llanaferred.

To:

ICE-ERO
o PENDING PLACEMENT

Medical Status

fo)(7!

Baggage Check t

Good

~b )( 7) ( E)

TTJ2.86JI64

Received the above listed persons, property and baggage checks

1. Shew whether deport, ram011alelc. ..
2. Explain: canvld.lcn/lraud, dangerous, likely ta escape
3. Shaw wt)81.heralien detained al Service expense lmmadiately prior to transfer
4. lncficatemedical smtus.diseased epneplic,Insane etc.

~04

Signature:
Printed Name and Tltfe:
Transfer Authorized By :
Place and date :

~

2019-ICLl-00051 751

DHS-ICE-19-0196, 19-0197-G-000051

5/11/2018

)



a"

POINT OF CONTACT

PRINCIPAL

ALIEN:

.o..

INFORMATION

Roy Alexander

HERNANDEZ

Rodriguez
COUNTRY

OF CITIZENSHIP:

Honduras

A# 206 418 141

POINT OF CONTACT:f b)(6); (b)(
?)(C)
~-------------'
RELATIONSHIP:
Brother
PHONE NUMBER(S):
ADDRESS:
STATE:

CITY:
ZIP CODE:

TOTAL#

IN FAMU 1

(INCLUDING PRINCIPAL ALIEN)

AMER CAN

pVERSIGHT

DHS-ICE-19-0196, 19-0197-G-000052
2019-ICLl-00051 1752



Page 1 of 1

U.S. DEPARTMENTOF HOMELAND SECURITY

FORM 1-21&, RECORD OF PERSONS AND PROPERTY TRANSFERRED

DataofTransrer.

Fridav,Mav11, 2018

From:

ND M

Name DfPerson

Sax Citizenship

1

HERNANDEZRODRIGUEZ,ROY ALEXANDER

M

206418141

Birth Date

HONDURAS 02/18/1985

To:

ICE-ERO - PENDING PLACEMENT

I

Stall.IS

Medical Status

~(b
)(
..,. , 1 r-

READY FOR TRANSPORT

Good

i(b)( 6 ):

Baggage Ched: #

I

7732863164

Received the above listed peraans, property and baggage checks

1. Show whether deport. removal etc...
2. Explain: conviction/fraud,dangerDus,likely lo escape
3. Show wllell'ler alien detained al Serv1oeexpense lmmed!ately prior to transfer
4. Indicate medical status, diseased epllepllc. Insane etc.

Use a separateline for each person transferred.

2504

Sl9nature:
Printed Name and Title:
Transfer Authorized By :

Place and dais :

(

DHS-ICE-19-0196, 19-0197-G-000053

2019-ICLl-00051 11753

5/11/2018



Page 1 of 1

U.S. DEPARTMENTOF HOMELAND SECURITY

FORM 1-218, RECORD OF PERSONS AND PROPERTY TRANSFERRED

Date ofTransfer:

From:

Frtdav, May11,2018

No M

Name of Pen.on

Sex Cilitan!lhip

1

HERNANDEZ RODRIGUEZ.ROY ALEXANDER

M

206418141

Birth Data

2504

Status

HONDURAS Ol/1811985 READY FOR TMNSPORT

To:

ICE-EROo PENDING
PLACEMENT

Medical Status

(b)(7)( I

Good

ith H R\.

BaggageChed<#
1 773286ll

64

Racelved the above 1fstadpe111ona,property and baggage checks

1. Show whathM deport, removal etc. ..
2. Explain: conviction/fraud, dangaroua, lil!aly to 1t9C8pa
J. Show whethar alien detained at Service expanse lmmadlataly prior to transfar
4. Indicate madlcal slaws, dll88&ed apilaplic. ini:,ane etc.

Slgn.atura:
Prtnted Name and Title:

Use a saparalDJina for aadl P8f9C)ntransfarred.

Transfer Authorized By :

Place and date :

(

r

AMFRICAN

It-I

DHS-ICE-19-0196, 19-0197-G-000054
2019-ICLl-00051

} 754

5/11/2018



!(b)(6); (b)(7)(C); (b)(7)( E)I
U.S. Dcpar lmcnl of ll omcland Secu r ity

Subject

Record of Dep ort able/ln admi ssible Alien

rD : 3613 4 2789

l-ltsr

Ey<<

Cmplllll

BRO

BRO

LBR

We,ght

Occupation

Mjddlc

f amily Namo(CAPS)

BERNANDRZ RODRIGUEZ, Roy Alexander
Couinryor Ci11un,h1p

fl o N11rnh:c:1

Cas e No ~r~h~\~/~~w\~.---~

HONDURAS

160

A206 4 1814l

Scan:and M111ks

U,S. /\dJrc,s

OHS CUSTODY
P:tSSM
ger Boarded at

b)(7)( E)

T I JUANA
Numb-.c.r,
S11c:c1,
Cily , l'rovincc (Suitt) and C01.mtryofPcrmM cnl Rc.11
ldcm:c

ISP
OG.ti.,
orAttion

DAieof Uuth

02/18/1985
ury, ""'"""

05/11/

Age : 33

ll

(S1.. ,) Md Countryof Ruth

(ID

Loc11ri0fl
Code

2018

Date/Hout

At/N ear
SYS

SND/SYS

05/09 /2 018 1433

Form . (Ti-pc and No ,) lifl,d O Nocl,Acd 0

HONDURAS,N/A,HONDURAS
NlV l.u,11nKf'oit and !',1VNunib<r

SoctAISecurity Aa:ot:ru Name

None

None

StmJ> When Fo<ald

Siat\d 11 Entry

TRAVBL/SB&IO'.NG

No Documents

D~tc \'1u lnucd

Soaal S<<-u:uyNumb<,

t.,,,~th ufTimc llkpllym US .

None

None

AT ENTRY

lmm11.11t.16n Rerord

Cnmlfla.JRecord

POSITIVE

Non e Known

- See Narrative

Number .-.d Na.uonaluyo( M..inor C1iildrm

Name.o Addrcu.. J.nc'.f
Nthonallty of Spouse (Maiden Name. 1f AppropriAIC)

NONE
Mother's Prcscnl ~d M1tdrn NlllllCS
, N~ionlllity, Md Adds~s. if Known
t l-. \1 "7 \l r- \ f llTIONALITY:
HONDURAS

!t C...\I C, \.

f ingerprinted?o

~Ionics 0ue/r1upc:r1:yin \ J,S, Not m lmmcdi3lCPossession

None

~

Ch"l! o CodoWord!(, )

Yes

I7Al.

Claimed
T)'P<orUn,ployme,11

Nomo ond i\ dd,,s o of(Lut)(C' orrcnt) U.S. En,ployor

F.mploted from/to

Sal111)'

'"

N:m1111ve(OutllPe p1rucul1.I'; under which 11lienwu lou tr d/app rchende-d. Include d<UUl.tno t 5hown abov-c rcgudin ~ lime-. pl?ce and milnner of l<l.Jlentry , 1ucmp1td entry , nr-any other tntt y , and
c:lenunu wh1th c..sc.abhsh admini!i tr :uiv~ and/o r crimini:al viol :m on lnd1c-01cmun, a.nd rou te of 1u ..oe-lto interior ,)

l(b)( ?);.i_b)(7 )(C);

I

Left

Index

fingerprin

t

Right

I ndex

fingerprint

OTHER ALIASES KNOWNBY:
HERNANDBZ1 JEFREN RODRI GUEZ
HBRNANDBZ,JBFFRY
HBRN.ANDBZ,JEFRBN
HERNANDBZ-RODRIGUEZ,JBIFRI
HERNANDEZ-RODRIGUEZ,JBI FRI ALEXANDER
. . . (CONTINUED ON I - 831J

(b)(6);

~..=-11
(b )(7)(
CBP OFFICE C)

..._l
(b.,_,_
)(6....c;,.
);
I\Ue-n ha.s been 1dvucd of communic-uion

1

pri v11c:s cs:

AFILE

nuuro

?nd

T11le-o f lrnrrui.;n tio n Officer)

(Re~o ,1 of Inter view)

01 str1bu11on .

om<< (b )(6); (b )(7)(C)
on;

Di, oo , i tion ,

(b)(6) 1---

20 1

May l l.,

Exped it ed Removal

Examinln~ Officer :

7
)

wi ~~ ))(

pVERSIGHT

-

ib le

Fe ar

(b)(6); (b)(7)(C)

'--------.--------~
AMFRCAN

(1imel

3(Rev. 08/01/07)

DHS-ICE-19-0196, 19-0197-G-000055
2019-ICU -00051 1755



Alien' s Name
HERNANDEZ

RODRIGUEZ

,

Roy

I213

Continuation Page for Form

U.S. Oeparlmcnt of Homeland Secu ri ty

File Number b 6 .
(b)(6): (b)(7)( C): (b)(7)( E)
Event No: b)(6): (b)(7)( C):

Alexander

Dal e
05/11/201B

HERNANDEZ-RODRIGUEZ,YENFRI
SECTION CODES
212a7AiI

FUNDS IN POSSESSION
United

States

Dollar

6.00

On May 9, 2018,
at approximately
admission
into
the United
States
Ysidro
Port of Entry,
California.

1030
from

hours,
Mexico

Roy Alexander
HERNANDEZ Rodriguez
via the pedestrian
primary
lanes

applied
for
at the San

Customs
and Border
Protection
(CBP) Officer
~kb=
)~<~S~
):~-~
pedestrian
primary
lanes
when HERNANDEZ approa .c,ll~1,.,.,;i:.a.i:..,,,J.IJLAC2B.1~
.~-1..C.u..._m:.w~~.ti-"iL....l!la.lLICli2L.llLl2.c1.Jlie.Jil.aJ..QILQf any
valid
u. s. entry documents.
(b}(7)(E); (b)(3) Unspec1f1ed Statute
CBP
Officer
!rh)fn).
I escorted
HERNANDEZ to t e
n o.rcemen
ice for
f urther
inspection.
While
in seconda .ry,
CBP database
queries
HERNANDEZ was issued
Texas .
During
an oral
Officer
!<b)(6):
the following:

the biographical
infor1I1ation
and
indicated
prior
immigration
and
A#206 41B 141 for Prior
Expedited

interview
and
witnessed

Iand

sworn statement,
by l(b)(6) ; (b)(7)( C)

HERNANDEZ admitted
Honduras.

being

a citizen

HERNANDEZ admitted
through
the United

not possessing
States.

HERNANDEZ admitted

being

HERNANDEZ admitted

to

any

single

have

and

with

departed

conducted
in the Spanish
language
by CBP
HERNANDEZ freely
and voluntarily
admitted

national
legal

fingerprints
of HERNANDEZ were queried
criminal
h,iatory
for HERNANDEZ. H
Removal
on 01/23/2014
in Houston ,

of Honduras
en try

by birth

documents

to

in:

enter,

Comayagua,

reside,

or pass

no children.
his

home in

Honduras

in

AR~il

201B.

r o .

HERNANDEZ admitted
river
into
Mexico.

have

traveled

HERNANDEZ admitted
to have
by train
and bus to Tijuana,

s tayed
Baja

HERNANDEZ admitted
caravan
of Central

to

to departed
Americans.

HERNANDEZ admitted
to not paying
. . . (CONTINUED ON NEXT PAGE)
Signature

by bus

until

five
days
California,

Tapachula,
money

in

arriving

Tapachula,
Mexico.

Chiapas,
to

anyone

(b)(6) ; (b)(7) (C)

to

Mexico
to

t ravel

Guatemala

and

Chiapa~,

Mexico

on April

201B

from

Honduras

then

befor

crossed

e departing

accompanying
to

the

a

a

U. S .

Title
CBP OFFICER

_ _2 _ of ___ 3 _ Pages
Forni 1-831 Continuation Page (Rev. 08/0 1/07)

pVERSIGHT

DHS-ICE-19-0196, 19-0197-G-000056
2019-ICLl-00051 1756

.



.

.

US . Department
of Hom eland Secu ri ty
'

Co nt inu at ion P age for Fo rm

HERNANDEZ admitted

to

have

arrived

to

File Number A206418141
l<b)(6): (b )(7)(C): (b )(7)( E)
Event
No : ~b)(6): (b)(7)(C):
Tijuana,
Baja Califo rn ia,

HERNANDEZ admitted

to

have

arrived

to

the

United

HERNANDEZ admitted

he would

reunite

with

Al ien 's Name

HERNANDEZ RODRIGUEZ,

,.-

Roy Alexander

to

like

States
his

Date
05/11/2018
on April

Mexico

on May 9,
brother

I213

in

201.8 and

the

United

2018.
asylum

requested

,

States.

(b)(?)( E)

I
HERNANDEZ admitted

that

he was

HERNANDEZ admitted

to

not

HERNANDEZ admitted

to

having

been

HERNANDEZ admitted

to

being

arrested

HERNANDEZ admitted

to

have

have

raped

by

asked

for

four

removed

help

in

the

in

from

4 times

resided

members
his

the

while

United

of

the

Maras

country.
United

States.

living

illegally

States

illeg~llX

in
I

for

the

States

United

t wo years.

l

(b)(?)(E); (b)(3):Unspecified Statute
While detained,
o r ganizations

HERNANDEZ was were provided
and attorneys
which provide

HERNANDEZ admitted

to

not

having

no Point

meals.
free
legal
Of Contact

HERNANDEZ was
services
.

provided

with

a list

of

information.

I

HERNANDEZ was provided
DISPOSITION:
HERNANDEZ
was detained
(b)(?)(E);
I

wi th ~b)(?)(E); (b)(3)Unspecified Statute
the custody
of Department
of Homeland
Security
under
1 HERN~EZ
is presumed
inadmissible
( h \17\f ~ \ - /h\/':t\ . l lncnor
ifio n ~tah 1to
and
212 (a l ( 7 ) (A) (i l ( I l of the Immiaration
the Unit e d States
in accordance
with
into
Nationality
Act, ~b)(?)(E); (b)(3)Unspecified Statute
land
Executive
Office
of Immigration
Review.

...

~ ~ "')

~

Signature

(b)(6); (b)(?)(C)

ITit le
CBP OFFICER

3

of

3

Pages

Fonn 1-83 1 Continuation Page (Rev . 08/01/07)

pVERSIGHT

DHS-ICE-19-0196, 19-0197-G-000057
2019-ICLl-00051 1757



~h \ /l'l \. f h \ /7 \f (' \. f h \ /7 \f l=\

l

DATE PREPARED

05/11/2018
1. NAME

20,

BBIIIIMllD llODILI CWIIZ

0. OATS OP BIRTH

41.8 1.41
M

See

oo cnize:NaHIP

1-831

BONDVJUUI

, .._ Pl.AC& OP BIR'Tli

,=

02/18/1995

a.

ALE

.

3. Oll1EiR NAMES U8m> 0A ICN0WN fN

n

lA

INFORMATION FOR TRAVEL DOCUMENT OR PASSPORT

.. 8EX

11.oy Alazandor

7. HEIGKT

JtV11nt Ko I l(b)(6); (b)(7)(C); I

I

BON1l'l1US

Jll/ I.

KOlnltrUJI

1= ICOMIUXION

IWEICUff
160

NEAAE8T LAAG6 CITY TO PlA06

IIWldOA90AA8

~R

8. 018TANCe AND DIR20Tl0til

OP BIA'TH

OF PI.AC6 OF BIR(TM) PROM THJS I.MO& CITY

10. IF Cff lZl:N8HIP 18 DIFFIIA&NT FflOM OOYNTRV OF BIRTH. ll!JCPLAIN.lF NAT\J.MUZl!D IN Al<< COUlin"AV. SHOW DATE AND PI.AC8
OF NATURMJZATION. CERTIP10ATe ~&ER,
ANO &TATE HOW CmzEHStl.lP W/1.8 AOOUIAm.
S0lfDUIU,.I

11, HAMES: LOCATIONS AND DATEB ('l'EARSI OF ATTENOAHO&
OF FOREIGN 8CHOOL.8

12. NMIEJI, EXACT LDCAnDNB AND DATES~
ATll!HCNCCB
Of' R)N!IGN Cl4UACHEL IHCI U0B DA
ANO
'T\,IRE OF Nff
RBUQIOi.e CEJIEr,a::)MY WHICH MAY MA.Vii 8l!l!N RECCRDED .

.. ,.

Kot Applicable
1$. I.AST ~MANENT

.

.

Kot:" Appllcabh

/...,,._,,,...__,
---.-.-.
,..._,,,.......,_,...,__.._I

N!.810SH08 IN 00WCTRY OF crnzacatlP

14. ADDRE88 IN OOUNTR'f' OF LA8'T FOAIEIGH RS81Cl!NCtl

..

18. Pl.ACE OF ENTRY WTO UNrn!tl

BAH YSIDRO,

8TATE8

CA

.

l

DAT& OF ENTRY INTO UNITl!D STATE&

5/t/2018

10)0

18. UST DATli AHO fll.AC&OP saauAHCe AHD NUIMIER OF PAS81'0RT, BIA'TH CER'TU'10AT1;. BAl"TIIIMA.LCERTIPICATE OR COCUMl!HT
OF IDENTIT't'. 8P&01PY DAT&S OP MIUTAAV 8ERVICE, 00I..IHTRY ANO UHl'T, RAHi(. 8ERW.. NUM!Mm, AND PL.Aeea OF INDUCmON
..
AND DIACHMCH!.

WOHi
17. IN POIMIIINIQN OF TAAVl!L DOCUMENT' 0A I'~
AT TINE Of' EN'TWf: ? YES ii NO. D&aa.111& DOQ I~),
IF 8ua,EOT
P~
AT TIME Of' EHfflY 0A DOI!& NOT HAY'li ~ ADOQUMINT
, INDCOATE
010 NOT tlAVI! TAA\IQ. 00CUM6HT'~
~ffl
E!V1:ROBT"'NEO ONE:
VR
NCJ..8TATI? Haw,
MD WKl!Ali rr WNJ O AINeD: ~T
KIND Of' DOCUMl!JfT
IT WMI, AND WHAT BECAME OF rt'.

WHEN,

Mot Applicable

..

1a. FATH&R"S HAMB
p..,.u.10
~n

I

I
I~;;F
I I

PRE8GBPNT ADQfll!U
19. MOn4ER'eMAIDSNNAME
Mado
IIOIJRICIVBZ

""

.. ....

l'LACE OF Ill~

0.-.TBOFBtffflt

~

~

. ..1ptACEOFB1~

IIUfflt

PfUi8ENT ADDRSSS

..

110. NAME, RE1AT10NSHIP. AND ADOR688E8 OF ASLATl'\IE8 AIIRCU'D

"~

..

Not Applicable
11, Pf\EV10U8L Y

U

EXQ I IDE> ? DEPORTliD

ON

.. . ..
o.

? NiQUIIUiD

T0 Da"AAT

Kot Applicablll

r"""J
~o
VE8

tc-71

IN PRISON CA A f'U8UO IN8TT'T\1"0N
NO. IF 80. GIVE 0A.Tlil8 AND l'lAOE8

oat

IN THII OOUNTI'IY OF .Wt:41CHA NATIONAL,

1:
~"..
rr .,
, ;~!

1.

MC

DATI? AND PUCE OF MARJ\lABE

-

~

r~vEFf
? rcrA
u.s.

,'
.

.

.

auo ,

TO CANADA.GIVE DATE

Kot Am>lielll>lo

. '

.

., "

:M. NAME& AQll8, AND ADORE.88EII OF AU.CNILIJREN

Dl!PORT'ABL&

o

Applicable

23. NAME, NATIONAUTV AND PRESeNT ADDRESS OF 8P0U9E,

N(D

PCftTOP

ARRIVAl. JN CANADA, NG

NAME OF VEa&a..

--

Dtpar1me?I of Homtla11dS<<urily

~

..

l ~

TO

i-i

2l5. 11'N0NCANADIAN

,I

Pfl0 .. 1l4E UNrral> 9TATES

VLlt,

Z2. INDICATE WH~
JEOT OR cmzl;N:

~

DHS-ICE-19-0196, 19-0197-G-000058
2019-ICLl-00051 1758



Page 1759
Withheld pursuant to exemption
(b )(3):Unspecified Statute
of the Freedom of Informat ion and Privacy Act

Atv.(:~CAN

pVERSIGHT

DHS-ICE-19-0196, 19-0197-G-000059



Page 1760
Withheld pursuant to exemption
(b )(3):Unspecified Statute
of the Freedom of Information and Privacy Act

AMc ~ICAN

pVERSIGHT

DHS-ICE-19-0196, 19-0197-G-000060



Bn1.ea u o f C u stoms aucl Borcle1. P1.otectiou
Sau Ys id r o Por t of Eu try Admi ss ibility Euforceme u t l:u it
Co mput er C h ec kli s t fo r Expedit e d nnd Ot h er RemoYal s

Name:

I

Alien Regis tration Number:

I

Prior Expedited Removal:

0

EOIR /J removed:

? YES

0

NO

MALE

Sex:

206 418141
HONDURAS
YES
? NO

02/18/ /985

DOB:

HERNANDEZ RODRIGUEZ, Roy Alexander

Cou nt ry of Citizenship:

o

Fraud type:
Date:

01123120/4

Date:

ASYLUM
Location:

I

HOUSTON

!Location:

ERCF/Detain ed

DISPO SITIO N:

RESULTS:

SYSTEMS QUERIES:

b)(?)( E)

0

Pos111ve

?

Pos111ve

? Negative
0 Negative

u

Posu1ve

~ Negative

0
?

Positfre

? Negative
0 Negative

Posufre

Warrant:

N

TLookout:I

?
0
0

Positive

0

Negative

Positive

?
?

Negative

Positive

N

Negative

C RIM INA L AN D ID ENT I FICAT ION I NFOR:\IA TIO N:

(b)(7)( E)

NIA

Criminal State Identification Number:

(b )(6); (b )(7)(C);
(b )(7)( E)

NIA

State Identification Number/Driver Lie :

Nll t

Social Security#:
ITECS:

0

D

Kb)(?)(! Inpu t Com plctc (i.c cha rgc,

l(b)( 6); (b)(?)(C)

p o1uAR : I

l(b )(6); (b )(7)(C)

~

G- 166 (If appli ca ble)

,uldrc ss, rclati\'C s, misc numh crs}

!E\'cnl Pa ge in ,\ File

0

kb)(7)( E)

0

FD-2 49 (Ca rd or Paper)

0

R-8 4 Fin al Dis pos iti on Report (if nppl ica blc)

Kb)(6); (b)( ?)(C)

0

II

0

Co py of l\li sc Docs
(i.e. mat-wit info, s eized d ocu ment s, etc)

1--BJ (D} Referra l

0a ggagc C he ck#

U.SC BPOff !CER

FILE PREPARED DATE:

-----------7732863/6 4

5110120/8

*iVIA ND/\TORY Printed Name & Title of(Fi lc) Prepari ng Office r and date

AML--{CAN

pVERSIGHT

DHS-ICE-19-0196, 19-0197-G-000061
2019-ICLl-00051 1761



05/11/2018
01:23

CLAIMS MAINFRAMESYSTEM
UPDATE PROCESSING MENU

l(b)(6);

f b)(6): (b)(7)(Cj

SELECT AND COMPLETE ONE LINE
1.

RECEIPT NO. :
(SELECTIONS BELOW FOR APPLICATIONS

PETITIONS ONLY)
DATE:

2.

USER ID:

3.

BENEFICIARY/APPLICANT
NAME (LAST) :
BIRTH DATE:

4.

A NUMBER:

5.

REFERENCE NO.:

6.

AND

(MMDDCCYY)

(FIRST):
(MMDDCCYY)

A2 06418141

PETITIONER

{FIRST):
FOUND
FOR
THE
ALIEN
NUMBER
AS
ENTERED
NO RECEIPTS

NAME (LAST) :

DC997986

l(b)(7)( E)

AML--{ICAN

pVERSIGHT

DHS-ICE-19-0196, 19-0197-G-000062
2019-ICLl -00051 1762



l(b)(7)(E)

SELECT
1.

05/11/2018

CLAIMS MAINFRAME SYSTEM
UPDATE PROCESSING MENU
AND

01:23

COMPLETE ONE LINE

RECEIPT NO.:
(SELECTIONS BELOW FOR APPLICATIONS AND PETITIONS
DATE:

2.

USER ID:

3.

BENEFICIARY/APPLICANT
NAME (LAST): HERNANDEZ RODRIGUEZ
BIRTH DATE; 02181985
(MMDDCCYY)

4.

A NUMBER:

5.

REFERENCE NO. :

(FIRST):

ONLY)
(MMDDCCYY)

ROY ALEXANDER

A

PETITIONER
NAME (LAST) :
NO RECEIPTS FOUND FOR NAME ENTERED.
6.

fb)(7)( E)

ENTER RECEIPT#

I

AME-~CAN

pVERSIGHT

(FIRST):
OR A-# TO CHECK ARCHIVE.

DHS-ICE-19-0196, 19-0197-G-000063
2019-ICLl-00051 1763



U.S. Customs and Border Protection
U.S. Department of Homeland Security
Yb )( 7 )( ~ Person Query
Generated 8y:l(b)( 6 ); (b)(?)(C)

05/11/2018 01 :51 AM EDT
~Crtl8r1a
Record

(b)(
Last:

Page 1 of 1

JD:

Name~

HERNhNDEZ

ROY

Kiddle

N

l)cb

(Start

STC:

Doc

N:

St,.te/Prov:

Alien

N:

Alien

Rcpt

J.Usc

Pilot

Lie N:

Pilot

Country:

First

Nar..c:

Name:

y

A

RODRJGIJEZ
Nickname:

N

SSN,
entry
Hise

or Issuance:
N:

Criminal
Phone

Affiliation:

Soundex!

Type:

Case#:
Alt

N:

ATF Profile:

(Eridl,

InterNt

A

N:

Alt CC>mT!\
Type:
Non S1,1spccts:

't

Archived

N

Incident.

y

Secondary

N

NLE'TS

y

NLETS

State

NLETS

State!5):

CTI"P:

Electronic

Kedia:

JI

CTI"P:

NLETS Statc(2):

TX

IILETS

OUR:

N

Stcate

w
Country:

Sta::es:

NLETS State

(l):

Race:
Address

LogG:

Fin Account,

14) :

Gender:

)

l Pre fix:

y

y

Control

Deb

Doc Type:

Ph<;,nc Type:

Comm:

History:

Record

02/l8/19R5

Sub-Records:

Encounter

OTTS Type:

l :

M

State/Prov:

Record&:

Inspections,
( 1) :

y

Y
CA

Citizenship:
ASA:

N:

[Total Number of Records:D

)

AMERICAN

pVERSIGHT

For Official Ilse Calv 'LaJPY.' liAleFBeR'leRt&enaitlote
DHS-ICE-19-0196, 19-0197-G-000064
2019-ICLl-00051 1764



U.S. Customs a nd Bo rder Protection
U.S. Department of Homeland Secu rity
Person Encounter Detail
Page 1 of 1

Generated By : Kb)(6); (b)( ?)(C)

05/11/2018 01 :52 EDT

Encounter
Last Name

Arst Name

HERNANDEZ RODRIGUEZ

ROY

Document Numbor

Person

Detail

Mlddle lnitul

c;.nder

M

0 2 /18/1985

Document Type

Document Country

Cl~U of Admission

Admit Until Date

EncounterUno Tvoa

Encounter Date

Encounter Tlme

Terminal Lane

Site/Encounter Loc ation

PEDESTRIAN

05/09/20

14 : SO

R9VE

L2 55 - CBP-S AN YSIDRO ,
LAND BORDER

Enc ounte

Inbound/Outbound

IN BOUND

18

lt nspector
I

l(h )( R ). ( h )f7H

r. )

I

r Person

Date of Birth

-

Detail

-

I Pflm.a,v Query Re5u1t

I Reten"NI To Aaency

I

lrns

-

Man ifest Data
Manifest Indicator

IPassenaer Status

IFllahtNesse!

N

I

I

Transmitted Bv

IDeoarture Loc ation

Number

l camerCode

IAnival

I

I

I
Location

)

AMERICAN

pVERSIGHT

For Offi~ial U&;eOnlJ ' Lao EHfereeFReRt ao R&itiue
2019-ICLl-00051 1765

DHS-ICE-19-0196, 19-0197-G-000065



U.S. Customs and Border Protection
U.S. Dep~t
of Homeland Security
~ Query Result
Page 1 of 1

I

Generated Bv: l(b)(6); (b)(7)( C)

05/11/2018 01 :52 EDT
REQUEST

A . D03/1985

70497364

05/11 / 2018

! .TXT NAM/HERNANDEZ RODRIGUEZ,R OY

~b)(6).

Seo

Date and Time
01:51:25

--

Reauest Messane Detail
DQ. CACBP3615. CA. TX.

0 21 8.SE X/ .

.

RESPONSE

I

Source
1,1-..\/

DR.TX OLNOOOO
22 : 51 05/10/2018
22 : 51 05/10/2018

irh HR).
IX I

19520
86293

I

I

7 \/ C:\

Date and Time
05/ 11/2018

01 : 51 : 26

I
I

.

.o

..

Status
Unacknowledqed

CJ\CBP3615

I

QUERY DATA
NAM/HE RNANDEZ RODRIGUEZ, ROY DOB/1985 - 02 - 18 SEX/M
NO RECORDS FOUND

RESPONSE

I
T

Source

L-'h
\/ 7 \f l=\ I

Date and Time
05/ 11 /2 0 18 01 :5 1 : 26

I
I

'

.,,,.

,,',

St.itus
Unack nowledoed

DR. CAOLNOOOO
22 : 51 05/1 0/ 20 18 428 28
2 2.5 1 05/10 2018 86291 CACBP3615

lrnwn.

1

TXT
DATE: 05.10.18
*TIME: 22.51
HERNANDEZ RODRIGUEZ ,R OY A;B 19850218
ERRORo
NAM
ANI END

AML--{CAN

pVERSIGHT

For Official Use Only / Law Enforcement Sensitiv e

DHS-ICE-19-0196, 19-0197-G-000066

2019-ICLl-00051 1766

' .'



U.S. Customs and Border Protect ion
U.S. Dep~rtroeot of Homeland Security
} )(6); _, ~uery Result
Gen erated By. kb)(6). (b)(7)(C)
'

05/11/2018 01 .53 EDT

I

Page 1 of 1

..

REQUEST
Reau est Messaae Detail
lNOlNN70497357.QW.CACBP3615.NAM/
HERNANDEZ RODRIG~Z.ROY

RESPONSE
Source

khHRI

-

A . DOB/ 19850218

.: ..

I

I

Date and Time
05/11/2018

01:51:24

..

Date and Time
05/11 / 2018 01 : 51 : 24

l
I

,, .,._,.,. ....
,
Sea
70497357

.--....
..., .o' .,:' '?'. _,..

Status
Unacknowl

eda ed

1L01NN70497357
CAC3P3615
NO ~ WANT NAM/HERNANDEZ RODRIGUEZ, ROY A DOB/19850218
o oo MESSAGE KEY QW SEARCHES WANTED PERSON FILE FELONY RECORDS REGARDLESS OF
EXTRADITI ON AND MISDEMEANOR RECORDS INDICATING POSSIBL E INTERSTATE
PERSONS
EXTRADITION FROM THE INQUIR ING AGENCY'S LOCATION. ALL OTHER~
FILES ARE SEARCHED WITHOUT L IMIT ATIONS.

AML--{ICAN

pVERSIGHT

Fer OUieial Use ORiy / Law Enforeeme 11tSe11~itioe

DHS-ICE-19-0196, 19-0197-G-000067

2019-ICLl-00051 1767



Vehicle /Pedestrian Lane#: __
Primary Officer : _ _ ___

Release Time : __

___

_ __

_ _ _

___________

_____

__

__

______

Search Start Tim e: _ __

_
_ _ _

Appendix
**o*.
~
~

__

____

_

Arrival/Inspection Date & Time: -~;....;S:;...,..../o
=-?'-'--/--'\--='6a.-.
__ _ _ _

_ _ _

_______

_____J

IOAA#: 2018-AR- _ _ ______

_

Wris tband Color: ____

Claim/Bag Check#: ___

IOIUSAS# : 2018-2504- _._____________

_

Off icer Completin g Form: ________
Basket#/Letter; __

.. (b)(6); (b)(7)(C)

It-------t

kb)(7)(E)
.__ ___

_

__

Secondary Officer : _ __

Mc__,,,

__

Search Stop Time: __

__

Sector Notified At:

Agen t Responded At: __

Agent Arrived At:

fb )(7)( E)

_

_ _

D - SYS P.O.E.

Persona l Search Worksheet

o*" * .. ..... ~ ..........
"'A ,. o ...,, ---...o**H* *......................
.........tt o .--oo*:i,** o *o Jt.......o ....
"...o ...,. ...... 11.. "'I\....... .. ****"****"~*...o ? ? o o o 4
SON SEARCHED: ARE YOU ILL, TAKING Af\lY EDICATIONS , OR ARE YOU UNDER MEDICAL CAR E:
NO, IF YES EXPLAIN: ___J~'"!:.
~\):....._
- .....:O~Q.,:::.;
~\ec.,
~ .~-;\,<\,,L_.....:~=--.u,i.iu_~()..~L_
- -------- - -,i ....

<i ,.,. ...

o

Name, Last

,.-Jft

<II

ir- ~ llt .. 11;

~<\

\\Q,t'(\().V\c}Q;i.

Alia s Names & DOBs Used: _ ______

_ _ _ _______

'UJ(p41Q i~1
,:n_/\~/~S AGE : ? :>

Alien File#: A

SSN: _______

DOB:

MINOR?

YES?

N~

_ ____

State: __

__

__

--

----

POB City: __

___

Residence Address: -City: ----Race:

--

W

----

-,--- ---

\v\'

Sex:

__

_ __

___

__

- ----

_

Marital Status: __

NO[&

c;Dct ~ &3

~\6

Eyes

---

_ ___

"6t"-r,

_

___

_

__

_

\- 3/4 "-J,..:Q
:._
V'l---=6-=V
:..;f
:..:O.:.:..S..L-----

------

Zip code : _ __

Hair:

___

_ __

SID#:___

Country : __

----

- ----

WT:

YES?

UAC?

F\\~'f\(}QX

Middle:

_ STATE DLN (OLN): __

---

State: ~---

HT:

'\f.-Oy

First:

0\)Q,"2.

------

Country: ----,

----

\\a'AO\)f(Xl]

Citizenship:

*o**********~o*********~*****~****oo..,.._~*
oo. .. . .oo ***************o*******~-o oo o ooooo o*****X***oo~. . . ~~- ~~~-~-o ***~~~,\ilr#kif-***
***********~o*****

W

Conveyance Type:
Vehicle Make: __

_ __

In/Out:

AY\

Model: __

Color: _ __

_ ___

'<.

Results : Q_

Search Type: _ _ ___

(PIN) If Search Positive : __

___

License#: _______

tt ooooo fto-oo..,,
...-k1t*****.......**.,_.***1t*****
o oo71.lt
oo oo 4 t:******....-111:
***********ti***tt
Incident Type:

VIN : __

__

______

__

Year : ___

o o..-,,-6:. .............

_ __

o ~oo1t":it*H-...1r"#fo o..o

oo oooo

ST/CTRY : _ _ _ _
--

Funds on Person: (USO) S

_

oooo********ill*iil*oo;o.oooIt111>**

Reason For Search : ---------

_ ____

_ ____

Co

- --

- --,-

Rf

other Funds:

Incident Types: N=Negative Search; P=Passenger Protesl; R=Port Runner, T=Pote ntially Violent; O=OTHER ; S=Non-SAS POSITIV E Search; C=Non-SAS
Category II Violation (e.g.: AD-Forced amended Declaration : AG-Agricullure Violation; IN-Immigration Violation, NC-NCIC Intercepted; X-Non Extradited; OTOther Agency (I.E., FDA); PR-Prohibited/Abandoned Items)
.
(b)(6); (b)(7)(C)
1 ===
Search Officer.'=.
===

.

=i===.1 W itness:

J (b)(6); (b)(7)(C)
1

Authorizing Superviso r:

___

L

rb )(6); (b)(7)(C)

.
.
1-

...__~

, _____

__J

_

... ... . ... .... .. (b)(7)(E)
(b)(7)(E)

EV ENT#: SY
(b )(7)(E)

IF YES . LO, RC I AR x: ---

Released To : 0W D/ER (VR)
Released By: ______

?North (USA )

_ ___

Supervisor Appro ving Release: ___

?P.E.T.

[]OTHER : ______

Date Released: _ _ _____
_ __

___

'i1 f S-1<ef ~

FINSt:

_

Time: _ ___

_ ______

_ __

_ ____

Typ e of Fraud: OFC? DFC0 EWl 0 I MP? CFT/AL T DOCS? T/ HO ASYLUM?
O
Smugg ler/Driver
D Co-smuggler/passenger
Type: ___
_ _ _ ___
E': -=-=:;.,;;;...
____
-=:..._
__
....;;_;:..._....;...
_ _ .;;....__ Document
~..,
(b)(7)(E)

_

NOD

1,b)(?)(E)

!Event:

(b)(7)( E)

I

_

Total# of People in Vehicle : ___
Concealed? YESO

I

_ _

_

Location:

ATTA CH PROPERTY TAG HERE

resu
!ts.
~,,e ~l(~;;~);~o(;
;reau~rizcdl
JPY Ar1mll....
_
Mon ~
Th l s wor ksh ee t should be used to record rnfonna tion on

wt, er1no e nfprcemon\ action

1
-----------'.

u,~ s earth

for farer t.ransa.cticn into TECS . VVhen tho SC!ateh res.Jt s tn a sei:z.\!
re and/o r arrest. tne W orksti eet Decomes pan of the smz.ure docu:rnen tatrort

the Worl<sheet st-.o.Jl
d be rclruned loeally along "1th consent l c,ms and other petllnen t do a.'ffle11tsin ct.rooo logical order for two years and lllrec months from the date of the

b)(6); (b)(7)(C)

- -ICLl-000511768

DHS-ICE-19-0196, 19-0197-G-000068
SPOUSE:__
__
_ __

_

Oc<cber01
2017 FY2 01S



NEGATTVE PERSONAL SEARCH - SuPERVISOR'S

CHECK SHEET

This check sheet roust be completed by supervisors when the personal search does not lead to - or is not conducted - in essociation with an
enforcement action (e.g. seizure or arrest).

DA TE OF SEARCH: -------l!:~:..l..

) _(?_) JINCIDENT LOG NUMBER: 2018-250~_:~ ______

_

ooooooooo~oooooooooooooooooooooooooooooooooooo
s ;: ?? m ? m ??
r o o ' ? .a ??
o
A

MARK EACH ITEM WHEN COMPLETED. FOR THOSE NOT COMPLETED, PROVIDE AN EXPLANATION IN THE
REMARKS SECTION BELOW.

I. -.-2.
3.

4.
5.
6.
. 7.

SEARCH CRITERIA REVIEWED BY SUPERVISOR AS BEING APPROPRIATE
PERSON PROVIDED WITI-I A GENERAL EXPLANA TI.ON ON WHY TI-IESEARCH WAS
CONDUCTED
PERSON PROVIDED WITI-I TI-IEAPPROPRIATE PAMP.ffi.ET
(E.G., WHY DID nns HAPPEN TO ME?)
PERSON PROVIDED WITH COMMENT CARD
TI-IE PERSON'S QUESTIONS ON CUSTOMS EXAMINATION WERE ADDRESSED
PERSON OFFERED ASSISTANCE WITHRESOLV1N0 PERSONAL ISSUES .
BAGGAGE, ONWARD TRAVEL,
RESULTING FROM THE _s_EARCH (E.G. REPAC~G
,:f
CONTACTING FRJENWR.ELATIVES, ETC.)
SUPERVISOR REVIEWS;I1IE SEARCH CRITERY.. AND RE SUL TS, EXAMINATION,
AND PERSONAL SEAR~R PROCESS WlTH TI-IE OFFICER FOR LESSONS LEARNED

,

/:

REMARKS: ---------+."-'-'---------------------------'---

~.

SUPERVISOR:

___________

_

NAME

SIGNATURE

R<Qin on file localI~ in chn,oclosical order, to.. tbcr l"ilh LIieotliu P"pcrwork ILIJOCialcd
witt, lhc ~b

fer iwc ycan OAdllin:.,
moclhl l'n>inthe Ible of the sear-oh..

Atv.ERCAN

pVERSIGHT

DHS-ICE-19-0196, 19-0197-G-000069
2019-ICLl-00051 1769



Page l of 6

PrintRapsheet Screen

USVISITOZ

kb)(6); (b)( 7)(C); (b)( 7)( E)

b)(7)(E)

(b)(6);
(b)(7)(C)

NAME
HERNANDEZ.JEFREN RODRIGUEZ

(b )(7)( E)

DHS-ICE-19-0196, 19-0197-G-000070
2019-ICLl-00051 1770

5/9/2018



Page 2 of 6

Print Rapsheet Screen

(b)( 7)( E)

DESCRIPTORS ON FILE ARE AS FOLLOWS :
NAME HERNANDEZ,JEFREN RODRIGUEZ
SEX
M

RACE
BIRTH DATE HEIGHT WEIGHT EYES
W
1984/12/24 505
110
BROWN
BLACK

HAIR

BIRTH CITY
BIRTH PLACE
UNREPORTED
MEXICO
CITIZENSHIP
UNITED STATES
PATTERN CLASS
l(b)(?)(E)

OTHER BIRTH
SOCIAL
DATES
SCARS-MARKS-TATTOOS
1985/02/13
1987/09/22

NONE

SECURITY

NULL
!rh\f ~ \. fh\ f7
l<b)( 6): (b)( 7)(C)

MISC. NUMBERS

\f r' \

I

ALIAS NAME(S)
HERNANDEZ ,JEFFRY
HERNANDEZ ,JEFREN
HERNANDEZ-RODRIGUEZ .JEIFRI A
HERNANDEZ-RODRIGUEZ .JEIFRI ALE

DHS-ICE-19-0196, 19-0197-G-000071
2019-ICLl-0005 1 1771

5/9/20 18



Page 3 of 6

Print Rapsheet Screen

END OF COVER SHEET

b)(7)( E)

NAME
FBI UCN
HERNANDEZ,JEFREN RODRIGUEZ
SEX RACE BIRTH DATE HEIGHT WEIGHT EYES HAIR
M W
1984/12/24 505
110 BRO BLK
BIRTH PLACE
MEXICO
CITIZENSHIP
UNITED STATES

PATTERN CLASS

l(b)(7)( E)

1-ARRESTED OR RECEIVED 2006/04108 !(b)(6); (b6(7JtF?
AGENCY-POLICE DEPARTMENT DALLAS (TXDP O 0
AGENCY CASEj (b)( 6);

I

I

FINGERPRINT INFORMATION
lrh )( R ). (h)f7)(

r. )

I

PRINT DATE/2006/04/08
CHARGE 1-THEFT >"'$50<$500,
COURT-CO CRIM CRT NO 5 DALLAS (TX057303J)
CHARGE-THEFT PROP>=$50 < $500
2006-04-20 CONVICTED TME-30D FNE-0800 CST-0249

END OF rART 1 - PART 2 TO FOLLOW

Arv

pv .__
___________

DHS-ICE-19-0196, 19-0197-G-000072
~20~1~9-~IC~L
~l-~00~0~5~
1~17u7~2
________

_J

5/9/2018



Page 4 of 6

Print Rapsheet Screen

b)(7)(E)

CHARGE 1-PROSTITUTION 43.02(A) PC
COURT-CO CRIM CRT NO 4 DALLAS (TX057283J)
CHARGE-PROSTITUTION
2009-05-12 CONVICTED TME-45D FNE-0400 CST-0313
3-ARRESTED OR RECEIVED 2009/04125l (b)( 6 ); (b)( 7)( C)
AGENCY-POLICE DEPARTMENT DALLAS (TXDPDOOO0)
AGENCY CASE-l(b)( 6);

I

I

F.INGEBPBINI INEQB~ATION
kb)( 6); (b)( 7)( C)
_
PRINT DATEr.!009/04/25
NAME USED-HERNANDEZ.JEFFRY
CHARGE 1-LEWD/IMMORAL.11NDECENTCONDUCT 104.01 ABC
COURT-CO CRIM CRT NO 4 DALLAS (TX0572B3J)
CHARGE-LEWDnMMORAUINDECENT CONDUCT
2009-05-12 CONVICTED TME-45D FNE-0100 CST-0253
CHARGE-LEWDIIMMORAL.11NDECENT CONDUCT
2009-05-12 CONVICTED TME-30D FNE-0750 CST-0249

END OF PART 2- PART 3 TO FOLLOW

DHS-ICE-19-0196, 19-0197-G-000073
u

2019 ICLI 00051 177J

5/9/2018



Page 5 of 6

Print Rapsheet Screen
~b)(6); (b )(7)(C); (b )(7)( E)

USVISITOZ
PART3

l

(b)( 7)( E)

FINGERPRINT INFORMATION

!

fo )(6): (b)(7)(C)

PRINT DATE/2014/01/23
PHOTO INFORMATION - 1 PHOTOS AVAILABLE

Kb)(6); (b)( 7)(C)

POSE/DESC/

I

PHOTO DATE/2014/01 /23
NAME USED-HERNANDEZ,JEFREN
CHARGE 1-ENTRY WITHOUT INSPECTION, TIME OR PLACE NOT DESIGNATED
CHARGE 2-ALIEN INADMISSIBILITY UNDER SECTION 212

COURT- 0
CHARGE-ILLEGAL ENTRY
DOCKET #l-14-PO096 45 DAYS 1-27-14

S-ARRESTED OR RECEIVED 2014/01123A
AGENCY-CBP-WEST BP SECTOR LAREDO (TXCBP3300)
AGENCY CASEPRINT INF

MATJON

RIN
PH TO INFORMATION - 2 PHOTOS AVAILABLE

(b)(6); (b)( 7)(C)
POSE/ DE /
PHOTO DATE/2014/01123

l(b)( 6); (b)( 7)(C)

PoSE7DESC/

I

PHOTO DATE/2014/01/23
NAME USED-HERNANDEZ-RODRIGUEZ,JEIFRI ALE
CHARGE 1-0301-tLLEGAL ENTRY

END OF PART 3- PART 4 TO FOLLOW

USVISIT0Z
PART4

b)(6); (b)( 7)(C)
'----,.,,..,..,==,-----.L....,
- FBI IDENTIFICATION RECORD (b)(?)(E)

8-ARRESTED OR RECEIVED 2014/03/07
AGENCY-ICE/ERO HSTN DTN ]AC HOUSTON (TXICE6900)

f

b)(7)( E)

DHS-ICE-19-0196, 19-0197-G-000074

5/9/2018



Page 6 of 6

Print Rapsheet Screen

F.INGEBPB INT INEQRMj TION

l(b)(6); (b)(7)(C)
PRINT DATE/2014/03/07
NAME USED-HERNANDEZ-RODRJGUEZ,JEIFRI ALE
CHARGE 1-ALIEN INADMISSIBILITY UNDER SECTION 212
RECORD UPDATED 2014/03/07

ALL ARREST ENTRIES CONTAINED IN THIS FBI RECORD ARE BASED ON
FINGERPRINT COMPARISONS ANO PERTAIN TO THE SAME INDIVIDUAL.
THE USE OF THIS RECORD IS REGULATED BY LAW. IT IS PROVIDED FOR OFFICIAL
USE ONLY AND MAY BE USED ONLY FOR THE PURPOSE REQUESTED.

A~ r...) r AN
r'.VC C-.(~UT
1_
~ _L,~15'
2_
(7_~(
' E~--'U__ - ____________

DHS-ICE-19-0196, 19-0197-G-000075
___.:.
________
___JI
2019-ICLl-00051 1775
. 5/9/2018



Page 1 of I

Candidate

Subject

Print I - V-iew
_ A
_ l-ert_s___,,-- E_n_co
_u_n_te-rs--,' '

'----~~--

Compare !mag~

~

I Cancel j

A~~~~

pv u

~-----------~2~01+rn~,cokl~1

DHS-ICE-19-0196, 19-0197-G-000076

0JV0v:;05H1---41-1-77u.6>----------____.

5/9/2018



Page I of 1

Encounter History

FIN#: 17851616

(b)(7)(E)
(b )(7)(E)

1/1212015 21:57:23 R
3/07/2014 17:30:44

IR
0
0
0
0

1289 163805
389228 4

Encounter IDs

NO PHOTO

NO PHOTO

A~

pv~
~-______________o.... c.....

DHS-ICE-19-0196, 19-0197-G-000077

____.2
.....1....
9=-1
....1...::1...
0....
00....
s....
1..........
17.._7,__7.__
__________

__, 5/9/20 18



Page I of 1

Candidate Bio

Terminal
Picture

j

l1
.....
(b_).....
(6.....
)...
; _ __.

Client Status

First Name

Last Name

IHER NANDEZ-RODR

IGUEZ

Sex

DOB (MM/DD/YYYY)

IM

10211311985

Country or Citizenship

A#

IMEX

1206418141

Address-City Residence

Address-State Residence

Country or Birth

Location

Addre ss-Country Residence

I
Comments

Co!!','1\ent text
o ' . '' '.' '.'''

I

nay be incoirplet,o
. Pcfer
LO Event k h)( 7 )( F )
for
'' '. .' '. o' o o o o o o AOOENDt.:M J/07 / 14 o o . . o o . . ' o . ' . . . . o o o

,,n Janu .. ry 27 , 201.; , tlloc SubJ.-ct
Cou1t , Sourhe1n
District
of Tt>X.l'

w,1~ convicted
,11.d &t:'ntenc<>d

7t

ICFD

I'\

v

Date/Tome or Apprehension (dd-Mon-yy HR:MM)

L
Length or Tome Illegally In US

Apprehended By

Status of Entry

l(b)(6); (b)(7)(C)

[Q
NK

c _____

Mlsc2

Misc 3

Misc 1

I

.

01 8 use 1325 a) <11 1n U . S . Oiscrict
LO 45 d,1ys con11n,oment .
(' : 1.;- po - 00960)

Location of Apprehens ion

Method or Location/Apprehens,on

details

___J

l(b)(7)( E)

A~

PV 1w~r~~
Eq\j H

I

DHS-ICE-19-0196, 19-0197-G-000078

2019-ICU-000511778

5/9/20 I 8



Page I of 1

Candidate Bio

Userl(b )(6);
Picture

!

Terminal c!,;,
!l( b;;;,,);,;,,(6;;;,;);;,,:
__

Client Status

First Name

Last Name

!HERNANDEZ

Sex

DOB (MM/DDNYYY)

Country of Birth

jM

109/22/1987

JMEXICO

Country of Citizenship

A#

Location

IDAL

!MEXICO
Address-C ity Residence

Address-State Restdence

Address-Country Residence

\UNK

Loca~on of Appr ehension

Date/Time of Apprehension (dd-Mon-yy HR;MM)

Apprehended By

Status of Entry

Length of Time Illega lly in US

Misc 1

M1sc2

Misc3

Melhod of Location/Apprehens ion

JUNK

l(b)(7)( E)

DHS-ICE-19-0196, 19-0197-G-000079

2019 ICU 00061 1779

5/9/2018



Page I of I

Candidate Bio

User ~~ )(6);_

I]

Picture

Term inal k..,,,b""'
),.,,(
6,,.)..,:_

1

___.,_,I
I

Client Status

First Name

last Name

IHERNANDEZ-RODRIGUEZ
Sex

008 (MM/00/YYYY )

Country of Birth

@_
7101/1985

!MEX ICO

Country of Citizensh ip

A#

Locat ion

!MEXICO

E

Address-City Residence

Address-Stale Residence

Address-Country Residence

IUNK

Comme nts
SUBJECT JS /\ CROSSDRESSER Tl!AT ENTERED THE Ut,ITED STATES ILLEGALLY
NEAR THE TE:</ME :<
RAILROAD VAROS .
SUBJECT CLAIMS TO BE A C!TlZEN
OF !.IEX!CO .
SUBJECT WAS GRANTED A
VOLUIITARY Pr:TURN TO MEXICO .

Method of Location/Apprehens 1on

~-------_J
Apprehended By
!fh )( fi) . (h)( 7 )( r, )

!

LocabOn of Apprehens ion

Date/Time of Apprehension (dd-Mon-yy HR.MM)

l-5miles

@6-0CT-05 03:08

E of LAR

Status of Entry

Length of nme Illegally in US

IPWAM

~---------'

M1sc2

M1sc3

l(b)( 7)( E)

Ar

f)V1
~;~~e:s-=a=
--------------o

DHS-ICE-19-0196, 19-0197-G-000080

2019 ICU 00061 1780

5/9/2018



E! s1.:scrito '?icec6nsu! de H.::-;~duzs c1 '.
:, ,1.gencia Ccnsu!c:r de Sa :iiilo , Co2huiia,
Lit.:enc;ado Juan Carlos Po:-'o:; G::--::3 e~
~ '.:Se2 :c est=i~lacldo en !a Co nven
ci6n
oe Vi ena so:-:>rs R~l adon:,;s Cc,-1s,il2r
2.: 2n su .t\rti:u!o 5 "FUNC IONES
CON SUL .A.r<ES"Lite ral e) P: cs..:~: ayu ~s
J' 2sistenciu c: !os naci ona les del Esta
do
-:;:..:
c envia, sean person~- ': i:2 ':1.;re,e5 c it.!ric
;c:::s: ;;er e:::~2.r:~edio Ha c e Con star que
;2, ,:,=,rtificaci6n de Act; de Na~;:.:iF.:ttc !'-.. c~0.
!oi'GBPl'.::<-:
...:::~o-~-7.c Norr:bre de F:OY
l~L=::
.(_~_ND~K ~-1f=R~i,tJ'5CEZ
..1:.!:-:::~~::: ~;-~- 1:..c:-i.:1,:~ ~ -:.?.t:~t}'3rc de 1~3!::
c.tel
-. p;,..,
de ----c...,.,
,~~
--,
,r..'
1.~. , .. ;V!
- ~.-;..,~
H.J
-::::~~
.
-11c.
. -----\:'" .. .
. -.... -. ~JC::.;
...:-~i 1 !...: . o...
<qr-,'c.
~ ....,:
! ~..:::, ::~ ..:.. , .l . .~r
ll ~ .A
.. n tU.;::, ,h. 'ij'o de MJ"'t
..."!
0 ..: LOS A \ JGELE~ ROD =t~
:JJJ=.l y -~.: ;..~:_;
1.nN~i::Z,
.,'. :;:._
c , Hc\.:.
.
:,
~-:u
enta
con
f:rr:,
a
y ~e:!o cor;a s pordl. snt E ,:::.sl Rs1isc:.auc,,
:-~1,/;, ratifk.an do 2sf su nacio nalidad
1-<<ondur
efla.
'...J

, o o

Dov Fe:

P2,2. los fin.as que al i:1ta ,e~ado c01wen:;al":. .::2
exi:l6nde 1a
de S~iti!lo, CoahLi!a, Mexicc, a !os 09 cs
i'!1ayo cs
2:0,6.

Atent&mente

JC PG/
,. '. o
nrc1:1v

.....
DHS-ICE-19-0196, 19-0197-G-000081
2019-ICLl-00051 1781



Pedestrian

DEPARTMENT OF HOM ELAND SECURITY

U.S. Customs and Border Protection

VehicleLicense No.

.

No. Persons \

M ULTIPLE INSPECTION REFERRAL

OS/0<\/\'6

Today's Dato

UNDEC

DEC
FT?

TECS
OFC/DFC
1324
STATUS
DOCS
1-94
PHS/CDC

BAGCHK
K-9
F&W
COMPEX
DUTY U/F
APV

Comments:~

\bc..s \C)\

MEAT
FRUIT/VEGETABLES
BIOLOGICALS
PLANTS/SE ED/SOIL
LIVE ANIMALS
GROCERIES/FOOD
OTHER

f\E\)

(\v\C')

ITlmoOut

Tlme In: \ ()

~Q)

Referredby:I

b)(6); (b)(7)(C)

IExitCode:

I

Off........
.~., ..~--,,,_,_.._.

---1) \iK?'S
I
Clearedby:

Lano.

CBP Form 1-443(08/05)

DEPARTMENT OF HOMELAND SECUR ITY

U.S. Customs and Border Protection

Pcdcstnan
Vehicle Uccnso No.
No. Persons \

MULTIPLE INSPECTION REFERRAL

Today's Dato

OS/0'1/\'6
DEC

TECS

FT?

OFC/DFC
1324
STATUS
DOCS

BAGCHK
K-9
F&W
COMPEX
DUTY U/F
APV

1-94
PHS/CDC
Comments: ~

\)::)c.,
C., \C),

f\E\)
---1) \

(V\C')
Time In: \

C)::,~

Referred by:

ExrtCode:

I TimeOUL

l<b
)(6); (b
)(7)(C)

Officer's lllllials and Number

Q;X.O.
0

Clearodby:

I
Lane#

AMr ~ICAN

pVERSIGHT

UNDEC

MEAT
FRUIT/V EGETABLES
BIOLOGICALS
PLANTS/SEED/SOIL
LIVE ANIMALS
GROCERIES/FOOD
OTHER

CBP FOITTI
1-443(08/05)

DHS-ICE-19-0196, 19-0197-G-000082
2019-ICLl-00051 1782



Office of Information Governance and Privacy
U.S. Department of Homeland Security
500 12th St., SW
Washington, D.C. 20536

U.S. Immigration
and Customs
Enforcement

May 15, 2020
Daniel McGrath
American Oversight
1030 15th Street NW, B255
Washington, DC 20005
RE:

American Oversight. v ICE et al., 1:19-cv-01817-RCL
ICE FOIA Case Number 2019-ICLI-00051
Second Supplemental Production

Dear Mr. McGrath:
This letter is a second supplemental response to your Freedom of Information Act (FOIA)
request to U.S. Immigration and Customs Enforcement (ICE), dated February 8, 2019, for all
records pertaining to Jeffry Hernandez Rodriguez aka Roy Alexander Hernandez Rodriguez aka
Roxsana Hernandez and Mergensana Amar.
ICE has considered your request under both the FOIA, 5 U.S.C. § 552.
For this production, ICE reviewed 5 pages and 1 excel spreadsheet. These documents have been
Bates numbered 2019-ICLI-00051 1783 through 2019-ICLI-00051 1787.
ICE has applied FOIA Exemptions 6 and 7(C) to protect from disclosure the names, e-mail
addresses, and phone numbers of DHS employees contained within the documents.
FOIA Exemption 6 exempts from disclosure personnel or medical files and similar files the
release of which would cause a clearly unwarranted invasion of personal privacy. This requires a
balancing of the public’s right to disclosure against the individual’s right to privacy. The privacy
interests of the individuals in the records you have requested outweigh any minimal public
interest in disclosure of the information. Any private interest you may have in that information
does not factor into the aforementioned balancing test.
FOIA Exemption 7(C) protects records or information compiled for law enforcement purposes
that could reasonably be expected to constitute an unwarranted invasion of personal privacy.
This exemption takes particular note of the strong interests of individuals, whether they are
suspects, witnesses, or investigators, in not being unwarrantably associated with alleged criminal
activity. That interest extends to persons who are not only the subjects of the investigation, but
www.ice.gov

VERSIGHT

 

ICE FOIA Number 2019-ICLI-00051

Page 2 of 2

those who may have their privacy invaded by having their identities and information about them
revealed in connection with an investigation. Based upon the traditional recognition of strong
privacy interest in law enforcement records, categorical withholding of information that
identifies third parties in law enforcement records is ordinarily appropriate. As such, I have
determined that the privacy interest in the identities of individuals in the records you have
requested clearly outweigh any minimal public interest in disclosure of the information. Please
note that any private interest you may have in that information does not factor into this
determination.
ICE has applied FOIA Exemption 7(E) to protect from disclosure internal agency case numbers
contained within the document.
FOIA Exemption 7(E) protects records compiled for law enforcement purposes, the release of
which would disclose techniques and/or procedures for law enforcement investigations or
prosecutions, or would disclose guidelines for law enforcement investigations or prosecutions if
such disclosure could reasonably be expected to risk circumvention of the law. I have
determined that disclosure of certain law enforcement sensitive information contained within the
responsive records could reasonably be expected to risk circumvention of the law. Additionally,
the techniques and procedures at issue are not well known to the public.
If you have you any questions about this matter, please contact Assistant U.S. Attorney Benton
Peterson at Benton.Peterson@usdoj.gov or 202-252-2534.
Sincerely,

Catrina Pavlik-Keenan.
FOIA Officer

Enclosure(s): 5 page(s) and 1 excel spreadsheet
cc:
Benton Peterson
Assistant U.S. Attorney
CWA Building 501 3rd Street, NW
Washington DC 20001

PVERSIGHT

 

I
' llj .,,f/s

Date:

Z;;:-

,-/tf

Time starte d:
Location:

_
N ame:

l(b)(6); (b)(7)(C)

'-------------

Title: RN Y- 2! 5

r ·

)µ/,r ,,;;.
,/r~ ~~~ r~#- «-''°~ )
C--72-- p...,,__,,.,<.,,,,--~✓

Employer:
Background:

1. Tell me what you remember about Ms. HERNANDEZ.
2. Do you speak Spanish proficiently?

...

/~

-

b)(6); (b)(7)(C)

3. Why did you use

De11talAsst. for interpretation?

'-----------------'

4. What time did medical first lay eyes on Ms. HERNANDEZ?
5. Ho•w is medi,cal notifi,ed if a detainee appears ill upon arrival?

Jt-

~

~

#:J-~

~

__

?'U~

-

~

-

6. Was medical notifi,ed in this case?

7. Did Ms. HERNANDEZ mentio•n she had been evaluated on May 11, 2018 at an ER in
California?
~ / ~/
_~~
8. What is tl1e Tb protocol?
9. Did you place a mask

011

?
Ms. HERNANDEZ?

.

.c...P

- .

10. What 1s the protocol for abnormal VS ~n~;/

~ ~

~ ~J~
~ . ,.,,J~ /"-'v-1
_~

~12. Shot1ldyou l1avetreate •d the temp of 100.8 at intake? ,_..__

;J-<'

~?- ~ ~

~ So/

And the temp of 102.0 at 0'900 hours?

_..~..a:://{;,,? .

~,4£:J

~

h

1

13. Should a complete set of vital signs have been obtained at 0900 hours versus just a temp?·
14-;-Wharistlie policy-for--plaeing--semcc,n,e ir1I11edical obseryv
•atiort?
t5. Was that-policy followed in trii~case?

~ . ~

-

16. Do you have anytl1ing else you wo,u]d like to add?

AMERICAN

pVERSIGHT

2019-ICLl-00051 1783

DHS-ICE-19-0196, 19-0197-I-000001

 

.

'

,

(b)(6); (b)(7)(C)

_/

..
~
-

~

L

•

I
.

/.

.~ --'&&tt'f

Id► --

v t:;

/

'/.

,

-

_,

~-

/ __-·

_/
•

•

-✓ ~,~4" ~ -,c., c, ..-<I!
.

/4- ...........
,~

'

-

~_L,,
r

., ,~

-

••

..,
--

-

•

-~

•

....
*
,..__---,..
P
"ffe>
-

- -

-t'

-

•

-

r::..i,,,

-

•

'

.
.

-

-

.

-

.

.

-

.

.

•

.

.

.

.

.

-

•

-

~

.

.
•
,

-

.

.
.
.

.

•

~

~

--

-

-

-

-

- -

.

,

AMERICAN

pVERSIGHT

2019-ICLl-00051 1784

DHS-ICE-19-0196, 19-0197-I-000002

--

 

Date:

Time started:
Location:
l(b)(6); (b)(7)(C)
(b)(6); (b)(7)(C)

Name: l

~----__J

Title: MD

X

Employer·:
Backgr·ound:
1. Tell me what you remember about Ms. HERNANDEZ.

~~

.

~;7

~

2. Did Ms. HERNANDEZ m,ention she had been evaluated on May 11, 2018 at an ER in
California?
fa ·

3. What is the protocol for abnormal VS at intake? ~
4. Whati,s the peli-cyJor

si~r~ing
off orders?

5. Should the RN have placed a mask on Ms. HERNANDEZ once the history was obtained
during intake?
~

7

6. What is the protocol for abnormal V:S at intake?

~

7. Should the RN have documented a physical exam of Ms. HERNANDEZ at intake?
8. Should the RN have treated the temp of 100.8 at i11take?
And th,e temp of 102.0 at 0900 hours?
9. Should a complete set of . ital signs have be.__.obtained at 0900 hours versus just a temp?
9. What is the policy for placing someone i11medical observation?

/2 · ---

~

£--

10. Was that policy followed in this case?
11. Do you have anything else you would like to add?
Time Ended:

AMERICAN

pVERSIGHT

2019-ICLl-00051 1785

DHS-ICE-19-0196, 19-0197-I-000003

 

•

r

Date:
Time started:
Location:
b)(6); (b)(7)(C)

Name:

Employer:
Background:

~2.-(

/,-//t

1. Tell me what yo11remember about Ms. HERNANDEZ.
2. How is medical notified if a ~etainee
~

,....,-V!'_
~<30, ,,e...,.►;r,c:=,

,-=-

,h~

a;we~~
ill upon arrival?
.
'1/lf/$
·~.,...,,,...--~

,e::;,t'c_~--

;A.-1,,/42--

3. Was medica notified in this case?

1~ I _A d/1-'?+: ~1!Y'/r . 'b --1 d'
?
4. What 1s your o icy requirements 1or reportmg commun1ca . e 1seases.
v-,!-<

r

'

~

~·

~·~~

6. Do you review and discuss infec ious and commW1icable disease control i11 your quarterly
~ 1 l,,A ~ ~
· · .n? C 62£
administrative meetings?

r~

7: Do you re~•ort to, the IH~C Publ~c Health, Saf~ty, and P~ep~redness Unit all deta~~~
diagnosed with a communicable disease of public health significance? ~ ~
~

8. Does the medical isolation room(s) provid ,e negative pressure?

. \b~
9. What is the Tb protocol?
J. '

'

~·

.,....,.,.<-- ·

·

L:>-":. .

.

~

.

~

.,.-<- ~ .~

-«----

~

1(~)(6); (b)(7)(C)

r~

~ e:,-/

,,,,;;

/4_.,A:--J~~

-~~

/

~

~ ~~~ <Q, lr<..,;i"~ ~ ,.~_,-,_,

-- ..,✓.,

13. Should the RN have treated the temp of 100.8 at intake?
And the temp of 102.0 at 0900 hours? '

/?

.

.

~~

µ;V

12. Did the R}1 perform a physical . exam of Ms. HERNANDEZ?

/fd,

2 ~:

~--:

.

( f .
"

J/

·

_

-

~ ~

~/

,.,., ~ ,:f, ~ ~ ...Ll .

jt-.4/'
~

.

-~~~_,.:e

14. Should a complete set of vital signs have been obtained at 0900 hours versus just a temp?
15. What is the poli ,cy for signing off orders?

~

~

0

..deA

•

. _.
,t?·

~
~
A.~/
· r.-;, /
,<;3~._&,·

prr//

16. What is the policy for placing someone in medical observation?
~
/

v--"I'

/

-

·

/4

r,-

~

~

AMERICAN

pVERSIGHT

2019-ICLl-00051

1786

DHS-ICE-19-0196, 19-0197-I-000004

 

(b)(6); (b)(7)(C)

17. Was that polic followed in this case?
18. Do you have anything else you would lik,e to add?

Time Ended:

AMERICAN

pVERSIGHT

2019-ICLl-00051 1787

DHS-ICE-19-0196, 19-0197-I-000005

 

For Official Use Only. This document contains pre-decisional and/or deliberative process information exempt from mandatory disclosure under the Freedom of Information Act, 5 U.S.C. 552(b) (5). Do not release without prior approval of U.S. Immigration and Customs Enforcement, ICE Health Service Corps.
SEQUENCE OF EVENTS - FACT FINDER OBSERVATIONS
A#:

206 418 141
Jeffry HERNANDEZ
18-Feb-85

Name:
DOB
Age:

33

COC:

Honduras

Fact-Finder:

CDR b(6), b(7)(c )
KEY for SOURCE ABBREVIATIONS: AF=alien file; DET=detention file; b(7)(e ) database records; EMS=EMS records; INT=interview; IR=incident report/memo; MED=medical records; OBS=site-visit observation; P&P=policy and/or procedure; SEN=significant event notification; VID=videotape

Date

Time

5/9/18
5/13/18
5/15/18
5/16/18
5/16/18 11:00 p.m.

Event

Source

CBP detained Ms. HERNANDEZ at the San Ysidro border crossing.

b(7)(e )

ERO booked Ms. HERNANDEZ into SLRDC for manifest purposes.
ERO transferred Ms. HERNANDEZ from SLRDC to EPC

b(7)(e )
b(7)(e )

ERO transferred Ms. HERNANDEZ from EPC to CCCC.
ERO booked Ms. HERNANDEZ into CCCC.

b(7)(e )
b(7)(e )

An RN completed the intake screening, noting a history of HIV and HepA (Ms. HERNANDEZ later denied having
Hep A). Ms. HERNANDEZ identified herself as transgender. VS: T 100.8, P 136, R 16, BP 81/61, O2 sat 92%, height
63", weight 89#, BMI 15.8. RN noted hx of persistent cough with weight loss for several weeks. Ms. HERNANDEZ
was placed in respiratory isolation and to be seen by MD. A referral to mental health was also placed. The transfer
summary from San Luis Regional Detention Center did not have Tb clearance, no medical information, and was not
signed by a transferring facility staff member. The RN signed he had reviewed this transfer summary. The TS from
EPC did not have Tb clearance, no medical information, and was not signed by a transferring facility staff member. The
RN did not sign this TS.

Fact Finder Observations

MED

b(6), b(7)(c ), RN (RN b(6), b(7)(c ) - Do you speak Spanish proficiently? Why did you use b(6), b(7)(c ), Dental Asst. for interpretation? HSA b(6), b(7)(c ): What is your policy/requirements for reporting communicable diseases? Did you report this case of HIV? Do you review and discuss infectious and communicable disease control in your
quarterly administrative meetings? Do you report to the IHSC Public Health, Safety, and Preparedness Unit all detainees diagnosed with a communicable disease of public health significance? Does the medical isolation room(s) provide negative pressure? HSA b(6), b(7)(c ) and RN b(6), b(7)(c ): What time did medical first lay eyes on Ms.
HERNANDEZ? How is medical notified if a detainee appears ill upon arrival? Was medical notified in this case? What is the Tb protocol? Did the RN place a mask on Ms. HERNANDEZ? What is the protocol for abnormal VS at intake? Did the RN perform a physical exam of Ms. HERNANDEZ? What is the policy for signing off orders? [Dr.
b(6), b(7)(c ) wrote orders on 5/17. b(6), b(7)(c ), LPN noted these orders on 5/24. b(6), b(7)(c ), RN noted orders written by Dr. b(6), b(7)(c ) but her note doesn't include date or time.])

An MD completed the physical exam with these findings: VS; T 102.0, P 128, R 20, BP 81/61, O2 sat 92%; Ms.
HERNANDEZ reported she was diagnosed with HIV 6 months PTA but had not been treated; weight loss began
around the same time she was dignosed; mucus membranes dry, multiple dental caries, coarse breath sounds, muscle
wasting, tachycardia, emaciated, and very poor skin turgor. The MD ordered a mask be placed on Ms. HERNANDEZ
for her own protection, transport to local hospital for eval and treatment by facility vehicle. The MD also wrote
multiple diagnostic orders to be carried out at the hospital. Ms. HERNANDEZ was transferred to Cibola General
10:00 a.m. Hospital.

MED

Dr. b(6), b(7)(c ); Did Ms. HERNANDEZ mention she had been evaluated on May 11, 2018 at an ER in California?

CGH emergency department (ED) received Ms. HERNANDEZ. VS: T 104.9, P 137, R 18, BP 82/57, O2 sat 89%. The
ED MD ordered multiple laboratory and radiology diagnostic studies, intravenous (IV) fluids for rehydration,
acetaminophen for fever control, IV antibiotics (azithromycin and ceftriaxone), and IV famotidine. The ED MD
diagnosed septic shock, anemia, dehydration, HIV infection, lymphadenopathy, nodular pulmonary disease, and
thrombocytopenia. The ED MD spoke to an MD at Lovelace Medical Center (LMC), Albuquerque, NM, who agreed to
accept Ms. HERNANDEZ on transfer. The ED MD ordered air ambulance transportation to LMC, which was carried
11:59 a.m. out at an unknown time.

MED

5/18/18

LMC reported Ms. HERNANDEZ was stable and admitted to ICU for Tb isolation. VS were: T 98.6, P 98, BP 102/66,
and O2 sat 99%. The IV antibiotics were changed to piperacillin/tazobactam and vancomycin, and levophed was added
to increase BP. Ms. HERNANDEZ developed an appetite, and was provided with meals and oral fluids, which she
tolerated well. Further diagnostic studies were being performed

MED

5/19/18

LMC reported Ms. HERNANDEZ remained stable, but did develop a fever of 104.0. A CT showed an enlarged spleen,
which was concerning for T-cell lymphoma. The CD 4 count was 189.

MED

5/22/18

LMC reported Ms. HERNANDEZ had run a fever up to 102.0 most of the day, and had lost her appetite. The IV
antibiotics were discontinued, and new antibiotics were ordered: sulfamethoxazole/trimethoprim, orally, once a day,
and a once weekly injection of penicillin.

MED

5/17/18 7:35 a.m.

LMC reported Ms. HERNANDEZ was in critical condition. VS were: T 97.8 (maximum 104.5), P 104 (maximum 150
bpm), R 18, BP 118/74, and O2 sat 100% while receiving oxygen at two liters per minute via nasal cannula. IV
antibiotic piperacillin/tazobactam and IV midodrine (to treat low blood pressure) were ordered. The chest x-ray
5/24/18 11:00 a.m. revealed small, bilateral pleural effusions (excess fluid surrounding the lung causing difficulty breathing).

MED

3:00 p.m.

LMC performed a thoracentesis (procedure to remove the pleural effusions), and removed a total of 1600 cc’s of fluid.

MED

7:45 p.m.

LMC intubated Ms. HERNANDEZ, and placed her on a mechanical ventilator, because her O2 sat had dropped to
74%.

MED

Ms. HERNANDEZ developed bradycardia, which changed to PEA. CPR began immediately and Ms. HERNANDEZ
was revived at 10:16 p.m. Ms. HERNANDEZ then developed supraventricular tachycardia that was not responsive to
10:10 p.m. treatment.

MED

LMC reported Ms. HERNANDEZ was experiencing cardiopulmonary arrest every few minutes, and she had minimal
brain activity.
LMC reported Ms. HERNANDEZ had been pronounced dead by two LMC physicians.

MED
MED

5/25/18 1:30 a.m.
3:32 a.m.

AM -RICAN

VERSIGHT

1

DHS-ICE-19-0196, 19-0197-I-000006

 

For Official Use Only. This document contains pre-decisional and/or deliberative process information exempt from mandatory disclosure under the Freedom of Information Act, 5 U.S.C. 552(b) (5). Do not release without prior approval of
U.S. Immigration and Customs Enforcement, ICE Health Service Corps.
INTERVIEWS
Date

Location

6/19/18 CCCC

Interviewer

CDR b(6), b(7)(c )

Interviewee

Relevant Information

RN b(6), b(7)(c )

RN with 23 years experience - dialysis unit, home health, med/surg and county jail. Fulltime employee with Correct Care Solutions (CCS) at CCCC for 8
months. The following statements are responses made by RN b(6), b(7)(c ) to my questions related to the intake screening he performed on 5/17/18, and
processes at CCCC.
We greet the detainees as they get off the incoming bus. The nurse checking the bus identifies detainees needing to be seen now and brings them straight to
medical. Ms. HERNANDEZ didn’t complain of anything and she was able to ambulate without assistance so she didn’t stand out just to look at her.
The nurse checking VS brought Ms. HERNANDEZ straight to me for intake instead of placing her back in the holding cell.
Ms. HERNANDEZ did not mention she had been evaluated on May 11, 2018 at an ER in California.
We have a protocol for abnormal vital signs but I can’t quote it. I’m sure I should have called the doctor, and would have if the doctor hadn’t come in for her
shift on time.
We do not treat fever without a doctor's order.
Our Tb protocol requires we mask the patient and place directly in medical isolation then call a doctor. I did not do this. Ms. HERNANDEZ didn't wear a mask
until she was brought out of the cell to see the doctor.
I did not perform a physical exam on Ms. HERNANDEZ. Looking back on it, I can see where I should have.
Our abnormal VS protocol requires we recheck the VS every 4 hours. But, if I took the time to recheck the temp, I could have done a full set just as easily.
We should have an order to place a patient in medical observation. I knew the doctor was expected within a few minutes and didn’t want Ms. HERNANDEZ
getting moved around so I put her in a respiratory isolation room for a few minutes without an order.
I knew she was sick. I was afraid if we didn’t move her quickly, she may die on us that day.

6/19/18 CCCC

CDR b(6), b(7)(c )

Dr. b(6), b(7)(c ), MD

Board certified family practice MD with over 30 years worldwide experience. 4 years corrections experience, 14 months at CCCC. Independent contractor to
CCS . The following statements are responses made by Dr. b(6), b(7)(c ) to my questions related to her exam of Ms. HERNANDEZ on 5/17/18, and processes
at CCCC.
Ms. HERNANDEZ was very ill, weak, dehydrated. I instructed for her to be sent directly to the ER because I feared she was dying. We could have done more
as far as examination and diagnostics but that would have only delayed getting her to the hospital.
No, I don’t recall Ms. HERNANDEZ reporting she was seen by a doctor before arriving here.
The temperature of 100.8 would not have been treated. I did not treat the other abnormal VS because those were not critical and I wanted the ER doctor to see
what I was seeing.
Placing anyone in medical observation requires an order. No order was given in this case, but it wouldn't have changed anything.

6/19/18 CCCC

CDR b(6), b(7)(c )

HSA b(6), b(7)(c )

Registered dental hygienist x 20+ yrs. 21 years corrections experience. At CCCC x 18 months as HSA. The following statements are responses made by HSA
b(6), b(7)(c ) to my questions related to processes at CCCC.
A nurse meets new arrivals at the bus. Anyone with an acute complaint or is obviously ill is brought directly to medical.
I think the staff did a good job identifying how ill Ms. HERNANDEZ was and getting her to a hospital so soon after her arrival.

AMERICAN

1
PVERSIGHT
DHS-ICE-19-0196,

19-0197-I-000007

 

For Official Use Only. This document contains pre-decisional and/or deliberative process information exempt from mandatory disclosure under the Freedom of Information Act, 5 U.S.C. 552(b) (5). Do not release without prior approval of U.S. Immigration and Customs Enforcement, ICE Health Service Corps.
INFORMATION LOG
INFORMATION

AMERICAN

FILE LOCATION

1
PVERSIGHT
DHS-ICE-19-0196,

19-0197-I-000008

 

For Official Use Only. This document contains pre-decisional and/or deliberative process information exempt from mandatory disclosure under the Freedom of Information Act, 5 U.S.C. 552(b) (5). Do not release without prior approval of U.S. Immigration
and Customs Enforcement, ICE Health Service Corps.

Mortality Review Fact-Finder Case Notes
A#:
Name:
DOB
Age:
COB:
Fact Finder:
Peer Reviewers:

206 418 141
Jeffry HERNANDEZ
18-Feb-85
33
Honduras
CDR b(6), b(7)(c )

Detention History:
Detention Location

Book In Date

Book Out Date

San Luis Reg Det Cntr
El Paso Processing Cntr
Cibola Co Corr Cntr

5/13/18
5/15/18
5/16/18

5/15/18
5/16/18
5/25/18

Brief Statement Describing Circumstances Surrounding Death
On 5/17/18, CCCC transferred Ms. HERNANDEZ to local ER for evaluation and treatment of HIV, dehydration, starvation, fever, and cough, Local hospital transferred Ms. HERNANDEZ to a regional referral center on 5/17/18. Ms. HERNANDEZ died of
cardiopulmonary arrest on 5/25/18.
Current/Past Health History
HIV - untreated
Septic shock
Anemia
Dehydration
Nodular pulmonary disease
Thrombocytopenia
Syphilis
Manner and Cause of Death
Pending autopsy and death
certificate

AM t HIGAI\J

VERSIGHT

1

DHS-ICE-19-0196, 19-0197-I-000009

 

Offi ce of Information Governance and Pr ivacy
U.S. Department of Homeland Security
500 121h St.. SW
Washington, D.C. 20536

U.S. Immigration
and Customs
Enforcement

July 31, 2020
Daniel McGrath
American Oversight
1030 15th Street NW , B255
Washington , DC 20005

RE:

American Oversight. v ICE et al., 1:19-cv-01817-RCL
ICE FOIA Case Number 2019-ICLI-00051
Supplemental Production

Dear Mr. McGrath:
This letter is a supplemental response to your Freedom of Information Act (FOIA) request to
US. Immigration and Customs Enforcement (ICE) , dated February 8, 2019, for all records
pertaining to Jeffry Hernandez Rodriguez aka Roy Alexander Hernandez Rodriguez aka Roxsana
Hernandez and Mergensana Amar.
ICE has considered your request under the FOIA, 5 U.S .C. ? 552.
For this production , ICE reviewed 529 pages of potentially responsive records. Of those 529
pages, ICE determined that 273 pages were nonresponsive or duplicative and 256 pages were
responsive. This production consists of 218 pages. These documents have been Bates numbered
2019-ICLI-00051 1828 through 2019-ICLI-00051 2045 .
Please note, the remaining 38 responsive pages require further coordination with another
agency /component.
ICE has applied Exemption 5 to protect from disclosure intra-agency documents that contain the
recommendations , opinions, and conclusions of agency employees. The disclosure of these
communications would discourage the expression of candid opinions and inhibit the free and
frank exchange of information and opinions among agency personnel on important agency
decision-making by having a chilling effect on the agency ' s deliberative process.

FOIA Exemption 5 protects from disclosure those inter- or intra-agency documents that are
normally privileged in the civil discovery context. The three most frequently invoked privileges
are the deliberative process privilege , the attorney work -product privilege, and the attorney-client
privilege. After carefully reviewing the responsive documents , I have determined that portions
w,vw.ice.gov

AMERICAN

pVERSIGHT



ICE FOIA Number 2019-ICLI-00051

Page 2 of 3

of the responsive documents qualify for protectionunder the deliberativeprocess privilege,the
attorney-clientprivilege, and the attorney work-productprivilege. The deliberativeprocess
privilege protects the integrity of the deliberativeor decision-makingprocesses within the
agency by exemptingfrom mandatory disclosureopinions, conclusions,and recommendations
included within inter-agency or intra-agencymemorandaor letters. The release of this internal
informationwould discouragethe expression of candid opinions and inhibit the free and frank
exchange of informationamong agency personnel. The attorneywork-product privilege protects
documents and other memorandaprepared by an attorney in contemplationof litigation. The
attorney-clientprivilege protects confidentialcommunicationsbetween an attorney and his client
relating to a legal matter for which the client has sought professionaladvice. It applies to facts
divulged by a client to his attorney, and encompassesany opinions given by an attorney to his
client based upon, and thus reflecting,those facts, as well as communicationsbetween attorneys
that reflect client-suppliedinformation. The attorney-clientprivilege is not limited to the context
of litigation.
ICE has applied FOIA Exemptions6 and 7(C) to protect from disclosurethe names, e-mail
addresses, and phone numbers ofDHS employeescontainedwithin the documents.
FOIA Exemption 6 exempts from disclosure personnel or medical files and similar files the

release of which would cause a clearly unwarrantedinvasion of personal privacy. This requires a
balancing of the public's right to disclosure against the individual's right to privacy. The privacy
interests of the individuals in the records you have requested outweigh any minimal public
interest in disclosure of the information. Any private interest you may have in that information
does not factor into the aforementionedbalancing test.
FOIA Exemption 7(C) protects records or informationcompiled for law enforcementpurposes

that could reasonablybe expected to constitute an unwarranted invasion of personal privacy.
This exemptiontakes particular note of the strong interests of individuals, whether they are
suspects, witnesses, or investigators,in not being unwarrantablyassociatedwith alleged criminal
activity. That interest extends to persons who are not only the subjects of the investigation,but
those who may have their privacy invaded by having their identities and informationabout them
revealed in connectionwith an investigation. Based upon the traditional recognition of strong
privacy interest in law enforcementrecords, categoricalwithholding of informationthat
identifies third parties in law enforcementrecords is ordinarily appropriate. As such, I have
determinedthat the privacy interest in the identities of individualsin the records you have
requested clearly outweigh any minimal public interest in disclosure of the information. Please
note that any private interest you may have in that informationdoes not factor into this
determination.
ICE has applied FOIA Exemption 7(E) to protect from disclosureinternal agency case numbers
containedwithin the document.
FOIA Exemption 7(E) protects records compiled for law enforcementpurposes, the release of

which would disclose techniques and/or proceduresfor law enforcementinvestigationsor
prosecutions,or would disclose guidelinesfor law enforcementinvestigations or prosecutions if
such disclosure could reasonablybe expected to risk circumventionof the law. I have

AMERICAN

PVERSIGHT



ICE FOIA Number 2019-ICLI-00051

Page 3 of 3

determined that disclosure of certain law enforcement sensitive information contained within the
responsive records could reasonably be expected to risk circumvention of the law . Additionally,
the techniques and procedures at issue are not well known to the public.

If you have you any questions about this matter, please contact Assistant U.S . Attorney Benton
Peterson at Benton .Peterson@usdoj.gov or 202-252-2534 .
Sincerely,

i?~

c~~n-1f~

Catrina Pavlik-Keenan
FOIA Officer

Enclosure(s): 218 page(s)
cc:
Benton Peterson
Assistant U.S . Attorney
CWA Building 501 3rd Street, NW
Washington DC 20001

AMERICAN

PVERSIGHT



From :

Sent:

l<b)(6); (b)(7)(C)

24 Nov 2018 23:18:11 +0000

(b)(6); (b)(7)(C)

Subject:
Attachments:

Amar Log
Detainee Amar log.docx

See attached.

l(b)(6); (b)(7)~C)

Lieutenan t/CERT Commander
GEO Corrections & Detention (R)
Northwest Detention Center
1623 East J Street
Tacoma, Washington 98421
Tel: b)(6); (b)(7)(C)
Cell:
Fax:.______
_.
l(b)(6); (b)(7)(C)

www .geoqroup .com

This email and any files transmitted w ith it are confidential and are intended solely
for the use of the individual or entity to which they are addressed. If you are not the
intended recipient or the person responsible for delivering the email to the intended
recipient, be advised that your have received this email in error and that any use,
dissemination, forwarding, printing or copying of this email is strictly prohibited. If
you have received this email in error, please immediately notify by replying to this
email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000001
2019-ICLl-00051 1828



Log for detainee Amar A#216269802

Log started by Sgt l(b)(6);~- 111-15-18

1627- Hospital log begins: Officers

lrblf6\

1and l<bl(6); (b)(?)(C)bresent with detainee Amar. Amar is

unconscious and unresponsive at St Joes medical center (X-ray room). We have been advised
that Amar has no brain activity at this time, but this needs to be confirmed with a neurologist,
D/O \~/\~\--,

asked for Amar's next of kin on behalf of TPD.

1637- Detainee Amar has been moved from the emergency room (X-ray room) to room #1-B.
1637-1704- Nothing to report.
1705- I instructed D/O f~b_)(6
_);_ _.lthat we are waiting for a point of contact for Amar's next of kin.
1713- The neurologist is expected to be there to evaluate Amar tomorrow

(11/16/18), but

could be there as early as today.

1728- TPD departs St Joes medical center and no longer needs Amar's next of kin.
1728-1750- Nothing to report
1751- Amar isn't expected to have any change unti l he is seen by a neurologist. Amar is on life
support.

1752-1939- Nothing to report.
1940- Amar has been moved from room #1-B to intensive care room #6-B-6. D/O )~()
~(;r,
reported that they will be evaluating Amar for organ donation (Life Center).

1941-2044- Nothing to report.
2045- Amar is reportedly barely breathing under his own power. His breathing is still being
assisted with a machine.

2046-2154- Nothing to report.
2155- D/O!"<b
- .)<6
:..:..
..:.:.
);_ _.Ian~ \~/\~/;_
~, ~ report that Amar has been evaluated by medical staff and
reportedly has a 0% chance of recovery. He is considered to be 3/4  brain dead. If he stops taking
breaths on his own, he will be considered medically braindead. At that point, per St. Joe's
protoco l, he can then be evaluated for organ donation, St. Joe's has requested Amar 's next of
kin information
information

as well as his drug history for organ donation purposes. I advised them that this

wou ld have to come from an ICE contact,

2156-2224- Nothing to report

AMERICA~

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000002
2019-ICLl-00051 1829



2225- TPD on scene at St. Joe's medical center to take photos for the case.
2226-2300- Nothing to report. Log will be continued by Sgt )~()~(ir:,
11-16-18
0100- Nothing to report.
0300- Nothing to report.
0500- Nothing to report.
0700- Nothing to report. Log will be continued by LT. b)(6);

h \/ 7\ /1":\

0800 - Officer

i~l
i~l
cc)reports shift change conducted.

0835 - Officer ~_~

advises that fo llowing the Dr. visit they were advised OT would be given

anti-seizure medication, however no further efforts would be made to revive him. Also,
advised that Dr. would be in contact with the Warden regarding above stated information.
0900 - No changes to status
1100 - No changes to status. Test to measure brain activity will be conducted in approx. an
hour or so.
1300 - Office
begin shortly.

)~l)~l,r.,reports

no change to detainee status . Test to measure brain activity to

1500 - No change in detainee status. Sgtl\~(\~/:c, ~akes over Log.
1700- No change in detainee status. In room 6B6
1900- No change in detainee status, Majod ~()~(rr:, on site
2100-No change in Detainee status.
2200- Sgtfbl(6);__ ~akes over Log.
.
b)(6);
2240 - Off ice h 1n,1r,

6)
h \/71/rl
an d 1(b)(6); (b)(7)(C) IRe I.1ved Off' 1cer /(b)(

an d

b)(6);
h 111, 1r:,

2300 - No change in detainee status.
11-17-18
0100 - No change in detainee status.
0300 - No change in detainee status.
0500 - No change in detainee status.
0600- No change in detainee status. LI fbl(6);__ ~akes over Log.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000003
2019-ICLl-00051 1830



0700 - Shift change conducted . Officer..._!
(b~
)(6~
);_ ___,~advised no change in DT status
0900 - Officer b)(6);
b)(7)(C)

advised no change to DT status.

1100 - Officer

reports no change to DT status

1300 - Officer <bl
1335 - Officer

eports no change to DT status

1~/\~L, Ireports

DT blood pressure is dropping and medical staff advise they

have maxed out medication they can administer.
1440 - Shift change conducted.
to cont inue log.

~ posted on watch.

Officer i~\i~\(C)

Sgt (b)(6);

/h\/ 7 \/r,\

1500 -Officer (b)(6);
eports no change to DT status
(b)(7)(C)
1637- Officer~_~calls

in count of 1
n site, no change to status

1900-Officer

reports no change to detainee status

2100 -Officer

reports no change to detainee status.
calls in count 1 log passed to Sg1(b)(6>
;~-

2200-Officer
~-~

I

2240- Office~ (b)(B); (b)(?)(C) ~nd fb)(6); (b)(7)(C) Relived officen._b~
)(6~
);_~jand (b)(6):

2300 - No change in detainee status.

11-18-18
0100 - No change in detainee status.
0300 - No change in detainee status.
0500 - No change in detainee status.

I

0600 - No change in detainee status. SGTrb)(B); (b)(?)(C) takes over Log.
Day shift 11/18/18 Sgt. l(b)(6);(b)(7)(C)
0700 - Shift change conducted.
notified that per Majon 1h11
R,

Officerf h1m,

1~ 111 ,rr,

1advised

no change in DT status/also

I rletainee to have no restraints on .

0900- Office (b)(6); notifies Sgt. (b)(B); (b)(?)(C) no change in detainee Amar status.
(b)(7)(C
.

1100-Offlcer

)

otifies Sgt.

1300 -Officer ._______, otifies Sgt . .___
___
1402 Majo (b)(6);

10

change in detainee Amar status .

__.10

change in detainee Amar status .

notified to have hospital staff place restraints on detainee Amar.

/h \/ 7 1/C:\

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000004
2019-ICLl-00051 1831



1404 Lt. ~~(~~(;"'

notified Officer j(b)(6)~to restrain detainee Amar per directives.

1408 Officer ~~(~~(; notified detainee Amar is now restrained.

I

1414 Notified Majorl (b)(6);~- restrains were applied at 1408 hours per his directives.
1443 Officersfb )(B); (b)(?)(C)
1500 Officerl <bl/6l

ion post, shift change conducted.

No change in status.

I- no change in status - D/T Amar was in process of being

ladvised LUh\CR
\

seen by "nuclear" medicine doctors.
1632 Officer

.

1700 Officer

i~l\~lcc
called in for count.
)

called in stat ing he was on the line with the doctor-

no update yet-will

relay when there is a change - no change in status at this time.
1707 Officerl (b)(6); k:alled back- stated at 1651 to 1656 Doctor came in to conduct a brain
response test, 1705 Doctor came in to confirm Amar is "brain dead" - stated she has been in
contact with PHS ~b)(6); _

I

1718 Called on call Majo~ (b)(6);~- ~o advise of update.
1900 Officer

.

2100 Officer

i~lmc
c::ailed in to report
)

2200 Officer
2205 Lttb)(6);

no change in status.

::ailed in to report no change in status.
called in his count of 1- No change in detainee Amar's status.
!passes log to SgUbl(6l:

2250 D/Q (b)(6); (b)(7)(C)

lat this time.

land D/tj <b)(B); (b)(?)(C)

~elieve D/O l<b/<~>:.~I and D/O l\bl\~l;_I- No changes for

D/T Amar at this time.
11-19-18
0033 D/ (b)(6); (b)(7)(C) eports his headcount of 1. No change of status for D/T Amar.
eports his headcount of 1. No change of status for D/T Amar.

0432 D/
0639 D/ ._ ___

_. reports no status change of status for D/T Amar.

0700-Day shift 11/19/18 Sgt.fb)(B); (b)(?)(C) rec eived pass down that there is no change in
detainee Amar status. Officer'SKb)(6); (b)(7)(C)
0810- Officerl (b)(6); (b)(7)(C)

I notifies

Iand

~(~~('"'

on post.

that the neck brace has been removed from detainee, not

other changes at t his time in D/T Amar status.
1000 -Officerl (b)(6);(b)(7)(C)

Icalls in H/C 1 and

1211 -Office!<bl/6) (bl/7)/Cl

lnotifies Sgt. (b)(B); (b)(?)(C)

no changes to status of D/T Amar.
that there is no change to D/T Amar.

AMERICA~

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000005
2019-ICLl-00051 1832



I

1355- Officer b)(5); (b)(?)(C) notifies Sgt.l<b)(5); (b)(?)(C) that there was no change.
1448- Officers l(b)(6); Iand l\~1\
~1~
~,

Ihave assumed post for officersKb)(6);__ Iandl(b)(

5 ); (b)(
?)(C)

I.

There are no changes to report regarding detainee Amar.
reports headcount of 1. No change to report regarding detainee Amar.

1632- Officerl~<b~
)<6
~);~~1

1700 - Office (b)(6): eports no change at this time.
(b)(7)(C)
1900- Office

reports no change at this time.

2058 - Office

reports no change at this time.

2203- Office ~-~

calls in headcount of 1. No other change at this time.

2257 (b)(6);

/h \/ 7 \/r.\

reports no change.

11-20-18
0103 b)(6); (b)(7)(C)

eports no change.

0257

reports no change.

0435

eports no change.

0700-Day shift Sgt.fb)(6); (b)(7)(C) 10n shift 11/20/18 Officers l(b)(6); (b)(7)(C) r and i~~i~~(C)on shift at
hospital for D/T Amar.
0800- Officer b)(5); (b)(?)(C)

reports in no change to D/T Amar.

1014- Officer

calls in H/C 1 at Hospital/No change in D/T Amar Status.

1225- Officer

calls no change to D/T Amar Status.

1412-Officerfb )(6); (b)(7)(C)

jails and said no change at this time, however the doctor to ld him

that they will most likely pull the plug on detainee Amar tomorrow.
1500-Sgt \~/\~/:~, assumes log. Office~ (b)(6);

Majorf b)(6);~-

!calls and says he and ~re

Inotified.

on post, also

hospital staff are complaining about the use of restraints. Contacted Majorf ?!\~!:,~, Iwho stated
D/T Amar will have leg restraints.
1630 - Off 1cer(b)(?)(C)
(b)(6)
::alls in count of 1
1700-Officer

reports no change to D/T Amar status

1900-Officer .___~

reports no change to D/T Amar status-Log passed to Lt

1900-LT tb)(6);

irn
~l(c)

1assumes log. Received pass-down. Nothing to report.

I

2100-Officer l<b)(6);~- called with update. No change.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000006
2019-ICLl-00051 1833



2230-Office~ (b)(6); Icalled about D/T Amar. Hospital staff are in contact with Amar's relatives in
Russia. They are utilizing an interpreter

to inform the family on Amar's condition. We should be

informed of a decision to take Amar off or keep him on life support very soon. AW

~\;~\ic:
has

been informed of the situation.
2330j(b)(6);

Inotified.- ~~1\~1
;c, Ireports

no change.

11-21-18
010 (b)(6); (b)(?)(C)

reports no change.

025

reports no change .

043

eports no change.

063 '---------'eports

no change.

0700- Day shift Lt ~(~
~(~,_, C and Sgt.fbl(6); (b)(7)(C) Ion shift. Officer'

)~~)
~~;r,

and K.__
_b
~)(6=);~__.I on

post at the hospital for detainee Amar.
0800 - Office (b)(6); (b calls and notifies no change to detainee Amar status at this time.
(b)(7)(C)
1003- Office :=====_.a lls in H/C of 1 for count no change to D/T Amar Status .
1200-Officerfb J(6);

reports no change in D/T Amar status.

1400{ ?1\~1;,~- I reports no change in D/T Amar status-Sgt ~~~~~;r, takes over log
1500 l(b)(6); (b)(7)(C) Ion post no change
16301\?1\~/;,~ lreports count 1, AW ~~~m(C) on site, PERA

~~(~~(;,_,

RESTRAINTSREMOVED.

1700J(b)(~); _lreports no change
1814 -dr, Buddhists minister, and interpreter

in room performing service.

1830-Dr, Buddhists minister and interpreter

leave room , service complete.

1900 (b)(6); eports no change to status
(b)(7)(C)
2100.__,eports

no change to status

2230 log passed to Sgtl~
<b_)(6_);_~
(b)(6);
2300 (b)(7)(C) eports no change.

11-22-18
0100 b)(6); (b)(7)(C)

eports no change ,

0300

reports no change .

'---------'

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000007
2019-ICLl-00051 1834



0505 b)(5); (b)(?)(C) reports no change.
0650 ._ ___

_.reports no change.

0714 - Officer ~~~
~~;,--, andKb)(6)
; (b)(7)(C)Ion post. No changes reported .
0900 - Officer (b)(6);

reports no change to status .

1100- Officer .__~

reports not change to status.

(b)(7)(C)

I

1315- Office~Cb)(5); (b)(?)(C) reports no change to stat us.
5)
1458 - Off .Icer (b)(
. - no change in status
(b)(6
?))CCa IIe d reporte d on post wit. h Off'Icer (b)(
,..,m;,--,
)

1710- Officer ~~

eported in - no change in status.

1900 - Officer (b}(6); reported in - no change in status
(b)(7)(C)

2100 - Officer
2200 - Officer

reported in - no change in status

_ _, reported

,...__

head coun t of 1 in the hospital - no change in status.

2300 - ~~/\~/:.~, ~eports no change .
11-23-18
OlOI(b)(6)
; (b)(7)(C)

eports no change.

030(

reports no change.

050 1

eports no change.

0651

eports no change.

'----~

0709- Officer l(b)(6);~,

l repots in from hospital watch that shift change is comp lete . No change

to status.

0900 - Officerl (b)(6); ~-

Irepo rts no change to the

detainee status . However, the medical

prov iders w ill be reaching out to his family again at approx. 1630 today.

1100 - Officer (b)(6);

eports no change to detainee status.

1300 - Officer ,...__
__

_. eports no change to detainee status.

(b}(7)(C)

1500-11 -23-18 SgtKb)(6); ~-! takes over Log, rb)(6); (b)(7)(C)
1630- ~calls

pn post. No change to status

in count of 1

1700 b)(6); reports no changes
b)(7)(C)

1900
2100

reports no changes
~~

reports no changes

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000008
2019-ICLl-00051 1835



2200-Log passed to Sgtl(b)(6);~-

l Office d(b)(6);

I reported head count of 1 in the hospita l - no

change in status.
2300 - ~b)(6); (b)(?)(C) Ire ports no change .

11-24-18
0100 - Kb)(6); (b)(7)(C) Ire ports no change.
0300- (b)(6); (b)(7)(C)

reports no change.

0505 -

eports no change.

0650 -~---~

eports no change.

0710 - Shift change comple t ed. Officer ~/~
~/;"'

nd l(b)(6); (b)(7)(C)

posted.

0900 - No changes to detainee status. Doctors will attempt contact with the family again this
evening at approx. 1600.
1100 - No changes to detainee status.
1300 - No change to detainee status.
;
1430 - Off .1cers (b)(6)
(bl(7)(Cl
1500 - Office d(b)(6);

now posted on watc h

!advises no changes to detainee status.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000009
2019-ICLl-00051 1836



l(b)(6); (b)(?)(C)

From:
Sent :
To :

25 Nov 2018 17:22:09 +0000
(b)(6); (b)(?)(C)

Cc:
(b)(6); (b)(?)(C)

AMAR

Subject :
G oo d M

.
ornm

,rr.

(b)(6);

h
1 117

Following up on our phone call from last night, please book AMAR out. I will have someone get you a
203 sometime today.
Thanks,
l(b)(6); (b)(7)(C)

I

Assistant Field Office Director
DHS/ICE/ERO
Northwest Detention Center
Seattle Field Office
Desk: (b)(6); (b)(?)(C)
Cell: ~---~

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000010
2019-ICLl -00051 1837



From :

Sent:
To:

Subject :

!(bl(6l (bl(7l(Cl
19 Nov 2018 03:25:05 +0000
kbl(6): (b)(7)(C)
!
Automatic reply: Hospital ICU Update A#: 216269802

I am currently unavailable and do not have access to email. If you need immed iate management
b; in Seattle please contact!<bl(6l: I
assis tance in Detroit, please contac t DCC ~b)(6);
Thank you,
l(b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000011
2019-ICLl-00051 1838



From :
Sent :
To :
Subject:

I

l(b)(6); (b)(7)(C)
19 Nov 2018 03:43:26 +0000
!(b)(6); (b)(7)(C)
!
Automatic reply: Hospital ICU Update A#: 216269802

I am out of the office today, November 19th 2018.
For urgent inquiries please contac ~,_
(b"""
)(6
_),"-(b
"""
)("7)
--"(C
"""""
)________

AMERICAr--..

pVERSIGHT

_.

DHS-ICE-19-0196, 19-0197-J-000012
2019-ICLl-00051 1839



U.S. IMMIGRATION AND CUSTOMS ENFORCEMENT
DIRECTIVE TITLE: NOTIFICATION AND REPORTING OF DETAINEE DEATHS
INDIVIDUAL INCIDENT CHECKLIST

Field Office:
Detainee Name:
A#:

Date of Death:

a) Immedi ately following the death of a detainee:
i) Enforcement and Removal Operations (ERO)
Field Office Director (FOD) shall:
Date:

Status:

Time Person making
Time: Zone: Notification:

Person Notified:

Manner :

?Contact

the ERO AssistantDirector for Field
Operations.
? Joint Intake Center (TIC)by telephone to report
the death.
?The AssistantDirector for Field Operations shall
notifythe ExecutiveAssociate Director by telephone.
? Report the detainee death as a "significan
t
incident"to the ICE Reportingand Operations
Center (IROC) usingthe electronicICE Significant
Event Notification(SEN) system.
? The ExecutiveAssociate Director shall provide

telephonicnotificationto the Officeof the Director.
?The JIC, upon being notified, shallprovide
telephonicnotificationto the DHS Office of the
Inspector General (OIG).
b) Within 24 hours of the death of a detainee:
i) The FOD shall provid e email, telephonic , or in
person notification to:
Date:

Status:

I

tim e !Person making
Time: Zone: Notification:

IPerson Notified: IManner :

~

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000013
2019-ICLl-00051 1840

I



U.S. IMMIGRATION AND CUSTOMS ENFORCEMENT
DIRECTIVE TITLE: NOTIFICATION AND REPORTING OF DETAINEE DEATHS
INDIVIDUAL INCIDENT CHECKLIST
? The appropriate Chief Counsel Office (who will

notifythe alien's attorneyofrecord , EOIR, BIA and
CircuitCourt officials).
? Attorney of Record notification.

AMf::HICAN

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000014
2019-ICLl-00051 1841



U.S. IMMIGRATION AND CUSTOMS ENFORCEMENT
DIRECTIVE TITLE: NOTIFICATION AND REPORTING OF DETAINEE DEATHS
INDIVIDUAL INCIDENT CHECKLIST
? The appropriate state agency(ies), in states that

require notification.
?Toe local ICE public affairsofficer.
?The ICE Health Service Corp (IHSC).
ii) The Executive AssociateDirector of ERO
shall:
Status:

Date:

Time Person making
Time: Zone: Notification:

Person Notified:

Manner :

? Provide emailor

telephonicnotificationto the
DHS Officeof HealthAffairs.
? Provide emailor telephonicnotificationto the Civil
Ri!:!htsand CivilLiberties.
? Provide writtennotificationto OAD via a
Director's Note.
? Provide writtennotificationto the Office of
ProfessionalResponsibilityvia a Director's Note.
? Provide writtennotificationto the Office of Public
Affairsvia a Director's Note.
? Provide writtennotificationto the Office of
Con!lfessionalRelationsvia a Director's Note.
? Provide writtennotificationto the Office ofICE
Policy, via a Director'sNote.
c) Within 48 hours of the death of a detainee, the
Executive Associate Director of ERO shall:
? Ensure that copies of all availablemedicalreports
are provided to the DHS Office of Health Affairs
(OHA) in order to provide OHA the abilityto initiate
a proper mortalityreview. (All other relevant
documents shall be provided to OHA in

A MERICAi\

Iaccordance with sectio n 8.)

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000015
2019-ICLl-00051 1842



U.S. IMMIGRATION AND CUSTOMS ENFORC EMENT
DIRECTIVE TITLE: NOTIFICA TION AND REPORTING OF DETAINEE DEAT HS
INDIVIDUAL INCIDENT CHECKLIST

NOTE: All notificationsprovided in accordance with
this section, along with an acknowledgmentthat the
notificationwas received (if possible), shall be
documented and maintainedin the decedent' s alien
file(A-file).
7.2 Notification to Consulate and Detainee's Next-of-Kin.
a) Within 24 hours of the death of a detainee:
Status:

Date:

Time Person making
Time: Zone: Notification :

Person Notified :

Manner :

Time Person making
Time: Zone: Notification:

Person Notified :

Manner :

?The FOD shalltelephonicall
y notifythe applicable
consulate of the death and coordinate with consular
officials, as necessary, to locate the next-of-kin.
? The FOD shallensure that, unless consular
officialsare unwilling to do so, allnotifications to next
of-kin are made by consular officials.
? If consular officialsare unwillingto notifynext-ofkin, the FOD shall telephone the person named as
the next-of-kinto informthem of the death in a
larnmagethey can understand.
b) Within 48 hours of the next-of-kin being notified:

Date:
? The FOD

shall send a condolence letter to the
next-of-kin (see attached template), with a copy to
the applicableconsulate.
Name of Next-of
Kin:
Address:
Relation:

AVH::HICAN

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000016
2019-ICLl-00051 1843



U.S. IMMIGRATION AND CUSTOMS ENFORCEMENT
DIRECTIVE TITLE: NOTIFICATION AND REPORTING OF DETAINEE DEATHS
INDIVIDUAL INCIDENT CHECKLIST

7.3. Notification to Congress, the Media and Nongovernmental Organizations .
a) Within 24 hours of the death of a detainee, the
ICE Officeof CongressionalRelationsshallprovide
e-mailnotificationto the Chair and Rankingmember
of the followingCommittees:
Status:

Date:

I

Time Person making
Time: Zone: Notification:

Person Notified:

Manner :

? Those House and

Senate members who have
iurisdictionover where the death occurred
? Senate JudiciaryCommittee.
? House JudiciaryCommittee.
? Senate JudiciaryCommittee,Subcommitteeon
Immi!rration.Refugeesand Border Security.
? House JudiciaryCommittee,Subcommitteeon
Immigration,Citizenship,Refugees,Border Security
and InternationalLaw.
? Senate Homeland Securityand Governmental
AffairsCommittee.
? House HomelandSecurityCommittee.
? Senate AppropriationsCo1mnittee
.
? House AppropriationsCommittee.
NOTE: OCR shallcoordinate with the ICE Office of the Chief FinancialOfficer before sendingnotificationsto
House and Senate A1212ro12riations
Committeestaff.
lcoMMENTS:

I

AMf::HICAN

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000017
2019-ICLl-00051 1844



U.S. IMMIGRATION AND CUSTOMS ENFORC EMENT
DIRECTIVE TITLE: NOTIFICA TION AND REPORTING OF DETAINEE DEAT HS
INDIVIDUAL INCIDENT CHECKLIST
? The Office of Public Affairs shall provide a media release
to the local press and the Associated Pre ss, and post the
media release on ICE's Internet website. (After notification
of the next-of-kin, or when the next-of-kin cannot be located
but reasonable efforts have been made by DRO (in
coordination with the consulate) to locate the next-of-kin.)
? The ICE Office of Policy shall provide a copy of the media
release to nongovernmental organizations (NGOs) via the
ICE/NGO workirn! ,:i:rouoco-chairs.
? In instances where the consulate has been notified of a
deta inee ' s death but the next-of-kin have not been located
yet efforts to locate them continue, notifications to
Congr ess, the media or NGOs shall include information that
efforts to reach next-of-kin are ongo ing.

8 ONGOING REPORTI NG REQUIREMENTS.
8.2.
Detention Ma nagemen t Division.

-

Upon the death of a detainee in a detentionfacility,
the ERO AssistantDirector for Management(ADM)
shall require:
Status:

Date:

Time Person making
Time : Zone: Notification:

Person Notified:

Manner :

? In coordinationwith OPR,

A vlt:HlliAI\J

an internalreview of all
facilityinspectionrecords for the detentionfacilityat
whichthe death occurred.
? A review of all contract documentationfor the
detentionfacilitvwhere the death occurred.
? If the death occurs at a medicalfacilityor while
the detainee is in transit, the ADM shallrequire such
reviewat the facilitywhere the decedent was last
held in custody.
b) The ADM shall submit the records within 14
calendar days of the death of the detaineeto:

pVERSIGHT

I
DHS-ICE-19-0196, 19-0197-J-000018

2019-ICLl-00051 1845



U.S. IMMIGRATION AND CUSTOMS ENFORCEMENT
DIRECTIVE TITLE: NOTIFICATION AND REPORTING OF DETAINEE DEATHS
INDIVIDUAL INCIDENT CHECKLIST
Status:

Date:

Time Person making
Time: Zone: Notification:

Person Notified:

Manner :

Time Person making
Time: Zone: Notification :

Person Notified:

Manner:

?

ICE senior management
? OPR
? 0 HA for inclusionin OHA' s mortalityreview
? CRCL
? OIG (if the investigation
is being conducted by
theOIG).
I

c) The ADM shallprovide autopsy and toxicology
results (if applicable), a copy of all treatment
authorizationrequests (TAR), a copy of the death
certificateand all other relevantdocuments (ie., state
and local law enforcementinvestigatoryinformation),
as soon as they become availableto:
Status:

Date:
?

OHA for inclusionin OHA's mortalityreview
? CRCL
? OIG (if the investigation is being conducted by
theOIG).

AMf::HICAN

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000019
2019-ICLl-00051 1846



U.S. IMMIGRATION AND CUSTOMS ENFORCEMENT
DIRECTIVE TITLE: NOTIFICATION AND REPORTING OF DETAINEE DEATHS
INDIVIDUAL INCIDENT CHECKLIST

AMERICAN

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000020
2019-ICLl-00051 1847



Office of Detention and Removal Operations
U.S. Department of Homeland Securi ty
500 12th Street, SW
Washi ngton, DC 20536

U.S. Immigration
and Customs
Enforcement

[Date]
[Name of Relative]
[Address]

Dear Mr./Ms. [Name of Relative] ,
I am writing you on behalf of U.S. Immigration and Customs Enforcement (ICE) and regret
that I must inform you of the death of your [insert relative's relationship with detainee , i.e.
brother, sister, etc.], [detainee name]. I extend to you and your family the deepest sympathies
of our entire agency for your loss.
In order to ensure that all of your questions are answered, please feel free to contact [name of
the POD] at [phone number of the POD] or [name of the consulate offic ial] at [phone number
of the consulate official].
Please accept our deepest condolences for your loss.
Sincerely,

[FOD Name]
Field Office Director
[Detention Facility]

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000021
2019-ICLl-00051 1848



!(b)(6); (b)(?)(C)

From:
Sent :
To :

7 Dec 2018 14:45:16 +0000
(b)(6); (b)(?)(C)

Cc:
AMAR Notifications Checklist

Subject:
(b)(6);
/ h \f7\tr:I

Have you utilized a checklist for the various death notifications for AMAR? We should probably get that
into the file ASAP.
Thanks,
j(b)(6); (b)(?)(C)

Assistant Field Office Director
DHS/ICE/ERO
Northwest Detention Center
Seattle Field Office
Des b)(6); (b)(?)(C)
Cell ,._

____

_.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000022
2 019 -ICLl -00051 1849



From :
Sent :
To :
Subject:

!(b)(6); (b)(7)(C)

25 Nov 2018 16:11:44 +0000
l(b)(6); (b)(7)(C)

I

Automatic reply: AMAR

!\~!:~, I will serve as Acting
I will be out of the office on Friday , November 23. During my absenceJ?
AFOD over Seattle Non-Detained, and as the POC for Congressional and Media Affairs, as well as Public
Outreach !\?!\~/;_ Ian be reached at Kb)(6); (b)(7)(C)
lo 1(b)(6); (b)(7)(C)
I
For issues involving Mission Support, please contact SMSSj(b)(6); (b)(7)(C) I atfo \/6\ /b\/7\/C\
fb)(6); (b)(7)(C)

I

lor

I will be available via iPhone and email.
Thank you.
(b)(6);
( 1,-,.
\/ 7 \lf"'\

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000023
2019-ICLl-00051 1850



Fro m :

l<b)(6); (b)(?)(C)

Sent:

21 Nov 2018 04:45:27 +0000

To:

(b)(6); (b)(?)(C )

Subje ct:

Automatic rep y: communication to hospital for Amar family

I am out of Warsaw until November 27, 2018.
I will monitor my email while I am away (less driving).

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000024
2019-ICLl-00051 1851



Page 1852
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000025



Page 1853
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000026



Page 1854
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000027



Page 1855
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000028



Fro m :

~b)(6); (b)(?)(C)

Sent:

2 Oct 2018 03:45:01 +0000

(b)(6); (b)(?)(C)

Subje ct:

Declined Mea ls

As of dinner meal on 10-1-18, these detainees have declined their dinner meal.
Medical Isolation:
Amar - #216269802- Missed his 122nd missed meal. Detainee has been eating apples,
drinking water, boost and pedialyte, but has no commissary in his cel l.
D-2:
(b)(6); (b)(?)(C)

missed meal
1issed meal
1st missed meal
1st missed mea l

H-seg:
st missed meal
2nd missed meal

(b)(6); (b)(?)(C)

Informat iona l repo rts have been submitted.
l(b)(6); (b)(?)(C)

I

Sergeant
GEO Corrections & Detention (R)
Northwest Detention Cente r
1623
East J Street
Tacoma, Washington 98421
Tel (b)(6); (b)(?)(C)

Fa.-----~
www.geogroup.com
T his email and any files transmitted with it are confidential and arc intended solely for the use of the individual or entit y to
which they ar e addressed. If you ar e not the intended recipient or the p erson respon sible for deli ver ing the email to the
int ended recipient , be advised that your have received this email in error and that any nse, dissemination , forwarding, printin g
or copying of this email is stri ctly prohibited. If you have received this email in error , please immediatel y notify by replying to
this email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000029
2019-ICLl-00051 1856



Fro m :

Sent:

rb)(6); (b)(7)(C)

12 Nov 2018 05:18:54 +0000

(b)(6); (b)(7)(C)

Subject :

Declined meals (dinner)

The following detainees declined their dinner meal today.
H-seg:
Amar #216269802 - 48th missed meal.
F-4:
~l
<b
_)<_6)_;(b
_)<
_7)_<c
_) ______

~l 2nd missed meal.

Informationa l reports have been submitted.
l<b)(6); (b)(7)(C)

Sergeant
GEO Corrections & Detention (R)
Northwest Detention Center
1623
East J Street
Tacoma, Washington 98421
Tel b)(6); (b)(7)(C)

Fa
(b)(6); (b)(7)(C)

www.geogrouo.com
Thi s email and an y tiles tran smitt ed with ii are confidential and are intended solely for the use of the indi vidual or entit y to
which they ar e addr essed. If you are not the intend ed recipient or the p erson responsible for deli vering the email to the
intended recipient, be advised that your hav e received this email in error and that any use, dissemination, forwarding, printing
or copying of this email is strictl y prohibit ed. If you have received this email in error, plea se immediately notify by replying to
thi s email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000030
2019-ICLl-00051 1857



Fro m :

(b)(6); (b)(7)(C)

Sent:

6 Nov 2018 21:19:03 +0000

(b)(6); (b)(7)(C)

Subje ct:

Declined meals

As of the lunch meal today, the following detainees declined their meals:

Hl:

fo l<6U bl/7l/Cl
~ 2nd
Amar #216269802 - 32nd

Med. lso:

f bl(6); (b)(7J(Cl

r 25th

Info reports submitted.

l(b)(6); (b)(7)(C)

I

Lieutenant/CERT

Commande r

GEO Corrections & Detention (R)
Northwest Detention Center
1623 East J Street
Tacoma, Washington 98421
Tel: (b)(6); (b)(7)(C)
Cell

Fax:~----~
l(b)(6); (b)(7)(C)

www .geogroup.com

This email and any files transmitted with it are confidential and are intended solely
for the use of the individual or entity to which they are addressed. If you are not the
intended recipient or the person responsible for delivering the email to the intended
recipient, be advised that your have received this email in error and that any use,
dissemination, forwarding, printing or copying of this email is strictly prohibited. If
you have received this email in error, please immediately notify by replying to this
email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000031
2019-ICLl-00051 1858



From:

l(b)(6); (b)(?)(C)

Se nt:

20 Nov 2018 18:59:54 +0000

To :

r b)(6); (b)(?)(C)

Cc:
Subje ct:

_
..,.c
....
n=e=c=k
=u
=t....,
s
e=t=c
,-.--------------~

Attachments :
Detainee Death Checklist.xis, condo lence_letter_template2.doc, FW: DRAFT
detainee death notice re: AMAR

Sir,

Iprov ided the

above attac hments to me bac k in 20 16. Also enclosed, is l\?!\~U
email, please use the attached draft DON for upda tes and please see the comment from
IHSC.

f b)(6); (b)(?)(C)

Below is the some policies
(b)(?)(E)

f b)(6); (b}(?)(C)

J

Domes tic Opera 10ns Desk Officer-West (Los Angeles & Seattle)
HQ- Enforcement and Removal Operations
b)(6); (b)(?)(C)
Desk
Mobile
l(b)(6); (b)(?)(C)

Warning : This document is UNCLASSIFIED//FOR OFFICIAL USE ONLY (U//FOUO) . It contains information that may be exempt from public
release under the Freedom of Information Act {5 U.S.C. 552) . It is to be controlled, stored, handled, transmitted, distributed, and disposed of
in accordance w ith DHS policy relating to FOUO information and is not to be released to the public or other personnel who do not have a
valid "need -to -know " without prior approval of an authorized DHS official. No portion of this report should be furn ished to the media, either
in written or verbal form.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000032
2019-ICLl -00051 1859



From:

t b)(6); (b)(7)(C)

Sent :

20 Nov 2018 18:56:45 +0000

To :

(b)(6); (b)(?)(C)

Subject :
Attachment s:

FW: DRAFT etainee death notice re: AMAR
RE: DRAFTdetainee death notice re: AMAR, DRAFT---- Detainee Death
Notification-ERO Seattle-Mergensana A216 269 802 V6{MC) with IHSCedits .DOC
I've attached the latest version with comments from IHSC.
f b)(6); (b)(7)(C)
ERO Domest ic Operations - West
Unit Chie
(b)(6);
(Desk) Kb)(6);

I(Mobi le)

From: l(b)(6); (b)(7)(C)

Se nt: Tuesday, November 20, 2018 12:40 PM
[ b)(6); (b)(?)(C)

Subject: RE: DRAFTdetainee death notice re: AMAR
Stand by. I have OPLA looking at this.
Dr.Kb)(6); (b)(?)(C)
fV1PH, CCHP
Assistant Dir ector I ICE Hea lth Service Corps
I Cell: b 6 . b 7)(C)
Office: b)(6);
Email (b)(6); (b)(7)(C)
ExecutiveAssistant: Ms.~/b=\/=6\~: /=b\=/7~\/~C~\ -------------~

I

From:l(b)(6);(b)(7)(C)

Se nt: Tuesday, November 20, 2018 12:40 PM
~~r

~

)(6); (b)(7)(C)

Subject : RE: DRAFTdetainee death notice re : AMAR
(b)(6);
/ h \/ 7 \/

Per our discussion , see the response received from OPLA attached.
Thank you.
l(b)(6); (b)(7)(C)

rs

Chief o f Staff I ICE li ealt Service Corps
Desk: (b)(6); (b)(7)(C) iPhone: (b)(6); (b)(7)(C)
Email: b)(6); (b)(7)(C)

From*b)(6); (b)(7)(C)
Sent : Tuesday, November 20, 2018 11:57 AM

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000033
2019-ICLl -00051 1860



To :l(b)(6); (b)(?)(C)

Subject : RE: DRAFTdetainee death notice re : AMAR

Hell~
Attached is the updated IHSC information. Please advise if you have addit ional questions.
Thank you.
l(b)(6); (b)(?)(C)

J

MS

ChiefofStaff l ICE Health Service Co s
Desk: kh \/ R\ lh \/ 7 \/C:\ I iPhone: b)(6); (b)(?)(C)
Email: (b)(6); (b)(?)(C)

I

From: l<b)(6); (b)(?)(C)
Sent : Tuesda November 20 2018 8:58 AM
To: (b)(6); (b)(?)(C)
SuoJect:
Importance: High

Good morning,
We've been preparing the attached Detainee Death memo in anticipation of AMAR being taken off life
support . Can IHSCtake a look at the attached and provide some input? We've utilized your medical
exsum (also attached) but I had a couple of follow-ups. They are the highlighted comments in the draft.
Thanks and if we could get it back ASAP,that would be great. We understand the hospital will be ending
life support efforts this morning and we'll need to get the final version of the doc submitted ASAPafter
that.

l(b)(6) ; (b)(?)(C)

ERO Domestic Operations - West

UnitChief
l(b)(6); (b)(?)(C)

From :~b)(6); (b)(?)(C)
Sent : Tuesday, November 20, 2018 7:37 AM
(b)(6); (b)(?)(C)

Subject: FW: DRAFTdetainee death notice re : AMAR
Importance: High

~~1\~L I

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000034
2019-ICLl-00051 1861



Mr.

~\~~\ir:, has some

comm ents in bot h documents, please see attac hed and below.

According to our HS SP site, the hunger strike started on 8/22/2 0 18 when he first meal
was misse d, his 9 th would have bee n on the 8/25 which be conside r ed the official hunge r
strike and he was r emoved from the HS on SP on 10/16, when he consume d his full solid
I
meal. j(b)(5); (b)(6); (b)(7)(C)
(b)(5)

f b)(6); (b)(7)(C)

Domestic Operations Desk Officer-West (Los Angeles & Seattle)
HQ- Enforcement and Remova l Operat ions
(b)(6); (b)(7)(C)
Desk
~---~
Mobile
l(b)(6); (b)(7)(C)
Warning : This document is UNCLASSIFIEO//FOR OFFICIAL USE ONLY (U//FOUO) . It contains information that may be exempt from public
release under the Freedom of Information Act {S U.S.C. SS2). It is to be controlled, stored, handled, transmitted, distributed, and disposed of
in accordance with OHS policy relating to FOUO information and is not to be released to the public or other personnel who do not have a
valid "need-to-know" without prior approval of an authorized OHS official. No portion of this report should be furn ished to the media, either
in written or verbal form.

From~(b)(6); (b)(7)(C)
Sent: Monday, November 19, 2018 11:46 PM
~~ (b)(6); (b)(7)(C)

Subject: RE: DRAFTdetainee death notice re: AMAR
Importance: High

See my comments in both documents.
It needs to be clear that AMAR did not go without eating from 8/25 unti l 10/16, the dates his hunger
strike officially started and ended.
It might also be noted (thoughts?) that the public believes he has been on hunger continuously from
8/22 until today, as he and his handlers have not relayed to anyone t hat he was off his hunger strike, nor
has ICEmade this announcement, due to AMAR's threats to resume his hunger strike if we did so and
our desire to ensure he was healthy enough for removal.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000035
2019-ICLl-00051 1862



I

From~(b)(6); (b)(7)(C)

Sent : M onday, November 19, 2018 1:22 PM

Subject : FW: DRAFTdetainee death notice re: AMAR

Good afternoon,
FYSA,we received an executive summa ry from the IHSC side of the house, we have
inco rporated some their information onto the draft DDN document you last provided on
Friday . We also sent it up to the front office acting Co ~\
~~Irr, for pre liminary rev iew.
Please see t he attac hed, an d use this vers ion to address any comments and ad d any updates
fro m ERO Seatt le.
Thank you,
~b)(6); (b)(7)(C )

Domestic Operations Desk Officer-West (Los Angeles & Seattle)
H - Enforcement and Remova l Operations
(b)(6); (b)(7)(C )
esk
obile
l(b)(6); (b)(7)(C)

Warning : This document is UNCLASSIFIED//FOR OFFICIAL USE ONLY (U//FOUO) . It contains information that may be exempt from public
release under the Freedom of Information Act {S U.S.C. S52). It is to be controlled, stored, handled, transmitted, distr ibuted, and disposed of

in accordance with OHSpolicy relating to FOUO information and is not to be released to the public or other personnel who do not have a
valid "need-to-know " without prior approval of an authorized OHS official. No portion of this report should be furn ished to the media, either
in written or verbal form.

From : l(b)(6); (b)(7)(C )

Sent : Monday, November 19, 2018 3:21 PM
To : fo l/6\ lbl /7l lC l

Subject : FW: DRAFT detainee death notice re: AMAR
Good afternoon,
See attached from 11. Please provide to SEAto address the comments and for their use in updating
going forward.
Thanks!(b)(6 ); Sb)(7)(C )

ERO Domestic Operatio ns - West
UnitC

202-73

esk) 202-20

obile)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000036
2019-ICLl-00051 1863



Fr o m :kb)(6); (b)(7)(C)

Se nt : Monday, November 19, 2018 3:04 PM
To : ~b)(6); (b)(7)(C)
Cc: I

'---------------------'

Subject: RE: DRAFTdetainee death notice re: AMAR
Please see attached with edits and comments. Please use this draft to update.
Thank you,
l(b)(6); (b)(7)(C)

(A) ChiefofStaff
Enforcement and Removal Operations
500 l ih Street, SW
Washington, D.C. 20536
fb) (6); (b)(7)(C)

I

From l <b)(6); (b)(7)(C)

Se nt: Monday, November 19, 2018 11:48 AM
To:l (b)(6); (b)(7)(C)

Cc:

-----------=--,------,------,---,---.,....-------------'

Subje ct: DRAFTdetainee death notice re: AMAR
Good morning,

We've been monitoring this detainee's medical case closely since last week . Medical staff have declared
him brain dead and EROis attempting to locate next of kin to authorize the discontinuance of life
sustaining efforts . While we wait, please review the attached draft det ainee death notification and
provide comments for anything else we'll need from IHSCor the field office.
Thanks,
!(b)(6); (b)(7)(C)

I

ERV Domesl/c Vp eratwns - West
Unit Chief
Enforc ement and Remova l Operations
U.S. Immigrat ion and Customs Enforcement

II S Qeuartweotof HomelandSecurity
l(b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000037
2019-ICLl-00051 1864



From :

l<b)(6); (b)(7)(C)

Sent:

20 Nov 2018 17:20:57 +0000

To:

(b)(6); (b)(7)(C)

Cc:
Subject:
Adding

AR

Iand

l(b)(6);

Unfortunately

my co ll eague~~ /\~/:~, l who

I'm at a depo sition

i s also working

on these issues now .

all day today , but here' s my very

quick

take:

(b)(5); (b)(6); (b)(7)(C)

Sent with

BlackBerry

Work

(www.blackberry.com)

t

From:{b) (6); (b)(7)(C)

Date: ,:uesday , Nov 20, 2018, 12:02 PM
To: fb l(6); (b)(7)(C)
Subject: FW: DRAFT detainee death notice re: AMAR

I

(b)(6);
/bl/71/Cl

Please see below . Do you concur?

Dr.j(b)(6); (b)(7)(C) ~ MPH, CCHP
Assistant Director I ICEHealth Service Corps
Cell: (b)(6);
Office: !(b)(6l:
Email: t hwn- t h v 7 1tr1

!I

Executive Assistant : Ms. 1l h-\/=n\- /~h\-17_\/=
C:_
\ ------------~

From :l(b)(6); (b)(7)(C)

Sent: Tuesday, November 20, 2018 11:03 AM
(b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000038
2019-ICLl-00051 1865



b)(6);
b)(7)(C)

I made some ed its to the draft.

1~)(5)

He is still on life support though and is still viewed as "b eing alive." Legally he is considered
dead. Once life suppo rt measures are withdrawn, there wi ll be a variable amo u nt of time that
his body may continue to function on its own (hear t beat and breathing) before his body ceases
all f unctioning.
OPLA can opine if needed on this as well on the official definition.
Thanks,Kb)\~);I
CAPT l(b)(6); (b)(7)(C) IMD USPHS
Deputy Me dical Director
ICE Health Serv ice Cor ps/ERO/ICE/OHS
610 W. Ash St. (b)(6 San Die o CA 92101

b)(6); (b)(7)(C)

I

From:j (b)(6); (b)(7)(C)
Sent : Tuesday, November 20, 2018 6:19 AM
To :,(b)(6); (b)(7)(C)

Cc:

'---------------------'

Subject: FW: DRAFT detainee death notice re: AMAR
Importance : High
6 );
Good morn ing (b)(
/ h \/ 7 \/

Not sure if you are working as of yet. When you recei ve this email , can you please take a
look and provide some input ?
Thank you .
~b)(6); (b)(7)(C)

!MS

Chief of Staff I ICE Health Service Co s
Desk: !(b)(6); (b)(7)(C) !I iPhone: (b)(6); (b)(7)(C)
Emai l: kb)(6); (b)(7)(C)

From: Laws, Joseph P
Sent : Tuesday, November 20, 2018 8:58 AM

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000039

20 19-ICLl-00051 1866



T o : l(b)(6); (b)(7)(C)

Subj ect: FW: DRAFTdetainee death notice re: AMAR

Importa nce: High

Good morning,
We've been preparing the attached Detainee Death memo in anticipation of AMAR being taken
off life support . Can IHSCtake a look at the attached and provide some input? We've utilized
your medical exsum (also attached) but I had a couple of follow -ups. They are the highlighted
comments in the draft .
Thanks and if we could get it back ASAP,that would be great . We understand the hospital will be
ending life support efforts this morning and we'll need to get the final version of the doc
subm itted ASAPafter that .

perations - West
Unir Chie(
l<b)(6); (b)(7)(C)
From : l<b)(6); (b)(7)(C)

Sent : Tuesday, November 20, 2018 7:37 AM
b)(6); (b)(7)(C)

SubJect : FW: DRAFTdetainee death notice re: AMAR

Importance: High

M r.

b)(6);
h \/7\/f'\

has some comments in both documents, please see attached and below.

According to our HS SP site, the hunger strike started on 8/22/2018 when he first
meal was missed, his 9 th would have been on the 8/25 which be considered the
official hunger strike and he was removed from the HS on SP on 10/16, when he
consumed his full solid meal. f b)(5); (b)(6); (b)(7)(C)

I

(b)(5)

f b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000040
2019-ICLl-00051 1867



Domestic Operations Desk Officer-West (Los Angeles & Seattle)
HQ- Enforceme nt and Removal Operations
(b)(6); (b)(?)(C)
Desk
Mobile
r b)(6); (b)(?)(C)

Warning: This document is UNCLASSIFIED//FOROFFICIAL USEONLY (U//FOUO}. It contains informat ion that may be exempt from
public re lease under the Freedom of Information Act (S U.S.C. 552) . It is to be controlled, stored, handled , transmitted,
distributed, and disposed of in accordance with DHS policy relating to FOUO informat ion and is not to be released to the public or
other personnel who do not have a valid " need-to-know " withou t prior approval of an aut horized DHS official. No portion of this
report should be furnished to the media, either in written or verbal form.

From:l (b)(6); (b)(?)(C)

Sent: Monday, November 19, 2018 11:46 PM
(b)(6); (b)(?)(C)

See my comments in both documents.
It needs to be clear that AMARdid not go without eating from 8/25 until 10/16, the dates his
hunger stri ke officially started and ended.
It might also be noted (thoughts?) that the public believes he has been on hunger cont in uously
from 8/22 until today , as he and his handlers have not relayed to anyone that he was off his
hunger stri ke, nor has ICEmade th is announce ment, due to AMAR's threats to resume his
hunger stri ke if we did so and our desire to ensure he was healthy enough for removal.

er 19, 2018 1:22 PM

Subject: FW: DRAFTdetainee death not ice re: AMAR

Good afternoon,
FYSA,we received an executive summary from the IHSC side of the house, we have
incorpora ted some t heir inform ation onto t he draft DDN document you last
provided on Friday. We also sent it up to the front office acting CoS j\~/\
~L,~ for

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000041
2019-ICLl-00051 1868



preliminary review. Please see the attached, and use this version to address any
comments and add any updates from ERO Seatt le.
Thank you,

""DiITTITe'Stlrc-1:JITT;T<rtl
ons Desk Officer-West (Los Angeles & Seattle)
HQ- Enforcement and Removal Operations
(b)(6); (b)(?)(C)
Desk
Mobile
i<b)(6); (b)(?)(C)

Warning: This document is UNCLASSIFIEO//FOR OFFICIAL USE ONLY (U//FOUO). It contains information that may be exempt from
public release under the Freedom of Informat ion Act (S U.S.C. 552}. It is to be controlled, stored, handled, transmitted,
distributed, and disposed of in accordance with OHS policy relating to FOUO information and is not to be released to the public or
other personnel who do not have a valid "need -to-know" without prior approval of an authorized OHS official. No portion of this
report should be furni shed to the media, either in written or verbal form.

From:f b\/6\ /b\/ 7\/C\
I
Sent: Monday , November 19, 2018 3:21 PM
To : f b)(6); (b)(?)(C)

Subject: FW: DRAFTdet ainee death notice re: AMAR
Good afternoon,
See at tached from 11. Please provide to SEAto address the comments and for their use in
updating going fo rward .
Thanks-

~b)(6); (b)(?)(C)

From: f b)(6); (b)(?)(C)
Sent: Monday, November 19, 2018 3:04 PM
To (b)(6); (b)(?)(C)

Cc:
SubJect: RE: DRAFT
Please see attached with edits and comments. Please use this draft to update .
Thank you,
l(b)(6); (b)(?)(C)

I

(A) Chief of Staff
Enforcement and Removal Operation s

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000042
2019-ICLl -00051 1869



500 12th Street, SW
Washin ton, D.C. 20536
(b)(6); (b)(7)(C)

From : l(b)(6); (b)(7)(C)

Sent : Monday, November 19, 2018 11:48 AM
~~ r )(6); (b)(7)(C)

Subject: DRAFTdetainee death not ice re: AMAR

r

Good morn ing,
We've been mon itor ing th is detainee's medical case closely since last week. Medical staff have
declared him brain dead and EROis att empt ing to locate next of kin to authorize the
discontinuance of life sustaining efforts . Wh ile we wait, please review the attached draft
detainee death notificat ion and prov ide comments for anyth ing else we 'll need from IHSCor the
field off ice.
Thanks,

i

l(b)(6), (b)(7)(C)
ERO Domesli c Op erations - West

Unir Chief
Enforcement and Removal Operat ions
U.S . Immigration and Customs Enforcement
U.S. Department of Homeland Security
l(b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000043
2019-ICLl-00051 1870



Page 1871
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000044



Page 1872
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000045



Page 1873
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000046



Page 1874
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000047



From:
Sent :
To :

l(b)(6); (b)(7)(C)

28 Nov 2018 00:46:37 +0000
rb)(6); (b)(?)(C)

Cc:
Conversation with Pierce county Medical Examiner Investigator

Subject:

I was able to get in contact with the Invest igator on the case for Mr Amar at the Pierce County Medica l
Examiner's Office. His name is Kb)(6)land his phone number is:l(b)(6); (b)(?)(C) I
He told me since this is a coroner's case, they are in charge of talking to next of kin regarding disposition
of the body. They are finished with their examination, and if they can release the body to a funeral
home of the family's consent then the death certificate can be signed. Because we have the family's
name and contact phone numbe rs I did release this information to the Investigator. This should he lp
hurry the process and lead to a conclusion. The full coroner's report will take more time to be complete
but I sent them my request for a copy of the report when it becomes available.
The Medica l Examiner's office will also contact us when the decision is made as to what the family wants
for the body's disposition. Let me know if you have any further questions.
V/R

l(b)(6); (b)(?)(C)

IMD

Clinical Director
ICE Health Service Corps (IHSC)
Enforcement and Removal Operations (ERO)
US Immigration Customs Enforcement (USICE)
Northwest Detention Center
1623 E. J St. Suite ~

Tacoma, WA- 98""'4=2
'-'l ~,,..,...----.
Main office: b)(6); (b)(?)(C)
Voic
(C;,:-;)
-1---__J
Cell :r:.:';';~; ~ (?"')
fax (
(b)(6); (b)(?)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000048
2019-ICLl -00051 1875



From:

Sent:

l(b)(6); (b)(7)(C)

10 Nov 2018 05:35:59 +0000

b)(6); (b)(7)(C)

Subject:

Daily Notificat ions 11.09.18

During dinner meal on November 9th the following detainee declined their meal.
H-unit
Amar# 216269802 declined his 42nd meal. Amar has been accepting alternate
nutritional sources from medical.
Intake
5
7
-fb_l<_l_
; (b
_l_
<_
J<c
_i___

~Ideclined his 1st meal due to menu options.

G-3 is the only cohort unit . Their are 12 detainees housed in the unit. The cohort status
is schedu led to end on November 9th 2018.

Lieutenant
GEO Corrections & Detention (R)
Northwest Detention Center
1623
East J Street
Tacoma Washington 98421
Tel: (b)(6); (b)(7)(C)
Cell
Fax
l(b)(6); (b)(7)(C)

I

www.geogroup.com
This email and an y tiles tran smitted with it are confidential and are intended solely for the use of the indi vidual or enti ty to
which they ar e addr essed. If you are not the intended recipient or the per son responsible for deliverin g the email to the
int ended recipient, be advised that your have received this email in err or and that any use, disseminati on, forwardin g, printin g
or copying of this email is strictl y pr ohibit ed. If you have received this email in er ror , please immediat ely notify by replying to
th is email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000049
2019-ICLl-00051 1876



Fro m :

l(b)(6); (b)(?)(C)

Se nt:

3 Oct 2018 05:29 :10 +0000

b)(6); (b)(?)(C)

Declined meal

SubJe ct :

The following detainees refused their dinner meal on 10/2/18:
D-3:

5
7
f,__
b_H_l;_<b_l<_ l_<c_l __

.....,l1st

missed mea l

D-2:
(b)(6); (b)(?)(C)

l

_________
,._

It missed mea l
_,~1st missed meal

G-2:
(b)(6); (b)(?)(C)

~----------~

~sed mea l
missed meal
1st missed meal
~t missed meals

Medical iso:
Amar- #216269802- 125th missed mea l
Informat iona l reports submitted.
fb )(6); (b)(?)(C)

Sergeant
GEO Corrections & Detention (R)
Northwes t Detent ion Center
1623
East J Street
Tacoma , Washington 98421
Te l: b)(6); (b)(?)(C)

Fax
(b)(6); (b)(?)(C)

www.geog roup.co m
This email and an y 111estransmitt ed with it ar e confid ential and ar e intended solely for the use of the individual or entit y to
which the y ar e add ressed. If you are not the intended recipient or the person re sponsible for deli verin g the email to the
intended recipient , be advised that yonr have received this email in error and that any use, dissemination , for warding , printing
or copying of this email is strictl y prohibited. If you have recei ved this email in error , plea se immediatel y notify by replying to
thi s email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000050
2019-ICLl-00051 1877



Fro m :

I

!lh\ /n\ /h\/7\/C:\

26 Oct 2018 21:44:42 +0000

Se nt:
(b)(6); (b)(7)(C)

Declined meals

SubJe ct :

As of the lunch meal today, the following detainees declined their meals:

Hl- Amar #216269802 #30
A2 i (b)(6); (b)(7)(C)

G2 - f b)(6); (b)(7)(C)
Med. lso ~(b)(6); (b)(7)(C)
Info. reports submitted.

l(b)(6); (b)(7)(C)

I

Lieutenant/CERT Commander
GEO Corrections & Detention (R)
Northwest Detention Center
1623 East J Street
Tac'1-U-_.__._._,....,_,_.........,.....,,.~
98421
Tel:
;
Cell
_.
Fax: ,__

____

l(b)(6); (b)(7)(C)

www.geogroup.com

This email and any files transmitted with it are confidential and are intended solely
for the use of the individual or entity to which they are addressed. If you are not the
intended recipient or the person responsible for delivering the email to the intended
recipient, be advised that your have received this email in error and that any use,
dissemination, forwarding, printing or copying of this email is strictly prohibited. If
you have received this email in error, please immediately notify by replying to this
email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000051

2019-ICLl-00051 1878



From :

I

l(b)(6); (b)(7)(C)

Sent:

24 Oct 2018 22:00:41 +0000

b)(6); (b)(7)(C)

Declined meals

Subject:

As of the lunch meal on 10/24/18 the following detainees declined their meals.

Bl l(b)(6); (b)(7)(C)
D2-

b)(6); (b)(7)(C)

F4 _~b)(6); (b)(7)(C)
Med lso.

1(b)(6J; (b)(7)(CJ

Hl - Amar #2 16269802 -24th
Info. reports have been submitted.

(b)(6); (b)(7)(C)

Lieutenan t CERT Commander
GEO Corrections & Detent ion (R)
Northwest Detention Center
1623 East J Street
Tacoma Washinqton 98421
Te l:

(b)(6); (b)(7)(C)

Cell:

Fax:..__~------'
l(b)(6); (b)(7)(C)

www.q eoqrou p.com

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000052
2019-ICLl-00051 1879



~b)(6); (b)(7)(C)

From:

Sent:

19 Oct 2018 22:13:29 +0000

b)(6); (b)(7)(C)

Declined meals

Subject:

As of the lunch meal on 10/18/19 the following detainees declined their lunch meals:
A2 - ICb)(6); (b)(7J(Cl

I-

1st

Hl - Amar #216269802 - 9th
lso

{b l(6); (b)(7)(Cl

I-2nd

Info . report were submitted for the meals.

l(b)(6); (b)(7)(C)

I

Lieut enan t /CERT Command er
GEO Corrections & Detention (R)
Nort hwest Detention Center
1623 East J Street
Tacoma Washinqton 98421
Te l: (b)(6); (b)(7)(C)
Cell:
Fax: ~----~
~b)(6); (b)(7)(C)

www.geogroup.com

This email and any files transmitted with it are confidential and are intended solely
for the use of the individual or entity to which they are addressed. If you are not the
intended recipient or the person responsible for delivering the email to the intended
recipient, be advised that your have received this email in error and that any use,
dissemination, forwarding, printing or copying of this email is strictly prohibited. If
you have received this email in error, please immediately notify by replying to this
email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000053
2019-ICLl-00051 1880



From :

rb )(6); (b)(7)(C)

Sent:

6 Oct 2018 20:27:58 +0000

b)(6); (b)(7)(C)

SubJect:

Declined meals

As of the lunch meal today, the following detainees declined their meals:

Al - !(b)(6); (b)(7)(C)
D2 ~(b)(6); (b)(7)(C)

I1st

Medical lso - Amar #216269802 - 136th
Info. reports have been submitted.

kb)(6); (b)(7)(C)

Lieutenant/CERT Commander
GEO Corrections & Detention (R)
Northwest Detention Center
1623 East J Street
Tacoma Washinaton 98421
Te l: (b)(6); (b)(7)(C)
Cell:
Fax: .______
__,
l(b)(6); (b)(7)(C)

www .qeoqroup.cor11

This email and any files transmitted with it are confidential and are intended solely
for the use of the individual or entity to which they are addressed. If you are not the
intended recipient or the person responsible for delivering the email to the intended
recipient, be advised that your have received this email in error and that any use,
dissemination, forwarding, printing or copying of this email is strictly prohibited. If
you have received this email in error, please immediately notify by replying to this
email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000054
2019-ICLl-00051 1881



Fro m :

l(b)(6); (b)(7)(C)

Sent:

9 Nov 2018 22:13:59 +0000

b)(6); (b)(7)(C)

Subject:

Declined meals

As of the lunch meal today, the following detainees declined their meals:
02

(b)(6); (b)(7)(C)

A2 :

(1st)
1st)
> (2nd)

b)(6); (b)(7)(C)

2nd)

I(1st)

F4 :l(b)(6); (b)(7)(C)
H : Amar #216269802 (41st)
Med. lso : l<b)(6); (b)(7)(C)

~te his lunch tray today .

Info. reports submitted .

b)(6); (b)(7)(C)

1eutenant

RT Commander

GEO Corrections & Detention (R)
Northwest Detention Center
1623 East J Street
Tacoma, Washington 98421
Tel: b)(6); (b)(7)(C)
Cell:
Fax: .__ ____
___,
l(b)(6); (b)(7)(C)

www.qeoqroup.com

This email and any files transmitted with it are confidential and are inte nded solely
for the use of the individual or entity to which they are addressed. If you are not the

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000055
2019-ICLl-00051 1882



Kb)(6); (b)(7)(C )

From:

7 Nov 2018 22:42:20 +0000

Sent:
(b)(6); (b)(7)(C )

Declined meals

Subject:

As of the lunch meal today, the following detainees declined their meals:
Medical lso

!{28th)

- !(bl(6l: (bl(7l (C l

H-unit - Amar #216269802 (35th)
fb l(6); (b)(7)(Cl
1st)

I(

l(b)(6); (b)(7)(C l

11st)

Info reports submitted.

RT Commander
GEO Corrections & Detention (R)
Northwest Detention Center
1623 East J Street
Tacoma Washinaton 98421
Tel: (b)(6); (b)(7)(C)
Cell
Fax:
f b)(6); (b)(7)(C)

vvvVvV
.geo g , ou p. co 111

This email and any files transmitted with it are confidential and are intended solely
for the use of the individual or entity to which they are addressed. If you are not the
i ntended recip ient or the person responsible for deliver ing the email to the intended
recipient, be advised that your have received this email in error and that any use,
dissemination, forwarding, printing or copying of this email is strictly prohibited. If
you have received th is ema il in error, please immediately notify by reply ing to th is
email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000056
2019-ICLl-00051 1883



rb)(6); (b)(7)(C)

From :
Sent:

1

2 Nov 2018 21:37:41 +0000

b)(6); (b)(7)(C)

:)UDJect:

uec11nea meals

As of the lunch meal today, the following detainees declined their meals:

Hl - Amar #216269802 -20th
A3

-f

b)(6); (b)(7)(C)

/l <b)(6); (b)(7)(C)

I-1st

Medical lso ~(b)(6); (b)(7)(C)
D1 -

I- 1st

!13th

b)(6); (b)(7)(C)

All DT's from D1 are at t heir first decli ned meal.
Info. reports submitted.

!(b)(6); (b)(7)(C)

!

Lieutenant/CERT Commande r
GEO Corrections & Detention (R)
Northwest Detention Center
1623 East J Street
Tacoma, Washington 98421
Tel: (b)(6); (b)(7)(C)
Cell
Fax:

-----~

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000057
2019-ICLl-00051 1884



F"" ~'
. @geogroup.com
www.geogroup.com

This email and any files transmitted with it are confidential and are intended solely
for the use of the ind ividual or entity to which they are addressed. If you are not the
intended recipient or the person responsible for delivering the email to the intended
recipient, be advised that your have received this email in error and that any use,
dissem ination, forwarding, printing or copying of this email is strictly prohib ited. If
you have received this email in error, please immediately notify by replying to this
email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000058
2019-ICLl-00051 1885



From:
Sent:

0:59 +0000

(b)(6); (b)(7)(C)

u Ject :

The following detainees declined their dinner meal today.
H-seg:
Amar - #216269502- 25th missed meal. Detainee accepted an apple, a boost protein
drink and a pedialyte drink . He has no commissary in his cell.
C-2:
..._!
(b"""
)(6
....,_
),......
<b
....,_
)('""'
7)"<c
""....:..
>_____

__.llst

missed meal

G-2:
(b)(6); (b)(7)(C)

1st missed meal
st missed meal
1st missed meal

Information reports submitted.
l(b)(6); (b)(7)(C)

Sergeant
GEO Correct ions & Detention (R)
No rthwest Detention Center
1623
East J Street
Tacoma, Washin
Tel: b)(6); (b)(7)(C)

Fax
b)(6); (b)(7)(C)

www.geogroup .com
T his ema il and any files tran smitt ed with it ar c confid ential a nd ar c int end ed solely for the use of th e indi vid ual or entit y to
which they ar e addre sse d. If you ar e not the intended recipi ent or th e per son res pon si ble for d eliver ing the email to the
int end ed r ecipi ent, be ad vised that your have r eceived thi s email in error and th at an y use, dissemination , forwarding , printin g
or copying of thi s email is stri ctly prohibited . If you ha ve recei ved thi s email in error , plea se imm ediatel y notify by r eplying to
thi s email.

AMERfCAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000059
2019-ICLl-00051 1886



Fro m :

l(b)(6); (b)(7)(C)

Sent:

24 Oct 2018 05:4 1:19 +0000

b)(6); (b)(7)(C)

Subje ct:

Declined meals

These detainees have declined the ir dinne r meal today .
D-2 :
b)(6); (b)(7)(C)

1st missed meal
missed meal
missed meal
2nd missed meal

H-seg:
Amar - #216269802 - 22nd missed meal
Informationa l reports submitted
f b)(6); (b)(7)(C)

Sergeant
GEO Corrections & Detention (R)
Northwest Detention Center
1623
East J Street
Tacoma , Washi n
Te l: b)(6); (b)(7)(C)

Fax
b)(6); (b)(7)(C)

www.geogroup.com
T his ema il a nd a ny 111
es tran smitted with it are confid entia l a nd are intended solely for the use of th e indi vidu al or enti ty to
which they ar e addr essed. If you ar e not th e intended recipient or th e p erson responsible for d eliver ing the email to th e
intend ed recip ient, be advised that yonr have received this email in error and th at any use, disseminati on, for wardin g, pr intin g
or copying of this ema il is strictl y pr ohibited. If you have received this ema il in er ror, please immediate ly notify by replying to
this e mail.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000060
2019-ICLl-00051 1887



Fro m :

Sent:

rb )(6); (b)(7)(C)

22 Oct 2018 04:47:15 +0000

(b)(6); (b)(7)(C)

Subje ct:

Declined meals

The following detainee declined his dinner meal on 10/2 1/18.
H-seg:
Amar- #216269802- 16th missed meal (D/T has no commissary in his cell and he
accepted the apple)
Informationa l report submitted.
l(b)(6); (b)(7)(C)

Sergeant
GEO Corrections & Detention (R)
Northwest Detention Center
1623
East J Street
Tacoma , Washington 98421
Te l: (b)(6); (b)(7)(C)

Fax
(b)(6); (b)(7)(C)

www .geogroup.com
This email and any 11Ies tran smitt ed with it are confidential and are intended solely for the use of th e indi vidua l or entit y to
which they ar e addre ssed. If you are not the intended recipient or the person re sponsible for deli verin g the email to the
intend ed recipient , be advised that your ha ve received this email in error and that any use, dis seminati on, forwardin g, printin g
or copying of this email is strictl y prohibited. If you ha ve recei ved this emai l in error, plea se immediate ly notify by replying to
th is email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000061
2019-ICLl-00051 1888



From:

Sent:

rb )(6); (b)(7)(C)

19 Oct 2018 05:55:13 +0000

(b)(6); (b)(7)(C)

SubJect:

Declined meals

The following detainee missed his dinner meal on 10/18/18 .
H-seg:
Amar #216269802 - 7th missed meal
Information report submitted
f b)(6); (b)(7)(C)

Sergeant
GEO Corrections & Detention (R)
Northwest Detention Center
1623
East J Street
Tacoma , Washington 98421
Tel: b)(6); (b)(7)(C)
Fax:
~b)(6) ; (b)(7)(C)

www.geogroup .com
This ema il and an y tiles tran smitted with it are confidential and arc intended solely for the use of the individu al or entity to
which they are addressed. If you are not the intended recipient or the p erson responsible for deliver ing the email to the
int ended recipient, be advised that your have received this email in error and that any use, disseminati on, forwardin g, printin g
or copying ofthis email is str ictly prohibit ed. If you ha ve received this email in er ror , please immediat ely notify by replying to
thi s email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000062
2019-ICLl-00051 1889



l(b)(6); (b)(7)(C)

From :

12 Oct 2018 19:21:15 +0000

Sent:
(b)(6); (b)(7)(C)

Subject:

Declined meals

During the serving of the lunch meal on 10/12/18, Detainee Amar #216269802 declined
his tray making this his 154th consecutive declined meal.
Info. report submitted.

f b)(6); (b)(7)(C)

I

Lieutenant/CERT

Commander

GEO Corrections & Detention (R)
Northwest Detention Center
1623 East J Street
Tacoma, Washington 98421
Tel: (b)(6); (b)(7)(C)
Cell
Fax
f b)(6); (b)(7)(C)

www.qeoqroup.com

This email and any files transmitted with it are confidential and are intended solely
for the use of the individual or entity to which they are addressed. If you are not the
intended recipient or the person responsible for delivering the email to the intended
recipient, be advised that your have received this email in error and that any use,
dissemination, forwarding, printing or copying of this email is strictly prohibited. If
you have received this email in error, please immediate ly notify by replying to this
email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000063

20 19-ICLl-00051 1890



From :
Sent :
To :
Subject:

~b)(6); (b)(?)(C)
30 Nov 2018 22:35:18 +0000
fb)(6); (b)(?)(C)
Detainee suicide

Good afternoon,
I wanted to inform you that DHS OIG received t he information regarding the death of ICE detainee
Mergensana Amar and we opened a case. I wanted to inquire about getting copies of any
reports/records, surveillance video, list of involved employees to interview, etc. Should I deal directly
with AFOD j(b)(6); (b)(?)(C)~ on this matte r?
Thanks l(b}~~);_J Feel free to call either Vince or myself if you have any questions.
(b)(6);
f h \1 7 \lr\

Uh\/n\ /h\/ 7\/C:\

Special Agent
Departme nt of Homeland Security
Office of the Inspect or General
Seattle Resident Office
Phone i(b)(6); (b)(7)(C)

I

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000064
2019-ICLl -00051 1891



Case 3:18-mc-05016-BHS

Document 1-1

Filed 09/06/18

Page 1 ot 3

The Honorable Judge Benjamin H. Settle

2

3
4

5
G

CNITED STATES DISTRICT COURT FOR THE
WESTERN DISTRICT OF WASHI!\GTO:.'\f
AT TACOMA

7
8
9 NIBEMATIEROF:

3:18-n1c-05016 -BHS

NO.

10 MERGENSANA AMAR
11 File No. A216-269-802

[PROPOSED]
EMERGENCY EX PARTE MOTION
TO PROVIDE INVOLUNTARY

12

MEDICAL TREATMENT

13
The United States Department of Homeland Security, Immigration and Customs

14
15

16

Enforcement (hereafter "ICE"), by and through the Lnited States Attorney for the Western District
of Washington, has filed an ex parte motion for an order permitting ICE to immediately provide

17
18

J9

involuntary hydration and medical treatment for Mergensana Amar, "o. A21 G-269-802, who is
currently being held as a civil detainee at the Northwest Detention Center in Tacoma, Washington.

20
21

Rascd on the declarations of
Officci

<b)(6 ); (b)(7 )(C)

Dr.! (b)(6); (b)(7)(C)

Ithe Court finds that there is sufficient

land Supervisory Detention and Deportation
cause to believe that without the requested

22
23

medical testing and treatment, Mr. Amar is in danger of irreparable injury, and possible death.
'lhcrcforc, IT IS HERERY ORDERED that ICE may undertake necessary medical treatment

24
25

and testing lo save Mr. /\mar's life and prevent injury to him, including:

26

1.

involuntary hydration through administering intravenous (IV) Ouids;

2

physical examination with daily weight assessments and frequent vital sign checks;

27

28
ORDEi<.GRANTING EMERGE~CY EXPARTE MOTION
TO PROVIDE 1:--.lVOLU~TARYMEDTCAL TREATME:KT-1

AMERICAr--..

pVERSIGHT

UNJTrns.:xno,s kf1;?
1:w1 PAcno1cAwNi;1t .

6 ,~,
/Uo

oo."

TACOMA. WAS!!INGTON 98402
(253) 42Ht i-.\/ R\ I

DHS-ICE-19-0196, 19-0197-J-000065
2019-ICLl-0005 1 1892



Case 3:18-mc-05016-BHS

1

3

2

3

Document 1-1

laboratory tests at leasl every 48
a.

Filed 09/06/rn

Pc1f~C2 ot 3

72 hours consisting of:

Complete metabolic panel. This test reveals an increase in markers of kidney

function in view of any renal inJ ury The panel tests include: BUN (blood urea nitrogen), creatininc

4

5
6

level, urinalysis and protems. lt also reveals electrolyte dislurbances as potassium, phosphate,
magnesium and glucose levels can lead to heart arrhythmia~.

7
8

b.

Complete blood count. This test reveals the hemoglobin level.

c

Urinalysis, which reveals the presence ofketoncs, blood and crystals in the

d.

Magnesium and phosphate levels to assess deficiency after day 13 of a hunger

e.

Electrocardiogram, if the patient shows elevated potassium, is necessary to

9
10

unne.

11
12

strike.

13
14

treal conditions which can lead to lethal arrhythmias.

15
f

16
17

Creatine kinase (CK) levels determine whether CK levels increase

CK is an

enzyme found msidc muscle cells and should be measured as it is released into the blood, when the

18 muscle cells rupture. The increase in CK as a result of the destruction of muscle tissue can lead to
19

acute renal failure and death.

20
g.

21

Pre-albumin levels. Pre-albumin is used as a marker for nutritional status

22

evaluation, and levels will decrease over time the longer a patient fails to consume adequate

23

nutrition. The pre-albumin level correlates with patient morbidity and mortahty risk Normal pre-

2'1

albumin is 15-35 mg/dL

When pre-albumin falls to 5-1 l mg/dL, significant morbidity risks exist

25

26

and aggressive nutritional support is necessary
IT IS I IEREl3Y FURTHER ORDERED that if Amar continues to refuse the necessary

27

28 medical treatment and monitoring, ICE and medical staff at the Northwest D etention Center may use
ORDER GRANTING EMERG ENCY EX PARTE MOT ION
TO PROV!DE INVOLUNTARY MEDICAL TREATMENT - 2

UNITED STATES A~(Y

121tl

PACIFIC AVE.Nt:_E'.
b)(~); __
TACOMA, W ASl,.N(; I 0~

(25)) 42l (b)(6)I

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000066
2019-ICLl -00051 1893



Case 3:18-mc-05016-BHS

Document 1-1

Filed 09/06/18

Page 3 of 3

soft medical restraints to assure the safety of Amar and the medical staff when administering the
2

necessary treatment

3

[CR is directed to provide a copy of this order to \1r. Amar forthwith.

4

5
DATED this ___

6

day of September, 2018.

7
8

BENJAMIN IL SETTLE
UNITED STATES DISTRICT JUDGE

9

10
ll

Presented by:

12

13 ANNETTE L. HAYES
14

15

United States Attorney
(b)(6); (b)(?)(C)

16

ornc
o ewa

17

Seattle W
Tele
18
Fax:
19

rec,
98101

)(6);
)(7)(C)

(6); (b)(?)(C)

20
21

22
23
24

25

26
27
28
ORDER GRANTING GBP::ME
R GEKCY EX PAR TE MOTION
TO PROVIDE INVOLGNTARY MEDICAL TREATMENT -3

AMERICAr--..

pVERSIGHT

U:-liTEIJ STATT.SA1rlRl:,jty
1201 l'AC!FJC /\VFSUE, (b)(6);
TACOMA, WAS~402
(,.51)4 ~

DHS-ICE-19-0196, 19-0197-J-000067
2019-ICLl -00051 1894



Case 3:18-mc-05016-BHS

Document 1 Filed 09/0ti/18

Pagr: l of 7

The Honorable Judge Benjamin Il. Settle

2
3
4

5
6
UNITED STATES DISTRICT COURT FOR THE
WESTERN DISTRICT OF W ASHINGTOl\
AT TACOMA

7
8
9

IN THE MATTER OF:
NO.

10

3: 18-mc-05016-BHS

ll
MERGENSANA

AMAR

EMERGE'.'JCY EX PAR.TE MOTION
TO PROVIDE INVOLUNTARY
MEDICAL TREATMENT

12 File No. A216-269-802
13

14

15
16

.11ie L'nited States Department of Homeland Security, Immigration and Customs
Enforcement (hereinafter "ICE"), by and through the United States Attorney for the Western District

17

18

of Washington, respectfully applies to this Court for an order pernutting ICU to immediately provide

19

involuntary medical testing, treatment and hydration for Mergensana Amar, File ?'o A21(>-269-802

20

(hereinafter "Amar"), a civil detainee of the Northwest Detention Center ("NWDC") in Tacoma,

21

Washington.

ICE seeks authorizat10n to pursue these measures to prevent substantial injury or loss

22
23

of life due to Amar's self-imposed hunger strike

24

REI,EVA~T FACTS

25

Amar is a 39 year-old male, a native and citizen of Russian, and applied for admission to the

26

United States at the San Ysidro port of entry on December 2, 2017 without valid immigration

27
documents.

28

Declaration of

J(b)(6); ~-

l(' ~

Decl. ") submitted herewith at

E'vlERGENCY EX PARTE MOTION TO PROVIDE
[\/VOLUNTARY MEDICAL TREATM Er-;T - 1

ii 2; Declaration of Dr.

UNIIT.D STATES
120] PAC!FlC t\VF.S\J
TACOMA, W ASHISGlffl"i?t#trz-~

(253)42~ (b)(6) ;

AMlf ICAr--..

pVERSIGHT

!

DHS-ICE-19-0196, 19-0197-J-000068
2019-ICLl -00051 1895



Case 3:18-mc-05016- BHS Document 1 Filed 09/06/18

1 l(b)(6)
; (b)(7)(C)

Page 2 of 7

l("Dj(b)(6)
; (b)(7)(C) !Deel.") submitted herewith at, 2. On December 19, 2017,

2 Amar was transferred from California into custody at the NWDC, and placed into removal

3

proceedings on January 3, 2018 charged with inadmissibility under section 212(a)(7)(A)(i)(I) of the

4

5

Immigration and Nationality Act. Id. On August 7, 2018, an Immigration Judge ordered Amar

6 removed from the United States, and Amar has until September 6, 2018 to appeal this order, but to
7 date, he as not filed an appeal. Id.

8
9

10

While in NWDC custody, Amar began a hunger strike on August 22, 2018 stating the
5
); (b}(?)(C)eel. at ,ni 5, 11.
purpose behind his actions was to obtain release from custody. Dr. b}(

11 Amar has missed 45 meals since his hunger strike began, and is now on his fifteenth day of
12 monitored missed meals. Id. at,, 5, 8. In addition to refusing to eat, Amar has also refused to drink
13

water or any other liquids offered to him since August 25, 2018, and staff has observed him taking

14
15
16

only small sips of water on approximately three occasions in the last five days. Id. at 6. Amar is
further refusing medical care necessary to assess his well-being to include: monitoring of his vital

17 signs, physical examination, glucose checks, laboratories, urinalysis, and weight assessments. Id. at
18 7. Amar' s last known weight was obtained on August 22, 2018 when he weighed 163 pounds, and
19
he has refused any further attempts to weigh him since that date. Id. at 8. As of today's date, Amar

20
21

continues to be unwilling to eat or comply with necessary medical care. Id. at 9.
On August 31, 2018, medical staff observed that Amar's condition began to noticeably

22

23 decline. Id. at ,r9. Amar expressed that he was experiencing dizziness and extreme weakness with

24

physical movement coupled with diffuse body pain, especially over his kidneys. Id. Amar spends

25
26

the majority of his time lying flat in his bed, and staff monitoring Amar observe he passes urine very

27 infrequently. Id. at ,r10. As a result, the NWDC Clinical Director Dr. t~1~~1
;"'
28

Iinvolved with

Amar's treatment believes he is in imminent danger of renal failure, liver failure, and becoming
EMERGENCY EXP ARTE MOTION TO PROVIDE
INVOLUNTARYMEDICAL TREATMENT- 2

AMEnlCAr--..

pVERSIGHT

UNTIEDSTA'IES A,ry:C)PIIIDY
1201 PACIPIC AVE~b)
TACOMA,WAS~8402
(253)428 ~

(6 ); _

I

DHS-ICE-19-0196, 19-0197-J-000069
2019-ICLl-00051 1896



Case 3:18-mc-05016-BHS

Document 1 Filed 09/06/18

Page 3 of 7

1

comatose due to dehydration and hypotension (low blood pressure) leading to permanent injury of

2

his internal organs or death. Id. Dr.

3

concludes that involuntary medical monitoring and

(b)(6);
"'l h:.:.:.
117.:....
11
'-'-'
r. "-\ _

_.

hydration are necessary measures that must be administered at this time to save Amar's life and

4
5

prevent irreversible injury. Id. at~, 10, 17, 19, 22.

Ihas personally

6

explained to Amar in his native language the dire medical

7 conditions he faces to by virtue of his refusal to consume appropriate nourishment and fluids. !d. at
8

i.16. She has also explained the involuntary measures that medical stafT will be forced administer to

9
10

stabilize his medical condition. Id. at 17 Amar was also evaluated by a mental health team with the

1 1 assistance of a Russian interpreter on August 29, 2018 in an attempt to have Amar end his hunger
12
13

strike, and these efforts were unsuccessful. Amar has no known significant medical history or
mental conditions that would cause him not to consume nounshment. Id at 4, 11.

14

The measures Dr

b)(5 ); (b)(?)(C)

finds arc medically necessary to adequately treat Anwar's

15

16 condition ifhe elects to continue his hunger strike include:
17

18

19

l.

involuntary hydration through administering intravenous (lV) fluids;

2.

physical examination with daily weight assessments and frequent vital sign checks;

3.

laboratory tests at least every 48 - 72 hours consisting of

20
a.

21

Complete metabolic panel. This test reveals an increase in markers of kidney

22

function in view of any renal inJUf)'. The panel tests include: BC~ (blood urea nitrogen), creatinine

23

level, urinalysis and proteins

24

It also reveals electrolyte disturbances as potassium, phosphate,

magnesium and glucose levels can lead to heart arrhythmias.

25

26
27
28

b.

Complete blood count This tcs t reveals the hemoglobin level.

C.

Urinalysis, which reveals the presence ofketoncs, blood and crystals in the

urine.
EMERGE~CY EX PARTE MOTION TO PROVJUE
n,.-vOJ,U:--!TARY MEDICAi. TREAT\1ENT" 3

IJNJTEI) STATES

/1.'JTOBXEY

1201 PACIFIC /l.v1-::-;uJPY
b)(6);
TACOMA, WASIIINC.:1"-_()..:..:K.,,.:9~'--40""1---'

(253) 42, b)(~);_j

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000070
2019-ICLl-00051 1897



Case 3:18-mc-05016-BHS

1

Document 1 Filed 09/06/18

Page 4 of 7

d.

\,fagnesium and phosphate levels to assess deficiency after day 13 of a hunger

e.

Electrocardiogram, if the patient shows elevated potassium, is necessary to

2 strike.

3
4
5

treat conditions which can lead to lethal arrhythmias

f.

6

7
8

Creatinc kinase (CK) levels determine whether CK levels increase. CK is an

enzyme found inside muscle cells and should be measured as it is released into the blood, when the
muscle cells rupture. The increa'>e in CK as a result of the destruction of muscle tissue can lead to

9
10

acute renal failure and death.
g.

11

Pre-albumin levels. Pre-albumm is used as a marker for nutritional status

12 evaluation, and levels will decrease over time the longer a patient fails to consume adequate
13

nutrition. The pre-aJbumm level correlates with patient morbidity and mortality risk. Normal pre-

14
albumin is 15-35 mg/dL. When pre-albumin falls to 5-1 lmg/dL, significant morbidity risks exist

15
16 and aggressive nutritional support is necessary
17 Id at~~ 18-20.
18
19

If Amar continues to refuse the medical treatment and monitoring, the use of soft medical
restraints will be required to assure the safety of Amar and the medical staff when administering the

20
21

necessary treatment

Id at 2 L.

DISCUSSION

22
23
24

The majority of courts that have considered this issue have held that involuntary feeding and
treatment orders do not violate a hunger-striking prisoner's constitutional rights In the rec ent case

25
26

27

of Aamcr v Obama, 742 F 3d 1023 (D.C. Cir. 2014), the D.C. Circuit held that a force-feeding
protocol instituted against three detrunecs did not violate those individuals' constitutional rights

28
EMERGENCY EX PARTE :v!OT ION TO PROVIIJE
INVOLlJNT ARY MEDICAL TREATME~T - 4

AMERICAr--..

pVERSIGHT

u;s;tWD ST ATES /\ITOR$Y
1201 PACrFIC ilVhNt:d (b)(6);
TACOY.A. WASll:N(;TON ~H40 2
(2S) ) 42l(b)(6);

I

I

DHS-ICE-19-0196, 19-0197-J-000071
2019-ICLl -00051 1898



Case]: 18-mc-05016-BHS

Document 1 Filed 09/06/18

when weighed against the government's legitimate penological interests.
2

3

Page S of 7

1

In Aamer, three alien

detainees who had been cleared for release nonetheless remain held at the United States Kava!
Station at Guantanamo Bay. Id. at 1026. The government instituted a force-feeding protocol, and

4
5
6

the detainees sought a preliminary injunction. ld. at 1026-27.

In holding that the force-feeding

protocol did not violate the detainees' constitutional rights, the Court concluded that the government

7 had legitimate peno!ogical interests in preserving the lives of those in its custody, and noted that the
8

ovenvhelmtng ma_i
ority of courts have concluded that absent exceptional circumstances, prison

9

10

officials may force-feed a starving inmate at risk of death. Id at I 040-41

The weight of authority

11

appears to support this position. See, e.g, In re: Grand Jury Subpoena John Doe v. United Stales,

12

150 F.3d 170 (2d Cir 1998) (force-feeding order issued against a prisoner did not violate that

l 3 individual's constitutional rights when weighed against the state's interests such as the preservation
14
of life, prevention of suicide, and enforcement of prison security, order, and discipline); Martinez v.
15
16
17

Turner, 977 F.2d 421 (8th Cir. 1992), cert. denied, S07 C.S l 009 (l 993) (upholding the validity of a
district court's force-feedmg order and stating that petitioner failed to assert a conslltutional claim

18 when challenging the order); Uarza v. Carlson, 877 F.2d 14 (8th Cir 1989) (affirming the right of

19

prison officials to force-feed prisoner asserting a right to die as a result of a religious fast); McNabb

20
21

v. Dept. 4Correclions,

163 Wash.2d 393, 403, 405, 180 P.3d 1257 (2008) (slate interests of

22

maintaining security and orderly administration in its prison system and preservation of life where

23

medical treatment will in fact save the patient's life outweighed prisoner's right to refuse state's

24

force-feeding protocol); Laurie v. Senecal, 666 A2d 806 (R.I. 1995) (prisoner has no right to

25

26
27

28

t Citrng Turner v. Safley, 482 lJ S 78, 107 S. Ct 2251, 96 L. f<:d.2dM (I 987) (holding that the general test for assessing
the !cgality of a prison regulation that "impinges on" an inmate's constitutional rights , holding that such a regulation is
"valid iflt is reasonably related to legitimate penological interest.,. " ) Id. at 89, 107 S.Ct. 2254

EMElUJEl\'CY EX PARTE MOTION TO PROVID E
JNVOLUNTARYMEDICAL
TREATMENT5

UNITillJ STA"11'.SArrORNEY
1201 l'AC~!C AW'-IUE,~b)(6) ;
T ACO~lA,

WASHP--Gr
6 fti84iJi

(]51)42K f b)(~); _

AMERICAr--..

pVERSIGHT

I

DHS-ICE-19-0196, 19-0197-J-000072
2019-ICLl -00051 1899



Case 3:18-mc-0S0}G-BHS

Document 1 Filed 09/06/18

Page G of 7

commit suicide through starvation); State v. Vogel, 53 7 N .W. 2d 358 (N. D 1995) (for purposes of

2 determining extent of prisoner's right to refuse medical treatment, courts cannot condone prisoner's
3

manipulation of his medical circumstances to the detriment of state's interest in prison order,

4
5

security, and discipline); In re Caulk, 480 A.2d 93 (N.H 1984) (state's interest in maintaining an

6

effective criminal justice system and in preserving life prevails over prisoner's asserted

7

constitutional rights); In re Sanchez, 577 F. Supp. 7 (S.D.N.Y 1983) (rejecting hunger-striker's

8

constitutional claims stating that motive was lo manipulate system to vacate his contempt order);

9
10

White v. Narick, 292 S.E.2d 54, 58 (W. Va. 1982) (state's interest in preserving life and preventing

11

manipulation of system outweighs any privacy interest inmate may assert in contesting force-

12

feeding); Von [!olden v. Chapman, 450 ~ YS 2d G23 (N.Y App. Div. 1982) (right to privacy docs

13

not include the right to commit suicide by starvation); see also In the Matter of Rahi Guled-Ahth,

14

Case "1\ol 2-MC0249-JLR (W.D. WA December 11, 2012); (Order granting ICE Motion to pursue
15
16

17

involuntary feeding); In the Matter ofAbdallah Ahdirahman Yu.1"14~
Case No. 12-MC-248-MJP
(W D WA December 7, 2012) (same); In the Matter ofAhdul HahmanAlmaghzar,

Case No. 07-

18 5006 -FDB (W. D. WA March 13, 2007) (same)
19
20

II

21

//
II

22

23
24

25

26
27

28
EMERG.El\CY EX PAR TE MOTION TO ,'ROVI DE
J~;vou;l\TARY
MEDICAL TREATMENT- (,

U:\ITElJ STAff.S
1201 PACll'!C Av

TACO~:A,WASH,..;__~ffi'rif;'-...J
(]51)42

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000073
2019-ICLl -00051 1900



Case 3:18-mc-05016-BHS

Document .1 Filed D9/06/1.8

Page 7 of 7

CONCL!JSION

2
3

Based on the foregoing, the United Stales rcspcclfully requests that the court issue an order to
allow ICE to pursue involuntary hydration and medical monitoring of detainee Amar.

4

DATED this 6th day of September, 2018

5

6

7

Respectfully submitted,

8

ANNETrE L. llAYES

United States Attorney
9

10

____.r

r b-)(-6)-; (b
....
- )(-7)-(C_) __________

11

Assistant United States Attorney
United Slates Attorney's Officc
~~ic:\
700 Stewart Street, Suit )~~)
Seattle, Washington 98
l
Phone: f bl(6l: (bl(7)(Cl
E-mail: f b)(6); (b)(7)(C)

12

13
14

15
16
17

18
19

20
21

22
23

24
25

26
27

28
EMERGENCY EX PARTE MOTIO\I TO PROV1DE
lNVOl,UNT/1.RYMEDICAL TREATMENT- 7

UNJ'l1J) STATES ATIORNEY
IJ.OlPACIF!CJ\v,.'
TACOMA, WAS!

):
8402

(25] ) 4

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000074
2019-ICLl -00051 1901



Case 3:18-mc-05016-BHS

Document 2 Filed 09/06/18

PD.\Je1 of 6

2
3

4,

5
6

7

8
9
10

}l

I

UNITED STATES DISTRICT COURT FOR THE
WESTERN DISTRICT OF WASHINGTON
AT SEATTLE

12
13
14

15

IN THE EX PARTE MATIER OF:

CASE NO.

3:18-mc-05016-BHS

16
17

MERGENSANA

AMAR

DECLARATION OF

A2 l 6-269-802

DR.K b)(6); (b)(?)(C)

18

IMD

in Support of the United States'

19

Ex Partc Motion to Administer
Emergency Medical Treatment

20

21 l--22

I, D r.l (b)(6); (b)(?)(C)

23

Ideclare

as follows:

24
I am an Internal Medicine Doctor and serve as the Clinical Director for ICE

25
26

27
28

Health Services Corps (II-ISC) at the Northwest Detention Center (NWDC) in Tacoma,
Washington.

I have been employed at this facility since September 30, 2015, and my

duties include providing and overseeing the medical care of detainees housed at this
facility.
LNITED STATES A .rnHNFY
700 STEWART Srnf .-. b)(6); ~,
SEi\TfLE, W AS,llt,li.i.lL~I
OI
(206) 553

[)Rk b)(6); (b)(7)(C) !DECLARATION - l

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000075
2019-ICLl -00051 1902



Case 3:18-rnc-05016-BHS

2.

Document 2

Filed 09/06/1.8

Page 2 ot 6

I am familiar with the medical condition of detainee Amar Mergcnsana. I

2 am the supervising physician for the detainee, and I make this declaration based upon my
3 review of his medical records, my examination of the detainee, and my discussions with
4 other members of the medical staff providing treatment to the detainee.

5

3.

This affidavit is made in support of the petition hy the United Stalcs

6 Department of Homeland Security, U.S. Immigration and Customs Enforcement (ICE) to
7 ohtain a court order for daily weight measurements, necessary physical examination,
8 laboratory blood work and urinalysis every 48 to 72 hours, for the Detainee on hunger
9 strike and, to provide hydration through an intravenous line to prevent further
10 deterioration of the Detainee.
11

12

DETAINEE ~ERGENSANA /-\MAR

13

4.

Detainee Mergensana Amar (hereinafter "Amar") is a 39-year-old male

14 who has been detained at NWDC since December 19, 2017 pending removal from the
15 United States. He is a native and citizen of Russia and has no known significant medical

16 h'!Story.
17

5.

Amar has be;:enon a hunger strike since August 22, 2018 and has missed 45

18 meals to date.
19

6.

In addition to refusing meals, Amar has been refusing to drink water or any

20 other offered liquid since August 25, 2018. He has been observed taking small sips of
21 water on approximately three occasions in the last five days.

22

7.

Amar is not only refusing meals and liquids, but since August 22, 2018, he

23 has also refused medical monitoring, including: monitoring of his vital signs, physical
24 examination, glucose checks, laboratories, urinalysis, and weight assessments. He is not
25 allowing the medical staff to assess his physical condition to ensure his health and safety

26 : during the hunger strike.
27

8.

His last known weight, as of August 22, 2018 was 163 Ibs. His current

28 weight is not known because he has been refusing weight assessment since August 22,
2018. He is now going un his 15th <layof monitored missed meals.
DRl(b)(6); (b)(?)(C)

lJ~ITED STATES ATTOR>H-'.Y

l)ECLARATION - 2

.100S:tWAII.T

Srnn:rJ= b)=(6-"); _

_,

S~AHLE, WASl!INGIUN 9810 l
(206) 55] /h \l R\

AMlf ICAr--..

pVERSIGHT

I

DHS-ICE-19-0196, 19-0197-J-000076
2019-ICLl -00051 1903



Case 3:18-mc-05016-BHS

9.

Document?

Filed 09/06/18

Page 3 of 6

As of September 6, 2018, Amar rnntinues to be unwilling to eat or comply

2 with medical care. On August 31, 2018, Amar's condition began to decline. At that

3 time, he expressed that he was experiencing dizziness and extreme weakness with
4 movement, such as walking to the toilet. He also voiced complaints of diffuse body

5 aches, especially over his kidneys. Despite these complaints he continues to refuse all
6

offered medication and care.

7

10.

Since August 31, 2018, Amar stopped talking to IHSC medical personne l

8 and GEO officers, even with the aid of a Russian interpreter. Amar spends most of his
9 time lying flat in hed, and he has not gotten out of bed to take a shower. Under constant

10 watch, medical staff has observed Amar pass urine very infrequently. Based on these
11 events, it is my opinion Amar is in imminent danger of going into renal failure, liver
12 failure or becoming comatose due to dehydration and hypotcnsion. Either of these

13 conditions could also lead to his imminent death. It is my professional opinion that

14 medical monitoring of his r.;ondilionand hydration are imperative al this time.
15

1 [.

Amar was evaluated by the mental health team with the assistance of a

16 Russian interpreter on August 29, 2018, in efforts to have him discontinue his hunger
17 strike. He docs not have any known psychiatric conditions that would cause him not to
18 eat. Ile has stated that the purpose of his hunger strike is obtain release from custody.
19

THE EF<JECT_QFA HUNGER STRIKE ON THE HUMAN BO.PY

20
21
22

12.

It is difficult to predict for how long the human body can survive without

food, and if an individual docs not have adequate fat stored, this time decreases

23 significantly. If an individual goes without water for approximately eight to ten days, he
24 will suffer from dementia, delirium seizures and ultimately become unconscious.
25 Dehydration greatly accelerates a progressive starvation because the waste that the body
26 produces is not excreted. Death by terminal total fasting occurs by acute depiction of
27 thiamine (vitamin B 1), causing fatal arrhythmia and/or cardiac arrest.
28

13.

Between the 15th and 30th day of a hunger strike, a patient may suffer

neurological symptoms which are severe enough to warrant hospitali:zation.
UNITED STATES ATTORt-;EY

:::>R.k
b)(6); (b)(7)(C) !DECLARATION - 3

7()0 S7EW1'RT STRF.Erfjl.:;
bc,.,.
l(::..,.6
),_
; _...J
SEAITLt,WA~II..

AMERICAr--..

pVERSIGHT

(8[01

(206) 55.

DHS-ICE-19-0196, 19-0197-J-000077
2019-ICLl -00051 1904



Case 3:18-mc-05016-BHS

14.

Document 2 Filed 09/06/18

Page 4 of 6

Medical literature reflects that metabolic imbalance caused hy fasting is

2 likely to result in permanent bodily damage and/or death once weight loss reaches 18% of
3 the patient's initial weight.
15.

4

The medical staff has explained to the Detainee through a Russian

5 interpreter the medical necessity to eat and drink to preserve his health and the medical
6 risk!i incurred during a hunger strike. Other staff members have repeatedly talked to the

7 Detainee in attempts to convince him to eat solid foods and drink water, however, the
8 Detainee continues to refuse to resume eating or drinking sufficient liquids to sustain life.

9

16.

I have personally explained to the Detainee in Russian my concerns

10 regarding his condition and the medical risks involved with a continued lack of
11 inappropriate nourishment. That is, the risks of significant metabolic changes induced by
12 a decreased nutritional intake. If he continues to be on a hunger strike, he will reach a
13 state of severe metabolic imbalance, with a high risk of adverse consequences such as
14 permanent damage to their kidneys, liver, heart failure and the risk of death.
15

17.

I have counseled the Detainee in Russian about the effects of self-imposed

16 dehydration and starvation on his body. I have also informed him of involuntary
17 hydration and feeding procedures that will be administered to prevent injury and or death
18 should he continue not to eat.
19

18.

In my professional medical judgment, the Detainee is now at a point where

20 he requires immediate medical intervention to prevent further deterioration and serious
21 medical complications. This intervention includes administering involuntary hydration,
22 and performing necessary laboratory tests requiring involuntary blood draws.

23 Additionally, medical staff must perform physical evaluations to monitor and assess the
24 dctaincc's clinical condition. If the laboratory tests reveal 0U1er conditions requiring
25 emergency medical attention, it may be necessary to seek a further court order to
26 administer nutritional supplements and/or medications.

27

19.

In my professional medical judgment, it is necessary to obtain a court order

28 to require laboratory tests at least every 48 - 72 hours, hydration as medically necessary,
physical examination, uri.nalysis, daily weight assessment, and frequent vital sign checks
L~ITED STATES ATTORNEY
700 STFWART STR .... '-'-'-"-'"-'.-__J

DR !(b)(6); (b)(?)(C) jLJLC:LARA:-JON o 4

SEATl'l.E, W /\SH :..:i:aa=u,l

AMERICAr--..

pVERSIGHT

OI

(206) 55"-"-'-'-'C!!!...J

DHS-ICE-19-0196, 19-0197-J-000078
2019-ICLl -00051 1905



Case 3:18-rnc-0~0Hi-BHS

Document 2

Filed 09/06/18

Page 5 of 6

for the Detainee if he continues on hunger strike. Laboratory tests are urgently needed to
2 evaluate the metaholic state, to include electrolytes and kidney function.

3

20.

The laboratory tests that need to be obtained during a hunger strike include:

a.
Complete metabolic panel. This test reveals an increase in markers
of kidney function in view of any renal injury. The panel tests include: BL'N (hlood urea
5
nitrogen), creatinine level, urinalysis and proteins. It also reveals electrolyte disturbances
6 as potassium, phosphate, magnesium and glucose levels can lead to heart arrhythmias.

4

7

b.

Complete blood count. This test reveals the hemoglohin level.

C.

Urinalysis, which reveals the presence of kctones, blood and crystals

d.
a hunger strike.

Magnesium and phosphate levels to assess deficiency after day 13 of

8
9

10

ll

in the urine.

12

e.
Electrocardiogram, if the patient shows elevated potassium, is
13 necessary to treat conditions which can lead to lethal arrhythmias.
14

f.
Creatine kinase (CK), is an enzyme found inside muscle cells and
15 should be measured as it is released into the blood, when the muscle cells rupture. The
increase in CK as a result of the destruction of muscle tissue can lead to acute renal
16 failure and death.
17
g.
Pre-albumin is used as a marker for nutritional status evaluation.
18 Pre-albumin will decrease over time the longer a patient fails to consume adequate
19 nutrition, and the pre-albumin level correlates with patient morbidity and mortality risk.
Normal pre-albumin is l 5-35 mg/dL. When pre-albumin falls to 5-11 mg/dL, significant
20 morbidity risks exist and aggressive nutritional support is necessary.
21

22

23
24

21.

To ensure the Detainee's health and survival, if the Detainee continues to

refuse to cooperate with blood work, medical soft restraints will be required to
immobilize the Detainee and prevent unnecessary injury to both the Detainee and medical
staff during medical intervention of intravenous IV fluids and IV lab draw.

25
26

27

22.

Considc1ing the Dctaincc's hunger strike and refusal of medical care, in my

professional medical judgment, it is medically necessary to obtain a court order for the

28

D~ (b)(6); (b)(7)(C)

t.;\ITED

IOECLARATION - S

700

AMERICAr--..

pVERSIGHT

STATES ATfORNF.Y

STEWAR T $ TREE (b)(6);

DHS-ICE-19-0196, 19-0197-J-000079
2019-ICLl -00051 1906



Case 3:18-mc-0:?J01fi-BHS

Document 2

Filed 09/0fj/18

Page 6 of G

above-mentioned procedures to immediately start monitoring the Detainee's physical
2 condition and ensure their health.

3 /(
4
5

Pursuant to 28 L".S.C. ? 1746, I declare under penalty of perjury that the
foregoing is true and correct to the best of my knowledge and belief.

6 JI

7

Executed this 6th day of September, 20 I 8.

8

b)(6); (b)(7)(C)

9
(b)(6); (b)(7)(C)

10

M.D.

Board Certified Internal Medicine
Clinical Director
Northwest Detention Center
Tacoma, Washington

11
12
13
14
15

16

17
18
19

20
21

22
23
24

25
26

27
28

DR. (b)(6); (b)(7)(C)

lECLARATIO~-

CNlTLD STATES 1r..!--:'. ......._.--"-i
STREE
(b)(5 );
700 SfEW/\l'.r
.
"
.
l h \f 7 \ t r\
SE/\rrLI,, WASHINGTON 9810\
(20(,) 55:lJ{b)(~); _I

-6

"=!.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000080
2019-ICLl-00051 1907



Case 3: 18-mc-05016-BHS

Oocume11t 3 Filed 09/06/J 8 Page 1 of 4

l ,

2

4

lJNITED STATES DISTRICT COURT FOR Tlll-:
WESTFRN DJSTRICT OF W/\SHl\lCilO:\
AT SEATTI_F

.'i

7

x,I, 1\1 Tiff: r-x PJ\RTE MATTER or:
l)

3: 18-mc-05016-BHS

,:
I:

DLCLARAT IOt\ OF

10 . \11!-:RCiFNSAJ\iAAMAR
I l : /\2 ! (i-2(19-802

Jb)(6); (b)(7)(C)

I

in Support llf the l Jnitcci States.
Ex Partc Motion to Ad111i11isH.:r
Erncrgcllcy Medic.ii lre,1tme11t

12

11
-----------.

14

15

-

j f b)(6); (b)(7)(C)

I.

,

------

ldcc\,1re as follow.-;:

1 am crnploycd elsa Supervisory Detention and Dcrortation Officer

17

(SDDU) with the L'11itcdStates Dcpartlllent of I lorncland Security. United States

18

Ilrn111igratio11and Customs

[ l)

Enforcement (!CT), in 1hc Seattle, \~'ashing!on Field Of'Cicc,

I

20

and l1c1vebeen employL:d as a detention officer since 2U07. l ain c:urrcntly assigned to the

21 '

I

NortlJ\vest Detention Center (l\;WJ)C') 1n

12
23

Washington. 1 ,1111providing this

dcc]aratioll bJsed upon n~y personal knowledge cind rcvicvv of ~1d111inistn1ti
1-crccmds n:-

2
27
28

T:1co1~1<1.

Det,1inee Mcrgcns.ina J\rnar is ,l ci!w::11of Russia who is currently detained

by ICE at the f\\f\/1)('
i

in lacrnm.

Stc:1tc:;
at the San Ysidrn port
l(b)(6); (b)(7)(C)

puT.\:c\

1

\Vashington. I k applied for admission into the Lnitcd

orc11trywithout valid

iurn11grntion docu111cnts011 December

JO'-_ ,

l.",I: '.U ';!,\ il 'i A T ICJl{Nl:Y
'.'::11s 1:o 11 .11<'1s 11,.r:c: ..'-'-'f
h=
\IR
.:.:..
\._ _,
SI ..I

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000081
2019-ICLl-00051 1908



Case 3:18-mc-05016-BHS

t

I 2, 2(1 I 7. :\111,uwas transfened

2

Document 3 Filed 09/0Ei/.18 Page 2 of 4

into custody at the I\WDC on December

I(), J())

7. I le

was p!accd into removal prncccclings on .JamiaryJ.2018 and charged with

rnadmissibil:ty under section 2 !2(a)l7)(A)(i)(l)

of lhe lmrni~rntion

and l\ationality Act.

5 [ 011 1\ugust 7, 7.0IS. an !rnrnigr,ilion Judge ordered Amc1r1-crnovcdfrom the lJrnted Suites.
6

I

20 l 8 to file a notice of appeal lo the Board

1\tnar li:is until September

(1,

Appec1ls. lo date. !CT has

110

orlmrni?r,:tion

7

8

9
l {I

record 1h<11
t\n1M h,b Viled n NotJCc;of !\ppcJI.

The medical staff <111l1c\IWDC have informed me that if the Detainee

it ,viii be necessary to
continu,::-, to refuse nccess,iry nu1ricnts and medical t.rcal111c11L

Il

12

!J

perform l.iboratnry k'sls and physical evaluations to munitor and nssrss the Deh1i1~ec's
cli11ic.1Icondition, and administer hydration, in order 10 SilVC his life.

14

Based on rny training am! expnicncc as a detention officer. I ,rn1,iware that

4_

Lhe death

orthe Detainee

as a resull of his refusal receive nutrients and medical trentnicn1

\\Ould scrimi.sly affcc: the oper8tion of the NWDC and would adverc;cly affi:ct 1uy ability

IX

;irn! ici-:.s efforts lo mai1:rni111:lcsecurity aml necessary order requ111:dat this dctcntiou

19

L1cili1yi1; the following \\ily~:
21

n

a.

f'cr(:eptions

111dy

be formed hy the detaillcd popuimion that the

deknt1011 a11dn~rnoval stafTsimply let the Detainee die, without doing anything to save

21

24

thelll,. 1Nhichcould le,Hl to :icts of detainee violence and disru11tio11s.The dct,1incd

:ZS popuL=ition. having formed sucl1 a perception, cou!d act ;dune or

26

dclcntion facility

i11

groups to disrupi the

1 ,1111
concerned 1h.1tfood -.t:ikes or o1hGrdisruptive ur vioicn: acts

27
:?,~'

\vmild he directed at staff or ,!gainst government prnpl.'.rly, in urdn to express the

-

dctai11L'CS,

a11p.cr.

!TSCIJl!llClll.

a1,d rnislr ;1tin11s.
\i'\ITETl

l(b){6); (b)(?)(C)

ST;\ .1.:S \I

i()l(\l:.Y

1::1:~I1o.1.:.r,1 <;w1:.f b)(6);
\r:11 :1, -.W.\SI:::,,. ,,, C),S:I:,

( 2ii(, l '~-'f b)(6);

AMERICAr--..

pVERSIGHT

I

~-1

DHS-ICE-19-0196, 19-0197-J-000082
2019-ICLl-00051 1909



Case 3:18-rnc-(b0l6-BHS

h.

Document 3

Fiicd 09/06/18

Page 3 of ri

lf"such d1srupti,.c :icts \\.c1-cto occu1.. tensions between r.lcinincc.~ and

')Istc>.ffwould be ileightcncd,

making ,1111tost
,ill aspects uf the detention operation mme

.3 ~

di rficult and potenti,dly dangerous for st,1ff to per!.orni.
C.

h

!:or a detainee to cmise his own cleath without staff intervention

would cumplctGly thwart lCF's obligation to :.ender ,1pprnpriate medical care and prcvrnt

7

detainee suicides, ,rnd may cause other delaincc"> to decide to commit suicide by starving
llle1me1vcs

9

Io I
1

10

tkath
d

O!hcr lklamccs 111ayalso decide that they liHvc lost c:011fidcnccin the

I

ll
skills ,,bility, or w:llingnt:ss of medical -:;tafL.nthe NWDC to ,1drni11i~(crtheir 1ned1cal
12
lI

I~

icare.

They may he reluctant to seek treatment fiom the 111cdicalstaff, reluctallt to cJcc:::pl

14 I
.:the trcatnienls n..:c01nmcndctl. ,111<1
mcl\ dcL:idc there is a rH.Td lu ..sc...:omlguess". the

Is
16

I

!_judgments of the medical st;dl lc;1drn1_!lo emergency situ,1tHJ1lSth:-11
could have been

17 avoided liad the detainee .,ought lllcdic,11help at ,111earlier time.
I

'l

'X

i,
.I

lkt,1i11ccs \\.ho 1wrtic.1pc1tcin hunger strikes rnay sn.crl'.ly and pcrnwncntly

C.

darnagc their st,ite of health, requiring lCL to 11J111cccssc1rily
cx;,cnd large sum~

)()

orllloncy

21 for their irnrned1:1te:rnd lung-term medical care.

22

Uthe:. dct;1i11ccs111ayp<1rttcipatc i1: hu11)2erstrikes in arte111pb to 11w11ipulaw

f.

23 \
::,
4

ltile swff

iii

efforts to ~ain \.',iriuus hcncfih :md privileges. l or cx:nnple. detainees may

111itt,1lchunger :;trikes in an attempt to pre~~mc sttiff to transfer tlicrn c1way from the
NVv'DC. or tu gc11:1
their release front detention

\Vithout tlic ability to interve111.:'
,,.,,-lien

27

28

111edically11cccs~a1y the dctL:n1io11
facility will he forced to allcrn' tl1c detainee to die

l ll

contravention nf JCE's kgal and l'thical nbligat1011s.
(b)(6); (b)(7)(C)

JJ!:CIAl(A'

'.U'\

l ::<r;11) '-, I All ~ ,\TTO:{ '\ I Y
,~u ~: 1 .,1 ,H 1 ~ . 1u : ,l(b)(6); ~s....\l 111-.o 1v."''."'""" c;~1n:
,. 1.,.11,,<s;Kb)(6); !

_;

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000083
2019-IC Ll-00051 1910



Case 3:18-mc-05016-BHS

I

2

0

c,.

Document 3 Filed 09/06/1.8

Page 4 of 4

Snme del8inecs will merely voice threats to go on a hunger strike, gaining

j

i additional staff attention, drn\ving attention away from other detainees, and 1rrnki11gstaff

J

I

4, apprehensive in their Jppnrncli to such detainL~cs.
!

SI
6

For tlic reasons stc1tedahovc, the adverse effects resulting from l\WDC

medical staff not being able to pcrfrirm the necessary labor::itory tests and physical

7

ev,1lw1tionto monitor ,md ,;sscss tile Dcrainee.s clinical condition. and administer lifesustaining hydration, would harrn rcr-:.s ability to opcrntc in a safe ,rnd orderly manner
1
O and potentially cause in severe disrnption to the detention facility.
I1
Pursuant to 28 lJ.S.C. ~ 1746. I declare under penalty of periury that the
'1

12

foregoing is true and correct to the best of rny knowledge and belief.

16

Fxc:.:utcd this 6th day of SL:ptembcr, 2018.

17

(b)(6); (b)(7)(C)

IX
19

f b)(6); (b)(7)(C)

I

SupGrv1sory Detention and Deport,,tion Officer
U.S. Di.:partrncnt of Hornel,1nd Security
U.S. lrnrnigrn11on and Customs [11forccmc1r!.

20
21

22

Tacoma, W /\

23
I

25'

26
27

28
l: r-.'I I U) S I ,, ITS . rrn i' ''>l Y
7(10Sr11, ..,,,1 Sr . (b)(5 );.~ ): .,I: 11. \Y ..
\'-.LJ.L>,!L.....U."'.),s, Ii I
t~O(,J 5

=~ cu

AMERICAr--..

pVERSIGHT

I

DHS-ICE-19-0196, 19-0197-J-000084
2019-ICLl-00051 1911



Case 3:lS-mc-05016-BHS

Docurncnt 6 Filed 09/07/18

Page 1 of 2

The l lonorablc Judge BcnJamin H. Settle

2
3

4
5
6

7

v~rrED STATES DISTRICT COURT FOR THE
WESTERN DISTRICT OF WASHINGTON
AT TACOMA

8
9
10

IN Tl IE MATTER OF:

NO 18-MC-5016HHS

11
12

13

MERGENSANA AMAR
File No. A216-269-802

EX PAR.TE
STATUS REPORT

14

15
The United States Department of Homeland Security, Immigration

and Customs

16
17
18

Enforcement (hereinafter "ICE"), by and through the United States Attorney for the Western District
of Washington, provides this status report to update the Court concerning the condition of detainee

19 Mergensana Amar ("Amar").

20

On September 6, 2018, fCE obtained an order to administer involuntary medical treatment to

21
22

include hydration, laboratory tests and physical examinations

of Mr. Amar in response to a hunger

23

strike he began on August 22, 2018

24

staff administering the necessary treatment sought in the order. Accordingly, medical staff are not

25

On September 7, 2018, Mr. Amar consented to the medical

proceeding with any involuntary treatment.

If Mr. Amar's medical status changes, or if additional

26
measures arc deemed necessary to preserve his life, ICE will promptly notify the Court

27

28
STATUS HEPORT18-MC-501 C,HIIS

U'IITED STATI!S Ar: O RNEY

l

120 I l'ACIFIC AVl!NULJb)( 6 );
TACOMA, W ASH[NG:?N 98402
(253 ) 4 2, b)(6)

I

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000085
2019-ICLl -00051 1912



Case 3:18-rnc-05016-BHS

Document 6

Filed 09/07/1.B

Page 2 of 2

As outlined in lhe motion and order seeking to administer involuntary treatment, Mr. /\mar is
2

3

detained based on his inadmissibility under section212(a)(7)(A)(i)(l)

of the lnunigration and

Nationality Act, and was ordered removed from the United Stales on August 6, 2017. Mr. Amar had

4

5
6

until September 6, 2018 to appeal the Immigration Judge's order of removal, and ICE can fmd no
record that any such appeal was filed.

7

DATED this 7th day of September, 2018

8
9
Respectfully submitted,

10

ANJo<ETrEL. HAYES
United States Attorney

11
12

b)(6); (b)(7)(C)

13
14

Assistant Unite
Lnited Stales Att
700 Stewart Stre

15

'.

ffice

(b)(5); (b)(?)(C)

S cattle, Washing ton 98 I 01
Phone: l(b)(6); (b)(7)(C)
E-mail: .__

16

_________

17

____.

18
19

20
21

22
23

24
25

26
27

28

f'QIJ
'>l.Y
I

UNJTED ST A11'.S J,.

STATUS REPORT- 2
18-MC-5016BIJS

l201PACW!CAVF.!>.1JI' b)(6); .
TACOMA, W ASHI>;c;TQ!'-r9!Vi02

(7.51) 42~(b)(6)1

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000086
2019-ICLl -00051 1913



l(b)(6); (b)(7)(C)

From :
Sent:

13 Oct 2018 03:42:43 +0000

b)(6); (b)(7)(C)

u Jee :

The following detainees declined dinner meal on 10.12.18.
B-2
~l
(b_)(6_);_(b_)(_
7)(_C_)

----~!de

clined first meal due to menu.

----~~

eclined first meal due to menu.

D-2
~fb_)(6_);_(b_)(7
_><
_c _)

Med-lso
Amar# 216269802 declined 155th meal due to hunger strik e.
Information reports were completed and logged.
tb )(6); (b)(7)(C)

!

Lieutenant
GEO Corrections & Detention (R)
Northwest Detention Center
1623
East J Street
Tacoma, Washington 98421
Tel b)(6); (b)(7)(C)
Ce !

Fa,
l(b)(6); (b)(7)(C)

I

www .geogroup .com
This ema il and any files transmitt ed with it ar e confide ntial and are intended solely for the use of the indi vidua l or entity to
which they are addr essed. If you are not the intended recipient or the per son re sponsible for deli verin g the email to the
intended recipient , be advised that your have received this email in error and that any use, dissemi nati on, forwarding , printing
or copyin g of this ema il is strict ly prohibited . If you ha ve received this email in er ror, pleas e immediate ly notify by replying to
thi s email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000087

20 19-ICLl-00051 191 4



(b)(6); (b)(7)(C)

Fro m :

14 Oct 2018 04:12:38 +0000

Sent:
b)(6)
; (b)(7)(C)

Declined Mea ls 10.13.18

Subject :

The following detainees have declined their dinner mea l on 10.13.18.
D-3
(b)(6)
; (b)(7)(C)
_________
._

l

D-2
(b)(6)
; (b)(7)(C)

11st meal due to menu .
__.2nd meal declared hunger strike.

1st meal due to menu.
nd meal due to menu.

Med-lso
Amar #216269802 158th meal declared hunger strike.

C-1
6l_
....
l(b
_l(_
; (_
bl_
(7_l(C
_l____

....
llst meal due to menu.

G-4

[b_)(6
....
_l;_(b_l(_7l_(C
_l ___

_.Jlst meal due to menu.

Information reports were completed.

I

fb)(6);(b)(7)(C)

Lieutenant
GEO Corrections & Detention (R)
Northwest Detention Center
1623
East J Street
Tacoma , Washington 98421
; (b)(7)(C)
Te l: b)(6)
Ce ll
Fax:

l(b)(6);(b)(7)(C)
www.geogroup.com

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000088
2019-ICLl-00051 1915



Fro m :
Se nt:

l<b)(6); (b)(7)(C)

8 Nov 2018 22:50:28 +0000

b)(6); (b)(7)(C)

u Ject:

The following detainees declined their lunch meals on 11.08.18.
H-unit
Amar# 216269802 declined his 38th meal. Detainee is accepting a fruit and alternate
nutrition from medical.
fb )(6); (b)(7)(C)
~eclined his 1st meal due to menu choice.
Med -lso
~fb~l<6
~>~
:<b
~>~
<7~
l<C
~l___

~l declined his 31st meal. Detainee is accepting alternate nutrition

from medical.
Info reports were completed.
!(b)(6); _.

Lieutena nt
GEO Corrections & Detention (R)
No rthw est Dete ntion Center
1623
East J Street
Tacoma Washinf!ton 98421
Te l b)(6); (b)(7)(C)
Ce!
Fa)
kb)(6); (b)(7)(C)

www.geogroup .com
T his email and any files tran smitt ed with it are confid ential and ar e int end ed solely for th e use of th e individual or ent ity to
which the y ar e addre ssed. If you ar e not th e int ended recipient or th e p erson respon sible for d eliverin g the email to the
intend ed recipi ent, be ad vised that your ha ve received thi s email in error and th at an y use, disseminati on, forwarding , printin g
or copyin g of thi s email is strictl y prohibited. If you ha ve received thi s emai l in er ror , please imm ediate ly notify by repl ying to
this email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000089
2019-ICLl-00051 1916



From:

l(b)(6); (b)(7)(C)

Sent:

4 Oct 2018 22:04:01 +0000

(b}(6); (b}(?)(C)

Subject:

Declined meals for Lunch on 10/4/18

The following declined there meals for lunch
Amar A#216269802 declined his 130th meal -Med lso
(b)(6); (b)(?)(C)

ned her 1st tray-G-2
ed her 1st meal -G-2
Declined her 1st meal-G-2
ed her 1st meal -G-2
~ed her 1st meal- G-2

(b)(6); (b)(?)(C)

ergeant
GEO Corrections & Detention
Northwest Detention Center
1623 East J Street
Tacoma, Washington 98421
Te l (b)(6); (b)(?)(C)
Cel

(R)

www.geogroup.com
This email and any files transmitted with it are confidential and are intended solely for the use
of the individual or entity to which they are addressed. If you are not the intended recipient or
the person responsible for delivering the email to the intended recipient, be advised that your
have received this email in error and that any use, dissemination, forwarding, printing or
copying of this email is strictly prohibited. If you have received this email in error, please
immediately notify by replying to this email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000090
2019-ICLl-00051 1917



~b)(6); (b)(7)(C)

From :
(b)(6); (b)(7)(C)

Subject:

Declined meals

As of the lunch meal today, the following detainees had declined their meals:
D2: ~b)(6); (b)(7)(C)
j(b)(6); (b)(7)(C)

K1st)
1(1st)

A2 :l(b)(6); (b)(7)(C)

~1st)

Hl: Amar #216269802 (44th)
Info. reports submitted.

~b)(6); (b)(7)(C)

Lieut enant/CERT Comman de r
GEO Corrections & Detention (R)
Northwest Detention Center
1623 East J Street
Tacoma, Washington 98421
Tel: b)(6); (b)(7)(C)
Cell:
Fax: .______

__,

l(b)(6); (b)(7)(C)

www .geoqroup .com

This email and any files transmitted with it are confidential and are intended solely
for the use of the individual or entity to which they are addressed. If you are not the
intended recipient or the person responsible for delivering the email to the intended
recipient, be advised that your have rece ived this email in error and that any use,
dissemination, forwarding, printing or copying of this email is strictly prohibited . If
you have received this email in error, please immediately notify by replying to this
ema il.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000091
20 19-ICLl-0005 1 1918



fb)(6); (b)(?)(C)

From :

Sent:
To:

16 Nov 2018 02:03:29 +0000
JOINT INTAKE

Subject :

Detain ee Suicide

Please see the below concerning a detainee suicide at the Northwest Detention
Center:

Alcon,
The below detainee attempted suicide by hanging on 11/ 15/2018. He was revived on the scene by Tacoma
Fire and Rescue. He had a pulse with re
.
. thm on ECG and was being bagged by paramed ics
when he left the building at 1535. LCD b)(5); (b)(?)(C) eceived an update .
Name: Amar, Mergensana
A#: 216269802
DOB: 10/23/ 1978
COB: Russia
DOA: 12/19/20 17
Relevant Medica l History: Was on Hunger Strike but current ly eating three meals a day with liquid
nutritiona l supplem ents
Reason sent to ER: CPR initiated due to deta inee being found unconsc ious and hanging with no pulse .
Current Status: Peq (b)(5); (b)(?)(C) RN: detain ee is still non-res p ons ive, ha s an anoxic bra in

I

injury, po ss ible spina l cord injury, pupils fixed and dilated,
Mode of transportation: ACLS
Name of Transport Company: Tacoma Fire and Rescue
Hospital being sent to: St. Joseph's

All notifications by the Field Office Director
11003 .2 , Section 4 .3
l(b)(6); (b)(?)(C)

organ li fe center no tified.

ha v e been made per ICE Policy Number

I

Acting Field Office Director
ICE Enforcement & Removal Operations, Seattle, WA
)("'
6,....
);..,,
(b..,.
)("7"'"'
')("'"
C,....
) -,
Main; !lhvfn 1hv71rr1 I / Desk:fol<6l (bl/7l/Cl !/ Cell: "'"kb..,.

CONFIDENTIALITY: This emai l and attachment s are intended for the above name only and are confidential. If you are not the intended
addressee, or the person responsib le for deliveri ng it to the intended addressee , you may neither copy , disseminate, nor distribute it to anyone
else or use it in any unauthorized manner. To do so is strict ly prohibit ed and may be unlawful. If you receive this email by mistake , please
advise the sender immedia tely by using the reply facility in your mail software and delete it from your computer.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000092
2019-ICLl-00051 1919



I

fb)(6); (b)(7)(C)
6 Dec 2018 20:22:34 +0000
(b)(6); (b)(7)(C)

From:
Sent :
To:

Cc:
FW: AMAR A216 269 802

Subject:

b)(6);
b)(7)(C)
Please see the update below on the remains of AMAR. Can we discuss next steps?
l(b)(6); (b)(7)(C)
Assistant Field Office Director
DHS/ICE/ERO
Northwest Detention Center
Seattle Field Office
Desk (b)(6); (b)(7)(C)
Cell: ,__ ____
_,

Fron, (b)(6); (b)(7)(C)

I

Sent : Thursday, December 6, 2018 12 :12 PM
To: rb)(6); (b)(7)(C)
Subject: AMAR/ A216 269 802

I spoke w ith AMAR's siste (b)(6); (b)(7)(C)
today (1012 am - 1036 a m)
via OHS interpreter.
Ms. (b)(6); (b)(7)(C) mentioned that a non-profit organizat ion (I th ink Northw e st
Res istance or NWIRP) he pe
e am1ly get information/documents
from Pierce County regard ing
AMAR's death. She also ment ioned that she received the informat ion from the Consul in
Wash ington DC, but they have not received the condolence letter. She also mentioned that the nonprofit is assisting in making a rr a ngements with a funera l home to have the body cremated and the
remains sent to Russia. Ms. fb)(6);(b)(7)(C) !asked if the agency is going to pay for the expenses and I
to ld her that her family will have to pay for the funeral expense s. I asked if she could provi de the
name of the funera l home ju st in case they needed our assistance but she refu se d .

Seattle Field Office
NWDC-1623 East J St.
Tacoma, WA 98421

b)(6);(b)(7)(C) Mobile)
Desk)

Fax)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000093
2 019 -ICLl-00051 19 20



l(b)(6); (b)(?)(C)

From:

26 Nov 2018 19:54:12 +0000

Sent :

(b)(6); (b)(7)(C)

To:

Cc:
Subject:

FW: AMAR, Mergensana A216 269 802

l(b)(6); ~ - linally

got a response from the Embassy, Not sure how we should respond to them at this point ,

From~ (b)(6); (b)(?)(C)

I

Sent : Monday, November 26, 2018 11:19 AM
To! (b)(6); (b)(7)(C)

Subject : FW: AMAR, Mergensana A216 269 802

From : l(b)(6); (b)(?)(C)

Sent : Monday, November 26, 2018 6:56 AM
To: l<b)(6); (b)(?)(C)

Cc:1

~----------------~

Subject : AMAR, Mergensana A216 269 802
Deaj (b)(6); __

I

Thank you for information!
We would like to know what are your next steps in this situation.
Best regards ,
~(b)(6); (b)(?)(C)

Consul of Consular Division
Embassy of Russia.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000094
20 19-ICLl-0 0051 1921



~b)(6); (b)(?)(C)

From:

17 Nov 2018 19:32:26 +0000

Sent :

!(b)(6): (b)(?)(C)

To :

!

'
,
FW: A#: 216269802 Hospital ICU report

Subject:
FYI

I MD USPHS
Deputy Medical Director
ICE Health Service Corps/ERO/IC E/OHS
610 W. Ash St. # 1405, San Die o CA 92101
(O lfbl/6) (bl/ 7)/Cl
(C (b)(6); (b)(?)(C)
CAPT11h\16)lh\17\IC\

l

From: b)(6); (b)(?)(C)

Sent : Satur ay, Novem er 17, 2018 11:26 AM

Subject: FW: A#: 216269802 Hospital ICU report

Froml (b)(6); (b)(?)(C)

Sent : Friday, November 16, 2018 2:00 PM
r b)(6); (b)(?)(C)

Subject: A# : 216269802 Hospital ICU report for 1330
Hospital day Update for ICU
A#:216269802
NAME: Amar, Mer
DOB: 10/23/1978
COB: Russia
DOA: 12/19/2017
Relevant Medical History: Was on self- imposed protest Hunger Strike that ended last week with patient
in good medical condition
Reason sent to ER:CPRinitiated due to detainee asphyxiation from self harm strangulationand
transferred to ICU when pulse was achieved.
Current Status : pt with anoxic brain injury. He is intubated and on IVs to sustain his BP. He had an EEG
yesterday with the results not yet available. Pt has acidosis and hyperkalemia with liver and renal failure.
He is still in a deep coma but is not brain dead completely due to the fact he is over-breathing the
ventilator .
In the initial hours of this patient's care on 11/16, our NWDC warden talked with the attending and was
told of the poor prognosis for this patient. He then indicated to the attending he agreed with her not do
any medical interventions other than basic supportive care. Unfortunately this was passed on to the
nursing team in ICU.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000095
2019-ICLl-00051 1922



During my initial conversation with Dr~
on 11/16, I let her know our NWDC warden does not have
any medical authority over this patient and she would need to work through me and our IHSC
administrative team for progress reports and direction of medical care.
At this point, Dr~has
said she w ill work with the hospital's ethics board on the recommendations
for the care of this comatose patient . She will notify us of the EEGresult, but will also work to correct
any dehydration, electro lyte imbalance, etc. for life sustaining measures for this patient . She will call me
on my cell phone for any changes in condition.
Location : St Joseph's Hospital, ICU Rm 6Bravo6.
Attending Physician: Drl(b)(~);_~- Trauma Physician al(b}(6); (b)(?)(C)
RN ~b)(6); (b)(?)(C)
the ICU Trauma
PA phone n 1h 11~ 1- 1h 1n11r1

I

fb)(6); (b)(?)(C)

I,

( MD

Clinical Director
ICE Health Service Corps (IHSC)
Enforcement and Removal Operations (ERO)
US Immigration Customs Enforcement (USICE)
No rthwest Detention Center
1623 E. J St(b)(6);
/ h \/ 7 \ff-..\

fax
l(b)(6); (b)(?)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000096
2019-ICLl-00051 1923



From:
Sent:
To:
Subject :
Importance :

!(b)(6); (b)(7)(C)

17 Nov 2018 19:44:41 +0000
!(b)(6); (b)(7)(C)

J

FW: A#: 216269802 Hospital ICU report
High

Just in case you didn't get this

J(b)(6); (b)(7)(C)

AFO D/OIC
NWDC
Seattle Field Office
Fromfb

)(6); (b)(7)(C)

Date : Saturday, Nov 17, 20 18, 11:43
To: #IHSC SEN Medical 1:.-b--)(6- );-(b-)(=7)-(C-) ---------,,
#IHSC SEN Mental Health
(b)(6); (b)(7)(C)
#NWD-Notification-Medica (b)( 5 ); (b)(?)(C)
(b)(6); (b)(?)(C)
, #NWD-Notification Mental Health (b)(6); (b)(7)(C)
Subject: FW : A#: 216269802 Hospital ICU report

Hospital day Update for ICU as of 11:30 am PST 11/17/2018
DAY 3

A#:216269802
NAME: Amar, Mer

DOB: 10/23/1978
COB: Russia

DOA:12/19/2017
Relevant Medical History: Was on self-imposed protest Hunger Strike that ended last
week with patient in good medical condition
Reason sent to ER: CPRinitiated due to detainee asphyxiation from self harm
strangulationand transferred to ICU when pulse was achieved.
Current Status: pt with anoxic brain injury. He is intubated and on IVs to sustain his BP.
He had an EEGyesterday with the results not yet available. Pt has acidosis and
hyperkalemia with liver and renal failure. He is still in a deep coma but is not brain dead
completely due to the fact he is over-breathing the ventilator.
In the initial hours of this patient's care on 11/16, our NWDC warden talked with the
attending and was told of the poor prognosis for this patient. He then indicated to the
attending he agreed with her not do any medical interventions other than basic
supportive care. Unfortunately this was passed on to the nursing team in ICU.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000097
2019-ICLl-00051 1924



During my initial conversation

with Dr ~)\~\ -,

n 11/16, I let her know our NWDC warden

does not have any medical authority over this patient and she would need to work
through me and our IHSC administrative team for progress reports and direction of
medical care.
At this point, Dr l\?!\~!:~, lhas said she will work with the hospital's ethics board on the
recommendations for the care of this comatose patient. She will notify us of the EEG
result, but will also work to correct any dehydration, electrolyte imbalance, etc. for life
sustaining measures for this patient. She will call me on my cell phone for any changes
in condition,
Location: St Joseph's Hospital, ICU Rm 6Bravo6.
Attending Physician: Dr ~b)(6); trrauma Physician a*b )(6);(b)(7)(C)
the ICU Trauma PA phone lfb H6); (b)(7)(C)

~

RN l(b)(6);(b)(7)(C)

I

Thank you Dr (b)(6);
/h\1

7 \/ f'\

I

LCDRl(b)(6);(b)(7)(C)
MLS(ASCP)
Assistant Health Services Administrator
Department of Homeland Security
Immigration & Customs Enforcement (ICE)
Enforcement & Removal Operations (ERO)
USPHS,ICE Health Service Corps.
Northwest Detent ion Center
1623 East J Stree h\/
b)(6);
7 \/
Tacoma, WA 98421
Office: (b)(6); (b)(7)(C)
Cell (b)(6);(b)(7)(C)
Fax:
l(b)(6); (b)(7)(C)

Warning: This document is UNCLASSIFIED//FOROFFICIALUSEONLY(U//FOUO) . It contains
information that may be exempt from public release under the Freedom of Information Act (5
U.S.C. 552). It is to be controlled, stored , handled, transmitted, distributed, and disposed of in
accordance with DHS policy relating to FOUO information and is not to be released to the public
or other personnel who do not have a valid "need -to-know" without prior approval of an
authorized DHSofficial. No portion of this report should be furnished to the media, either in
written or verbal form.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000098
2019-ICLl-00051 1925



From :

Sent:
To:

l(b)(6)
; (b)(7)(C)
27 Oct 2018 03:29:40 +0000
#IHSC_SEN_Me ntal Health;#NWD - Notification Mental Healt~~ /\~/;~,

fb)(6); (b)(7)(C)
Subject :

FW: ALERTSUICIDE WATCH

LCDR l(b)(6); (b)(?)(C) l MLS(ASCP)
Ass istant Health Services Administrator
Department of Homeland Security
Immigration & Customs Enforcement (ICE)
Enforcement & Removal Operations (ERO)
USPHS , ICE Health Service Corps .
Northwest Detention Center
1623 East J Stre{b)(~); _I
Tacoma, WA 98421
Office (b)(6)
; (b)(7)(C)
Cell: (b ;
Fax:
(b)(6)
; (b)(7)(C)
r )(6); (b)(7)(C)

Warn ing: This document is UNCLASSIFIE D//FOR OFFICIAL USE ONLY (U//FOUO).
It contains information that may be exempt from public release under the Freedom of
Information Act (5 U.S.C. 552). It is to be controlled, stored, handled, transm itted,
distributed , and disposed of in accordance with DHS policy relating to FOUO
information and is not to be released to the public or other personnel who do not have a
valid "need-to-know" without prior approval of an authorized DHS official. No portion of
this report should be furnished to the media, either in written or verba l form.
From: 1C
b)(6); (b)(7)(C)

Date: Friday,Oct 26, 2018, 6:04 PM
To: #IHS C_ Tacomaj"'"
(b.,..,.
)(6);=-(b
;,..,..,
)(=
7)=
(c.,) -------.
Subject: SUICIDE WAT CH

SUIC IDE WATCH IN ITIATED

Name: AMAR, MERGENSANA
A#: 216 -269-802
DOB: 10/23/1978
Date of Arrival: 12/1 9/2017
Country: RUSSIA

Relevant Medical / Mental Health History: Starvationhx, Hunger strike

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000099
2019-ICLl-00051 1926



Reason placed on Suicide Watch: An approximately 6 foot handmade rope was found under his
mattress, potential for suicide.
Detainee was seen by Provider (b) who placed him on suicide watc h
(6)
fb)(6); (b)(7)(C)

IRN IHSC

STGI Contractor
ICE Health Service Corps
Northwest Dete~ (~)(6):
ter
1623 E. J St. Su, (b)(7)(C)
Tacoma WA 98421
Office : {b)(6); {b){7)(C)
Fax : (b)o('or.,,,,.,,-r,rn,r--

--~

.....

Warning: This document is UNCLASSIFIED//FOROFFICIALUSEONLY (U//FOUO). It contains
information that may be exempt from public release under the Freedom of Informat ion Act (5
U.S.C.552). It is to be controlled, stored, handled, transmitted, distributed, and disposed of in
accordance with DHS policy relating to FOUO information and is not to be released to the public
or other personnel who do not have a valid "need-to-know" without prior approval of an
authorized DHS official. No portion of this report should be furnished to the media, either in
written or verbal form.

AM RICAN

PVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000100
2019-ICLl-00051 1927



l(b)(6); (b)(7)(C)
27 Oct 2018 18:09:25 +0000
#IHSC_SEN_Mental
Health;#NWD-Notification
Mental Health;!(b)(~);_~-

From :

Sent:
To:

l(b)(6
); (b)(7)(C)
FW:ALERT:
Downgradedto Mental Health Observationwith q 10

Subject:

minute irregular checks

! MLS(ASCP)
LCDR!(b)(6); (b)(7)(C)
Assistant Health Services Administrator
Department of Homeland Security
Immigration & Customs Enforcemen t (ICE)
Enforcement & Removal Operations (ERO)
USPHS, ICE Health Service Corps .
Northwest Detention Center
1623 East J Stree (b)(6);
Tacoma, WA 98421
Office : b)(6); (b)(7)(C)
Cell (b)(6); (b)(7)(C)
Fax:
(b)(6); (b)(7)(C)
/ h\ / 7\ /

Warn ing: This document is UNCLASSIFIED//FOR OFFICIAL USE ONLY (U//FOUO).
It contains information that may be exempt from public release under the Freedom of
Information Act (5 U.S.C. 552). It is to be controlled, stored, handled, transmitted ,
distributed, and disposed of in accordance with DHS policy relating to FOUO
information and is not to be released to the pub lic or other personnel who do not have a
valid "need-to-know" without prior approval of an authorized DH S official. No portion of
this report should be furnished to the media , either in written or verba l form.
From: fb)(6); (b)(7)(C)
Date: Saturday, Oct 27 , 20 I 8, I 0:53 AM

(b)(6); (b)(7)(C)

Subject: ALERT: Downgraded to Menta l Health Obs ervatio n with q IO minute irregu lar checks

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000101

2019-ICLl-00051 1928



Name: AMAR , MERGENS ANA
A# : 216-269-802
DOB: 10/23/ 1978
Date of Arrival: 12/ 19/2017
Co untry: RUSSIA
Relevant Medical / Mental Health History: Starvation hx, Hunger strike
Reason placed on Suicide Watch: An appro ximately 6 foot han dmade rope was found under his
mattress, potential for suicide.
Deta inee was seen by Provider l(b)(6); f'ho placed him on suicide watch
Update 10/27 /20 I 8:
Pt. seen for th e first time in MHU with !(b)(6); !RN who did Russian int erpretat ion. He was put on suicide
watch on 10/26/20 18 due to an approximately 6-foot long handmade rope that was found under his
mattress, potential for suicide. He was seen by Dr. kb)(6) !vesterday who place him on suicide watch. No selfharm behavior not ed not suicidal ideatio n expr esse d per staff. Pt. was very cooperative, pleasa nt with fair
eye contact. He reported good sleep and appetite. He denied hallucination, delusions, suicidal or homicidal
ideations. When asked about why he made a rope , he replied" I had nothing to do". He was remind ed that it
is unsafe to be making a rop e and hiding it und er his mattre ss as it can be stolen by someone and can be
used for suicid e attempt as well as hurt ing someo ne. He expr essed understanding . Pt. denied hx of
psychiatric hospitalization, outpatient psychiatric treatment or counseling, drug or alcohol abuse, family hx
of mental illness. He denied acti ve ment al he alth issues including hx of suicide attempts., depression or
psychosis. Plan: 1. Discontinue suicide watch . 1. Place him on mental health observation with q 10 minut e
irregular custody checks. 2. Follow-up as scheduled.

~f
b-)(6
_)_
; (b
_)-(7-)(C
_)___

~I
MD

STG International, Inc.
Staff Physician, CTR
ICE Health Service Corps
Enforcement and Removal Operations
US Immigrat ion and Customs Enforcement
Northwest Detention Center

1623 E. J stl~
?!\~!;,~-

I

Tacoma, WA 98421
Office!(b)(6); (b)(7)(C)
Fa b)(6); (b)(7)(C)
b)(6); (b)(7)(C)
Warning: This document is UNCLASSIFIED//FOROFFICIAL USE ONLY (U//FOUO). It contains
information that may be exempt from public release under the Freedom of Information Act (5
U,S.C 552). It is to be controlled, stored, handled, transmitted, distributed, and disposed of in
accordance with OHS policy relating to FOUO information and is not to be released to the public
or other personnel who do not have a valid "need-to-know" without prior approval of an
authorized OHSofficial. No portion of this report should be furnished to the media, eith er in
written or verbal form.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000102
2019-ICLl-00051 1929



From :

!(b)/6): (b)/7)/C)

Sent:

16 Nov 2018 06:02:44 +0000

I

j(b)(6); (b)(7)(C)

To:

Subject:
Attachments:

FW: Amar
Amar suicide attempt.doc

l(b)(6); (b)(7)(C)

AFOD /OIC
NWDC
Seattle Field Office
From j(b)(6); (b)(7)(C)

Date: Thursday, Nov 15, 2018, 2 1:55
To:fb )(6); (b)(7)(C)
Sul>Ject: Fw: Amar
(b)(6);
/h\/ 7 \/r.\

See attached .

From ~(b)(6); (b)(7)(C)

Se nt: Thursd ay, November 15, 201 8 5:10 PM

I

To:l (b)(6); (b)(7)(C)

Subj ect: Fw : Amar
b)(6);
h \/ 7 \/r.

Here is the initial report.

From:

J(b)(6); (b)(7)(C)

I

Sent : Thursd a , November 15, 201 8 5:09 PM
To: (b)(6); (b)(7)(C)
Subject: Amar

fb )(6); (b)(7)(C)

I

ASSISTANT WARDEN OF FINANCE AND ADMINISTRATION

The GEO Group, Inc. (R)
Northwest Detention Center

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000103
2019-ICLl-00051 1930



1623 East J Street
Taco m a, Washi ngton 98 4 21
Tel j<b)(6); (b)(7)(C)

Io

Fax : 1Cb)(6); (b)(7)(C)

ee l 1:l<b)(6); (b)(7)(C)
l(b)(6); (b)(7)(C)

www.geogroup.com
This emai l and any files transm itted with it are confident ial and are intended sole ly for the use of the
individ ual or enti t y to wh ich they are addressed. If you are not the intende d recipien t or the person
responsible for delivering the email to the intended recipient, be advised that you have received this email
in error and that any use, dissemination, forwarding, printing or copying of this emai l is strictly prohib ited.
If yo u have received th is emai l in error, please immediately notify by reply ing to this email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000104
2019-ICLl-00051 1931



l(b)(6); (b)(?)(C)

From :

5 Nov 2018 23:37:53 +0000

Sent :
To :

r b)(6); (b)(7)(C)

Cc:
FW: AMAR - A216-269-802
High

Subject:
Import ance:
(b)(6);
( 1,...,
\1 7 \f,,....\

Please confirm that AMAR's passport is still valid and schedule him for an escorted removal ASAP. Please
call HQ and find out if they expedite country clearance due to the circumstances and let me know what
they say.
Thanks,
l(b)(6); (b)(7)(C)

I

Assistant Field Office Director
DHS/ICE/ERO
Northwest Detention Center
Seattle Field Office
Des (b)(6); (b)(?)(C)
Cell:

Fron, JPYb)(6);
(b)(7)(C)
;
Sent : M onday , November 5, 2018 2:35 PM
~~r

(6); (b)(7)(C)

Subject: RE: AMAR - A216-269-802

He has a passport? How long w ill it take to remove him?
(b)(6);
(h \(7)/C:\

From~(b)(6); (b)(7)(C)
Sent : Monday, November OS, 2018 2:28 PM
~~r

)(6); (b)(?)(C)

Subject : FW: AMAR - A216-269-802

Amar 's appeal has been dismissed as untimely.

l(b)(6); (b)(?)(C)

I

Assistant Chief Counsel

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000105
2019-ICLl -00051 1932



Seattle Office of Chief Counsel / OPLA
Ta coma sub-office
U.S. Immigration and Customs Enforcement

u.s Deoactmeot of Homeland Sec1JC
itv

Tel: J (b)(6); (b)(7)(C)
E-m _

*** w 'ar_n_,,
i-n-g""'
*=o*,,...
A
..,,....,..,
tt_o_rn_e_y....,
t""
C""
Ii,e
- -n..,..
t =P,-ri,v""'
....i1,-e-g-e""'
*=
**,...
Attorney Work Product ***
This communication and any attachments may contain confidential and/or sensitive attorney/client privileged
information or attorney work product and/or law enforcement sensitive information. It is not for release, review,
retransmission, dissemination, or use by anyone other than the intended recipient. Please notify the sender if this
email has been misdirected and immediately destroy all originals and copies. Furthermore do not print, copy, retransmit, disseminate, or otherwise use this information. Any disclosure of this communication or its attachments
must be approved by the Office of the Principal Legal Advisor, U.S. Immigrat ion and Customs Enforcement. This
document is for INTERNAL GOVERNMENT USE ONLY and may be exempt from disclosure under the Freedom of
Information Act, 5 USC?? 552(b)(5), (b)(7).

From :~b)(6); (b)(7)(C)

Se nt: Monday, November 05, 2018 2:26 PM

1)(6);(b)m(CJ

Subject: AMAR - A216-269-802
The BIA issued a decision dismissing this alien's appeal. It should be uploaded to PLAnet short ly.

l(b)(6); (b)(7)(C)

I

Assistant Chief Counsel
Seattle Office of the Chief Counsel/ OPLA
Tacoma Sub-Office
U.S. Immigration and Customs Enforcement
U.S. De artment of Homeland Security
Faxl/h\/6\ lh\17)/C\
Tel (b)(6 ); (b)(?)(C)

***Warning*** Attorney/Client Privilege*** Attorney Work Product ***Sensitive/Privileged***Pre-Decisional***
This communication and any attachments may contain confidential and/or sensitive attorney/client privileged info rmation or
attorney work product and/or law enforcement sensitive information. It is not for release, review, retransmission,
dissemination, or use by anyone other than the intended recipient. Please notify the sender if this email has been misdirected
and immediately destroy all originals and copies. Furthermore do not print, copy, re-transmit, disseminate, or otherwise use
this information. Any disclosure of this communication or its attachments must be approved by the Office of the Principal Legal
Advisor, U.S. Immigration and Customs Enforcement. This document is for INTERNALGOVERNMENTUSEONLY and may be
exempt from disclosure under the Freedom of Information Act, 5 USC?? 552(b)(S}, (b}(7}.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000106
2019-ICLl -00051 1933



OI~ UF I~ TO UFT-\1'\

OR lff.U.- ...\'-,F -\Lil:'\

TO: (NAMEand TITLE of Person in Charge of Facility)
(Name of Facility)

Please

LJ Detain

Name of Alien
Age
40

I

LJ

Release

Date

I Date of Birth (Mo.Day.Yr.)
10/23/1978

I

File Number

~F.RGF,~~;ANA

AMAR,

ISex I
M

Nature of Proceedings

Nationality
RUSSIA

l

A216269802

Foreign Address 36

AVIL>tJEVA

ST.

KfiT;RA."1$HA,

1VOLG!NS!<I

,RlJSSIA

ISignature of Offict'lr Receiving Alien

Rl:\L\RKS:

Signature of Officer Authorizing Action

Title

Office

,,,..
l(b)(6); (b)(7)(C)

Form 1-203(Rev. 081

L-r~
l':'\ITED STATES DFl'.-\RnU:'.\T

()F 11()\IEI..-\\I) SH 1.RITY

AMlf ICAr--..

pVERSIGHT

Time

DHS-ICE-19-0196, 19-0197-J-000107
2019-ICLl -00051 1934

rJ



Fro m :

!(b )(6 );

Sent:

25 Nov 2018 22:21:23 +0000

b)(6); (b)(7)(C)

Subject:
Attachme nts:

Fw: Amar A216269802
AMAR A216269802.pdf

From: !(b)(6); (b)(7)(C)
Se nt: Sunday, November 25, 2018 1:51 PM
To: ~b)(6); (b)(7)(C)
Cc: ._l__________________
Subject: Amar A2 l 6269802

__,

At approximately 1330 hours, ICEarrived in Intake with 1203 (autho rization to Release)
Detainee Amar A216269802. Attached is a scanned/copy of the orig inal 1203. I removed
deta inee from facility head count and notified H-Seg of Amar being a book-out. Be
advised, per ICEthey informed me to hold all properties belong ing to Detainee Amar
until further notice. I placed detainee's property bag and value pack into the Abandoned
Shelf & secured the shelf. I did not access any of Amar's properties. I placed them on the
shelf as is (sealed).
Nothing further.
l<b)(6); (b)(7)(C)

I

Property Officer

GEO Corrections & Detention (R)
Northwest Detention Center
1623 East J Street
Tacoma, Washington 98421
;:~

r )(6); (b)(7)(C)
1

r b)(6); (b)(7)(C)

www .geogroup .com
This email and any files transmitted with it are confidential and are intended solely
for the use of the ind ividual or entity to which they are addressed . If you are not the
intended recipient or the person responsible fo r delivering the email to the intended
recipient, be advised that your have received this email in error and that any use,
dissem ination, forwarding, printing or copying of this ema il is strictly prohibited. If
you have received this email in error, please immediately notify by replying to this
email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000108
2019-ICLl-00051 1935



OI~ UF I~ TO UFT-\1'\

OR lff.U.- ...\'-,F -\Lil:'\

TO: (NAMEand TITLE of Person in Charge of Facility)
(Name of Facility)

Please

LJ Detain

Name of Alien
Age
40

AMAR,

I

LJ

Release

Date

File Number

~F.RGF,~~;ANA

I Date of Birth (Mo.Day.Yr.)
10/23/1978

Nature of Proceedings

I

ISex I
M

Nationality
RUSSIA

l

A216269802

Foreign Address 36

AVIL>tJEVA

ST.

KfiT;RA."1$HA,

1VOLG!NS!<I

,RlJSSIA

ISignature of Offict'lr Receiving Alien

Rl:\L\RKS:

Signature of Officer Authorizing Action

Title

Office

(b)(6); (b)(?)(C)
Form 1-203(Re

l':'\ITED STATES DFl'.-\RnU:'.\T

()F

AMlf ICAr--..

pVERSIGHT

Time

11()\IEI..-\\I)

SH 1.RITY

DHS-ICE-19-0196, 19-0197-J-000109
2019-ICLl -00051 1936

[)



kb)(6); (b)(7)(C)

From:
Sent:

30 Nov 2018 18:12:57 +0000

(b)(6); (b)(7)(C)

u Ject:
Attachments :
Importance :

ergensana
Information Request Detainee Death Review - Mergensana AMAR.DOC
High

f b)(6); (b)(7)(C)

It looks like we are probab ly going to have QPR here the week of the 10th through the 14th . I need to
st art upload ing t he required documents ASAP. Please forward them to me as you get them . I need the
videos today .
f b)(6); (b)(7)(C)

Assistant Field Office Director
DHS/ICE/ERO
Northwest Detention Center
Seattle Field Off ice
Desk(b)(6); (b)(7)(C)
Cell:~---~

From~ (b)(6); (b)(7)(C)

I

Sent : Thursdav November 29 2018 11:53 AM
(b)(6); (b)(7)(C)

Subject: FW: Detainee Death Review-Mergensana AMAR
Importance: High
l(b)(6); (b)(7)(C)

I

The attachment conta ins the init ial list of items that I need to provide to ICEOPR in advance of t heir site
visit. While I do not know the exact date s yet that they will be on sit e, my best guess is that it will be the
second or third week of December.
Would you please start gathering the required items and providing them to me as soon as possible? I
will upload the documents as you provide them to me. I would like to get as much upline as soon as
possible so that we can coordinate the investigation as well as possible in advance. I also realize that
there will be significant overlap for the items required for the IHSCinquiry.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000110
2019-ICLl-0 0051 1937



Please let me know if you have any questions or would like to meet to discuss this.
~b)(6); (b)(7)(C)

I

Assistant Field Office Director
OHS/ICE/ERO
Northwest Detention Center
Seattle Field Office
Des (b)(6); (b)(7)(C)
Cell:

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000111
2019-ICLl-00051 1938



Office of Professional Responsibility
U.S. Department of Homeland Security
950 L' Enfan t Plaza SW
Washing ton, DC 20536

U.S. Immigration
and Customs
Enforcement

MEMORAN DUM FOR :

!(b)(6); (b)(7)(C)

!

Assistant Field Office Director (AFOD)
ICE ERO Seattle, Northwest Detention Center
FROM:

l(b)(6); (b)(7)(C)

ICE OPR Externa l Reviews and Analysis Unit
SUBJECT :

Information Reque st for IlCMS Case *b )(6); (b)(7)(C)
Deta inee Death Review - Mergensana AMAR
2162698 02

Summary
The ICE Office of Professional Respon sibility (OPR), Externa l Reviews and Ana lysis
(ERAU), will review JICMS (b)(6); (b)(7)(C)
which concerns the death of detainee Mergensana
AMAR. AMAR expired on Novem er 4, 2018, while in the custody of ICE at the Northwest
Detention Center (NWDC) in Tacoma , WA. In furtherance of this review , please pro vide the
items described below by close of business on December 5, 2018.
Background Info
Please fill out the table below :
Male
Population count on day of detainee death:

Female
Total

Detention standards facility is required to meet:
Facility security provided by:
Facility medical care provided by:
The IHSC Field Medical Coordinator is:
Facility Type (CDF/SPC/IGSA/DIGSA):

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196,
19-0197-J-000112
www.i ce.gov
2019-ICLl-0005 1 1939



Records Requested
1. Detainee Records:

r Intake screening fonrn
r Medical screening forms
r Detention file

r Medical file
r Alienfile
r All sick-ca ll req uests and responses submitted
r All detainee req uest forms and responses submitted
r All grievances and responses submitted

r All housing record s includingsegregation/special housing
r All incident statements concerning the detainee's death
r Telephone records
r Hospital and EMT records

r All facilityinvestigations concerning the detainee's death
r All Local Law Enforcement investigations concerning the detainee' s death

r Autopsy report
r Death certificate
r No tification of detainee's death to his/her co untry of origin's Consulate
2. Faci lity and ERO Records:

r Po st logs (Housing, Con troi Medicai

Transport , and Hospital) for following date(s):

o

Hou sing unit , Control, Medical, and Transport logs for all sign ific ant medical
eve nts, movement from the faci lity to the hospit al, and at the hospit al.

o

Hosp ital post log s for entire length of stay .

o

Administrat ive segregat ion/protective custody /MHU /suic ide observation logs
(Se ptember /Oct ober/November 2018)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000113
2019-ICLl-00051 1940



r Shift roster for followingdate(s):
o
o
o

(Medical and Security)
August 25, 2018 hunger strike;
October 26, 2018 cell check;
November 15, 2018 incident /incident response.

r Video surveillance footage of detainee's housing unit and relevant facilitylocations
for the following date(s) :
o

Hou sing unit, arrival, any significant events or medical appointments .
o

Identitie s of officers and staff in the footage

o

Additionally , plea se archive and retain all facility video surveillance
footage for the following date( s): Date of arr ival, date of transport to the
hospital , any significant events or appointments (including August 2018
hunger strike; October 26, 2018 cell check; November 15, 2018
incident/incident response.)

r Any video footage relevant to the detainee's death, to include handheld, if applicable
o

Identit ies of officers and staff in the footage

r Names of detainee's cellmates
r Name of detainee' s Deportation Officer

r Names of all ERO personnel who had contact with detainee
r Complete roster of medical staff at facility,with titles
r Complete medical staffingplan
3. Facility Policies :

r Facility Medical Policies and Procedures
r Facility Policy on Medical Emergencies
r Local Operating Proc edures for Medical Emergencies

r Facility Policy on Incident Reporting
4. Additional Documentation
o

October 27, 2018, psychiatric evaluation/order

o

"Life Knife" or other removal tool training records

o

Local After-Action Reviews (AAR) minutes

o

Property disposition records

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000114
2019-ICLl-00051 1941



o

Officer reports /statements related to Augu st, 2018 hunger strike; October 26, 2018 cell
check; Nove mber 15, 2018 incident and related response

o

Facility schema tic

o

September 6, 2018 , order to permit involuntary medical monitoring and hydration

All responses to this request should be routed to:
OPR Shared drive
l(b)(6); (b)(?)(C)

Cell : b)(6); (b)(?)(C)
(b)(6); (b)(?)(C)

DHS ICE OPR ERAU
950 L'Enfant Plaza, SW
Mail Stop 5501 , Room

l(b)(B)I

Washington, DC 20536

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000115
2019-ICLl-00051 1942



Page 1943
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000116



Page 1944
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000117



Page 1945
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000118



Page 1946
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000119



Page 1947
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000120



Page 1948
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000121



Page 1949
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000122



l(b)(6); (b)(7)(C)

From:
Sent:

20 Nov 2018 12:37:15 +0000

rb)(6); (b)(7)(C)
Subject:
FW: DRAFTdetainee death notice re: AMAR
DRAFT----Detainee Death Notification-ERO Seatt le-Mergensana A216 269 802
Attachments :
VS(MC).doc, MEDICAL EXSUM - AMAR Mergensana.doc
Importance :
High

(6);
Mr. b)
h \/ 7\/f'

\

has some comments in both documents, please see attached and below.

According to our HS SP site, the hunger strike started on 8/22/2018 when he first meal
was missed, his 9 th would have been on the 8/25 which be considered the official hunger
strike and he was r emo ved from th e HS on SP on 10/16, when he consumed his full solid
I
mea q(b)(5); (b)(6);(b)(
7)(C)
b)(5)

omest1c perat10ns Desk Officer-West (Los Angeles & Seattle)
H - Enforcement and Removal Operations
(b)(6);(b)(7)(Cl
esk

obile

Warning: This document is UNCLASSIFIED//FOR OFFICIAL USE ONLY (U//FOUO) . It contains information that may be exempt from public
release under the Freedom of Information Act {S U.S.C. 552) . It is to be controlled, stored, handled, transmitted, distr ibuted, and disposed of
in accordance w ith DHS policy relating to FOUO information and is not to be released to the public or other personnel who do not have a
valid "ne ed-to-know " without prior approval of an authorized DHS official. No portion of this report should be furnished to the media, either
in written or verbal form.

Sent :

on ay,

er 19, 2018 11:46 PM

~~r )(6); (b)(7)(C)
Subject: RE: DRAFTdet ainee death notice re: AMAR
Importance : High

See my comments in both documents.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000123
2019-ICLl -00051 1950



It needs to be clear that AMAR did not go without eating from 8/25 until 10/16, the dates his hunger
strike officially started and ended.
It might also be note d (thoughts?) that the public believes he has been on hunger continuous ly from
8/22 until today, as he and his handlers have not relayed to anyone t hat he was off his hunger str ike, nor
has ICEmade this announce ment, due to AMAR's threats to resume his hunger strike if we did so and
our desire to ensure he was healthy enough for removal.

Froml (b)(6); (b)(7)(C)

Se nt : Monday, November 19, 2018 1:22 PM

r)(6;)(b)(7XCJ

Subject : FW: DRAFT detainee death notice re: AMAR

Good afternoon,
FYSA,we received an execut ive summary from the IHSC side of the house, we have
incorporated some their information onto the draft DDN document you last provided on
Friday. We also sent it up to the fron t office acting CoS(~)\~t,, for preliminary review.
Please see the attac hed, and use this vers ion to addr ess any comments an d ad d any updates
from ERO Seatt le.
Thank you,
l(b)(6); (b)(7)(C)

I

Domestic Operations Desk Office r-West (Los Angeles & Seatt le)
H - Enforcement and Remova l Operat ions
(b)(6); (b)(7)(C)
esk
obile
l(b)(6); (b)(7)(C)
Warning : This document is UNCLASSIFIED//FOR OFFICIALUSE ONLY (U//FOUO). It contains information that may be exempt from public
release under the Freedom of Information Act (5 U.S.C. 552). It is to be controlled, stored, handled, transmitted , distributed, and disposed of
in accordance w ith DHS policy relating to FOUO information and is not to be released to the public or other personnel who do not have a
valid "need-to-know" without prior approval of an authorized DHS official. No portion of this report should be furn ished to the media, either
in wr itten or verbal form.

From :~b)(6); (b)(7)(C)

I

Se nt : Monday, November 19, 2018 3:21 PM
To : (b)(6); (b)(7)(C)

SubJect: FW: DRAFT

notice re: AMAR

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000124
2019-ICLl-00051 1951



Good afternoon,
See attached from 11. Please provide to SEAto address the comments and for their use in updating
going forward.
Thanks-

1Jeraho ns - West

From* b)(6); (b)(7)(C)

Sent: Monday , November 19, 2018 3:04 PM
To:l (b)(6); (b)(7)(C)

Cc:
Subject : RE: DRAFTdetainee death notice re: AMAR

~----------------~

Please see attached with edits and comments . Please use this draft to update .
Thank you,

I

l(b)(6); (b)(7)(C)

(A) Chief of Staff
Enforcement and Removal Operation s
500 I ih Street, SW
Wash ingto n, D.C. 20536
Kb)(6); (b)(7)(C)
Fromf

I

b)(6); (b)(7)(C)

Sent: Monday , November 19, 2018 11:48 AM
To: ~b)(6); (b)(7)(C)

Cc:I
Subject : DRAFTdetainee death notice re : AMAR

~------------------~

Good morning,
We've been monitoring this detainee's medical case closely since last week. Medical staff have declared
him brain dead and EROis attempting to locate next of kin to authorize the discontinuance of life
sustaining efforts. While we wait, please review the attached draft det ainee death notification and
provide comments for anything else we'll need from IHSCor the fie ld office.
Thanks,
fb )(6); (b)(7)(C)
ERO Domesti c Operation- - West
Unit Chief
Enforcement and Remova l Operations
U .S. Immigration and Customs Enforcement
U.S. Dc artment of Homeland Securi ty

0

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000125
2019-ICLl-00051 1952



Page 1953
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000126



Page 1954
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000127



Page 1955
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000128



Page 1956
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000129



Page 1957
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000130



Page 1958
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000131



Page 1959
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000132



Page 1960
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000133



Page 1961
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000134



Page 1962
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000135



Page 1963
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000136



Page 1964
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000137



From:

l(b)(6); (b)(?)(C)

Se nt:

25 Nov 2018 17:48:25 +0000

To :

l(b)(6); (b)(7)(C)

Cc:
Subje ct:
Attachments :

~-----------~

FW: D/T Amar #216269802
DRAFT----Detainee Death Notification-ERO Seatt le-Mergensana A216 269 802
V6(MC) with IHSCand OCCedits.doc

(b)(6);

I just received this from BW, I added the JI0C information.
has not been updated.

Mr.l(b)(6);
1h1nvo

FYI, the consulate information

I

Do you have an update on this?
l(b)(6); (b)(?)(C)

I

Domestic Operat10ns Desk Officer-West (Los Angele s & Seattle)
HQ- Enforcement and Removal Operations
b)(6); (b)(?)(C)
Desk
Mobile
f b)(6); (b)(?)(C)

Warning: This document is UNCLASSIFIED//FOR OFFICIAL USE ONLY (U//FOUO). It contains information that may be exempt from public
release under the Freedom of Information Act {S U.S.C. S52). It is to be controlled, stored, handled, transmitted, distr ibuted, and disposed of
in accordance with OHS policy relating to FOUO information and is not to be released to the public or other personnel who do not have a
valid "ne ed-to-know " without prior approval of an authorized OHS official. No portion of this report should be furn ished to the media, either
in wr itt en or verbal form.

Fromd <b)(6); (b)(7)(C)

Se nt: Sunday, November 25, 2018 12:33 PM
To :l(b)(6); (b)(?)(C)

Subject : FW: D/T Amar #216269802

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000138
2019-ICLl-00051 1965



Adding a few edits on the legal side. Also to reflect Amar's individual hearing was via VTC with a Salt
Lake IJ.

f b)(6); (b)(7)(C)

I

Assistant Chief Counsel
Seattle Office of Chief Counsel / OPLA
Tacoma sub-office
U.S. Immigration and Customs Enforcement
U.S. Departmentof HomelandSecurity
Tel: Jb )(6); (b)(7)(C)
E-m ._
______________
_.
***Warning*** Attorney/Client Privilege*** Attorney Wo rk Product ***
This communication and any attachments may contain confidential and/or sensitive attorney/client privileged
information or attorney work product and/or law enforcement sensitive information. It is not for release , review,
retransmission , dissemination , or use by anyone other than the intended recipient. Please notify the sender if this
email has been misdirected and immediately destroy al l originals and copies. Furthermore do not print, copy, retransmit, disseminate , or otherwise use this information. Any disclosure of this communication or its attachments
must be approved by the Office of the Principal Legal Advisor, U.S. Immigrat ion and Customs Enforcement. This
document is for INTERNAL GOVERNMENT USE ONLY and may be exempt from disclosure under the Freedom of
Information Act , 5 USC?? 552(b)(5) , (b)(7).

Su j ect: FW: D T Amar #216269802
Import ance: High

All,
With AMAR's being taken off life -support last night and passing, today will likely be a busy day for us all.
See below and attached, the draft death notice that wi ll have to be refined this morning .

From!(b\(6) (b\(7\(C\
Sent : Sunday, November 25, 2018 8:36 AM

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000139
2019-ICLl-00051 1966



Subject : RE: D/T Amar #216269802
Importance: High

Here's the latest.
It will need to be looked at by IHSC here locally for some clarity on Amar's seg status (see comments on
page 4).
One thing needing to be done at th is point is contacting the Russian Embassy. Will that be covered by
RIO or do you want us to attempt to do that here? (and does someone have a fax number with which to
do that?)

From:l (b)(6); (b)(7)(C)

Sunday, November 25, 2018 7:42 AM
1~Sent
)(6;)(b:)(7)(C)

Subject : RE: D/T Amar #216269802

. Mr., b)(6);
Goo d morning
,,_
,,_,,,,...,
Mr. !<bl(6l :

Is inquring on the eta for the DDN? Can you provide a status?

Thank you

From: kb)(6); (b)(7)(C)

Date : Sat urday, Nov 24, 2018, 9:28 PM

Subject : RE:D/T Amar #216269802
Thank you,
Please prov ide the updated detainee death notice first thing in the AM.
If you need any additional information please let me know,

Thanks

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000140
2019-ICLl-0005 1 1967



l(b)(6); (b)(7)(C)

Unit Chief
Domestic Operations West
(b)(6); (b)(7)(C)

ent w it
ac erry Work
(www .blackberry.com)

From: ~b)(6); (b)(7)(C)
Dat e: Saturday, Nov 24, 2018, 9:21 PM

Subject : FW: D/T Amar #216269802

This from GEO. I am expecting the hospital should be getting in touch with IHSCshortly

Sent with BlackBerry Work
(ww w.blackberry.com )

Subject : D/T Amar #216269802

at 1754 hour s i was info rmed by D/O \~)\~\ -, that the hospita l staff had got
authorization to rem ove D/T Amar from the ventilator. at approx 1805 D/T Amar

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000141
2019-ICLl-00051 1968



!(b)(6); (b)(?)(C)

Sergeant

GEO Corrections

& Detention

Northwest Detention
1623 East J Street
Tacoma, Washington

(R)

Center
98421

(_bl..,.
(6..,
); (__
bl_(?_l(_c)_....&..---:..F.::::,
ax:
.,,;T:,..:;e;.:..
I ::.1.

l(b)(6); (b)(?)(C)

b)(6); (b)(?)(C)

www.geogroup.com
This email and any files transmitted
with it are confidential
and are intended solely for the
use of the individual or entity to which they are addressed. If you are not the intended
recipient or the person responsible for delivering the email to the intended recipient , be
advised that your have received this email in error and that any use, dissemination,
If you have received
forwarding,
printing or copying of this email is strictly prohibited.
this email in error, please immediately
notify by replying to this email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000142
2019-ICLl-00051 1969



Page 1970
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000143



Page 1971
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000144



Page 1972
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000145



Page 1973
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000146



Page 1974
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000147



From :
Sent :
To :

I

l(b)(6), (b)(?)(C)

20 Nov 2018 17:14:05 +0000
(b)(6); (b)(?)(C)

Cc:
Subject:
Import ance:

l

Good morning, Kb)(B); ~- Please see the email from IHSCbelow that technica lly Mr. Ama r died on
November 18. We need some guidance about whether this changes how we message this issue, and
how we hand le the Congressional offices. We need to come up with a plan of how we move forward
from here.
Thanks

I

From : l(b)(B); (b)(?)(C)
Sent : Tuesday, November 20, 2018 9:09 AM
T~ (b)(6); (b)(?)(C)

Subject: FW: email from IHSCHQ

l(b)(6); (b)(?)(C)

Acting Field Office Director
ICE E-,u..u,-!,Ll-'-1~~.......,,._
---emovalO erations, Seattle, WA
Main: (b)(B); (b)(?)(C) / D esk (b)(6); (b)(7)(C)
Cell l~(b~)(6~);~(b~)(=
7)~
(C~) ~

CONF IDENTIALITY: This email and attachments are intended for the above name only and are confidential. If you are not the
intended add ressee, or the person respons ible for deliver ing it to the intended addressee, you may neither copy, disseminate, nor
distribute it to anyone else or use it in any unauthorized manner. To do so is strictly proh ibited and may be unlawful. If you receive
this emai l by mistake, please advise the sender immediate ly by using the reply faci lity in your ma il software and delete it from your
computer.
From :l(b)(6); (b)(7)(C)

Sent : Tuesda , November 20, 2018 8:56 AM
(b)(6); (b)(?)(C)

See Dr ~(b)(6); ~Is concerns about the actual legal time of Amar' s death . As indicated below and I've
just been told by Dr. b)(6);
hen they do eventually take him off life support and issue a death
h " 7 \/ f""\

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000148
2019-ICLl-00051 1975



certificate the date and time of death is going to be shown as the 18th at 2:45 pm, not t he date and time
he is removed from life support and stops breathing . That being the case, do we issue the death notice
now with a date Shown as the 18th at 2:45 PM, and in this case, are the HIPA privacy rights gone? And
do we now issue a notice to the congressiona ls and the media?
Sent with BlackBerry Work
(www.blackberry.com )
From:~b)(6); (b)(7)(C)

Date: Tuesday, Nov 20, 2018, 8:30 AM
rb)(6); (b)(7)(C)
Subject: email from IHSCHQ

All,
Please see message from D~(b)(6); (b)(7)(C) ~el ow . Can we please meet ASAP!

V/R,

CAPT l(b)(6); (b)(?)(C)
[ LCSW-C , BCD
Health Services Administrator
USPHS
ICE Health Service Corps
Northwest Detention Center
1623 E. J St. Suitel(b)(~);I
Tacoma , WA 98421
Offidb )(?): (b)(7)(C)

BB (b)(6); (b)(7)(C)
Fa.______

~

l(b)(6); (b)(7)(C)

Warning: This document is UNCLASSIFIED //FOR OFFICIAL USE ONLY (U//FOUO). It
contains information that may be exempt from public release under the Freedom of Informat ion
Act (5 U.S.C. 552) . It is to be controlled , stored, handled , transmitted , distributed, and disposed
of in accordance with DHS po licy relating to FOUO informat ion and is not to be relea sed to the
public or other per sonne l who do not have a valid "need-to-know" without prior approval of an
authori zed DHS official. No portion of this report should be furnished to the media , either in
written or verba l form.

Fromt b)(6); (b)(7)(C)

Sent : Tuesdav November 20 2018 7:46 AM
(b)(6); (b)(7)(C)

Subject: Can you call me when you can?

CAP (b)(6); (b)(7)(C)Dr.l(b)(6); (b)(7)(C)

I

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000149
2019-ICLl-0005 1 1976



I know you're probably finishing morning report . I'm reviewing the death not ification draf t from ERO for
Mr. Amar. I don't t hink Mrl (b)(6):~, r, ay not understand the significance of Mr. Amar being declared
brain dead on 11/18 at 2:45 pm - that that is effectively his date of death for the death cerficate.
I know the re can be some confusion with physical death (removal of life support and cessation of
breathing and heart beat) and brai n death (the legal determination of th e time/day of deat h that can
perm it actions such as organ harv esting or other legal matters to proce ed.
If just want to verify if ERO and OCCare aware that he is "d ead" for all int ents and purposes? They're
ju st contin uing lif e supp ort m easures fo r the next of kin notification.
Thanks
From:!(b)(6); (b)(7)(C
)

I

Sent : Monday, Novembe r 19, 2018 10:14 PM
(b)(6); (b)(7)(C)

Subject : Hospital/ICU update Amar

Name: Amar, Merg ensana
Hospital day #5 in ICU
A# : 216269802
DOB: 10/23/1978
COB: Russia
DOA: 12/19/2017
Relevant Medical History: Was on self-impo sed Hunger Strike but began eating
three meals a day with liquid nutritional supplements
Reason sent to ER: CPR initiated due to asphyxiation from self harm (hangin g)
and trans ferred to ICU when pulse achieved.
Current Status: No changes from previous update, Detainee had massive anoxic
brain injury. H e was pronounced brain dead yesterday 11/18/18 at 1445. He
remain s non-respon sive and intubated with stable vital signs. He is on 1 medic ation
(levafed) to support his blood pressure.
Location: St. Joseph 's ICU Room 6B6 (b) (6), (b) (7)(C)
. p hys1cian:
. .
Dr. (b)(6)
Att en d mg
~
t.100 receive
o d from : RN b)(B)
1n.orma
h\mrc:i
,:.;.
l h:.;:_
\/ 7.;_;;
\ ~.;...
r .;...
\ ~---

CAP (b)(6); (b)(7)(C)

D USPHS

AM RI AN

PVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000150
2019-ICLl-00051 1977



 

ICE Health Service Cor SIEROIICEIDHS

510 w. Ash St San Diego, CA 92101


(O) 619-3380311161 202-210 1211?;

19-0197-J-000151
201 B-ICLI-00051 1978



l(b )(6); (b )(7)(C)

From :

Sent:

20 Nov 2018 18:37:44 +00 00

l(b)(6); (b)(7)(C)

To:

Subject :

FW: ema il from IHSC HQ

FYSA ,
See below . We' re working on issuing the death notice
l(b)(6); (b)(7)(C)
Acting Field Office Director
ICE Enforcement & Remova l Operatio ns, Seattle, WA

I/Desk:l<b)(6);(b)(7)(C) I/ Cel1J b)(6);(b)(7)(Cl

Main: l(b)(6); (b)(7)(C)

CO NFIDENTIALI TY: This ema il and attachments are intended for the above name only and are confidentia l. If you are not
the intended addressee, or the person responsi ble fo r delivering it to the intended add ressee , you may neither copy ,
disse minate, nor distribute it to anyone else or use it in any unauthor ized manne r. To do so is strictly prohibited and may
be unlawful. If you receive th is ema il by mistake , please adv ise the sende r immediate ly by using the reply facility in your
mail softwa re and dele te it from you r compute r.

F rom :tb)(6); (b)(7)(C)
;

;:

Sent: Tuesday, Nove mber 20, 2018 10:37 AM
To: b)(6); (b)(7)(C)
Cc: .__-.....,.....----r---'
Subject: FW: email from IHSC HQ

(b)(6);
(b)/7)/C)
Please see below .
According to IHSC and OPLA, our detainee was officia lly "dead" (brain dead but on life
support) on 11/18/ 18 at 2:45pm.
According to our notification policy , we have to have the death notification within 48
hours of the death. So our notice is due by 2:45p m our time (in 4 hours). Have you
worked on the draft? We need to get that finalized and submitted.
fb)(6); (b)(7)(C)
Act ing Field Office Director
ICE Enforcement & Remova l Operatio ns, Seattle, WA

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000152
20 19-ICLl-0005 1 1979



~ Desk:

Main:~b)(6); (b)(7)(C)

~b)(6); (b)(7)(C)

I/

Cell: 1Cb)(6); (b)(7)(C)

CO NFIDE NTIALITY: This ema il and attachments are intended for the above name only and are confidentia l. If you are not
the intended add ressee, or the person responsible fo r delivering it to the intended add ressee, you may neither copy,
disseminate, nor distribute it to anyone else or use it in any unauthor ized manne r. To do so is strictly prohib ited and may
be unlawful. If you receive th is ema il by mistake, please adv ise the sender immed iate ly by using the reply fac ility in your
mail software and delete it from your computer.

From:

l(b)(6); (b)(7)(C)

I

Sent: Tuesday, November 20. 2018 10:29 AM

Subject: FW: email from IHSC HQ
l(b )(6 );

11118/18 is the date of death and you need to initiate the death notication s.

Sent with BlackBerry Work
(www .blackben-y.com)
From:l (b)(6); (b)(7)(C)

Date: Tuesday, No v 20, 2018 , 10:20 AM
To: fb )(6); (b)(7)(C)
l(b)(6); (b)(7)(C)

Subject: RE: email from IHSC HQ
(b )(6 );

(b)(7}(C}
b )(S)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000153
2019-ICLl-00051 1980



Adding

kb)(6) ; (b)(7)(C)

Ias well for further clarific ation.

Thanks,
l(b)(6); (b)(7)(C)

Associat e Lega l Advisor
Enfor cemen t Law Section
Enforc ement and Removal Oper ation s Law Division
Office of th e Principal Lega l Advisor
U.S. Immi grat ion and Custom s Enforcemen t (ICE)
500 12th Str ee t, S.W.
Washi ngton , D.C. 2002 4
(b)(6); (b)(7)(C)

*** Warning *** Attorney/Client Privilege *** Attorney Work Product***
This communication and any attachments may contain confidential and/or sensitive attorney /client
privileged infonnation or attorney work product and/or law enforcement sensitive information. It is not for
release, review, retransmission, dissemination, or use by anyone other than the intended recipient. Please
notify the sender if this email has been misdirected and immediately destroy all originals and copies .
Furthermore do not print, copy, re-transmit, disseminate, or otherwise use this infonnation . Any disclosure
of this communication or its attachments must be approved by the Office of the Principal Legal Advisor,
U.S. Immigration and Customs Enforcement. This documen t is for INTERNAL GOVERNMENT USE
ONLY and may be exempt from disclosure under the Freedom of Information Act, 5 USC?? 552(b)(5) ,
(b)(7).

From: l<b)(6); (b)(7)(C)
Sent: Tuesday, Nove mber 20, 2018 1:07 PM
(b)(6); (b)(7)(C)

Subject : RE: email from IHSC HQ
b)(6);
h\ (7\ (C:\

I'm meeting with ERO and IHSC.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000154
2019-ICLl-00051 1981



Hospital has declared him deceased. Death cert will report 11118/18 as date of death .
Hospital reports thre has been no contact with family. Hospita l is plann ing to turn off life
support this afternoon .
b)(S)

Sent with BlackBerry Work
(www.b lackberry.c om)
From: l(b)(6); (b)(7)(C)
D ate: Tuesday, Nov 20, 20 18, 8:40 AM
r )(6); (b)(7)(C)

Subjec t: RE: email from IHSC HQ
(b)(6);
/h \/ 7\ /f:\

(b)(S)

Reg ards,
l(b)(6); (b)(7)(C)

Associate Legal Advisor
Enforcement Law Section
Enforcement and Removal Operations Law Division
Office of the Principal Legal Advisor
U.S. Immigration and Customs Enforcement (ICE)
500 12th Street, S.W.
Washington, D.C. 20024

1~)(6);(b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000155
2019-ICLl-00051 1982



*** Warning *** Attorney/Client Privilege *** Attorney Work Product***
This communication and any attachments may contain confidential and/or sensitive attorney/client
privileged infonnation or attorney work product and/or law enforcement sensitive information. Tt is not for
release , review , retransmission , dissemination, or use by anyone other than the intended recipient. Please
notify the sender if this ema il has been misdirected and immediately destroy all originals and copies.
Furthennore do not print , copy, re-transmit , disseminate , or otherwise use this infonnation. Any disclosure
of this communication or its attachments must be approved by the Office of the Principal Legal Advisor ,
U.S. Immigration and Customs Enforcement. This document is for INTERNAL GOVERNMENT USE
ONLY and may be exempt from disclosure under the Freedom oflnfonnation Act, 5 USC?? 552(b)(5),
(b )(7).

Fr om :1Cb)(6); (b)(?)(C)
Sent: Tuesday, November 20, 2018 11:35 AM

Subject: FW: email from IHSC HQ
Importance: High

\~!\
~!i,..., is pointing out that when Amar was pronounced brain dead yesterday, that
is the official date of death. Should ERO be using the 11/18/18 14:45 date and time as the
official date and time of death for all reporting purposes?
Dr.

(b)(6);
/ h \/ 7 \/r'\

Fro m :~b)(6); (b)(?)(C)
Sent: Tuesday, November 20 , 2018 8:31 AM
rb)(6); (b)(?)(C)
Subject: email from IHSC HQ

All,
Please see message from Dr.

li~\i
~\b

!below. Can we please meet ASAP!

V/R,

CAPTl(b)(6)
; (b)(?)(C)
l LCSW-C, BCD
Health Services Administrator
USPHS
ICE Health Service Corps
Northwest Detention Center
1623 E. J St. Suite i~bl<61
Tacoma, WA 98421
Qffirpo Kb
)(6)
; (b)(?)(C)
I
BB: (b)(6)
; (b)(?)(C)
Fax ....______

~

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000156
2019-ICLl-00051 1983



l(b)(6); (b)(7)(C)

Warning: This document is UNCLASSIFIED //FOR OFFICIAL USE ONLY (U//FOUO).
It contains information that may be exempt from public release under the Freedom of
Information Act (5 U.S.C. 552). It is to be controlled , stored , handled , transmitted ,
distributed , and disposed of in accordance with DHS policy relating to FOUO
information and is not to be released to the public or other per sonnel who do not have a
valid "need-to-know" without prior approval of an authori zed DHS official. No portion of
this report should be furnished to the media , either in written or verbal form.
From:

l(b)(6); (b)(7)(C)

Sent: Tuesday, November 20, 2018 7:46 AM

Subject: Can you call me when you can?
CAPT

l(b)(6): (b)(7)(C) fDr. fb )(6); (b)(7)(C)

I

I know you 're probably finishing morning report . I'm reviewing the death notification
draft from ERO for Mr . Amar. I don't think Mr. ,~/\~/;,.._,may not understand the
significance of Mr. Amar being declared brain dead on 11/18 at 2:45 pm-that that is
effectively his date of death for the death cerficate.
I know there can be some confusion with physical death (removal of life support and
cessation of breath ing and heart beat) and brain death (the legal determination of the
time/day of death that can pennit actions such as organ harvesting or other legal matters
to proceed.
If just want to verify if ERO and OCC are aware that he is "dead" for all intents and
purposes? They're just continuing life support measure s for the next of kin notification .
Thanks
From:fb

)(6); (b)(7)(C)

I

Sent: Monday, November 19, 2018 10: 14 PM
(b)(6); (b)(7)(C)

Subject: Hospital/ICU update Amar

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000157
2019-ICLl-00051 1984



Name: Amar , Mergensana
Hospital day #5 in ICU
A#: 216269802
DOB: 10/23/ 1978
COB: Russia
DOA: 12/19/2017

Relevant Medical History: Was on self-impo sed Hung er Strike but began
eating thr ee meal s a day with liquid nutritional supplemen ts
Reason sent to ER: CPR initiated due to asphyx iation from self harm
(han ging) and tran sferred to ICU when pulse achi eved .
Current Status: No changes from previous updat e. Detainee had massive
anoxic brain injury . He was pronounced brain dead yesterday 11/ 18/18 at
1445. He remains non-responsive and intubat ed with stable vital sign s. He is
on 1 medication (levafed) to support his blood pre ssure.
Location: St. Joseph 's ICU Room 6B6

. .
Dr.
. phys1c1an:
Att en d mg

b)(6)

h\/?\ r,, ,

Information received from : RN
CAPT l(b)(6); (b)(7)(C)

(b) (6), (b) (7)(C)

~l~
~;r.
\,

IMD USPHS

Deputy Medical Director

ICE Health Service Corps/ERO/ICE/OHS
6 10 W. Ash St~

San Diego, CA 92101

fb)(6); (b)(7)(C)

AM RICAN

PVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000158
2019-ICLl-00051 1985



fb)(6);(b)(7)(C)

From :

Sent:

18 Nov 2018 20:38:36 +0000
#ERO FODS;#ERODFOD1.,_.
lb""'
\16=
\.....,,
: l=b
\..,_
17"""
\IC
=\______

To:

__.fEROCHIEFSOF

STAFFkb
)(6): (b)(?)(C)

Subject:
Attachments:

FW: CBP Processing Complete and In Custody Breakdown 1118 18
OFO SWB MCAT 72 hours report_2018-11-18-15-00-39.xlsx, USBP InCustody Breakdown 20 18-11-18-15-00-34.x lsx

FYSA - apologies to those who already receive this...
Tho se 3 Air and Marine bodies are
Concerning ?

Assistant Director
Field Operations
Fromfb )(6); (b)(?)(C)

Date: Sunda

(b)(6); (b)(?)(C)

Nov 18 2018, 15:08

Afternoon update.
From :l(b)(6); (b)(7)(C)

Date: Sunda

b)(6);(b)(7)(C)

Nov 18 20 18 9:54 AM

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000159
2019-ICLl-00051 1986



From:
Sent:

~b)(6); (b)(7)(C)

16 Nov 2018 05:06:41 +0000

rb )(6); (b)(7)(C)

Subject:

FW: Death of detainee at Tacoma detention center

Sent with BlackBerry Work
(www .blackberry.com)

r

From:l(b)(6); (b)(7)(C)
Date: Thursday, Nov 15, 2018, 9:03 PM

I>

To: l(b)(6); (b)(7)(C)

Subject: FW: Death of detainee at Tacoma detention center

Regard s,
!(b)(6); (b)(7)(C)

Publi c Affair s Officer/Spokesper son
Alaska, Idaho, Oregon , Washington State
U. S. Immi ration & Customs Enforcement
Cell: b)(6); (b)(7)(Cl
Froml (b)(6); (b)(7)(C)

Date: Thursday, Nov 15, 2018, 9:03 PM
To: b)(6); (b)(7)(C)

SubJect:
(b)(6);

b 7 C

I received word that Mergensana Amar (216269802) died today.
Questions for ICE:

1. Was a forced feed ing order ever attained? If not, why not?
2. Was he under medical supervis ion? If so, what kind of medical care was he receiving?
3. Was there an outbreak of chicken pox or other commun icable diseases at the time of
his death?
4. When exact ly was his body discovered? Who discovered it?
5. What will happen to his body?
6. Has his family been notified?
7. How many other people have died at the detention center in Tacoma?

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000160
2019-ICLl-00051 1987



8. Is there anyone else who is currently on a hung er strike?
I am publishing a sto ry in the morning so plea se respond as quickly as possib le.

Crosscut / Staff writer
Office: b)(6);(b)(7)(C)
Mobil~""-T----Twitter: b)(6);(b)(7)(C)

From: Roman, Tanya J
Sent: Tu esday, October.......,
~~~~~-----~
To: j(b)(6);(b)(7)(C)
Subject: RE: Interview with someone in detention at the NW Detention Center in Tacoma

I

Hitb)(6)1Thank you for your patience. Here is our response. Please use this versus the previous
general response I sent as this contains additional information:
One detainee is voluntarily drinking a meal replacement shake in lieu of their daily scheduled
meals. We are not seeking a court order as there is no present need to medically intervene.
ICE respects the right s of all people to voice their opinion without interference. ICE does not
threaten or retaliate in any way against hunger strikers and explains the negative health effects of
not eating to our detainees. Additionally, for their health and safety, ICE closely monitors the
food and water intake of those detainees identified as being on a hunger strike .
ICE ' s detention standards concerning hunger strikes may be reviewed here:
http:/ /www.ice .gov/doclib/ detention -stan dards/20 I I /hunger strikes.pdf. "

Tanya Roman
Public Affairs Officer
Alaska, Idaho, Oregon , Washington State
U.S. Immigrations & Customs Enforcement
Cell: l(b)(6);(b)(7)(C)

I

From: l(b)(6)
; (b)(7)(C)
Sent: Tuesday, October 9, 2018 12:35 PM
To: Roman, Tanya J (b)(6); (b)(?)(C)
Subject: Re: Interview w1

someone

in

e en 10n at the NW Detention Center in Tacoma

If you could get me a response by t he end of the day th at would be great. I am on
deadline.
Thank you,

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000161
2019-ICLl-00051 1988



Crosscut I Staff wri ter
Office: (b)(6); (b)(7)(C)
Mobile
T witte r
From: Roman, Tanya J ~~
(b_l(_
6)_;(_bl_(7_l(_C_
) ------~
Sent: Tuesday, October 9, 2018 12:24 PM
To: l<b)(
6); (b)(7)(C)

I

Subje ct: RE: Interview w ith someone in detention at the NW Detent io n Center in Tacoma
Hikb)(6); !
Thank you for the informat ion. I am working a response for you now and will send it as soon as
possible. When is your deadline or w ill you wa it for us so tha t you have a complete story?
Also, how did you coordinate the interviews w ith the detainees? I don't remember having
interview consent forms signed for the individual you mentioned . Did you speak to them after
they were released from ICEcustody?
We'll need the detainee to sign p rivacy waiver forms to provide backgro u nd on their medical
situations. I've attached those waivers for your convenience.
Lastly, I've attached some resent court findings for your use. It is not about the specific detainee
you identified but does have some excellent background information for your use. Best, Tanya

Tanya Roman
Public Affa irs Officer

Alaska, Idaho, Oregon , Washington State
U .S. Immigration s & Customs Enforcement
Cet q(b)(6); (b)(7)(C)
From: l(b)(6); (b)(7)(C)

I

~

Se nt: Tuesday, October 9 1 2018 11:19 AM
6l_;(_bl_<7_l<_
To : Roman, Tanya J <f~b-l(_
C_______
l
~
Subject: Re : Interview with someone in detention at the NW Detention Center in Tacoma
Hi Tanya ,
I've been able to ta lk to t he deta inee I had i nqu ired abou t. He is on a h unge r strike at
the detention center and has said he has had certain privi leges revoked and threatened
w it h force f eed ing via a tube through h is nose because he is on strike.
Human Rights Watc h sent th is recen t lette r about the hunge r strikes after vis it i ng the
detent ion center. https ://www.hrw.org/news/20
18/10/02/hu nger-st ri kers-icedetention-r isk

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000162
2019-ICLl-00051 1989



Do you have a response? Also, is ICEcurrent ly seeking a force feeding order for any
detainee at the detention center in Tacoma?
Thank you,
(b)(6);
f l,,. \f ? \lr'

Crosscut I Staff writer
Office :(b)(6); (b)(7)(C)
Mob ik
~
Twitte _____
From : Roman , Tanya J f.._
b_)(_
6)_
; (_
b)_
(7_
)(C
_)_______

~

Sent : Thursday, October 4, 20 18 6:08 PM
To:l(b)(6); (b)(7)(C)

I

Subj ect: RE: Interview with someone in detention

at the NW Detention Center in Tacoma

Hi )~l)~li Please send me the nam e and DOB or alien number of the detainee and I'll
begin working this reque st. Thank s

Tanya Roman
Public Affairs Officer
Alaska , Idaho , Oregon , Washington State
U.S. Immi ration & Custom s Enforcement
Cell: (b)(6); (b)(7)(C)
From!(b)(6); (b)(7)(C)
Date: Thursday , Oct 04, 2018, 3:46 PM
6l_;<_
To: Roman, Tanya J .....
l(b....,.
)(_
bl_C7_)(C
_l_____
,.........,
Subject : Interview with someone in detention at the NW Detention Center in Tacoma

Hi Tanya,
I'm a reporter in Seattle working on a story about the hunger strike at the Northwest
Detention Center in Tacoma. I'm wondering if it would be possible to visit the detainee
on strike (in the presence of a guard or anyone else you deem necessary) and talk to
him for 20 minutes?
Please let me know soonest.
Thanks much,

Crosscut I Staff writer

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000163
2019-ICLl-00051 1990



Office: (b)(6); (b)(7)(C)
Mob ik
Twitte

Disclaimer
The information contained in this communication from the sender is confidential. It is intended solely for
use by the recipient and others authorized to receive it. If you are not the recipient, you are hereby
notified that any disclosure, copying, distribution or taking action in relation of the contents of this
information is strictly prohibited and may be unlawful.
This email has been scanned for viruses and malware, and may have been automatically archived by
Mimecast Ltd, an innovator in Software as a Service (SaaS) for business. Providing a safer and more
useful place for your human generated data. Specializing in; Security, archiving and compliance. To find
out more Click Here .

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000164
2019-ICLl-00051 1991



From :

l(b)(6); (b)(?)(C)

Sent:

19 Oct 2018 01:37:19 +0000

To:

l(b)(6)
; (b)(?)(C)

Subject:

FW: Detainee Amar 206269802

!

GEO should know better than to think someone refus ing meals but drinking Boo st does
not need to be repor ted
Sent with BlackBerry Work
(www .blackbe rry. co m)
Fromfb)(6); (b)(?)(C)
Date: T hursday, Oct 18, 2018 , 5:00 PM
To~(b)(6); (b)(?)(C)
Subject : RE : Detainee Amar 206269802

So he is off Hunger Strike and reque sted protective custody and is in SEG . We learned
this afternoon in SEG review that he has been refu sing the fac ility mea l tray s but
continuing the liquid nouri shmen t and eating fruit. We have not been getting notified by
GEO about this. Because his calorie consumption is more than adequate, he is not
cons idered official hu nger strike.
I hope thi s clarifies.
V/R,

CAPT l(b)(6); (b)(?)(C)

~

LCSW-C, BCD

Health Services Administrator
USPHS
ICE Health Serv ice Corps
Northwest Detention Center
I 623 E. J St. Suitd(b)(6);I
Tacoma WA 98421
Office (b)(6); (b)(?)(C)
BB: b)(6); (b)(?)(C)
Fax:
l(b)(6); (b)(?)(C)
Warning: Thi s docum ent is UNCLASSIFIED //FOR OFFICIAL USE ONLY (U//FOUO).
It contains information that may be exem pt from pub lic release under the Freedom of
Information Act (5 U.S.C. 552) . It is to be controlled, stored, handled, transm itted ,
distributed, and dispo sed of in accordance with DHS policy relating to FOUO
information and is not to be released to the publ ic or other personnel who do not have a
va lid "need-to-know" without prior approval of an authori zed DHS official. No portion of
this report should be furnished to the med ia, either in wr itten or verba l form.
From: l(b)(6); (b)(?)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000165
20 19-ICLl-00051 1992



Date : Thur sday , Oct 18, 2018, 4:40 PM
To: l(b)(6); (b)(7)(C)
Subject: RE: Detainee Amar 206269802
(b)(6);
/ h\/7\

/r'\

So Amar is off hunger strike but still in MHU?

Sent with BlackBerry Work
(www .blackberry .com)
From: i<b)(6); (b)(7)(C)
Date: Thursda , Oct 18, 2018 , 4:39 PM
b)(6); (b)(7)(C)

Update on this patient who was taken off Hunger Strike in MHU due to adequate calorie
intake:
1. Amar is continuing to dr ink his usual prescribed calorie supplements of boost and
Pedialyte.
2. He has also been eating his fresh fruit from the trays even though he is refusing the rest
of the food trays.
3. His current calorie intake in segregation is the same as it was in MHU. So he continues
to not qualify as hunger strike.
4. Medical is going to cont inue monitoring his weight and vitals regularly on a weekly
basis.
5. We ask that the segregation officer continues to notate his refused trays as per GEO
pol icy, and any food that is taken off the tray to be eaten, including the ordered evening
snack.
Respectfully,

f b_)(6_); _(b_
.....
)(7_)(C
_)___

_,lMD

Clinical Director
ICE Health Service Corps (IHSC)
Enforcement and Removal Operat ions (ERO)
US Immigrat ion Customs Enforcement (USICE)
Northwest Detention Center
1623 E. J St. Suit~b)( 61
Tacoma, WA 98421
(7-)(C
_ )_ _,
Main office: .-(b-)(-6)-; (-b)--Voice Mail:
Cell (b)(6); (b)(7)(C)

fax
b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000166
2019-ICLl-00051 1993



From :

Sent :
To :

Subject:

l(b)(6); (b)(7)(C)
20 Nov 2018 15:48:14 +0000
#IHSC_SEN_Medical;#NWD-Notification-Med ical
FW: Hospital/ICU update Amar

CAPT l(b)(6); (b)(7)(C)
ILCSW-C, BCD
Health Services Administrator
USPHS
ICE Health Service Corps
Northwest Detention Center
1623 E. J St. SuiteKbl(~);I
Tacoma , WA 98421
Office (b)(6); (b)(7)(C)
BB: b)(6); (b)(7)(C)
Fax
b)(6); (b)(7)(C)
Warning: This document is UNCLASSIFIED //FOR OFFICIAL USE ONLY (U//FOUO) . It
contains information that may be exempt from public release under the Freedom oflnfo rmation
Act (5 U.S.C. 552). It is to be controlled, stored, handled, transmitted , distributed, and disposed
of in accordance with DHS policy relating to FOUO information and is not to be released to the
public or other personnel who do not have a valid "need-to-know" without prior approval of an
authorized DHS official. No portion of this report should be furnished to the media, either in
written or verba l form.
From :~b)(6); (b)(7)(C)

Sent : Tuesdav November 20 2018 7:37 AM

(b)(6); (b)(7)(C)

Subject : RE: Hospital/ICU update Amar

Name: Amar , Mergensana
Hospital day #5 in ICU
A#:2 16269802
DOB: 10/23/ 1978
COB: Russia
DOA: 12/ 19/2017

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000167
2019-ICLl-0005 1 1994



Relevant Medical History: Was on self-impo sed Hun ger Strik e but began eating
three meal s a day with liquid nutritional supplem ents
Reason sent to ER: CPR initiated due to asphyxiatio n from self harm (hangin g)
and transferred to ICU when pu lse achie ved.
Current Status: N o chang es from prev ious updat e. Detain ee had massive anoxic
brai n injury. He was pron ounced brain dead yesterday 11/18/18 at 1445. He
remain s non -respon sive and intuba ted with stabl e vital signs. He is on 1 medication
(levafed) to supp ort his bl ood pressure. No new upd ates - awaiting decision from
fami ly .
Location: St. Jo seph 's ICU Room 6B6 (b) (6 ), (b) (?)(C)
Attending physician: Dr. ,~!~~L,
~
t.100 receive
o d from : RN (b)(G)
I n1orma
<bl<7)cc)

="'-"=---

Fromd (b)(6); (b)(7)(C)

Sent: M onda y, Novem ber 19, 2018 10 :14 PM
(b )(6); (b)(7)(C)

Subject : Hospita l/ ICU update Amar

Name: Am ar, Mergensana
Hosp ital day #5 in ICU
A# : 216269 802
DOB: 10/23/1 978
COB: Russia
DOA : 12/19/201 7
Relevant Medical History: Wa s on self-impo sed Hun ger Strik e but began eating
three meal s a day with liquid nutritional supplem ents
Reason sent to ER: CPR initiated due to asphyx iation from self harm (han ging)
and transferred to ICU when pu lse achieve d.
Current Status : N o changes from pre vious update . Detainee had massive ano xic
brai n injury . He was pron ounc ed brain dead yesterday 11/ 18/ 18 at 1445. He
remain s non-re spon sive and intubat ed w ith stable vital signs. He is on 1 medication
(levafed) to supp ort his blood pressure.
Location: St. Joseph 's ICU Room 6B6 #253-4 26-672 8
. .
Dr.=(b)(6)
. p hys1c1an:
Att en dmg
'"=""'=':"..;.:.
' ---Inf ormation received from : RN !~\~~\<cl

AM RICAN

PVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000168
2019-IC Ll-00051 1995



Next call due in 8 hours at 0600
l(b)(6); (b)(7)(C)

IRN

LCDR, U.S. Public Health Service
ICE Health Services Corps
Northwest Detention Center
1623 East J Street
Tacoma , WA 98421
r b)(6); (b)(7)(C)

The Commissioned Corps of the U.S. Public Health Service:
"Protecting, promoting and advancing the health and safety of the nation."

CONFIDENTIALITYNOTICE:This document may contain information covered under the Privacy Act, 5 USC522(a), and/or the Health
Insurance Portability and Accountability Act (PL 104-191) and its various implementing regulations, and must be protected in accordance
with those provisions. Healthcare information is personal and sensitive, and must be treated accordingly. If this correspondence contains
healthcare information, it is being provided after appropriate authorization from the patient or under circumstances that do not require
patient authorization. Redisclosure without additional patient consent or as permitted by law is prohibited. If you receive this
correspondence

Warning: This document is UNCLASSIFIED//FOROFFICIAL USE ONLY (U//FOUO). It contains information that may be exempt from public
release under the Freedom of Information Act (5 U.S.C. 552). It is to be controlled, stored, handled, transmitted, distributed, and disposed of
in accordance with OHSpolicy relating to FOUO information and is not to be released to the public or other personnel who do not have a
valid "need-to-know" without prior approval of an authorized DHS official. No portion of this report should be furnished to the media, either
in written or verbal form.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000169
2019-ICLl-00051 1996



rb)(6); (b)(7)(C)

From:
Se nt:
To:

19 Nov 2018 23:20:19 +0000
rb}(6); (b}(7)(C)

Cc:
Subje ct :

FW: ICE Contract Language, B. Manage a Detainee Death

FYSA

From:~b)(6); (b)(7)(C)

Se nt : Monday, November 19, 2018 3:19 PM
To: ~b)(6); (b)(7)(C)

Cc: ~l----------------~

Subject : RE: ICE Contract Language, B. Manage a Detainee Death

If will not be necessary for GEO to take fingerprints
ta ke care of this.

of AMAR. If it becomes necessary to do so, ICE will

I

l(b)(6); (b)(7)(C)

Assistant Field Office Director
OHS/ICE/ERO
Northwest Detention Center
Seattle Field Office
Desk b}(6); (b)(7)(C)
Cell:

L..------'

From:fb)(6); (b)(7)(C)
Se nt : M onday, November 19, 2018 1:04 PM
To:i<b)(6); (b)(7)(C)

Subject: Fw: ICE Contract Language, B. Manage a Detai nee Death

Here it is ...

from :l(b)(6); (b)(7)(C)

I

Sent: Monday, November 19, 2018 12:59 PM
To (b)(6); (b)(7)(C)

Sut>Ject:

ontract

anguage , B. Manage a Detainee Death

Warden,

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000170
2019-ICLl -00051 1997



Excerpt from current ICE contract, Section X. Health Services, Paragraph B. Manage a Deta inee
Death.

kb)(6); (b)(7)(C)

!

ASSISTANT WARDEN, SECURITY

The GEO Group , Inc . (R)
Northwest Detention Center, 1623 East J Street
Tacoma, Was hing t on 98421

Io

Fax: t b)(6); (b)(7)(C)
Te l :kb)(6); (b)(7)(C)
Mobile: !(b)(6); (b)(7)(C)
kh \/n\ (h\(7\(C:\

www .qeoqroup.com

I
I

This email and any files t ransmitted
entity to which they are addressed.
the email to the intended recipient,
dissemination, forwarding, printing
error, please immediately notify by

with it are confidential and are intended so lely for the use of the ind ividual or
If you are not the intended recipie nt or the person responsible for delivering
be advised that you have received this email in error and that any use,
or copying of this email is strictly prohibited. If you have received this email in
rep lying to this email.

From:lU?.l(R),
); (b)(7)(C)
Sent : Monday, November 19, 2018 1:44 PM
To;t b)(6); (b)(7)(C)

I

Subject: Message from KM_C759

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000171
2019-ICLl -00051 1998



From :

Se nt:
To:

Subject:

l(b)(6); (b)(?)(C)
26 Nov 2018 16:59:50 +0000
l(b)(6); (b)(?)(C)
FW: ICE detainee passes away at local hospital

!

Good morning. Below ii'=b-l/6-l_-

ls explanation on how the congressional notification works.

Thanks
From~ (b)(6); (b)(?)(C)

Se nt : Monday, November 26, 2018 7:55 AM
T4(b)(6); (b)(?)(C)
SubJect: RE: ICE detainee passes away at local hospital
OCR already sent the email below with the press release attached to the committees of jurisdic t ion and
the DC offices of the Washington state congressional delegation {bot h senators and the House
representative/s of the district where the detainee passed away. Feel free to share it with your local
congressional contacts. Than ks
!<b
l/6):
From *b )(6); (b)(?)(C)

Se nt : Monday, November 26, 2018 10:50 AM
To :l(b)(6); (b)(?)(C)

Subject: RE: ICE detainee passes away at local hospital

I

Good morning ,(b)(6);~- Thank you . How does notification work for congressional members? Do you
have t o notify them separately or does the press release suffice?
Thanks

l\~?\~L,
From~ (b)(6); (b)(?)(C)

Se nt : Monday, November 26, 2018 7:38 AM
To: l(b)(6); (b)(?)(C)
Subject : FW: ICE detainee passes away at local hospita l
fyi
From :~ )(6); (b)(?)(C)

Se nt :

~

onday, November6,
T4 b)(6); (b)(?)(C)

2018 9:59 AM

Subject : ICE detainee passes away at local hospital
Ladies and gentlemen -

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000172
2019-ICLl -00051 1999



TACOMA, Wash. - Mergensana Amar, 40, a Russian national in the custody of U.S. Immigration and
Customs Enforcement (ICE) was removed from life support yesterday afternoon, after attempting to
take his own life on Nov. 15.
See attached media release for additional information.

V/R,
~b)(6); (b)(?)(C)

Deputy Assistant Director
Office of Congressional Relations I U.S. Immigration and Customs Enforcement
(b)(6); (b)(?)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000173
2019-ICLl-00051 2000



Fro m :

Se nt:
To:

Subje ct:

rb)(6); (b)(7)(C)

19 Nov 2018 12:45:52 +0000

l

!(b)(6); (b)(7)(q

FW: Hospital ICU Update A#: 216269802

FYSA

Assistant Director
Field Operat ions
FromJ (b)(6); (b)(7)(C)

Date: Sunday , Nov 18, 2018 , 23:07
To: fb )(6); (b)(7)(C)
Subject: RE: Hospital ICU Update A#: 216269802

r

Will do

Sent with BlackBerry Work
(www .blackberry .com)
From: Kb)(6); (b)(7)(C)
Date: Sunda , Nov 18, 2018 , 11:05 PM
To : (b)(6); (b)(7)(C)
SubJeC:

Hi can we get a Russia assist?

Assistant Director
Field Operations
Fro m: l(b)(6); (b)(7)(C)
Date: Sunday, No v 18, 2018, 22:22
1)(
6);(bJ(7)(C)

Subjec t: RE: Hospital ICU Update A#: 21626980 2
More on this ...
No time -frame given for the hospital to take him off life -support. Though not specifically stated,
the hospital is allowing us more time to locate next-of -kin in the hopes they will approve organ
donations.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000174
2019-ICLl-00051 2001



According to the -213, Amar has a common-law wife in Russia. We have a phone number for her
we tried, but the phone only rang and was not answered. As a common-law wife , she'd have no
authority to make medical decisions for him. Still, we'll continue to try to reach her in the
morning. The number we have isl(b)(6); (b)(7)(C)

I

Our local consulate was officially closed and we've been try ing to contract the consulate in DC
but have not been able to make contact. I'd like to see RIO get directly invo lved in making
contact with the Russians in the morning as we have information on his parents and siblings in
Russia.
The parents are:
b)(6); (b)(7)(C)

(DOB: 10/08/1950)
(DOB: 03/16/1950)

Siblings:
(b)(6); (b)(7)(C)

DOB: 08/12/1980)
DOB: 01/12/1987)
DOB: 12/07/1988)
DOB: 11/23/1977)

Common-law wife:
l(b)(6); (b)(7)(C)

(DOB: 01/04/1989)

As the hospital has not ended life support and is not expected to overnight, I don't think it is
time to issue a death notice yet .
Let me know if you think otherwise or have any questions,

Fromf b)(6); (b)(7)(C)

Sent: Sunday, November 18, 2018 6 :20 PM
r )(6); (b)(7)(C)

Cc:Asher, Nathalie R (b)(6); (b)(7)(C)
""=..,...,..,,--,---,-,-,-,,...,...,,=-,,-=-:-=-=---'

Subject: FW: Hospital ICU Up ate A#: 216269802

See below .
Amar has no blood flow to the brain and has been declared brain dead. They are going to turnoff life suppprt

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000175
2019-ICLl-00051 2002



Sent with BlackBerry Work
(www .bl ackberry.com )
Fro m:fb)(6); (b)(7)(C)

Date: Sunday, Nov 18, 2018, 6:15 PM

Subject: FW: Hospital ICU Update A#: 216269802
Please see below .

V/R

LLCSW-C, BCD

CAPTtb}(6); (b}(7)(C)

Health Services Administrator
USPHS
ICE Health Service Corps
Northwest Detention Center
1623 E. J St. Suit J(b)(6 !
Tacoma, WA 98421
Officfb )(6); (b)(7)(C)
BB: (b)(6); (b)(7)(C)

I

Fax
l(b)(6); (b)(7)(C)
Warning: This document is UNCLASSIFIED//FOR OFFICIAL USE ONLY (U//FOUO). It contains
information that may be exempt from public release under the Freedom of Information Act (5
U.S.C. 552). It is to be controlled, stored, handled, t ransmitted, distributed, and disposed of in
accordance with OHS policy relating to FOUO information and is not to be released to the public
or other personnel who do not have a valid "need-to -know" without prior approval of an
authorized OHS official. No portion of this report should be furnished to the media, either in
written or verbal form.
From: !(b)(6); (b)(7)(C)

Date: Sunday, Nov 18, 2018, 5:56 PM
(b)(6); (b)(7)(C)

Subject: Hospital ICU Update A#: 216269802
ICU Update from Saint Joseph Hospital for 11/18/18 at 1730
Name: AMAR, MERGENSANA
A# : 216269802
DOB: 10/23/1978
COB: Russia
DOA: 12/19/2017

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000176
2019-ICLl-00051 2003



Relevant Medical History: 40 yo Russian male admitted to St Joes Hospita l after causing selfinflicted harm.
Room: ICU 6B6
Date of Admission: 11/15/2018
Current Diagnosis: Anoxic Brain Injury
Attending physician: Drl b)(6);
I
Current status: Cerebral blood flow study done today showed no flow to the brain. All testing
indicates brain death, so the patient is now declared dead and life support will be turned off
unless there is next of kin to request otherwise. Life Centers Northwest is requesting for organ
donation but with no available next of kin there is no one to authorize this.
Discharge Plan: Will be turned over to the medical examiner
Information provided by (name and t itle): Dr!(b)(6); land the CMO Drl(b)(6); (b)(7)(C)

l(b)(6); (b)(7)(C)

IMD

Staff Physician,
ICE Health Service Corps (IHSC)
Enforcement and Removal Operations (ERO)
US Immigration Customs Enforcement {USICE)
Northwest Detention Center

1623 E. J St. SuiteK?lli
Tacoma, WA 98421
Main office :,.,,.
(b.,..,
)(=
6).;...,
(,.....,
b)"(7
""""'
)(=
c ,....
) --,
Voice Mail:
C
6); (b)(7)(C)
(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000177
20 19-ICLl-0 0051 2004



Page 2005
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000178



Page 2006
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000179



I

From :

fb)(6); (b)(?)(C)

Se nt:

19 Nov 2018 03:46:50 +0000
!(b)(6); (b)(?)(C)
FW: Hospital ICU Update A#: 216269802
DRAFT----Detainee Death Notification-ERO Seatt le-Mergensana A216 269 802

To :

Subject:
Attachment s:
IHSCupdates.doc
FYI
Fromf b)(6); (b)(?)(C)

I

Se nt: Sunday, November 18, 2018 7:43 PM
~~r )(6); (b)(?)(C)
1

Subject: FW: Hospital ICU Update A#: 216269802
Marc, (b)(6);
{h.\/ 7 \/r"'

Sorry for the early email, flipping this to you directly for the sake of time ...
We have a Russian national detainee who is in the hospital brain -dead but on life support. He hung
himself. We're looking for next -of-kin who can make a decision on the life support and organ donations.
We've had no luck contacting the common -law w ife in Russia (unders t anding that she cannot make
these decisions but may be able to get us in contact w ith his parents. Her name and phone numberf b)(6);
b)(6); (b)(?)(C)
e am1y are et
The parents are:
(b)(6); (b)(?)(C)

ongo 1ansan

1vein or around Ulan Ude in Bunyatia Republic, Russia

OB: 10/08/1950)
DOB: 03/16/1950)

I ings:
(b)(6); (b)(?)(C)

DB: 08/ 12/ 1980)
o: 01/ 12/1987)
(DOB: 12/ 07/ 1988)
: 11/23/1977)
'--~--~--~-~~-~-----'
Please see th e attached draft ESfor more info rmation,
Anything your folks might do would be greatly appreciated,
(b)(6)
;

I~
/h\/ 7\/C:\

From (b)(6); (b)(?)(C)

Se nt: Sunday, November 18, 2018 7:22 PM
)(6); (b)(7)(C)

Subject : RE: Hospital ICU Update A#: 216269802
More on this ...
No t ime-frame given for the hospital to take him off life-support . Though not specifically stated , the
hospital is all owing us more time to locate next-of-kin in the hopes they will approve organ donat ions.
According to the -213, Amar has a common-law wife in Russia. We have a phone number for her we
tried, but the phone only rang and was not answered . As a com mon-law wife, she'd have no authority to
make medical decisions for him . Still, we'll cont inue to try to reach her in the morn ing. The number we
have i*b)(6); (b)(?)(C)

I

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000180
2019-ICLl -00051 2007

I



Our local consulate was officially closed and we ' ve been trying to contract the consu late in DC but have
not been able to make contact. I'd like to see RIO get directly involved in making contact with the
Russians in the morning as we have information on his parents and siblings in Russia.
The parents are:
b)(6); (b)(7)(C)
pOB: 10/08/1950)

r

~------~l
Siblings:
(b)(6); (b)(7)(C)

(DOB: 03/16/1950)

B: 08/12/1980)
: 01/12/1987)
(DOB : 12/07/1988)
: 11/23/1977)

Common- aw wi e:
!(b)/6\: /b)/7)/C)
(DOB: 01/04/1989)
As the hospital has not ended life support and is not expected to overnight, I don ' t think it is time to
issue a death notice yet.
Let me know if you think otherwise or have any questions,
(b)(6);

(b)(l )(C (b)(6); (b)(7)(C)
Sent : Sunday. November 18. 2018 6:20 PM
rb)(6); (b)(7)(C)

Cc:Asher, Nathalie R <t"""
b""""
\/6'-'\:"/b'""'
-'-\/-'--'7
\"""'
/C'-'-\ ______

_.
Subject: FW: Hospital ICU Update A#: 216269802
See below.
Amar has no blood flow to the brain and has been declared brain dead. They are going to turn-off

life

suppprt
Sent with BlackBerry Work
(www.b lackbe rry .com)
From: kb)(6); (b)(7)(C)

1~Date:
)(6); Sunday, Nov 18, 2018, 6:15 PM
(b)(7)(C)

Subject: FW: Hospital ICU Update A#: 216269802
Please see below.
V/R
CAPTl(b)(6); (b)(7)(C)
LCSW-C, BCD
Health Services Administrator
USPHS

I

ICE Health Service Corps
Northwest Detention Center
1623 E. J St. Suitdb )(6}!
Tacoma, WA 98421
Office l(b)(6); (b)(7)(C)
~=Jb )(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000181
2019-ICLl-00051 2008



l(b)(6); (b)(7)(C)
Warning: This document is UNCLASSIFIED//FOROFFICIALUSEONLY (U//FOUO) . It contains information
that may be exempt from public release under the Freedom of Information Act {5 U.S.C. 552). It is to be
controlled , stored, handled, transmitted, distributed, and disposed of in accordance with DHS policy
relating to FOUO information and is not to be released to the public or other personnel who do not have
a valid "need -to-know" without prior approva l of an authorized DHS official. No portion of this report
should be furnished to the media, either in written or verbal form.
Fro m :tb)(6); (b)(7)(C)

Date: Sunday, Nov 18, 2018, 5:56 PM
b)(6); (b)(7)(C)

u Jee : osp1 a
p ate
ICU Update from Saint Joseph Hospital for 11/18/18 at 1730
Name: AMAR, MERGENSANA
A#:216269802
DOB: 10/23/1978
COB: Russia
DOA: 12/19/2017
Relevant Med ical History : 40 yo Russian male admitted to St Joes Hospital after causing self-inflicted
harm .
Room : ICU 6B6
Date of Admission : 11/15/2018
Current Diagnosis: Anoxic Brain Injury
5)',~, I
tb )(m
. .
Dr.c,_,
Atten d .mg p hys,c,an:
Current status : Cerebral b lood flow study done today showed no flow to the brain . All testing ind icates
brain death, so the patient is now declared dead and life support w ill be turned off unless there is next
of kin to request otherwise . Life Centers Northwest is requesting for organ donation but with no
availab le next of kin there is no one to author ize this .
Discharge Plan: Will be turned over to the medical examiner
Information provided by (name and title): /h\/
(b)(76\/f"'\
);
and the CMO DJ(b)(
6); (b)(7)(C)
I~
l(b)(6); (b)(7)(C)
MD

I

Staff Physician,
ICE Health Service Corps {IHSC)
Enforcement and Removal Operations (ERO)
US Immigration Customs Enforcement {USICE)
Northwest Detention Center
1623 E. J St. SuitJPYb)(6);
Tacoma, WA.,,...,.,
9""'
84
_2,,,....,
1-=--:-.,,..,..----,
Mai n office (b)(6); (b)(7)(C)
Voice Mail:
Ce l b)(6); (b)(7)(C)
fax
l(b)(6); (b)(7)(C)

I

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000182
2019-ICLl-00051 2009



~b)(6); (b)(7)(C)

From :
Sent:
To:
Cc:
Subject:

19 Nov 2018 02:56:47 +0000
rb)(6); (b)(7)(C)
FW: Hospita l ICU Update A#: 216269802

Good even ing, (~!\~!ir, an
in this format.

\~1\~1;,~,Please see below

information to the extent it is helpfu l

Sent with Black.Berry Work
(www .blackberry .com)
~

From:l (b)(6); (b)(7)(C)

Date: Sunday. Nov 18. 2018, 9:53 PM

Subject : RE: Hospital ICU Update A#: 216269802
In case it's helpful, I'm collecting the consulate and family information

here in one location.

Russian Consulate in Seattle:
Consu l Genera ~(b)(5); (b)(?)(C)
600 University Street, Suite 2510, Seattle, WA 98101
b)(6); (b)(7)(C)
phone

~----~

fax

consu l@se anet.com
Office hours: M-F 9 AM to 12:30 PM, 2-5:30 PM

Family Information from the 1-213:
AMAR was born in Khuramsha, Ulan-Ude, Buryatia, Russia on 10/23/1978.
His parents are still alive and still live in Ulan-Ude.
Curr:nt Wi~e: l(b)(6); (b)(?)(C)
~B: 01/04/1989)

I

Previous Wife_
Chi Id ren ( both ~d:--a-ug
-:h-:t-er- s:---)
:;,:;:kb:;:::;
)(6
;;::
);::;(b:::;::
)(:7):,.,,
;;:(C,,....
)

--.I

(DOB: 2010 j<b)(5); (b)(7)(C)

10/13/2012)
Siblings: (b)(6); (b)(7)(C)
F DOB: 11 23 1977
DOB: 08/ 12/198 (b)(5); (b)(?)(C)
kb)(6); (b)(7)(C)

M,

01/12/1987),

and b 6 ; b 7 c

l(DOB:

b)(6); (b)(7)(C)
(M, DOB:
988)

All are citizens and nationa ls of Russia; all still res ide in Russia .

viso r

ICE/OPLA/EROLD
f b)(6); (b)(7)(C)
desk

I

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000183
20 19-ICLl-00051 2010



~l
<b_)(6_
); _<b_
)(7_
)<C
_)_~l

cell

***WARN ING*** Attorney-Client Privilege and/or Attorney Work Product
This commun ication and any attachments may conta in confidential and/or sensit ive attorney -client privi leged information ,
attorney work product , and/or law enforcement sensitive informatio n. It is not for release, review , retransm ission ,
dissemination , or use by anyone othe r than the intended recipient. Please notify the sender if this e-ma il has been
misdir ected and immed iate ly destr oy all orig inals and copies. Further, do not print, copy, or re-transmit, dissem inate or
otherwise use th is informat ion. Any disclosure of th is communication or its attachments must be approved by the Office of
the Principal Legal Advisor, U.S. Imm igration and Customs Enforcement. This document is for INTERNAL
GOVERNMENT USE ONLY and may be exempt from disclosu re under the Freedom of Information Act , 5 U.S.C .
552(b)(5) and/or (b)(7).

[::eel:

RE: Hospita l ICU Update A#: 216269802

Okay. Thank you for the follow -up! Pis keep us posted.

Sent with BlackBerry Work
(ww w.blackberry.com)
Fron1{b)(6); (b)(7)(C)

Date: Sunday, Nov 18, 2018, 9:35 PM

SubJect: RE: Hospital ltU Update A#: 216269802
I don't think EROhas been able to contact next of kin. EROwas unable to get a hold of the
consulate on Friday. EROhas not reported that they were able to contact family in Russia. I sent
an email to the DFOD to see if they were able to make contact with family.

Sent with BlackBerry Work
(www.blackberry.com)
Fromfb )(6); (b)(7)(C)

Date: Sunda Nov 18 2018 6:30 PM
(b)(6); (b)(7)(C)

I

Thanks for the updatd (b)(6);
I had the same question a ~~(~
~(;"' Have we/ERO/IHSC provided
any next-of-kin information to the hospital? The 1-213 had some relatively detailed information
about his current partner, ex-wife, and two daughters.

AMERICA~

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000184
2019-ICLl-00051 2011



l(b)(6); (b)(?)(C)

Associate Legal Advisor
ICE/OPLA/EROLD
(b)(6); (b)(?)(C)
desk
cell
***WARNING*** Attorney-Client Privilege and/or Attorney Work Product
This communicat ion and any attachment s may conta in conf ident ial and/or sensit ive attorney-client privileged information,
attorney work product , and/or law enforcement sensitive informat ion. It is not for release, review, retransm ission ,
dissemination, or use by anyone other than the intended recipient. Please notify the sender if this e-mail has been
misdirected and immed iate ly dest roy all originals and copies . Furthe r, do not print, copy , or re-transm it, dissem inate or
otherw ise use th is information. Any disclosure of this communication or its attachments must be approved by the Office of
the Principal Legal Advisor , U.S. Immigration and Customs Enforcement. This document is for INTERNAL
GOVERNMENT USE ONLY and may be exempt from disclosure under the Freedom of Informa tion Act , 5 U.S.C.
552(b)(5) and/or (b)(?) .

From: ~b)(6); (b)(?)(C)
Sent: Sunday, Novem ber 18, 2018 9:28 PM

Subject: RE: Hospital ICU Update A#: 216269802

Okay. Well, do we know if EROwas successful in making contac t with any next of kin t hroug h
the consulate or otherwise?

Sent w ith BlackBerry Work
(www .blackberry .com)
From:rb)(6); (b)(?)(C)
Date: Sunday, Nov 18, 2018, 9:19 PM

Subject: FW: Hospital ICU Update A#: 216269802

It looks like Amar has now been decla red brain dead, and lif e support w ill be turned of unless
next of kin requests otherwise.

Sent with BlackBerry Work
(www .blackberry .com)
From* b)(6); (b)(?)(C)
Date: Sunday, Nov 18, 2018, 6:15 PM

rb)(6), (b)(7)(CJ
Subject: FW: Hospital ICU Update A#: 216269802

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000185
2019-ICLl-00051 2012



Please see below.

V/R
CAP1l(b)(6); (b)(7)(C)

l LCSW-C,BCD

Health Services Administrator
USPHS
ICE Health Service Corps
Northwest Detention Center
1623 E. J St. Suite lnill]
Tacoma, WA 98421
Office: j(b)(6); (b)(7)(C)
BB: b)(6); (b)(7)(C)
Fax
l(b)(6); (b)(7)(C)
Warning: This document is UNCLASSIFIED//FOROFFICIALUSEONLY (U//FOUO). It contains
information that may be exempt from public release under the Freedom of Informati on Act (5
U.S.C. 552) . It is to be controlled, stored, handled, transmitted, distributed, and disposed of in
accordance with OHS policy relating to FOUO infor mation and is not to be released to the public
or other personnel who do not have a valid "need -to -know" without prior approval of an
authorized OHSofficial. No portion of this report should be furnished to the media, either in
written or verbal form .
From1(b)(6); (b)(7)(C)
Date:

Ja1 ,aay,

1.;,00 10,

zoio , J.Jo,

101

b)(6); (b)(7)(C)

Subject: Hospital ICU Update A#: 216269802
ICU Update from Saint Joseph Hospital for 11/18/18 at 1730
Name: AMAR, MERGENSANA
A#: 216269802
DOB: 10/23/1978
COB: Russia
DOA: 12/19/2017
Relevant Medical History: 40 yo Russian male admitted to St Joes Hospital after causing selfinflicted harm.
Room: ICU 6B6
Date of Admission : 11/15/2018
Current Diagnosis: Anoxic Brain Injury
Attending physician: Dr.Kb)(6); " I
Current status: Cerebral blood flow study done today showed no flow to the brain . All testing
indicates brain death, so the patient is now declared dead and life support will be turned off

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000186
2019-ICLl-00051

2013



unless there is next of kin to reque st otherwise . Life Centers Northwes t is reque st ing for organ
donation but with no available next of kin there is no one to authorize thi s.
Discharge Plan: W ill be turned over to the medical examiner
Information provided by (name and title): D~(b)(6);
Ind the CMO Dr l(b)(6); (b)(?)(C)

..._l
(b"-"
)(6
--"'
);'--'(b-')("-'
7)..:..
(C-') ___

___,,.I
MD

Staff Physician,
ICE Health Service Corps {IHSC)
Enforcement and Removal Operations (ERO)
US Immigration Customs Enforcement (USICE)
Northw est Detention Center
1623 E . J St. Suit~
Tacoma, WA 98421
Mai n offi ce""b...,..
)(=6),;....
(.b,..,,
,,...
)(7"'"
)(""
C.,...
) --.
Vo ice Mail :
Cell (b)(6); (b)(7)(C)
fax
(b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000187
2019-ICLl -00051 2014



From :

l<b)(6); (b)(7)(C)

Sent:

20 Nov 2018 20:54:02 +0000

To:

(b)(6); (b)(7)(C)

Subject:

FW: Hospital ICU Update A#: 216269802

Fyi

Sent with BlackBerry Work
(www .blackberry .com)
Fromfb )(6); (b)(7)(C)

Date: Tuesday, Nov 20, 2018, 5:57 AM

Subject: RE: Hospital ICU Update A#: 2 16269802
Good morning,
The Embassy of Russia has already spoken to his relatives . The relatives have been in contact
with the hospital. Beyond that I do not have further information but will inquire as to what steps
the relatives are taking and also to keep the field office informed.

l\b)(61
Fromj (b)(6); (b)(7)(C)

I

Sent: Tuesday, November 20, 2018 8:44 AM
~~r

(6); (b)(7)(C)

Subject: RE: Hospital ICU Update A#: 216269802
Grea~thanks.
Having a couple days to think about this, the question is the GOV of Russia doing the outreach to
the parents or will we have to do this? At least initially , it would probably be better for their
government to do this and act as intermediary between the parents and the hospital.
Another alternative is to simply give the hospital the ir phone numbers and leave it to them to
reach out to the parents, but I think the optics on do ing that will not be good .
To my knowledge , we don' t have a articulated process in place for overseas next-of -kin
notifications for ICEdetainees.
Sent w ith BlackBerry Work
(www .blackberr y.com )
From:Kb)(6); (b)(7)(C)

Date: Tuesday, Nov 20, 2018, 4:56 AM

rbX6); (b)(7)(C)
Subject: RE: Hospital ICU Update A#: 216269802

Thanks!rbl/6l I

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000188

2019-ICLl-00051 2015



Department of Homeland Security
ICEAttache Office- Rome

(b)(6); (b)(7)(C)

Warnin g: This docum ent is UNCLASSIFIED
// FOROFFICIALUSE ONLY (U/ /FOUO}. It contains information that may be exempt from
publ ic re lease under the Freedom of Inform at ion Act (S U.S.C. 552). It is to be contro lled, sto red, handled , transmitted ,
distribut ed, and dispo sed of in accordanc e with DHS policy relating to FOUO information and is not to be released to th e public or
othe r pe rsonn el who do not have a valid " need-to -kn ow " w ithout prio r appr oval of an authoriz ed DHS official. No portion of t his
r~:~rlc~

);bc'MWx2~ed to the mria , either in wr itte n or v erbal for m .

Sent: Tuesday, November 20, 2018 1:46 PM
To : b)(6); (b)(7)(C)

Cc:
(b)(6); {b)(7)(C)
Subject: RE: Hospital ICU Update A#: 216269802
Importance: High
kb)(6);

I

The LESin Moscow was able to talk to the common law spouse and we received phone numbers
for the parents:
I received a message from l(b)(6); (b)(7)(C)

I regarding

his parents contact

information in Russia.
Mothe 1(b)(6); (b)(7)(C)
Father:
~---------------~
His parents don't have email address.
She doesn't know contact information for his siblings~as
a kid from AMAR and she kindly
asked to keep her posted. She stated that she had talk to ~/\~\ ---, from t he US hosp ital and she
send him email and asked do not stop AMAR's life suppor t.
Re ards
b)(6); (b)(7)(C)
Department of Homeland Security
Imm igr ation and Customs Enforcement
Assistant Attache - Removal
covering : Republic of Belarus, Republic of Estonia, Republic of Kazakhstan, Kyrgyz Republic,
Republic of Latvia, Republic of Lithuania, Republic of Poland
Russian Federation, Republic ofTajikistan, Turkmenistan, Ukraine, and Republic
of Uzbekistan
U.S. Embassy - Warsaw
tb)(6); (b)(7)(C)
Celll(b)(6); (b)(7)(C)
Des~.------~

Subject: RE: Hospital ICU Update A#: 216269802
Sorry I meant we contacted the Embassy in DC, not the Consulate in SFR.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000189
2019-ICLl-00051 2016



From:!(b)(6); (b)(?)(C)
Sent : Monday, November 19, 2018 8:04 AM

Subject : RE: Hospital ICU Update A#: 216269802
!(b)(6);

!

I attached photocopies of his PP and all other ID in the file. At the direction of HQ, we tried to
contact the Embassy in DC, not the Consulate in DC.
!/h\ffi\ /h\/ 7 \/r.\

!

Assistant Field Office Director
DHS/ICE/ERO
Northwest Detention Center
Seattle Field Office
Des (b)(6); (b)(?)(C)
Cell: '-;:=::=:::::::::====--~
From: fb)(6); (b)(7)(C)
Sent : Monday, November 19, 2018 5:13 AM

Subject: RE: Hospital ICU Update A#: 216269802
Looping in the Desk Officer, !<b\/6\ I
l(b)(6);

I

AAR-Warsaw
From :~
~b-)(6-);-(b-)(7
- )(_C_) -~
Sent : Monday, November 19, 2018 1:51 PM

Subject: RE: Hospital ICU Update A#: 216269802
Am including AFOD!(b)(B); (b)(?)(C)

I

We'll get that info ASAP
Thanks
Sent with BlackBerry Work
(www .bl ackberry.co m )

From tb)(6);(b)(?)(C)
Date: Sunday, Nov 18, 2018, 10:53 PM
l(b)(6); (b)(?)(C)
Subject : RE: Hospital ICU Update A#: 216269802
Morning again,
I dropperkb
)(B);
'!!h
\/ 7 \/r'\
r~ff as he doesn't have a role in this.
1. Could I please have a copy of the Russian passport? The name searches are easier with
their identity document .

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000190
2019-ICLl-00051 2017



2.

If they ask to contact the Field Office: ( I can foresee the possibility of the Russians not
providing such personal information and will want to provide the parents the
opportunity to reach out on their own , if they choose to do so):
a. What number should they call
b. Who/what position should they ask for
c. What time should the call be made
If we are going to call, what time (their local) should they expect a call?

3.
Thanks,
!lb)/6 !

AAR-Warsaw
From : kb)(6); (b)(7)(C)
Sent : Monday, November 19, 2018 7:29 AM
To~(b)(6); (b)(7)(C)

______________________________

,...._
Cc:1

__.

Subject: RE: Hospita l ICU Update A#: 216269802
!(b)(6);
Has the Russian Consulate been notified? San Francisco , I believe?
Thanks,

!

l(b)(~);I

AAR-Warsaw
From :~f
b-)(6-);-(b-)(7
~)(_C_) -~
Sent : Monday, November 19, 2018 5:07 AM

Subject : RE: Hospita l ICU Update A# : 216269802

Thanks everyone .
If you have EARM available, the -213 has everyth ing we know
Kb)(6!
From: !(b)(6); (b)(7)(C)

I

Sent: Sunday , Novem ber 18, 20 18 8:05 PM

Subject : RE: Hospita l ICU Update A#: 216269802
!/b)/6):

!

Add ing AARfb)(6);

JWe will see what we can find out .

Sent w ith BlackBerry Work
(www. blackberry .com )
From: l(b)(6); (b)(7)(C)
Dat e: Monday , Nov 19, 2018, 4:47 AM
To:l(b)(6); (b)(7)(C)

Cc:

----------,--------,---------------'

Subject: RE: Hospital ICU Update A#: 216269802

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000191
2019-ICLl-00051 2018



From: j(b)(6); (b)(7)(C)
Sent : Sunday, November 18, 2018 7 :43 PM

To~(b)(6); (b)(7)(C)

Cc:I

~----------------~

Subject: FW: Hospital ICU Update A#: 216269802

(b)(6); (b)(7)(C)
orry or t e early email, flipping this to you directly for the sake of time ...
We have a Russian national detainee who is in the hospital brain-dead but on life support . He
hung himself. We're looking for next -of-kin who can make a decision on the life support and
organ donations . We've had no luck contacting the common-law wife in Russia (understanding
that she cannot make these decisions but may be able to get us in contact with his parents. Her
name and phone number :l(b)(6); (b)(7)(C)
The family are ethnic Mongolians and live in or around Ulan Ude in Bunyatia Republic, Russia
The parents are :
b)(6); (b)(7)(C)
DOB: 10/08/1950)

I

,__

______

_. (DOB: 03/16/1950)

Siblings:
(b)(6); (b)(7)(C)

>B:08/12/1980)
: 01/12/1987)
DOB: 12/07/1988)
11/23/1977)

~------------~
Please see the attached

draft ESfor more information,
Anything your folks might do would be greatly appreciated,
b)(6);
h\(7\(C:\

I

From: (b)(6); (b)(7)(C)

I

Sent: Sundav November 18 2018 7:22 PM
(b)(6); (b)(7)(C)

Subject: RE: Hospital ICU Update A#: 216269802
More on this ...
No time-frame given for the hospital to take him off life -support. Though not specifically stated,
the hospital is allowing us more time to locate next -of -kin in the hopes they will approve organ
donations.
According to the -213, Amar has a common -law wife in Russia. We have a phone number for her
we tried, but the phone only rang and was not answered. As a common-law wife, she'd have no
authority to make medical decisions for him. Still, we'll continue to try to reach her in the
morning . The number we have isfb)(B); (b)(?)(C)

l

Our local consulate was officially closed and we've been try ing to contract the consulate in DC
but have not been able to make contact . I'd like to see RIO get directly invo lved in mak ing
contact w ith the Russians in the morning as we have information on his parents and siblings in
Russia.
The parents are:
rb)(6); (b)(7)(C)
pOB: 10/08/1950)

~l-----~

kDOB: 03/16/1950)

Siblings:

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000192
2019-ICLl-00051 2019



(b)(6); (b)(7)(C)

~B:08/12/1980)
: 01/12/1987)
DOB: 12/07/1988)
11/23/1977)

~------------~
Common-law wife:

r )(6); (b)(7)(C)
poB: 01/04/1989)
As the hospital has not ended life support and is not expected to overnight, I don't think it is
time to issue a death notice yet.
Let me know if you think otherwise or have any questions,
(b)(6);
/h)/7)/

From:l (b)(6); (b)(7)(C)
November 18 2018 6:20 PM
(b)(6); (b)(7)(C)

Sent: Sunda

b)(6); (b)(7)(C)

u Ject:
: osp1ta CU Update A#: 216269802
See below.
Amar has no blood flow to the brain and has been declared brain dead. They are going to turnoff life suppprt
Sent w ith BlackBerry Work
(www. bl ackberry.com)
From :l(b)(6); (b)(7)(C)

Date: Sunda
b)(6); (b)(7)(C)

Nov 18 2018 6:15 PM

Please see below .

V/R
CAP

~------~
.

LCSW-C, BCD
m1n1strator

ICE Health Service Corps
Northwest Deten t ion Center
1623 E. J St. Suit t b)\~/;,!
Tacoma, WA 9842 1
Office: (b)(6); (b)(7)(C)
BB: b)(6); (b)(7)(C)
Fax
b)(6); (b)(7)(C)
Warn ing: This document is UNCLASSIFIED//FOROFFICIA L USE ONLY (U//FOUO) . It contains
informat ion t hat may be exempt from public release under the Freedom of Informat ion Act (5
U.S.C. 552) . It is to be controlled, stored , handled, transm itted, distr ibuted, and disposed of in
accordance w ith DHS policy relat ing to FOUO information and is not to be released to the public
or other personnel who do not have a valid "need -to -know" without prior approval of an

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000193
2019-ICLl-0 0051 2020



authorized DHS official. No portion of this report should be furnished to the media, eith er in
written or verbal form.
Fromfb )(6); (b)(7)(C)
Date : Sunday, Nov 18, 2018, 5:56 PM
(b)(6); (b)(7)(C)

Subject: Hospital ICU Update A#: 216269802
ICU Update from Saint Joseph Hospital for 11/18/18 at 1730
Name: AMAR, MERGENSANA
A#:216269802
DOB: 10/23/1978
COB: Russia
DOA: 12/19/2017
Relevant Medical History: 40 yo Russian male admitted to St Joes Hospital after causing selfinflicted harm.
Room: ICU 686
Date of Admission: 11/15/2018
Current Diagnosis: Anoxic Brain Injury

)~;)~\ic:,

Attending physician: Dr
Current status: Cerebra
oo
ow study done today showed no flow to the brain. All testing
indicates brain death, so the patient is now declared dead and life support will be turned off
unless there is next of kin to reque st otherwise. Life Centers Northwest is requesting for organ
donation but with no available next of kin there is no one to authorize this.
Discharge Plan: Will be turned over to the medical examiner
Information provided by (name and title): D~(b)(6);
~nd the CMO Dr b)(6); (b)(7)(C)
~b)(6); (b)(7)(C)
MD

I

Staff Physician,
ICE Health Service Corps (IHSC)
Enforcement and Removal Operations (ERO)
US Immigrat ion Customs Enforcement (USICE)
Northwest Detention Center
1623 E. J St. Suit eKbl(
Tacoma, WA 98421
Main offic ~(,....,b
)..,.,
(6,,...
);"""
(b..,.,
)(=7
)..,.,
(C,..,.
)--,

I

fax
fb)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000194
2019-ICLl-00051 2021



l(b)(6); (b)(7)(C)

Fro m :

20 Nov 2018 14:28:36 +0000
fb)(6); (b)(7)(C)

Se nt:
To:
kb)(6); (b)(7)(C)

FW: Hospita l ICU Update A#: 216269802

Subje ct:

We' ll wait until later in the morning to hear from the hospita l before we call them

Sent with BlackBerry Work
(www .blackberry .com)
Fro m fb)(6); (b)(7)(C)

Date: Tues day , Nov 20, 2018, 6:06 AM
(b)(6); (b)(7)(C)

Subject: RE: Hospital ICU Update A#: 216269802

Thank you

Sent with BlackBerry Work
(www .blackberry .com)

f

From: l(b)(6); (b)(7)(C)

Date: Tuesday,_Nov 20, 2018, 5:57 AM

rb):~:::~~

:ospUal ICU O~ate A# Zl6W9802

Good morning,
The Embassy of Russia has already spoken to his relatives. The relatives have been in contact
with the hospital. Beyond that I do not have further information but will inquire as to what steps
the relatives are taking and also to keep the field office informed.
(b)(6);
(b)(7)(C)
From : l<b)(6)
; (b)(7)(C)

Se nt: Tuesday, November 20, 2018 8:44 AM
To~(b)(6); (b)(7)(C)

Cc.
Su. Ject: RE: Hospital ICU Update Art: 21 6 2 69802

I

Great tb)(6); thanks.
Having a couple days to think about this, the question is the GOV of Russia doing t he outreach to
the parents or will we have to do this? At least initially, it would probably be bet t er for their
government to do this and act as intermediary between the parents and the hosp ital.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000195
2019-ICLl-00051 2022



l(b)(6); (b)(?)(C)

Fro m :

20 Nov 2018 14:07:23 +0000

Sent:

l(b)(6); (b)(?)(C)

To:
Subj e ct :

FW: Hospital ICU Update A#: 216269802

Fysa
Still to be confirmed bu the hospital

Sent with BlackBerry Work
(www.blackberry.com)
From: l(b)(6); (b)(?)(C)

r

Date: Tuesday, N ov 20, 2018, 5:57 AM
)(6); (b){7 )(C)

Subject: RE: Hospital ICU Update A#: 21626 9802
Good morning,
The Embassy of Russia has already spoken to his relatives. The relatives have been in contact
with the hospital. Beyond that I do not have further information but will inqu ire as to what steps
the relatives are taking and also to keep the field office informed .
(b)(6);
(b )(7 )(

Fro m: kbl(6l: (b\(7\(C\
Se nt: Tuesday, November 20, 2018 8:44 AM
~ ~t

)(6); (b)(?)(C)

Subj ect : RE: Hospital ICU Update A#: 216269802
5 ); th
Grea (b)(
/ h \1 7\ /1''
an ks.
Having a couple days to think about this, the question is the GOV of Russia doing the outreach to
the parents or will we have to do this? At least initially, it would probably be better for their
government to do this and act as intermediary between the parents and the hospital.
Another alternative is to simply give the hospital their phone numbers and leave it to them to
reach out to the parents, but I think the optics on doing that will not be good.
To my knowledge, we don't have a articulated process in place for overseas next-of -kin
notifications for ICEdetainees .
Sent with BlackBerry Work
(www .blackberry .com)

Fro m : [(b)(6); (b)(?)(C)

Date: 1uesday, Nov 20, 2018, 4:56 AM

subJect: RE:Hospital ICU Update A#: 216269802

Th an k

b)(6);
h \/ 71 rr1

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000196

2019-ICLl-00051 2023



Fro m :

~b)(6); (b)(7)(C)

Sent:

20 Nov 2018 13:57:07 +0000

To:

l(b)(6); (b)(7)(C)

Subje ct:

FW: Hospita l ICU Update A#: 216269802

See below .
Contact with the common-law wife was made. We have phone numbers for the parents.
My concerns, expressed below is who does the outreach to the parents.
I think it's preferable that the Russian government do this, and this all be betweent
hebhospital and the gov of Russia , but if they don ' t, should we just give this contact
informat ion to the hospital or do we commun icator ourselves?

, or shall I do it from my office ... I have a native
If we do it, should it be OIA 1Cbl(6 l; (bl( 7 l(C) D
Russian speaker DO who can probabably communicate with the parents.

Sent with BlackBerry Work
(www .blackberry .com)
From: l(b)(6); (b)(7)(C)

Date: luesday , Nov 20, 2018, 5:44 AM

Subject: RE: Hospital ICU Update A#: 216269802

Having a couple days to think about this, the question is the GOV of Russia doing the
outreach to the parents or will we have to do this? At least initially , it would probably be
better for their government to do this and act as intermed iary between the parents and the
hospital.
Another alternative is to simply give the hospital their phone numbers and leave it to
them to reach out to the parents , but I th ink the opt ics on doing that will not be good.
To my know ledge , we don ' t have a articulated process in place for overseas next-of-kin
notifications for ICE detainees.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000197
2019-ICLl -00051 202 4



I

l<b)(6), (b)(
7)(C)

From :

Wed, 21 Nov 2018 09:46:33 +0000

Sent:

l<b)(6); (b)(7)(C)

To:

I

FW: communication to hospital for Amar family

Subject:

Fysa
Sent with BlackBerry Work
(www.blackberry.com)
Fromfb l(6l (bl(7l(Cl

Date: Wednesday, Nov 21, 2018, 10:44 AM
To: fb)(6); (b)(7)(C)
Subject : RE: communication to hospital for Amar family

Good morning,
The consulate has been in contact with both the parents and the common-law wife. The
parents do not have the ability to come to the United States and getting a visa can take up
to 300 days. The Head Consul stated he will give me another update soon as to the
family's wishes . In the mean time the field office is welcome to reach out to the parents
via an interpreter, keeping time differences in mind.

I

l(b)(6); (b)(7)(C)
Detention and Deportation Officer
U.S. Departm ent of Homeland Security
ICE I ERO I HQ I RMD
Remova l & International Operations (Asia-Europe)
Embassy Liaison
500 12th St. SW, Rooml<b)(6); I
Wash ington, DC. 20536
Desk: b)(6); (b)(7)(C)
....,..
__,
Cell:
Email: (b)(6); (b)(7)(C)

______________

From:k6)(6); (b)(7)(C)
Date: Wednesday, Nov 21, 2018, 12:01 AM

To:l(b)(6); (b)(
7)(C)
Cc :
'------------------'
Subject:
RE : communication to hospital for Amar family
(b)(6);

(b)(7)
(C)
I think the parents had the expectation of your office reaching out to them. The common
law seems to be the active contact

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000198
2019-ICLl-00051 2025



ould be the POC if the consulate was going to contact.

Sent with BlackB erry Work
(www .blackberry .com)
Fro m: r b)(6); (b)(?)(C)
Date: Wednesday, N ov 21, 2018, 5:45 AM

~

T o~ b)(6); (b)(?)(C)

I

Su Ject : F W: commumcafton to ho sp na l tor Am ar famil y
b)(6);

He hv1,1r.,
The hospital has not heard from t he Russian government or the parents of Amar . If you can get
this informat ion to the GOV of Russia or the parents, I th in k we could say in good faith we've
done all we can do .

From:

I

l<b)(6); (b)(?)(C)

Sent: Tuesday, November 20, 2018 3 :00 PM
r b)(6); (b)(?)(C)

Subject: commun ication to hospital for Amar family

I

called me to give us h is persona l cell phone for any important
Just to let you know, ci{b )(6);
calls or messages regarding our mutua l pat ient : (b)(6); (b)(?)(C)
He also said the VP of St Joseph
Med Ctr has author ized him to not turn off life support or another 24 hours since there may be
a chance at contacting Amar's family . He wanted to relate he is w illing to take any call from the
Russian Government or from the Amar fami ly on his personal cell phone if needed at any t ime
day or night. He also gave us a back up phone number to call if we have informat ion regarding
family members needing to contact someone at the hospital , which would be l(b)(6); (b)(7)(C) [v1D
the Vice President for Operations atlh\ln\ 1h1m1c:1 I. I hope th is is helpful. Let me know if you
have any questions . I did not release any information to him about phone numbers for Amar's
parents as detailed in the morning's email.

f

~I MD

- b-)(6_);_(b_)(7_)(_C)___

C linical Dir ector
ICE Health Service Corps {IHSC)
Enforcement and Removal Operat ions (ERO)
US Immigrat ion Customs Enforcement (USICE)
Northwest Detention Center
1623 E. J St. Suit~r6) ;!
Tacoma, WA~ 9
_8_4___
~
Main office: b)(6); (b)(?)(C)
Voice Mail:
Ce ll (b)(6); (b)(?)(C)
fax _____
~

l(b)(6); (b)(?)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000199
2019-ICLl-00051 2026



From:
Sent:

!(bl/6)(bl(?l(C
l
!
22 Nov 2018 02:32:40 +0000

r )(6); (b)(?)(C)
Subject :
Attachments:
Importance :

FW: Hospital ICU Update A#: 216269802
FW communication to hospital for Amar family.em!
High

See below .
If anyone wants to call Dr.
so

~1
\~t-, on if todays call went through and the results,

please do

Thanks
Sent with BlackBen-y Work
(www .blackben-y.com)
From:g )(6);(b)(?)(C)
Date: ednesdav Nov 21 2018 1:51 PM
(b)(6)
; (b)(?)
(C)

Subject: RE: Hospital ICU Update A#: 216269802

Sorry folks, I started on this this morning and got side-tracked by many other things ...
We made progress last night in reaching the parents of AMAR ...
Both the Russian Embassy/Consulate in DC and the hospital, have been in touch with
the parents .
I received an IM at midnight last night from Dr. l(bl(6l; _ lthe person who will ultimately
make the decision on ending life support , advising that he had made contact (on a
conference call with, presumably, interpreters) with the parents and "it will take a few
more conversations to reconcile"
A couple hours later, I received the attached email from fbJ(6); (b)(?)(C) lin Warsaw showing
that "The consu late has been in contact with both the parents and the common-law
wife. The parents do not have the ability to come to the United States and getting a visa
can take up to 300 days. The Head Consul stated he will give me another update soon
as to the family's wishes."

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000200
2019-ICLl-00051 2027



So the likelihood is that a decision on life support could take a few more days as the
hospital tries to continue their conversation with the parents.

The hospital is supposed to have another conversation with the parents this afternoon.
I'll reach out to the doctor in a couple hours to see if that occurred and what transpired.

l(b)(6); (b)(7)(C)

Acting Field Office Director
ICE Enforcement & Removal Operat ions, Seatt le, WA
7)=
r Cell: l""~b.,..,.
)(6,,.,.
);--:,
(b...,..,
)(=
(c.,...
) -,
Main : l(b)(6); (b)(?)(C) 11Desk j(b)(6); (b)(7)(C)

CO NFIDENT IALITY: This ema il an d attachments are intended for the above name on ly and are con fidentia l. If you are not
the intended add ressee , or the pe rson responsible for deliver ing ii to the intended add ressee , you may neithe r copy ,
disse minate, nor distribute ii to anyone else or use ii in any unauthorized manne r. To do so is strictly prohibited and may
be unlaw ful. If you receiv e th is ema il by mistake , please adv ise the sende r immed iate ly by using the reply facility in your
mail softwa re and dele te it from your compute r.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000201
2019-ICLl-0005 1 2028



From:
Sent :
To :
Subject:

l(b)(6); (b)(?)(C)
20 Nov 2018 18:43:47 +0000
#IHSC_SEN_Medical;#NWD-Notification-Med ical
FW: Hospital ICU Update for A# 216269802

See below
V/R,

I

CAPTfb)(6); (b)(?)(C)
LCSW-C, BCD
Health Services Administrator
USPHS
ICE Health Service Corps
Northwest Detention Center
1623 E. J St. Suit, b)(6); I
Tacoma, WA 98421
Office: (b)(
6); (b)(
?)(C)
BB: b)(6); (b)(
?)(C)
Fax:
l(b)(6)
; (b)(?)(C)
Warning: This document is UNCLASSIFIED//FOR OFFICIAL USE ONLY (U//FOUO). It
contains information that may be exempt from public release under the Freedom oflnfo rmation
Act (5 U.S.C. 552). It is to be controlled, stored, handled, transmitted, distributed, and disposed
of in accordance with DHS policy relating to FOUO information and is not to be released to the
public or other personnel who do not have a valid "need-to-know" without prior approval of an
authorized DHS official. No portion of this report should be furnished to the media, either in
written or verbal form.
From:Kb)(6); (b)(?)(C)
Sent : Tuesday, November 20, 2018 10:30 AM

(b)(6); (b)(
?)(C)

Subject : Hospital ICU Update for A# 216269802

Name: Amar, Mergensana
Hospital ICU Update
A#:216269802
DOB: 10/23/1978
COB: Russia
DOA: 12/19/2017
Relevant Medi cal History : Was on self-imposed Hunger Strike but began eating th ree meals a day w it h

liquid nutr itional supplements

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000202
2019-ICLl -00051 2029



Reasonsent to ER: CPR initiated due to asphyxiation from self harm (hanging) and transferred to ICU
whe n pulse achieved.
Current Status : No changes from previous update . He was pronounc ed brain dead Sunday 11/18/ 18 at
1445 . He remain s int ubated and on BP (levafed) IV for his o nly life sup port. If th e family has not been
co ntacted by this afternoon he will be removed from life support measu res.
Location:St. Joseph' s ICU Room 6B6 :~~~ (6), (b) (7)
6
Attending physician: Dr. 1{"bili)(:zi
)ilf.
, :.:in:;\~-,
.
.
d
f
....
D
{b)(G)
Inf ormat 10nreceive rom: r lblm<c
l

..,.l
<b_
)<6_); <
_b)~
(7)-(C_) __

___.I
MD

C lm1cal Director
ICE Health Service Corps (IHSC)
Enforcement and Removal Operations (ERO)
US Immigration Customs Enforcement (USICE)
Northwe st Detention Ce nter
l 623 E. J St. Su ittJPYb)(6)!
Tacoma, WA 9842 l
Mai n office :,...
(b-)(-6)-; (-b)-(7-)(C
_ )___,,
Vo ice Mail:
Ce (b)(6); (b)(7)(C)
fa
(b )(6); {b)(7)(C)

AM RI AN

PVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000203
2019-ICLl-00051 2030



rb)(6); (b)(7)(C)

From :
Sent :
To :
Subject:

20 Nov 2018 23:09:16 +0000
#IHSC_SEN_Medical;#NWD-Notification-Med ical
FW: Hospital ICU update for A#216269802

l LCSW-C, BCD
Health Services Administrator
USPHS
ICE Health Service Corps
Northwe st Detention Center
1623 E. J St. Suih:f b)\~)
;_I
Tacoma , WA 98421
Office:l<b)(6); (b)(
7)(C)
BB : b)(6); (b)(7)(C)
Fax
b)(6)
; (b)(7)(C)
CAPT Kb)(6); (b)(7)(C)

Warning: This document is UNCLASSIFIED//FOR OFFICIAL USE ONLY (U//FOUO). It
contains information that may be exempt from public release under the Freedom oflnfo rmation
Act (5 U.S.C. 552). It is to be controlled, stored, handled, transmitted , distributed, and disposed
of in accordance with DHS policy relating to FOUO information and is not to be released to the
public or other personnel who do not have a valid "need-to-know" without prior approval of an
authorized DHS official. No portion of this report should be furnished to the media, either in
written or verbal form.

From f

)(6); (b)(7)(C)

Sent :uesday,

J

November0,

2018 3:06 PM

rb)(6); (b)(7)(C)
Subject : Hospital ICU update for A#216269802

Name: Amar, Mergensana
Hospital ICU Update
A#:216269802
DOB: 10/23/1978
COB: Russia
DOA: 12/19/2017
Relevant M edical History : Was on self-imposed Hunger Strike but began eating th ree meals a day w it h

liquid nutr it ional supplements
Reaso n sent to ER: CPRinitiated due to asphyxiat ion from self har m (hanging) and transferre d to ICU
when pulse achieved.
Current Status : He remains intubated and on BP (levafed) IV for only life support only despite brain
death. This life support will continue fo r another 24 hours to allow for the family to contact the
attending physician. Dr A<bl(6l: !cell phone can be given out for him to be reached by any officials (ICE,

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000204
2019-ICLl -00051 2031



Russian government) or fami ly members of the patient.
phone numb er on a three way with a translator.
Location: St. Joseph' s ICU Room 6B6 4b )(6); (b)(7)(C)
Atten d.mg p hys1c1an
. . : Dr (b)(6)
(b)( )(C)

l(b)(6); (b)(7)(C)

lif needed he can call a Russian

7

Information received frhni.----r,.J'?'
(b-)(6-); ~
/ h \/ 7 \/r"'-\

t b)(6); (b)(7)(C)

IMD

Clinical Director
ICE Health Service Corps (IHSC)
Enforcement and Removal Operations (ERO)
US Immigration Customs Enforcement (USICE)
No rthwest Detent ion Center
1623 E. J St. Suit4/bl/6l:!
Tacoma, W,.,,.
A~9,,...
84...,,
2..,.,
l=,------,
Main offic (b)(6); (b)(7)(C)
Voice Mai l
Cel (b)(6); (b)(7)(C)

fax
l(b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000205
2019-ICLl-0 0051 2032



l(b)(6); (b)(7)(C)

Fro m :

17 Nov 2018 19:37:59 +0000

Se nt:

!

fb) (6); (b)(7)(C)

To:

FW: Hospita l Report - ICU - Amar

Subje ct :

(FYI)

Sent with BlackBerry Work
(www .blackberry .com)
From

:l(b)(6); (b)(7)(C)

Date: Saturday, Nov 17, 2018 , 11:33 AM
T o : j(b)(6); (b)(7)(C)

Subject : RE: Hospital Report - ICU - Amar
l(b)(6);

!~\
l~\rci

Warden has told
that he had a discussion with the trauma surgeon yesterday but
is adamant that he to t e surgeon that the call was ICE ' s, not his. I'm dubious ... I think
he has potentia l, but he is still in the BOP Warden mentality .
I'm hoping that you will raise this issue with GEO at a higher level so word gets back
down to the warden that he provides a service, running a business , and is not the final
author ity on any matters relating to the deta inees .
Sent with BlackBerry Work
(www.blackberry.com)

I~

Fro mf b)(6); (b)(7)(C)

Da te: Saturday , Nov I 7, 2018, 11: 14 AM
)(6); (b)(7)(C)

Subject : RE: Hospital Report - ICU - Amar

FYSA this report is not correct - all life saving steps will be taken absent a family
member who would advise otherwise. Warden part of this is misstated.

Assista nt Director
Field Operations
From:

l(b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000206
2019-ICLl-00051 2033



r

Date, Saturda~ Nov 17 2018, 13:51
)(6); (b){7)(CJ

~

Subject: RE: ospual
: ,port- ICU - Arna,
Thanks.
From: f~b)(6
-);-(b-)(7-)(-C-)Sent: Saturday, Novembe r 17, 2018 1:51 PM
To~ (b)(6); (b)(7)(C)
Subject: FW: Hospital Report - ICU - Am ar
Importance : High

Status on Amar ...
"Warden" highlighted below, is a hospita l term, does not refer to the NWDC/GEO
warden.
This means the hospital won't expend any additional life-saving efforts if his condition
deteriorates
fb)(6); (b)(7)(C)

I

Acting Field Offic e Director
ICE Enforcement & Removal Operat ions, Seattle, WA
Mair,. l(h\/n\ (h\(7\(1,)
I Desf b)(6);(b)(7)(C)
Cell!~(b-)(-6)-; (-b)-(7-)(C
_)_~

r

CONFIDENTIALITY:This email and attachme nt s are inte nded fo r t he above name only and are confident ial. If you are not t he
inten ded addressee, or the person responsib le fo r deliver ing it to the inten ded addressee, you may neither copy, disseminate , nor
d istri but e it to anyone else or use it in any unauthorized manne r. To do so is str ictly pro hibite d and may be unlawfu l. If you receive
this email by mistake, please advise th e sender immediate ly by using t he rep ly facil ity in your mail software and delete it from your
computer.

From: !(b)(6)
; (b)(7)(C)
Sent: Saturday, Novembe r 17. 2018 10:09 AM
5
To: #IHSC_SEN_ Medical ~(b)( ); (b)(?)(C)
#IHSC_SEN_ Mental Health
"""
b.,..,)
(6
"'"),-,("b"""
)(=7"""
)(C
=)-------'=======;-;;#;:-;N;-;-W-;;:D:;--7:N~o7'ti"fi
-ca-;-t.,...io
n- Medi caI 1(b)(6); (b)(7)(C)

f;

....
<b_
)(_
6)_;(_b)_(7_)(C
_)___

.......,.
; #NWD-Notification

Me nta l Health f~b_)(6
_);_(b_)(_7)_(C_) _____

~

u Ject:

osp1tal Report - ICU - Amar
Importance: High
Status as of 09:30 PST:
Stable with no changes .Warden ordered no escalation of care. EEG/Neurology testing is

Pending.
LCDRl~
(b-)(6
-);-(b-)(7-)(C
- )-~M

LS(ASCP)

Assistant Health Services Admin ist rato r
Department of Homeland Security
Immigration & Customs Enforcement (ICE)
Enforcement & Remova l Operations (ERO)
USPHS,ICE Health Service Corps.
Northwest Detention Center
1623 East J StreP{h \/~1
Tacoma , WA 98421
Office J<b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000207
2019-ICLl-00051 2034



Cell: b)(6); (b)(?)(C)
Fax:
(b)(6); (b)(?)(C)
cid:image007.png@0lD297FB.19484D80cid:image008.png@0lD297FB.19484D80cid:image009.
png@01D297FB.19484D80

Warning: This document is UNCLASSIFIED//FOROFFICIAL USE ONLY (U//FOUO). It contains
information that may be exempt from public release under the Freedom of Information Act (5
U.S.C. 552). It is to be controlled, stored, handled, transmitted, distributed, and disposed of in
accordance with DHS policy relating to FOUO information and is not to be released to the public
or other personnel who do not have a valid "need-to-know" without prior approval of an
authorized DHS official. No portion of this report should be furnished to the media, either in
wr itten or verbal form.
From:l(b)(6); (b)(?)(C)
Date:SaturdayNov 17 2018 9:55AM

Subject: Hospital Report

Hospital day: 3 (17 November 2018)
Hospital Update: 9:30
A# : 216269802
Amar, Mergensana
DOB: 10/23/1978
COB: Russia
DOA: 12/19/2017
Relevant Medical History:
40 yo Russian male adm itted to St Joes Hospital after causing self- inflict ed harm. He is stable.
Warden ordered no escalation of care . His diagnosis is brain inju ry . He is currently
non responsive.
Room : 86
Current status : Stable but with no changes
Discharge Plan: No plan yet.
Information provided by (name and t itle}!(b)(6);~- IRN (ICU)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000208
2019-ICLl-00051 2035



From :

~b)(6); (b)(7)(C)

Sent :

16 Nov 2018
f b)(6); (b)(7)(C)

To :
Subject:
Saint Joseph's

20:18:41 +0000

FW: HOSPITAL UPDATE - ICU Amar#
Hospital

in Tacoma,

216-269 -802

SU ICE ATTEMPT

WA.

l(b)(6); (b)(7)(C)
A cting F i eld O ffice Dir ecto r

ICE Enforcement & R emoval O perat i ons, Seattle, =W_ A;;..;c__
~~~
Ma in: f bl(6); (b)(7)(C)
D esk : fb }(6); (b}(7)(C)
Cell: (b)(6); (b)(7)(C)

I

I;

CONFIDENTIALITY: This email and attachments are intended for the above name only and are confidential. If you are not the
intended addressee, or the person responsible for delivering it to the intended addressee, you may neither copy, disseminate, nor
distribute it to anyone else or use it in any unauthorized manner. To do so is strictly prohibited and may be unlawful. If you receive
this email by mistake, please advise the sender immediately by using the reply facility in your mail software and delete it from your
computer.

Sent : n ay,

ovem

er

16, 2018 11:19

AM

I

T9 (b)(6); (b)(7)(C)

Subject: RE: HOSPITAL UPDATE-

ICU A m ar#

216-269-802

SUICE ATTEMPT

What hospita l is he at?

r

From : ~(b}(6}; (b)(7)(C)

Sent : Friday , November

16, 2018 7:23

AM

)(6); (b)(7)(CJ

Subject: FW: HOSPITAL UPDATE - ICU Amar#

216 -269-802

SU ICE ATTEMPT

Import ance: High
Latest from the hospital.

Sent with BlackBerry

Work

(www .black be rr y.com )

From (b)(6); (b)(7)(C)
Date: Friday, Nov 16, 2018 , 6:46 AM
To: # IHSC_SEN_ Medica l =(b..:...
)(~6)-; (-b)~(7~)(=c -) ------~
(b)(6); (b)(7)(C)
(b)(6); (b)(7)(C)

, #NWD -Notification

>, #NWD -Notification
#IHSC_ SEN_ Mental

I

_.

216 -269 -802 SUICE ATTEMPT

AMERICAr--..

pVERSIGHT

I<~

Menta l Hea lth i (b)(6); (b)(7)(C)

Heal t h ._l
(b_)(_6)_;(_b)_(7_)(C
_ )_________

Subject : RE: HOSPITAL UPDATE - ICU Amar#

- Medical

DHS-ICE-19-0196, 19-0197-J-000209
2019-ICLl-00051 2036



Update as of 6:45 am PT: Current Status - remains the same. He is sti ll non-responsive , has an
anoxic brain inju ry, no brain activ ity, no corneal response, and intubated. He is still in ICU
Room 6B6. On full life support with a temperature of 34.9 C and a warming blanket. Labs are all
abnormal. No gag reflex, no retraction from painfu l stimuli but he is still overbreathing the
ventilat or. EEGis not indi cated at th is time due to the patient not meeting all brain death
criteria.

LCDRfb)(6)
; (b)(7)(C)

IM LS(ASCP)

Assistant Health Services Administrator
Departme nt of Homeland Security
Immigration & Customs Enforce m ent (ICE)
Enforcement & Removal Operations (ERO)
USPHS, ICE Health Service Corps.
Northwest Detentio n Center
1623 East J Street !(b)(6
Tacoma, WA 98421
Offii (b)(6); (b)(7)(C)

I

Cell:
Fax:
l(b)(6); (b)(7)(C)

Warning: This docume nt is UNCLASSIFIED//FOROFFICIAL USEONLY (U//FOUO). It contains informat ion that may
be exempt from public release unde r t he Freedom of Information Act (5 U.S.C.552). It is to be controlled, stored,
handled, transmitted, distributed, and disposed of in accordance wit h OHSpolicy relating to FOUO information and
is not to be released to the public or other personnel who do not have a valid "need-to -know" without prior
approval of an authorized OHSofficia l. No portion of this report should be furnished to t he med ia, either in written
or verba l form .

I

From : J/b\/6\ /b\/7\/C\

Sent : Friday, November 16, 20 18 6:16 AM
To: #IHSC_SEN_Medical <k~
b-)(=
6)-; (-b)=
(7-)(C
=)-------~,

l(b)(6); (b)(7)(C)
!(b)(6)
; (b)(7)(C)

; #NWD-Notification-Medical

~ #NWD-Notification

Mental Health
#IHSC_SEN_Mental Health ,...._
(b)(6); (b)(7)(C)

!;

b)(6); (b)(7)(C)

_____________

__.

Subject : FW: HOSPITAL UPDATE - ICU Amar# 216-269-802 SUICEATTEMPT
Importance: High

Update as of 3:00 PT 11/16/2018: Current Status- Deta inee 's status remains the same. He is still nonresponsive, has an anoxic brain injury, no brain activity, no corneal response, and intubated. He is still in
ICU Room 6B6. On full life support with a temperature of 40.1 C (104.18 F).

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000210
2019-ICLl-0005 1 2037



. receive
. d f ram R
Inf ormat1on

(b)(6)
rhin, ,r,

LCD Rtb)(6) ; (b)(7)(C)

IMLS(ASCP)
Assistant Health Services Administrator
Department of Homeland Security
Immigration & Customs Enforcement (ICE)
Enforcement & Removal Operations (ERO)
USPHS,ICE Health Service Corps.
Northwest Detention Center
1623 East J Street ~~!\~/;!
Tacoma, WA 98421
Offic b)(6) ; (b)(7)(C)
Cell:
Fax:
l(b)(6); (b)(7)(C)

Warning: This document is UNCLASSIFIED//FOROFFICIALUSEONLY (U//FOUO). It contains information that may
be exempt from public release under the Freedom of Information Act (5 U.S.C.552). It is to be controlled, stored,
handled, transmitted, distributed, and disposed of in accordance with OHSpolicy relating to FOLIOinformation and
is not to be released to the public or other personnel who do not have a valid "need-to-know" without prior
approval of an authorized OHSofficial. No portion of this report should be furnished to the media, either in written
or verba l form.

I

Fromfbl(6); (b)(7)(C)
Sent: Friday, November 16, 2018 3:00 AM

Subject: HOSPITALUPDATE

Hospital day #2 in ICU
A#:216269802
DOB: 10/23/1978
COB: Russia
DOA : 12/19/2017
Relevant Medical History: Was on Hunger Strike but began eating three meals a
day with liquid nutritional supplement s

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000211
2019-ICLl-00051 2038



Reason sent to ER: CPR initiated due to detainee being found uncon scious and
hangin g with no pulse. Detainee attempted suicide by han ging on 11/15/201 8. He
was revive d on the scene. He had a pul se with regular heart rhythm on ECG and
was being bag ged by paramedic s when he left the building
Curr ent Status: Detainee's status remain s the same. He is still non-r esponsive, has
an anoxic brain injury , no brain activity , no corneal respon se, and intubated. He is
still in ICU Room 6B6. On full life support with a temperatur e of 40.1 C (104.18
F).
c
.
. d from RN bb)(?
)(6)
In1ormahon
receive
J(Cl
rb )(6); (b)(? )(C)

~ (CTR)

Maxim Government Services
BSN,RN
Northwest Detention Center
ICE Health Service Corps (IHSC)
Enforcement and Removal Operations (ERO)
U.S. Immigration and Customs Enforcement (ICE)
1623 E J St
Tacoma , WA 98391
Offi ~ b)(6); (b)(? )(C)

Fax:

l

~(b)(6); (b)(?)(C)

The Commissioned Corps of the U.S. Public Health Service:
"Protecti ng, p romot ing and adva ncing the health and safety of the nation."
CONF ID ENTIA LITY NOTI CE: Thi s docume nt may contain informat ion cove red under the Privacy Act, 5 USC
522(a), and/or the Health Insurance Portab ility and Accountability Act (PL 104-191) and its vario us implem enting
regulations, and mu st be protecte d in accor dance with those provis ion s. Healthca re information is personal and
sensit ive, and must be treated accor dingly . If this correspondence contai ns healthcar e information, it is being
provi ded after approp riate authorizatio n from the pati ent or under circumstan ces that do not require pati ent
authorizatio n. Re-disclosure without additio nal pat ient consent or as penn itted by law is prohib ited . If you receive
this correspondence in error, plea se notify the sender at once and destroy any copies you have made .
Warning: This document is UNC LASS IFIED//FOR OFFICIAL USE ONLY (U//FOUO). It contains infom1ation
that may be exempt from public release under the Freedom of Informa tion Ac t (5 U.S.C. 552). It is to be controlled ,
stored, handled, transmitted , distribute d, and dispose d of in accordance with DHS policy relating to FO UO
information and is not to be released to the public or other personne l who do not have a valid "need-to-know"
without prior approva l of an authori zed DHS official. No portion of this report shou ld be furn ished to the med ia,
either in written or verba l form.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000212
2019-ICLl-00051 2039



l(b)(6); (b)(7)(C)

From :

Sent:

22 Nov 2018 02:56:49 +0000
#IHSC_SEN_Medical;#NWD-Notification-Medical
FW: Hospita l Update Amar

To:

Subject:

FYI

LCDR!
(b)(6); (b)(?)(C)

, ,

,

MLS(ASCP)

Assistant Health Services Admin istrato r
Depar tment of Homel and Secur ity
Immigration & Customs Enforcement (ICE)
Enforceme nt & Removal Operations (ERO)
USPHS, ICE Health Service Corps .
No rthwe st Detention Center
1623 East J Street @El
Tacoma , WA 98421
Office (b)(6); (b)(?)(C)
Cell: 1
Fax: (
l(b)(6); (b)(7)(C)

cid:image007 .png@0 1D297FB. l 9484D80cid :image008 .png@0 1D297FB.19484D80 cid:i
mage009. png @0 1D297FB.19484D80

Warning: This docume nt is UNCLASSIFIED //FOR OFFICIAL USE ONLY (U//FOU O).
It contains information that may be exem pt from public release under the Freedom of
Informat ion Act (5 U.S.C. 552). It is to be controlled, stored , handled, transm itted ,
distributed , and disposed of in accordance with DHS policy relating to FOUO
info1mation and is not to be released to the public or other personnel who do not have a
va lid "need-to-know" without prior approval of an authori zed DHS officia l. No portion of
this report should be furnished to the media, either in written or verbal form.
From:

l(b)(6); (b)(7)(C)

Date: Wednesday, Nov 21, 2018, 6:53 PM

Subject: Hospital Update Am ar

Name: Amar, Mergensana
Hospi tal day #7 in ICU
A# : 216269802
DOB: 10/23/ 1978

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000213
2019-ICLl-0005 1 2040



COB: Russia
DOA: 12/ 19/2017
Relevant Medical History: Was on self -impo sed Hunger Strike but began
eating three meals a day with liquid nutritional supplement s
Reason sent to ER: CPR initiated due to asphyxiation from self harm
(hanging) and transferred to ICU when pulse achieved.
Current Status: Detainee had massive anoxic brain injury. He was
pronounced brain dead on 11/18/18 at 1445. He remain s non-re spon sive and
intubated with stable vital signs. A meeting was recently conducted over the
phone with detainee' s mother. Dr. i~ii~lir\ and Buddhist priest were some of
the individuals present.
It was expressed that the mother was struggling with under standing brain
death and expressed wanting to keep him on life support. The mother stated
she was going to have a gathering tomorrow with a Shaman. Dr.l~~~mtr,lis
planning to speak with the mother again on Friday 11/23.
Location: St. Joseph's ICU Room 6B6 ~b )(5); (b)(?)(C)
I
.
h
.
.
D
b)(6)
Att en d mg p ys1c1an: ="-" -,-,;~"'~----~~
Information received from: RN

~\[
~\cc)

l(b)(6); (b)(7)(C)

JlN

LCDR, U.S. Public Health Service
ICE Health Service s Corp s
Northwest Detention Center
1623 East J Street
Tacoma , WA 98421
r b)(6); (b)(?)(C)

The Commi ssioned Corp s of the U.S. Public Health Service :
"Protecting, promoting and advancing the health and safety of the nation."
CONFIDENTIALITYNOTICE: This document may contain information covered under the Privacy Act, 5 USC522(a), and/or the
Health Insurance Portability and Accountability Act (PL 104-191) and its various implementing regulations, and must be protected
in accordance with those provis ions. Healthcare information is personal and sensitive, and must be treated accordingly . If this
correspondence conta i ns healthcare i nformation, it is being provided after appropriate authorization from the patient or under
circumstances that do not require patient authorization. Redistlosure without additional patient consent or as permitted by law
is prohibited. If you receive this corr espondence

Warning: This document is UNCLASSIFIED//FOROFFICIALUSEONLY (U//FOUO). It contains information that may be exempt from
public release under the Freedom of Information Act (5 U.S.C. 552). It is to be controlled, stored, handled , transmitted ,
distributed, and disposed of in accordance with DHS policy relating to FOUO information and is not to be released to the public or
other personnel who do not have a valid "need-to-know" w ithout pr ior approval of an authorized DHS official. No portion of th is
report should be furnished to the media, either in written or verbal form.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000214
2019-ICLl-00051 2041



From:
Sent :
To :
Subject:

, b)(6); (b)(7)(C)

16 Nov 2018 17:39:02 +0000
#IHSC_SEN_Medical;#NWD-Notification-Med ical
FW: Hospital Update for 216269802

See update below

LCSW-C, BCD
.........
---~--...,.........
mm1s ra or
ICE Health Service Corps
Northwest Detention Cente r
1623 E. J St. Suite fbH6>
Tacoma , WA 98421
Offic b)(6); (b)(7)(C)
BB:
Fax :

I

~b)(6); (b)(7)(C)

Warn ing: Th is document is UNCLASSIFIED //FOR OFFICIAL USE ONLY (U//FOUO) . It
contains informat ion that may be exempt from public relea se under the Freedom oflnfo rmation
Act (5 U.S.C. 552). It is to be controlled, stored, handled, transmitted , distributed, and disposed
of in accordance with DHS pol icy relating to FOUO information and is not to be released to the
public or other per sonne l who do not have a valid "need-to-know" without prior approval of an
authorized DHS official. No portion of this report should be furnished to the media, either in
written or verba l form.
From:fb)(6); (b)(7)(C)
Sent : Friday, November 16, 2018 9:26 AM
b)(6); (b)(7)(C)

Hospital day # 1 in ICU
A#:216269802
NAME: Amar, Mer
DOB: 10/23/1978
COB: Russia
DOA : 12/19/20 17
Relevant Medical History: Was on self-imposed protest Hunger Strike but began
eating three meals a day with liquid nutritional supplements

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000215
2019-ICLl-0005 1 2042



Reason sent to ER: CPR initiated due to detainee asphyxiation from self harm and
transferred to ICU when pulse was achieved.
Current Status: pt with massive anoxic brain injury. He is intubated with no
reflexes except for respiratory hyperventilation which is not life sustaining. His
temperature and blood pressure are very unstable. He has started having seizures
which are being treated and is requiring large dose medication to support his blood
pressure. He will have a neurology consult with EEG today but is on supportive
care and may still code again at any moment. He is still in ICU Room
LOCATION: St Joseph's Hospital, ICU Rm 6Bravo6.
6l;
Attending Physician: D bJC
Trauma Physician, RN l\~1\
~/:,~, ~tlC
blC5>;CblC7lCCl
I am in contact with D \~l\~l;r, She has my desk hone#, and I have her phone as
7Jcc>
5l;C
7JccJ ~ the ICU Trauma PA is at phone CblC
5l;C
blC
blC
ICblC
._,l
(b...,
)(6
_J;_(b_
)(7)(C
,-,
......
)_,---~

~

Chmcal Director
ICE Health Service Corps (IHSC)
Enforcement and Removal Operations (ERO)
US Immigration Customs Enforcement (USICE)
Northwest Detention Center
1623 E. J St. Suit ~(b)(6
Tacoma, WAr--'
9'-"8-=
42=1=~
6);(b)(?)(C)
Main office: (b)(
Voice Mail:
;(b)(7)(C)
Cell: (b)(6)

I

fax (

(b)(6);(b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000216
2019-ICLl-00051 2043



From:
Sent:
To:
Subject:

~b)(6);(b)(7)(C)
20 Nov 2018 13:20:44 +0000
#IHSC_SEN_Medical;#NWD-Notification-Med ical
FW: Hospital/ICU update Amar

I

CAPTl(b)(6);(b)(7)(C)
LCSW-C, BCD
Health Serv ices Adm inistrato r
USPHS
ICE Health Service Corps
Northwest Detention Center
1623 E. J St. Suitd(b)(6); I
Tacoma , WA 98421
Offi< b)(6)
; (b)(7)(C)
BB:
Fax :
l(b)(6); (b)(7)(C)
Warning: This document is UNCLASSIFIED//FOR OFFICIAL USE ONLY (U//FOUO). It
contains inform at ion that may be exempt from public release under the Freedom oflnformation
Act (5 U.S.C. 552). It is to be controlled, stored, handled, transmitted, distribut ed, and disposed
of in accordance with DHS policy relating to FOUO information and is not to be released to the
public or other personnel who do not have a valid "need-to-know" without prior approval of an
authorized DHS official. No portion of this report should be furnished to the med ia, either in
written or verbal form.

ovember 19 2018 10:14 PM

Name: Amar, Mergensana
Hospital day #5 in ICU
A#:216269802
DOB: 10/23/ 1978
COB: Russia
DOA: 12/ 19/2017

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000217
2019-ICLl-00051 2044



Relevant Medical History: Was on self-imposed Hunger Strike but began eating
three meal s a day with liquid nutritional supplements
Reason sent to ER: CPR initiated due to asphyxiation from self harm (hanging)
and transferred to ICU when pulse achieved.
Current Status: No changes from previous updat e. Detain ee had massi ve anoxic
brain injury. He was pronounced brain dead yesterday 11/18/ 18 at 1445. He
remains non-r esponsive and intubated with stable vital signs. He is on 1 medication
(levafed) to support his blood pres sure.
Location: St. Joseph 's ICU Room 6B6 # l<b><5>;(b)<7><c>
Attending physician: Dr ~ii~iir.,
. receive
o d from
=-=:.
~)(=
6.,)~
I nf orma t 100
. RN~ ~ (b,,._"
,;,_,

Next call due in 8 hour s at 0600
l<b)(6); (b)(7)(C)

IRN

LCDR, U.S. Public Health Service
ICE Health Services Corps
Northwest Detention Center
1623 East J Street
Tacoma, WA 98421
rb )(6); (b)(7)(C)

The Commissioned Corps of the U.S. Public Health Service:
"Protecting, promoting and advancing the health and safety of the nation."
CONFIDENTIALITYNOTICE:This document may contain information covered under the Privacy Act , s USC522(a), and/or the Health
Insurance Portability and Accountability Act {PL 104-191) and its various implementing regulations, and must be protected in accordance
with those provisions. Healthcare information is personal and sensitive, and must be treated accordingly. If this correspondence contains
healthcare information, it is being provided after appropriate authorization from the patient or under circumstances that do not require
patient authorization . Redisclosure without additional patient consent or as permitted by law is prohibited. If you receive this
correspondence

Warning: This document is UNCLASSIFIED//FOROFFICIALUSE ONLY (U//FOUO). It contains information that may be exempt from public
release under the Freedom of Information Act {S U.S.C. 552). It is to be controlled, stored, handled, transmitted, distributed, and disposed of
in accordance with DHS policy relating to FOUO information and is not to be released to the public or other personnel who do not have a
valid "need-to-know" without prior approval of an authorized DHS official. No portion of this report should be furnished to the media, either
in written or verbal form.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-J-000218
2019-ICLl-00051 2045



LJECEIVEn

n

u

Office of InformationGovernanceand Prn1acy
U.S. Deparhnent of Homeland Security
500 12111St., SW
Washington, D.C. 20536

SEPO1 2020

BY: A<JPiO
~

U.S. Immigration
and Customs
Enforcement

August 28, 2020
Daniel McGrath
American Oversight
1030 15th Street NW, B255
Washington, DC 20005

RE:

American Oversight. v ICE et al., 1:19-cv-01817-RCL
ICE FOIA Case Number 2019-ICLI-00051
Tenth Interim Production

Dear Mr. McGrath:
This letter is the tenth interim response to your Freedom of Information Act (FOIA) request to
U.S. Immigration and Customs Enforcement (ICE), dated February 8, 2019, for all records
pertaining to Jeffry Hernandez Rodriguez aka Roy Alexander Hernandez Rodriguez aka Roxsana
Hernandez and Mergensana Amar.
ICE has considered your request under the FOIA, 5 U.S.C . ? 552.
For this production , ICE reviewed 532 pages of potentially responsive records . Of those 532
pages, ICE determined that 134 pages were nonresponsive or duplicative and 398 pages were
responsive . This production consists of 218 pages. These documents have been Bates numbered
2019-ICLI-00051 2046 through 2019-ICLI-00051 2443.
ICE has applied Exemption 5 to protect from disclosure intra-agency documents that contain the
recommendations, opinions, and conclusions of agency employees. The disclosure of these
communications would discourage the expression of candid opinions and inhibit the free and
frank exchange of information and opinions among agency personnel on important agency
decision-making by having a chilling effect on the agency's deliberative process.

FOIA Exemption 5 protects from disclosure those inter- or intra-agency documents that are
normally privileged in the civil discovery context. The three most frequently invoked privileges
are the deliberative process privilege, the attorney work-product privilege, and the attorney-client
privilege . After carefully reviewing the responsive documents, I have determined that portions
of the responsive documents qualify for protection under the deliberative process privilege, the
attorney-client privilege, and the attorney work-product privilege. The deliberative process
privilege protects the integrity of the deliberative or decision-making processes within the
www.icc.gov

AMERICAN

pVERSIGHT



ICE FOIA Number 2019-ICLI-00051

Page2 of3

agency by exempting from mandatory disclosure opinions, conclusions, and recommendations
included within inter-agency or intra-agency memoranda or letters. The release of this internal
information would discourage the expression of candid opinions and inhibit the free and frank
exchange of information among agency personnel. The attorney work-product privilege protects
documents and other memoranda prepared by an attorney in contemplationof litigation. The
attorney-client privilege protects confidential communicationsbetween an attorney and his client
relating to a legal matter for which the client has sought professional advice. It applies to facts
divulged by a client to his attorney, and encompassesany opinions given by an attorney to his
client based upon, and thus reflecting,those facts, as well as communicationsbetween attorneys
that reflect client-suppliedinformation. The attorney-clientprivilege is not limited to the context
of litigation.
ICE has applied FOIA Exemptions 6 and 7(C) to protect from disclosure the names, e-mail
addresses, and phone numbers ofDHS employees contained within the documents.
FOIA Exemption 6 exempts from disclosure personnel or medical files and similar files the

release of which would cause a clearly unwarranted invasion of personal privacy. This requires a
balancing of the public's right to disclosure against the individual's right to privacy. The privacy
interests of the individuals in the records you have requested outweigh any minimal public
interest in disclosure of the information. Any private interest you may have in that information
does not factor into the aforementionedbalancing test.
FOIA Exemption 7(C) protects records or information compiled for law enforcement purposes

that could reasonably be expected to constitute an unwarranted invasion of personal privacy.
This exemption takes particular note of the strong interests of individuals, whether they are
suspects, witnesses, or investigators,in not being unwarrantably associatedwith alleged criminal
activity. That interest extends to persons who are not only the subjects of the investigation, but
those who may have their privacy invaded by having their identities and information about them
revealed in connection with an investigation. Based upon the traditional recognition of strong
privacy interest in law enforcementrecords, categoricalwithholding of information that
identifies third parties in law enforcementrecords is ordinarily appropriate. As such, I have
determined that the privacy interest in the identities of individuals in the records you have
requested clearly outweigh any minimal public interest in disclosure of the information. Please
note that any private interest you may have in that information does not factor into this
determination.
ICE has applied FOIA Exemption 7(E) to protect from disclosure internal agency case numbers
contained within the document.
FOIA Exemption 7(E) protects records compiled for law enforcement purposes, the release of

which would disclose techniques and/or proceduresfor law enforcementinvestigations or
prosecutions, or would disclose guidelines for law enforcement investigations or prosecutions if
such disclosure could reasonably be expected to risk circumvention of the law. I have
determined that disclosure of certain law enforcement sensitive information contained within the
responsive records could reasonably be expected to risk circumvention of the law. Additionally,
the techniques and procedures at issue are not well known to the public.

AMERICAN

PVERSIGHT



ICE FOIA Number 2019-ICLI-00051

Page 3 of3

If you have you any questions about this matter, please contact Assistant U.S. Attorney Benton
Peterson at Benton.Peterson@usdoj.gov or 202-252-2534.
Sincerely,

v~c9-~,,_ltf6.,
Catrina Pavlik-Keenan
FOIA Officer

Enclosure(s): 398 page(s)
cc:
Benton Peterson
Assistant U.S. Attorney
CWA Building 501 3rd Street, NW
Washington DC 20001

AMERICAN

PVERSIGHT



From :

Wilcox,

Sent :

10

1~)(6)
;(b)(7)(C)

Oct

Bryan S

2018 18:43:03 +0000

Subject :

FW: Signed Court O r der for Medical

Att achments :

Signed Order Amar.pdf

Monitoring

& Hydration

- Amar

(b)(6);
(b)(?)(C)

Looking at this again, I'm surprised there's no end-date to this order.
Do you agree that we have an open-ended order that we can use if Amar again stops drinking?
(which he has, beginning this morning)

Br yan

S. W i lcox

D ep u ty F ield O ffice D irector
ICE Enforcement
& Removal O perations, Seattle, .,;,
W':-;
A
~ ,,...,...,,=-,----,
Ma i n: f bl(6); (b)(7)(C)
D esk: l(b)(6); (b)(7)(C)
Ce ll : f bl(6); (b)(7)(C)

I/

t

CONFIDENTIALITY: This email and attachments are intended for the above name only and are confidential. If you are not the
intended addressee, or the person responsible for delivering it to the intended addressee, you may neither copy, disseminate, nor
distribute it to anyone else or use it in any unauthorized manner. To do so is strictly prohibited and may be unlawful. If you receive
this email by mistake, please advise the sender immediately by using the reply facility in your mail software and delete it from your
computer.

~

From: Sm ith, Stewart D ~~
~b
-)(_6)_; (_b)_(7_)(C
_ )______
Date: Monday, Sep 10, 2018, 06:22
To : Asher, Nathalie R""!
(b..,..,
)(=
6)-; (,...,
b)..,,,
(7"")(""
c ,...
) -----------.P
Jennings , David W kb)(6); (b)(7)(C)

rice, Corey A
!(ronen , CM

Subject: FW: Signed Court Order for Medica l Monitoring

b)(6); (b)(7)(C)

~~--------~~
b)(6); (b)(7)(C)
~--------~
- Amar

& Hydration

FYSA.
Dr . Stewart

D . Smith,

I

MPH, CCHP

ICE Health
Assistant Director
Office: (b)(6); (b)(7)(C)

Service

Corps

Cell: b)(6); (b)(7)(C)
From :l(b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000001
2019-ICLl -00051 2046



Se ft : Friday SeptemberZ 20 18 10-45AM

To

b)(6);(b)(7)(C)

Subje ct: FW: Signed Court Order for Medical Monito ring & Hydration - Amar
FYSA;hunger str ikers at Tacoma. Initiating court orders for forced feed ing.

V/R,

IRN,
USPHS

CAPT l(b)(5); (b)(?)(C)

Health Services Administrator, Western Region
T. Don Hutto Residential Center (TDHRC)
ICE Health Service Corps (IHSC)
Immigration and Customs Enforcement (ICE)
Enforcement and Removal Operations (ERO)
1001 Welch Street, Taylor , TX 76574
0:
b)(6); (b)(7)(C)

BB :
Fax :
fb)(6); (b)(?)(C)
Warning : This document is UNCLASSIFIED//FOR OFFICIAL USE
ONLY (U//FOUO). It contains information that may be exempt from
public release under the Freedom oflnformation Act (5 U.S.C. 552). It
is to be contro lled, stored, handled , transmitted , distributed , and
disposed of in accordance with DHS policy relating to FOUO
information and is not to be released to the public or other personnel
who do not have a valid "need-to-know" without prior approval of an
authorized DHS officia l. No portion of this report should be furnished
to the media , either in written or verbal form.
From :l(b)(6); (b)(7)(C)

Sent: Friday, Sept ember 7, 2018 8:13 AM

To:1Cb)(6); (b)(?)(C)
Cc:

'-,----~~~--~~~--~~-~---,---,

Subje ct: FW: Signed Court Order for Medica l Mon itor ing & Hydration - Amar

i~ii~irc:i

Good Morning CAP
Please find attached t e court orde r to allow us to medically monitor and
hydrate one of our three remaining hunger str ike detainees . This is a new
step towards forced feed ing that was insisted upon by the legal side of the
house. Reportedly, they want to show a graduated response in these
situations.
Facility ;leadership will meet th is morning to determ ine what happens next
\~t ,, w ill
and what this w ill look like. As today is my regular day off, LCD \~1
attend the meeting with our Clinical Director and I am available by phone to
participate .

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000002
2019-ICLl -00051 204 7



V/R,

I

CAPT l(b)(5); (b)(
l)(C)
LCSW-C, BCD
Health Services Administrator
USPHS
ICE Health Service Corps
Northwest Detention Center
1623 E. J St. Suite l(b)(I
Tacoma, WA 98421
Office: (b)(6); (b)(7)(C)
BB;(b)(6);(b)(7)(C)
Fax
(b)(6); (b)(7)(C)
Warning: This document is UNCLASSIFIED //FOR OFFICIAL USE
ONLY (U//FOUO). It contains information that may be exempt from
public release under the Freedom oflnformation Act (5 U.S.C. 552). It
is to be controlled, stored, handled, transmitted, distributed, and
disposed of in accordance with DHS policy relating to FOUO
information and is not to be released to the public or other personnel
who do not have a valid "need-to-know" without prior approval of an
authorized DHS official. No portion of this report should be furnished
to the media, either in written or verbal form.
From:rb)(6); (b)(7)(C)
Sent: Thursday, September 6, 2018 4:46 PM

b)(6); (b)(7)(C)

The court has signed the order for medical monitoring and hyd ration for
Mergensana Amar. Please keep us updated .

rb)(6); (b)(7)(C)
Assistant Chief Counsel
Seattle Office of Chief Counsel / OPLA
Tacoma sub-office
U.S. Immigration and Customs Enforcement
U.S. De artment of Homeland Security
6);(b)(7)(C)
Tel: (b)(
E-mail: [(b)(6); (b)(7)(C)
*** Warning ***Attorney /Client Privilege *** ttorney Work Product ***

l

This communication and any attachments may contain confidential and/or sensitive
attorney/client privileged information or attorney work product and/or law enforcement
sensitive information. It is not for release , review , retransmission , dissemination , or
use by anyone other than the intended recipient. Please notify the sender if this email
has been misdirected and immediately destroy all originals and copies. Furthermore

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000003
2019-ICLl-00051 2048



Case 3:18-mc-05016-BHS

Document 4

Filed 09/06/18

Page 1 of 3

1
The Honorable Judge Benjamin H. Settle

2
3
4

5
6
UNITED STATES DISTRICT COURT FOR THE
WESTERN DISTRICT OF WASHING TON
AT TACOMA

7

8
9 IN THE MATTER OF:
lO MERGENSANAAMAR
11 File No. A216-269-802

NO . 3:18-mc -0 5016-BH S
EMERGENCY EX PARTE MOTION
TO PROVIDE INVOLUNTARY
MEDICAL TREATMENT

12

13
The United States Department of Homeland Security, Immigration and Customs

14
15

Enforcement (hereafter "ICE"), by and through the Un ited States Attorney for the Western District

16 of Washington, has filed an ex parte motion for an order permitting ICE to immediately provide
17

involuntary hydration and medical treatment for Mergensana Amar, No. A2 l 6-269-802, who is

18
19

currently being held as a civil detainee at the Northwest Detention Center in Tacoma, Washington.

20

Based on the declarations of Dr. Shei Malakhova and Supervisory Detention and Deportation

21

Officer Tim Petrie, the Court finds that there is sufficient cause to believe that without the requested

22 medical testing and treatment, Mr . Amar is in danger of irreparable injury, and poss ible death.
23
Therefore, IT IS HEREBY ORDERED that ICE may undertake necessary medical treatment

24
and testing to save Mr. Amar's life and prevent injury to him, includ ing :

25

26

1.

involuntary hydration through administering intravenous (IV) fluids;

27

2.

physica l examination with dai ly weight asse ssments and frequent vital sign check s;

28
ORDER GRANTING EMERGENCY EX PARTE MOTION
TO PROVIDE INVOLUNTARY MEDICAL TREATMENT- I

AMlf

ll.Ji\l\i

pVERSIGHT

UNITED STATES ATTO RNEY
120 I P ACIFI C AV ENUE, S UITE 700
TA COMA , WASH ING TON 984 02
(253) 428-38 00

DHS-ICE-19-0196, 19-0197-K-000004
2019-ICLl-00051 2049



Case 3:18-mc-05016-BHS

1

3.

2

Page 2 of 3

laborato ry tests at least every 48 - 72 hours consisting of:

a.

3

Document 4 Filed 09/06/18

Complete metabolic panel. This test reveals an increase in markers of kidney

function in view of any renal injury. The pane l tests include: BUN (blood urea nitrogen), creatin ine

4
level, urinalysis and prot eins. It also reveals electrolyte disturbances as potassium, phosphate,

5
6

magnesium and glucose leve ls can lead to heart arrhythmias.

7

8

b.

Complete blood count. This test reveals the hemoglobin level.

c.

Urinalysis, which reveals the presence of keto nes, blood and crysta ls in the

d.

Magnesium and phosp hate leve ls to assess deficiency after day 13 of a hun ger

e.

Electrocardiogra m, if the patient shows elevated potassium, is necessary to

9
10

urme.

11
12 strike.
13

14
treat conditions which can lead to letha l arrhythmias.

15

f.

16

Creatine kinase (CK) levels determine whethe r CK levels increase . CK is an

17 enzyme found inside muscle cells and should be measured as it is released into the blood, when the
18 muscle cells rupture. The increase in CK as a resu lt of the destruction of muscle tissue can lead to
19
acute renal failure and death.

20
g.

21

Pre-album in leve ls. Pre-albumin is used as a marker for nutr itional status

22

evaluation , and levels will decrease over time the longer a patient fails to consume adequate

23

nutrition . The pre -albumin level coITelates with patient morbidity and mortality risk . Norma l pre-

24

albumin is 15-35 mg/dL. When pre-albumin falls to 5-1 lmg /dL, significant morbidity risks exist

25
26

and aggressive nutritional support is necessa ry.

27

IT IS HEREBY FURTHER ORDERED that if Amar continues to refuse the necessary

28

medical treatment and monitoring, ICE and medica l staff at the Nort hwest Detention Cente r may use
ORDER GRANTING EMERGENCY EX PARTE MOTION
TO PROVIDE INVOLUNTARY MEDICAL TREATMENT-2

AMlf

ll.Ji\l\i

pVERSIGHT

UNITED STATES ATTORNEY
120 I P AC IFIC A VENUE, SUIT E 700
TACOMA, W ASH ING TON 98402
(253) 428-3 800

DHS-ICE-19-0196, 19-0197-K-000005
2019-ICLl-00051 2050



Case 3:18-mc-05016-BHS

Document 4

Filed 09/06/18

Page 3 of 3

1 soft medical restraints to assure the safety of Ama r and the medical staff when administering the
2

necessary treatment.

3

ICE is directed to prov ide a copy of this order to Mr. Amar forthw ith.

4

5

Dated this 6th day of September, 2018.

6

7

8
9
INH. SETTLE
United States District Judge

10

11
12
13

Presented by:

14
ANNETTE L. HAYES
United States Attorney

15
16

17 /s/ Lisca Bor ichewski
l S LISCA BORICHEWSKI
Assistant United State Attorney
19 700 Stewart Street , Suite 5220
Seattle, WA 98101
20 Telephone : (206) 553-7970
Fax: (206) 553-4073
21
E-mai l: lisca. borichewski @usdoj.gov
22

23

24
25

26
27

28
ORDER GRANTING EMERGENCY EX PARTE MOTION
TO PROVIDE INVOLUNTARY MEDICAL TREATMENT- 3

AMlf

ll.Ji\l\i

pVERSIGHT

UN IT ED ST A T ES A TTORNEY
120 I PACIFIC AVENUE,SUITE 700
TACOMA, WASHINGTON98402
(253) 428-3800

DHS-ICE-19-0196, 19-0197-K-000006
2019-ICLl-00051 2051



From:

l(b)(6); (b)(7)(C)

Se nt:

19 Nov 2018 19:58:54 +0000
Wilcox, Bryan S
l(b)(6); (b)(7)(C)

To:

I

Cc:
Subje ct:

FW: Status for A#216269802

No DL in the file, and he should not have one since he was taken into custody at the POE.
From : l(b)(6); (b)(7)(C)

Se nt : Monday, November 19 2018 11:57 AM
To: Wilcox, Bryan (b)(5); (b)(?)(C)
b)(6); (b)(7)(C)
Subject: RE: Status for A#216269802

To: Bryan Wilcox

I

I just received a phone call from the Chief Medical Officer of St Joseph' s Hospital, Dr i<b)(6); (b)(?)(C)
asking if Amar, Mergansana had a driver's license and if yes, did he indicate a donor status? I told him I
did not know but he could ask you that kind of information. I gave him your cell phone. His cell number
i~(b)(6); (b)(7)(C)

I

I

(b)(6); (b)(7)(C)
,MD
l.
....,
C""li,n.,...
...ic_a.,..,
ID
= i,re
..._c_t-or_ __,
ICE Health Service Corps (IHSC)
Enforcement and Removal Operations (ERO)
US Imm igration Customs Enforcemen t (USICE)
Northwest Detention Center
1623 E. J St. Suite l(b)(61
Tacoma, WA 98421
Main office: .-(b-)(6
.,...
),- (b
- )(=7).(C
..,,-)----,
Voice Mail: (
C b)(6); (b)(7)(C)

Bryan S. Wilcox
Act ing Field Office Director
ICE Enfo rcement & Remova l Operat ions, Seattle, WA
D esk: J(b)(6); (b)(7)(C) I/ Cell: f,-b....,
)(6,....
);-(b---,
)(7--)(..,..
C)---,
Main: l(b)(6); (b)(7)(C)

t

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000007
2019-ICLl-00051 2052



From:

Sent :
To :

fb)(6); (b)(7)(C)
19 Nov 2018 13:12:46 +0000

l(b)(6); (b)(7)(C)

rb)(6); (b)(7)(C)
(bl(5l;(b)(l )( b)(6) (b)(7)(C)
Stewart D

b)(6); (b)(7)(C)
(b)(6); (b)(7)(C)
Subject:

ilcox, Bryan ~b)(6); (b)(7)(C)
FW: ICU Hospital Update

See below for night shift update: Per ICU RN there are no new updates; still have gotten ahold of next of
kin. No treatment being pursued.

V/R,

l

CAPTl(b)(5); (b)(l )(C)
LCSW-C, BCD
Health Services Administrator
USPHS
ICE Health Service Corps
Northwe st Detention Center
1623 E. J St. Suite!(b)(6}!
Tacoma , WA 9842 1
Office (b)(6); (b)(7)(C)
BB (b)(6); (b)(7)(C)
Fa
l(b)(6);(b)(7)(C)
Warning: This document is UNCLASSIFIED //FOR OFFICIAL USE ONLY (U//FOUO). It
contains information that may be exempt from public release under the Freedom of Informat ion
Act (5 U.S.C. 552). It is to be controlled, stored, handled, transmitted , distributed, and disposed
of in accordance with DHS po licy relating to FOUO information and is not to be released to the
public or other personnel who do not have a valid "need-to-know" without prior approval of an
authorized DHS official. No portion of this report should be furnished to the media, either in
written or verbal form.
From:l(b)(6);(b)(7)(C)
Sent : Monday, November 19, 2018 3:29 AM

1~)(6);(b)(7)(C)

SubJect: Hospital Updat e
FYSA
Per ICU RN there are no new updates ; still have gotten a hold of next of kin. No t reatment being
pursued. Below is the previous update in case anyone m issed it, there is no new information .

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000008
2019-ICLl-0005 1 2053



ICU Update from Saint Joseph Hospital for 11/18/18 at 1730
Name: AMAR, MERGENSANA
A#:216269802
DOB: 10/23/1978
COB: Russia
DOA: 12/19/2017
Relevant Medical History: 40 yo Russian male admitted to St Joes Hospit al after causing self-inflicted
harm.
Room: ICU 6B6
Date of Admission: 11/ 15/2018
Current Diagnosis: Anoxic Brain Injury
Attending physician: Drj(b)(6);
Current status: Cerebral blood flow study done today showed no flow to the brain. All testing indicat es
brain death, so the patient is now declared dead and life support will be turned off unless there is next
of kin to request otherwise. life Centers Northwest is requesting for organ donation but with no
availab le next of kin there is no one to authorize this.
Discharge Plan: Will be turned over to the medical examiner
Informat ion provided by (name and title): Dr l(b)(6); _ ~nd the CMO Dr (b)(B); (b)(?)(C)

I

LTJG!(b)(6); (b)(?)(C) ~ BSN
USPHS
ICE Health Service Corps (IHSC)
Enforcement and Removal Operations (ERO) Northwest Detention Center
1623 East J Stree~(b)(6)1
Tacoma, WA 98321
C: (b)(6); (b)(?)(C)
(b)(6); (b)(?)(C)
Warning: This document is UNCLASSIFIED//FOROFFICIAL USEONLY (U//FOUO). It contains information
that may be exempt from public release under the Freedom of Information Act (5 U.S.C. 552). It is to be
controlled, stored, handled, transmitted, distributed, and disposed of in accordance with DHS policy
relating to FOUO information and is not to be released to the public or other personnel who do not have
a valid "need -to-know " without prior approval of an authorized DHS officia l. No portion of this report
should be furnished to the media, either in written or verbal form .

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000009
2019-ICLl-00051 2054



Fro m :

Se nt:
To:

Subje ct:

rb)(6); (b)(7)(C)
25 Nov 2018 03:35:36 +0000
#IHSC_SEN_Medical;#NWD-Notification-Medical
FW: ICUUpdate

CAP (b)(6); (b)(7)(C)

CSW-C, BCD
mm1s ra or

ICE Health Service Corps
Northwest Detention Center
1623 E. J St. Suit~(b)(5>I
Tacoma, WA 98421
Office l(b)(6); (b)(7)(C)
BB: b)(6); (b)(7)(C)
Fax
(b)(6); (b)(7)(C)
Warning: This document is UNCLASSIFIED //FOR OFFICIAL USE ONLY (U//FOUO).
It contains informat ion that may be exempt from pub lic release under the Freedom of
Information Act (5 U.S.C. 552) . It is to be controlled , stored, handled , transm itted ,
distributed, and disposed of in accordance with DHS policy relating to FOUO
information and is not to be released to the public or other personnel who do not have a
valid "need-to-know" without prior approva l of an authorized DHS offic ial. No po1tion of
this report should be furnished to the media , either in written or verba l form.
From:t )(6); (b)(7)(C)
Date:aturday,
Nov 24. 2018, 6:28 PM

1~

)(6); (b)(7)(C )

Subject: ICU Update

Name: AMAR,MERGENSANA
A#:216269802
DOB:10/23/1978
COB:Russia
DOA:12/19/2017
Relevant Medical History:40 year old Russianmale admitted to St Joes Hospitalafter causing
self-inflictedharm.
Room: ICU686
Date of Admission:11/15/20 18
Current Diagnosis:AnoxicBrain Injury
Attending physician:D~(b)(6);~Current status: No change according to the RN,1800 Lifesupport removed per Dr (b)(6); (b)(7)(C)
1805 cardiac death per RNl\~/\~/
:,

I

,

0

I

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000010
2019-ICLl-00051 2055



Discharge Plan: Morgue, then county corone r
,-------,
Information provided by (name and title): R (b)(6);
/ h \1 7 \lr"\
f b)(6); (b)(7)(C) ~ RN (CTR)
STG International
ICE Health Service Corps (IHSC)
Enforcement and Removal Operations (ERO)
US Immigration Customs Enforcement (USICE)
Northwest Detention Center
1623 East J Street
Tacoma WA 98421
[ b)(6); (b)(7)(C)

Dr (b)(6); (b)(?)(C)

I

CONF IDENTIALITY NOT ICE : This document may contain information cove red und er the Privacy Act, 5
US C 522(a) , and/or the Hea lth Insura nce Porta bili ty and Acco untabili ty Act (PL 104-19 1) and its various
impl ement ing regu lations, and must be protected in acco rdance with those provisions. Healthcare
information is perso nal and sensitive, and must be treated accordingly. If this correspo ndence contains
healthcare informatio n, it is being prov ided after appropr iate authorization from the patient or under
circumstances that do not require patient authorization. Redisclosu re without additiona l patient cons ent or
as permitte d by law is prohibited. If yo u rece ive this correspo ndence in error , p lease notify the sender at
once and destroy any copies you have made.
Warn ing: This document is UNCLASSIFIED//FOR OFFICIA L USE ONLY (U//FOUO) . It conta ins
information that may be exempt from public release under the Freedom of Informat ion Act (5
U.S.C. 552). It is to be controlled , stored , handled , transmitted, distributed, and disposed of in
accordance with DHS policy relating to FOUO informatio n and is not to be released to the public
or other personnel who do not have a valid "need-to-know " without prior approval of an
authorized DHS official. No portion of this report shou ld be furnished to the media , either in
writte n or verbal form.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000011
2019-ICLl -00051 2056



CCHHCK
RUSSIAN FEDERATIO

(bX6) ; (b}{7XC)

rlA(rv.'.!

I

MT

-

......
'
p

AM~P /

AMAR

it...

M

J)oo

20

/JaQo

20 08 2025

pVERSIGH

AHA AA6 AE:B I If

-t

'.\01

(b)(6) ; (b)(7)(C)

P<RUSAMAR<<MERGENSANA<<<<<<<<<<<<<<<<<<<<<<<
7521443826RUS7810233M2508201<<<<<<<<<<<<<<06
2019-ICLl-00 051 2057

DHS-ICE-19-0196, 19-0197-K-000012



From:

l(b)(6); (b)(7)(C)

Sent :

29 Nov 2018 01:30:35 +0000
Wilcox, Bryan S
rb)(6); (b)(7)(C)

To :

Cc:
Subject:
Attachments :

1

FW: Letter of Condolence/ AMAR, Mergensana
AMARPP.pdf

FYSA

~~r
(;
Sent :

Subject : FW: Letter of Condolence/ AMAR,Mergensana

Dear Consul l<b)(6);~I would like to express our sincere appreciation for your assis tance in coordinating communication
w ith Mr. Amar's next of kin for purpo ses of sending an official condolence lette r and forwarding his
persona l effects. In order to facilitate de livery of a condolence letter to Mr. Amar's family as
exped itious ly as possible , my office would like to ask if your Embassy might be w illing to act as an
intermediary in send ing the letter to them in Russia. If yo u are willing to do this, I w ill forward the
condolence letter to you directly.
As to your questions , Mr. Amar applied for admission to the United States at the San Ysidro port of
entry on December 2, 2017 and was taken into custody after it was determined he did not have
valid documents allowing him to be admitted to the Unite d States. He remained in custody pend ing
remova l proc eedi ngs before an Immigration Judge and subsequent appeal.

Attached is a copy of Mr. Amar's Russian passport. As to your request for additional records, a
death certificate has not yet bee n issued. At this time, Mr. Amar's death has been determined to be
a result of anoxic brain injury due to self-inflicted asphyxiation. We are still awaiting the official
autopsy report and have not yet been not ified when Mr. Amar's body will be released by the local
medical examiner's office for dispos iti on. I would be happy to arrange a te lephone conversat ion
w ith our office rega rding release of records, when they are availab le, and to address concerns
regarding transportation and/or burial.
Should you have any questions or concerns, please do not hesitate to contact me by email or by
phone atj(b)(6); (b)(7)(C)

I

Resp ectf ully,

I

l(b)(6);(b)(7)(C)

Supervisory Detention and Deportation Officer
Seattle Field Office
NWDC-1623 East J St.
Tacoma, WA 98421

b)(6);(b)(7)(C)ol(bl(6l:

~--~

I

(Fax)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000013
2019-ICLl-0005 1 2058



From : ICb)(6); (b)(?)(C)
Sent: Wednesday, November 28, 2018 9:41 AM
~~(b)(6); (b)(?)(C)

Subject: Re: Letter of Condo lence/ AMAR, Mergensana
Dear M~\?!\~!;,~.
Thank you so muc h for your assistance in this matter !
I'll find out his parents's address and let you know as soon as possible.
I have some quest ions to you.
Consular Division has not received any officia l notification on Mr. Amar's arrest in USA, as per Article
12(2) of Bilateral Consular Convention (1964).
In this regard, we would like to know when he was arrested as well as the reasons of his arrest.
Also I kindly ask you to send me copies of his documents confirm ing his Russian citizenship and medical
report or anoth er offic ial document about the reason of his death .
The Embassy is very concerned this situation and we would like to know what is ICE's next steps in this
case . Who w ill do Mr. Amar funera ls? Do ICE plan to transfer Mr. Amar's body to Russia?

Best regards,
l(b)(6); (b)(?)(C)

Consul of Consular Division
Embassy of Russia.
6
7
cpeAa, 28 H0916pfl2018 r. 11:46:19 EST,~f
b_)C
_l_
; C_
bl_
C_
lcc
_J___________

~~ Ham1can(-a):

;
D ear Consu 1 b)(6)
b)(?)(C)

I am wr it i ng yo u regarding the case ofMergensana

AMAR (DOB : 10-23-1978) based at the
Northwest Detention Center in Tacoma , Washington.
I have been the Deportation Officer in
charge of the case and I am respectfully requesting your assistance with getting a letter of
condolence to t he fam il y of M r. AMAR, or if poss i ble, prov ide me with the parent's address so
that I can get that letter delivered to them . Also, Mr . AMAR had a few personal belong i ngs and
our office wou l d like to return those items to the family as well.

Please let me know if yo u are abl e to assist wit h this situat ion, and shou ld you need furthe r
deta il s and or information .

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000014
2019-ICLl-00051 2059



Respectfully ,

fb )(6); (b)(7)(C)

Deportation Officer
1623 E. J St. Suit 9~b)(6

I

Tacoma, WA 98421
Desk (b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000015
2019-ICLl-00051 2060



HCKAH <l>E)l
RUSSIAN FEDERA:

b)(6) ; (b)(7)(C)

-p

AMAP /
A\IA
A A A6AE B H'f

23 10 1971
!\.

M/M

~"o-...:

20 08 201:,

,.c.,..-

~

20 08 2025

b)(6) ;

"'

~b)(7)(C)

PVE RSIG

P<RUSAMAR<<MERGENSANA<<<<<<<<<<<<<<<<<<<<<<<
Hr

s21443826RUS7810233M2508201<<<<<<<<<<<<<<06
2019-ICLl -00051 2061
===-,;a;

DHS-ICE-19-0196, 19-0197-K-000016



Office of Enforcemenr and Remova l Opera lions

U.S. Departm ent. of Homeland Securit y
Seaule Field Office
12500 T ukwila Interna tiona l Blvd.
Tukw ila, WA 98 168

U.S. Immigration
and Customs
Enforcement
Nove mber 30 , 2018
b)(6); (b)(7)(C)
c/o Embassy of Ru ssia
264 1 T unlaw Road , NW
Was hington DC, 20007

Dear Mr. and Mr s. rb)(6); (b)(7)(C)
I am writing yo u on behalf of U.S . Immi grat ion and Customs Enforce ment (ICE) and regret that
I must inform yo u of the dea th of yo ur son, Mergensana A mar. I ex tend to yo u and your famil y
the deepest symp athies of our entire age ncy fo r yo ur loss .
Yo ur son passe d away on Nove mber 18, 20 18. Acco rding to the hosp ital, his deat h was the
res ult of an anox ic brain inj ury due to asp hyxia tion.
In ord er to ensure that all of o ur uestions are answered , P,lease fee l free to co ntact Field Office
Dir ector Brya n S. Wilcox at b)(5); (b)(l)(C)
r Co nsulj<b)(5); (b)(l )(C)
J afb)(
6); (b)(7)(C)

I

(b)(6);
/ h\ / 7 \/r'\

Please acce pt our deepest co ndolences for yo ur loss .

Since rely,

l(b)(6); (b)~)( C)

Brya n S. W ilcox
Acti ng Field Off ice Dir ec tor
Seatt le, WA

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000017
2019-ICLl-0 0051 2062



l(b)(6); (b)(7)(C)

From :

30 Nov 2018 23:49:58 +0000

Sent :

Wilcox Bevans

To:

Cc:
Subject:
Attachments :

l(b)(6); (b)(7)(C)

FW: Letter of Condolence/ AMAR, Mergensana
Amar-condolence _letter 11.30.18 .pdf

FYSA
From~ (b)(6); (b)(7)(C)

Sent : Friday November 30, 2018 3:49 PM

;:r:::~:~:~:nae1
AL <M
1cnae1.A.
Fe
rna
naez~
ICO
.ans
.gov>
Subject : RE: Letter of Condolence/ AMAR, Mergensana

Thank you for forwarding the letter to Mr. Amar's famil y . The or iginal letter will be forward to you
via UPS. Your assistanc e is great ly appreciat ed.
Respectfully,
f b)(6); (b)(7)(C)

SDDO
Seattle Field Office
NWDC-1623 Ea st J St.
Tacom a, WA 98421
(b)(6); (b)(7)(C)
'------'

Fax)

From~ (b)(6); (b)(7)(C)

h

Sent : Friday, November 30, 2018 11:47 AM
To: (b)(6); (b)(7)(C)

Subject : Re: Letter of Condolence AMAR, Mergensana
Dear offic ej(b)(6); ~.
Y ou can send lett er to us and we wi ll transf er it to Mr . Amar' s relat ives .
Our address is 2641 Tu nla w Rd. , W ashin gt on D C, 20007 fo r Con sul ar Di vis ion of the Ru ssi an Emb assy

Best regards,
l(b)(6); (b)(7)(C)

Consul of Consular Divis ion
Embas sy of Russia.

n5!THHl..la,
30 H05!6p5!2018 r. 12:28:53 ES~~b-)(6_)_;<_b)-(7-)(_C)-------------~~

AMERICAr--..

pVERSIGHT

HanHcan(-a):

DHS-ICE-19-0196, 19-0197-K-000018
2019-ICLl-0005 1 2063



Good morning Consu l l(b)(6); ~-

Thank you for passing the information to Mr. Amar's relatives. Our office is required to deliver the letter of
condolence to the Mr. Amar's family and sincere ly appreciate if your Embassy might be willing to act as an
intenned iary in sending the letter to them in Russia. Please let me know if you are able to assist in this matte r and I
will forward the condolence letter to you.

Please contact me if you have any questions or concerns.

Respectfully,
(b)(6); (b)(7)(C)

Supervisory Detention and Deportation Officer
Seattle Field Office
NWDC -1623 East J St.
Tacoma, WA 98421
l(b)(6); (b)(7)(C)
""-!
(b-'-'
)(6
....:.
)a....
; _

___.!(Fax)

Subject: Re: Letter of Condo lence/ AMAR, Mergensana

Good morning, officer !(b)/6) :
Thank you so much for information!

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000019
2019-ICLl-0005 1 2064



I passed all information to Mr. Amar' s relatives and they will contact to you.

Best regards,

r b)(6); (b)(7)(C)

Consul of Consular Divis ion
Embas sy of Russia .

7
6
...._)<_ >_; <_b>_<_><
_c _) -----------------'~
cpe;w, 28 H0$16p$1
2018 r. 19:02:31 EST, l<b

Ham1can(-a):

Dear Consu l (b)(6);
/ h \/ 7 \tr\

I would like to express our sincere appreciation for your assistance in coordinat ing communication with
Mr. Amar 's next of kin for purposes of sending an official condolence letter and forwarding his persona l
effects . In order to fac ilitate delivery of a condolence letter to Mr. Amar's fami ly as expeditious ly as
possible, my office would like to ask if your Embassy might be willing to act as an intermediary in sending
the letter to them in Russia. If you are willing to do this, I will forward the condolence letter to you directly.

As to your questions , Mr. Amar applied for admission to the United States at the San Ysidro port of entry
on December 2, 2017 and was taken into custody after it was determined he did not have valid
documents allowing him to be admitted to the United States. He remained in custody pending remova l
proceedings before an Immigration Judge and subsequent appea l.

Attached is a copy of Mr. Amar's Russian passport . As to your request for additional records , a death
certificate has not yet been issued. At th is time, Mr. Amar's death has been determined to be a result of
anox ic brain injury due to self-inflicted asphyx iation . We are still awaiting the official autopsy report and
have not yet been notified when Mr. Amar 's body will be released by the local medical examiner's office
for dispos ition . I would be happy to arrange a telephone conversation with our office regarding release of
records, when they are available , and to address concerns regarding transportation and/or burial.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000020
2019-ICLl-00051 2065



Respectfully ,

l(b)(6); (b)(7)(C)

Supervisory Detention and Deportation Officer
Seattle Field Office
NWDC-1623 East J St.
Tacoma, WA 98421
(b)(6); (b)(7)(C)
Fax)

~

From j(b)(6); (b)(7)(C)

Sent : Wednesda:

November 28 L2018 9:41 AM

~~
J:::
::::.~II
1

O GOI IOOlel ice I K IM~

Dear M

. Mel gel ISdl Id

b)(6);
b)(7)(C)

Thank you so much for your assistance in this matter!
I'll find out his parents's address and let you know as soon as possible.
I have some quest ions to you.
Consular Division has not received any official notification on Mr. Amar's arrest in USA, as per Article
12(2) of Bilateral Consular Convention (1964).
In this regard, we would like to know when he was arrested as well as the reasons of his arrest.
Also I kindly ask you to send me copies of his documents confirming his Russian citizenship and medical
report or another official document about the reason of his death .

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000021
2019-ICLl-0 0051 2066



TheEmbassyis veryconcernedthis situationandwe wouldliketo knowwhatis ICE'snextstepsin this
case. Whowill do Mr. Amarfunerals? Do ICEplanto transferMr. Amar'sbodyto Russia?

Best regards,

r )(6)
; (b)(7)(C)

Consul of Consular Division
Embassy of Russia .

cpeAa,28 HOS16pS12018
r. 11:46:19EST~l
<b
_)<6
_>;_(b
_l<_7>_
<_
C
) ___________

~~ Han1-1can(-a):

Dear Cons ~(b)(6)
; (b)(7)(C)

I am writing you regarding the case of Mergensana AMAR (DOB: 10-23-1978) based at
the Northwest Detention Center in Tacoma, Washington . I have been the Deportation
Officer in charge of the case and I am respectfully requesting your assistance with
getting a letter of condolence to the family of Mr. AMAR, or if possible , provide me with
the parent's address so that I can get that letter delivered to them. Also, Mr. AMAR had
a few personal belongings and our office would like to return those items to the family
as well.

Please let me know if you are able to assist with this situation, and should you need
further details and or information.

Respectfu Ily,

fb)(6)
; (b)(7)(C)
DeportationOfficer

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000022

2019-ICLl-000512067



1623 E. J St. Suite #2
Tacoma, WA 98421
Desk : l(b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000023
2019-ICLl-00051

2068



Enforcement and Removal Operations

I CE Health Se111ice Corps
U.S. Department of Homeland Security
500 12th Street, SW 2nd Floor
Washington, DC 20536

U.S. Immigration
and Customs
Enforcement
November 16, 2018

MEMORANDUM FOR:

(b)(6); (b)(7)(C) MD
Deputy Assistant Director , Clinical Services

FROM:

SUBJECT:

12/ 19/2017
Detaine e
Detention Center (SLRD

.....
fb_
)(6
_);_(b)_(7_)(C
_)___
__.I
MD
Clinical Director
Northwest Detention Center
Summary of Medical Record
AMAR , Mergensana A#2 16-269-802
DOB 10/23/ 1978; Russia

~~~~"Jo{

NWDC after presen ting him self to San Luis Regional
He was deemed healthy without chronic conditions.

08/ 17/2018
Detaine e had only infrequent and minor visits to medical until being referred for
an RN Wellness Check on this date. He said he was fee ling depressed at having no one in his
dorm to talk you in his native Rus sian language. He asked to be moved to a different dorm , G3
where other Russians resided. He did state he was stressed by his immigration and legal
issues. The record was reviewed by our psychologist and deemed no further MH visit needed
at that time.
08/22/20 18 Was seen by medical provider in clinic for declaration of hunger strike. Patient
explained , "he has no intentions of eating from now on." Stated he is rotestin because he
5); (b)(
?)(C)
Stated he
think s it is taking too long for the immigration system to<b)(
has been in the facility for about 8 months and he wants to be released in the USA . He does not
want to be depo1ted. Denies SI/HI. Detain ee was placed in segregat ion for official meal
monitor ing.
08/25/2018
Detainee was admitted to MHU infirmary for official Hunger Strike. At that
time, he was experiencin g dizziness from not eating or drinking water. Labs were ordered
which he refused. Our mental health social worker was contacted and evaluated him on
08/29/18 .
08/27 - 09/06/2018 Detainee continues to refuse all medical evaluation. This include s vitals,
intake/output measurement, weigh ts and laboratory testing including urinalysis. Detainee
denies taking a shower for 4 days. He denies getting out of bed. He will only accept a book to

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000024
2019-ICLl-00051 2069



Summary of Medical Record: AMAR, Mergensana A#216-269-802
Page 2 of 3

read. He refuses to go to the hospital to get an evaluation. We do not know the extent of his
weight loss. He is not eating anything and only taking small sips of water in the night when he
believes no one is watching. Detainee is clear minded and goal oriented. There is no indication
of hallucination. He states his body hurts all over especially his back. He refuses pain
medication. Declaration for forced IV fluids and monitoring is sent to the court for approval.
09/07 - 10/15/18
Court order received authorizing involuntary vital sign measurement ,
medical care, and IV hydration as needed. Involuntary treatment was not needed as the
detainee allowed labs, vitals and agreed to drink Pedialyte for hydration. At this point he had
lost 27 lbs. from his original baseline weight. After 7 days of drinking only Pedialyte, he
agreed to also drink Boost for calorie supplement to bolster his strength. His vitals stabilized
and lost no further weight. He continued to be seen daily in MHlJ during this time as official
Hunger Strike.
10/ 16/18
Detainee ate a sack lunch which was offered to him, and was frequently taking
fresh fruit off the food trays. As a result, he was taken off hunger strike even though he claimed
continued protest for not accept ing fu ll food trays due to wanting release from detention.
Detainee requested to be in protective custody isolation. He asked to be in D3 but after this
request was made D3 was closed so he was transferred to H Segr egation. He continued to eat
fruit, drink Pedialyte and Boost nourishments.
10/17-10 /25/18 Detainee had daily Seg rounds with the nurse , and pill line nurse brought
him his Pedialyte and Boost three times daily. He refused trips to medical for visits and for
vitals. He did have weekly MH visits.
10/26-11/04 / 18
Detainee was admitted to MHU on Suicide Watch due to GEO finding a
"LONG HAND-MADE ROPE MADE OF BEDDING HIDDEN IN ROOM , AS POSSIBLE
SUICIDAL GESTURE". He was seen by the psych iatr ist and denied SI/HI/AVH . He was put
on constant watch but would refuse to answer questions about any suicidal ideation. Detainee
was transferred from MHU to Segregat ion on 10/29/ 18 still on 10 min irregular mental health
observation (MHO) checks.
11/05 -11/10 / 18
Detainee removed from MHO for previous suicidal gesture. He was
released to GEO for housing. Detainee remained in Segregation due to his request to be housed
there. It was not for disciplinary or medical reasons. His diet remained as Boost, Pedialyte,
PM snack, and fresh fruit.
11/12/ 18
Detainee began eating facility provided meals at lunch, consumed 100% of
lunch and dinner.
11/14/18
Detainee had his Boost and Pedialyte discontinued following his starting to eat
the food on his meal trays consistently. He also expressed his desire to leave segregatio n and
return to General Population.
11/15/ 18
Call for medical emergency in H Segregation. Medical staff responded.
Detainee found hanging with self-made ligature around his neck . Details are still being sought,

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000025
2019-ICLl-00051 2070



Summary of Medical Record: AMAR, Mergensana A#216-269-802
Page 3 of 3

but the preliminary report is the detainee had tied the noose to the upper bunk and was hanging
next to the bed in a near-seated position. Custody staff had cut the noose from his neck,
lowered him to the ground, and cut open his shirt for CPR. He was blue and pulseless. CPR
was initiated. EMS arrived, took over CPR, and the detainee regained a spontaneo us heartbeat
and transported to the hospital. He was intubated and is being treated in the intensive care unit
for anoxic brain injury. Further testing is being done to help determine his prognosis.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000026
2019-ICLl-00051 2071



l(b)(6); (b)(7)(C)

From :

17 Nov 2018 19:36:01 +0000
Wilcox, Bryan S
FW: Med Rec Summary RE: HOSPITALUPDATE- ICU Amar# 216-269 -

Sent:
To:

Subject:
802 SUICIDE ATTEMPT
Attachments:
Medica l Summary Amar, Mergensana 216269802.doc

FYSA
Sent with BlackBerry Work
(www .blackberry .com)
From:r )(6); (b)(7)(C)
Date: nday, Nov I6, 2018, 15:27

Subject : RE: Med Rec Summ ary RE: HOS PIT AL UPDATE - ICU Amar# 216-269-80 2 SUICID E
ATTEM PT
(b)(6);

Dr (b)(7)(C)
Please find the attached medical care summary for your rev iew . Let us know you need
additiona l info.
CAP b)(6); (b)(7)(C)
Depu y

e 1ca

MD USPHS
1rec or

ICE Health Serv ice Corps/ERO/ICE/OHS
610 W. Ash St. (b)(6) , San Diego, CA 92101
{O b)(6); (b)(7)(C)
{C) l(b)(6); ~-

I

From b)(6); (b)(7)(C)

Sent: Fri ay, Novem er 16, 2018 2:13 PM

Subject: Med Rec Summary RE: HOSPITALUPDATE- ICU Amar# 216-269 -802 SUICIDE
ATTEMPT
Please find attached the requested summary.

V/R
CAP'J1 (b)(6); (b)(7)(C)

~ CSW-C

, BCD

Health Services Adm inistrator
USPHS

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000027
2019-ICLl-00051 2072



ICE Health Service Corps
Northwest Detention Cente r
1623 E. J St. Suite l~b)<61
Tacoma , WA 98421
Office :l(b)(6); (b)(7)(C)
BB: b)(6); (b)(7)(C)
Fax
(b)(6); (b)(7)(C)
Warning: This docum ent is UNCLASSIFIED //FOR OFFICIAL USE ONLY (U//F OUO).
It contains informat ion that may be exempt from public relea se under the Freedom of
Informat ion Act (5 U.S.C. 552). It is to be controlled, stored , handled , transmitted,
distributed , and disposed of in accordance with DHS policy relating to FOUO
informat ion and is not to be released to the public or other personnel who do not have a
valid "need-to-know" without pr ior approva l of an autho rized DHS offic ial. No portion of
this report should be furnished to the media, either in written or verba l form.
From:l(b)(6); (b)(7)(C)
Sent: Friday,November 16, 2018 8:23 AM
(b)(6); (b)(7)(C)

SubJect:

RE: HOSPITAL
UPDATE
- ICUAmar# 216-269 -802 SUICEATTEMPT

All,

Dr.!(b)(6); Ineeds a summary of this case by the end of the day to present to Dr ~()~(;r, Would
you be able to put together a summary of stay? It doesn't need to be incredib y etai ed.
Relevant info would include any expressed suicidal ideation, findings of assessments, etc.
know he was on hunger strike previously.
Thanks and let me know if you need assistance.
CAP
~(b)(6); (b)(7)(C) !MDUSPHS
DeputyMedica
l Director
ICEHealthService Corps/ERO/ICE/OHS
610 W. AshSt.f{b
)(6);!SanDiego,CA92101
{O)kb)(6);
I (Cll~b)(6!);
I

Su Ject: RE: HOSPITAL
UPDATE
- ICUAmar# 216-269-802

SUICEATTEMPT

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000028
2019-ICLl-00051 2073



PER Hospital RN,
EEG is not indicated at this time due to the patient not meeting all brain death crite ria.
From~ b)(6); (b)(7)(C)

Sent: Fridav November 16 2018 6:28 AM
(b)(6); (b)(?)(C)

Subject: RE: HOSPITAL UPDATE - ICU Amar# 216-269-802 SUICE ATTEMPT
Per Hospital RN, he does not appear to be a candidate for organ donation.
now to confirm if EEG was performed and will let you know.

Will call the hospital

Thank you
LCDRfbl(5); (b)(?)(C)

I

M LS(ASCP)

Assistant Health Services Administrator
Department of Homeland Security
Immigration & Customs Enforcement (ICE)
Enfo rcement & Remova l Operations (ERO)
USPHS, ICE Health Service Corps.
Northwest Detention Center
1623 East J Stree ~(b)(6I
Tacoma, WA 9842 1
Office: ~b)(6); (b)(7)(C)
Cell: (b)(6); (b)(?)(C)
Fax:
l(b)(6); (b)(?)(C)

Warning: This document is UNCLASSIFIED//FOROFFICIALUSEONLY {U// FOUO). It contains information
that may be exempt from public release under the Freedom of Information Act (5 U.S.C.552). It is to be
controlled, stored, handled, transmitted, distributed, and disposed of in accordance with DHSpolicy
relating to FOUO information and is not to be released to the public or other personnel who do not have a
valid "need -to - know" without prior approval of an author ized DHSofficial. No portion of this report
should be furnished to the media, eit her i n written or verbal form.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000029
2019-ICLl-00051 207 4



From:l (b)(B); (b)(?)(C)

Sent: Friday, November 16, 2018 6 :20 AM
(b)(6); (b)(?)(C)

Subject: RE: HOSPITAL UPDATE - ICU Amar# 216-269-802 SUICE ATTEMPT

i~\i~\;r.,

Thanks for the update LCD
Last night's updates mentioned organ
harvesting/donation . Is that something that is still being considered? I assume someone would
need to give consent to donate organs unless he was a known organ donor.
Has he been declared brain dead? "No brain activity" is mentioned
already?

below-did

they do an EEG

CAPTl(b)(6); (b)(?)(C) j\,1
0 USPHS
Deputy MedicalDirector
ICEHealthService Corps/ERO/ICE/OHS
61'ti'R'~~~~!lJ
San Diego, CA92101
{O ,.__ __

__.

)~b)\~);_- ,

I

From (b)(6); (b)(?)(C)
Sent: n ay, ovem er 16, 2018 6 :16 AM
To : #IHSC SEN Medical ""
(b.,..,
)(.,,.,.6
)"""
; (,..,.
b)""'
(7.,..,.
)(C
=)---------.
; #NWD -Notification-Medical
(b)(B); (b)(?)(C)
. #NWD-Notification
Mental Health J(b)(6);

I

; #IHSC SEN Mental Hea lt h

Subject: FW: HOSPITAL UPDATE - ICU Amar# 216-269-802 SUICE ATTEMPT
Importance : High
Update as of 3:00 PT 11/16/2018: Current Status- Detainee's status remains the same. He is still
non- responsive, has an anoxic brain inju ry, no brain activity, no corneal response, and
intubated. He is still in ICU Room 686. On full life support with a temperature of 40 .1 C (104.18

F).
Information

received from RN (b)(6);

LCD~(b)(6); (b)(?)(C)

/h \/ 7 \/r,\

IMLS(ASCP)

Assistant Health Services Administrator
Department of Homeland Security
Immigration & Customs Enforcement (ICE)
Enforcement & Removal Operations (ERO)
USPHS, ICE Health Service Corps.
Northwest Detention Center

1623 East J Stree *b l(B!
Tacoma, WA 98421
Office (b)(6); (b)(7)(C)
Cell (b)(6); (b)(?)(C)
Fax:
(b)(6); (b)(?)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000030
2019-ICLl-00051 2075



Warning: This document is UNCLASSIFIED//FOROFFICIALUSEONLY(U//FOUO). It contains information
that may be exempt from public release under the Freedom of Information Act (5 U.S.C.552). It is to be
controlled, stored, handled, transmitted, distributed, and disposed of in accordance with OHSpolicy
relating to FOUO info rmat ion and is not to be released to the public or other personnel who do not have a
valid "need-to -know" without prior approval of an authorized OHSofficial. No portion of this report
should be furnished to the media, either in written or verbal form.

Subject: HOSPITALUPDATE

Hospital day #2 in ICU
A#: 216269802
DOB: 10/23/ 1978
COB: Russia
DOA: 12/ 19/2017
Relevant Medical History: Was on Hunger Strike but began eating three
meals a day with liquid nutritional supplements
Reason sent to ER: CPR initiated due to detainee being found unconscious
and hanging with no pulse. Detainee attempted suicide by hanging on
1 l / 15/2018. He was revived on the scene. He had a pulse with regular heart
rhythm on ECG and was being bagged by paramedics when he left the
building
Current Status: Detainee' s status remain s the same. He is still nonresponsive, has an anoxic brain injury, no brain activity, no corneal
response, and intubated. He is still in ICU Room 6B6 . On full life support
with a temperature of 40.1 C (104.18 F).
. receive
. d firom D7'.~
Infiormat10n
n..J. ~~
tcTR)
Maxim Government Services

fb><6>
; (b)(7)<c>

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000031
2019-ICLl-00051 2076



BSN,RN
Northwest Detention Center
ICE Health Service Corps (IHSC)
Enforcement and Removal Operations (ERO)
U.S. Immigration and Customs Enforcement (ICE)
1623 E J St
Tacoma, WA 98391
Office: b)(6); (b)(?)(C)
Fax: (b)(6); (b)(?)(C)
l(b)(6); (b)(?)(C)

The Commissioned Corp s of the U.S. Public Health Service:
"Protecting, promoting and advancing the health and safety of the nation."
CONFIDENTIALITY NOTICE: This document may contain information covered under the Privacy Act, 5
USC 522(a), and/or the Health Insurance Portability and Accountability Act (PL 104-191) and its various
implementing regulations, and must be protected in accordance with those provisions. Healthcare
information is person al and sensitive , and must be treated accordingly . If this correspondence contains
healthcare information, it is being provided after appropriate authorization from the patient or under
circumstances that do not require patient authorization. Re-disclosure without additional patien t consent or
as permitted by law is prohibited. If you receive this correspondence in error, please notify the sender at
once and destroy any copies you have made.
Warning: This document is UNCLASSIFIED //FOR OFFICIAL USE ONLY (U//FOUO). It contains
information that may be exempt from public release under the Freedom of Information Act (5 U .S.C. 552).
It is to be controlled, stored , hand led, transmitt ed, distributed, and disposed of in accorda nce with DHS
policy relating to FOUO infonn ation and is not to be released to the public or other personne l who do not
have a va lid "need-to-know" without prior approval of an authorized DHS official. No portion of this report
should be furnished to the media, either in written or verbal form .

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000032
2019-ICLl-00051 2077



Sent:

Wilcox, Bryan S
22 Nov 2018 02:32:57 +0000

To:

!(b)(6); (b)(?)(C)

Subject :

FW: Request for Status Update Re Amar, Mergensana, A#: 216269802

From :

J

Missed you
Sent with BlackBerry Work
(www.b lackberry.com)
Fro m: Wilcox, Bryan S ._f
b_)<6_);_(b_)(_7)_(C_) ______
Date: Wednesday, Nov 21 2018 6:28 PM

_.

(b)(6); (b)(?)(C)

Subject: RE: Request for Status Upda te Re Amar, Mergensana, A#: 2 16269802

Yes the hospital has contacted the parents last night.
I thought I had notified all parties. I' ll send my previous ema il

Sent with BlackBerry Work
(www.blackbe1Ty.com)
Fromj(b)(6)
; (b)(?)(C)

Date: Wednesda , Nov 21, 20(8, 6:23 PM
b)(6); (b)(7)(C)

ilcox, Bryan
Subject: FW: Request for Status Update Re Amar,
b)(6); (b)(?)(C)

.

b 7 C

" 'lr::==~~:r.-rT"r"rrn-OTr'1r-~

Did an update get sent today regarding fami ly contact and life support status? Please see
belo w. Thx
CAPT
IHSC

6); (b)(?)(C)

MD
irector

b)(6); (b)(

From : l(b)(6); (b)(?)(C)
Date: Wednesday, Nov 21, 2018, 17:58
b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000033
2019-ICLl-00051 2078



b)(6); (b)(7)(C)

Subject: Request for Status Update Re Amar, Mergensana, A# : 2 162698 02

Apologies in advance for this late email. OPLAwas notified today that a group called NWDC

Resistance ~b)(6); (b)(7)(C) 0may seek an adult order of protection from the Pierce
County Superior Court against ICE on behalf of Amar. Do you know if the family has
made contact with the hospital and, if so, what instructions they have given? Also, has there
been any update on the case or the status of the death certificate? Please advise at your
earliest opportunity as this case may be further discussed on Friday.
Happy Thanksgiving to all!

VISOr

Enforcement Law Section
Enforcement and Removal Operations Law Division
Office of the Principal Legal Advisor
U.S. Immigration and Customs Enforcement (ICE)
500 12th Street, S.W.
Washine:ton D.C.20024
(b)(6); (b)(7)(C)

*** Warning *** Attorney/Client Privilege *** Attorney Work Product***
This communication and any attachments may contain confidential and/or sensitive attorney/client
privileged information or attorney work product and/or law enforcement sensitive information. It is not
for release, review, retransmission, dissemination, or use by anyone other than the intended recipient.
Please notify the sender if this email has been misdirected and immediately destroy all originals and
copies. Furthermore do not print, copy, re-transmit, disseminate, or otherwise use this information. Any
disclosure of this communication or its attachments must be approved by the Office of the Principal Legal
Advisor, U.S. Immigration and Customs Enforcement. This document is for INTERNALGOVERNMENTUSE
ONLYand may be exempt from disclosure under the Freedom of Information Act, 5 USC?? 552(b)(S),
(b)(7).
From:l (b)(6); (b)(7)(C)

Sent: Tuesday, November 20, 2018 7:53 PM
r )(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000034
2019-ICLl-00051 2079



b)(6); (b)(7)(C)

SubJect: SDI Update: Amar, Mergensana, A#: 216269802

SDI UpdateCurrent Status 1809 EST: He remains intubated and on BP (levafed) IV for only life support

only despite brain death . This life support will continue for another 24 hours to allow for the
family to contact the attending physician. Dr /(b)(6);
cell phone can be given out for him to be
h \/ 7 \ tr" \
reached by any officials (ICE, Russian government) or fam ily members of the patient. l(b)(6);~~((~(;r If needed he can call a Russian phone number on a three way with a translator.

I

Current Status 1344 EST: No changes from previous update.

He was pronounced brain dead
Sunday 11/18/18 at 1445. He remains intubated and on BP (levafed) IV for his only life
suppo rt. If the family has not been contacted by this afternoon he will be removed from life
suppo rt measures.

Current Status 1044 EST: No changes from previous update. Detainee had massive anoxic brain

injury. He was pronounced brain dead yesterday 11/18/18 at 1445. He remains non-responsive
and intubated with stable vital signs. He is on 1 medication (levafed) to support his blood
pressure. No new updates - awaiting decision from family.
Current Statu s 0821 EST: No changes from previous update. Detainee had massive anoxic brain

injury. He was pronounced brain dead yesterday 11/18/18 at 1445. He remains non-responsive
and intubated with stable vital signs. He is on 1 medication (levafed) to support his blood
pressure.
Location : St. Joseph's ICU Room 6B6 #253-426 -6728

Respectfully,
LCDRl(b)(6); (b)(7)(C)

I

Managed Care Coordinator
Office: (b)(6); (b)(7)(C)
iPhone:
l(b)(6); (b)(7)(C)
Fromj(b)(6); (b)(7)(C)

I

Sent: Monday, November 19, 2018 9:31 AM

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000035
2019-ICLl-00051 2080



b)(6); (b)(7)(C)

ergensana,
Please see SDI UpdatePer ICU RN there are no new updates; still have gotten ahold of next of kin. No treatment
being pursued. Below is the previous update in case anyone missed it, there is no new
information.

ICU Update from Saint Joseph Hospital for 11/18/18 at 1730
Name: AMAR, MERGENSANA
A#:216269802
DOB: 10/23/1978
COB: Russia
DOA: 12/19/2017
Relevant Me dical History: 40 yo Russian male admitted to St Joes Hospital afte r causing selfinflicted harm.
Room : ICU 6B6
Date of Admission: 11/15/2018
Current Diagnosis: Anoxic Brain Injury
~k--,
Attending physician: Dr. ~/~
Current status: Cerebral blood flow study done today showed no flow to the brain. All testing
indicates brain death, so the patient is now declared dead and life support will be turned off
unless there is next of kin to request otherwise. Life Centers Northwest is requesting for organ
donation but with no available next of kin there is no one to authorize this.
Discharge Plan: Will be turned over to the medical examiner
Information provided by (name and title): DrKb)(6); _ and the CMO Dr 1Cb)(6); (b)(7)(C)

I

I

Respectfu Ily,
LCD (b)(6); (b)(7)(C)

er 19, 2018 7:09 AM

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000036
2019-ICLl-00051 2081



(b)(6); (b)(7)(C)

Subject: SDI Update: Amar, Mergensana, A#: 216269802

Good morning, please see SDI update:
ICU Update from Saint Joseph Hospita l for 11/18/18 at 1730
Name: AMAR, MERGENSANA
A#: 216269802
DOB: 10/23/1978
COB: Russia
DOA: 12/19/2017
Relevant Medical History : 40 yo Russian male admitted to St Joes Hospital after causing self inflicted harm .
Room : ICU 686
Date of Admiss ion : 11/15/2018
Current Diagnosis: Anoxic Brain Injury
Attending physician: Dr.l(b)(6);
Current status : Cerebral blood flow study done today showed no flow to the brain. All testing
ind icates bra in death, so the pat ient is now declared dead and life support will be turned off
unless there is next of kin to request otherwise . Life Centers Northwest is requesting for organ
donation but with no available next of kin there is no one to authorize this .
Discharge Plan: W ill be turned over to the medical examiner
Information provided by (name and t itle): D~b)(6); _ pnd the CMO D~(b)(6)
; (b)(7)(C)

I

fbl(6); (b)(?)(C)

~ RN, MSN, NP-C

LCDR, United States Publ ic Health Service
Managed Care Coordinator
ICE Health Service Corps
Imm igration Customs Enforcement
Enforcement Removal Operation
500 li h St. SW
Washington , DC 20536
iPhone: !(b)(6); (b)(7)(C)
efaxl(b)(6); (b)(7)(C)
fb)(6); (b)(7)(C)

I

The Commissioned Corps of the U.S. Public Health Service:

"Protecting, promoting, and advancing the health and safety of the nation."
Warning: This document is UNCLASSIFIED//FOR OFFICIAL USE ONLY (U//FOUO) . It
contains information that may be exempt from public release under the Freedom of
Information Act (5 U.S.C. 552). It is to be controlled, stored , handled, transmitted,
distributed, and disposed of in accordance with OHS policy relating to FOUO information
and is not to be released to the public or other personnel who do not have a valid "need-

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000037
2019-ICLl-00051 2082



to-know" withou t prior approval of an authorized OHS official. No portion of this report
should be furnished to the media, eithe r in written or verbal form.

From j(b)(6); (b)(?)(C)

Se nt: Sunday, November 18, 2018 3:58 PM
b)(6); (b)(?)(C)

ergensana,

Please see SDI update:
Current status as of 09:42 am PST:
Pt is no longer over breathing the ventilator, his oxygenation and pH have improved. His blood
pressure is stable with less IV pressor support . He is making urine with stable renal function and
normal potassium. He has no reflexes or response to any stimuli. His EEGresult showed no brain
activity. The attending physician has not yet rounded. The hospital will follow their protocols for
his medical care and keep us posted .
Respectfu Ily,
~l
(b_)(6_);_(b_)(?_)(C
_ )__

~IRN, MSN, NP-C

LCDR,USPHS
Managed Care Coordinator
ICE Health Service Corps
500 12th St. SW
Washington, DC 20536
i Phone: (b)(6); (b)(?)(C)
Efax (b)(6); (b)(?)(C)
(b)(6); (b)(?)(C)

Sent with BlackBerry Work
(www. blackberry.com )
From:fb )(6); (b)(?)(C)

Date: Saturday, Nov 17, 2018, 10:09 PM
r b)(6); (b)(?)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000038
2019-ICLl-00051 2083



(b)(6); (b)(7)(C)

SubJect:Saturday 11/17 : SDI Update: Amar, Mergensana, A#: 216269802

Please see SDI update:
Status update as of 18:55 PST

Pt with unstable blood pressure and temperature in deep non responsive coma with
fixed and dilated pupils. He is on the venti lator with BP IV support . He has mild to
moderate kidney dysfunction at this time so dialysis is not indicated. Nephrologist was
at the hospital doing a consultation. The EEG results are back showing no active brain
waves . The hospital ethics committee will be convening but the prognosis is very poor
for any meaningful neurological recovery. The patient has been having all necessary life
support to this time with nothing withdrawn . They are recommending this patient be
DNR in the case of sudden cardiac arrest. They wi ll continue to give us updates on the
patient's condition including treatment recommendations or any recommendations for
withdrawal of care.

Respectfu Ily,
~l
(b_)(6_l;_(b_)(7_)(C
_ )_~I

RN, MSN, NP-C

LCDR, USPHS
Managed Care Coord inator
ICE Health Service Corps
500 12th St. SW
Wash ington, DC 20536
iPhone: (b)(6); (b)(7)(C)
Efax: (b)(6); (b)(7)(C)
l(b)(6); (b)(7)(C)

Sent w ith BlackBerry Work
(w ww .bl ackb err y.co m)
From1 (b)(6); (b)(7)(C)

Date: Saturday, Nov 17, 2018, 3:57 PM

r

b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000039
2019-ICLl-00051 2084



(b)(6); (b)(?)(C)

Please see am update:
Status as of 09:30 PST:
Stable with no changes .Warden ordered

no escalation

of care. EEG /Neurology

testing is

Pending.

Respectfu Ily,
~l
(b_)(6_);_(b_)(7_)(_C)__

~IRN, MSN, NP-C

LCDR, USPHS
Managed Care Coordinator
ICE Health Service Corps
500 12th St. SW
Washin ton DC 20536
iPhone: (b)(5); (b)(?)(C)
Efax: (b)(6); (b)(?)(C)
~b)(6); (b)(?)(C)

Sent with BlackBerry W ork
(www .blackberry.com )
Fromf b)(6); (b)(?)(C)

Date : Saturday, Nov 17, 2018, 1:10 AM
b)(6); (b)(?)(C)

Subject: SDI Update: Amar, Mergensana, A#: 216269802

Please see SDI UpdateName: Amar, Mergensana

A#:21 6269802
DOB: 10/23/1978
COB: Russia

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000040
2019-ICLl-00051 2085



DOA: 12/19/2017
AOR: SEA
Facility: Northwest Detention Center
Relevant Medical History: Was on Hunger Strike but current ly eating three meals a day
with liquid nutritional supplements
Reason sent to ER: CPR initiated due to detainee being found unconscious and hanging
with no pulse.

11/16/2018 Current Status ICU Update as of 20:15 PST: Detainee has massive anoxic brain
inj ury. He remain s unstable, non-responsive , and intubated. He is on 3 different med icat ions to
support his blood pressure. He had a neurolo gy consu lt and EEGcompleted but results w ill not
be available unti l tomorrow or the day after (due to being the weekend).
11/16/2018 Current Status ICU Update as of 14:00 PST: Pt with massive anoxic brain injury. He
is intubated with no reflexes except for respiratory hyperventilation which is not life sustaining.
Pt is now having an EEGtest. His blood pressure is slowly dropping despite being on pressor IV
drip. His immediate prognosis is very poor.
Location: St Joseph's Hospital, ICU Rm 6Bravo6.

11/16/2018 (1239) Current Status: Pt with massive anoxic brain injury. He is intubated
with no reflexes except for respiratory hyperventilation which is not life sustaining. His
temperature and blood pressure are very unstable. He has started having seizures which
are being treated and is requiring large dose medication to support his blood pressure.
He will have a neurology consult with EEGtoday but is on supportive care and may still
code again at any moment.
He is still in ICU Room LOCATION: St Joseph's Hospital , ICU
Rm 6Bravo6.
Attending Physician: Dr ~~~m(C) Trauma Physician , RNl(b)(6); Jat l(b)(6);(b)(7)(C)
11/16/2018 Current Status: Update as of 6:45 am PT: Current Status - remains the
same. He is still non-responsive, has an anoxic brain injury, no brain activity, no
corneal response, and intubated. He is still in ICU Room 686. On full life support with
a temperature of 34.9 C and a warming blanket. Labs are all abnormal. No gag reflex,
no retraction from painful stimuli but he is still overbreathing the ventilator. EEG is
not indicated at this time due to the patient not meeting all brain death criteria.
11/16/2018 0300 Current Status: Detainee's status remains the same. He is still nonresponsive, has an anoxic brain injury, no brain activity, no corneal response, and
intubated. He is still in ICU Room 686. On full life support with a temperature of 40.1
C (104.18 F).
Information received from RN(b)(6);
(b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000041
2019-ICLl-00051 2086



11/15/2018

(PM) Current Status: 2hrs update: patient is still non-responsive, has an

anoxic brain injury, No brain activity, No corneal response, intubated.
estimated time when Organ Life Center will arrive.

11/15/2018 Current Status: 1935 Per

Moved to ICU.No

~(i~(rci

N in ER: detainee is still non-responsive,
has an anoxic brain injury, No brain activity, No corneal response, intubated. Moved to
ICU Room 6B6 at 1930, Nurse will be b)(6); No estimated time when Organ Life Center
h \/ 7 \/(""\
will arrive.
Mode of transportation: ACLS
Name of Transport Company: Tacoma Fire and Rescue
Hospital being sent to: St. Joseph's
The above detainee attempted suicide by hanging on 11/15/2018. He was revived on
the scene by Tacoma Fire and Rescue. He had a pulse with regular heart rhythm on ECG
and was being bagged by paramedics when he left the building at 1535. LCDRfbJ(6)j
6);~- !received a 2 hour update at 1735.
ICb)C

Respectfully,

LCD (b)(6); (b)(7)(C)
Manage Care Coor inator
Office: (b)(6); (b)(7)(C)
iPhone
(b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000042
2019-ICLl-00051 2087



Ge(R)

MEMORANDUM

Corrections

Date:
To:

The GEO Group, Inc.
GEO Corrections

November 16, 2018
7

.....
l(b
-)(6_>;-(b-l( _>(c
_>__

Northwest Detention Center
1623 East J . Street
Tacoma WA 98421

_.IDirector of Operations

www.geogro up.com

cc:
From:

i<b)(6); (b)(?)(C)

RE:

SUICIDE ATTEMPT TIME LINE
AMAR, MERGENSANA A# 216269802

!Warden

~;)~\re:,
nitiated

On Nove mber 15, 2018 at 1506.32 (Verified via camera footage) hour s Officer
an Incident Management System (IMS) in the Restrictive Housing Unit (RHU) ce
Amar, Mergensana A# 216269802 was causing self-harm by hanging.

106; detainee

At 1440.18 Officer [~lm(C) onducts health and Welfare check on cell 106.

i~\i
~\rci

as viewed on camera conducting his health and welfare check. He
At 1506.32 Office
reports he saw detamee mar in a sitting position with a pillow case over his head and a thin
twine tied to the top bunk ending under the pillow case . Imm ediately initiates an IMS.
At 1507 .26 Responding staff arrive to assist with the incident.
At 1507.31 (Verified via camera footage) respon ding staff ente red the cell and lifted the detainee
to loosen the pressure around his neck and use the life knife to cut the twine.
At 1507.57 The detainee was removed from the cell and laid on the floor .
At 1508.10 Responding staff begin to access the detainee and administer first aid.
At 1508.55 (Verified via camera footage) IHSC medical staff arrived and started administering
CPR to the deta inee on the floor outside the cell.
At 1511 Medical staff arrive with the facility gurney
At 1512 hour (b)(5); (b)(?)(C) Associate Warden of Finance was notified of the situat ion.
At 1515 l(b)(6)
; (b)(?)(C)

poti fied Warde (b)(5); (b)(?)(C)

At 151~b)(5); (b)(?)(C)

IAFOD , was notified .

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000043
2019-ICLl-00051 2088



At 1516.20 an EMS ambulance arrived at the facility and EMS paramedics took over CPR of the
detainee.
At 1525.16 EMS paramedics are still conducting CPR on the detainee.
At 1527.15 Detainee is assisted to the gurney by the EMS paramedics and still conducting CPR.
At 1528.23 Detainee is being escorted out of the RHU onto the ambulance.
At 1529 paramedics reported that the detainee had a pulse and would be taken to St. Joseph
Hospital.
At 1531 RHU cell 106 was secured as a crime scene.
At 1534.39 the ambulance departs the facility with detainee Amar and escorting staff.
At 1536.18 TPD arrives to the scene.
was in the ambulance
At 1536 the ambulance arrived at St. Joseph Hospital. Officers b)(~t --,
5
7
5
and Officer (b)( ); (b)( l(C) was in the chase vehicle. Officer (b)( );
was ordered to report to the
shift every 15 minutes with an update on the status of the detainee.

~l~
~lc
c)

reported that as the detainee arrived at the hospital CPR was being
At 1545 hours Sgt.
by EMS staff.
administered to the aetm:nre'1e
At 1617 GEO hospital staff reported that the detainee was intubated to assist with breathing and
was currently in X-ray.
At 1627 GEO officers at the hospital report that x-ray results indicate no brain activity that this
would have to be verified by a neurologist.
At 1637 it was reported that detainee Amar was moved to room Bl at St. Joseph hospital and
that hospital staff are requesting next of kin information.
At 1638 TPD forens ics enters the cell.
At 1720 TPD forensics completes their initial investigation.
On August 22, 2018 Detainee Amar was placed in the Restrictive Housing Un it at the request
from medical to monitor meals. Medical classified Detainee Amar as a hunger strike on August
25, 2018 and placed in the MHU. On October 16, 2018 Detainee Amar is no longer on hunger
strike per medical and was released to genera l population.
On October 16, 2018 Detainee Amar was placed in the Restrictive Housing Unit due to refusing
to go to genera l population and requested to be placed on Protective custody without reason.

AMERICAr--..

pVERSIGHT

Page 2 o/3

2019-ICLl-00051 2089

DHS-ICE-19-0196, 19-0197-K-000044



On October 26, 2018 at approxima tely 1815 hours Detainee Amar 216269802 was placed on
suicide watch by medica l staff, due to staff finding a rope made from a sheet approximately 6
feet long during a routine cell search. The Suicide watch ended on October 27, 2018 at 1010
hours per medical.
On October 28, 2018 Detainee Amar was released from the Medical Housing Unit (MHU) and
placed in the Restrictive Housing Unit (RHU) under protective custody at his request.

AMERICAr--..

pVERSIGHT

Page 3 o/3

2019-ICLl-00051 2090

DHS-ICE-19-0196, 19-0197-K-000045



From:

Sent:

~b)(6); (b)(?)(C)

16 Nov 2018 22:07:39 +0000

To:

Cc:
Subject:
Attachments :

";::!
(b=
)(==
6)=;(=b
)::::::
(?==
)(C
===
)==:::;-------------'Wilco
r b)(6); (b)(?)(C)

x, Bryan

S

FW: Re: How close ..
Amar suicide attempt time line.doc

FYSA
From:f b)(6); (b)(?)(C)

Sent: Friday, November 16, 2018 1:32 PM
To: fb )(6); (b)(?)(C)

Subject: Fwd: Re: How close ..

She attached
Get Outlook for Android

Froml <b)(6); (b)(?)(C)

Sent: Friday, November 16, 2018 1:27:32 PM
To (b)(6); (b)(?)(C)

Here it is boss

rb )(6); (b)(?)(C)

Captain
GEO Corrections

& Detention

(R)

Northwest Detention Center
1623 East J Street
Tacoma Washin ton 98421
Tel:

b)(6); (b)(?)(C)

Cel I : i<b)(6); (b)(?)(C)
l(b)(6); (b)(?)(C)

www.geogroup.com

This email and any files transmitted with it are confidential and are intended solely for the use of the
individual or entity to which they are addressed. If you are not the intended recipient or the person

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000046
2019-ICLl-00051 2091



responsible for delivering the email to the intended recipient, be advised that your have received this
email in error and that any use, dissemination, forwarding, printing or copying of this email is strictly
prohibited. If you have received this email in error, please immediately notify by replying to this email.

From: r b)(6); (b)(7)(C)

I

Sent: Friday, November 16, 2018 1:14:09 PM
To:j (b)(6); (b)(7)(C)

I

Subject: How close ..

Are you to being finished .
Get Outlook for And roid

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000047
2019-ICLl-00051 2092



Fro m :

Se nt:
To:

Subje ct:

~b)(6); (b)(7)(C)
18 Nov 2018 00:58:20 +0000

rb)(6); (b)(7)(C)

1

FW: Saturday 11/17: SDI Update: Amar, Mergensana, A#: 216269802

Please see below from OPLA HQ.
We need succinct language from OPLA to convey to thehospital

Sent with BlackBerry Work
(www.blackberry.com)

I>

From :l(b)(6); (b)(7)(C)

Date: Saturday , Nov l 7, 2018 , 3:55 PM

To:Kb)(6)
;(b)(7)(C)
fb)(6);(b)(7)(C)

tNilcox, Bryan S

Subj ect : FW: Saturday 11/17: SDI Update: Amar, Mergensana , A#: 216269802

See below
5 ); (b)(?)(C)
CAPT l(b)(
ILCSW-C, BCD
Health Services Administrator
USPHS
ICE Health Service Corps
Northwest Detention Center
1623 E. J St. Suit~ l<bl/6!
Tacoma, WA 98421
I
Office :l<b)(6); (b)(7)(C)
BB: b)(6); (b)(7)(C)
Fax
~b)(6); (b)(7)(C)
I

Warning: This document is UNCLASSIFIED//FOR OFFICIAL USE ONLY (U//FOUO).
It contains information that may be exempt from public release under the Freedom of
Information Act (5 U.S.C. 552). It is to be controlled, stored, handled, transmitted,
distributed, and disposed of in accordance with DHS policy relating to FOUO
information and is not to be released to the public or other personnel who do not have a
valid "need-to-know" without prior approval of an authorized DHS official. No portion of
this report should be furnished to the media, either in written or verbal form.
Fro m: kb)(6); (b)(7)(C)

Date: Saturday, Nov 17, 2018 , 3:26 PM

rX6J;(b)( 7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000048
2019-ICLl-00051 2093



Subject: FW: Saturday 11/17: SDI Update: Amar, Mergensana, A#: 216269802
(b)(6);
(b)(?)(C)

One of the HQ OPLA attorneys just sent this. Maybe this will help when you talk with
(b)(6);
(b)(7)(C)

CAP~

IMD

(b)(6); (b)(?)(C)

IHSC Deputy Medical Director
202-210-1694
Fro~

(b)(6); (b)(?)(C)

Date: Saturda , Nov I/, 2018 , 15:22
(b)(6); (b)(?)(C)

Good evening all,
Thank you so much for keeping us in the loop on this case- it is much appreciated.
(b)(5)

Of course, GEO should also have its own counsel who can offer guidance to the warden
and other facility staff on these issues.
Hope this is helpful - don ' t hesitate to reach out with any question s.
Best
(b)(6);
/ h \/ 7 \/r

\

l(b)(6); (b)(?)(C)

I

Associate Legal Advisor
ICE/OPLA/EROLD

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000049
2019-ICLl-00051 2094



(b)(6); (b)(7)(C)

desk
cell

Sent with BlackBerry Work
(www.blackberry.com)
Fromfb )(6); (b)(7)(C)
Date: Satur day, Nov I 7, 20 18, 3:57 PM
(b)(6); (b)(7)(C)

Subject: Saturday 11/17: SDI Update: Amar , Mergensana , A# : 216269802

Please see am update:
Status as of 09:30 PST :
Stable with no changes .Warden ordered no escala t ion of care. EEG/Neuro logy te st ing
is Pending.

Respectfully,
f b)(6); (b)(7)(C)

IRN, MSN, NP-C

LCDR , USPHS
Manage d Care Coordinator
ICE Health Serv ice Corps
500 12th St. SW
Washington , DC 20536
iPhon (b)(6); (b)(7)(C)
Efax : b)(6); (b)(7)(C)

Sent with BlackBerry Wor k
(www.b lackberry.com)

r

From )(6); (b)(7)(C)
Dat e:aturday , Nov 17, 2018 , 1:10 AM
b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000050
2019-ICLl-00051 2095



(b}(6); (b}(7)(C)

Please see SDI UpdateName: Amar, M erge nsana

A#:2 16269802
DOB: 10/23/ 1978
COB: Russia
DOA: 12/ 19/2 017
AOR: SEA
Facility: Nor th west Deten tio n Center
Relevant Medical History: Was on Hunge r Strike but curre nt ly eat ing th ree me als a day
wit h liq uid nut rit io nal supplements
Reason sent to ER: CPR initiated due to detainee being found unconscious and hanging
with no pulse.
11/16/2018 Current Status ICU Update as of 20 :15 PST: Detainee has massive anoxic brain
injury. He remains unstab le, non-responsive, and intubated. He is on 3 different medications to
suppo rt his blood pressure. He had a neurology consult and EEGcomp leted but results will not
be available until tomorrow or the day after (due to being the weekend).
11/16/2018 Current Status ICU Update as of 14:00 PST: Pt with massive anoxic brain injury. He
is intubated with no reflexes except for respiratory hyperventilation which is not life sustaining.
Pt is now having an EEGtest. His blood pressure is slowly dropping despite being on pressor IV
drip. His immediate prognosis is very poor.
Location: St Joseph's Hospit al, ICU Rm 6Bravo6.
11/16/2018 (1239) Current Status: Pt with massive anoxic brain injury. He is intubated
with no reflexes except for respiratory hyperventilation which is not life sustaining. His
temperature and blood pressure are very unstable. He has started having seizures which
are being treated and is requiring large dose medication to support his blood pressure.
He will have a neurology consult with EEGtoday but is on supportive care and may still
code again at any moment. He is still in ICU Ro om LOCATION: St Joseph's Hosp ita l, ICU
Rm 6Bravo6 .
b_H6_l;_(b_)<7_l<
_c_) ____
__.
Atte nd ing Physician : Dr~~/\~L, ~ Trau ma Physic ian, R~._
11/16/2018 Current Status : Update as of 6:45 am PT : Current Status - remains the
same . He is still non-responsive, has an anoxic brain injury, no brain activity, no
corneal response, and intubated . He is still in ICU Room 6B6. On full life support with a
tempe rature of 34 .9 C and a warming blanket . Labs are all abnormal. No gag refle x, no
retraction from painful stimuli but he is still overbreathing the ventilator . EEGis not
indicated at this time due to the patient not meet ing all brain death criteria .
11/16/2018 0300 Current Status: Detainee 's status remains the same . He is still nonresponsive, has an anoxic brain injury, no brain activity, no corneal response, and
intub ated . He is still in ICU Room 6B6. On full life support with a temperature of 40 .1 C
(104.18 F).

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000051
2019-ICLl-00051 2096



Information received from RN Molly .
11/15/2018 (PM) Current Status: 2hrs update: patient is still non-responsive, has an
anoxic brain injury, No brain activity, No corneal response, intubated. Moved to ICU.No
estimated time when Organ Life Center will arrive.
11/15/2018 Current Status: 1935 Pe~b)(6)
; _ IRN in ER: detainee is still non-responsive,
has an anoxic brain injury, No brain activity, No corneal response, intubated. Moved to
ICU Room 6B6 at 1930, Nurse will bej(b)(6); INo estimated time when Organ Life Center
will arrive.
Mode of transportation: ACLS
Name of Transport Company: Tacoma Fire and Rescue
Hospital being sent to: St. Joseph's
The above detainee attempted suicide by hanging on 11/15/2018. He was revived on
the scene by Tacoma Fire and Rescue. He had a pulse with regular heart rhythm on ECG
and was being bagged by paramedics when he left the building at 1535. LCD \~/\~/;
!(b)(6); !received a 2 hour update at 1735.
Respectfully,
LCDRl(b)(6); (b)(7)(C)
Managed Care Coordinator
Office: (b)(6); (b)(7)(C)
iPhon _____
l(b)(6); (b)(?)(C)

~

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000052
2019-ICLl-00051 2097



From :

Wilcox, Bryan S

Sent:

16 Nov 2018 01:22:10 +0000

To:

Subject :

rb)(6); (b)(7)(C)

1

FW: SEAsuicide attempt

FYSA

Sent with BlackBerry Work
(www.blackberry.com)
From: Wilcox, Bryan S f....,,
b=
)(6);~
~(b~)(7
~)(~C~) ~--------'
Date: T hursday , Nov 15, 2018 , 5:2 1 PM

To~(b)(6); (b)(7)(C)

Subject : FW: SEA suicide attempt

b)(6);
h \ (7\ (1.\

A heads-up that Amar has comitted suicide by hanging. He has a pulse, but has no brain
activity. This just happened over the past two hours. I'll send you a copy of the ES when
it's done.
Of course, no one knows about this yet, just us

Sent with BlackBerry Work
(www.blackberry.com)
From: Wilcox, Bryan s ...
~b-)(6_J;_(b_l(_7l_(c_J______
Date: Thur sday , Nov l 5, 2018 , 5: 16 PM

__,

1~)(6);

(b)(7)(C)

Subject: RE: SEA suicide attempt

I' ve been in conversation withl._
<b_l<6_l;_(b_l<_7l_<c_J _____

___.

This is an on-going situation and I've ju st heard through GEO (but not IHSC) that the
hospital teports he has no brain activity.
We are preparing an ES/death notice

Sent with BlackBerry Work
(www.blackberry.com)
From~b )(6);(b)(7)(C)
Date : . hursday , N ov I.5, 2018 , 4:43 PM

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000053
2019-ICLl-00051 2098



To: Wilcox , Bryan S
Cc: (b)(6); (b)(7)(C)

b)(6); (b)(7)(C)

(b)(6); (b)(7)(C)

Good evening,
I dont recall seeing a SEN on this situation. Please see below, the UC would like an ESin
the morning unless the sitauation gets worse. I hope nothing bad happens but please
see a go -by death notification just in case.

Fro m! (b)(6); (b)(7)(C)

Date : Thursday, Nov 15, 2018, 6:59 PM
Tofb )(6); (b)(7)(C)

Subject: SEA suicid e attempt

Good evening
There was a serious suicide attempt in SEA . This is the text from

r b)(6 ); (b)(?)(C)

SEA had a serious suicide attempt
Detainee hung himself, blue in the.face, now has pulse and on way to hospital.
Amar, A216269802
A SWB case, Russian national on extended unofficial hunger strike (drinking boost,
eating occasional fruit)
No need for an ES for our man agemen t tonight but they ' ll need to provide something first
thing in the AM.
Unless he goes south, then norma l detainee death protocol.
Let me know if you need anything additiona l informat ion.
Thanks .
f b)(6); (b)(7)(C)

Unit Chief
Dome stic Operations West
r b)(6); (b)(7)(C)

1

Sent with BlackBerry Work
(www .blackberry .com)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000054
2019-ICLl-00051 2099



From :

Wilcox,

Se nt:

Bryan S

16 Nov 2018 20:18:53
l(b)(6); (b)(?)(C)

To :

Subject:

+0000

FW: SEN Suicide Attempt

A216 269 802 AMAR

Bryan S. Wilcox
Acting Field Office Director
ICE Enforcement & Removal Operations , Seattle, WA

11Desk:

Main J(b)(5); (b)(?)(C)

I/ Cell

Kb)(6); (b)(?)(C)

J~
(b-)(6~);-(b~)(?~)(=c )-~

CONFIDENTIALITY: This email and attachments are intended for the above name only and are confidential. If you are not the
intended addressee, or the person responsible for delivering it to the intended addressee, you may neither copy, disseminate, nor
distribute it to anyone else or use it in any unauthorized manner. To do so is strictly prohibited and may be unlawful. If you receive
this email by mistake, please advise the sender immediately by using the reply facility in your mail software and delete it from your
computer.

I

From :l(b)(6); (b)(?)(C)

Se nt: Friday

, November

16, 2018 12:14 PM

r b)(6); (b)(?)(C)
~T-o-j(-b)-(6-);-(b-)(?_)(_C_) --;::::::==========---------------~~

Cc: Wilcox,

sf~b_)(_6)_;(_b)_(?_)(C_)______

Bryan

Subject : RE: SEN

Suicide Attempt

SEN 2019SIR0002221

successfully

1

~

A216 269 802 AMAR
submitted

.

X

l11111gefnNnwebpege
You have successfully submitted report number
2019SIR0002221.

OK

From : rb)(6); (b)(?)(C)

Se nt: Fr iday ,

November
To :l(b)(6); (b)(?)(C)

16, 2018 11:48 AM

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000055
2019-ICLl-00051 2100



I

Cc: f b)(6); (b)(?)(C)
Subject: FW: SEN Suicide Attempt A216 269 802 AMAR
Good to go.
From~ (b)(6); (b)(?)(C)

Se nt : Friday, November 16, 2018 10:00 AM
To : Wilcox, Bryan S b)(6); (b)(?)(C)
Cc (b)(6); (b)(?)(C)

Subject : SEN Suicide Attempt A216 269 802 AMAR

Bryan ,
For your review and appro val:

On November 15, 2018, at 3:16 PST,GEO staff at the Northwest Detention Center alerted EROSeatt le
that an IMS had been called after detainee Mergensana AMAR, A216 269 802, a 40-year -old cit izen of
Russia, was discovered attempting self-harm by strangulation. The Tacoma Fire and Rescue paramedics
responded, init iated cardiopu lmonary resuscit ation, and transported AMAR to Saint Joseph's Hospital in
Tacoma, WA, where he remains in the ICU and his condition is unstable .

Immigrat ion and Criminal History:

On December 2, 2017, AMAR applied for admission with a valid Russian passport at the San Ysidro, CA
Port of Entry (POE). AMAR claimed fear of returning to Russia and requested asylum in the United
States. U.S. Customs and Border Protection (CBP)determined AMAR to be inadmissible pursuant to
section 212(a)(7)(A)(i)(I) of the Immigration and Naturalizat ion Act (INA), as amended, as an immigrant
without immigrant visa, and processed him for an expedited removal pending a cred ible fear claim .
On December 6, 2017, CBPtransferred AMAR to EROSan Diego custody at the San Luis Regional
Detention Center.
On December 19, 2017, EROSan Diego transferred AMAR to EROSeattle at the Northwest Det ention
Center in Tacoma, WA to await a credible fear interview with United States Citizenship and Imm igration
Services (USCIS) Asylum off ice in San Francisco, CA.
On January 3, 2018, a USCISSan Francisco Asylum Pre Screening Officer (APSO)conducted a telephonic
interview with AMAR in Tukw ila, WA.
On January 4, 2018, the APSO rendered a positive credible fear determinat ion in AMAR' s case and
served him a Notice to Appear, Form 1-862, alleging inadmissibi lity pursuant to section 212(a)(7)(A)(i)( I)
of the INA, as amended, as an immigrant without immigrant visa.
On February 1, 2018, an immigration judge (IJ) in Tacoma, WA determined the court had no j urisdiction
in a custody hearing due to AMAR being an arriving alien.
On February 7, 2018, EROSeattle served AMAR a Parole Advisal and Scheduling Notification.
On February 26, 2018, EROSeattle denied AMAR parole due to posing a risk of flight .
On August 7, 2018, an IJ in Tacoma, WA denied AMAR's application for asylum, w ithholding of remova l,
and withhold ing of removal under the Convention Against Torture (CAT) and ordered AMAR removed to
Russia. AMAR reserved appeal, which was due by Septembe r 6, 2018.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000056
2019-ICLl -00051 2101



On August 22, 2018, AMAR declared himself to be on hunger strike and IHSCbegan monitoring his
meals.
On August 25, 2018, AMAR declined his ninth consecutive meal and IHSCinitiated hunger strike
protocol.
On September 6, 2018, ICEobtained a medical monitoring/force hydration order from the United States
District Judge. Amar began drinking Pedialyte and allowing medical monito r ing. AMAR also began
drinking boost nut r itional shakes and eating pieces of fruit .
On September 19, 2018, EROSeattle scheduled AMAR for an escorted commercial removal with his valid
Russian passport for October 24, 2018.
On October 1, 2018, AMAR filed an untimely notice of appeal with the Board of Immigration Appea ls
(BIA). EROSeattle cancelled AMAR's scheduled removal.
On October 16, 2018, AMAR consumed a full meal and IHSCdeclared an end to official hunger strike
protocol.
On November 2, 2018, the BIA dismissed AMAR's appeal as having been filed untimely.
On November 8, 2018 EROSeattle scheduled AMAR for an escorted commercial removal to Russia on
November 28, 2018.
On November 15, 2018, at approximately 3:06 P.M PST,GEO contract staff at the Northwest Detention
Center observed AMAR, in his cell in the restric t ed housing unit, causing self-harm by self-induced
strangulation and initiated the Incident Management System (IMS).
On November 15, 2018, at approximately 3:09 P.M PST,ICE Health Service Corps (IHSC)arrived and
began adm inistering CPRto AMAR.
On November 15, 2018, at approximately 3:29 P.M ..PST,paramed ics reported that AMAR had a pulse
and transported him to Saint Joseph's Hospital in Tacoma, WA.
On November 15, 2018, at 3:42 P.M . PST,EROSeattle notified ERO HQ Field Operations of AMARs
suicide attempt.
On November 15, 2018, at 5:31 P.M .. PST,IHSCnotified EROSeattle that AMAR had no brain activi t y and
was pend ing additional testing.

EROSeattle and local IHSCare carefully monitoring the case; Seattle OCChas been made aware of the
case and is also monitor ing.
Acting Field Off ice Director Bryan S. Wilcox reviewed and approved the SIR.

~b)(6); (b)(7)(C)

Assistant Field Office Director
DHS/ICE/ERO
Nor thwest Detention Center
Seattle Field Office
Des b)(6); (b)(7)(C)
Cell:

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000057
2019-ICLl-00051 2102



Case 3:18-mc-05016-BHS

Document 4

Filed 09/06/18

Page 1 of 3

1
The Honorable Judge Benjamin H. Settle

2
3
4

5
6
UNITED STATES DISTRICT COURT FOR THE
WESTERN DISTRICT OF WASHING TON
AT TACOMA

7

8
9 IN THE MATTER OF:
lO MERGENSANAAMAR
11 File No. A216-269-802

NO . 3:18-mc -0 5016-BH S
EMERGENCY EX PARTE MOTION
TO PROVIDE INVOLUNTARY
MEDICAL TREATMENT

12

13
The United States Department of Homeland Security, Immigration and Customs

14
15

Enforcement (hereafter "ICE"), by and through the Un ited States Attorney for the Western District

16 of Washington, has filed an ex parte motion for an order permitting ICE to immediately provide
17

involuntary hydration and medical treatment for Mergensana Amar, No. A2 l 6-269-802, who is

18
19

currently being held as a civil detainee at the Northwest Detention Center in Tacoma, Washington.

20

Based on the declarations of Dr. Shei Malakhova and Supervisory Detention and Deportation

21

Officer Tim Petrie, the Court finds that there is sufficient cause to believe that without the requested

22 medical testing and treatment, Mr . Amar is in danger of irreparable injury, and poss ible death.
23
Therefore, IT IS HEREBY ORDERED that ICE may undertake necessary medical treatment

24
and testing to save Mr. Amar's life and prevent injury to him, includ ing :

25

26

1.

involuntary hydration through administering intravenous (IV) fluids;

27

2.

physica l examination with dai ly weight asse ssments and frequent vital sign check s;

28
ORDER GRANTING EMERGENCY EX PARTE MOTION
TO PROVIDE INVOLUNTARY MEDICAL TREATMENT- I

AMlf

ll.Ji\l\i

pVERSIGHT

UNITED STATES ATTO RNEY
120 I P ACIFI C AV ENUE, S UITE 700
TA COMA , WASH ING TON 984 02
(253) 428-38 00

DHS-ICE-19-0196, 19-0197-K-000058
2019-ICLl-00051 2103



Case 3:18-mc-05016-BHS

1

3.

2

Page 2 of 3

laboratory tests at least every 48 - 72 hour s consisting of:

a.

3

Document 4 Filed 09/06/18

Complete metabolic panel. This test reveals an increase in markers of kidney

function in view of any renal injury. The panel tests include: BUN (blood urea nitrogen), creatinine

4
level , urinalysis and prot eins. It also reveals electrolyte disturbances as potassium, phosphate,

5
6

magnesium and glucose levels can lead to heart arrhythmias.

7

8

b.

Complete blood count. This test reveals the hemoglobin level.

c.

Urinalysis, which reve als the presence of ketones, blood and crystals in the

d.

Magnesium and phosphate levels to assess deficiency after day 13 of a hun ger

e.

Electrocardiogram, if the patient show s elevated potassium, is necessary to

9
10

urme.

11
12 strike.
13

14
treat conditions which can lead to lethal arrhythmias.

15

f.

16

Creatine kinase (CK) levels determine whether CK levels increase. CK is an

17 enzyme found inside muscle cells and should be measured as it is released into the blood, when the
18 muscle cells rupture. The increase in CK as a result of the destruction of muscle tissue can lead to
19
acute renal failure and death.

20
g.

21

Pre-albumin levels . Pre-albumin is used as a marker for nutritional statu s

22

evaluation , and levels will decrease over time the longer a patient fails to consume adequate

23

nutrition . The pre-albumin level coITelates with patient morbidity and mortality risk . Normal pre-

24

albumin is 15-35 mg/dL. When pre-albumin falls to 5-1 lmg /dL, significant morbidity risks exist

25
26

and aggressive nutritional support is necessa ry.

27

IT IS HEREBY FURTHER ORDERED that if Amar continues to refuse the necessary

28

medical treatment and monitoring, ICE and medica l staff at the Nort hwe st Detention Cente r may use
ORDER GRANTING EMERGENCY EX PARTE MOTION
TO PROVIDE INVOLUNTARY MEDICAL TREATMENT-2

AMlf

ll.Ji\l\i

pVERSIGHT

UNITED STATES ATTORNEY
120 I P AC IFIC A VENUE, SUIT E 700
TACOMA, W ASH ING TON 98402
(253) 428-3 800

DHS-ICE-19-0196, 19-0197-K-000059
2019-ICLl-00051 2104



Case 3:18-mc-05016-BHS

Document 4

Filed 09/06/18

Page 3 of 3

1 soft medical restraints to assure the safety of Ama r and the medical staff when administering the
2

necessary treatment.

3

ICE is directed to prov ide a copy of this order to Mr. Amar forthw ith.

4

5

Dated this 6th day of September, 2018.

6

7

8
9
INH. SETTLE
United States District Judge

10

11
12
13

Presented by:

14
ANNETTE L. HAYES
United States Attorney

15
16

17 /s/ Lisca Bor ichewski
l S LISCA BORICHEWSKI
Assistant United State Attorney
19 700 Stewart Street , Suite 5220
Seattle, WA 98101
20 Telephone : (206) 553-7970
Fax: (206) 553-4073
21
E-mai l: lisca. borichewski @usdoj.gov
22

23

24
25

26
27

28
ORDER GRANTING EMERGENCY EX PARTE MOTION
TO PROVIDE INVOLUNTARY MEDICAL TREATMENT- 3

AMlf

ll.Ji\l\i

pVERSIGHT

UN IT ED ST A T ES A TTORNEY
120 I PACIFIC AVENUE,SUITE 700
TACOMA, WASHINGTON98402
(253) 428-3800

DHS-ICE-19-0196, 19-0197-K-000060
2019-ICLl-00051 2105



From:

Wilcox, Bryan S

Se nt:

10 Oct 2018 18:36:49 +0000

To:

(b)(6); (b)(?)(C)

Subject:
Attachment s:

FW: Signe

ica Monitoring

& Hydration - Amar

Signed Order Amar.pdf

Bryan S. Wilcox
Deputy Field Office Director
ICE Enforcement & Removal Operations , Seattle, WA
Main: !(b)(6); (b)(?)(C)
Desk: !(b)(6); (b)(7)(C)
Cell J~
(b~)(6~);~(b~)(=
7)~
(C~) -~

I/

I/

CONFIDENTIALITY: This email and attachments are intended for the above name only and are confidential. If you are not the
intended addressee, or the person respons ible for delivering it to the intended addressee, you may neither copy, disseminate, nor
distribute it to anyone else or use it in any unauthorized manner. To do so is strictly prohibited and may be unlawful. If you receive
this email by mistake, please advise the sender immediate ly by using the reply faci lity in your mail software and delete it from your
computer.

From : Jennings, David W

Se nt : Monday , September 10, 2018 4: 15 AM
To: Wilcox, Bryan S"'"l
(b-')('6)
""'";'""
('"'"
b)'-'(7-')('C'"'"
"'") ______
___,
Subject: FW: Signed Court Order for Medical Monitor i ng & Hydration

- Amar

Assistant Director
Field Operations

From: Smith, Stewart D~fb_l(_
6)_;(_bl_(?_)(_
C_______
l
~
Date: Monday, Sep 10, 2018 , 06 :22
To: Asher , Nathalie R b)(6); (b)(?)(C)
Price, Core~ A !{bl{6l (bl{7)(Cl
6l...,
Jenn ings, David
b)(6); (b)(?)(C)
Cron en , C M !-f
b_l<_
; (,....
bl_<7_l(_C_l _____
Subject: FW: Signed Court Order for Medica l Monitoring & Hyd ration - Amar

~----------~

__.

FYSA.
Dr. Stewart D. Smith, MPH, CCHP
Assistant Director I ICE Health Service Corps
Office :!/h\/fi \ l h\17\IC:\
Cell: kb)(6); (b)(7)(C)
Fro m: f b)(6); (b)(?)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000061
2019-ICLl-00051 2106



Se nt : Friday, September 7, 2018 10:45 AM
To: !(b)(6); (b)(7)(C)

Subje ct: FW: Signed Court Order for Med ical Monito ring & Hydration - Amar
FYSA;hunger strikers at Tacoma. Initiating court orders for forced feeding.

V/R,
CAPTl(b)(6); (b)(?)(C)
USPHS
Health Services Administrator, Western Region
T. Don Hutto Residential Center (TDHRC)
ICE Health Service Corps (IHSC)
Immigration and Customs Enforcement (ICE)
Enforcement and Removal Operations (ERO)
1001 Welch Street, Taylor , TX 76574
0: (b)(6); (b)(7)(C)
BB:
Fax:

IRN,

fb)(6); (b)(7)(C)

Warning: Thi s document is UNCLASSIFIED //FOR OFFICIAL USE
ONLY (U//FOUO). It contains information that may be exempt from
public release under the Freedom oflnformation Act (5 U.S.C. 552). It
is to be controlled , stored, handled , transmitted , distributed , and
disposed of in accordance with DHS policy relating to FOUO
information and is not to be released to the public or other personnel
who do not have a valid "need-to-know" without prior approval of an
authorized DHS official. No portion of this report should be furnished
to the media , either in written or verbal form.
FromjCb)(6);(b)(7)(C)

Sent : Friday, Sept ember 7, 2018 8:13 AM
To:1Cb)(6); (b)(7)(C)
Cc:

-----------------~

Subject : FW: Signed Court Order for Medical Monitoring & Hydration - Amar
Good Morning CAPT!(b)(6);~Please find attached the court o rde r to allow us to medically monitor and
hydrate one of our three remaining hunger strike detainees . This is a new
step towards forced feeding that was insisted upon by the legal side of the
house. Reportedly , they wan t to show a graduated response in these
situations.
Facility ;leadership will meet this morning to determine what happens next
and what this will look like . As today is my regular day off, LCD b)(6);
ill
h " 7 \/f""\
attend the meeting with our Clinical Director and I am available y p one to
participate.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000062
2019-ICLl -00051 2107



V/R,

I

6); (b)(
CAPTl(b)(
?)(C)
LCSW-C, BCD
Health Services Administrator
USPHS
ICE Health Service Corps
Northwest Detention Center
1623 E. J St. Suite!(b)(
6)I
Tacoma, WA 9842 1
Office: b)(6); (b)(7)(C)
BB: (b)(6); (b)(7)(C)
Fax:
(b)(
6); (b)(
7)(C)
Warning: This document is UNCLASSIFIED //FOR OFFICIAL USE
ONLY (U//FOUO). It contains information that may be exempt from
public release under the Freedom oflnformation Act (5 U.S.C. 552). It
is to be controlled, stored, handled, transmitted, distributed, and
disposed of in accordance with DHS policy relating to FOUO
information and is not to be released to the public or other personne l
who do not have a valid "need-to-know" without prior approval of an
authorized DHS official. No portion of this report should be furnished
to the media, either in written or verbal form.
From:l(b)(6); (b)(7)(C)

r

Se nt : Thursday, Septemb er 6, 2018 4:46 PM
)(6); (b)(7 XCJ

Subject : Signed Court Order for Medical Mon itoring & Hydrat ion - Amar
The court has signed the order for medical monitoring and hydra t ion for
Mergensana Amar. Please keep us updated .

l(b)(6); (b)(7)(C)
Assistant Chief Counsel
Seattle Office of Chief Counsel / OPLA
Tacoma sub-office
U.S. Immigration and Customs Enforcement
U.S. De artment of Homeland Security
Tel: (b)(6); (b)(7)(C)
E-mail: b)(6); (b)(
7)(C)
*** Warning
ttorney
1ent riv1ege
ttorney Work Product ***
This communication and any attachments may contain confidential and/or sensitive
attorney/cl ient privileged information or attorney work product and/or law enforcement
sensitive information. It is not for release , review , retransmission , dissemination, or
use by anyone other than the intended recipient. Please notify the sender if this email
has been misdirected and immediate ly destroy al l originals and copies. Furthermore

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000063
2019-ICLl -00051 2108



Case 3:18-mc-05016-BHS

Document 4

Filed 09/06/18

Page 1 of 3

1
The Honorable Judge Benjamin H. Settle

2
3
4

5
6
UNITED STATES DISTRICT COURT FOR THE
WESTERN DISTRICT OF WASHING TON
AT TACOMA

7

8
9 IN THE MATTER OF:
lO MERGENSANAAMAR
11 File No. A216-269-802

NO . 3:18-mc -0 5016-BH S
EMERGENCY EX PARTE MOTION
TO PROVIDE INVOLUNTARY
MEDICAL TREATMENT

12

13
The United States Department of Homeland Security, Immigration and Customs

14
15

Enforcement (hereafter "ICE"), by and through the Un ited States Attorney for the Western District

16 of Washington, has filed an ex parte motion for an order permitting ICE to immediately provide
17

involuntary hydration and medical treatment for Mergensana Amar, No. A2 l 6-269-802, who is

18
19

currently being held as a civil detainee at the Northwest Detention Center in Tacoma, Washington.

20

Based on the declarations of Dr. Shei Malakhova and Supervisory Detention and Deportation

21

Officer Tim Petrie, the Court finds that there is sufficient cause to believe that without the requested

22 medical testing and treatment, Mr . Amar is in danger of irreparable injury, and poss ible death.
23
Therefore, IT IS HEREBY ORDERED that ICE may undertake necessary medical treatment

24
and testing to save Mr. Amar's life and prevent injury to him, includ ing :

25

26

1.

involuntary hydration through administering intravenous (IV) fluids;

27

2.

physica l examination with dai ly weight asse ssments and frequent vital sign check s;

28
ORDER GRANTING EMERGENCY EX PARTE MOTION
TO PROVIDE INVOLUNTARY MEDICAL TREATMENT- I

AMlf

ll.Ji\l\i

pVERSIGHT

UNITED STATES ATTO RNEY
120 I P ACIFI C AV ENUE, S UITE 700
TA COMA , WASH ING TON 984 02
(253) 428-38 00

DHS-ICE-19-0196, 19-0197-K-000064
2019-ICLl-00051 2109



Case 3:18-mc-05016-BHS

1

3.

2

Page 2 of 3

laboratory tests at least every 48 - 72 hour s consisting of:

a.

3

Document 4 Filed 09/06/18

Complete metabolic panel. This test reveals an increase in markers of kidney

function in view of any renal injury. The panel tests include: BUN (blood urea nitrogen), creatinine

4
level , urinalysis and prot eins. It also reveals electrolyte disturbances as potassium, phosphate,

5
6

magnesium and glucose levels can lead to heart arrhythmias.

7

8

b.

Complete blood count. This test reveals the hemoglobin level.

c.

Urinalysis, which reve als the presence of ketones, blood and crystals in the

d.

Magnesium and phosphate levels to assess deficiency after day 13 of a hun ger

e.

Electrocardiogram, if the patient show s elevated potassium, is necessary to

9
10

urme.

11
12 strike.
13

14
treat conditions which can lead to lethal arrhythmias.

15

f.

16

Creatine kinase (CK) levels determine whether CK levels increase. CK is an

17 enzyme found inside muscle cells and should be measured as it is released into the blood, when the
18 muscle cells rupture. The increase in CK as a result of the destruction of muscle tissue can lead to
19
acute renal failure and death.

20
g.

21

Pre-albumin levels . Pre-albumin is used as a marker for nutritional statu s

22

evaluation , and levels will decrease over time the longer a patient fails to consume adequate

23

nutrition . The pre-albumin level coITelates with patient morbidity and mortality risk . Normal pre-

24

albumin is 15-35 mg/dL. When pre-albumin falls to 5-1 lmg /dL, significant morbidity risks exist

25
26

and aggressive nutritional support is necessa ry.

27

IT IS HEREBY FURTHER ORDERED that if Amar continues to refuse the necessary

28

medical treatment and monitoring, ICE and medica l staff at the Nort hwe st Detention Cente r may use
ORDER GRANTING EMERGENCY EX PARTE MOTION
TO PROVIDE INVOLUNTARY MEDICAL TREATMENT-2

AMlf

ll.Ji\l\i

pVERSIGHT

UNITED STATES ATTORNEY
120 I P AC IFIC A VENUE, SUIT E 700
TACOMA, W ASH ING TON 98402
(253) 428-3 800

DHS-ICE-19-0196, 19-0197-K-000065
2019-ICLl-00051 2110



Case 3:18-mc-05016-BHS

Document 4

Filed 09/06/18

Page 3 of 3

1 soft medical restraints to assure the safety of Ama r and the medical staff when administering the
2

necessary treatment.

3

ICE is directed to prov ide a copy of this order to Mr. Amar forthw ith.

4

5

Dated this 6th day of September, 2018.

6

7

8
9
INH. SETTLE
United States District Judge

10

11
12
13

Presented by:

14
ANNETTE L. HAYES
United States Attorney

15
16

17 /s/ Lisca Bor ichewski
l S LISCA BORICHEWSKI
Assistant United State Attorney
19 700 Stewart Street , Suite 5220
Seattle, WA 98101
20 Telephone : (206) 553-7970
Fax: (206) 553-4073
21
E-mai l: lisca. borichewski @usdoj.gov
22

23

24
25

26
27

28
ORDER GRANTING EMERGENCY EX PARTE MOTION
TO PROVIDE INVOLUNTARY MEDICAL TREATMENT- 3

AMlf

ll.Ji\l\i

pVERSIGHT

UN IT ED ST A T ES A TTORNEY
120 I PACIFIC AVENUE,SUITE 700
TACOMA, WASHINGTON98402
(253) 428-3800

DHS-ICE-19-0196, 19-0197-K-000066
2019-ICLl-00051 2111



Case 3:18-mc-05016-BHS

Document 4

Filed 09/06/18

Page 1 of 3

1
The Honorable Judge Benjamin H. Settle

2
3
4

5
6
UNITED STATES DISTRICT COURT FOR THE
WESTERN DISTRICT OF WASHING TON
AT TACOMA

7

8
9 IN THE MATTER OF:
lO MERGENSANAAMAR
11 File No. A216-269-802

NO . 3:18-mc -0 5016-BH S
EMERGENCY EX PARTE MOTION
TO PROVIDE INVOLUNTARY
MEDICAL TREATMENT

12

13
The United States Department of Homeland Security, Immigration and Customs

14
15

Enforcement (hereafter "ICE"), by and through the Un ited States Attorney for the Western District

16 of Washington, has filed an ex parte motion for an order permitting ICE to immediately provide
17

involuntary hydration and medical treatment for Mergensana Amar, No. A2 l 6-269-802, who is

18
19

currently being held as a civil detainee at the Northwest Detention Center in Tacoma, Washington.

20

Based on the declarations of Dr. Shei Malakhova and Supervisory Detention and Deportation

21

Officer Tim Petrie, the Court finds that there is sufficient cause to believe that without the requested

22 medical testing and treatment, Mr . Amar is in danger of irreparable injury, and poss ible death.
23
Therefore, IT IS HEREBY ORDERED that ICE may undertake necessary medical treatment

24
and testing to save Mr. Amar's life and prevent injury to him, includ ing :

25

26

1.

involuntary hydration through administering intravenous (IV) fluids;

27

2.

physica l examination with dai ly weight asse ssments and frequent vital sign check s;

28
ORDER GRANTING EMERGENCY EX PARTE MOTION
TO PROVIDE INVOLUNTARY MEDICAL TREATMENT- I

AMlf

ll.Ji\l\i

pVERSIGHT

UNITED STATES ATTO RNEY
120 I P ACIFI C AV ENUE, S UITE 700
TA COMA , WASH ING TON 984 02
(253) 428-38 00

DHS-ICE-19-0196, 19-0197-K-000067
2019-ICLl-00051 2112



Case 3:18-mc-05016-BHS

1

3.

2

Page 2 of 3

laboratory tests at least every 48 - 72 hour s consisting of:

a.

3

Document 4 Filed 09/06/18

Complete metabolic panel. This test reveals an increase in markers of kidney

function in view of any renal injury. The panel tests include: BUN (blood urea nitrogen), creatinine

4
level , urinalysis and prot eins. It also reveals electrolyte disturbances as potassium, phosphate,

5
6

magnesium and glucose levels can lead to heart arrhythmias.

7

8

b.

Complete blood count. This test reveals the hemoglobin level.

c.

Urinalysis, which reve als the presence of ketones, blood and crystals in the

d.

Magnesium and phosphate levels to assess deficiency after day 13 of a hun ger

e.

Electrocardiogram, if the patient show s elevated potassium, is necessary to

9
10

urme.

11
12 strike.
13

14
treat conditions which can lead to lethal arrhythmias.

15

f.

16

Creatine kinase (CK) levels determine whether CK levels increase. CK is an

17 enzyme found inside muscle cells and should be measured as it is released into the blood, when the
18 muscle cells rupture. The increase in CK as a result of the destruction of muscle tissue can lead to
19
acute renal failure and death.

20
g.

21

Pre-albumin levels . Pre-albumin is used as a marker for nutritional statu s

22

evaluation , and levels will decrease over time the longer a patient fails to consume adequate

23

nutrition . The pre-albumin level coITelates with patient morbidity and mortality risk . Normal pre-

24

albumin is 15-35 mg/dL. When pre-albumin falls to 5-1 lmg /dL, significant morbidity risks exist

25
26

and aggressive nutritional support is necessa ry.

27

IT IS HEREBY FURTHER ORDERED that if Amar continues to refuse the necessary

28

medical treatment and monitoring, ICE and medica l staff at the Nort hwe st Detention Cente r may use
ORDER GRANTING EMERGENCY EX PARTE MOTION
TO PROVIDE INVOLUNTARY MEDICAL TREATMENT-2

AMlf

ll.Ji\l\i

pVERSIGHT

UNITED STATES ATTORNEY
120 I P AC IFIC A VENUE, SUIT E 700
TACOMA, W ASH ING TON 98402
(253) 428-3 800

DHS-ICE-19-0196, 19-0197-K-000068
2019-ICLl-00051 2113



Case 3:18-mc-05016-BHS

Document 4

Filed 09/06/18

Page 3 of 3

1 soft medical restraints to assure the safety of Ama r and the medical staff when administering the
2

necessary treatment.

3

ICE is directed to prov ide a copy of this order to Mr. Amar forthw ith.

4

5

Dated this 6th day of September, 2018.

6

7

8
9
INH. SETTLE
United States District Judge

10

11
12
13

Presented by:

14
ANNETTE L. HAYES
United States Attorney

15
16

17 /s/ Lisca Bor ichewski
l S LISCA BORICHEWSKI
Assistant United State Attorney
19 700 Stewart Street , Suite 5220
Seattle, WA 98101
20 Telephone : (206) 553-7970
Fax: (206) 553-4073
21
E-mai l: lisca. borichewski @usdoj.gov
22

23

24
25

26
27

28
ORDER GRANTING EMERGENCY EX PARTE MOTION
TO PROVIDE INVOLUNTARY MEDICAL TREATMENT- 3

AMlf

ll.Ji\l\i

pVERSIGHT

UN IT ED ST A T ES A TTORNEY
120 I PACIFIC AVENUE,SUITE 700
TACOMA, WASHINGTON98402
(253) 428-3800

DHS-ICE-19-0196, 19-0197-K-000069
2019-ICLl-00051 2114



From :

(b)(6); (b)(7)(C)

ov
: :54 +0000
To:
#IHSC_SEN_Medical;#NWD-Notification-Medical;#IHSC_SEN_Mental
Health;#NWD-Notification Mental Health
Subject:
RE: A#: 216269802 Hospital ICU report for 2000
Sent:

ICU Update as of 20 : 15 PST:

Detainee has massive anoxic brain injury. He remains unstable , nonresponsive, and intubated. He is on 3 different medications to
support his blood pressure. He had a neurology consult and EEG
completed but results will not be available until tomorrow or the day
after (due to being the weekend).
6); (b)(?)(C)
LCD~(b)(

IMLS(ASCP)

Assistant Health Services Admin istrato r
Department of Homeland Security
Immigration & Customs Enforcement (ICE)
Enforcement & Remov al Operations (ERO)
USPHS, ICE Healt h Service Corps .
Northwest Detention Center
1623 Eas t J Street l(b)(6ll
Tacoma, WA 9842 1
Office : (b)(6); (b)(7)(C)
Cell: (b)(6)
; (b)(7)(C)
Fax:
tb}(6)
; (b}(
?)(C)
cid:image007. png @0 1D297FB .19484 D80cid: image008. png @0 1D297FB .19484 D 80cid: i
mage009 .png @0 1D297FB.19484D80

Warning: This documen t is UNCLASSIFIED //FOR OFFICIAL USE ONLY (U//FOUO).
It contains information that may be exem pt from public release under the Freedom of
Information Act (5 U.S.C. 552) . It is to be controlled, stored , handled, transm itted ,
distributed, and disposed of in acco rdance w ith DHS poli cy relating to FOUO
information and is not to be released to the public or other personnel who do not have a
va lid "need-to-know" without prior appro va l of an authorized DHS official. No portion of
this report should be furnished to the media , either in wr itten or verba l form.

From: fb)(6); (b)(
?)(C)
Date: Friday, Nov 16, 2018, 3:45 PM
To: #IHSC SEN Medical .(b-)(6-);-(b~)(?~)(=c)------~
, #NWD-Notification-Medical
(b)(6); (b)(7)(C)
, #IHSC_SEN_Mental Health

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000070
2019-ICLl-00051 2115



r::-j':7.
(b:::-)
(6-);::.(b
.,.,
:::)(-7)
:--:::
.,....
(C
_) ________
#NWD-Notific
ationMental Healthfb)(6)
; (b)(
7)(C)
fb)(6)
; (b)(7)(C)
~
Subject: FW: A#: 216269802 HospitalICU reportfor 1330
_J~

,

ICU Update as of 14:00 PST:
Pt is now having an EEGtest . His blood pressure is slow ly dropp ing desp ite being on
presser IV drip. His immediate prognosis is very poor.

LCDRl(b)(
B); (b)(
?)(C)
IMLS(ASCP)
Assistant Health Services Administrator
Department of Homeland Security
Immigration & Customs Enforcement (ICE)
Enforcement & Removal Operations (ERO)
USPHS, ICE Health Service Corps.
Northwest Detention Center
1623 East J Street~b)(61
Tacoma, WA 98421
OfficeJb )(6); (b)(7)(C) !1
Cell (b)(6)
; (b)(
7)(C)
Fax:
(b)(6); (b)(7)(C)
cid:image007.png @0lD297FB.19484D80cid :image008 .png@0lD2 97FB.19484D80cid:i
mage009 .png@0 1D297FB.19484D80

Warning: This document is UNCLASSIFIE D//FOR OFFICIAL USE ONLY (U//FOUO).
It contains information that may be exempt from public release under the Freedom of
Informat ion Act (5 U.S.C. 552). It is to be controlled, stored, handled, transmitted,
distributed , and disposed of in accordance with DHS policy relating to FOUO
information and is not to be released to the pub lic or other personnel who do not have a
valid "need-to-know" without prior approval of an authorized DH S official. No po1tion of
this report should be furnished to the media, either in written or verbal form.
From: ~b)(6); (b)(7)(C)
Date: Friday, Nov 16, 2018, 2:00 PM

rb)(6)
; (b)(7)(C)
Subject: A#: 216269802 HospitalICU reportfor 1330
Hospita l day #1 in ICU 1330 report
A#: 216269802
NAME: Amar, Mer
DOB: 10/23/1978

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000071
2019-ICLl-00051 2116



COB: Russia
DOA: 12/19/2017
Relevant Medical History : Was on self-imposed protest Hunger Strike but began eating t hree
meals a day w ith liquid nutr itiona l supplements
Reason sent to ER: CPR initiated due to detainee asphyxiation from self harm and transferred to
ICU when pulse was achieved.
Current Status: pt with massive anoxic brain injury . He is intubated w ith no reflexes except for
respiratory hyperventi lation wh ich is not life sustaining . Pt is now having an EEGtest. His blood
pressure is slow ly dropp ing despite being on presser IV drip . His immediate prognosis is very
poor.
Location: St Joseph's Hospital, ICU Rm 6Bravo6 .
Attending Physician: Drkb)(6); rrrauma Physician, RN(b)/6) Pt2 (b)(5); (b)(?)(C) ; the ICU Trauma
PA is at phone #l(b)(6); (b)(7)(C)

I

l(b-)(6~);~(b-)(7-)(C
....
~)-----'I

MD

Ch mcal Director
ICE Health Service Corps (IHSC)
Enforcement and Removal Operations (ERO)
US Immigration Customs Enforcement (USICE)
Northwest Detention Center

I 623 E. J St. Suitt>!/bl/ l

Tacoma, WA 98421
Main office :"'(b"""'
)(""'6
)-; (""'b
)'""
(7,.,..
)("C,...
"') ---,
Vo ice Mail :
Ce!
); (b)(7)(C)
fax

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000072
2019-ICLl-00051 2117



From :

Sent:
To:

Subject :

rb)(6); (b)(7)(C)

1

12 Mar 2019 21:59:16 +0000
!/b)/6) (bl/7)/Cl !
RE: A-File A216269802

Thanks
Bryan S. Wilcox
Acting Field Office Dire ctor
ICE Enforc ement & Remo val O eration s, Seattle, WA
Main j(b}(6);(b)(7)(C) j/ Desk: (b)(6); (b}(7)(C) / Cell: .-l
(b-)(6
-);-(b-)(7--)(_C_,
)

I

CONFIDENTIA LITY: This email and attachments are intended for the above name only and are con fident ial. If you are not the intended
addressee, or the person respons ible fo r delive ring it to the intende d add ressee, you may neither copy , disseminate, no r distribute it to anyone
else o r use it in any unauthorized manner. To do so is str ictly p rohibited and may be unlawful. If you receive this email by mistake, please
advise the sender immed iately by using the reply facility in your mai l software and delete it from your computer.

From: W ilcox , Bryan S
Se nt: T uesday , March 12, 2019 2:06 PM
To: l<b)(
6); (b}(7)(C)
SubJect: A-File A2 I 6269802
(b)(6);
(b)(7)(C)

Please assign in RAILS the above-named a file to me

Bryan S. Wilc ox
Actin g Field Office Dire ctor
ICE Enfor ceme nt & Removal Operat ions, Seattl e, WA
Mainkbl/6\ lbl(7)/Cl I/ Des~(b}(6);(b}(7)(C) j I Cellj'"""
(b..,...,
}(=)6"""'
; (,...,.
b)""'
(7.,...,.)
(C
=)--.

CONFIDENTIA LITY: This email and attachments are intended for the above name only and are con fident ial. If you are not the intended
addressee, or the person respons ible fo r delive ring it to the intende d add ressee, you may neither copy , disseminate, no r distribute it to anyone
else or use it in any unauthorized manne r. To do so is strictly prohibit ed and may be unlawful. If you receive this email by m istake , please
advise the sender immediately by using the reply facility in your mai l software and delete it from your computer.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000073
2019-ICLl-00051 2118



From :

l<b)(6); (b)(7)(C)

Sent:

17 Nov 2018 03:19:22 +0000

To:

Wilcox, Bryan S
FW: URGENT:Amar Mergensana
AmarMergensana.pdf

Subject:
Attachments:

FYSA

Assistant Director
Field Operations
From:l (b){6); (b){7)(C)

Date: Frida , Nov 16, 2018, 22: 11
(b)(6); (b)(7)(C)

Cc: #E RO CHIE FS OF
Subject: FW: U RGENT:

STAFF

(b)(6); (b)(?)(C)

Amar ,,,_
e_r-ge_n_s-an_a________

___.

Good evening
We have a detainee in Seattle on life support. We have a congressional member
requesting information and thought it may be best to do a telephone briefing and wanted
to loop you all In.

Assistant Director
Field Operat ions
From: Wilcox , Bryan S F~
b_)(6_);_(b_)(_7_
)(C
_)______
Date: Friday, Nov 16, 2018, 22:00
To: Jennings, David W 1"'"
<b..,...,
)(6.,,,.
)......,
; (b,..,.
)(=7),(C
...,.,
,,.,..
) --------,

~

Subject: FW: URGENT : Amar Mergen sana

Dave, see email and attached from Senator Patty Murray's office
Sent with BlackBerry Work
(www .blackberry .com)
From: ~b){6); (b){7)(C)
Date: Friday , Nov 16, 2018, 3:38 PM
To: Wilcox, Bryan S 1~
(b-)(6
_)_
; (b
- )-(7-)(C
- )------~
Subject: FW: URGENT : Amar Mergen sana

FYI

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000074
2019-ICLl-00051 2119



Sent with Black.Berry Work
(www.blackbe1Ty.com)
Fromfb )(6); (b)(7)(C)

Date: Friday, Nov 16, 201.8, 3:34 PM
Tol (b)(6); (b)(7)(C)

Subject: URGENT: Amar Mergensana

I have a signed ICEwaiver from Mr. Mergensana, who I heard passed this morning.
Our office was waiting to receive more information on his case before submitting an inquiry.
However, due to circumstances, we would like to respectfully request the reason for his death
and the steps taken by the Detention Center to prevent this.
ICEWaiver and Privacy Release form attached.
!(b)(6); (b)(7)(C)
u

I~.,ll-fw,,,v

SwVU-#

~

Ov.-fru,..e,wREUR.f-)1'~

Offic e of US Senat or Patty Murra y l!b)(6)

I

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000075
2019-ICLl-00051 2120



DE P A R TMENT O F H OMELAND SECUR IT Y
U .S . Immigra tion and Customs Enforcement

PRIVACY WAIVER AUTHORIZING DISCLOSURE TO A THIRD PARTY
Use :his form to i.luliiorize the U.S. Department of Homelcmd Security ('"OHS "/ to disc lose informat,o" andior records about vou to a
ln1ro party. Tak ing rh1s action is en tirely voluntary; you are under no obligation to consent to the release of your informa:ion to any thi.d
party. Au tho rity: Privacy Ac t of 1974 (5 U.S.C. ? 552a); OHS Privacy A c: Regulat1ons (6 C.F.R. ? 5.2 1t d) ).

STEP 1

Provide information about yourself and identify the third party that you intend to receive
your information and/or records (the "Recipient ").

YA~~:
/1
''
( i
v 'It

Your A lien Registratio}~t:mber

N ame:

~ !

(,

oI

I l /.}

< ,('/

....?ILGBP?'J..l,

.

..J

Your Cu rrent Address:

D a te of Birth :

11LL.1U(_,

-

..; l

Recipient's

-

-

..

-- .

<-:

Recipien t's Ma ilin g Ad d ress (ocquored

'

Recipient's

- -- .- -

r

Identifying

. -

d,s~.losur? by mail:.

,r,equeshr,i

..-

.o

o\ .l"'c r

Organizauon.

-.

STEP 2
C

..

.

--

k'. -]

~:-

(if applicable)

:

7~

Country of Birth:

Recip ie nt's Name :
"

1 ) ('~l

111h
e wa,v,011.v<I'
,.,.m.y to : '" ~- news .m:d

. --- .

-- - .
-

;.

:,-:.:

.

-

,.

.. ..

c1

.

~\1"--';')\/:
Phone N umber:

---

..
J - -

' '

:

.'

Io

.

.

.

, ..

-

.

c:C'1(rcsstn-1;1 ciH.,;~ l.iw hr~1,:

o'

Spec ify what information and/or records OHS is authorized to share with the Recipient.
Data :o,a. r/ c o.ti -,::

D lmmig ra :ion Case
LJA li en Fil e {A -File )

=

I I Travel/Border Cross
:7 Medical Informat ion
::JCriminal Case

[ : Family Data

l ] Detention

D Crimina

Information

l H istory

in g

A ND /OR

T he following

information/records

'r.J,
~LL
information

(describ e 1:

------

- - - - ------

----

----

--- --

OR
and /o r Records

Requested

by the Rec ipient

For Alifil~ _Qnly : If ycu t1ave applied fer or received any oi the 1mmigrat1on benefits below. you are legally ent itled to con f dent1ahty.
1See reverse for rriore information./ If you wart OHS to share info rmat ion about these benefits with the Recipient. you m:.ist wa ive
your cont,denti<'lhty rights b/ checking the approoo,atc boxes helow Waiver of tr.ese rights is no: rca:.i1red ; however . 1fyo., do "O l
wa,ve these nghts OHS rnav be unable to disclose to the Recipient some or a ll of the :nfun-1a:1ur1you dentif ied c1uove.

I wa ive my right to confiden t ia li ty and aut hor ize disclos u re to t he Reci pie nt rega rding these im m igration benefi t s:

i7

Temporary

~ Seasonal

Protected

Status (TPS )

A gricu lt ura l Worker

? T Vi sa ,for tm'f 1CK1J"gv.ct ms)

LJU Visa

rJ B atte red

LJViolence

Seeking

L_ Asy lum

Spouse /Child
Hc1rds hi p Waiver

1'or v1~t11n,orc<,11<i
In cr,n,es)
A gainst Women Act

iVAWA,

(con ',centiaU;oo~plres eve, 1fpet111on1scernec,,

ST EP 3

Sign th~ ~tatement below authoriz ing OHS to disclos e your information and/or records to
the Rec,prent.

I certify under penalty of perjury that the nformauor <11.Jovtl
Is ar:cLJrate.I authorize OHS. its componen ts. ott'ces . employees. contractors
agents, and assignees to disclose the 1r1form2-hon
or records specified above :o t~e R1:1cip,enlI .inderst. md t~,is may 11clude and is not
lio111tedto repor!s. evalLiations <inc:notes o: any k1n<1c:.mta1ned ,.1any recorc: keeo,nc; syster.1 mainta 1ed liy or on benalf of OHS tnal
CHS oeta,ris ttie d1scret,on to decide 1fpart,cutar records or 1nfonrnt1on we w,th1n tile sco;:,e or th,s W,uver. und that UHS nas no cortro l
over row l'1e Rec1p1ent w,11usci or dIssemInatc my ,nformm,on. I agree to release ao1dhold 11arn,IessOHS. ils components. offices.
e'11ployees.contractors. agents . and ;:iss,gnees. from ary a1.d ;ill claims of ac:io1 or damages of any kine <1nsingfrom. or ,n any way
connecied to. the release or use of any nforrr.atiooi or records pursuan! to tr 1sWaiver
(b)(6); (b)(7)(C)
Your Signature :
/ti.,<,,<Y-.v
W itness Signatu,
Da te:

f i - (c - ~O{J

.~11va::::;y
\/oJarver1s vu!ld ro!'HtJ days 'r-om da t.-:-of s1~1.at,He

Witness Name:
.\ri.iuncss may nc1 o~ t

ICE Form 60-001 (2 11)

AMEHl('Af\

pVERSIGHT

fi!n l"s e~1ployer

Page ' of 2

1

DHS-ICE-19-0196, 19-0197-K-000076
2019-ICLl-00051 2121



C0 "1Mll 11::E-.S

PAITY MURRAY

!..FJ.JF('1PRIA- .ON$ . BIJCGGBP l

~c.,-"'-11-

ECJ,.;Al::lf\ u,cor< A.m~n -.s1C
r..J.:;.
Rl ,~ E:\ .:..\Ir,,:,J)"/lr,lc;lk.A f l'.)~~

~niteb ~t ates ~ enate

/lfLPAtJS).Jf

~l~S

PRIVACY RELEASE FORM

Please1t I m.t this fo.m ,o ,hdl the off ce of St>ndto. Murray nn as, , 1you,,, ,he rra::er vou dlo,tr,be be .ow . Pu.suant to Public Law 93 -579 ,
,l'e Priv.;cy Act of 1974 , OLr olf,ce ord na.dy c;,nno1 o,s.,1 ,nd.v,dual, "' deohrg wit'l federal agt>n(1e, without their exprPss w,i:1.,n wrisenl.

0

Mr

M0

s.D Ms. ?

Date of B,rth :

:

~ull Name :

1l,,t.J'D(~,

Address.
...-<':\((
C.

1:y: - _)

(

-

{1fl/\C_~_
'f'__ ~_~_t_.f_
,.')~d
_
.-_1'_:::>_u_t_1)_
C
~ "------

;s

1 -. 2_ )..) - [ [ .

Phone:

f:mil i I:

, -~

----------.-

-

--- -----

StalP.

) \,\ I.. ..,_

Please provide us with the following informotion

J ( (} ..)((:

Alie--. Registrat ion II: ,]

------

ONLY if pertinent to the issue for which you are requesting assistance:

i YJ.2

B'anch of Scov,cc:

j

Case/ Receipt ll :
Receipt/ Priorit y Dvtc: _ __

Soci<1
I Security n:

_

Housirr, . oan/ Account I::

Jf'ncfa 1ary( iesj:

---

---

- -

Have you contacted ano t he r congressional office? If so please specify which office(s) or state " not ap plicable" be low:

In the space provided below ple.:ise provide a br e' exolar -at 1on of you reJso n tor rec;uest ing assistance f.om Senator Patty
Mwrray's office . If 1ee ded please include <1separate shPe: w,:M a cont :nuation of your reason for request ing ~ssistance.
Pleas<' attac h copie~ of ;iny ~upport ,ng dornr rH~, t~ separ;i:0ly. ___
______
__ _____
__ _ __ __ _

~

I.

~

and her staff to ,ncercede 011 rn- ehol/ re.laced ro the martC'r dC>scnbedabove , including c/le righl ro receive any
information contoined in my file. to forward correspo()dence sen/ by me/us reqordinq this matter. or any other ac r1on I
hove related to the matter described above.
I u11denta nd that any doc11ments provided to Senator Potty Murray or her ~raff moy be wpied um.Jforwarded to orhers
111 reior,on

to th is matter . I ol.\o 11nder~rond that this ,nqu,r y may not c:ondvde

111 my

best mtcrcst.

lJy sign ing I certify that I om thC' person named above. nnd that the Joreqoing information provided is ncwrote, to
the best of my knowledge.

A,

1'\Ct

Signature :
Signature:
?

--

~ '__

Date:

Dat e : _ _ ______

- --

__

__

_

Checkbox to acknowledge that on ad dit iona l signature _is requ ired if information is also in spouse/ representat ive/dual applicant's
name ()fl_if you wont our office to shore finding s with o third party (family member. friend. representative, other}
You may submit this form electronically

by sending it to casework@mur ray.sena t e.gov

SEATTLE OFFICE :

SPOK A NE OFFICE:

VAN COUVER OFFICE:

515 ?nd Avenue

10 Norlll Poq Street
Suite 600

ThP MMsh~ll Ho11~P
1323 Offi cers Row
VJ'ICCuver. WA 98661
PHONE: 360 696 -7797
FAX. 360 696 7798

Suite 2988
Seattle. WA 98174
PHONE: 206 -553-5545

Spokdne . WA 99201
~HONE: 509-624-95~5

FAX 20 6 S53 -0891

~AX : 509 624 9561

AMEHl('AI\

pVERSIGHT

TACOMA OFFICE:
950 Pacific /\venue
Room 650
Tacoma, WA 98402
PHO;\![: 253-572-3636
FAX: 253-5 72-91188

DHS-ICE-19-0196, 19-0197-K-000077
2019-ICLl-00051 2122



Wniteb~tate~ ~enate

r>_1,.,..r,
...oUR.RA."
o.,VJ\Sfi:l 'J~)TON

/ .I : t,o ! ~n,f :o ,rr- .!O if 1G~ ;1,r olf,i

Ptrr,;l,-

; 9;.:, o:.,r ,_,.ff,uonr a,nor:,\o

[0/l!HJ!

1.

l~,; ~1<<.:

of 5e~oG~or ,1.,:mon>>. 1 ouo :..:.~~o:,l ~o!h.t ,r: i 1/2 r l'il'l' :r .:.r r.JU h)\:r.:w

;o.ui ;v10110:~ '! -Jt'v:1o;-;;l."? li,'1 .r~a,-ra:, ; (}('f/

{

.'f'' w1N,ou:

tr.

0 ,,

lw lm v flur-. ,,m,, tu Pub!o< Low 93~579. rnP Provccy .Jct of

e~ r..'t)> ,o;tl!!t':,

'on,p 1-;r

SECTION I

Peti tion er/ Applicant:
Full Name: (Circle : Mr./

Mrs.

I Ms

}

J\t'"""l(t .--- J\,,l
r ( :l~.1 ) 1/LJ) C '>
1

..o ,,(1 ~,.
Country o fa 1rt
. h : \ .\1 o I .., l _,,(
Da t e o f B.1rt h : '11..
.., _;o<.--,
~
1

Ali.-'nnumber / USCISReceipt Number (if any): o..ce..2"-'-/
..,.l"-.: ;_ _ _: _;e,.;;...~__

/ ~('

Ii
l::ma1I:________

__ ____

_ _

. :)...

)A

Phone Number: __

_ ____

__

_ _

Beneficiary:
Full Name: {Circl0: Mr ./ Mrs./

Ms.)

-- +t)_._,/f' +/-..
'
I C \._ -

------

-- - Country-of-8-irth~ __

Date of Birth:

Alien n umb er /USCIS Receipt Number (if any): ___
Address: _ ______________

-----

__

____

_

Phone Number.

Dale of fi lin g: _____

Place of fil;ng: _ __~--.-- - --

____

_

--

Form type(s) - check all that apply:

:-- G-639

=1-90

_ l-129

r . l-29F

=1-130

u

1-131

: N-140

-. 1-212

n

. 11-360

C 1-485

C 1-526

LI 1-539

! I 1-589

DI -590

::: l-600A

r

I -600

'.J 1-601

::: l-600A

r

7 1-730

. 1-751

, 1-765

=1-918

- - 1-924

1-690
....:1-824

=N-400

_

_

_____

Emai l:

__

::- 1-829
:--:N-600

, : 1-914 Supplement A/ 8/C

N-565
I

I-290B

=N -644

1-612

r-::1-821

=1-928

OTHER:

Have you contacted another congressional o ff icP' If so. please sp0cify which officf>. PIPase note tha t dup icate
inquiries may cause cJ delay in your request s.

AMEHl('Af\

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000078
2019-ICLl-00051 2123



2
Section II
Brief descrip t ion of the issue (if you need more space, attach a separate shee t) :

Staff Member (print): Megan Ut emei Phone: 206 -553 -:,:,45 Email: ca;ework@murray .senate.gov

SECTION Ill
Section must be completed by the person who is the subject of the records :
I certify, under oenalty of perjury , that 1) I provided or au,horized all of th~ information in this privacy release and any
documenr submitted w ith it; 2) I reviewed and under stand all of t he informat ion contained in my privacy release and
submitted with it; and 31 all of th is informat ion is compl ete, true, and correct.

f\l

/vl()f

~

(print your name)
'.riu I C '
( )
I v .{
' authorize USCISto release information
contained in my USCIS records as relevant ~ch ecking my case inquiry , and to the extent permitted by law, to
Senato r Patty Mu rray and the Member's staff . In add itio n, I hereby request and authorize the Office of Senator Patty
Murray and her staff to assist me re lated to t he matter described above.

I,

By signing, I certify tha t I am th e person named ;ibove, and the foregoing information provided is accurate. to the
best of my knowledge.
Signature (Petitioner/Bene fi ciary):
Signature {Petitioner/Bene f iciary): ___

___

______

_____

Date: _ _ __

_ __

_

Yo:. may scobm t this fo r r, electron1Ca1ly by sending il to : casework@m urrav.sc :i.:;:c .gov or via tux or mail below .

Office of U.S. Sen ator Patty Mu rray, Sea ttl e
Ql 'i 2"" AvPnu P
Suit e 2988
Sc;ittlc , WA 98174

Phone: 206-S51-'i5-15Fax: 206-'>53-0891

AM enI( 'Al\

j)VERSIGHT

DHS-ICE-19-0196, 19-0197-K-000079
2019-ICLl-00051 2124



From:

l(b)(6); (b)(7)(C)

Sent:

16 Nov 2018 01:30:50 +0000
To:
#IHSC_SEN_Medical;# IHSC_SEN_Mental Health;#NWD-Notification
Mental Health;#NWD-Notification-Medical
Subject:
FW: ***ALERT*** SUICIDEATTEMPT AND ER UPDATEAT
Importance :
High

LCD (b)(B)
; (b)(?)(C)

MLS(ASCP)

Assistant ea t erv 1ces Administrator
Department of Homel and Security
Immigr ation & Customs Enforcemen t (ICE)
Enforceme nt & Remo val Operations (ERO)
USPHS, ICE Health Service Corps .
No rthwe st Detention Center
1623 East J Stree ~(bl(5ll
Tacoma, WA 98421
Offic (b)(6); (b)(7)(C)
Ce ll:
Fax:
rb)(6)
; (b)(7)(C)
I
cid:image007.png @0lD297FB.19484D80cid
mage009.png @0lD297FB.19484D80

:image008 .png @0lD297FB .19484D80c id:i

Warning: This document is UNCLASSIFIED //FOR OFFICIAL USE ONLY (U//FOUO).
It contains information that may be exempt from public release under the Freedom of
Informat ion Act (5 U.S.C. 552). It is to be controlled, stored, handled, transmitted ,
distributed, and disposed of in accordance with DHS poli cy relat ing to FOUO
inform ation and is not to be released to the pub lic or other personnel who do not have a
va lid "need -to-know" without prior approval of an authorized DHS official. No portion of
this report should be furnished to the media , either in written or verbal form.

Fro mt b)(6); (b)(7)(C)

Date: illUISuay , NOV 15 , 20115 , 5.29 PM

r

[b)(6); (b)(7)(C)
SubJect: ***ALERI *** SUICIDE A 11EMPI AND ER OPDAIE A l
Alcon,

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000080
2019-ICLl-00051 2125



The below detainee attempted suicide by hanging on 11/15/2018 . He was revivedon the scene
by Tacoma Fire and Rescue. He had a pulse with regular heart rhythm on ECGand was being
(b)(6); (b)(7)(C)~eceived an update.
bagged by paramedics when he left the buildingat 1535 . LCD~
Name: Amar, Mergensana
A#: 216269802
DOB: 10/23/1978

COB:Russia
DOA: 12/19/2017

RelevantMedicalHistory:Was on HungerStrike but currentlyeating three meals a day with liquid
nutritionalsupplements
Reason sent to ER:CPRinitiateddue to detainee being found unconsciousand hanging with no
pulse.
Current Status: Per ~b)(6); (b)(7)(CJIRN: detainee is still non-responsive, has an anoxic brain
injury, possible spina l cord injury, pupils fixed and dilated, organ life center notified.
Modeof transportation: ACLS
Name of Transport Company:Tacoma Fire and Rescue
Hospital being sent to: St. Joseph's
If you have any questions or need further updates, please call me at l(b)(6); (b)(7)(C)

VeryRespectfully,
!(b)(6); (b)(7)(C)
Lieutenant Commander, USPHS
MS, BSN, RN, CCHP
Nurse Manager
No rthwest Detention Center
ICE Health Service Corps (IHSC)
Enforcement and Remova l Operation s (ERO)
U.S. Immigration and Customs Enforcement (ICE)
1623 E J St
Tacoma , WA 98391
Office: kbl(6); (b)(7)(C)
ICE iPhone:l(b)(6); (b)(7)(C)
!(bl(6l:(b)(7)(Cl
Warning: This document is UNCLASSIFIED //FOR OFFICIAL USE ONLY (U//FOUO).
It contains informat ion that may be exempt from public release under the Freedom of
Information Act (5 U.S.C. 552). It is to be controlled , stored, handled , transmitted ,
distributed, and disposed of in accordance with DHS policy relating to FOUO
information and is not to be released to the public or other personnel who do not have a
valid "need-to-know" without prior approva l of an authorized DHS official. No po1tion of
this report should be furnished to the media , either in written or verba l form

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000081
2019-ICLl-00051 2126



Page 2127
Withheld pursuant to exemption
(b)(S); WIF Draft
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000082



U.S. IMMIGRATIONAND CUSTOMSENFORCEMENT

Policy Number 11003.3: Notification and Reporting of Detainee Deaths
Issue Date:
September 30, 20 16
Effective Date: September 30, 2016
Superseded:
ICE Direct ive 1J 003.2 , "Noti fication and Reporting of
Detainee Deaths" (May 19, 201 1)
Federal Enterpri se Architecture Number: 306- l 12-002b
1.

Purpose/Background. This Directive provide s policy and procedures to be followed
when providing initial notification and ongo ing reporting of the death of a detainee in the
custody of U.S. Immigration and Custo ms Enforcement (ICE) to internaJ ICE program
offices, the Department of Homeland Security (DHS) , Congress , the media , and
nongovernmental organizations (NGOs).

2.

Policy. It is ICE policy to ensure appropriate and timely notification and ongoing
reporting of the death of a detainee occurs. The procedures apply to any detaine e death
that occurs, including but not limited to, in a detent ion facility, medical facility, or in
transit between any such facility.

3.

Definitions . None .

4.

Responsibilities.

4.1.

The Office of Enforcement and Removal Operations (ERO) Executive Associate
Director (EAD) is responsible for:
I) Notifyi ng the Office of the Director (OD) and appropriate ICE and DHS program
offices of a detainee death. At a minimum , offices to be notified includ e the ICE
Offices of the Principal Legal Advisor (OPLA), Profess ional Responsibility (OPR) ,
Public Affairs (OPA) , Congress ional Relations (OCR) , Diversity and Civil Rights
(ODC R); and the OHS Offices of Health Affairs (DHS-OHA) and the DHS Office
for Civil Rights and Civil Liberties (DHS-CRCL); and
2) Ensuri ng all medical reports are provided to the appropr iate program offices (e.g. ,
OHA , JCE Health Services Corps (IHSC), etc.) to initiate a mortal ity review.

4.2.

The ERO Assistant Director for Custody Management (AD CM) is responsible for:
J) Conduc ting an internal review of all facility inspection reco rds whe re the detainee
death occurred ;

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000083
2019-ICLl-00051 2128



2
2) Subm itting a report of the interna l review to ICE se nior management , appropriate ICE
program o ffice s (includi ng OPLA , OPA, OCR , and ODCR) , and OHS CRCL , and the
DHS Office of Inspector Genera l (O IG); and

3) Maintaining
custody.

4.3.

a cumu lative report for each fisca l yea r of detaine e deaths in ICE

Th e ERO Field Offi ce Directo rs (FODs) arc respon s ible for:
I) Co nta ct ing ERO 's Assistant Director s for Field Opera tions and Custody
Management, the Joint Intake Ce nter (J IC), the loca l Office of Chief Co unse l, the
appropriate state age ncies, the local ICE public aff airs o fficers, and the IH SC;

2) Coordinat ing with the appropr iate co nsulate to notify the next-of-kin; and
3) Sending condolen ce letter s to the next-of-kin .

4.4 .

Th e ERO ICE NGO Workin g Group (NGOWG) Point of Cont act (POC) is
res pon s ible for notif yi ng the NGOs of the detain ee death in acc ordance with the
procedures in sec tion 5.3 of thi s Directive , as direct ed by the ERO EAD.

4.5.

Th e ICE Health Service Corp s (IHSC) Medical Director is responsibl e for:
I) Ens uring that the mortality review is comp leted by the appropriate entity; and
2) Pro vi ding autopsy and tox ico logy results. a copy of all Medical Payme nt
Authorization Reque s ts (MedPAR), or any other similar authori za tion(s), a copy of
the death certificate , and all ot her re leva nt documents to the appropriate entity fo r a
mortalit y re view , appropriate ICE progra m offices (including OPLA, OPA. OCR, and
ODCR), and to DHS-CR C L, OPR, and O IG (if the invest igation is being conducted
by O IG).

4. 6.

Th e Offi ce of Profe ssional Responsibili ty (OPR ) is responsible for:
I)

oti fying O IG thro ugh the J IC of the detainee dea th;

2) Upon declinati on by OIG , initiatin g a review into the circum sta nces su rrou nding the
death o f a the detaine e;
3) Pro vid ing the OPR Detainee Death Rev iew to ICE se nior management, the
appropriate ICE program offices (including OPLA , OPA, OCR, and ODCR), the
appr op riat e entity conducting the morta lity review , and DHS-CRCL: and
4) Gathering and preserving all document s and evidence relevant to the detainee's
mort ality, including electro nicall y stored information. electroni c ma il, and other
record s such as the deta inee 's dete nt ion and medica l files, video footage (including

E

Notification and Reponi ng of Detainee Deaths

pVE:Ht>ll:i

DHS-ICE-19-0196, 19-0197-K-000084
2019-ICLl -00051 2129



3
but not limited to handheld camera footage in which the detainee may be featured ,
surveillance footage, etc.), and relevant facility policies.

4.7.

Th e Offic e of Congressional Relations (OCR) is responsible for notifyi ng Congress of
a detainee death. See section 5.3 for the Congressional notification procedures.

4.8.

Th e Offic e of Publi c Affairs (OPA) is respo nsible for notify ing the media of the
detainee death in accordance with the procedures in section 5.3 of this direct ive.

4.9.

The Office of the Principal Lega l Advisor (OPLA) is responsible for initiating its own
inquiry and collection of evidence if deemed appropriate.

4.10.

The Office of Diversity and Civil Rights (ODCR) is responsible for providing a
secondary notification to DHS-CRCL of the detainee death, and to serve as a l iaison
between DHS-CRCL and the ICE prog ram offices throughout the course of the detainee
dea th review .

5.

Procedures.

5.1.

Notification and Reporting Within the Department of Homeland Security (OHS).
1) Immediately followin g the death of a detainee:

a) The FOO in the jurisdict ion where the death occurred must:
i) Contact the ERO Ass istant Directors for Field Operat ions and Custody
Management and the JIC to report the death; and
ii) Report the detainee death as a "significant incident " to the Joint Intelligence
Operations Center (JIOC) using the electro nic ICE Sign ificant Event
Not ification (SEN) system.
b) The ERO EAD must prov ide not ification to the Office of the Director (OD).
c) The JIC, upon notification , must provide notificat ion to the OIG.
2) Within 24 hours of the death of a detainee:
a) The FOO must provide electro nic-mail, telephonic, or in person notification to:
i) The appropr iate Office of Chief Counsel (OCC) in order for the OCC to notify
the local attomey(s) and court officia ls of the death , as appropriate , if there is
a case pending ;
ii) The appropriate state agency( ies), in states that require notification;
iii) The local ICE public affairs officer; and

AM Ef

Notification and Reporting of Detainee Deaths

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000085
2019-ICLl-00051 2130



4

iv) IHSC (if the death did not occur in an lHSC-staffed fac ility).
b) The ERO EAD must:
i) Provide email or telepho nic notification to the OHA and CRCL;
ii) Provide written notification , via a Director ' s Note , to OD and the approp riate
ICE offices , to include at a minimum , OPLA , OPR, OPA, and OCR , and
ODCR ; and
iii) Provide email or telepho nic notification to the DHS-OHA and DHS-CRCL.
3) Within 48 hours of the detainee death, the ERO EAD must ensure that copies of aJI
available medical reports are provided to the appropriate entity (e.g., DHS-OHA ,
IHSC , etc.) to initiate a mortality review , and the IHSC Medical Director must ensure
that the mortality review is comp leted within 45 days. All other relevant documents
must be provided in accordance with section 5.4 of this Directive.
4) All notificat ions provided in accordance with this section, along with an
acknowledgement that the notification was received (if possible) , must be
documented and maintained in the decedent's A-file.
5.2.

Notification to Consulate and Detainee's Next-of-Kin .
I) Within 24 hours of the detainee death :

a) The FOD must telephonically notify the applicab le consulate of the death and
coordinate with consular officials, as neces sary, to locate the next-of-ki n.
b) The FOD must ensure that, unless consular officials are unwilling to do so, all
notifications to next-of-kin are made by consular offic ials.
c) If consular offic ials are unwilling to notify next-of-kin, the FOD must telephone
the person named as the next-of-kin to inform them of the death in a language he
or she can understand.
2) Within 48 hours of the next-of-kin being notified , the FOO must send a condo lence
letter to the next-of-kin (see attached temp late), with a copy to the applicable
consulate.
3) All notifications provided in accordance with this section , along with an
acknow ledgeme nt that the notification was received (if poss ible), must be
documented and maintained in the decedent ' s A-file.

AM Ef

Notification and Reporting of Detainee Deaths

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000086
2019-ICLl-00051 2131



5
5.3.

Notification to Congress, the Media, and Nongovernmental Organizations.
1) Within 24 hours of the death of a detainee, or the next bus iness day , OCR must
provide electronic mail notificat ion to the Chair and Rank ing Member of the
followi ng Committees , as well as to those House and Senate membe rs who represent
the distr ict and state where the death occurred:
a) Senate Judiciary Comm ittee;
b) House Judiciary Comm ittee;
c) Senate Jud iciary Committee , Subcommittee on Immigration and the National
Interest ;
d) House Judic iary Committee , Subcommittee on Immigration and Border Security;
e) Senate Homeland Security and Governmental Affairs Committee;
f) House Home land Security Committee;

g) Senate Appropria tions Com mittee; and
h) House Appropriations Comm ittee.
2) OCR must coordinate with the ICE Office of the Chief Financial Officer before
sending notifications to the House and Senate Appropriat ions Comm ittee staff.
3) In instances where the cons ulate or next-of-k in have not yet been contac ted, OCR
must advise Congress accordingly.
4) Upon comple tion of notifica tions to Congress and the next-of-kin , or when the nextof-kin cannot be located but reasonable efforts have been made by ERO (in
coordinat ion with the consulate) to locate the next-of-kin , OPA must prov ide a media
release to the local press and the Associated Press, and post the media release on
ICE ' s internet website.
5) The ERO ICE NGOWG POC must provide a copy of the med ia release to NGOs via
the ICE/NGO working group co-chairs.
6) In instances where the consulate has been notified of a deta inee's death and the nextof-kin have not been located yet efforts to locate them continue , notificat ions to
Congress , the med ia, or NGOs must include informatio n that efforts to reach next-ofkin are ongoing.
7) Nothing in this section must be construed to prohibit ICE personne l from providing
add itional notifications of the detainee death if deemed necessary by senior ICE
officials.

AMER

Notificati on and Reporting of Detainee Deaths

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000087
2019-ICLl-00051 2132



6

5.4.

On going Reportin g Requir ements.

I) QPR must:
a) Initiate a review of the circumstances surrounding the death of the detainee in
accordance with OPR policies and procedures if DHS 010 declines to investigate
the death;
b) Provide the OPR Detainee Death Revie" to ICE senior management, the
appropr iate entity conducting the mortality n.:vicw, and CRCL; and
c) Assist and coordinate
review/investigation.

with

DI IS-CRC L

as

needed

m

its

death

2) OPLA must initiate its own inquiry and collection of evidence into the circumstances
surrounding the detainee death if deemed appropriate.
3) The ERO Assistant Director tor Custody Management (AD CM) must:
a) In coordination with QPR, initiate an internal review of all facility inspection
records for the detention facility at which the death occurred and a review or all
contract documentation fo r the detention facility where the death occurred. If the
death occurred at a medical facility or while the detainee was in transit, the AD
CM must require such review of the facility where the decedent was last held in
custody.
b) Submit a report of the internal review within 14 calendar days of the detainee
death to ICE senior management, QPR, the appropriate entity conducting the
mortality review, CRCL. and 0 10 (if the investigation is being conducted by
010).
c) Gather and preserve all documents and evidence relevant to the detainee's
mortality, including electron ically stored information and electronic mail. Absent
such extenuating circumstances, such records (e.g., the detainee's detention and
medical files, video footage, and relevant facility policies), should be provided to
QPR within seven days of OPR's request. In the case o f' video footage, including
but not limited to handhcld camera footage in which the detainee may be featured,
surveillance footage. etc., timely preservation is particularly essen tial.
d) Maintain an accurate and up-to-date, cumulative report of those individuals who
have died ,,bile in ICE custody each fiscal year. To ensure that the report is
always current and accurate, thi.: J\D CM must update the report as soon as
information becomes available. At a minimum. the repo11(see attached template)
must include the alien. s name. A-number. date of death. location at time of death.
type of death (natural causes, suicide. homicide, accidental overdose. etc.), and
cause of death as reported on the death cerli ficate.

E

Notification and Reporting of Detainee Deaths

pVE:H~ll:i

DHS-ICE-19-0196, 19-0197-K-000088
2019-ICLl-00051 2133



7
e) Provide all approp riate program offices , includ ing OPA , OCR, OHA , OPLA,
ODCR , OPR , 0 10 , and DHS-OHA and DHS-CRCL with copies of the
cwn ulative report each quarte r and certify the accuracy of the report pr ior to its
distr ibution.
6.

Authoriti es/Referenc es.

6.1.

National Detention Standard , Termina l lllness , Advanced Directi ves and Death.

6.2.

Performance Based NationaJ Deten tion Standard, Termi naJ lllness , Advanced Direct ives
and Death .

6.3 .

OHS Management Directive 0810.1, The Office of the Inspector Genera] , Append ix A.

6 .4.

Memorandum from Margo Schlanger , Office r, OHS Office for Civil Rights and Civil
Liberties , to Kwnar Kibb le, Dep uty Director , U.S. Immigration and Customs
Enforcement , " ICE Coordination with the Office for Civ il Rig hts and Civil Liberties on
the deaths in ICE Custody , includ ing deaths of ICE detainees " (Novembe r 18, 2010) .

6.5.

House Report 113-481 , to accompany H.R. 4903, Department of Homeland Security
Appropriations Bill, 20 15 (June 14, 2014).

7.

Attachment s.

7.1.

Condo lence Letter Temp late

7.2.

Quarterly Report Template

8.

No Priv ate Right Statement. This direct ive is an internal po licy statement of ICE. It is
not intended to, does not, and may not be relied upon to create any right or benefit ,
substantive or procedural , enforceab le at law by any party in any administrative , civil, or
crim inal matte r.

b)(6) ; (b)(7)(C )

ara
a ana
Director
U.S . Immi g ration and Customs Enforceme nt

E

Notification and Reporting of Detainee Deaths

pVcttt>lu

DHS-ICE-19-0196, 19-0197-K-000089
2019-ICLl- 00051 2134



standards set by the National Commission on
Correctional Health Care {NCCHC) in its
provision of medical care to terminally ill
detainees .

4.7 Terminal Illness,
Advance Directives
and Death

3. In the event of a detainee' s death, or a detainee
becomes gravely ill, specified officials as listed
herein and required by ICE policies and the
detainee's designated next of kin shall be notified
immediately;

I. Purpose and Scope
This detention standard ensures that each facility 's
continuum of health care services addresses terminal
illness and advance directives, and provides specific
guidance in the event of a detainee 's death .

4 . In the event of a detainee's death, required

notifications shall be made to authorities outs ide
of ICE/ERO (e.g., the local coroner or medical
examiner), and required procedures shall be
followed regarding such matters as autopsies,
death certificates, burials and the disposition of
decedent's property . Established guidelines and
applicable laws shall be observed in regard to
notification of a detainee death while in custody;

This detention standard applies to the following
types of facilities housing ICE/ ERO detainees :
o

Service Process ing Centers (SPCs);

o

Contract Detention Facilities (CDFs); and

o

State or local government facilities used by
ERO through Intergovernmental Service
Agreements (IGSAs) to hold detainees for more
than 7 2 hours.

5. The health services administrator (HSA) at the
facility where the detainee was housed at the time
of his/her death shall ensure the decedent's
medical record is reviewed for completeness and
closed out ; and

Procedures in itahcs are speciflcally required for
SPCs, CDFs,and Dedicated !GSA lacihties . Non dedicated IGSA facilities must conform to these
procedures or adopt, adapt or establish alternatives,
provided they meet or exceed the intent represented
by these procedures.

6 . In the event of a detainee death , all property of
the detainee shall be returned within two weeks
to the detainee' s next of kin, unless property of
the decedent is being held as part of an
investigation into the circumstances of death;

Various terms used in this standard may be defined
in standard "7. 5 Definitions."

7. The facility shall provide communication
assistance to detainees with disabilities and
detainees who are limited in their English
proficiency (LEP) . The facility will provide
detainees with disabilities with effective
communication, which may include the
provision of auxiliary aids, such as readers ,
materials in Braille, audio recordings, telephone
handset amplifiers, telephones compatible with
hearing aids, telecommunications devices for deaf
persons (TTYs), interpreters , and note -takers, as
needed . The facility will also provide deta inees
who are LEPwith language assistance, including

11.Expected Outcomes
The expected outcomes of this detention standard
are as follows (specific requirements are defined in
"V. Expected Practices") .
I . The continuum of health care services provided to
detainees shall address terminal illness and
advance directives . Appropriate to the
circumstances, each detainee shall be provided
with an option to complete an advance medical
directive;
2. **The fadhty shall be in compliance with

.

t

r s, Advance Directives and

338

2019-ICLl-00051 2135

PBNDS 2011
DHS-ICE-19-0196, 19-0197-K-000090

(Revised December 2016 )



bilingual staff or professional interpretation and
translation services, to provide them with
meaningful access to its programs and activities.

The facility administrator, or designee, shall
immediately notify ICE/ ERO and IHSC.
A detainee in a community hospital remains
detained under ICE/ ERO authority, such that
ICE/ERO retains the authority to make
administrative, non -medical decisions affecting the
detainee (visitors, movement, authorization of care
services, etc.) . However, upon phys ical transfer of
the patient to the community hospital's care, the
hospital assumes:

All written materials provided to detainees shall
generally be translated into Spanish. Where
practicable, provisions for written translation shall
be made for other significant segments of the
population with limited English proficiency .
Oral interpretation or assistance shall be provided
to any detainee who speaks another language in
which written material has not been translated or
who is illiterate.

I . medical decision -making authority cons istent
with the contract (drug regimen, lab tests, x-rays,
treatments, etc.); and

Ill. Standards Affected

2 . authority over the detainee' s treatment, which is
exercised by the hospital's medical staff once
IHSC is notified of admission. However, IHSC
managed care and the facility's HSA shall follow
up on a daily basis to receive information about
major developments.

This detention standard replaces "Terminal Illness,
Advance Directives and Death" dated 12/2/2008.

IV. References
National Commission on Correctional Health Care,
Standards for Heald1 Care in Jails (2014).

To that end, the hospital's internal rules and
procedures concerning seriously ill, injured and
dying patients shall apply to detainees. The Field
Office Director or designee shall immediately notify
(or make reasonable efforts to notify) the detainee' s
next -of-kin of the medical condition and status, the
detainee' s location, and the visiting hours and rules
at that location, in a language or manner which they
can understand.

ICE/ERO Performance -based National Detention
Standards 2011: "4.3 Medical Care."
ICE Directive on "Notification and Reporting of
Detainee Deaths," Directive 7.9-0, October 1, 2009

V. Expected Practices
A. Terminal Illness

ICE/ERO, in conjunction with the medical provider,
shall provide family members and any others as
much opportunity for visitation as possible, in
keeping with the safety, security and good order of
the facility. Facility staff shall be reminded to observe
and maintain safety and security measures while
finding ways to respectfully accommodate the family
and detainee needs at this sensitive time .

When a detainee' s medical condition becomes lifethreatening, the facility's clinical medical authority
(CMA), or HSA, shall:
1. Arrange the transfer of the detainee to an
appropriate off-site medical or community facility
if appropr iate and medically necessary; and
2. Immediately notify the facility administrator
and/ or ICE/ERO Field Office Director both
verbally and in writing of the detainee' s
condition . The memorandum shall describe the
detainee's illness and prognosis.

.

t

r s, Advance Directives and

B. Living Wills and Advance Directives
Once a detainee is diagnosed as having a terminal
illness or remaining life expectancy of less than one
year, the medical staff shall offer the detainee access

339

2019-ICLl-0005 1 2136

PBNDS 2011
DHS-ICE-19-0196, 19-0197-K-000091

(Revised December 2016 )



to forms or other related mater ials on Advance
Directives or Living Wills, including the appropriate
translation services when needed. Likewise, when
the detainee is held at an off-site facility, staff at that
facility may assist the detainee in completing an
Advance Directive and/ or Living Will.

I . a DNR written by a staff physician requires the
CMA's approval;
2. the policy shall protect basic patient rights and
otherwise comply with state requirements and
jurisdiction in which the facility is located ;
3. a decision to withhold resuscitative services shall
be considered only under specified conditions:

All facilities shall use the State Advance Directive
form, appropriate to the state in which the facility is
located, for implementing Living Wills and Advance
Directives, the guidelines for which include
instructions for detainees who wish to:

a. the detainee is diagnosed as having a terminal
illness;
b. the detainee has requested and signed the
order (if the detainee is unconscio us,
incompetent, or otherwise unable to
participate in the decision, staff shall attempt
to obtain the written concurrence of an
immediate family member, and the attending
physician shall document these efforts in the
medical record); and

l . have a living will other than the generic form
made available by medical staff; or
2 . appoint another individual to make advance
decisions for him/her.
At any time, a detainee may request forms or other
related materials on Advance Directives or Living
Wills. These may be prepared by the detainee's
attorney at the detainee's expense.

c. the decision is consistent with sound medical
practice, and is not in any way associated with
assisting suicide, euthanasia or other such
measures to hasten death; and

When the terms of the Advance Directive must be
implemented, the medical professional overseeing
the detainee' s care shall contact the appropriate
ICE/ ERO representative .

4. the detainee's medical file shall include
documentation validating the DNR order:

ICE/ ERO may seek judicial or administrative review
of a detainee's Advance Directive as appropriate .

a. a standard stipulation at the front of the in patient record, and explicit directions: "do not
resuscitate" or "DNR"; and

C. Do Not Resuscitate (DNR) Orders

b. forms and memoranda recording:

Each facility holding detainees shall establish written
policy and procedures governing DNR orders. Local
procedures and guidelines must be in accordance
with the laws of the state in which the facility is
located .

I) diagnosis and prognosis;
2) express wishes of the detainee (e.g., living
will , advance directive, or other signed
document) ;

Health care shall continue to be provided consistent
with the DNR order . If the DNR order is not
physically present or there is any question about the
validity of the document, appropriate resuscitative
aid shall be rendered until the existence of an active,
properly executed DNR is verified.

4) consensual decisions and recomme ndations
of medical professionals, identified by
name and title;

Each facility's DNR policy shall comply with the
following stipulations :

5) mental competency (psychiatric)
evaluation, if detainee concurred in, but did

.

t

r s, Advance Directives and

3) immediate family's wishes, if immediate
family has been identified;

340

2019-ICLl-00051 2137

PBNDS 2011
DHS-ICE-19-0196, 19-0197-K-000092

(Revised December 2016 )



not initiate, the DNR decision; and

5. IHSC medical staff shall assist in the preliminary
medical evaluation , contingent on the availability
of resources; and

6) informed consent evidenced, among other
things, by the legibility of the DNR order,
signed by the order ing physician, and
CMA; and

6 . the facility shall coordinate arrangements for the
donation .

5 . a detainee with a DNR order may receive all
therapeutic efforts short of resuscitation;

E. Death of a Detainee in ICE/ERO
Custody

6 . the facility shall follow written procedures for
notifying attending medical staff of the DNR
order; and

Each facility shall have written policy and procedures
to be followed to notify ICE/ERO officials, next -ofkin and consulate officials of a detainee's death, in
accordance with ICE Directive on Notification and
Reporting of Detainee Deaths, Directive 7.9-0,
October I, 2009.

7 . as soon as practicable, the CD or HSA shall notify
the IHSC medical director and the respective ICE
Office of Chief Counsel of the basic circumstances
of any detainee for whom a DNR order has been
filed in the medical record .

F. Disposition of Property
Facilities shall turn over the property of the decedent
to ICE/E RO within one week for processing and
disposition. Unless property of a decedent is being
held as part of an investigation into the
circumstances of death, that property should be
returned to the decedent's next of kin, if known,
within two weeks .

D. Organ Donation by Detainees
If a detainee wants to donate an organ:
I . the organ recipient must be a member of the
donor's immediate family;
2. the detainee may not donate blood or blood
products;

G. Disposition of Remains

3. all costs associated with the organ donation (e.g.,
hospitalization, fees) shall be at the expense of the
detainee, involving no Government funds ;

Within seven calendar days of the date of
notification, either in writing or in person, the
family shall have the opportunity to claim the
remains. If the family chooses to claim the body, the
family shall assume responsibility for making the
necessary arrangements and paying all associated
costs (e.g., transportation of body, burial).

4. the detainee shall sign a statement that documents
his/her :
a. decision to donate the organ to the specified
family member;
b. understanding and acceptance of the risks
associated with the operation;

If the family wishes to claim the remains, but cannot
afford the transportation costs, ICE/ERO may assist
the family by transporting the remains to a location
in the United States. As a rule, the family alone is
responsible for researching and complying with
airline rules and federal regulations on transporting
the body; however, ICE/ERO may coordinate the
logistical details involved in returning the remains .

c. that the decision was undertaken of his/her

own free will and w ithout coercion or dure ss;
and
d. understanding that the Government shall not
be held responsible for any resulting medical
complications or financial obligations
incurred;

.

t

r s, Advance Directives and

If family members cannot be located or decline orally

341

2019-ICLl-00051 2138

PBNDS 2011
DHS-ICE-19-0196, 19-0197-K-000093

(Revised December 2016 )



or in writing to claim the remains, ICE/ERO shall
notify the consulate , in writing, after which the
consulate shall have seven calendar days to claim the
remains and be responsible for making the necessary
arrangements and paying all costs incurred (e.g .,
moving the body, bur ial).

respective ICE Office of Chief Counsel shall be
consulted ; and
3 . a copy of the written procedures shall be
forwarded to the ICE Office of Chief Counsel.
The written procedures shall address, at a minimum,
the following ;

If neither the family nor the consulate claims the

I . contacting the local coroner or medical examiner,
in accordance with established guidelines and
applicable laws;

remains, ICE/E RO shall schedule an indigent's
burial , consistent with local procedures . However , if
the detainee's record indicates U.S. military service,
before proceeding with the indigent burial
arrangements, ICE/E RO shall contact the Department
of Veterans Affairs to determine whether the
decedent is eligible for burial benefits.

2 . scheduling the autopsy;
3. identifying the person who shall perform the
autopsy;
4. obtaining the official death certificate; and

The Chaplain may advise the facility administrator
and others involved about religious considerations
that could influence the decision about the
disposition of remains.

5. transporting the body to the coroner or medical
examiner's office.
a. Who May Order an Autopsy
The FBI, local coroner, medical examiner, ICE
personnel or clinical medical/ administrative
health authority may order an autopsy and
related scientific or medical tests to be
performed in a homicide, suicide, fatal
accident or other detainee 's death, in
accordance with established guidelines and
applicable laws.

Under no circumstances shall ICE/ERO authorize
cremation or donation of the remains for medical
research.

H. Death Certificate
The facility administrator shall specify policy and
procedures regard ing responsibility for proper
distribution of the death certificate, as follows :
I . send the original to the person who claimed the
body, with a certified copy in the A-file on the
decedent; or

The FBI, local coroner, medical examiner, ICE
personnel or clinical medical/ administrative
health authority may order an autopsy or post mortem operation for other cases, with the
written consent of a person authori zed under
state law to give such consent (e.g., the local
coroner or medical examiner, or next -of-kin),
or authorize a tissue transfer author ized in
advance by the decedent.

2 . if the decedent received an indigent' s burial,
place the original death certificate in the A-file.

I. Autopsies
Each facility shall have written policy and procedures
to implement the provis ions detailed below in this
section .

b. Making Arrangements for an Autopsy
Medical staff shall arrange for the approved
autopsy to be performed by the local coroner
or medical examiner, in accordance with
established guidelines and applicable laws:

1. the facility chaplain shall be involved in
formulation of the facility's procedures ;
2. because state laws vary greatly, including when to
contact the coroner or medical examiner, the

.

t

r s, Advance Directives and

342

2019-ICLl-00051 2139

PBNDS 2011
DHS-ICE-19-0196, 19-0197-K-000094

(Revised December 2016 )



I) while a decision on an autopsy is pending,
no action shall be taken that shall affect the
validity of the autopsy results; and
2) local law may also require an autopsy for
death occurring when the decedent was
otherwise unattended by a physician.
3) Religious Considerations
It is critical that the Field Office Director, or
designee , verify the detainee' s religious
preference prior to fmal authori zations for
autopsies or embalming, and accommodate
religious -specific requirements .

.

t

r s, Advance Directives and

343

20 19-ICLl-00051 2140

PBNDS 2011
DHS-ICE-19-0196, 19-0197-K-000095

(Revised December 2016 )



Wilcox, Bryan S
27 Nov 2018 15:39:5 2 +0000

From:
Sent:
To:

rb)(6); (b)(7)(C)

f b)(6); (b)(7)(C)

Subject :
Letter of Condo lence
Attachments:
Amar-con dolence_lette r.docx, Detainee Death Checklist.xis,
11003.3_Notificat ionReport ingDetaineeDeat hs.pdf, PBNDS-4-7-Terminal Illness, Advance
Direct ives and Death.pdf
Importance :
High
(b)(6);
(b)(7)(C)

Acc ording to the detainee death protocol, the FOD has to send a letter of condolence to
the family within 48 hours of the notifica tion of death. Obviously , we can't stick to that
time frame in this case, but we need to close this loop as soon as possible.
Here's a draft letter. Acco rding to the temp late, we have to provide something on the
cause of death. I think the highlighted is the most sterile way we can do this.
The case officer is going to have to work with the RIO DDO on getting the rest of the
info for the letter and getting this letter to the parents and/or document ing his effo rts.

i<b)(6); (b)(7)(C)

Iplease feel free to commen t on the letter

Also, we need to ensure all the requireme nts of PBNDS have been, or are being met, and
in particular, the outreach to the family on disposition of the body primarially starting on
page four of the standard attached.

Bry an S. Wi lco x
A c ting F ield Offic e Dir ector
TCE E nfo rceme nt & R emo v . .,L,JPY,~~~.>.l
M ain :t b)(6); (b)(7)(C)
D esk :

f

eatt le, W A
/ Ce ll : ..,,.!
(b.,...,
)(=
6)"""
; (b,...,.
)(=7),(C
.,..,
,..,..
)--,

CONFIDENTIALITY: This emai l and attachments arc intended for the above name only and arc confident ial. If you arc not the intended
addressee , or the person respons ible for deliveri ng it to the intended addressee, you may neither copy, disseminate, nor distribute it to anyone

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000096
2019-ICLl-0 0051 2141



else or use it in any unauthorized manner. To do so is strictly prohibited and may be unlawful. If you receive this email by mistake, please
advise the sender immediately by using the reply facility in your mail software and delete it from your computer.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000097
2019-ICLl-00051 2142



Page 2143
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000098



U.S. IMMIGRATION AND CUSTOMS ENFORCEMENT
DIRECTIVE TITLE: NOTIFICATION AND REPORTING OF DETAINEE DEATHS
INDIVIDUAL INCIDENT CHECKLIST

Field Office:
Detainee Name:
A#:

Date of Death:

a) Immedi ately following the death of a detainee:
i) Enforcement and Removal Operations (ERO)
Field Office Director (FOD) shall:
Date:

Status:

Time Person making
Time: Zone: Notification:

Person Notified:

Manner :

?Contact

the ERO AssistantDirector for Field
Operations.
? Joint Intake Center (TIC)by telephone to report
the death.
?The AssistantDirector for Field Operations shall
notifythe ExecutiveAssociate Director by telephone.
? Report the detainee death as a "significan
t
incident"to the ICE Reportingand Operations
Center (IROC) usingthe electronicICE Significant
Event Notification(SEN) system.
? The ExecutiveAssociate Director shall provide

telephonicnotificationto the Officeof the Director.
?The JIC, upon being notified, shallprovide
telephonicnotificationto the DHS Office of the
Inspector General (OIG).
b) Within 24 hours of the death of a detainee:
i) The FOD shall provid e email, telephonic , or in
person notification to:
Date:

Status:

I

tim e !Person making
Time: Zone: Notification:

IPerson Notified: IManner :

~

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000099
2019-ICLl-00051 2144

I



U.S. IMMIGRATION AND CUSTOMS ENFORCEMENT
DIRECTIVE TITLE: NOTIFICATION AND REPORTING OF DETAINEE DEATHS
INDIVIDUAL INCIDENT CHECKLIST
? The appropriate Chief Counsel Office (who will

notifythe alien's attorneyofrecord , EOIR, BIA and
CircuitCourt officials).
? Attorney of Record notification.

AMf::HICAN

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000100
2019-ICLl-00051 2145



U.S. IMMIGRATION AND CUSTOMS ENFORCEMENT
DIRECTIVE TITLE: NOTIFICATION AND REPORTING OF DETAINEE DEATHS
INDIVIDUAL INCIDENT CHECKLIST
? The appropriate state agency(ies), in states that

require notification.
?Toe local ICE public affairsofficer.
?The ICE Health Service Corp (IHSC).
ii) The Executive AssociateDirector of ERO
shall:
Status:

Date:

Time Person making
Time: Zone: Notification:

Person Notified:

Manner :

? Provide emailor

telephonicnotificationto the
DHS Officeof HealthAffairs.
? Provide emailor telephonicnotificationto the Civil
Ri!:!htsand CivilLiberties.
? Provide writtennotificationto OAD via a
Director's Note.
? Provide writtennotificationto the Office of
ProfessionalResponsibilityvia a Director's Note.
? Provide writtennotificationto the Office of Public
Affairsvia a Director's Note.
? Provide writtennotificationto the Office of
Con!lfessionalRelationsvia a Director's Note.
? Provide writtennotificationto the Office ofICE
Policy, via a Director'sNote.
c) Within 48 hours of the death of a detainee, the
Executive Associate Director of ERO shall:
? Ensure that copies of all availablemedicalreports
are provided to the DHS Office of Health Affairs
(OHA) in order to provide OHA the abilityto initiate
a proper mortalityreview. (All other relevant
documents shall be provided to OHA in

A MERICAi\

Iaccordance with sectio n 8.)

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000101
2019-ICLl-00051 2146



U.S. IMMIGRATION AND CUSTOMS ENFORC EMENT
DIRECTIVE TITLE: NOTIFICA TION AND REPORTING OF DETAINEE DEAT HS
INDIVIDUAL INCIDENT CHECKLIST

NOTE: All notificationsprovided in accordance with
this section, along with an acknowledgmentthat the
notificationwas received (if possible), shall be
documented and maintainedin the decedent' s alien
file(A-file).
7.2 Notification to Consulate and Detainee's Next-of-Kin.
a) Within 24 hours of the death of a detainee:
Status:

Date:

Time Person making
Time: Zone: Notification :

Person Notified :

Manner :

Time Person making
Time: Zone: Notification:

Person Notified :

Manner :

?The FOD shalltelephonicall
y notifythe applicable
consulate of the death and coordinate with consular
officials, as necessary, to locate the next-of-kin.
? The FOD shallensure that, unless consular
officialsare unwilling to do so, allnotifications to next
of-kin are made by consular officials.
? If consular officialsare unwillingto notifynext-ofkin, the FOD shall telephone the person named as
the next-of-kinto informthem of the death in a
larnmagethey can understand.
b) Within 48 hours of the next-of-kin being notified:

Date:
? The FOD

shall send a condolence letter to the
next-of-kin (see attached template), with a copy to
the applicableconsulate.
Name of Next-of
Kin:
Address:
Relation:

AVH::HICAN

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000102
2019-ICLl-00051 2147



U.S. IMMIGRATION AND CUSTOMS ENFORCEMENT
DIRECTIVE TITLE: NOTIFICATION AND REPORTING OF DETAINEE DEATHS
INDIVIDUAL INCIDENT CHECKLIST

7.3. Notification to Congress, the Media and Nongovernmental Organizations .
a) Within 24 hours of the death of a detainee, the
ICE Officeof CongressionalRelationsshallprovide
e-mailnotificationto the Chair and Rankingmember
of the followingCommittees:
Status:

Date:

I

Time Person making
Time: Zone: Notification:

Person Notified:

Manner :

? Those House and

Senate members who have
iurisdictionover where the death occurred
? Senate JudiciaryCommittee.
? House JudiciaryCommittee.
? Senate JudiciaryCommittee,Subcommitteeon
Immi!rration.Refugeesand Border Security.
? House JudiciaryCommittee,Subcommitteeon
Immigration,Citizenship,Refugees,Border Security
and InternationalLaw.
? Senate Homeland Securityand Governmental
AffairsCommittee.
? House HomelandSecurityCommittee.
? Senate AppropriationsCo1mnittee
.
? House AppropriationsCommittee.
NOTE: OCR shallcoordinate with the ICE Office of the Chief FinancialOfficer before sendingnotificationsto
House and Senate A1212ro12riations
Committeestaff.
lcoMMENTS:

I

AMf::HICAN

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000103
2019-ICLl-00051 2148



U.S. IMMIGRATION AND CUSTOMS ENFORC EMENT
DIRECTIVE TITLE: NOTIFICA TION AND REPORTING OF DETAINEE DEAT HS
INDIVIDUAL INCIDENT CHECKLIST
? The Office of Public Affairs shall provide a media release
to the local press and the Associated Pre ss, and post the
media release on ICE's Internet website. (After notification
of the next-of-kin, or when the next-of-kin cannot be located
but reasonable efforts have been made by DRO (in
coordination with the consulate) to locate the next-of-kin.)
? The ICE Office of Policy shall provide a copy of the media
release to nongovernmental organizations (NGOs) via the
ICE/NGO workirn! ,:i:rouoco-chairs.
? In instances where the consulate has been notified of a
deta inee ' s death but the next-of-kin have not been located
yet efforts to locate them continue, notifications to
Congr ess, the media or NGOs shall include information that
efforts to reach next-of-kin are ongo ing.

8 ONGOING REPORTI NG REQUIREMENTS.
8.2.
Detention Ma nagemen t Division.

-

Upon the death of a detainee in a detentionfacility,
the ERO AssistantDirector for Management(ADM)
shall require:
Status:

Date:

Time Person making
Time : Zone: Notification:

Person Notified:

Manner :

? In coordinationwith OPR,

A vlt:HlliAI\J

an internalreview of all
facilityinspectionrecords for the detentionfacilityat
whichthe death occurred.
? A review of all contract documentationfor the
detentionfacilitvwhere the death occurred.
? If the death occurs at a medicalfacilityor while
the detainee is in transit, the ADM shallrequire such
reviewat the facilitywhere the decedent was last
held in custody.
b) The ADM shall submit the records within 14
calendar days of the death of the detaineeto:

pVERSIGHT

I
DHS-ICE-19-0196, 19-0197-K-000104

2019-ICLl-00051 2149



U.S. IMMIGRATION AND CUSTOMS ENFORCEMENT
DIRECTIVE TITLE: NOTIFICATION AND REPORTING OF DETAINEE DEATHS
INDIVIDUAL INCIDENT CHECKLIST
Status:

Date:

Time Person making
Time: Zone: Notification:

Person Notified:

Manner :

Time Person making
Time: Zone: Notification :

Person Notified:

Manner:

?

ICE senior management
? OPR
? 0 HA for inclusionin OHA' s mortalityreview
? CRCL
? OIG (if the investigation
is being conducted by
theOIG).
I

c) The ADM shallprovide autopsy and toxicology
results (if applicable), a copy of all treatment
authorizationrequests (TAR), a copy of the death
certificateand all other relevantdocuments (ie., state
and local law enforcementinvestigatoryinformation),
as soon as they become availableto:
Status:

Date:
?

OHA for inclusionin OHA's mortalityreview
? CRCL
? OIG (if the investigation
is being conducted by
theOIG).

AMf::HICAN

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000105
2019-ICLl-00051 2150



U.S. IMMIGRATION AND CUSTOMS ENFORCEMENT
DIRECTIVE TITLE: NOTIFICATION AND REPORTING OF DETAINEE DEATHS
INDIVIDUAL INCIDENT CHECKLIST

AMERICAN

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000106
2019-ICLl-00051 2151



b)(6); (b)(7)(C)

From :

6 Nov 2018 06:48:10 +0000

Sent:
b)(6); (b)(7)(C)

Re: 3rd shift declined meals 11/5/18

Subject:
b)(6); (b)(7)(C)

I 1st declined

________

i,,...,.,.,,.,....,,-:-=..,.,,.,..-----~-.

~__.

...,,._,_

meal

r-23rd declined

b)(6); (b)(7)(C)

meal

2nd declined meal

f 1st declined meal

(b)(6); (b)(7)(C)

H-Seg Amar A#216269802 - 30th declined meal
Thank you in advance.
b)(6); (b)(7)(C)

1eu enan
The GEO Group, Inc.(R)
Northwest Detention Center
1623 East J . St reet
Tacoma, WA 98421
rb )(6); (b)(7)(C)

fb )(6); (b)(7)(C)

www.qeoqro uo.com
From:

l(b)(6); (b)(7)(C)

Sent: Monda v Novemb er 5 201 8 10:09:08 AM
(b)(6); (b)(7)(C)

Day shift declined meals as are as follows for 11/5/18 Lunch
i.:<b.:...:.
)(6....:.;
);....:.;
(b...:..;
)(....:.7
).:....
<c.:....
) __
5
7
(b)( ); (b)( )(C)

--1..1,~lined her 5th meal - med iso/Hosp
declined his 22nd meal- Med iso

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000107
2019-ICLl-00051 2152



6
~jt
b-)(- )_
; (b- )(-?)-(C_l _______

~ldeclined his 1 tray- F-4

b)(6); (b)(?)(C)

ergean
GEO Corrections & Detention
Northwest Detention Center
1623 East J Street
Tacoma Washin ton 98421
Tel : (b)(6); (b)(?)(C)
Cell

(R)

This email and any files transmitted with it are confidential and are intended solely for the use
of the individual or entity to which they are addressed. If you are not the intended recipient or
the person responsible for delivering the email to the intended recipient, be advised that your
have received this email in error and that any use, dissemination, forwarding, printing or
copying of this email is strictly prohibited . If you have received this email in error, please
immediately notify by replying to this email.

From:l

(b)(6); (b)(?)(C)

Sent: Monda

I

November 5 2018 6:37:27 AM

(b)(6); (b)(?)(C)

v.

'

le;

As of breakfast meal Monday 11/5/18 the following detainees declined the breakfast
meal:
Med-lso
l(b)(6); (b)(7)(C)

I20th declined

meal

H-Seg

Amar #216269802, 28th declined meal

!(b)(6); (b)(?)(C)

SGT/HNT Commander
GEO Corrections & Detention
Northwest Detention Center
1623 East J Street
Tacoma, Washin ton 98421
Tel: (b)(6); (b)(7)(C)

(R)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000108
2019-ICLl-00051 2153



Cel I:

(b)(6); (b)(7)(C)

(b)(6); (b)(7)(C)

www.geogroup.com

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000109
2019-ICLl-00051 2154



l<b)(6); (b)(7)(C)

Fro m :

Se nt:
To:
~ohnson,

17 Nov 2018 21:01:39 +0000
Wilcox, Bryan sJPYb ){6); (b)(?)(C)

Uennings, David

W*b l/ 6\ /bl/ 7)/Cl

Tae D

Subje ct:

RE: A#: 216269802 Hospital ICU report

Thank you sit

From: Wilcox , Bryan s ....
~b_)(6_);_(b_)(_7)_
(C_) ______
Date: Saturda , Nov 17, 2018 , 3:43 PM
To b)(6); (b)(7)(C)

___.

{b)(6); (b)(7)(C)

Johnson, Tae D ~l(b_)(6_);_(b_)(_7)_(C_) _____
Subject: FW : A#: 216269802 Hospital ICU report

b)(6); (b)(7)(C)

~

The latest from IHSC

Sent with BlackBen-y Work
(www .blackben-y .com)
From:l(b)(6); (b)(7)(C)
Date: Saturday , Nov l / , 2018,
11:43 AM
,.,,....,.,
.,,,........,~,..,..,,..,.---------,
To: #IHSC SEN Medical (b)(6); (b)(?)(C)
VhbMl
)(6;;-;);7(b::\i)
i ("1i7
)Jr
(c") -(b)(6); (b)(7)(C)

, #IHSC SEN Mental Health
~--..__-----,..
,--:,:rr"l'TT'T'l
rT_"'TT":0=1=1
-=ca~1011-M
ed ical (b)(6); (b)(7)(C)
, #NWD-Notification Mental Health b)(6); (b)(7)(C)

269802 Hospital ICU report

Hospital day Update for ICU as of 11:30 am PST 11/17/2018
DAY 3

A#:216269802
NAME: Amar, Mer
DOB: 10/23/1978
COB: Russia
DOA: 12/19/2017
Relevant Medical History: Was on self-imposed protest Hunger Strike that ended last
week with patient in good medical condition
Reason sent to ER: CPR initiate d due to detainee asphyxiation from self harm
strangulationand t ran sferred to ICU when pulse was achieved.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000110
2019-ICLl-00051 2155



Current Status: pt with anoxic brain injury. He is intubated and on IVs to sustain his BP.
He had an EEGyesterday with the results not yet available. Pt has acidosis and
hyperkalemia with liver and renal failure. He is still in a deep coma but is not brain dead
completely due to the fact he is over-breathing the ventilator.
In the initial hours of this patient's care on 11/16, our NWDC warden talked with the
attending and was told of the poor prognosis for this patient. He then indicated to the
attending he agreed with her not do any medical interventions other than basic
supportive care. Unfortunate ly this was passed on to the nursing team in ICU.

)~ii~iir.,

on 11/16, I let her know our NWDC warden
During my initial conversation with Dr
does not have any medical authority overt 1spatient and she would need to work
through me and our IHSC administrative team for progress reports and direction of
medical care.
At this point, Dr~~/\~1:~. has said she will work with the hospital's ethics board on the
recommendations for the care of this comatose patient. She will notify us of the EEG
result, but will also work to correct any dehydration, electrolyte imbalance, etc. for life
sustaining measures for this patient. She will call me on my cell phone for any changes
in condition.
Location: St Joseph's Hospital, ICU Rm 6Bravo6.
Attending Physician: Drl(b)(6);~. Trauma Physician at l(b)(6); (b)(7)(C)
RN (b)(6); (b}(?)(C)
the ICU Trauma PA phone #tb )(6); (b)(?)(C)

I

I

I

Thank you Dr!/bl/6\: /bl/7)/Cl I

LCDRfb)(6); (b)(?)(C)
IMLS(ASCP)
Assistant Health Services Administrator
Department of Homeland Security
Immigration & Customs Enforcement (ICE)
Enforcement & Removal Operations (ERO)
USPHS,ICEHealth Service Corps.
Northwest Detention Center
1623 EastJ Street #4
Tacoma, WA 98421
Office: (b)(6);(b)(?)(C)
Cell: (b)(6); (b)(?)(C)
Fax:
l(b)(6);(b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000111
2019-ICLl-00051 2156



From :

Sent:
,....T_o~;
------~
~l
(b_)(6_);_(b_)(7_)(_CJ___

Johnson, Tae D
17 Nov 2018 21:03:23 +0000
Wilcox Bryan sfb l( 6); (b)(?)(C)

___,I

Subject:

~ennings, David v\.1(b)(6);

'

"-'-'--'-'---...J

RE: A#: 216269802 Hospital ICU report

Thx Bryan

Sent with BlackBerry Work
(www .blackberry .com)
From: Wilcox, Bryan S ....
l(b,..,.
)(6
..,..,
),,...
; (b--=
)(_7),(C
..,......
) ......,,.
_____
Date: Saturda , Nov 17, 201 8, 3 :43 PM
To (b)(6); (b)(?)(C)

~
ennings, David W

b)(6); (b)(?)(C)

ohnson, Tae
Subject: FW : A#: 2 16269802 Hospital ICU repor t

(b)(6); (b)(?)(C)

________

(b)(6); (b)(?)(C)
,__

___,

The latest from IHSC

Sent with BlackBerry Work
(www .blackberry.com)
From: 1Cb)(6); (b)(?)(C)
Date: Saturday, Nov 17, 20~18~1_1_:
4~3_A~M------~
To: #IHS C SEN Medi cal (b)(6); (b)(?)(C)
, #IHSC_SEN_Mental Health
(b)(6); (b)(?)(C)
, #NWD-N otification-M edical (b)(6); (b)(?)(C)
- ot1 .1cat1on Mental Health b)(6); (b)(?)(C) ~----~~

Subject: FW : A#: 16 69 802 Hospital ICU repor t

Hospit al day Update fo r ICU as of 11:30 am PST 11/17/2018

DAY3
A#:216269802
NAME: Amar, Mer
DOB: 10/23/1978
COB: Russia
DOA: 12/19/2017
Relevant Medical History: Was on self-imposed protest Hunger Strike that ended last
week with patient in good medical condition
Reason sent to ER:CPRinitiated due to detainee asphyxiation from self harm
strangulationand transferred to ICU when pulse was achieved.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000112
2019-ICLl-00051 2157



Kb)(6); (b)(7)(C)

From :

Sent:
To:

17 Nov 2018 01:33:42 +0000
Wilcox, Bryan (b)(6); (b)(?)(C)

Subject :

RE:A#:216269

ennings, David W
report for 1330

10/4, thanks.

Sent with BlackBerry Work
(www .blackbe rry.com)
From: Wilcox, Bryan S ._f
b_)(6
_)_
; (_
b)_(7_)(_
C_______
)
Date: Frida , Nov 16, 2018, 8:32 PM
b 6

___,

b 7 C

b)(5); (b)(?)(C)

nnings, David W ._l
(b_)(_6)_; (_b)_(7_)(_C_
) _______

__.

Subject: FW: A # : 216269802 Hospital ICU report for 1330

Please see below
We have confirmed that he has no family in the United States and obtained a phone
number for his wife in Russia. We have not been able to contact her, nor the Russian
consulate
Bryan S. Wilcox
Acting Field Office Director
ICE Enforcement & Removal Operations,
Desk J(b)(6); (b)(7)(C)
Main: !(b)(6); (b)(7)(C)

I/

Seattle, WA
Cell: l.,,..
(b"'""
)(6,,.,...
);....,,.
(b..,...,
)(=
7)(=c.,....
) -,

!/

CON FIDENTIALITY: This email and attachments are intended for the above name on ly and are confidential. If you are not
the intended addressee, or the person responsible for delivering it to the intended addressee , you may neither copy,
d isseminate , nor distribute it to anyone e lse or use it in any unauthorized manner. To do so is strict ly prohib ited and may
be unlawful. If you receive th is ema il by mistake , please adv ise the sender immed iate ly by using the reply facility in your
mail software and delete it from your computer.

From: i<b)(6); (b)(7)(C)

I

Sent: Friday, Novem ber 16, 2018 3:46 PM
To: #IHSC SEN Medical
(b)(6); (b)(7)(C)
~b
t )(6); (b)(7)(C)
fb)(6); (b)(7)(C)

.,,..,..,=-,,..,..,,,""='",-----------,

b)(6); (b)(7)(C)

; #NWD-Notification
#IHSC SEN Mental Hea lth

I,
.. #NWD - Notifi~ation

I

- Medical

5 );
Mental Hea lt (b)(
l h\/7\/r"\

Subject: FW: A#: 21 6 269802 Hospital ICU rep ort for 1330
ICU Update as of 14:00 PST :

Pt is now having an EEG test. His blood pressure is slow ly dropping despite being on
pre ssor IV drip. His immediate prognosis is very poor.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000113
2019-ICLl-00051 2158



LCD~(b)(6); (b)(?)(C)

IM LS(ASCP)

Assistant Health Services Administrator
Department of Homeland Security
Imm igration & Customs Enforcement (ICE)
Enforcement & Removal Operations (ERO)
USPHS,ICE Health Service Corps.
Northwest Detention Center
1623 East J Street rb)(6)1
Tacoma, WA 98421
Office: (b)(6); (b)(7)(C)
Cell: b)m-ri
, rTT'l'l"T.,,....,,
-----r'
Fax:
l(b)(6); (b)(7)(C)
cid:image007.png@010297FB.19484D80cid:image008.png@01D297FB.19484080cid:image009.
png@010297FB.19484O80

Warning: This document is UNCLASSIFIED//FOROFFICIALUSEONLY (U//FOUO). It contains
information that may be exempt from public release under the Freedom of Information Act (5
U.S.C. 552). It is to be controlled, stored, handled, transmitted, distributed, and disposed of in
accordance with OHS policy relating to FOUO information and is not to be released to the public
or other personnel who do not have a valid "need -to-know" without prior approval of an
authorized OHSofficial. No portion of this report should be furnished to the media, either in
written or verbal form .

Fromf b)(6); (b)(7)(C)

Date: Friday, Nov 16, 2018, 2:00 PM
l(b)(6); (b)(7)(C)
SubJect: A#: 216269802 Hospital ICU report tor 1330
Hospita l day #1 in ICU 1330 report
A#:216269802
NAME: Amar, Mer
DOB: 10/23/1978
COB: Russia
DOA: 12/19/2017
Relevant Medical History: Was on self-imposed protest Hunger Strike but began eating th ree
meals a day with liquid nutritiona l supplements
Reason sent to ER: CPRinitiated due to detainee asphyxiation from self harm and transferred to
ICU when pulse was achieved.
Current Status: pt with massive anoxic brain injury. He is intubated with no reflexes except for
respiratory hyperventi lation which is not life sustaining. Pt is now having an EEGtest. His blood

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000114
2019-ICLl-00051 2159



pressure is slowly dropping despite being on pressor IV drip . His immediate prognosis is very
poor .
Location: St Joseph ' s Hospital, ICU Rm 6Bravo6.
Attending Physician : D (b)(6);
Trauma Physician, RN l<bl(6l: lat l(b)(6); (b)(?)(C) ~ the ICU Trauma
PA is at phone b)(6); (b)(?)(C)

l(b)(6); (b)(7)(C)

IMD

Clinical Director
ICE Health Service Corps {IHSC)
Enforcement and Removal Operations (ERO)
US Immigration Customs Enforcement (USICE)
Nort hwes t Detent ion Center
1623 E. J St. Suite KffiJ
Tacoma , WA~ 98_4_2_1__
~
M ain office: (b)(6); (b)(7)(C)
Vo ice Ma il:
Ce ll (b)(6); (b)(7)(C)

fa x
!(b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000115
2019-ICLl-0005 1 2160



Wilcox, Bryan S
17 Nov 2018 01:24:57 +0000
rb)(6); (b)(?)(C)

From:
Sent :
To:
Subject:

1

RE: A#: 216269802 Hospital ICU report for 1330

Thanksl\~/\~L,
Bryan S. Wilcox
Acting F ield Office Director
ICE Enforcement & Removal Operations , Seattle, WA
Main JCb)(6); (b)(?)(C)
Desk: ~b)(6); (b)(?)(C)
Cell: f"'""
b'""
)(6"""
);..,,.
(b"""
)(7
")(
'"'.,..,
C)---.

I

I/

CONF IDENTIALITY: This email and attachments are intended for the above name only and are confidential. If you are not the
intended addressee, or the person responsible for deliver ing it to the intended addressee, you may neither copy, disseminate , nor
distribute it to anyone else or use it in any unauthorized manner. To do so is strictly proh ibited and may be unlawful. If you receive
this email by mistake, please advise the sender immed iately by using the reply faci lity in your ma il software and delete it from your
computer.

From : """K
b~)(6
=);~(b~)(=7)~(C
~)----.
Sent : Friday, November 16, 2018 3 :46 PM
To: #IHSC_ SEN_ Medical ; #NWD - Not ification -Med ical ; #IHSC_SEN_ Mental Health; #NWD -Notificat ion
Mental Health
Subject : FW: A#: 216269802 Hospital ICU report for 1330
ICU Update as of 14:00 PST :

Pt is now having an EEG test . His blood pressure is slow ly dropping despite being on presser IV
drip. His immediate prognos is is very poor .

I

LCD~(b)(6); (b)(?)(C)
MLS(ASCP)
Assistant Health Services Adm inistrator
Department of Homeland Security
Immigration & Customs Enforcement (ICE)
Enforcement & Removal Operations (ERO)
USPHS, ICE Health Service Corps .
Northwest Detention Center
1623 East J Street kb)(6j
Tacoma, WA 98421
Office : (b)(6); (b)(?)(C)
Cell (b)lo-r,
, rc-n-r"n"0".
.---,-1
Fax:
(b)(6); (b)(?)(C)
cid:image007.png@01D297FB.19484D80cid:image008.png@01D297FB.19484D80cid:image009.png@0l
D297FB.19484D80

Warning: This document is UNCLASSIFIED//FOROFFICIAL USE ONLY (U//FOUO) . It contains information
that may be exempt from public release under the Freedom of Information Act (5 U.S.C. 552). It is to be
controlled , stored, handled, transmitted, distributed, and disposed of in accordance with DHS policy
relating to FOUO information and is not to be released to the public or other personnel who do not have
a valid "need-to-know" without prior approva l of an authorized DHS officia l. No port ion of this report

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000116
2019-ICLl-00051 2161



should be furnished to the med ia, either in written or verbal form.

From:j(b)(6); (b)(7)(C)
Dat e: Friday, Nov 16, 2018, 2:00 PM

rb)(6); (b)(7)(C)
Subject : A#: 216269802 Hospital ICU report for 1330
Hospita l day # 1 in ICU 1330 report
A# : 216269802
NAME: Amar, Mer
DOB: 10/23/1978
COB: Russia
DOA: 12/19/2017
Relevant Medical History : Was on self-imposed protest Hunger Strike but began eating three meals a
day with liquid nutritional supp lements
Reason sent to ER: CPR initiated due to detainee asphyxiat ion from self harm and transferred t o ICU
when pulse was achieved .
Current Status : pt with massive anoxic brain injury . He is intubated with no reflexes except for
respiratory hype rventilation which is not life sustaining . Pt is now having an EEGtest . His blood p ressure
is slowly dropping desp ite being on presso r IV d rip . His imme d iate prognos is is very poor .
Locat ion : St Joseph's Hos ital ICU Rm 6Bravo6 .
Trauma Physician, RN~b)(~);_ l at l(b)(5); (b)(?)(C) ~ the ICU Trauma PA is at
Attendin Ph sician : D b)(5);
phone (b)(6); (b)(7)(C)

I

M0
~b)(6); (b)(7)(C)
Clinical Director
ICE Health Service Corps (IHSC)
Enforcement and Removal Operations (ERO)
US Immigration Customs Enforcement (USICE)
Northwest Detention Center
1623 E. J St. Suit ~(b)(6
T acoma, W-A_9_8_42
_l__
~
Main offic (b)(6); (b)(7)(C)
Vo ice Mai l
Ce l b)(6); (b)(7)(C)

I

fax

l(b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000117
2019-ICLl -00051 2162



l(b)(6); (b)(7)(C)

From :

Se nt:

17 Nov 2018 01:39:20 +0000

To :

Wilcox, Bryan SKb)(6); (b)(7)(C)
l(b)(6); (b)(7)(C)

Cc:
Subje ct:

RE:A#: 216269802 Hospital

Yes, one of my SDDOs tried

calling

the number

I

I

ICU report for 1330

a ll day that

5
b)( ); (b)(?)(C)

rovided:

no answer

and no

means to leave a message.

From : Wilcox,

Bryan S

Se nt : Fr iday,

16, 2018 5 :37 PM

November
To :l(b)(6); (b)(7)(C)

Cc:.....
__________________________________
Subject: RE: A#: 216269802 Hospital ICU report
I believe

___,
for 1330

so,

(b)(6);
/h\ / 7 \/('.\

Bryan S. Wilcox
Acting Field Office Director
ICE Enforcement & Removal Operat ions, Seattle, WA
Mai rfbl (6); (b)(?)(C)

I! D esk i(b)(6); (b)(7)(C) I/Ce ll : ~~b-)(6-);-(b-)(7-)(-C)~

CONFIDENTIALITY: This email and attachments are intended for the above name only and are confidential. If you are not the
intended addressee, or the person responsible for delivering it to the intended addressee, you may neither copy, disseminate, nor
distribute it to anyone else or use it in any unauthorized manner. To do so is strictly prohibited and may be unlawful. If you receive
this email by mistake, please advise the sender immediately by using the reply facility in your mail software and delete it from your
computer.

Sent : Fr i

er 16, 2018 5:36 PM

ay, Novem

To: Wilcox,

Bryan S f b}(6); (b}(7)(C)

Cci (b)(6); (b)(?)(C)

Subject : RE: A# : 216269802

Hospital

ICU report for 1330

Si r ,

Dt.d someone

. your
in

sf

o

tt.,ce

contac

t t he

From : Wi lcox, Bryan .._
b_)(_6)_; (_b)_(7_)(_C_
) ______
Date: Fr iday, Nov 16, 2018, 8:32 PM

.
DDO in

Rem ova Is.7

5

b)( l
b)(?)(C)

he r

name

.
t h.,s morning.

_,

AMERICAr--..

pVERSIGHT

I gav

DHS-ICE-19-0196, 19-0197-K-000118
2019-ICLl -00051 2163



To b)(6); (b)(7)(C)
Jennings, David w b)(6); (b)(7)(C)
Subject: FW: A#: 21,..,
6=2~
6=9=go
=2~H-o-sp
~i-ta~, c= u
~ re
_p_o_rt_ o
_ r__,.
1330

Please see below
We have confirmed that he has no family in the United States and obtained a phone number
for his wife in Russia. We have not been able to contact her, nor the Russian consulate
Bryan S. Wilcox
Acting Field Office Director
ICE Enforcement & Removal O erations, Seattle, WA
Desk: b)(6); (b)(7)(C) / Cell: j~
~b
-)(6~);-(b~)(7
~)(=C)~
Main 1(b)(6); (b)(7)(C)

ii

CONF IDENTIALITY: This email and attachments are intended for the above name only and are confidential. If you are not the
intended addressee , or the person responsible for delivering it to the intended addressee, you may neither copy, disseminate, nor
distribute it to anyone else or use it in any unauthorized manner. To do so is strictly prohibited and may be unlawful. If you receive
this email by mistake, please advise the sender immediate ly by using the reply faci lity in your mail software and delete it from your
computer.

From:K b)(6); (b)(7)(C)

Sent: Friday, November 16, 2018 3:46 PM
To: #IHSC SEN Medica l -f.,,.
lb.,.,.
)(6
"'");....
(b
"""
)(=7)'""
(c"""
)--------.I

#NWD-Notification

I#IHSC_SEN_Me ntal Health
I#NWD-Notification Mental

b)(6); (b)(7)(C)
j(b)(6); (b)(7)(C)
(b)(6); (b)(7)(C)

-M edical j(b)(6);

Health i <b)(6); (b)(7)(C)

I

Subject: FW: A#: 216269802 Hospital ICU report for 1330
ICU Update as of 14:00 PST :

Pt is now having an EEGtest. His blood pressure is slow ly dropping despite being on presser IV
drip. His immediate prognosis is ve ry poor.

LCDfltb)(6); (b)(7)(C)

MLS(ASCP)

Assistant Health Services Administrator
Department

of Homeland Security

Immigration

& Customs Enforcement (ICE)

Enforcement

& Removal Operations (ERO)

USPHS, ICE Health Service Corps.
Northwest Detention Center
1623 EastJ Street l(b)(6

I

Tacoma WA 98421
Office (b)(6); (b)(7)(C)
Cell: b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000119
2019-ICLl-0005 1 2164



(b)(6); (b)(7)(C)
Fax
(b)(6); (b)(7)(C)

cid:image007.png@0lD297FB.19484D80cid:image008.png@0lD297FB.19484D80cid:image009.png@0l
D297FB.19484D80

Warning: This document is UNCLASSIFIED//FOROFFICIAL USE ONLY (U//FOUO). It contains information
that may be exempt from public release under the Freedom of Information Act (5 U.S.C. 552). It is to be
controlled, stored, handled, transmitted, distributed, and disposed of in accordance with DHS policy
relating to FOUO information and is not to be released to the public or other personnel who do not have
a valid "need-to-know" without prior approva l of an authorized DHS officia l. No portion of this report
should be furnished to the media, either in written or verbal form.
From =rb)(6); (b)(7)(C)

Date: Friday, Nov 16, 2018, 2:00 PM
rb)(6); (b)(7)(C)
Subject : A#: 216269802 Hospital ICU report for 1330

Hospital day #1 in ICU 1330 report
A# : 216269802
NAME: Amar, Mer
DOB: 10/23/1978
COB: Russia
DOA: 12/19/2017
Relevant Medical History: Was on self- imposed protest Hunger Str ike but began eating three meals a
day with liquid nutritional supp lements
Reason sent to ER: CPR initiated due to detainee asphyxiation from self harm and transferred to ICU
when pulse was achieved.
Current Status: pt with massive anoxic brain injury. He is intubated with no reflexes except for
respiratory hyperventilation which is not life sustaining. Pt is now having an EEGtest. His blood
pressure is slowly dropping despite being on pressor IV drip. His immediate prognos is is very poor.
Location: St Joseph's Hospital, ICU Rm 6Bravo6.
the ICU Trauma PA is at
Attending Physician: DrKb)(~); _ Trauma Physician, RNfbl(5); (b)(?)(C)
I
phone J(b)(6); (b)(7)(C)

l

l(b)(6); (b)(7)(C)

IMD

Clinical Director
ICE Health Service Corps {IHSC)
Enforcement and Removal Operations (ERO)
US Immigration Customs Enforcement (USICE)
No rthwest Detention Center
1623 E. J St. Suitej/bl/6!
Tacoma, WA 98421
Main offic e.,,.
(b..,.,
)(=6
)....,
; (,....,
b)""'
(7,,...,
)(C
=)--,
Voice Mail:
Cell: (b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000120
2019-ICLl-00051 2165



 

 

 



 

 


201 Q-ICLI-00051 2156



(b)(6); (b)(?)(C)

From :

Sent:

8 Oct 2018 05:44:19 +0000

To:

b)(6) ; (b)(?)(C)

b)(6) ; (b)(?)(C)
(b)(6); (b)(?)(C)

ilcox, Bryan s

b)(6);

b)(6); (b)(?)(C)

(b)(6); (b)(?)(C)

Re: declined meals

Subject:

Declin ed meals for Dinner 10-7-18
._l
<b_)(6_J;_(b_l(_7 l_(C_) __

__.ID 2 declined her 2nd meal

Amar A#216269802 in Med 2 declined his 140th meal
Thank you in advance.
f b)(6) ; (b)(?)(C)

I

Lieutenant

The GEO Group, Inc.(R)
Northwest Detention Center
1623 East J. Street
Tacoma, WA 98421

1~)(6)
;

(b)(7 )(C)

l(b)(6); (b)(?)(C)

www.qeoq1oap.co1r1

From:~b

)(6); (b)(?)(C)

Sent: Sunday, October 7 20 18 9:26 AM

I

To:l (b)(6); (b)(?)(C)
b)(6); (b)(?)(C)

(b)(B); (b)(?)(C)

IBrvan S

Wilcox:Kb

)(6); (b)(?)(C)

rb )(6); (b)(?)(C)

I

I

Subj ect: Re: declined meals
Declined meals for lunch on 10/7 /18
Amar #216269802 in Med 2 decl in ed his 138th meal

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000122
2019-ICLl-00051 2167



(b)(6); (b)(7)(C)

-2 declined his 1st meal
G-2 decl ined her 1st meal

\~>in

'-------------'==-

G-2 declined her 1st meal

l(b)(6); (b)(7)(C)

Sergeant
GEO Corrections & Detention
Northwest Detention Center
1623 East J Street
Tacoma Washin ton 98421
Tel : b)(6); (b)(7)(C)
Cell:
Fax:

(R)

(b)(6); (b)(7)(C)

www .geogroup .com
This email and any files transmitted with it are confidential and are intended solely for the use
of the individual or entity to w hich they are addressed. If you are not the intended recipient or
the person responsible for delivering the email to the intended recipient , be advised that your
have received this email in error and that any use, d isse mination , forwarding, printing or
copying of this email is strictly prohibited . If you have received this email in error, please
immediately notify by replying to this e mail.

From: t b\/6\ /b\/ 7\/C\
I
Se nt: Saturdav October 6, 2018 6:54: 33 AM

I

To~ (b)(6); (b)(7)(C)
b)(6); (b)(7)(C)

Kb)(6); (b)(7)(C)

Bryan S Wilcox; f b)(6); (b)(7)(C)

I

I

b)(6); (b)(7)(C)

I
Subject: Re: decl ined meals
Amar #216269802 in Med 2 decl ined his 135t h meal

From

(b)(6); (b)(7)(C)

er , 2018 8:33:07 PM

Bryan S W 1 cox

bl(6l : (b\(7)(Cl

Subject: decl ined meals

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000123
2019-ICLl-00051 2168



Amar #216269802 in Med 2 declined his 134th meal
Kbl(6); (b)(7)(Cl
lin Dl declined her 1st meal
~;::::::;::::;::;;:;;:::;::;;:;::::==:::;----'
7
6
fb_lC_l;_Cb_lC_lc_ci __
....
__.lnD2 Declined her 1st meal
[b )(6); (b)(7)(C)

Sergeant
GEO Corrections & Detention
Northwest Detention Center
1623 East J Street
Tacoma, Washington 98421

(R)

rb)(6); (b)(7)(C)

www .qeogroup.com
This email and any files transmitted with it are confidential and are intended solely for the use
of the individual or entity to which they are addressed. If you are not the intended recipient or
the person responsible for delivering the email to the intended recipient, be advised that your
have received this email in error and that any use , dissemination, forwarding , printing or
copying of this email is strictly prohibited. If you have received this email in error, please
immediately notify by replying to this email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000124
2019-ICLl-00051 2169



l(b)(6); (b)(7)(C)

From :

Sent:

23 Oct 2018 21:56:56 +0000

To:

b)(6); (b)(7)(C)

(b)(6); (b)(7)(C)

(b)(6); (b)(7)(C)
(b)(6); (b)(7)(C)

Re: Declined meals

Subject:

The following detainee from D2 have also all declined their lu nch meals.
b)(6); (b)(7)(C)

r b)(6); (b)(7)(C)

Lieutenan t /CERT Commande r
GEO Corrections & Detention (R)
Nort hwest Detention Center
1623 East J Street
Tacoma Washinaton 98421
Tel: (b)(6); (b)(7)(C)
Cell:
Fax: .______
__,
f b)(6); (b)(7)(C)

www.geogroup.com

This email and any files transmitted with it are confidential and are intended solely
for the use of the ind iv idual or entity to which they are addressed. If you are not the
intended recipient or the person responsible for delivering the email to the intended
recipient, be advised that your have received this email in error and that any use,
dissemination, forwarding, printing or copying of this email is strictly prohibited. If
you have received this email in error, please immediately notify by replying to this
email.

From

(b)(6); (b)(7)(C)

cto er 23, 2018 2:3 9:4 8 PM

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000125

2019-ICLl-00051 2170



b)(6); (b)(7)(C)

IBryan Wilcoxfb

b)(6); (b)(7)(C)

)(6); (b)(7)(C)

I

!(b)(6), (b)(7)(C)

Subject: Declined meals
As of the lunch meal on 10/23/18 the following detainees declined their lunch meal.

Hl - Amar #216269802 - 21st

Bl

(b)(6); (b)(7)(C)

st
1st
st

Info. reports have been submitted.

f b)(6); (b)(7)(C)

Lieutenant/C ERT Commander
GEO Corrections & Detention (R)
Northwest Detention Center
1623 East J Street
Tacoma Washinaton 98421
Tel: (b)(6); (b)(7)(C)
Cell
_.
Fax ._

____

!(b)(6); (b)(7)(C)

www.geogroup.com

This email and any files transmitted with it are confidential and are intended solely
for the use of the individual or entity to which they are addressed. If you are not the
intended recipient or the person responsible for delivering the email to the intended
recipient, be advised that your have received this email in error and that any use,
dissemination, forwarding, printing or copying of this email is strictly prohibited. If
you have received this email in error, please immediately notify by replying to this
email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000126
2019-ICLl-00051 2171



Wilcox, Bryan S
19 Nov 2Ql8 l5.53.r

From :
Sent :
To :
Subject:

r b)(6); (b)(?)(C)

+0000

RE: Amar

10-4
Bryan S. Wilcox
Acting Field Office Director
ICE Enfo rcement & Removal Operat ions, Seattle, WA
Main: f b)(B); (b)(?)(C)
Desk: l(b)(6); (b)(?)(C)
Cell: f,,,...
b,...,.,
}(6,,....
); ..,,...
(b)'""'
(7,,...,.
)(C
=)---.

I/

I/

CONF IDENTIALITY: T his email and attachments are intended for the above na me only and are confidential. If you are not the
intended addressee, or the person respons ible for del ivering it to the intended addressee, you may ne ither copy , dissem inate, nor
distribute it to anyone else or use it in any unauthorized manner. To do so is str ictly proh ibited and may be unlawful. If you rece ive
this emai l by mistake , please advise the sende r immediate ly by using the reply faci lity in your ma il softwa re and delete it from you r
computer.

From:1 Cb)(6); (b)(?)(C)

Sent: Monday , Novembe r 19, 2018 7:11 AM
Toj /bl /6): /bl /7)/Cl

sl....

Wi lcox, Bryan <b_l<_6 l_;C
_bl_<7_lc_
c_
) ______

____.

Subject: Amar

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000127
2019-ICLl-0005 1 2172



I

l(b)(6); (b)(?)(C)

From :

28 Nov 2018 15:20:37 +0000
Wilcox, Bryan S
RE: Amar

Sent :
To :
Subject:
r b)(5); (b)(?)(C)

r b)(6); (b)(?)(C)
1

Assistan t Chief Counsel
Seattle Office of Chief Counsel / OPLA
Ta coma sub-office
U.S. Immigrat ion and Customs Enforcement
U.S. Department of Homeland Security
Tel: kb)(6); (b)(7)(C)
E-mail: kbl/ 6\: /bl/ 7)/Cl

I

***Warning*** Attorney/Client Privilege*** Attorney Work Product***
This communication and any attachments may contain confidential and/or sensitive attorney/client privileged
information or attorney work product and/or law enforcement sensitive information. It is not for release, review,
retransmission, dissemination, or use by anyone other than the intended recipient. Please notify the sender if this
email has been misdirected and immediately destroy all originals and copies. Furthermore do not print, copy, retransmit, disseminate , or otherwise use this information. Any disclosure of this communication or its attachments
must be approved by the Office of the Principal Legal Advisor, U.S. Immigrat ion and Customs Enforcement. This
document is for INTERNAL GOVERNMENT USE ONLY and may be exempt from disclosure under the Freedom of
Information Act, 5 USC?? 552(b)(5), (b)(7).
From : Wilcox , Bryan S
Sent : Wednesday, November 28, 2018 7:19 AM
To:l (b)(6); (b)(?)(C)

Subj ect: RE: Amar

Not yet .
b)(5)

Bryan S. Wilcox
Acting Field Office Director
ICE Enforcement & Remova l Operations , Seattle, WA
Main kb)(6); (b)(7)(C)

I/ Desk:

!/bl/ 6\: /b\(7)/Cl

vCell

~~
b-)(6-);-(b-)(7-)(-C)~

CONFIDENTIALITY: This email and attachments are intended for the above name only and are confidential. If you are not the
intended addressee , or the person responsible for delivering it to the intended addressee, you may neither copy, disseminate, nor
distribute it to anyone else or use it in any unauthorized manner. To do so is strictly prohibited and may be unlawful. If you receive
this email by mistake , please advise the sender immediately by using the reply facility in your mail software and delete it from your
computer.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000128
2019-ICLl-00051 2173



Se nt:

er 28, 2018 7 :16 AM

To : Wilcox, Bryan S
; 7)(C)
Subject : RE: Amar ~-----------~
(b)(5)

r b)(6); (b)(7)(C)

Assistan t Chief Counsel
Seattle Office of Chief Counse l / OPLA
Tacoma sub-office
U.S. Immigration and Customs Enforcement
U.S. Department of Homeland Security
Tel: lth1m,1h 117 11r,
;
;
E-mail : ,-l
(b-)(..,...
6)-; (-b)...,.
(7-)(C
..,...
)---------,1
*** Warning*** Attorney/Client Privilege *** Attorney Work Product ***
This communication and any attachments may contain confidential and/or sensitive attorney/c lient privileged
information or attorney work product and/or law enforcement sensit ive information. It is not for release, review,
retransmission, dissemination, or use by anyone other than the intended recipient. Please notify the sender if th is
email has been misdirected and immediate ly destroy all originals and copies. Furthermore do not print, copy, retransmit, disseminate, or otherwise use this informat ion. Any disclosure of this communication or its attachments
must be approved by the Office of the Principal Legal Advisor, U.S. Immigration and Customs Enforcement. This
document is for INTERNAL GOVERNMENT USE ONLY and may be exempt from disclosure under the Freedom of
Information Act, 5 USC?? 552(b)(5), (b)(7).

From: W ilcox, Bryan S
Sent : Tuesday, Novemb er 27, 2018 4 :31 PM
To:l <b)(6); (b)(7)(C)

Subject : RE: Amar
(b)(5)

Bryan S. Wilcox
Acting Field Office Director
ICE Enforcement & Removal Operations, Seattle, WA
Main: t b)(6); (b)(7)(C) !ID esk: l(b)(6); (b)(7)(C)
Cel f..,,.
b.,...,
)(6"""
);....,,
(b...,...
)(=7)..,.,
(C,.,...
) ---.

I/

CONF IDENTIALITY: Th is email and attachmen ts are intended for the above name only and are confidential. If you are not the
intended add ressee , or the pe rson respons ible for deliver ing it to the intended addressee, you may ne ithe r copy, dissem inate, nor
distribute it to anyone else or use it in any unautho rized manner. To do so is str ictly proh ibited and may be unlawful. If you rece ive
this emai l by mistake, please advise the sender immediate ly by using the reply faci lity in your ma il software and delete it from your
computer.

Fromi(b)(6); (b)(7)(C)
Sent : Tuesday, November 27, 20 18 3:57 PM

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000129
2019-IC Ll-0 0051 2174



!Wilcox, Bryan ~lCb_lC_6l_; C_bl_C7_lCC
_ l_______

To fb)(6);(b)(7)(C)

_

Subject: RE: Amar
b)(5)

I

ICb)(6); (b)(7)(C)

Assistan t Chief Counsel
Seattle Office of Chief Counse l / OPLA
Tacoma sub-office
U.S. Immigration and Customs Enforcement
U.S. De artment of Homeland Security
Tel: b) 6 . b 7 C
E-mail : (b)(6); (b)(7)(C)
*** Warning
orney 1en nv1ege
ttorney Work Product ***
This communication and any attachments may contain confidential and/or sens itive attorney/c lient privi leged
information or attorney work product and/or law enforcement sensit ive information. It is not for release, review,
retransmission, dissemination, or use by anyone other than the intended rec ipient. Please not ify the sender if th is
email has been misdirected and immediate ly destroy al l originals and copies. Furthermore do not print, copy, retransmit, dissem inate, or otherwise use this informat ion. Any disclosure of this communication or its attachments
must be approved by the Office of the Princ ipa l Legal Advisor, U.S. Immigration and Customs Enforcement. This
document is for INTERNAL GOVERNMENT USE ONLY and may be exempt from disclosure under the Freedom of
Information Act , 5 USC?? 552(b)(5), (b)(7).

From :l(b)(6); (b)(7)(C)

Se nt : Tuesday, November 27, 2018 3:49 PM
To: Wilcox , Bryan S b)(6); (b)(7)(C)
(b)(6); (b)(7)(C)

Cc (b)(6); (b)(7)(C)

Subject: RE: Amar
No, I have not.
She has no G-28, so I say no.
From : W ilcox, Bryan S
Se nt : Tuesday, November 27, 2018 3:48 PM
r b)(6); (b)(7)(C)

Subject: FW: Amar
PLANet shows that she did represent AMAR in proceedings, but my understanding
filed his appeal pro-se

is that he

5/1/2018
6:30 AM
8/7/2018
0:05 PM

Merits

Detained Tacoma VTC merits hearing . Case set for 1-589 ASY/WOR/CAT
merits. Rand RAKb)(6); (b)(7)(C) lare PIC in Tacoma Washington. OHS and
the IJ are PIC in SLC. Exhibits: NTA = EX1; OHS Evidence Submission (1-213 +

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000130
2019-ICLl-00051 2175



AO lnterv iew) = EX2; Frivolous ASY Warning = EX3; 1- 589 Applicat ion = EX4; R's
349-page Evidence Packet=EX5; DHS 75-page Evidence Packet =EX6; RA has
a new submission that was just faxed. IJ will retrieve. R is the so le witness. 6page evidence submission. ORDER: Removal Order to Russia. 1- 589
ASY/WOR/CAT Application is Denied. Appeal Reserved by R. Appeal Wa ived
by DHS.

What do you think?
Do I let her know?
6 );
b)(
him,r,

h ave you spo ken t o her.?

B r yan S. Wilcox
Acting

F i eld Office

D irecto r

ICE Enforcement
& Removal O perat i ons, Seattle, WA
Main: l(b)(6); (b)(7)(C)
D esk !(b)(6); (b)(7)(C)
Ce ll :~l
(b~)(6
~);~(b~)(=7)~
(C~) ~

II

I/

CONF IDENTIALITY: This email and attachments are intended for the above name only and are confi dential. If you are not the
intended add ressee , or the person respons ible for deliver ing it to the intended addressee, you may neithe r copy, disseminate , nor
distribute it to anyone else or use it in any unauthorized manner. To do so is strictly proh ibited and may be unlawful. If you receive
this emai l by mistake, please advise the sende r immediate ly by using the reply faci lity in your ma il softwa re and delete it from you r
computer.

r

From :l(b)(6); (b)(7)(C)

Sent: Tuesday, November 27, 2018 2:14 PM
To: Wilcox, Bryan Sf._b_)(_6)_;(_b)_(7_)(C
_ )______
Subject:Amar

__,

Hello Officer Wilcox,
I represented Mr. Amar in removal. Can you tell me if his wife was notified? If no, i wi ll have to do that.
Thank you,
~b)(6); (b)(7)(C)

Sincerely,

l(b)(6); (b)(7)(C)

IEsq.
I

Law Office of j(b)(6); (b)(7)(C) P.S.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000131
2019-ICLl -00051 2176



8111st Avenue , Suite 212
Seattle , WA 98104
Tel: b)(6); (b)(?)(C)
Fax:
(b)(6); (b)(?)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000132
2019-ICLl-00051 2177



From:

l(b)(6); (b)(7)(C)

Se nt:

12 Oct 2018 21:39:56 +0000

To:

b}(6); (b}(?)(C)

Cc:

------,I

Wilcox, Bryan S (b)(6); (b)(7)(C)

~------------~

~"'"
b'""
)(6,.,...
);...,,.
(b.,...,
)(7=)-c=c ,....
)

Subject :

RE: Amar

I believe that is a good idea but he has now started dr inking his supplemental calorie drinks again. He is
cooperating with vitals and weights. So the only thing he is refusing is blood testing and the food on his
tray. So I guess we will wait to see what happens next week since he has now gained weight and has
improved blood pressure .

._l
(b_)(6_);_(b_)(7_)(_C)___

_.IMD

Clinical Director
ICEHealth Service Corps (IHSC)
Enforcement and Removal Operations (ERO)
US Imm igration Customs Enforcement (USICE)
No rthw est D ete ntion Ce nt er

1623

E.

J St.

Su i t d(b)(6

!

T acoma, WA 98421
M ain office: ,.,,.
(b.,...,
)(6
=)--,
; (,...,.
b)=
(7,...,.
)(C
=)---,
Voice Mai l :
C ell b)(6); (b)(7)(C)

fax
b)(6); (b}(?)(C)

From :~b)(6); (b)(7)(C)

I

Se nt: Thursday, October 11, 2018 3:27 PM
To: r b)(6); (b)(?)(C)

Cc:
Subject : RE: Amar
Dr (b)(6); (b)(7)(C)

This might be a good time to start on a new declaration, requesting to renew the court order for
hydration and medical monitoring . Here is you r last declarat ion . I hope that you sti ll have the Word
version of this declaration you can use as a template .
(b)(6);
f h \f ? \tr ' \

From : ICb)(6); (b)(?)(C)

1~

Se nt: Thursday, October 11, 2018 2:55 PM
)(6); (b)(7)(CJ

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000133
2019-ICLl -00051 2178



Cc b)(6); (b)(7)(C)
(b)(6); (b)(7)(C)

ilcox, Bryan

b)(6); (b)(7)(C)

b)(6); (b)(7)(C)

mar
He is pretty marginal so I am very glad he drank his boost and Pedialyte this afternoon also. We wi ll
draw labs on him later today if he will allow it. I wou ld like to get a new order ready j ust in case but it
doesn't look like we will need it before the week-end .

~IMD

~l
(b-)(6
_)_
; (b
_l_
(7-)(C
_ l ___

Clinical Director
ICEHealth Service Corps (IHSC)
Enforcement and Removal Operations (ERO)
US Immigration Customs Enforcement (USICE)
Northwest Detent ion Center
1623 E. J St. Suitefilill]
T acoma, WA 98421
Main office: ,.,,.
(b.,...,
)(6
=)--,
; (,...,.
b)=
(7,...,.
)(C
= )---,
Vo ice Mai l :
Cell (b)(6); (b)(7)(C)

fax
(b)(6); (b)(7)(C)

From :f b)(6); (b)(7)(C)

(b)(6); (b)(7)(C)

ilcox, Bryan S (bl( 6l; (bl( 7l(C)

b)(6); (b)(7)(C)

mar
That is great news.
(b)(6);
/h \/7\/C:\

r

From : l<b)(6); (b)(7)(C)

Se nt: Thursday, October 11, 2018 9:43 AM
)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000134
2019-ICLl-00051 2179



b)(6); (b)(7)(C)

Wilcox,BryanS l(b)(5); (b)(?)(C)

I

SubJect: RE: Amar

Good Morning!(b)(6);__ I
I am waiting for an updated notification to forward, but we were told in report that he drank his boost,
Pedialyte and water this morning for breakfast. Giventhat, we should not need to worry about court
orders at this time.
V/R,

I

CAPT l(b)(5); (b)(?)(C)
LCSW -C, BCD
Health Services Administrator
USPHS
ICE Health Service Corps
Northwest Detention Center
1623 E. J St. Suite~b)(6I
Tacoma, WA 98421
Office:fb)(6); (b)(7)(C)
BB: (b)(6); (b)(7)(C)
Fax :
b)(6);(b)(7)(C)
Warning : This document is UNC LASSIFIE D//FOR OFFICIAL USE ONLY (U//FOUO). It
contains information that may be exe mpt from public release under the Freedom oflnformation
Act (5 U.S.C. 552). It is to be controlled, stored, handled, transmitted, distributed, and disposed
of in accordance with DHS policy relating to FOUO information and is not to be released to the
public or other personnel who do not have a valid "need-to-know" without prior approval of an
authorized DHS official. No portion of this report should be furni shed to the media, either in
written or verba l form.
b)(6)
; (b)(7)(C)
Sent: Thursday, October 11, 2018 9:40 AM
From :

l(b)(6)
; (b)(7)(C)
(b)(6); (b)(7)(C)

!Wilcox,BryanS (b)(6); (b)(7)(C)

Subject: Amar

Anyupdates on Amar's condition? Is he stable, and likelyto be stable over the weekend?

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000135
2019-ICLl-00051 2180



(b)(6); (b)(7)(C)

Deputy Chief Counsel
Seattle Off ice of the Chief Counsel / OPLA
Tacoma sub-office
U.S. Immigration and Customs Enforcement
u.s.,.,.,,~
....,..~
~~ ome land Security
Tel:~---~
Faxt b)(6); (b)(?)(C)

***Warning *** Attorney/Clie nt Privilege* ** Attorney Work Product ***Sensitive/Privileged* **Pre-Decis ional***
This commun ication and any attachments may contain confidential and/or sensitive attorney/client privileged information or
attorn ey wo rk product and/or law enfo rcement sensitive information. It is not for release, rev iew, ret ransmission,
dissemination, or use by anyone other than the inten ded recipient. Please not ify the sender if this email has been misdirected
and immed iate ly destroy all originals and cop ies. Furthermo re do not print, copy, re-t ransmit, disseminate, o r othe rw ise use
this information . Any disclosure of this communication or its attachments must be app roved by the Office of the Principal Legal
Advisor, U.S. Imm igration and Customs Enforcement. This document is for INTERNALGOVERNMENTUSEONLY and may be
exempt from disclosure unde r t he Freedom of Info rmat ion Act, 5 USC?? 552(b)(S}, (b)(7).

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000136
2019-ICLl-0005 1 2181



Fro m :

Se nt:

l(b)(6); (b)(7)(C)

21 Dec 2018 19:54:42 +0000

To:

Wilcox, Bryan S;!(b)(6); (b)(7)(C)

Cc:

l(b)(6); (b)(7)(C)

Subje ct :

RE: Amar

I am not aware of any communication in either point. I guess I thought they were going
through ICE and or the family / Consu late ?
I have CC'd a few others to see if they know anything more.

I

CAPT f b)(5); (b)(l )(C)
LCSW-C, BCD
Health Services Administrator
USPHS
ICE Hea lth Service Corps
Northwest Detention Center
1623 E. J St. Suite !(b)( I
Tacoma , WA 98421
Office : b)(6); (b)(7)(C)
BB: (b)(6); (b)(7)(C)
Fax
(b)(6); (b)(7)(C)

Warning: This document is UNCLASSIFIED //FOR OFFICIAL USE ONLY (U//FOUO).
It contains information that may be exempt from public release under the Freedom of
Information Act (5 U.S.C. 552). It is to be controlled , stored , handled , transmitted ,
distributed , and dispo sed of in accordance with DHS policy relating to FOUO
information and is not to be released to the pub lic or other personnel who do not have a
valid "need-to-know" without prior approval of an authori zed DHS official. No portion of
this report should be furnished to the media, either in written or verbal form.
Fro m: Wilcox, Bryan s ._Cbl ..,.
)(6
_)_
; (b_)(_7)_(C_) ______
Date: Friday , Dec 21 , 20 J8, 11:37 AM

~

(b)(6);
(b)(7)(C)

Have we heard back from the medical examiner's office/coroner on a death certificate ,
and next of kin/disposition of body
Sent with BlackBerry Work
(www .blackberry .com)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000137
2019-ICLl-00051 2182



l(b)(6); (b)(?)(C)

From:

Se nt:

13

To:

Dec

2018 00:23:15 +0000

Wilcox,

Cc:
Subje ct:

Bryan S

!(b)(6); (b)(?)(C)

RE:Amar

10-4
From : Wilcox,

Bryan

Se nt: Wednesday,

S

December

12, 2018 4:21 PM

To:1(b)(6); (b)(?)(C)

Subject : RE:Amar
Yes
And the afile documented accordingly

Thanks

S. Wilcox
Act ing Field Office Director
ICE Enfo rcement & Removal O erat ions, Seattle, WA
Main: l(b)(6); (b)(?)(C) I/ Desk: b)(6); (b)(?)(C) / Cell: t-b-)(6-);-(b-)(7-)(-C-) ~
Br yan

CONFIDENTIALITY: This email and attachments are intended for the above name only and are confidential. If you are not the
intended addressee, or the person responsible for delivering it to the intended addressee, you may neither copy, disseminate, nor
distribute it to anyone else or use it in any unauthorized manner. To do so is strictly prohibited and may be unlawful. If you receive
this email by mistake, please advise the sender immediately by using the reply facility in your mail software and delete it from your
computer.
From :f b)(6); (b)(?)(C)

Se nt: Wednesday,

Do

you wan

t

me

December
12,
b)(6); (b)(?)(C)

t o h ave

20 18 4:13 PM

(b)(6);
.1h er a copy. ?
/ h \f 1r., ema1
71

From :f b)(6); (b)(?)(C)

I

Se nt: Wednesday,

December

12, 2018 3 :51 PM

To: Wilcox,

Bryan S l(b)(6); (b)(?)(C)
Subject : RE: Amar .__ _____________________________

AMERICAr--..

pVERSIGHT

_,

DHS-ICE-19-0196, 19-0197-K-000138
2019-ICLl -00051 2183



If providing a copy of the passport to Liya will assist her in making arrangements to return Amar' s body
to Russia, you can provide it to her.
b)(6);
h \/ 7 \/f:\

From : Wilcox, Bryan S

Se nt : Wednesday, December 12, 2018 3:46 PM
To:1Cb)(6); (b)(?)(C)

Subject : FW: Amar
A copy, I d on' t real ly see w hy not
(b)(6);
/ h \/ 7 \ff -..\

Bry an S.

Wilcox

Acting Field Office Director
ICE Enforcement & Removal Operations, Seattle, WA
Main i Cb)(6); (b)(?)(C)
VD esk: ICb)(6); (b)(?)(C)
Cell: ~l
(b-)(6-);- (b-)(-7)-(C-) ~

I/

CONF IDENT IALITY: Thi s email and attachments are intended for the above name only and are confidential. If you are not the
intended add ressee, or the person respons ible for delivering it to the intended addressee, you may neither copy, disseminate, nor
distribute it to anyone else or use it in any unauthorized manner. To do so is strictly proh ibited and may be unlawful. If you receive
this email by mistake, please advise the sender immediate ly by using the reply faci lity in your ma il software and delete it from your
computer.

I

From : 1Cb)(6); (b)(?)(C)

Sent : Wednesday, December 12, 2018 1:47 PM
To : Wi lcox, Bryan S...
ICb_)(_6)_; C
_b)_C?_)(_c _) ______
Subje ct: Re: Amar

___,

Hello Mr. WIicox,
I am helping to arrange the transportation of Mr . Amar 's body back to his family in Russia. I am in need
of a copy of his passport. Taken that I was the attorney of record for him, would it be possible for you to
provide me with a copy of the passport? I believe it is in possession of ICEat this t ime .

Sincerely,

l(b)(6); (b)(?)(C)

~ Esq.

Law Offi ce o~(b)(6); (b)(?)(C)

8111st Avenue, Suite

IP.5.

l~b)(6 1

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000139
2019-ICLl -00051 2184



Seattle, WA 98104
Tel: (b)(6); (b)(?)(C)
Fax.
~b)(6); (b)(?)(C)

~Iwrote :

b_)(6
_);_(b_)(_7)_(c_) ________
On Wed, Nov 28, 2018 at 9:21 AM ~f
thank you!

Sincerely,

!(b)(6); (b)(?)(C)

!l:sq.

Law Office o.f):b
)(6); (b)(?)(C)

IP.S.

8111st Avenue, Suite 212
Seattle, WA 98104
Tel: (b)(6); (b)(7)(C)
Fax.
(b}(6}; (b)(?)(C)

On Wed, Nov 28, 2018 at 7:31 AM Wilcox , Bryan S ~(b_)(6
_l;_(b_)(_7l_(C_) _____
M s.

~I wrote:

!~\)~\1r.1

The next of kin, including h is wi f e and parents have been notified
Regards

Sent with BlackBerry Work
(www. blackberry .com )
From:~ b)(6); (b)(?)(C)

Date: Tuesday, Nov 27, 2018, 2:21 PM
To : Wilcox, Bryan S ~l
(b_)(_
6)_;(_
b)_(?_)(C
_)______
Subject: Amar

~

Hello Officer Wilcox,
I represented Mr. Amar in removal. Can you tell me if his wife was notified? If no, i will have to do
that .
Thank you,

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000140
2019-ICLl -00051 2185



l(b)(6); (b)(7)(C)

Sincerely,

fb )(6); (b)(7)(C)

Law Office otl(b)(6)

IEsq.
; (b)(7)(C)

I P.S.

8111st Avenue, Suite 212
Seattle, WA 98104
Tel: (b)(6); (b)(7)(C)
Fax
tb )(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000141
2019-ICLl-00051 2186



From:

l(b)(6); (b)(7)(C)

Se nt:

25 Nov 2018 17:19:45
+0000
..,,....,..,=--,~~-----------,
Wilcox, Br an S (b)(5); (b)(?)(C)
(b)(6); (b)(?)(C)

To:

Cc:
Subje ct:

RE: AMAR

We're showing that on October 26th when he was moved to the MHU fo r suicide watch after we found
the rope in his cell? Yes, He was admitted to MHU on Suicide watch and a suicide risk assessment was
performed by the clinical physiatrist on 10/27.

Froml(b)(6); (b)(7)(C)

Se nt: Sunday, November 25, 2018 9 :07 AM
To: Wilcox, Bryan S --~
b_)(_
6)_
; (_
b)_
(?_)(C
_)______________

_.

Kb)(6); (b}(?)(C)
rb)(6); (b)(?)(C)

Subject: RE: AMAR
He was housed in MHU on September 26.

I

LCDRl(b)(6); (b)(?)(C)
MLS(ASCP)
Assistant Health Services Administrator
Department of Homeland Security
Im migration & Customs Enforcement (ICE)
Enforcement & Removal Operations (ERO)
USPHS, ICE Health Service Corps .
Northwest Detention Center
1623 East J Stree~(b)(6)I
Tacoma, WA 98421
Office: b)(6); (b)(?)(C)
Cell: (b)(6); (b)(?)(C)
Fax:
(b)(6); (b)(?)(C)

Warning: This document is UNCLASSIFIED//FOR OFFICIAL USE ONLY (U//FOUO). It contains information
that may be exempt from public release under the Freedom of Information Act (5 U.S.C. 552) . It is to be
controlled, stored, handled, transmitted, distributed, and disposed of in accordance with DHS policy
relating to FOUO information and is not to be released to the public or other personnel who do not have
a valid "need-to-know" without prior approva l of an authorized DHS officia l. No port ion of this report
should be furnished to the media, either in written or verbal form.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000142
2019-ICLl -00051 2187



From : Wilcox, Bryan S

Se nt : Sunday, November 25, 2018 8:12 AM
b)(6); (b)(7)(C)

Subject: AMAR
We'll be working on this death notice for AMAR, probably for the next several hours.

r b)(S)

(b)(5)

(b)(5)

See other comments as well.
I'm not done with my edits, just wanted to get going on this

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000143
2019-ICLl-00051 2188



r b)(6); (b)(7)(C)

Fro m :

25 Nov 2018 16:57:02 +0000
Wilcox, Bryan S
RE:AMAR

Se nt:
To:

Subje ct:

Working on it , I am trying to load up the e lectronic health record from home.

LCDifb)(5); (b)(?)(C)

, ,

,IMLS(ASCP)

As sistant Hea lth Serv ices Admin istrato r
Depart ment of Homela nd Secur ity
Immigration & Customs Enforcement (ICE)
Enforcement & Removal Operations (ERO)
USPHS , ICE Healt h Service Corp s.
Northwest Detention Center
1623 East J Street l~b)(6
Tacoma , WA 98421
Office : l(b)(6); (b)(7)(C)
Cell: b)(6); (b)(7)(C)
Fax:

I

l(b)(6); (b)(7)(C)

cid:image007 .png@0 1D297FB. l 9484D80cid :image008 .png @0 1D297FB .19484D80c id:i
mage009. png @0 1D297FB.19484D80

Warning: This docume nt is UNCLASSIFIED //FOR OFFICIAL USE ONLY (U//FOUO).
It contains information that may be exempt from public release under the Freedom of
Information Act (5 U.S.C. 552). It is to be controlled, stored , handled, transmitted ,
distrib uted, and dispo sed of in accordance with DHS policy relating to FOUO
info1mation and is not to be released to the public or other personnel who do not have a
va lid "need-to-know" without prior approval of an authori zed DHS officia l. No portion of
this report should be furnished to the media , either in written or verbal form.

From: Wilcox, Bryan S ._!
(b_)(6_);_(b_)(7_)(_C)_____
Date : Sunda , Nov 25, 2018 , 8: 11 AM

__,

(b)(6); (b)(7)(C)

We'll be working on this death notice for AMAR, probably for the next several hours. Please see

r)(5)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000144
2019-ICLl-00051 2189



See other comments as well.
I'm not done with my edits, just wanted to get going on this

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000145
2019-ICLl-00051 2190



From:

Se nt:
To:

Cc:
Subje ct:

l(b)(6); (b)(7)(C)

25 Nov 2018 15:06:21 +0000
Wilcox, Br an S
b)(6); (b)(7)(C)

RE:Amar

Do we expect we will be issuing the news release today?

l(b)(6); (b)(7)(C)

Assistant Chief Counsel
Seattle Office of Chief Counse l / OPLA
Tacoma sub-office
U.S. Immigration and Customs Enforcement
U.S. Department of Homeland Security
Tel: (b\(6): (b)(7)(C)
E-mail: (b)(6); (b)(7)(C)
*** Warning
Attorney 1ent Privilege
Attorney Work Product ***
This commun ication and any attachments may contain confidential and/or sensitive attorney/c lient privileged
information or attorney work product and/or law enforcement sensit ive information. It is not for release , review,
retransmission , dissemination , or use by anyone other than the intended recipient. Please notify the sender if th is
email has been misdirected and immediate ly destroy al l originals and copies. Furthermore do not print, copy, retransmit, disseminate, or otherwise use this informat ion. Any disclosure of this communica tion or its attachments
must be approved by the Office of the Principal Legal Advisor, U.S. Immigrat ion and Customs Enforcement. This
document is for INTERNAL GOVERNMEN T USE ONLY and may be exempt from disclosure under the Freedom of
Information Act , 5 USC?? 552(b)(5) , (b)(7).

From : Wilcox, Bryan S
Se nt : Saturday, November 24, 2018 5:33 PM
To: Jennings, David W K
"'"b..,..,
)(=
6)"""'
; (,....,
b)..,,,
(7""'
)(..,,.
C),----------------,
kbl(6l (b)(7)(Cl
b)(6); (b)(7)(C)

Subject: Amar

I

Just had a call from orJb )(~);_~from the hospital. The mother has agreed to end life support and that
should happen this evening. The expectation is that he will stop breathing and be in the morgue by the
morning .
The official notice should come this evening from the hospital to IHSC

Sent with BlackBerry Work
(www .blackberry .com)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000146
2 019 -ICLl -00051 2191



From :
Sent:
To:

Cc:

Jennings, David W
25 Nov 2018 02:23:45 +0000
Wilcox,
Bryan ~(b)(6); (b)(7)(C)
l(b)(6); (b)(7)(C)

!(b)(6); (b)(7)(C)

Subject:

RE:Amar

Thanks BW

Assistant Director
Field Operation s
From: Wilcox , Bryan S 4'-'(b.;..;.)
(6"""
);~(b..;..
)(;..;7
)..;..
(C..;..
) _____

___,

Date: Saturday, Nov 24, 2018, 20 :33
To: Jennings , David W Kb)(6); (b)(7)(C)

~---------------~

b)(6); (b)(7)(C)

I

I

b)(6); (b)(7)(C)

SubJect: Amar

Just had a call from DrJb) (6); !from the hospital. The mother has agreed to end life
support and that should happen this evening. The expectation is that he will stop
breathing and be in the morgue by the morning.
The official notice should come this evening from the hospital to IHSC

Sent with BlackBen-y Work
(www.blackben-y.com)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000147
2019-ICLl-00051 2192



~b)(6); (b)(7)(C)

From :

25 Nov 2018 01:40:04 +0000
ilcox, Bryan S;Jennings, David W; l(b)(6); (b)(7)(C)

Sent:

b)(6); (b)(7)(C)

To:

Cc:
(b)(6); (b)(7)(C)

RE: Amar

Subject:
Thanks,

I

Dr ICb)(
6); (b)(7)(C) a nd D rl(b)(6); (b)(7)(C)

Adding

I

b)(6);
h\/7\/r\

Sent with

BlackBerry

Work

(www.blackberry.com)

Fro m: l(b)(6); (b)(7)(C)
Date: Saturday, Nov 24,
2018 , 17:35
.....,..,.,,.,........,,-.-=..,.,,.,...-------,
To: Wilcox , Bryan S fb )(6); (b)(7)(C)

_
uennings, David W

(b)(6); (b)(7)(C)

Subject: RE: Amar
Thanks

for the heads up.

l(b)(6); (b)(7)(C)
Unit

Chief

Domestic
Operations
l(b)(6); (b)(7)(C)

I

Sent with
(www

West

BlackBerry

.blackberry

Work

.com)

From: Wilcox , Bryan S ....,!
<b__
l<6
.....
l:__
(b__
l<......
7l__
<C
__
l _____
Date: Saturday, Nov 24, 2018 , 8:33 PM
To: Jennings , David W l(b)(6); (b)(7)(C)

___.

~---------------~

I

(b)(6); (b)(7)(C)

Subject: Amar

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000148
2019-ICLl-00051 2193



I

Just had a call from Dr. l(bl(6l;~- from the hospitaL The mother has agreed to end life.
support and that should happen thi s evening. The expectation is that he will stop
breathing and be in the morgue by the morning .
The official notice should come this evening from the hospital to IHSC

Sent with BlackBerry Work
(www.blackberry.com)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000149
2019-ICLl-00051 2194



I

From :

l(b)(6); (b)(?)(C)

Sent:

25 Nov 2018 01:38:19 +0000
Wilcox, Bryan S
RE:Amar

To:

Subject :

Thank you for the update., sir.

From: Wilcox, Bryan S f b)(6); (b)(?)(C)
Date: Saturday, Nov 24,..,,,
2=0
~18~
,~g~
:J=3~p~M~------'
To : Jennings , David W i b)(6); (b)(?)(C)

I

(b)(6); (b)(?)(C)

Subject: Amar

Just had a call from Dr.l\~1\~1:~, !from the hospital. The mother has agreed to end life
support and that shou ld happen this evening. The expectat ion is that he will stop
breathing and be in the morgue by the morning.
The official notic e should come this eve ning from the hospital to IHS C

Sent with B lackBerry Work
(www.b lackberry.com)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000150
2019-ICLl-00051 2195



U.S. IMMIGRATION AND CUSTOMS ENFORCEMENT
ENFORCEMENT AND REMOVAL OPERATIONS
ICE HEAL TH SERVICE CORPS
HEALTH EVALUATION OF DETAINEES IN SPECIAL MANAGEMENT UNITS (SMU)
IHSC Directive : 03-06
ERO Directive Number: 11740.2
Federal Enterprise Architecture Number: 306-112-002b
Effective Date: 24 Mar 2016

By Order of the Acting Assistant Director
Stewart D. Smith, DHSc/s/

1.

PURPOSE : The purpose of this issuance is to set forth the policies and
procedures for the delivery and administration of healthcare evaluations for
detainees housed in a Special Management Unit (SMU).

2.

APPLICABILITY: This directive applies to all IHSC personnel, including but not
limited to, Public Health Service (PHS) officers and federal employees supporting
health care operations in ICE-owned or contracted detention facilities and to
IHSC Headquarters (HQ) staff. This directive applies to contract personnel when
supporting IHSC in detention facilities and at HQ. Federal contractors are
responsible for the management and discipline of its employees supporting
IHSC .

3.

AUTHORITIES AND REFERENCES :
3-1.

Section 322 of the Public Health Service Act (42 USC 249(a) ), Medical
Care and Treatment of Quarantined and Detained Persons .

3-2.

Section 232 of the Immigration and Nationality Act (INA) (8 USC 1222 ),
Detention of Aliens for Physical and Mental Examination.

3-3.

Title 8, Code of Federal Regulations, Section 235.3 (8 CFR ? 235 .3),
Inadmissible Aliens and Expedited Removal.

3-4.

Title 8, Code of Federal Regulations , Section 232 (8 CFR ? 232 ),
Detention of Aliens for Physical and Mental Examination.

3-5.

Title 42, Code of Federal Regulations , Part 34 (42 CFR 34), Public Health,
Medical Examination of Aliens .

Page 1 of 7
DHS-ICE-19-0196, 19-0197-K-000151

T
2019-ICLl-00051 2196



IHSC DIRECTIVE 03-06 : HEALTH EVALUATION OF DETAINEES IN SPECIAL MANAGEMENT UNITS

3-6.

4.

Review of the Use of Segregation for ICE Detainees, Policy No. 11065.1,
September 4, 2013.

POLICY: IHSC registered nurses (RN) or medical providers review the health
records of detainees transferred to the SMU. IHSC RNs or medical providers
make daily visits to detainees in the SMU to ensure access to care.
4-1.

Transfers to SMU. Facility staff immediately informs health care
personnel when a detainee is admitted to the SMU.

a.

An IHSC RN or medical provider reviews the medical record of any
detainee transferred to the SMU. The purpose of this review is to
determine whether:
(1) An existing medical, dental or behavioral health condition
contraindicates the placement of the detainee in the SMU. Such a
review is documented in the health record.
(2) The detainee requires special accommodations while in the SMU.
(3) Current medicatio ns need modifying from keep on person to
directly observed therapy status. NOTE: Patients may keep
nitroglycerin and asthma inhalers in their possession while in the
SMU.

4-2.

b.

The RN or medical provider conducts a brief physical assessment to
include vital signs and current signs of trauma. Where reason for
concern exists, a qualified medical or behavioral health provider
conducts a complete evaluation.

c.

The RN or medical provider reviewing the record notifies behavioral
health staff of the SMU placement if the detainee is currently under
the care of behavioral health services.

Daily Health Visits. Detainees in the SMU are afforded the same access
to health care as detainees housed in the general population. An RN or
medical provider conducts daily health visits to detainees in the SMU,
whether they are there for administrative, disciplinary, or protective
reasons . The RN or medical provider signs each detainee 's SMU record
when he or she visits a detainee in the SMU. These visits are screening
rounds and not clinical encounters.

a.

The IHSC RN or medical provider makes face-to-face visits in the
SMU, which are documented in both the detainee's health record and
in the SMU Log Book. The entry must include the date and time of the

Page 2 of7
DHS-ICE-19-0196, 19-0197-K-000152

T
2019-ICLl-00051 2197



IHSC DIRECTIVE 03-06 : HEALTH EVALUATION OF DETAIN EES IN SP ECIAL MANAGEMENT UNITS

contact and the signature or initials of the health staff member making
the rounds.
b. The RN or medical provider triages detainees who request sick call
and plans follow-up in a clinical setting, as deemed appropriate by the
RN or medical provider. The RN, medical provider or designee
promptly identify and inform custody officials of detainees who are
physically or psychologically deteriorating and those exhibiting other
signs of symptoms of failing health.

4-3.

Weekly Behavioral Health Visits. Behavioral health providers (BHPs)
or medical providers conduct weekly rounds in the SMU to assess the
behavioral health status of all detainees in the SMU .
a . The BHP or medical provider makes face-to-face weekly visits in
the SMU to assess behavioral health needs. He or she documents
these weekly visits in both the detainee's health record and in the
SMU Log Book.
b. The BHP or medical provider triages detainees who request sick
call for behavioral health issues and plans appropriate follow-up.

4-4.

4-5.

Assessment of Detainees with a Known Mental Health Condition.
a.

Detainees with No Active Psychiatric Symptoms. On a weekly basis, a
BHP or medical provider assesses detainees who do not currently
exhibit active psychiatric symptoms.

b.

Detainees with Active Psychiatric Symptoms . BHPs or medical
providers assess detainees placed in Special Management beds with
active psychiatric symptoms (suicidal ideations , psychosis , etc .) on a
daily basis . The BHP or medical provider uses his or her best efforts
to transfer the detainee to a behavioral health bed if symptoms require
stabilization , as soon as possible. If transferring to an outside facility
for psychiatric reasons, the Health Services Administrator or designee
coordinates with the appropriate Field Medical Coordinator or IHSC
Headquarters Behavioral Health Unit.

Detainees Housed in the SMU for Medical Reasons. A provider may
recommend a detainee for housing in the SMU for medical reasons,
including those intended to protect the safety of other detainees. He or
she may sign an administrati ve segregation order. A detainee housed in
the medical facility's Medical Housing Unit does not require an
administrative segregation order.

Page 3 of 7
DHS-ICE-19-0196, 19-0197-K-000153

T
2019-ICLl-00051 2198



IHSC DIRECTIVE 03-06 : HEALTH EVALUATION OF DETAINEES IN SPECIAL MANAGEMENT UNITS

5.

PROCEDURES:
Special Management Units Process:
5-1.

Medical Evaluation for SMU Placements.
a.

Health care personnel are immediately informed when a detainee is
admitted to the SMU.

b.

The IHSC RN or medical provider reviews the chart and conducts a
brief physical assessment to ensure the continuity of current medical
care, and to document any current signs of trauma or illness.

c.

If the RN conducts the medical evaluation, he or she contacts the oncall provider with any concerns regarding placement.

d.

If a patient is on medications , the following occurs:
(1)

Self-Carry medications:
(a) Place medications on pill-line status.
(b) Generate medication administration record (MAR).
(c) Place documentation on the MAR designating the patient's
housing status (i.e., SMU).
(d) Advise the pharmacy of the patient's placement in the SMU.

(2)

5-2.

Pill Line medications: Place documentation on the MAR
designating the patient's housing status (i.e., SMU).

On-going Medical Rounds in the SMU.
a.

The RN or medical provider conducts daily rounds in the SMU.

b.

The RN or medical provider queries each individual regarding
medical, dental , and behavioral health concerns or requests.
Particular consideration is given to the possibility of suicidal ideations
or attempts.

c.

The RN or medical provider documents the medical rounds in the
SMU Log Book and in the patient's health record. The progress note
is in the SOAP (Subjective-Objective-Assessment-Plan) format and
summarizes the patient's disposition (to include whether the patient is
stable ; has no medical or psychiatric concerns voiced or homicidal or
suicida l plan or intent; and if the patient will continue to receive

Page 4 of7
DHS-ICE-19-0196, 19-0197-K-000154

T
2019-ICLl-00051 2199



IHSC DIRECTIVE 03-06 : HEALTH EVALUATION OF DETAI NEES IN SP ECIAL MANAGEMEN T UNITS

monitoring daily while in the SMU). The eClinicalWorks (eCW) visit
type is segregation (Seg) for detainees in the SMU for non-medical or
mental health reasons, and medical housing unit, provider (MHU-P)
for those detainees in the SMU for medical or mental health reasons .
d.

The RN or medical provider documents any identified concerns or
requests in the patient's chart and makes appropriate referrals.

e.

Once a week , a BHP or medical provider makes rounds in the SMU to
inquire about any mental health concerns of the detainees housed in
the SMU. A BHP or medical provider will see detainees with active
psychiatric symptoms daily. Documentation of mental health rounds
are noted in each patient's health record and the SMU Log Book.

f.

The medical provider makes rounds in the SMU on detainees housed
in the SMU due to medical reasons . These rounds are in accordance
with the admitting provider's orders . Documentation of medical health
rounds are noted in each patient's health record and the SMU Log
Book .

6.

HISTORICAL NOTES : This policy replaces 03-06, Health Evaluation of
Detainees in Segregation Units, dated 10 Feb 2016 . It makes changes to 4-1 a
and 4-2b . It also adds definitions .

7.

DEFINITIONS:
Behavioral Health Providers - Behavioral health providers are psychiatrists ,
clinical psychologists , independently licensed social workers , psychiatric nurse
practitioners or any other behavioral health professional who , by virtue of their
license , education , credentials , and experience , are permitted by law to evaluate
and care for the mental health needs of patients .
eClinicalworks (eCW) - The electronic Health Record (eHR) system application
used by IHSC personnel to document health care that they provide to detainees
at IHSC-staffed detention facilities. The eCW application supports end-user 's
ability to prescribe medications needed for treatment , as well as provides
workflow support and reporting capabilities to ensure that appropriate care is
provided to each detainee .
Health Care Personnel or Providers - Health care personnel or providers are
credentialed individuals employed, detailed , or authorized by IHSC to deliver
health care services to detainees. It includes federal and contract staff assigned
or detailed (i.e. temporary duty) who provide professional or paraprofessional
health care services as part of their IHSC duties. (IHSC Operational Definition)

Page 5 of 7
DHS-ICE-19-0196, 19-0197-K-000155

T
2019-ICLl-00051 2200



IHSC DIRECTIVE 03-06 : HEALTH EVALUATION OF DETAINEES IN SPECIAL MANAGEMENT UNITS

Medical Providers - Medical providers include physicians, physician assistants ,
nurse practitioners, and clinical pharmacists. (IHSC Operational Definition)
Special Management Unit (SMU) - The SMU is a housing unit for detainees in
administrative or disciplinary segregation. (PBNDS 2011 Glossary)
8.

APPLICABLE STANDARDS :
8-1.

Performance-Based National Detention Standards (PBNDS):
Performance-Based National Detention Standards (PBNDS) 2011: 4.3,
Medical Care.

8-2.

American Correctional Association (ACA) :

8-3.

9.

a.

4-ALDF-2A-45.

b.

4-ALDF-2A-53.

c.

1-HC-3A-07 .

National Commission on Correctional Health Care (NCCHC):
Standards for Jails , 2014: J-E-09.

RECORDKEEPING. IHSC maintains detainee health records as provided in
the Alien Health Records System of Records Notice, 80 Fed. Reg. 239 (Jan. 5,
2015).
Protection of Medical Records and Sensitive Personally Identifiable
Information.
9-1.

Staff keeps all medical records, whether electronic or paper , secure
with access limited only to those with a need to know. Staff locks paper
records in a secure cabinet or room when not in use or not otherwise
under the control of a person with a need to know.

9-2.

Staff is trained at orientation and annually on the protection of a patient's
medical information and Sensitive Pl I.

9-3.

Only authorized individuals wit h a need to know are permitted to access
medical records and Sensitive PII.

9-4.

Staff references the Department of Homeland Security Handbook for
Safeguarding Sensitive Pl/ (Handbook) at:
l(b)(?)(E)

I

when add1t1onal1nformat1onIs needed concerning safeguard sensitive Pll.

Page 6 of7
DHS-ICE-19-0196, 19-0197-K-000156

T
2019-ICLl-00051 2201



IHSC DIRECTIVE 03-06 : HEALTH EVALUATION OF DETAINEES IN SPECIAL MANAGEMENT UNITS

10.

NO PRIVATE RIGHT STATEMENT. This directive is an internal policy
statement of IHSC . It is not intended to, and does not create any rights ,
privileges, or benefits, substantive or procedural, enforceable against the
United States; its departments, agencies, or other entities; its officers or
employees; or any other person.

Page 7 of7
DHS-ICE-19-0196, 19-0197-K-000157

T
2019-ICLl-00051 2202



ICE HEALTH SERVICE CORPS

OPERA TIO NS MEMORANDUM

OM 16-002 (version 2)
EFFECTIVE DATE: 28 MAR 2016

By Order of the Acting Assistant Director:
Stewart D. Smith, DHSc/s/

TO:

IHSC Public Health Service (PHS) Commissioned Corps Officers, Civilian
Federal Employees and Contract Personnel

SUBJECT:

Significant Self-Harm and Suicide Prevention and Intervention

1. App licabi lity. This Operations Memorandum (OM) is applicable to all U.S. Immigration and
Customs Enforcement (ICE) Health Service Corps (IHSC) personnel, including but not
limited to, Public Health Service (PHS) officers, federal employees and contract support
staff. It is applicab le to IHSC personnel suppo1ting health care operations in both ICE-owned
and contracted detention facilities, and to IHSC Headquarters staff.

2. Purpose. The purpose of this OM is to set forth the policies and procedures for preventing
self-harm and suicide prevention and intervention. This OM supersedes IHSC Directive: 0704, Significant Se[f-Harm and Suicide Prevention and Intervention.
3. General. The po licy will ensure consistency and continuity of care to all detainees /residents
(hereafter referred to as "detainees") to prevent significant self-harm and prevent potential
suicides. The policy also recognizes that the screening for suicide ideation, plan and/or intent
is an ongoing process that must occur throughout the period of custody of the detainee.
4. Definitions.

Potentially Suicidal Detainee - A potentially suicida l detai nee has pre-occupat ions about
suicide or self-injurious behavior without suicidal intent and plan. The detainee may present
with a recent history of self-destructive /self-injurious behavior.
Actively Suicidal Detainee - An actively suicidal detainee has suicidal ideation with a plan
and intent. The detainee may have taken steps to cause self-injury and the intent, whether
implicit or explicit, or suicidal in nature.
Suicide Attempt - Any nonfatal, self-directed, potentially injurious behavior with any intent
to die as a result of the behavior. A suicide attempt may or may not result in injury.

Page 1 of 19

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000158
2019-ICLl-00051 2203



Nonsuicidal Self-Directed Violence - Behavior that is self-directed and deliberately results
in inju ry or the potent ial for injury to onese lf. There is no evidence, whethe r implic it or
exp licit, of suicida l intent. Same as nonsuicidal self-injury.
Suicidal Intent - There is evidence (explicit and/or implicit) , that at the time of injury , the
individua l intended to kill self or wished to die, and the individua l understood the probable
consequences of his or her actions.
Suicide Gesture - IHSC staff should not use this term in relation to suicida l detainees.
Suicide Watch - Suicide watch always involves cont inuous visual observation of one
detainee by one security staff member (one-to-one). All detainees on suicide watch must be
housed individually in a cell deemed safe by custody staff and medical staff. Custody staff
collaborate with on-site medical staff to review the cell housing a suicide watch detainee and
ensure the cell is as suicide resistant as possible ( e.g., no protrusions of any kind that would
enable hanging or inflicting self-harm). Suicide watch detainees have their belongings and
issued clothing removed, wear a suicide smock, use a suicide blanket, have a mattres s to
sleep on the floor or on a fixed bed, and are given food that can be consumed without the use
of utensils (i.e., finger foods). Custody staff document welfare checks every 15 minutes , and
a health care provider (registered nurse (RN) or higher) document a welfare check at least
every 8 hours.
Constant Watch - Constant watch is less restr ictive than suicide watc h. Constant watch
involves continuous visual observation of one detainee by one security staff member (one-toone ); however , the detainee does not wear a suicide smock and does not use a suicide
blanket. A regular food tray is prov ided . The detainee must be housed individually in a cell
deemed safe by custody staff , have access to regular bedding materials that would be
avai lable for detainees not on suicide watch (i.e., regular bed , mattress, blanket, sheets and
pillow). Constant watch maximi zes safety wh ile decreasing the potential counter-therapeutic
impacts of the suicide smock and suicide blanket. Custody staff document welfare checks
every 15 minutes, and a health care provider (RN or higher) must document a welfare check
at least every 8 hours.
Mental Hea lth Obs ervat ion - Mental health observation is less restrictive than constant
watch . The deta inee may be housed individually or with other deta inees in the medical
housing unit (MHU) or other non-general population housing area. Continuous visual
observation is usually utilized. Custody staff performs staggered 15 minute welfare checks. A
health care provider (RN or higher) must document a welfare check at least every 8 hours.

5. Policy and Procedures.
a. Staff Roles.
(1) Behavioral health providers (BHP) include psychiatrists , clinica l psychologists ,
independently licensed social workers and psychiatric nurse practit ioners .

Page 2 of 19

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000159
2019-ICLl-00051 2204



(2) BHPs and primary care physicians are the only IHSC staff who can perform the initial
eva luation of a detainee who is potentially suicidal or is on suicide watch. If none is
ava ilable the detainee wi ll be sent to the local eme rgency department for eva luation
and treatment.
(3) BHP s and primary care ph ysicians can perform the follow-up eva luation(s) of a
detainee who is potent ially suicidal or who is on suicide watch . If a BHP or prima ry
care physician is not on-site, a mid -leve l provider (MLP) can perform the follow-u p
eva luation(s) but must send the progress note to the primary care physician for cosignature.
(a) If the MLP determines during the follow- up evaluation that the detainee is having
an acute exacerbation , shows evidence of deteriorating status and/or requires a
higher level of care, the MLP must immedia tely call the clinical director (CD) and
on call BHP for a telephone cons ultat ion. This telephone cons ultat ion must be
documented in the detainee's hea lth record.
(4) BHPs and primary care physicians are the only IHSC staff that can discontinue
suicide watc h, consta nt watch or mental health obse rvat ion.
b. Identification of Suicida l Detainees.
Suicide screening is done on intake of all newly arriving detainees. Any pe rson who is
identified in the intake process of being at risk of suicide because of ideat ion or intent
will be referred immediate ly to medical for further in-depth evaluation by a BHP or
primary care physician. Throughout the period of custody of a detainee , the BHP and
other medical providers will routinely assess for the possib ility of development of
suicidal ideat ion, p lan or intent by the detainee. Although there may be a higher incidence
of suicidal thought at the beginning of custody there is a need to target other high risk
periods, including when placed in segrega tion and upon return from court hearings that
resu lted in bad news. Those ident ified at risk will be referred to a BHP or prim ary care
physician for full eva luation.
(1) At any time , during the period of custody, anyone (custody staff or medical staff) may
ident ify a detainee who is potentially suicida l or act ively suicida l, or a detainee may
self-ide ntify as being suicida l.
(2) If a detainee self -identifies or is identified as being potentially or actively suicidal
(i.e., "at risk" for significant se lf-harm or suicide), the individual ident ifying thi s must
notify medical staff immediate ly. The detainee must be brought to the clinic (if the
detainee is not already there) and placed on suicide watch immediately.
(3) The detainee must be immediately referred to the BHP or primary care phys ician .
(4) Any detainee who expresses suicidal ideations or displays suicidal behaviors must be
fully evaluated and considered "at risk" until it is fully determined otherwise by the
Page 3 of 19

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000160
2019-ICLl-00051 2205



BHP or primary care physician. If neither is avai lable, the patient will be sent to the
local emergency department for evaluation and treatment.
(5) If the BHP or primary care physician dete1mines that a detainee is at imminent risk of
bodily injury or death , the BHP or primary care physician may make a referral to the
local emergency department for evaluat ion and/or treatment, as indicated.

c. Referrals.
(1) Detainees who are identified as being potentially suicidal, act ively suic idal or "at
risk" for significant self-harm or suicide must be immediately referred to the BHP,
primary care physician, CD or appropriate clinical designee.
(2) The referred BHP, primary care physician , CD or appropriate clinical designee must
eva luate the detainee within 24 hours of referra l and complete the appropriate suicide
risk assessment form.
(3) The detainee must be placed on suicide watch with one-to-one continuous visual
observation until the BHP, primary care physician, CD or appropriate clinical
designee eva luates the detainee and renders a treatment decision.
(4) If the BHP or primary care physician is unavailable in the next 24 hours, or if the
facility is not equipped to maintain suicide watch, the detainee must be sent off-site
for evaluation.
(a) The health serv ices adm inistrator (HSA) , CD or des ignee must coord inate the
transfer of the detainee to the off-site facility for eva luation.
(b) Custody staff must maintain one-to-one continuous visua l observation until the
detainee is seen at the off-site facility and the off-site facility assumes care of the
detainee.

d. Initial Evaluation/Suicide Risk Assessment.
(1) The BHP or primary care physician must assess the potentially suicidal , actively
suicidal or "at risk" detainee for suicide risk factors and must engage in a full health
record review lead ing up to and includin g time spent on suic ide watch.
(2) Two suicide assessment forms have been developed to standardize the eva luation and
medical record documentation when eva luatin g a suicid al detainee. These forms are
the "Initia l Suicide Risk Assessment" and "Fo llo w-Up Suicide Risk Assessment"
forms. Both of these forms are eClinicalWorks (eCW) Smart Forms.
(3) Only BHPs or primary care physicians can perform initial suicide risk assessments
and must complete the "Initial Suicide Risk Assessment" form.

Page 4 of 19

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000161
2019-ICLl-00051 2206



(4) The BHP or primary care physician must utilize the eCW Smart Form, "Initial
Suicide Risk Assessment" (Appendix A), during the initial evaluation of any detainee
at risk of suicide. This form must be included in the detainee' s health record. This
form include s:
(a) Psychological factors, including: previous and current mental health
conditions /treatment, previous and current suicidal ideations /attempts and mental
status examination.
(b) Lethality of suicide plan;
(c) Substance abuse/use;
(d) Important relationships; family history of mental conditions /su icide ;
(e) Adjustment to detention;
(f) Environmental factors;
(g) Physical health/ph ysica l pain;
(h) Determination of level of suic ide risk;
(i) Level of supervision needed;
(j) Referral /transfer for in-patient care , if needed; and
(k) Instructions to medical staff for care and monitoring.
(5) If the detainee requires suic ide watch , staff must follow the Protocol for Su icide
Watch (Appendix C).
e. Follow -Up Evaluation/Suicide Risk Assessment.
(1) The on-site BHP or primary care physician must evaluate detainees placed on suicide
watch on a daily basis and use the eCW Smart Form , "Follow-Up Suicide Risk
Assessment" (Appendix B). This form must be utiliz ed for any suicide risk
assessments after the initial risk assessment has been performed and prior to remo val
from precautions and/or suicide watch to document the daily observations in the
detainee ' s health record.
(2) If the BHP or primary ca re physician is not on-s ite, an MLP shou ld engage in the
follow-up re-evaluation of detainees placed on suicide watch.
(a) The MLP must document findings from their eval uation in the progress note in
the detainee's health record. The MLP must send the progress note to a primary
care physician for co-signature. The MLP must not utili ze the "Follow-Up Suicide
Risk Assessment" form.
Page 5 of 19

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000162
2019-ICLl-00051 2207



(3) If a detainee's mental health status remains unchanged or worsens (e.g., the detainee
continues to exhibit suicidal ideation with intent) after 72 hours of being on suicide
watch, the BHP or primary care physician must review the medic al record, consider
the detainee's full assessment and consider consultation with other BHP personnel ,
primary care physicians, and/or the CD regarding changes to the treatment plan and
possible hospitalization.
(4) The CD or clinical designee must be updat ed on detainee status changes daily.
f.

Treatment
( 1) The BHP must develop a treatment plan based on the evaluation and assessment of
the detainee. The BHP must document the treatment plan in the detainee's health
record.
(2) The treatment plan must address the relevant factors that contribute to the detainee's
suicidal ideation (e.g., environmental, historical, biological, psycho logical and social)
and must be updated , as necessary.
(3) Contracts for safety (i.e., no-suicide contracts) are not considered safe and must not
be utilized in the treatment plan.
(4) The BHP must assess the detainee's need for psychiatric evaluation , psychotropic
medication, or possible inpatient psychiatric treatment due to self-harm , suicidal
ideation or a suic ide attempt. The BHP may refer the detainee to a psychiatrist or offsite facility for a more intensive level of management (e.g., psychiatric evaluation ,
medications and inpatient treatment).
(5) A detainee placed on suicide watch must remain on suicide watch for a minimum of
24 hours before suicide watch can be discontinued, by a primary care physician
and/or psychiatrist.
(a) The primary care physician and/or psychiatri st may override the decision to keep
a detaine e on suicide watch based on their evaluation of the detainee and/or
consultation with the BHP.

g. Housing and Monitoring
When placing detainee s on and off watch, and monitoring for potenti al suicidal actions,
the BHP or primary care physician must keep in mind the principle of "least restrictive
environment". Therefore, unless the risk of suicide is considered imminently high , one
should choose constant watch over suicide watch whenever possible, as both involve
continuous visua l observation of one detainee by one security staff member (one-to-one).

Page 6 of 19

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000163
2019-ICLl-00051 2208



(1) The BHP or primary care physician may determine that the detainee is "potentially
suicidal," "actively suicidal ," or not suicidal at any given time. The housing and
monitoring of these detainees are distinct.
(2) While on-site , a health care provider (RN or higher) must perfonn clinical rounds and
document observations in the health record at least every eight hours. If the BHP or
primary care physician determines that nursing rounds are needed more frequently,
the BHP or primary care physician must determine the frequency and outline the
specific instructions for nursing care.
(3) A potentially suicidal detainee must be removed from general population and must be
placed in a setting where custody staff can observe the detainee at staggered intervals
not to exceed 15 minutes (e.g., medical housing unit (MHU)).
(a) The potentially suicidal detainee must be under mental health observation and
remain on this observation schedule until a BHP or primary care physician
determines a change in status/suicide risk level.
(b) A health care provider (RN or higher) must check on the detainee at least every
eight hours (or more frequently per the plan of care).
(c) The on-site BHP or primary care physician must evaluate and treat the detainee
daily.
(d) The on-site BHP or primary care physician may discontinue mental health
observation, if clinically indicated.
(4) An actively suicidal detainee must be removed from general population and must be
placed in a single person room that is free of objects or structured elements that could
facilitate a suicide attempt.
(a) Custody staff and medical staff must inspect the room used for suicide watch and
must remove any objects or hazards that pose a threat to the detainee's safety.
(b) The actively suicidal detainee must be under suicide watch and continuous (i.e.,
24 hours a day, seven days a week) one-to-one continuous visual observation by
custody staff.
(c) Custody staff must document security staff welfare checks every 15 minutes or
more frequently , if necessary.
(d) A health care provider (RN or higher) must check on the detainee and document
an assessment every eight hours (or more frequently per the plan of care).
(e) The on-site BHP or primary care physician must evaluate the detainee and
document an assessment using the "Follow-Up Suicide Risk Assessment" eCW
Smart Form (Appendix B).
Page 7 of 19

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000164
2019-ICLl-00051 2209



1) If the BHP or primary care physician is not on-site, an MLP must evaluate the
detainee and document finding s from their assessment in the progress note in
the detainee's health record. The MLP must send the progress note to the
prima ry care physician for co-signature. The MLP should not use the "Follow Up Suicide Risk Assessment" Form.
(f) The detainee must be under certain restrictions while on suicide watch. These
restrictions include:
1) The detainee must be provided a suicide smock to wear. No other clothing is
permitted. Special consideration for flexible appropriate attire should be given
to detainees with special vulnerabilities (e.g., act ively menstruating females,
detainees who suffer from incontinence, detainee s who have a colostomy).
The BHP and/or primary care phy sician must authorize these changes before
implementation.
2) Custody staff mu st take any belonging s from the detainee and place the
belongin gs in a secure area.
3) The detainee must only be provided food items that can be consumed without
uten sils (i.e., finger foods).
4) The detain ee must not be permitted to go to recreation.
5) The detainee may receive phone calls while under supervi sion.
6) The BHP or primary care physician must authorize any movement of the
detainee outside the suicide observation area (e.g., court, attorney visi ts), and
continuous custody observation must continue outside the suicide observation
area.
7) The BHP and/or primary care physician must authorize any changes made to
these restriction s.
(g) The detainee must be under certain restrictions while on constant watch. These
restrictions include:
1) Co ntinuou s visual observation of one detainee by one security staff member
(one-to-one).
2) The detainee does not wear a suicide smock; he/she may wear the issued
detention uniform.
3) Have access to regular bedding material (i.e. , regular bed , mattress , blank et,
sheet s and pillow).
Page 8 of 19

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000165
2019-ICLl-00051 2210



4) A regular food tray is provided.
5) The detainee must be housed individually in a cell deemed safe by custody
staff.
6) Custody staff document welfare checks every 15 minutes and a health care
provider (RN or higher) must document a welfare check at least every 8 hours.
h. Discharge from Suicide Watch

( 1) A detainee placed on suicide or constant watch must remain on suicide watch for a
minimum of24 hours before the watch can be discontinued , unless determined
otherwise by a primary care physician and/or psychiatrist.
(a) The primary care physician and/or psychiatrist may override the decision to keep
a detainee on suicide or constant watch based on their evaluation of the detainee
and/or consultation with the BHP.
(2) The BHP (or on-site primary care physician, if a BHP is not available) must assess
the detainee after the detainee is removed from suicide or constant watch, consistent
with the procedures described in the Protocol for Suicide Watch (Appendix C).
(a) The BHP (or on-site primary care physician , if a BHP is unavailable) must assess
the detainee for the presence of mental health symptoms , including persisting
suicidal ideations within 72 hours after the detainee is discharged from suicide or
constant watch.
(b) The BHP must determine whether additional follow-up appointments are required
in accordance with the clinical presentation of the detainee.
(c) If additional follow-up appointments are required , the BHP must assess the
detainee at each follow -up appointment for the presence of mental health
symptoms, including suicidal ideation.
(3) The BHP, primary care physician, CD or clinical designee are the only providers with
authority to remove a detainee from suicide or constant watch.
(4) If the detainee is detennined to not be actively suicidal , the detainee should be
transitioned off of suicide watch and to a less restrictive level of care (e.g. , constant
watch, mental health observation) or released to general population, if clinically
appropriate. The clinical team (e.g., BHP, primary care physician , CD) should
collaborate to determine whether discontinuation of suicide watch is appropriate.

Page 9 of 19

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000166
2019-ICLl-00051 2211



(5) IHSC HQ Senior Leadership may instruct a facility , at any time , to have two
providers evaluate a detainee in order to discontinue a suicide or constant watch. The
specifics of the process will be determined by IHSC HQ senior Leadership
(a) If a two evaluator discharge is required , one evaluator must be a BHP and the
other evaluator must be a BHP or primary care physician.
(b) The discharge disposition must be documented in the health record by both
evaluators.
i.

Chi ldren
(1) An actively suicidal child ( 17 years of age or younger) must be referred and
transferred to a local hospital for eva luation and treatment as soon as possib le.
(a) Until the transfer to a local hospital occurs, the child must be immediate ly placed
on constant watch with one-to-one continuous observation and the BHP or
primary care physician must assess the child using the "In itial Menta l Health
Suicide Risk Assessment" form.
(b) If a BHP or primary care physician is not available to conduct the evaluation , the
child must remain on one-to -one cont inuous observation until transferred to local
hospital.
(c) The child's parent should accompany the child through the hospital admission
process while under the supe rvision of ICE. The hospital should determ ine if the
parent is allowed to stay overnig ht. If allowed, the parent should stay overnight
with the child; if not allowed, the parent should be granted visitation.
(2) A potent ially suicida l chi ld ( 17 years of age or younger) must be placed in the least
restrict ive setting or in the MHU with one-to-one continuo us observation for up to 24
hours , until the BHP or primary care physician refers the child to a local hospital or
releases the child from observation.
(a) The child 's pare nt should be allowed in the MHU only if their presence is not a
safety issue.
(b) Medical staff must document the status of the child in observation every two
hours or more frequently as determined by the BHP.
(c) Custody staff must document observations every 15 minutes. (See ICE/DRO
Residential Standard , Suicide Prevention and Intervention.)

j . Intervention/Responding to a Suicide Attempt in Progress

Page 10 of 19

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000167
2019-ICLl-00051 2212



(1) Arriving health staff shall perform appropriate medical evaluation and intervention.
The CD or designee is notified in situations for which referral to the emergency room
of a local hospital is required.
k. Notification , Reporting, and Reviews of an Attempted/Completed Suicide

(1) In the event of an attempted suicide/completed suicide, the nurse-in-charge notifies
the HSA , CD, and BHP immediately via phone and email. Serious suicide attempts
and completed suicides are subject to the mortality review process.
(2) Every completed suicide, as well as a serious suicide attempt (i.e., requiring medical
treatment and/or hospitalization outside the facility) , should be examined through a
multidisciplinary morbidity-mortality review process that includes representation from
ICE, mental health, and medical. The primary purpose of the review is two-fold: "What
happened in the case under review?" and "What can be learned to reduce the likelihood
of future incidents?"
The review should include a critical inquiry of:
o The circumstances surrounding the incident
o Facility procedures relevant to the incident
o All relevant training received by involved staff
o Pertinent medical and mental health services /reports involving the incident
o Possible precipitating factors (i.e., circumstances which may have contributed to the
suicide or serious suicide attempt)
o Recommendations, if any, for changes in policy , training, physical plant, medical or
mental health services, and operational procedures

I. Psychological First Aid
(1) For completed suicides, the HSA or designee offers psychological first aid to
detainees and staff involved in the incident within 72 hours of the event. For staff,
additional services are available through respective human resource programs.
Detainees may be referred to in-house BHPs or chaplains for further support.
m. Self-Harm and Suicide Identification and Response Training

(1) All health staff receives training during orientation and annually thereafter. All staff
working with detainees remains current on the proper course of intervention and
referral for a detainee showing signs of suicide risk.
(2) The HSA or designee approves the training curriculum for staff, including
development of intake screening for potential and referral protocols, and training for
staff conducting the suicide screening at intake.
6. Applicable Standards:

Page 11 of 19

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000168
2019-ICLl-00051 2213



Performance-Based National Detention Standards (PBNDS) 2011:
4.6 Significant Self-Harm and Suicide Prevention and Intervention
ICE/DRO Residential Standard 2007:
4.5 Suicide Prevention and Intervention
National Commission on Correctional Health Care (NCCHC) Standards for Health
Services in Jails 2014 :
J-G-05: Suicide Prevention Program
7. Applicable References:
2012 Natio nal Strategy for Suicide Prevention: Goals and Objectives for Act ion: A
Report of the U.S. Surgeon General and of the Nat ional Action Alliance for Suicide
Prevention, Appendix F (http://www.ncbi.nlm.nih.gov /book s/NBK109908 /).
Carlson, David K., Psy.D. Jail Suicide Assessment Tool. Jail Screenin g Assessment Tool
(JSAT) User Manual: Guidelines for Mental Health Screening in Jails, 2002, 1-12.
White, Thomas W., PhD. How to Identify Suicidal People: A Systematic Approach to Risk
Assessment , 1999, 116- 121.
8. Appendices:
Appendix A - Initial Suicide Risk Assessment
Appendix B -Follo w-Up Mental Health Suicide Risk Assessment
Appe ndix C - Protocol for Suicide Watch
9.

HISTORICAL NOTES: This document replaces version 1, dated 2 Feb 2016

Page 12 of 19

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000169
2019-ICLl-00051 2214



Appendix A- Initial Suicide Risk Assessment (To be formatted into eCW)
Reference:

*** Insert/Expand Comment Box

Detainee /Resident Referred by:
Medical Staff
Custodia l Staff

***Other

Self-Referral

Na1Tative (What led to the referral and other pertinent information):
***Expands to Comment Box

Risk Factors:
(+) present
(-) absent

n/a

***Current thoughts of suicide
***Current suicida l intent
***Current suicida l plan
Feelings of hopelessness /helplessness
***Feeling like a burden to others
***Fear for own safety
***Recent significant loss
** *Social isolation (if yes, these selections will open up)
***detainee /resident withdrawn in general popu lation
***housed in segregat ion
***lack of family connect ions
***Current physical pain
(Insert pain scale: 1-10) and explanation box
***Sleep problems
***Agitation (e.g., restlessness, irritability, anxious, increased psychomotor activity, etc.)
***Current Intoxication or in withdrawal from a substance
***Adjustment to ICE detention (adequate /inadequate)
***Prob lem solving deficits (e.g ., rash decision making, inadeq uate strategies to get needs met,
impul sivity, etc.)
***Uncontrolled mental health symptoms
***Non-compliance with mental health treatment
Chronic medical condit ion
***History of self-injury or suicidal behavior
Explain (e.g., when, method, patient's reaction, etc.)
***Family history of suicide
Exp lain ( who, when, how did detainee /resident react, etc.)
** *History of violent behavior
** *History of mental illness
** *History of inpatient psychiatric hospitalizations
Exp lain (e.g ., when, duration of treatment, reason for hospitalization, etc.)
***History of ch ildhood abuse (physical/sexual)

Page 13 of 19

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000170
2019-ICLl-00051 2215



Protective Factors:
(+) present

(-) absent

n/a

*** Able to identify reasons for living
Denial of suicidal ideations
***Fear of death
** *Future orientation (e.g., plans for the future, etc.)
Adequate problem solving skills
Religious beliefs against suicide
***Socia l supp01i in detention center
** *Supportive family relat ionsh ips
Willingness to engage in mental health treatment
Mental Status Exam:
Appearance
Attitude
Psychomotor Activity
Abnorma l Body Movements
Attention
Degree of Awareness of Surroundings
Orientation
Affect
Mood
Speech
Judgement
Thought Conte nt
Perceptual Disorders
Abstraction
Aggression
Anger Contro l
Current Suicidality
Current Homicidally
Intelligence (estimate)
Impulse Contro l
Sexua l Impu lse Contro l
Suicide Risk Assessment:
High Acute Risk: psychiatric hospitalization or 1: 1 suicide watc h indicated/continued
(consideration for "high acute risk" include , but are not limited to, current suicidal ideations with
organized plan and/or intent , recent self-injurious behavior with suicide intent)
Moderate Acute Risk: 1:1 suicide watch indicated /continued (consideration for "moderate acute
risk" include, but are not limited to, the presence of suicidal ideation with vague plan and/or
intent in the presence of multiple risk factors and high acute distress)

Page 14 of 19

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000171
2019-ICLl-00051 2216



Low Risk: Mental Health Observation with or without 15 irregular custody checks (consideration
for "low acute risk" include, but are not limited to, suicidal ideation with no organized plan or
intent with high acute distress, transitioning from 1:1 suicide watc h)
Minimal Risk: Return to genera l population (consideration for "minimal acute risk" include , but
are not limited to, absence of active suicidal ideation and moderate to low levels of acute
distress)
Other
Constant Watc h: 1: 1 continuous observation indicated/co ntinued (considerat ion for "co nstant
watch" include, but are not limited to, exacerbation of mental health symptoms , risk of acute
decompen sation, concerns of potential self-injuriou s behavior)
Mental Health Follow Up:
Today
Within 72 hours
Tomorrow
Other

Page 15 of 19

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000172
2019-ICLl-00051 2217



Appendix B - Follow-Up Suicide Risk Assessment (To be formatted into eCW)
Ref erence: *** Insert/Expands to Comment Box

Risk Factors:
(+) present (-) absent

n/a

** *Current thoughts of suicide
***Current suicidal intent
***Current suicidal plan
Feel in gs of hopelessness /helplessness
***Feeling like a burden to others
***Fear for own safety
***Current physical pain
(Insert pain scale: 1-10) and explanation box
***Sleep problems
***Agitation (e.g., restless ness, irritability, anxiou s, increased psyc homotor activity, etc.)
***Unconh.olled mental health sympto ms
***Non-compliance with mental health treatment

Mental Status Exam:
Appearance
Attitude
Psychomo tor Activity
Abnormal Body Movements
Attention
Degree of Awareness of Smrnundin gs
Orientation
Affect
Mood
Speech
Judgement
Thought Content
Perceptual Disorders
Abstraction
Aggression
Anger Control
Current Suicidality
Curren t Homicidally
Intelligence (estimate)
Impul se Control
Sexual Impulse Control

Page 16 of 19

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000173
2019-ICLl-00051 2218



Suicide Risk Assessment:
High Acute Risk: psychiatric hospitalization or 1: 1 suicide watch indicated/continued
(consideration for "high acute risk" include , but are not limited to, current suicidal ideations with
organi zed plan and/or intent, recent self-injurious behavior with suicide intent)
Moderate Acute Risk: 1: 1 suicide watch indicated/continued (consideration for "moderate acute
risk" include, but are not limited to, the presence of suicidal ideation with vague plan and/or
intent in the presence of multiple risk factors and high acute distress)
Low Risk : Mental Health Observation with or without 15 irregular custody checks (consideration
for "low acute risk" include, but are not limited to, suicidal ideation with no organized plan or
intent with high acute distress , transitioning from 1:1 suicide watch)
Minimal Risk : Return to general population ( consideration for "minimal acute risk" include, but
are not limited to, absence of active suicidal ideation and moderate to low levels of acute
distress)
Other
Constant Watch: 1: 1 continuous observation indicated/continued (consideration for "constant
watch" include, but are not limited to, exacerbation of mental health symptoms, risk of acute
decompensation, concerns of potential self-injuriou s behavior)

Mental Health Follow Up:
Today
Within 72 hours
Tomorrow
Other

Page 17 of 19

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000174
2019-ICLl-00051 2219



Appendix C- Protocol for Suicide Watch

Initiation of Suicide Watch (One-to-One Continuous Visual Observation)
I) Notify the CD or designee , nurse manager, psychiatrist and treating team when a suicide
watch is initiated on a detainee. Place a telephone encounter to the CD or designee
(primary care physician , psychiatrist and/or BHP) requesting documentation of medical
orders.
2) Document the following within the detainee's health record:
o
o
o
o
o

o
o
o
o

Completed "Initial Suicide Risk Assessment" (Appendix A).
Environment (e.g., single person room).
Level of supervision (e.g., one-to-one continuous visual observation).
Intervals of nursing checks.
Clothing is limited to the suicide smock and blanket. Special consideration
for flexible appropriate attire should be given to detainees with special
vulnerabilities (e.g., actively menstruating fema les, detainees who suffer
from incontinence and detainees who have a colostomy, etc.). The BHP
and/or primary care physician must authorize these special considerations
prior to implementat ion.
Issued a Special Needs form for finger foods only and no utensils with
meals.
Property (e.g., personal belongings; clothing , toiletries).
Initiate a Global Alert with in the health record.
Create a treatment plan.

3) Comp lete a Special Needs Form to indicate placement on suicide watch and place in the
health record.
4) The BHP or primary care physician must reassess the detainee's status daily while on
suicide watch utilizing the "Follow-Up Suicide Risk Assessment" (Appendix B). If the
BHP or primary care phy sician is not on-site , an MLP can engage in the follow-up reevaluation and will document their findings from their assessment in the progress note
and send the note to the primary care physician for co-signature. The MLP will not utilize
the "F ollow-Up Suicide Risk Assessment" form to document their assessment.
5) If a detainee continues to have suicida l ideations with intent or the detainee 's mental
condition is not improving after 72 hours of being on suicide watch, the BHP, primary
care physician, CD or clinical designee will review the medical record, take into account
the detainee's full assessment and consider consu ltation with other BHP personnel ,
primary care phy sicians, and/or the CD regarding treatment plan and possible
hospitali zation.

Page 18 of 19

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000175
2019-ICLl-00051 2220



Discharge from Suicide Watch
1) The BHP or primary care physician completes the "Fo llow-Up Suicide Risk Assessment"

form (Appendix B) prior to a detainee 's discharge from suicide watch. The discharge
disposition must be documented in the health record.
2) The BHP or primary care physician places the detainee on mental health observation for
at least 24 hours following discontinuation of suicide watch, if clinically indicated .
3) The BHP or primary care physician will determine if mental health observation must be
continued.
4) When the detainee is deemed fit to be released from suicide watch or mental health
observation to general population , the BHP or primary care physician completes a
Special Needs Fo1m.
5) The BHP or primary care physician documents the mental health follow-up treatment
plan in the health record.

Page 19 of 19

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000176
2019-ICLl-00051 2221



l(b)(6); (b)(?)(C)

From :
Sent :
To :
Cc:
Subject:
Attachments :
Prevention .pdf

7 Dec 201817:51:12
f b)(6); (b)(?)(C)

I

+0000

~l
(b_}(6
_),_(b
_}(_7)_(C
_) __________

~~ilcox,

Bryan sJb)(6); (b)(?)(C)

RE: AMAR DDR
Health Evaluation of Detainee in Segregation.pdf,

Self Harm and Suicide

Good morning !(b)(6);
I have attached the policies that covers the requirements

for suicide prevention

and segregation rounds.

IHSC Policy 03-06 : Evaluation of Detainee in Segregation
IHSC Operations Memorandum 16-002 : Self-Harm and Suicide Prevention

V/r

LCDRl(b)(6); (b)(?)(C)

l MLS(ASCP)

Assistant Health Services Administrator
Department

of Homeland Security

Immigration

& Customs Enforcement

Enforcement

(ICE)

& Removal Operations (ERO)

USPHS, ICE Health Service Corps.
Northwest

Detention

Center

1623 East J Strei>~(b}(6}!
Tacoma, WA 98421
Office :l(b)(6); (b)(?)(C)
Cell: (b)(6); (b)(?)(C)

I

Fax:
~b)(6); (b)(?)(C)

Warning: This document is UNCLASSIFIED//FOROFFICIALUSEONLY (U//FOUO) . It contains information that may
be exempt from public release under the Freedom of Information Act (5 U.S.C.552). It is to be controlled, stored,
handled, transmitted, distributed, and disposed of in accordance with DHS policy relating to FOLIOinformation and
is not to be released to the public or other personnel who do not have a valid "need-to -know" without prior
approval of an authorized DHS official. No portion of this report should be furnished to the media, either in written
or verbal form.

From : l(b)(6); (b)(?)(C)
Sent : Thursday, December 6, 2018 3:36 PM

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000177

2 019 -ICLl-00051 222 2



r )(6); (b)(7J(C)

Cc:Wilcox, Bryan 1b)(6); (b)(7)(C)
!(b)(6); (b)(7)(C)
Subject : FW: AMAR DDR
Importance : High
(b)(6); (b)(7)(C)
The below email from ICE OPR poses a first list of questions that they would like answered as soon as
possible. I can answer the first question. The next several pertain to GEO, and the last to IHSC. Would
you please turn these around for me as quickly as you can?
The second list of bulleted items comprises things that OPR will need to be made available by the time
they hit the ground here on Tuesday morning. Please let me know if you see any issues with being able
to pull these items in time.
Lastly, the attachment contains the tentative list of witnesses for int erviews . Please do not forward this
list . At this point, the list is being provided for our planning purposes . I will forward out the revised list as
soon as I get it.
Thanks in advance,

I

~b)(6); (b)(7)(C)
Assistant Field Off ice Director
DHS/ICE/ERO
Northwest Detention Center
Seattle Field Office
Des (b)(6); (b)(7)(C)
Cell:

Froml<b)(6); (b)(7)(C)

Sent : Thursday, December 6, 2018 12 :05 PM
To: Kb)(6); (b)(7)(C)
Subject : AMAR DDR

Hello Sir:
Per our conversation.

Questions:

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000178
2019-ICLl-0005 1 2223



(b)(5)

Please have the following available on site:
o All Medical telephone encounters (none were included in the record)
o The paper medical file including all the scanned documents, to include any actual sick
call requests by the deta inee.
o Licenses and CPRCards for all doctors, mental health professiona ls, and mid level
providers (don't need to be brought to the room but must be available for review).
o There is a reference to a video of the cell search conducted after the hanging. Can we
get that video?

V/r,
l(b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000179
2019-ICLl-00051 2224



From :

Wilcox, Bryan S

Sent:

12 Mar 2019 21:57:46 +0000

To:

l(b)(6); (b)(?)(C)

Subject:

RE: Amar Death Cert. and medical exam iner's report

Ok
Brya n S. Wilco x
Acting Field Office Directo r
ICE Enforcement & Removal O erations Seattlc,~W
_ A___
~
Main !(b)(6); (b)(?)(C) !/Des (b)(6); (b)(?)(C) / Cell j(b)(6); (b)(?)(C)

CONFIDENTIALITY: This emai l a nd attachme nts are intended for the above name only and are confidential. If you are not the intended
addressee, or the perso n respons ible for deliveri ng it to the intended addressee, you may neither copy , disseminate, nor d istribute it to anyone
e lse or use it in any unauthorized manner. To do so is strictly p rohibited a nd may be unlawful. If you receive this ema il by mistake, please
advise the sender immed iately by us ing the reply facility in your mai l software and delete it from your computer .

F r om:l(b)(6); (b)(?)(C)

Sent: T uesday, Mar ch- 12::,,,...:
2:,.0
,..:,
19~ 2=:3""
3....,
P_,_
M
'-'-------------~
b)(6); (b)(?)(C)
To: Wilcox, B an S b)(6); (b)(?)(C)
(b)(6); (b)(?)(C)
Subject: RE: Amar Death Cert. and m edi cal examin er's repor t

I 0-4 , a copy of deat h Certifica te and A utopsy report have bee n scann ed into Amar 's electroni c medica l
record.

I

LCD *b )(5); (b)(?)(C)
MLS(ASCP)
Assistant Health Services Administrator
Department of Homeland Security
Immigration & Customs Enforcement (ICE)
Enforcement & Removal Operations (ERO)
USPHS, ICE Health Service Corps.
Northwest Detention Center
l 623 East J Street j(b)(6
Tacoma, WA 9842 I
Office b)(6); (b)(?)(C)
Cell b)(6); (b)(?)(C)
Fax:

I

Warning: This document is UNCLASSIFIED //FOR OFFICIAL USE ONLY (U//FOUO). It contains
information that may be exempt from public release under the Freedom of Infonnation Act (5 U.S.C. 552).

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000180
2019-ICLl-00051 2225



It is to be controlled, stored, handled, transmitted, distributed, and disposed of in accordance with DHS
policy relating to FOUO information and is not to be released to the public or other personnel who do not
have a valid "need -to-kn ow" without prior approval of an authorized OHS official. No portion of this repori
should be furnished to the media, either in written or verbal form.

From: Wilcox, Bryan S
Sent: Tuesda , March 12, 2019 2: 14 PM
To: (b)(6); (b)(?)(C)
Cc:
SutiJec :

I have Amar 's Afile and it contains The death certificate and medical examiner's report.
Have you made copies of these documents and sent them to wherever they need to go?

<< Fi le: Amar-A2 l 6269802- Death Cert..pdf >>

Bryan S. Wilcox
Acting Field Office Director
IC E Enforcement & Removal Operations, Seattle, '"'
W
-'-A
::..,::...~~~~
Main: l(b)(6); (b)(?)(C) Desk: l(b)(6); (b)(?)(C) Cell: (b)(6); (b)(?)(C)

ii

II

CONFIDENTIALITY: This emai l and auac hments are intended for the above name only and are confident ial. If you are not the intended
addressee, or the person responsibl e for delivering it to the intended addressee, yo u may neither copy, disseminate, nor distribut e it to anyone
else or use it in any unauthorized manner. To do so is strictly prohibited and may be unlawful. If you receiv e this email by mistake, please
advise the sender immed iately by using the reply facility in your mai l software and delete it from your computer.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000181
2019-ICLl-00051 2226



Fro m :

fb)(6)
; (b)(?)(C)

Sent:

26 Nov 2018 01:04:34 +0000

To:

Wilcox, Bryan

Subje ct:

RE: Amar ES

Sl(b)(6); (b)(7)(C)

He was determined by the Psychiatr ist on the 27th to not be suicidal. He was taken off of
Suicide Watch and Stepped down to constant watch and then Mental Health Obsevation
with q 10 min checks. He stayed in the MHU for 7 days under observation and was
determined to not be a danger to himself at any time while in the MHU.
CAPT l(b)(B)
; (b)(?)(C)
~ LCSW-C, BCD
Health Services Administrator
USPHS
ICE Health Service Corps
Northwest Detention Center
1623 E. J St. Suite ifil[]
Tacoma, WA 98421
Office : b)(B); (b)(?)(C)
BB b)(6)
; (b)(
?)(C)
Fax
rb)(6);(b)(?)(C)
Warning: This document is UNCLASSIFIED//FOR OFFICIAL USE ONLY (U//FOUO).
It contains information that may be exempt from public release under the Freedom of
Information Act (5 U.S.C. 552). It is to be controlled, stored, handled, transmitted,
distributed , and disposed of in accordance with DHS policy relating to FOUO
information and is not to be released to the public or other personnel who do not have a
valid "need-to-know" without prior approval of an authorized DHS official. No portion of
this report should be furnished to the media, either in written or verbal form.
From: Wilcox, Bryan S t.,,..
b,....,
)(6,.....
);...,..
(b-)==
(7)-==(C.,,...)
-,-------~
Date: Sunday, Nov 25, 2018, 4:57 PM

r )(6); (b)(7)(C)
Subject: RE : Ama r ES
Thanks.
.
I h ave ano th er ques t 10n

b)(6)
;
on other line)
b\(?\(C\

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000182
2019-ICLl-00051 2227



On October 29, 2018, NWDC staff transferred AMAR from the MHU to administrative
segregation but he remained on 10-minute irregular mental health observation (MHO)
checks.
From:l(b)(B); (b)(?)(C)

Se nt: Sunday, November 25, 2018 4:43 PM
To (b)(6); (b)(?)(C)

Wilcox, Bryan S

He was discha rged to Seg on Oct 16

LCDRl(b)(B); (b)(?)(C)

IMLS(ASCP)

Assistant Health Services Administrator
Department of Homeland Security
Immig ration & Customs Enforcement (ICE)
Enforcement & Remova l Operations (ERO)
USPHS,ICE Health Service Corps.
Northwest Detention Center
1623 East J Street~
Tacoma , WA 98421
Office: l(b)(B); (b)(7)(C)
Cell (b)(6); (b)(?)(C)
Fax
b)(6); (b)(?)(C)
cid:image007 .png@01D297FB .19484D80cid:image008.png@01D297FB.19484D80cid
png@01D297FB.19484D80

:image009.

Warning : This document is UNCLASSIFIED//FOROFFICIAL USE ONLY (U//FOUO) . It contains
information that may be exempt from public release under the Freedom of Information Act (5
U.S.C. 552) . It is to be controlled, stored, handled, t ransmitted, distributed, and disposed of in
accordance with OHS policy relating to FOUO information and is not to be released to the public
or other personnel who do not have a valid "need-to-know" without prior approval of an
authorized OHSofficial. No portion of this report should be furnished to the media, either in
written or verbal form.

Fro mf b)(6); (b)(7)(C)

Date: Sunday, Nov 25, 2018, 4:42 PM

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000183
2019-ICLl-00051 2228



To: Wilcox, Bryan s (b)(6); (b)(7)(C)
b)(6); (b)(7)(C)

Subjec t: RE:Amar ES
He was in SEGwhen the rope was found . I believe I saw in a previous t imeline that he was
discharged from the MHU to SEGfor protective custody on the 16th or 19th of October.
5

);
hb)(
, 17 vr,

do you reca II th e d at e ?.

CAPTl(b)(6); (b)(?)(C)

ILCSW-C, BCD

Health Services Admin istrator
USPHS
ICE Health Service Corps
Northwest Detent ion Center
1623 E. J St. Suit a(b)(6!
Tacoma, WA 98421
Office: l(b)(6); (b)(7)(C)
BB:(b)(6); (b)(7)(C)
Fa
l(b)(6); (b)(7)(C)
Warn ing: This document is UNCLASSIFIED//FOROFFICIAL USE ONLY (U//FOUO). It contains
info rmat ion that may be exempt from public release under the Freedom of Informat ion Act (5
U.S.C. 552) . It is to be controlled, stored, handled, transm itted, d istr ibuted, and disposed of in
accordance with OHS po licy relat ing to FOUO information and is not to be released to the pub lic
or other personne l who do not have a va lid " need -to-know " without prior approval of an
authorized DHS official. No portion of this report shou ld be f urni shed to the med ia, either in
wr itten or verba l form.
From : Wilcox, Bryan S j(b)(6); (b)(7)(C)
Date : Sunday, Nov 25, .,..
20""'1
..,8....
, .....
4-.:3'""5,....,
P
""'M
-.--------'

rb)(6); (b)(7)(C)
SUD)ect : RE: Amar ES

Also
When did AM AR leave t he MHU and ret urn? This bullet suggest he was not in the MHU when
they found the rope:

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000184
2019-ICLl-00051 2229



From: Wilcox, Bryan S
Sent: Sunda , November 25, 2018 4:33 PM
(b)(6); (b)(?)(C)

(b)(6);
(b)(7)(C)

In this block of bullets, there's a lot ofNWDC doing this or that, which I believe should
actually say IHSC

Am I right?

b)(5)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000185
2019-ICLl-00051 2230



Fro m :

Sent:

l(b)(6); (b)(7)(C)

To:

26 Nov 2018 01:01:55 +0000
Wilcox, Bryan sj(b)(5); (b)(?)(C)

Subje ct:

RE:Amar ES

He was on Suicide Watch till the 27. Then discharge from Suicide Watch to MH
observation with 10 minutes irregular check
LCDRfb)(6);
(b)(7)(C) !MLS(ASCP)
Assistant Health Services Administrator
Department of Homeland Security
Immigration & Customs Enforcement (ICE)
Enforcement & Removal Operations (ERO)
USPHS, ICE Health Service Corps.
Northwest Detention Center
1623 East J StreeHbl/6!
Tacoma, WA 98421
Office (b)(6); (b)(?)(C)
Cell (b)(6); (b)(?)(C)
Fax:
b)(6); (b)(7)(C)
cid: image007.png@0 1D297FB .19484D80cid: image008.png@0 1D297FB .19484D80cid: i
mage009 .png@0 1D297FB.19484D80

Warning: This document is UNCLASSIFIED//FOR OFFICIAL USE ONLY (U//FOUO).
It contains information that may be exempt from public release under the Freedom of
Information Act (5 U.S.C. 552). It is to be controlled, stored, handled, transmitted,
distributed, and disposed of in accordance with DHS policy relating to FOUO
information and is not to be released to the public or other personnel who do not have a
valid "need-to-know" without prior approval of an authorized DHS official. No portion of
this report should be furnished to the media, either in written or verbal form.

From: Wilcox , Bryan S t=b..:..:.
l<6=
l:"<""
b::..:..
l<"'"'7
l""iC
'-'Y_" __
Date: Sunday , Nov 25, 2018 , 4:57 PM
r6)

0
_. _

._.

__

_,

; ~ )(7)(C)

ubJec t: RE: Amar ES

Thanks.
I have anoth er question

~b
)(6);
b )l7)1C)

Ion oth er li ne)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000186
2019-ICLl -00051 2231



Is th is co rr ect: w as it dete rmine d th at he was not suicid al o n the 27th , but he wa s kept o n
suicide watch un it l t he 29 th . An d if so, what was the t rigger to send him back to ad seg and who
ma de this decisio n?

(b)(5)

From:l (b)(6); (b)(7)(C)

Sent: Sunday, November 25, 2018 4:43 PM

(b;,:-;
)(7_l(_c_J ------,_
r,;:T:;-;o~:f
-:-;
b
);::-;
(6); v.
77
l(b)(6); (b)(7)(C)

__________

_JIWilcox, Bryan S

Subject: RE: Amar ES

He was discharged to Seg on Oct 16

LCO~(b)(6); (b)(7)(C)

I MLS(ASCP)

Assistant Health Services Administrator
Department of Homeland Security
Immigration & Customs Enforcement (ICE)
Enforcement & Removal Operations (ERO)
USPHS, ICE Health Service Corps .
Northwest Detention Center
1623 East J Street l(b)(6
Tacoma, WA 98421
Office j(b)(6); (b)(7)(C)
Cell (b)(6); (b)(7)(C)

I

Fax
(b)(6); (b)(7)(C)
cid:image007.png@010297FB.19484D80cid:image008.png@010297FB.19484080cid:image009.
png@010297FB.19484080

Warn ing: This document is UNCLASSIFIED//FOR OFFICIAL USE ONLY (U//FOUO) . It contains
informat ion that may be exempt from public release under the Freedom of Informat ion Act (5
U.S.C. 552) . It is to be controlled, stored, handled, transmitted, distr ibuted, and disposed of in
accordance w ith OHS policy relat ing to FOUO information and is not to be released to the public
or other personnel who do not have a valid "need -to-know" without prior approval of an
authorized OHS official. No portion of this report should be furnished to the media, either in

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000187
2019-ICLl-00051 2232



written or verbal form.

Fro m :l(b)(6); (b)(?)(C)
Date : Sunday, Nov 25, 2018, 4:42 PM
,.,,...,..,,.,.,...-,....,...,,,...,..,,.,------------------,
To: Wilcox, Bryan S(b)(6); (b)(?)(C)
b)(6); (b)(?)(C)
Subject : RE:Amar ES

He was in SEGwhen the rope was found . I believe I saw in a previous time line that he was
discharged from the MHU to SEGfor protective custody on the 16th or 19th of October.
l(b)(6);

Ido you

recall the date?

CAPTl(b)(6); (b)(?)(C)

ILCSW-C, BCD

Health Services Administrator
USPHS
ICE Health Service Corps
Northwest Detention Center
1623 E. J St. Suite{~ )( I
Tacoma, WA 98421
Office: !(b)(6): (b)(?)(C)
BB: (b)(6); (b)(?)(C)
Fa
l(b)(6); (b)(?)(C)
Warning: This document is UNCLASSIFIED//FOR OFFICIAL USE ONLY (U//FOUO). It contains
informat ion that may be exempt from public release under the Freedom of Information Act (5
U.S.C. 552) . It is to be controlled, stored, handled, transmitted, distributed, and disposed of in
accordance with DHS policy relating to FOUO information and is not to be released to the public
or other personnel who do not have a valid "need -to-know" without prior approval of an
authorized DHS official. No portion of this report should be furnished to the media, either in
written or verbal form .
From: Wilcox, Bryan S ._l
(b_)(_6)_;(_b)_(?_)(_C_
) ______

____.

Date: Sunday, Nov 25, 2018, 4:35 PM

rb)(6); (b)(?)(C)
Subject: RE:Amar ES

Also
W hen did AM AR leave t he MH U and retu rn? This bu llet suggest he w as not in th e MH U when
t hey foun d th e rop e:

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000188
2019-ICLl-00051 2233



From: Wilcox, Bryan S
Sent: Sunday, November 25, 2018 4:33 PM
r )(6); (b)(7)(C)

Subject: Amar ES

(b)(6);
(b)(7)(C)

In this block of bullets, there 's a lot ofNWDC doing this or that, which I believe should
actually say IHSC

Am I right?

(b)(S)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000189
20 19-ICLl-00051 2234



Fro m :

~b)(6); (b)(7)(C)

Sent:

26 Nov 2018 00:33:53 +0000

To:

Wilcox, Bryan S~b
)(6); (b)(7)(C)
RE:Amar ES

Subje ct:

Yes, you are correct!
CAPJ1(b)(6); (b)(7)(C)
ILCSW-C,BCD
Health Services Administrator
USPHS
ICE Health Service Corps
Northwest Detention Center
1623 E. J St. SuiteKbl
(~l;!
Tacoma, WA 98421
Office: ~b)(6); (b)(7)(C)
I
BB: (b)(6); (b)(7)(C)
Fax
fb)(6); (b)(7)(C)
Warning: This document is UNCLASSIFIED//FOR OFFICIAL USE ONLY (U//FOUO).
It contains information that may be exempt from public release under the Freedom of
Information Act (5 U.S.C. 552). It is to be controlled, stored, handled, transmitted,
distributed, and disposed of in accordance with DHS policy relating to FOUO
information and is not to be released to the public or other personnel who do not have a
valid "need-to-know" without prior approval of an authorized DHS official. No po1tion of
this report should be furnished to the media, either in written or verbal form.
From: Wilcox, Bryan S _
lC
...,,
b~)(6~);~(b~)(~7)~(C~) ------~
Date: Sunday , Nov 25, 2018 , 4:32 PM

rb)(6); (b)(7)(C)

Subject: Amar ES

b)(6);
b)(7)(C)

In this block of bullets, there's a lot of NWDC doing this or that, which I believe should
actually say IHSC

Am I right?

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000190
2019-ICLl-00051 2235



 

 

130(5)

 

 

2019-ICLI-00051 2236





From:

Asher, Nathalie R
26 Nov 2018 01:07:09 +0000
Wilcox, Bryan S
RE: Amar ES

Se nt:
To:

Subject:
thx
From: Wilcox, Bryan S

Se nt : Sunday, November 25, 2018 8:06 PM
To : Asher, Nathalie R 4Cb)(6); (b)(?)(C)

Subject: FW:Amar ES ~---------~

From:rb)(6); (b)(?)(C)

Se nt : Sunday, November 25, 2018 5:05 PM
To: Wilcox, Bryan S~b)(6); (b)(?)(C)
Subject: RE: Amar E.!,eS
~-------------------------------'
He was determined by the Psychiatrist on the 27th to not be suicidal. He was taken off of Suicide Watch
and Stepped down to constant watch and then Mental Health Obsevation with qlO min checks. He
stayed in the M HU for 7 days under observation and was determined to not be a danger to himself at
any time while in the MHU .

CAPlfol<6l

!b\!7\!C\

I LCSW-C, BCD

Health Services Administrator
USPHS
ICE Health Service Corps
Northwest Detention Center
1623 E. J St. SuitE{b)(6)I
Tacoma, WA 98421
Office: {253) 779-6052
BB: (b)(6); (b)(?)(C)
Fax
l(b)(6); (b)(?)(C)
Warning: This documen t is UNCLASSIFIED//FOR OFFICIAL USE ONLY (U//FOUO). It contains informa t ion
t hat may be exemp t from public release under the Freedom of Information Act (5 U.S.C. 552). It is to be
controlled, stored, handled, transmitted, distributed, and disposed of in accordance with OHSpolicy
relating to FOUO information and is not to be released to the public or other person nel who do not have
a valid "need -to -know" without prior approva l of an authorized OHSofficia l. No portion of this report
should be furnished to the media, either in written or verbal form .
From: Wilcox, Bryan S fb)(6); (b)(?)(C)

Date: Sunday, Nov 25, ....
z~u ~1g~,~4~;5~7~pm1v
~1~--------'
l(b)(6); (b)(?)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000192
2019-ICLl-00051 2237



Subject: RE:Amar ES
Thanks.
I have another question (Nathalie on other line)
Is this correct: was it determined that he was not suicidal on the 27 th , but he was kept on suicide watch
unitl the 29 th . And if so, what was the trigger to send him back to ad seg and who made this decision?

(b)(S)

I

From : l(b)(6); (b)(?)(C)

Se nt : Sunday, November 25, 2018 4:43 PM
To: Kb)(6); (b)(?)(C)
~,,.=::::;::;:::::;==========;------------J
fb)(6); (b)(?)(C)

!Wilcox, Bryan S

Subject: RE: Amar ES
He was discharged to Seg on Oct 16

LCDRl(b)(B);(b)(?)(C)

IMLS(ASCP)

Assistant Health Services Administrator
Departme nt of Homeland Security
Immigration & Customs Enforcement (ICE)
Enfo rcement & Removal Operations (ERO)
USPHS, ICE Health Service Corps .
Northwest Detention Center
1623 East J Streetlailll
Tacoma, WA 98421
Office :~b)(6);(b)(?)(C)
Cell (b)(6); (b)(?)(C)
Fax
(b)(6); (b)(?)(C)
cid:image007.png@01D297FB.19484D80cid
D297FB.19484D80

:image008 .png@01D297FB .19484D80cid:image009 .png@0l

Warning : This document is UNCLASSIFIED//FOROFFICIAL USE ONLY (U//FOUO). It contains information
that may be exempt from public release under the Freedom of Information Act (5 U.S.C. 552). It is to be

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000193
2019-ICLl -00051 2238



controlled , stored, handled, transmitted, distributed, and disposed of in accordance with DHS policy
relating to FOUO information and is not to be released to the public or other personnel who do not have
a valid "need-to-know" without prior approva l of an authorized DHS officia l. No portion of thi s report
should be furnished to the media, either in written or verbal form.
Fromfb)(6); (b)(?)(C)
Date : Sunday, Nov 25, 2018, 4:42 PM
To : Wilcox, Bryan Sfr::b.,..,
)(6=
)-:
; (,...,
b).(7
.,,,
,.,..,
)(C
=),----------------------------,
Subject: RE:Amar E':::,

He was in SEGwhen the rope was found . I believe I saw in a previous timeline that he was discharged
from the MHU to SEGfor protective custody on the 16th or 19th of October.
Kb)(6); _ ~o you recall the date?

~ LCSW-C,BCD
CAP7l(b)(6); (b)(7)(C)
Health Services Administrator
USPHS
ICE Health Service Corps
Northwest Detention Center
1623 E. J St. SuitEfb)(6)!
Tacoma, WA 98421
Office b)(6); (b)(7)(C)
BB (b)(6); (b)(7)(C)

Fa
b)(6); (b)(?)(C)
Warning: This document is UNCLASSIFIED//FOROFFICIAL USEONLY (U//FOUO). It contains information
that may be exempt from public release under the Freedom of Information Act (5 U.S.C.552). It is to be
controlled , stored , handled, transmitted, distributed, and disposed of in accordance with DHS policy
relating to FOUO information and is not to be released to the public or other personnel who do not have
a valid "need-to-know" without prior approva l of an authorized DHS official. No portion of this report
should be furnished to the media, either in written or verbal form.
From: Wi lcox, Bryan Sf'=b=)(6
~)~
; (b
~)~
(7=
)(C
~)~------'
Dat e: Sunday, Nov 25, 2018, 4:35 PM
rb)(6); (b)(?)(C)
Subject: RE:Amar ES

Also
Wh en did AMAR leave the MHU and retu rn? This bull et suggest he w as not in th e MHU w hen th ey
fo und the rope:

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000194
2019-ICLl-00051 2239



From : Wilcox, Bryan S

Sent : Sunday, November 25, 2018 4:33 PM
rb )(6); (b)(7)(C)

Subject : Amar ES

(b)(6);
/h\/

7 \/ f"' \

In this block of bullets , there's a lot ofNWDC doing this or that, which I believe should actually
say IHSC

Am I right?

(b)(5)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000195
2019-ICLl-00051 2240



I

l(b)(6), (b)(7)(C)

From:
Sent :
To:

21 Dec 2018 22:23:02 +0000
l(b)(6); (b)(7)(C)

Wilcox, Bryan Sj(b)(6); (b)(7)(C)

l(b)(6); (b)(7)(C)

Cc:
Subject:

RE: Amar

The Pierce County Medical Examiner's office states the report will not be ready for another month or
two. They are running toxicology

tests on him. They will let us know when the report is finished and

availab le.

~fb_
)(6_);_(b_)(7
_)(_C_)

---~I

MD

Clinical Director
ICE Health Service Corps (IHSC)
Enforcement

and Removal Operations

US Immigration

Customs Enforcement

(ERO)
(USICE)

No rthwest Detent ion Center
1623 E. J St. Suitel(b)(
Tacoma, WA 98421
(b..,.,
)(=6
)"""
; (,....,
b)""'
(7,,.,.
)(C
=)--,
Main office .,,.
Vo ice Mail:
Cel (b)(6); (b)(7)(C)
fax

I

(b)(6); (b)(7)(C)

I

Fromf b)(6); (b)(7)(C)

Sent : Friday , December 21, 2018 11:55 AM
To: W ilc ox, Bryan 1b)(6); (b)(?)(C)

fb)(6); (b)(7)(C)
Subject: RE: Amar
I am not aware of any communication
or the family/

in either point . I guess I thought

they were going through

ICE and

Consulate?

I have CC'd a few others to see if they know anything more .

CSW-C, BCD
minis ra or

Heal
USPHS

ICE Health Service Corps
Northwest

Detention

1623 E. J St . Suitelb )(6
Tacoma, WA 98421

Center

I

Office: (b)(6); (b)(7)(C)
BB b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000196
2019-ICLl-00051 2241



Fax

b)(6); (b)(7)(C)

(b)(6); (b)(7)(C)

Warning: This document is UNCLASSIFIED//FOROFFICIAL USEONLY {U//FOUO). It contains information
that may be exempt from public release under the Freedom of Information Act (5 U.S.C. 552). It is to be
controlled , stored, handled, transmitted, distributed, and disposed of in accordance with DHSpolicy
relating to FOUO information and is not to be released to the public or other personnel who do not have
a valid "need -to-know" without prior approva l of an authorized DHS officia l. No portion of this report
should be furnished to the media, either in written or verbal form .
From: Wi lcox, Bryan Sl'-=(b~)(6~);~(b~)(~7)=(C~) ~------'
Date: Friday, Dec 21, 2018, 11:37 AM
r b)(6); (b)(7)(C)

Subject : Amar
l(b)(6); _.

I

Have we heard back from the medical examiner's office/coroner on a death certificate , and next of
kin/disposition of body
Sent with BlackBerry Work
(www. blackberr y.com)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000197
2019-ICLl-00051 2242



!(b)(6); (b)(?)(C)

From:

Se nt:

25 Nov 2018 19:11:07 +0000
(b)(6); (b)(?)(C)

To:

b)(6); (b)(?)(C)

Cc:

ilcox, Bryan Sl~
(b_)(6
_)_
; (b
_)_
(?_
)(C
_)______

~

l(b)(6); (b)(?)(C)

Subject :

RE: AMAR, Mergensana A216 269 802

10-4, thanks . We will also put in a case comment to memorialize this.
We wi ll cut a 203 today for GEO so that they book him out in their system. Should we book him ou t in
EADM? If so, should we make the book out time his time of declared death (last evening) or should it
correspond with when we cut the 203 for GEO?
Thanks,

I

l(b)(6); (b)(?)(C)
Assistant Field Office Director
DHS/ICE/ERO
Northwest Detention Center
Seattle Field Office
Deskt(b)(6); (b)(7)(C) I
Celll(b)(6); (b)(?)(C)

I

f rom~(b)(6); (b)(?)(C)

I

Se nt : Sunday, November 25, 2018 11:07 AM
To (b)(6); (b)(?)(C)

Cc

Wi ~
lc-ox- ,~B~r-ya_n_ s~ b~
)(5~)7; (bh\
)n
(7Vl
)(C
~)--------------------------,__J

Subject: RE: AM AR, Mergensana A216 269 802
Thanks,fb)(6); ~-jl'II put this in the notification
notification purposes.

and state that efforts continue. Good enough for the

r )(6); (b)(?)(C)

Fromj(b)(6); (b)(?)(C)

Se nt : Sunday, November 25, 2018 2:05 PM
Tn{ b)(6); (b)(?)(C)
Ccj(b)(6);(b)(?)(C)
fb)(6); (b)(7)(C)
l(b)(6); (b)(?)(C)

!Wilcox, Bryan S l(b)(6); (b)(?)(C)

Subject: FW: AMAR, Mergensana A216 269 802
(b)(6);
/ h " 7 \/f"

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000198
2019-ICLl -00051 2243



The hospita l declared a cardiac death last night for AMAR. EROSeattle is endeavoring to do everything
possible to notify the Russian Embassy of his passing. SDDq(b)(6);~ltried calling the Embassy at 1315
and 1320 (Eastern). We then sent the below ema il, as we thought it would be better than sending a fax .
SDDO
unsuccessfully tried calling again at 1350. The phone number we have for them is
apparent y not configured to receive voicemails; accordingly, we were not able to leave a message.

)~ii~iir.,

I gather that you were successfully able to contact the Russian authorities regarding this matter. I would
like to ask you for your help in conveying this message to the Russians in the event that you may better
be able to reach them . Thank you in advance for any assistance you may be able to provide.
l(b)(6); (b)(7)(C)

I

Assistant Field Office Director
DHS/ICE/ERO
Northwest Detention Center
Seattle Field Office
Desi b)(6); (b)(?)(C)
Cell

Fromf b)(6); (b)(7)(C)

I

Sent : Sunday, November 25, 2018 10:51 AM
b)(6); (b)(?)(C)

Vice-Consull(b)(6); (b)(7)(C)
I tried to contact you via telephone th is morning to inform you of new developments regarding the
hospitalization of Mr. Amar . This message is to inform you that Mergensana Amar , a cit izen and
national of Russia, who was located at St. Joseph' s Hospita l in Tacoma, WA, suffered card iac death at
6:05PM on November 24, 2018 . My office regrets to inform you of this matter, and if we can be of any
assistance, please feel free to contact our office .
Regards,

uperv1sory e ention and Deportation Officer
Northwest Detention Center
1623 East J Street
Tacoma, WA 98421
Desk b)(6); (b)(?)(C)
Cell: '--------'

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000199
2019-ICLl-00051 2244



From :

rb)(6); (b)(7)(C)

Sent:
To:

25 Nov 2018 21:04:27 +0000
J<b)(6); (b)(7)(C)
5); (b)(?)(C)

I

e)(

Cc:

~ilcox, Bryan

__,=====.--------------~

!..,,..
(b.,.,.
)(6
,,.,..
);...,,
(b..,..
)(=7
)..,.,
(C"""
) ___

RE: AMAR, Mergensana A216 269 802

Subject:

I have sent an email as well to the embassy but I do not foresee them responding until
Monday . I will let you know once I receive a response .

etention and Deportation Officer
U.S. Department of Homeland Security
ICE I ERO I HQ I RMD
Removal & Internatio nal Operations (Asia-Europe)
Embassy Liaison
500 12th St. SW, Room
Washington , DC. 20536
Des (b)(6); (b)(7)(C)
Cell:
.....................................
Email:
(b)(6); (b)(7)(C)

l~lmrc)

-------~

From:~b )(6); (b)(7)(C)

Date: unday, Nov 25, 2018, 2:05 PM

l ilcox,

Bryan S

r )(6); (b)(7)(C)

SubJect: F W: AMAR, Mergensana A2 l 6 269 802
b)(6);
h\17\lr\

The hospital declared a cardiac de ath last night for AMAR. ERO Seatt le is endeavoring to do
ried calling
everything possible to notify the Russian Embassy of his passing. SDDO
the Embassy at 1315 and 1320 (Eastern). We then sent the below email, as we thought it would
be better than sending a fax. SDDOl(b)(6); ~!unsuccessfully tried calling again at 1350. The
phone number we have for them is apparently not configured to receive voicemai ls; accord ing ly,
we were not able to leave a message.

~!~~t -,

I gather that you were successfully able to contact the Russian authorities

regarding thi s matter.

I would like to ask you for your help in conveying this message to the Russians in the event tha t
you may better be able to reach them. Thank you in advance for any assistance you may be able
to provide.
l(b)(6); (b)(7)(C)

I

Assistant Field Office Director

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000200
2019-ICLl-00051 2245



DHS/ICE/ERO
Northwest Detention Center
Seattle Field Office
Des~(b)(6); (b)(?)(C)
Cell:

From~b)(6); (b)(?)(C)

Sent: Sunday, Novem ber 25, 2018 10:51 AM
To (b)(6); (b)(?)(C)

Cc:
Sul:>J
ect:
Vice-Consui fbl(6); (b)(?)(C)
I tried to contact you via telephone this morning to inform you of new deve lopments regarding
the hospitalization of Mr. Amar. This message is to inform you that Mergensana Amar, a cit izen
and national of Russia, who was located at St. Joseph's Hospital in Tacoma, WA, suffered cardiac
death at 6:05PM on Novembe r 24, 2018. My office regrets to inform you of this matter, and if
we can be of any assistance, please feel free to contact our office.
Regards,
l(b)(6); (b)(?)(C)

I

Supervisory Detention and Deportation Officer
Northwest Detention Center
1623 East J Street
Tacoma, WA 98421
Desk (b)(6); (b)(?)(C)
Cell:

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000201
2019-ICLl -00051 2246



l(b)(6); (b)(7)(C)

From:

Sent:

26 Nov 2018 21:15:00 +0000
Wi lcox, Bryan S;Jennings, David W;Asher, Natha lie R
Asher, Nathalie R
RE: Articles

To:

Cc:
Subject :

Thanks .
b)(6);
!(b)(6); (b)(7)(C) !
(a)Dep uty Assistant Director
Immigration & Customs En forceme nt
ERO Domest ic Operations - West

From: Wilcox , Bryan S
Sent: Monday , November 26. 2018 3:53 PM
To: Jenn in os Dav i d W b)(6); (b)(7)(C)

sher Nat hali e R

(b)(6); (b)(7)(C)
b)(6); (b)(7)(C)

>

https://www.seattlepi.com/ seattlenews /article / Asylum-seeker-Amar-Mergensana-diesafter-10-days-1342025 9. php
https://www .theo lymp ian .com/news/local/article222 l 73990 .html
https ://www .seatt letimes.com/seatt le-news /ice-sa ys-russian-detainee-in-tacoma-hadattempted-suicide-disputes-claim-he-died-of-hunger-strike /
http: //www.tribtown.com /2018 / l l /26/wa-immigration-detention-center-death-the-latest/
https://komonews.com /news/ local/ russian-man-who-was-he ld-at-detent ion-center-hasdied

Bryan S. Wilcox
Acting Field Office Director
W""A'='"'".,,...,..,~,,..,...,
ICE Enforcement & Removal O erations, Seattle , .,,.
Main: l(b)(6); (b)(7)(C)
Desk: (b)(6); (b)(7)(C) / Cell: ~b)(6), (b)(7)(C)

t

I

CONFIDENTIALITY: This email and auachments are intended for the above name only and are con fident ial. If you are not the intended
addressee, or the person res ponsib le for delivering it to the intended addressee, yo u may neither copy, disseminate, nor distr ib ute it to anyone
else or use it in any unau thorized manner. To do so is strict ly prohibi ted and may be unlawful. If you receive this email by mistake, please
advise the sender immed iately by using the reply facility in your mai l software and delete it from your compu ter.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000202
2019-ICLl-00051 224 7



From :

Kb)(6); (b)(7)(C)

Sent:

24 Nov 2018 19:07:05 +0000

To:

Jennings, David W;Wilcox, Bryan S
RE: Checklist -- ICE policy

Subject :

10/4.

Sent with BlackBerry Work
(www .blackbe rry.com)
From: Jennings,David W ....
~b_)(6_);_(b_)(_
7)_
(C_) ______
Date: Saturday, Nov 24, 20 18, 2:05 PM
To: Wilcox , Bryan S!(b)(6); (b)(7)(C)
Cc~b)(6); (b)(7)(C)
Subject: RE: Checklist -- ICE policy

_,~

I

I

Assista nt Director
Field Operations
From: Wilcox , Bryan S '"=r
b..,,..
)(6
..,...,
);,.....
(b...,.
)(.7.,.
).(C
...,,.
-=)------~
~

Date: Saturday, Nov 24,_
, 2_0_1_8,~ 1=4~:0_3______
To: Jennings, David W'=
l(b~)
(6_);~(b_l(_
7l_
(C_) ------~
Subject: Checklist -- ICE policy
Dave,

Silvia gave me the attached detainee death checklist on the 20 t h o This corresponds to
the policy Notification and Reporting of Detainee Deaths also attached. It has been
impossible to adhere str ictly to the time-frames of these requirements
uncertainties about his death and possibility of survival.

due to

As you recall, we in it ially made all the telephonic notifications required under to policy
for a detainee death , believing him to have died/not expecting him to survive,
immediately after he was found hanging and sent to the ER. ICE OPR was actually at
the facility at that time and RAc fblC5l; CblC7lCCl
witnessed the EMT efforts , so that
notification was made. I also reached out to OHS OIG s4Cbl(5l; (bl(7JC
C)
Ito notify OIG

I

(though that's OPR' s responsibility).
After he survived on life support through the night, we submitted
attempt the following

day .

AMERICAr--..

pVERSIGHT

a SEN as a suicide

DHS-ICE-19-0196, 19-0197-K-000203
2019-ICLl-00051 2248



In anticipation
notification,

of his not recovering, we worked wit ~(b)(6); (b)(7)(C)

jon a draft death

but the document has not been formalized and issued.

On November 18 th at 8pm, we were notified by IHSCthat the hospital had declared our
detainee "brain dead", and were asking ICE about next of kin to make a decision about
maintaining life support .
Our efforts at identifying and commun icating w ith any next of kin began.
We were advised on November 20 t h by IHSCthat, with Amar having been declared
"brain dead" on Nov 18t h by the hospital, despite his body being alive on life support, he
was legally dead at that time and eventua lly, when he is taken off life support and the
body dies, the medical examiner 's office will show 11/18 t h as his officia l date of death.
We learned from HQ RIO on 11/20/2018, that the Russian Embassy had contacted the
next-of-k in.
The hospital not having heard from the parents or the Russian Embassy at this time, I
gave the attending/deciding doctor the parents contact informat ion and he was
successful at contacting the parents that night.
Over the past week , the hospital has had three conversations with the parents about
discont inuing life support.
According to IHSC, last night , the hospital again spoke with the fami ly and the attending
physician advised that he was expecting that ventilator will be off today after
conversation w/ one more family member to occur at 1600 PST.
In anticipation that the life support w ill be removed this evening, we will probably have
to run down this list tomorrow, particularly the notice to congress , etc. (I'm assuming
that has not been done), even though much has already been done defacto.

Bryan S. Wilcox
Acting Field Offic e Director
ICE Enforcement & Removal O erat ions, Seatt le, WA
Main: !(b)(6); (b)(7)(C) VDesk: b)(6); (b)(7)(C) / Cell: j~
(b-)(6-);-(b-)(7-)(~C)-~

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000204
2019-ICLl-00051 2249



Wilcox, Bryan S
21 Nov 2018 05:17:16 +0000

From:
Sent :
To:
Cc:
Subject:

(b)(6); (b)(?)(C)

RE:communicat ion to hospital for Amar family

10-4
I have a Ukrainian DO, we'll try calling them ourselves tomorrow.

From~(b)(6); (b)(?)(C)
Sent : Tuesday, November 20, 2018 9:02 PM
To: Wilcox Br an b)(6); (b)(?)(C)
Cc b)(6); (b)(?)(C)

: communica 10n o
Byran
I think the parents had the expectation of your office reaching out to them. The common law seems to
be the active contact
~o

uld be the POC if the consulate was going to contact.

Sent with BlackBerry Work
(www .blackberry.com )
From: Wilcox, Bryan s ~._
b_)(6_);_(b_)(_7)_(C
_)______
Date: Wednesday, Nov 21, 2018, 5:45 AM

____.

To :f b)(6); (b)(7)(C)

Subject : FW: communication to hospital for Amar family

He b)(6);

The hospita l has not heard from the Russian government or the parents of Amar. If you can get this
information to the GOV of Russia or the parents, I think we could say in good faith we've done all we can
do .

From:fb)(6); (b)(?)(C)
Sent : Tuesday, November 20, 2018 3:00 PM
To: Wilcox, Bryan s t b)(6); (b)(?)(C)
{ b)(6); (b)(7)(C)

Subject : communication to hospita l for Amar family

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000205
2019-ICLl -00051 2250



Just to let you know, D~b)(6); ~- ~alled me to give us his personal cell phone for any important calls or
He also said the VP of St Joseph Med Ctr has
messages regarding our mutua l patient: j(b)(6); (b)(7)(C)
authorized him to not turn off life support for another 24 hours since there may be a chance at
contacting Amar ' s family. He wanted to relate he is willing to take any call from the Russian Government
or from the Amar family on his personal cell phone if needed at any time day or night. He also gave us a
back up phone number to call if we have information regarding fami ly members needing to contact
b"'"'
)\~
""),- _~
-- ---,
someone at the hospital, which would b~b)(6); (b)(?)(C) J MD the Vice President for Operat ions at K"'",

I

l(b)(6); 1 1hope this is helpful. Let me know if you have any questions. I did not release any information to
him about phone numbers for Amar's parents as detailed in the morning's email.
~l
(b_)(6_);_(b_)(7
_)(_C)___

~IMD

Clinical Director
ICE Health Service Corps (IHSC)
Enforcement and Removal Operations (ERO)
US Immigration Customs Enforcement (USICE)
No rthwest Detention Center
1623 E. J St. Suite @Il
Tacoma, WA~9,,,.
84""'
2,..,.
1~=---.
Main office (b)(6); (b)(?)(C)
Voice Mail:
Ce! (b)(6); (b)(7)(C)

fax
!(b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000206
2019-ICLl-00051 2251



Fro m :

Se nt:
To:

Subje ct:

Wilcox, Bryan S
21 Nov 2018 11:35:50 +0000
Kb)(6);(b)(?)(C)
RE: communication to hospital for Amar family

Thanks!
The hospital also made contact with the parents last night. According to the parents , " It
will take a few more conversations to reconcile", meaning no decision was made on
continuation of life suppo1t or organ donations

Sent with BlackBerry Work
(www .blackberry .com)
Fro mj(b)(6); (b)(?)(C)

Date: Wednesday, Nov 21, 2018, I :46 AM
To: Wilcox, B1yan S ._
Kb
_)(6
_)_;(_
b)_(?_)(C
_)______________________
Subject: FW: communication to hospita l for Amar fami ly

_,

Fysa
Sent with BlackBerry Work
(www .blackberry .com)
From f b)(6); (b)(?)(C)

Date: Wednesday, Nov 21, 2018, 10:44 AM
ToJPYb)(6); (b)(7)(C)
Subject: RE: communication to hospital for Amar family

Good morning,
The consulate has been in contact with both the parents and the common-law wife. The
parents do not have the ability to come to the United States and getting a visa can take up
to 300 days. The Head Consu l stated he will give me another update soon as to the
family's wishes. In the mean time the field office is welcome to reach out to the parent s
via an interpreter, keeping time differences in mind.
~b)(6); (b)(?)(C)

Detention and Deportation Officer
U.S. Department of Homeland Security
ICE I ERO I HQ I RMD
Removal & International Operations (Asia-Europe)
Embassy Liaison
500 12th St. SW, Roo~
Washington, DC. 2053~

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000207
2019-ICLl-00051 2252



Des (b)(B); (b)(?)(C)
Cell L-r::-:-:=-c::-:-,: = :--~------,
Ema il: b)(B);(b)(?)(C)
From f b)(6); (b)(?)(C)

Date: Wednesday , Nov 21, 2018, 12:01 AM
To: Wilcox B an b)(6); (b)(?)(C)
Cc (b)(6); (b)(?)(C)

: commumca 10n o ospt

Byran
I think the parents had the expectation of your office reaching out to them. The common
law seems to be the active contact

Sent with BlackBerry Work
(www.blackberry.com)

s....

6>_; (_
_ )______
Fro m: Wilcox, Bryan lCb_J<
_
bl_
<7_)(C
Da te : Wednesda Nov 21 2018. 5:45 AM
To: b)(6); (b)(?)(C)

___.

mar am1y

Su bJec :

The hospital has not heard from the Russian government or the parents of Amar. If you can get
this information to the GOV of Russia or the parents, I think we could say in good faith we've
done all we can do .

From:l (b)(6); (b)(?)(C)

Se nt: Tuesday, November 20, 2018 3:00 PM
To: Wilcox , Bryan S j(b)(6); (b)(?)(C)
b)(6); (b)(?)(C)

~l)~lic:

Just to let you know, Dr
called me to give us his persona l cell phone for any important
He also said the VP of St Joseph
calls or messages regarding our mutua l patient : l(b)(6); (b)(?)(C)
Med Ctr has authorized him to not turn off life support for another 24 hours since there may be
a chance at contacting Amar's family . He wanted to rela t e he is willing to take any call from the
Russian Government or from the Amar family on his personal cell phone if needed at any time
day or night . He also gave us a back up phone number to call if we have information regarding
family members needing to contact someone at the hospital, which would b~(b)(6); (b)(?)(C)I MD
the Vice President for Operations ai(b)(B);(b)(?)(C) I- I hope this is helpful. Let me know if you

I

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000208
2019-ICLl -00051 22 53



have any question s. I did not release any information to him about p hone num bers for Amar's
pare nts as deta iled in the morning's email.

IMD

l(b)(6); (b)(7)(C)

Clinical Director
ICE Health Service Corps (IHSC)
Enforcement and Removal Operations (ERO)
US Immigration Customs Enforcement (USICE)
Northwest Detention Center
1623 E. J St. SuiteKb)(
Tacoma , WA 9842 I
Mai n offic "'"
(b..,...,
)(6
=)....,
; (b
,...,.
)(=7)"(C
" ,..,.
) ----,
Vo ice Mai l
Ce l b)(6); (b)(7)(C)

!

fax
(b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000209
2019-ICLl -00051 2254



l(b)(6); (b)(7)(C)

From :

14 May 2019 19:56:55 +0000
Wilcox, Bryan S
RE:criminal investigation into detainee death

Se nt:
To :

Subject:

OIG is complet ing the ir investigat ion. To my know ledge, they have not found any wrongdo ing.
They are somet imes slow due to staffing . They only have three agents and cover eight agenc ies.
Regards ,
(b)(6);
/ h\

/ 7 \/r'\

I

l(b)(6); (b)(7)(C)

Resident Agent-in-Charge
Office of Profess ional Respons ibility
Was hington I Oregon I Idaho I Alaska
U.S. Immigration and Customs Enforcement
Department of Homeland Security
915 Second Avenue, 31st Floor, Suite!<bl/6\: I
Seattle, Wash ington 98174
Cell:
Phone :
Fax :
Email:

b)(6);(b)(7)(C)

CONFIDENTIA LITY NOTICE: This document is UNCLASSIFIED //FOR OFFICIAL USE
ONLY (U//FOUO). This comm unication with its conte nts and any attachments may conta in
confidential and/or legally privileged information. It is solely for the use of the intended
recipient(s). Unauthorized interception , review , use or disclosure is prohibited and may violate
applicable laws including the Electronic Commun ications Privacy Act. If you are not the
intended recipient, please contact the sender immediately and destroy all cop ies of the
communication. Further, this commun ication with its contents and any attachments may be
exempt from public release under the Freedom oflnformation Act (5 U.S.C. ? 552(b)(5) ,
(b )(7)). It is to be contro lled, stored, hand led, transmitted, distr ibuted, and disposed of in
acco rdance with Depaitme nt policy relating to FOUO informat ion and is not to be released to the
public or other personnel who do not have a valid "need -to-know" without prior approval of an
author ized Department officia l. No portion of this communication should be furnished to the
media, either in written or verbal form.
From: Wilcox , Bryan S
Sent : Tuesday, May 14, 2019 12:33 PM

To:l(b)(6); (b)(7)(C)
Subject: RE: criminal invest igation into detainee deat h

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000210
2019-ICLl -00051 22 55



To my knowledge, there is no crimina l investigation of the Amar death ..
Can you confirm this fo r OPR and OIG?
Thanks
Sent with BlackBerry Work
(www.blackberry.com )
From : fb )(6); (b)(7)(C)

Date: tuesday, May 14, 2019, 12:16 PM
To: Wilcox, Bryan s f~b.,...,
)(6
,-)_; (_b l_(7,-)(C
_ )-,------,----,----,------,-~

Subject : FW: criminal investigation into detainee death

Hey Bryan, Can you confirm that this investigation is an ongoing OPR investigat ion, versus a
criminal one?
From~(b)(6); (b)(7)(C)

Se nt : Tuesday, May 14, 2019 11:59 AM
(b)(6); (b)(7)(C)

SubJect: FW: crimina l investigation into detainee death

l(b)(5); (b)(6); (bJUxc)

Thanks!
(b)(6);
(b)(7)(C)

From :fb)(6); (b)(7)(C)

Se nt : Tuesday, May 14, 2019 2:46 PM
To: ICEMedia J(b)(6); (b)(7)(C)
Cc:l (b)(6); (b)(7)(C)

I

I

Subject: criminal investigation into detainee death
Hi all. ICEFOIA has confirmed that your agency is conducting "an ongoing criminal investigation" into
t he death of Mergensana Amar. Can you please explain why? What changed since the medical examiner
ruled his death a suicide? Have any of the guards been reassigned or suspended whi le the criminal
investigation is ongoing, as of this month?
Please see attached .
ICE has already published the death report :
https://www .ice.gov/doclib/foia/reports/ddrAmarMergensana

.pdf

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000211
2019-ICLl-00051 2256



Here is the medical examiner's finding:
https://www.apnews.com/acd3Sbbe18314fdf90373d9a224cce98
Thanks so much,
fb)(6); (b)(?)(C)

I

Immigration reporter
The Washington Post
Deskj(b)(6); (b)(?)(C)
Signal/WhatsApp/Mobil~

I

(b)(6); (b)(7)(C)

b)(6); (b)(?)(C)
b)(6); (b)(?)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000212
2019-ICLl-00051 2257



From :

~b)(6); (b)(7)(C)

5 Nov 2018 06:29:36 +0000

Sent:
To:
Kb)(6); !Wilcox,
b)(6); (b)(7)(C)

l(b)(6); (b)(7)(C)

Bryan

~;;:::::::::;::::;;:=;;====================~
I

Sl (b)(6); (b)(7)(C)

Re: Declined Dinne r meals 11-4-18

Subject:

Please see declined dinner mea ls for 11/4/2018 .
Med-lso

119th declined meal

l<b)(6); (b)(7)(C)

H-Seg

Amar #216269802, 27th declined meal
Notified medical of declined mea ls
l(b)(6); (b)(7)(C)

I

Lieutenant
The GEO Group, Inc. (R)
Northwest Detention Center
1623 East J. Street
Tacoma, WA 98421
r b)(6); (b)(7)(C)

l(b)(6); (b)(7)(C)

www.geogroup.com

From:\~)\~/;,
..,,
Sent: Sunday, November 4, 20 18 10:27 AM
To: r b)(6); (b)(7)(C)

r

!Bryan S W

i lcox; l<bl/61

,

I

)(6); (b 1(7)(C)

Subj ect: Declined lunch meals 11-14-18

The following deta inees decl ined their lunch tray on Day Shift 11/4/18

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000213
2019-ICLl-00051 2258



H-Seg
Ll
<b_l(6_l;_(b_l(7_l<_c _
i

__

l lst

declined meal

Med-lso

declined meal

r.c
(b-,-:,
)(6;;-:);...,,
(b7,
)(7,,,
l(""c'J --~

._

_____

Ll
<b_J<
6_J;_<b_J<
7_l<_
ci ___

~

19th declined meal

fth declined meal

F4
Lfb_J<
6_J;_<b_J<
1_i<c
_ i________

l 1st declined meal

Al
Ll
<b
_)(6_J;_(b_)(7_l(_
ci _____

~ 2nd declined meal

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000214
2019-ICLl-00051 2259



I

From :

l(b)(6); (b)(7)(C)

Sent:

30 Oct 2018 05:16:15 +0000

To:

I

fb l(6); (b)(7)(C)

--,I

Wilcox, Bryan sJ:~b-)(6-);- (b-)(...
7)-(C_) __________________

!(b)(6l:

1~)(6);(b'." )(C)
Re: Declined dinner trays, 10-29-18

Subject:

The following detainees declined there dinner trays 10-29-18
Med iso
._[
b_)(6_l;_(b_l<_7l_<c_i ___

__,l

2nd declined meal

H-Seg

Amar A#216269802 1st declined meal
D-2 All 1st declined meal
(b)(6); (b)(7)(C)

The GEO Group, Inc.(R)
Northwest Detention Center
1623 East J. Street
Tacoma, WA 98421

I"''o

(b)(7)(C)

l(b)(6); (b)(7)(C)

www.geogrou p.com

From~ (b)(6); (b)(7)(Cl l

Sent: Monday , Octob er 29, 20 18 9:4 1 AM
To: l(b)(6); (b)(7)(C)

Bryan S W 1.lcox ; b)(6);
"'n "r-'

(b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000215
2019-ICLl-00051 2260



l(b)(6); (b)(7)(C)

Subject: Declmed lunch trays, I0-29-18
As of lunch, 10-29- 18, the following declined the ir lunch trays;
H unit
Amar #216269802- 32nd tray declined.
i<b)(6); (b)(7)(C)
1st t ray declined.

I

Med ISO
rb_)(6_); _
.....
(b)_(7_)(C_) __

__,~

1st tray declined.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000216
2019-ICLl-00051 2261



From :

l<b)(6); (b)(7)(C)

Sent:

15 Oct 2018 05:21:00 +0000

To:

~ilcox,

_j

l

b)(6); (b)(7)(C)

-------------------J

Bryan ~

;""'(b""')(..,..7).,...
(C.....
)
6""")

Subject:

Re: Declined IDinner Trays 10-14-18

Medical 2
Amar A#216269802 - 161 declined meals ate 2 apples and drinking water

C-1
__,~ declined

l<b_)(6_),_(b_)(_7)_(c_>____
....

2nd meal stated he ate soup last night

D-3

_.I
-declined 1st meal

6
7
rb_)<_>:_(b_)<_ >_<c_>____
....

D-2
(b)(6); (b)(7)(C)

eclined 1st meal
- declined 1st meal
declined 1st meal
odined 2nd meal

(b)(6); (b)(7)(C)

1eutenant

The GEO Group, Inc.(R)
Northwest Detention Center
1623 East J. Street
Tacoma, WA 98421

l(b)(6); (b)(7)(C)

WWW .geog, oup.toi 11

I~

From~ (b)(6); (b)(7)(C)

I

Sent: Sunday. October 14, 2018 9: 10 AM
To: ICb)(6); (b)(7)(C)

5
Bryan sw.1
1 cox,.Cb>C
,.... >:

\1 '"7 \1,..,.,

)(6); (b)(7)( C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000217
2019-ICLl-00051 2262



fb )(6); (b)(7)(C)

Subject: Declined lunch trays, 10-14-18
Following detainees refused their lunch trays, 10-14-18;
Med ISO
Amar #216269802 - 160th mea l declined.
D2
(b)(6); (b)(7)(C)
lh:-rn=-r<:"7"7'1'l'7""1"""----.--~

1st meal declined.
1st meal declined.

H unit
6
7
l<b_><_>;_<b_l<_ >_<c_>
....

--~I

1st mea l declined.

Cl
l<b_)<6
....
_);_<b
_)<7_><
_c>___

___,f
1st meal

declined.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000218
2019-ICLl-00051 2263



f b)(6); (b)(7)(C)

From :

Sent:

11 Oct 2018 19:50:59 +0000

b)(6); (b)(7)(C)

I\ U/\OJ; \U/\ f )(G)

Wilcox Brvan

5Jb )(6 ); (b)(7 )(C)

I

(b)(6); (b)(7)(C)

Subject:

Re: Declined lunch meals 10-11-18

Be advised this is a partial list.
Fromkb)(6); (b)(7)(C)

I

Sent: Thursday, Octob er l l , 2018 12:45:36 PM
r b)(6); (b)(7)(C)

!Brya n S

!(b)(6): (b)(7)(C)

Wilcox

(b)(6); (b)(7)(C)
(b)(6); (b)(7)(C)

Subject: Re: Declined lunch meals 10-11-18

Amar A# 216269802 , Med ISO, 151 declined meals.
i<b)(6); (b)(7)(C)
~ H-unit, 1st declined meal.

l(b)(6); (b)(7)(C)

L ieut enant
GEO Corrections & Detention (R)
Northwest Detention Center
1623 East J Street
Tacoma Washin ton 9842 1
Tel b)(6); (b)(7)(C)
Fa
b)(6); (b)(7)(C)

www.geogroup .com

From:l <b)(6), (b)(7)(C)

Sent : Thursda

I

Octob er 11 2018 1:32 PM

(b)(6); (b)(7)(C)

b)(6); (b)(7)(C)

Wilco x

ryan S

(b)(6); (b)(7)(C)

(b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000219
2019-ICLl-00051

2264



l(b)(6); (b)(7)(C)

Subject: D ecl ined lunch mea ls 10-11 - 18

(b)(6); (b)(7)(C)
~(b~)(~6)~; (~
b)~
(7):(C
":'!!
~) ------1

D2, 1st declined meal.
2, 1st declined meal.

b)(6); (b)(7)(C)

1eu enan
GEO Corrections & Detention (R)
Northwest Detention Center
1623 East J Street
Tacoma , Washin on 98421
Tel (b)(6); (b)(7)(C)

Fa
(b)(6); (b)(7)(C)

www.geogroup.com

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000220
2019-ICLl-00051 2265



l(b)(6); (b)(?)(C)

From:
Sent :
To:

I

17 Oct 2018 14:38:48
b)(6); (b)(?)(C)

+0000
ilcox, Bryan ~(b)(6); (b)(?)(C)

Cc:
Subject:

RE: Declined

lunch trays, 10-15-18

b)(6);
h \(7)/C:\

Any further

updates

on declined

meals?

b)(6);
b)(?)(C)

From*b)(6); (b)(?)(C)
Sent : Monday, Octobe r 15, 2018 4:5 1 PM
roF b)(6); (b)(?)(C)
=C.;_c;_J:._
b_)(6
...)__
; (.,.
b)_(?_)(C
_ )_________________
(b)(6); (b)(?)(C)

____._
ilc.c....;.,
ox, Bryan

S

Correction to earlier email. B-1 had detainees that did not want to get out of bed.

Update, detainee fbl(6); __ lhas been reported to medical already. Lunch would be his second
declined meal accord ing to the officer.

I

l(b)(6); (b)(?)(C)
ASSISTA NT WARDEN, SECURITY

The GEO Group, Inc . (R)
Nort hwest Detention Center, 1623 East J Street
Tacoma, Was hington 98421
Tel : (b)(
C
Mob1e:
)(?)(C)
(b)(6); (b )(C)
www .geoqroup.com
This email and any files t ransmitted
entity to which they are addressed.
the ema il t o t he inten ded recipient,
disse m ination, fo rwarding, print ing
error, please imme diate ly notify by
From :l(b)(6); (b)(?)(C)

Sent : Monda

with it are confi dential and are inte nded so lely for t he use of the ind ividua l or
If you are not the intended recipie nt or the person responsible for deliver ing
be advised that you have received this ema il i n error and t hat any use,
or copyi ng of this ema il is st rictly proh ibited. I f you have rece ive d th is ema il in
rep lyi ng t o this email.

I

October

15 2018 4:41:33

PM

T (b)(6); (b)(?)(C)

Cc:(b)(6); (b)(?)(C)
Subject: Re: Declined

Wilcox,

Bryan 5J b)(5); (b)(?)(C)

lunch trays , 10-15-18',_ _________

AMERICAr--..

pVERSIGHT

__,

DHS-ICE-19-0196, 19-0197-K-000221
2019-ICLl -00051 2266



b)(6);

b)(?)(C)

D-2 indicated they did not like the meal at lunch .

B-2 had some that did not want to get out of bed and did not want to eat.
indicated he is start ing hunge r st rike . Wi ll look fo r

Unit Off icer advised deta inee ~~()~(1r, 1
information report.
~b)(6); (b)(?)(C)
Assistant Warden , Secu rity
l<b)(6); (b)(?)(C)
I

Fromj (b)(6); (b)(?)(C)
Sent : Monday, October 15, 2018 3:35 :16 PM

To ~(b)(6); (b)(?)(C)

I

I

7l_
Cc:l(b)(6); (b)(?)(C)
Wilcox, Bryan S;_l
(b_)(6_);_(b_)<_
(C_) _____
Subject: FW: Declined lunch trays, 10-15-18
l(b)(6); (b)(7)(C)

_

~

This seems like a larger t han usua l numbe r of mea l refusa ls. Do we have any addit iona l insight
into this? Do any of the housing units appear to be engaging in group hunger strikes?
Thanks,
l(b)(6); (b)(?)(C)
Assistant Field Office Director
DHS/ ICE/ERO
Northwest Detention

Center

Seattle Field Office
Des (b)(6); (b)(?)(C)
Cell

f

From :~b)(6); (b)(?)(C)

Sent : Mondav October 15 20 18 2:43 PM
Tol (b)(6); (b)(?)(C)
L(b~)(6
~).....
(b
- )(-7)~(C
~)-~
~R\-/l~I/M ---------------,
Wi lcox, Bryan Sf'b)(B); (b)(?)(C)
(b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

I
________

I

_jl

DHS-ICE-19-0196, 19-0197-K-000222
2019-ICLl-00051 2267



(b)(6); (b)(?)(C)

Following declined their lunch tray s, 10-15-18;

Med ISO

Amar #216269802- 163rd declined tray .

03

~b)(6); (b)(?)(C)

l ________
.....

__.I1st declined tray.

D2- l st declin ed trays

(b)(6); (b)(?)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000223
2019-ICLl-0005 1 2268



b)(6); (b)(7)(C)

F4
IL
(b-)(6-);-(b-)(7-)(C
_ )______

~[

l st declined tray

D3
fLb-)(6-); -(b-)(7-)(C
_ )_____

__.l
lst declined tray

B 1- 1st decl ined trays
b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000224
2019-ICLl-00051 2269



From :
Sent :
To :

(b)(6); (b)(7)(C)

Cc:

b)(6); (b)(7)(C)

Subject:

RE: Declined lunch trays, 10-15-18

17 Oct 2018 14:38:48 +0000
b)(6); (b)(7)(C)

ilcox, Bryan s b)(6); (b)(7)(C)

(b)(6);
/ h \f7\lr\

Any further updates on declined meals?
(b)(6);
/ h \/7\lr

\

from :l(b)(6); (b)(7)(C)

Sent : Monday , Octobe r 15, 2018 4:5 1 PM
To: b)(6); (b)(7)(C)
.::b=)(:6)
;:=; (=b:::::
)(7==
)(:C=
;: ) ===================-W_
f b)(6); (b)(7)(C)

ilc.:..;_,
ox, Bryan S

I

Subject: Re: Declined lunch tr ays, 10-15-18

Correction to earlier email. B-1 had detainees that did not want to get out of bed.

I

Update, detaineet~?\~/;,..., has been reported to medic al already. Lunch would be his second
declined meal accord ing to the officer.

l(b)(6); (b)(7)(C)
ASSISTA NT WARDEN, SECURITY

The GEO Group, Inc . (R)
Nort hwest Detention Center, 1623 East J Street
Tacoma, Was hington 98421
rb)(6); (b)(7)(C)

www .geoqroup.com
This email and any files t ransmitted
entity to which they are addressed.
the ema il t o t he inten ded recipient,
dissemination, fo rwarding, print ing
error, please imme diate ly notify by

fromf b)(6); (b)(7)(C)

with it are confi dential and are inte nded so lely for t he use of the ind ividua l or
If you are not the intended recipie nt or the person responsible for deliver ing
be advised that you have received this ema il i n error and t hat any use,
or copyi ng of this ema il is st rictly proh ibited. I f you have rece ived th is ema il in
rep lyi ng to this email.

I

Sent : Monday, October 15, 2018 4:41:33 PM
To : (b)(6); (b)(7)(C)

Cc: (b)(B); (b)(?)(C)

ilcox, Bryan S;....
f b_)(6_),_.(b_
)_
(7_)(C
_)_____

__.

Subject: Re: Declined lunch trays , 10-15-18

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000225
2019-ICLl-0005 1 2270



D-2 indicated they did not like the meal at lunch .

B-2 had some that did not want to get out of bed and did not want to eat.
Unit Off icer advised deta inee ,~/~~/:~,
information report .

ndicated he is start ing hunge r st rike . Wi ll look fo r

en , Secu rity

~.,,,.......,--c-=..,.,,..,...---,

From:l(b)(6); (b)(7)(C)

Sent : Monday, October 15, 2018 3:35 :16 PM
To b)(6); (b)(7)(C)
Cc b)(6); (b)(7)(C)

ilcox, Bryan s._l
<b
_)(6
_),_(b
_l(_7l_(C
_l _____

___,

Subject: FW: Declined lunch tr ays, 10-15-18
l(b)(6); (b)(7)(C)
This seems like a larger t han usua l nu m be r of mea l refusa ls. Do we have any addit iona l insight
into t his? Do any of the housing units appear to be engaging in group hunger strikes?
Thanks,
l(b)(6); (b)(7)(C)
Assistant Field Offi ce Director
DHS/ ICE/ERO
Northwest Detention

Center

Seattle Field Office
Des b)(6); (b)(7)(C)
Cell: ._

____

_.

Fromf b)(6); (b)(7)(C)

I

Sent : Monday , October 15, 20 18 2:43 PM
b)(6); (b)(7)(C)
Wilcox Bryan ~b)(5); (b)(?)(C)
b)(6); (b)(7)(C)

I

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000226
2019-ICLl-00051 227 1



From :

Sent:
To:

Subject:

Wilcox, Bryan S
17 Oct 2018 21:47:00 +0000
f b)(6); (b)(7)(C)

J

RE: Declined lunch trays, 10-15-18

Linked to Tunkara .... ?

Sent with BlackBerry Work
(www .blackberry .com)
Fromj<6)
(6); (b)(7)(C)
Date: Monda Oct 15 2018. 9:09 PM
(b)(6); (b)(7)(C)

The following detainees declined their dinner trays 10/15/18:
G2- All missed first meal.
(b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000227
2019-ICLl-00051 2272



(b)(6); (b)(7)(C)

Med Isa 2
Amar A#216269802 - 164th meal

B-1

I- 2nd meal

(b)C5>; (b)(?)(C)

l~-------~

~st meal

F-4
,_~
b_)(6_);_Cb_l<_
7l(_c _) _____

_.~

1st mea I

Thank you all in advance

l(b)(6); (b)(7)(C)

Lieutenant

The GEO Group, Inc.(R)
Northwest Detention Center
1623 East J. Street
Tacoma, WA 98421

r

)(6). (b)(7)(CJ

l(b)(6); (b)(7)(C)

www.geogroup .com

I

From: fb )(6); ~Sent: Monday, October 15, 20 18 9:43:25 AM
b
,-,ryan

To l(b)(6); (b)(7)(C)

s w.11 coxi;h
rb \/711r,
)(6);
I

(b)(6); (b)(7)(C)

Subject: Declin ed lunch trays, 10-15-18
Following declined their lunch trays, 10-15-18;
Med ISO

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000228
2019-ICLl-00051 2273



Amar #216269802- 163rd declined tray.
G3
Ll
(b-)(6-);-(b-)(7-)(-c) ______

I-1st declined tray.

D2- 1st declined trays
(b)(6); (b)(7)(C)

F4
Lfb-)(6-);-(b-)(7-)(C
_ l_______

~ 1st declined tray

D3
Ll
(b-)(6-);_(b-)(7
- )(_c _) ----~'

1st declined tray

Bl- 1st declined travs
(b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000229
2019-ICLl-00051

227 4



l(b)(6); (b)(?)(C)

From :

13 Nov 2018 06:12:40 +0000

Sent:

l(b)(6); (b)(?)(C)

To:

jWilcox , Bryan

$Kb)(6); (b)(?)(C)
b)(6); (b)(?)(C)

Re: Declined lunch trays, 11-12-18

Subject:

Following declined their Dinner trays 11-12-18;
F4
._l
<b_)(6_);_(b_)(_7l_(c_)

--~I

2nd declined tray.

F4
._l
<b_l<6
_l;_(b_l<_7l_<c_l ____

~~ st declined tray.

Fl
._l
<b_l<6
_l;_<b_l<_?l_<c_) ---~ll

st declined tray.

Thank you in advance.

b)(6); (b)(?)(C)

1eutenant
The GEO Group, Inc.(R)
Northwest Detention Center
1623 East J. Street
Tacoma, WA 98421
[ b)(6); (b)(?)(C)

l(b)(6); (b)(?)(C)
www . geagro ? Q . com

6 );
From: (b)(
l h \1 7\ tr ' \
Sent: Monoay, November 12, 20 I 8 11 :35:28 AM

(b)(6); (b)(?)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000230
2019-ICLl-00051 2275



l<b)(6); (b)(7)(C)

Subject: Declined lunch trays, 11-12-18
Following declined their lunch trays 11-12-18;

F4
l,_
<b_)<6_); _
<b>
_<7_)<C
_>__

__.llst declined tray.

H unit
Amar #216269802- did accept his lunch tray and ate 100%.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000231
2019-ICLl-00051 2276



I

From :

l(b)(6); (b)(7)(C)

Sent:

21 Oct 2018 03:42:34 +0000

To:

l(b)(6); (b)(7)(C)

r b)(6); (b)(7)(C)

t b)(6); (b)(7)(C)
(b)(6); (b)(7)(C)

Subject:

Re: Declined meals

As of the Dinner meal on 10/20/18, the following detainees declined their meals:
Hl - Amar #216269802 - 13th

Info. reports have been submitted.

Tofb )(6); (b)(7)(C)
l(b)(6); (b)(7)(C)

!Bryan Wilcox; ll0 JtoJ; tDJll Jll,J

b)(6); (b)(7)(C)
b)(6); (b)(7)(C)

Subject: Declined meals

As of the lunch meal on 10/20/18, the follow ing detainees declined their meals:
D2

(b)(6); (b)(7)(C)

- 1st

t
A2 ~(b)(6); (b)(7)(C)

Fl

~(b)(6); (b)(7)(C)

1- 1st
~ 4th

Hl - Amar #2 16269802 - 12th
Info. reports have been subm itted.

b)(6); (b)(7)(C)

1eu enan

RT Commander

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000232
2019-ICLl-00051 2277



GEO Corrections & Detention (R)
Northwest Detention Center
1623 East J Street
Tacoma, Washington 98421
Tel: (b)(6); (b)(7)(C)
Cell:
Fax: .______
___,
rb }(6); (b}(7)(C)

www.geogroup.com

This email and any files transmitted with it are confidential and are intended solely
for the use of the individual or entity to which they are addressed. If you are not the
intended recipient or the person responsible for delivering the email to the intended
recipient, be advised that your have received this email in error and that any use,
dissemination, forwarding, printing or copying of this email is strictly prohibited. If
you have received this email in error, please immediately notify by replying to this
email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000233
2019-ICLl-00051 2278



From :

I

l<b)(6), (b)(7)(C)

Sent:

23 Oct 2018 06:02:13 +0000
(b)(6); (b)(7)(C)

Subject:

Re: Declined meals

Additional declined meal
G-2:

_.I1st missed meal.

.._l
<b_)<6
_>;_<b
_)<7
_><
_c _) _____

Informationa l report submitted.
rb )(6); (b)(7)(C)

Sergeant
GEO Corrections & Detention (R)
Northwest Detention Center
1623
East J Street
Tacoma, Washin ton 98421
Tel (b)(6); (b)(7)(C)

Thi s email and an y tiles tran smitted with it are confidential and arc intended solely for the use of the individu al or entity to
which they ar e addre ssed. If you ar e not the intended recipient or th e p erson re sponsible for delivering the email to the
intend ed recipient, be advised that your have received this email in error and that any use, disseminati on, forwarding , printing
or copying ofthis email is str ictly prohibit ed. If you have received this email in error , please immediate ly notify by repl ying to
this ema il.

Fromt

)(6); (b)(7)(C)

Sent:

onda

To

~

October 2 20 18 10:07:42 PM

(b)(6); (b)(7)(C)
: (b)/7)/C)

I COX ,

an S.

b)(6); (b)(7)(C)
; (b)(7)(C)

Additional declined meal
F-1:
1
5
~fb_>c_>_
; <b
_>_
c _>cc
_>___

~l

lst missed meal.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000234
2019-ICLl-00051 2279



Informational

report submitted.

(b)(6); (b)(7)(C)

ergean
GEO Corrections & Detention (R)
No rthwest Detent ion Center
1623
East J Street
Tacoma, Washington 98421
Tel: (b)(6); (b)(7)(C)
Fax
(b)(6); (b)(7)(C)

www.geogroup .com
Thi s ema il and an y files tran smitt ed with it arc confidential and arc intended solely for the use of the indi vidu al or e nti ty to
which they ar c addre sse d. If you ar e not the int end ed recipi ent or th e person res ponsible for d eliveri ng th e email to the
intend ed recipient, be advised that your have received this email in error and that any use, d issemination , forw arding, printing
or copying of this ema il is str ictly prohibit ed. If you have received thi s ema il in er ror , please immediatel y notify by repl ying to
th is emai l.

From: b)(6); (b)(7)(C)
Sent: Monday, Octo er 22, 2018 9:45:00 PM
T b)(6); (b)(7)(C)
(b)(6); (b)(7)(C)

Wilcox

Bryan S; (b)(6); (b)(7)(C)
r b)(6); (b)(7)(C)

Subject: Declined meals
The following detainees declined their dinner meal today.
H-seg:
Amar- #216269802- 19th missed meal. D/T accepted an apple from the dinner tray and
a pedia lyte. D/T has no commissary in his cell.

D-2:
~fb_)<6_);_<b_)<7
_)c
_c _)

---~I

1st missed meal.

A-2:
l<b_
....
>C
6>_
_
; Cb_
lc_1>
_cc_>___

___.l3rdmissed meal. D/T is fasting for religious purposes.

Informationa l reports submitted.
(b)(6); (b)(7)(C)

ergeant

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000235
2019-ICLl-00051 2280



GEO Corrections & Detention (R)
Northwest Detention Center
1623
East J Street
Tacoma, Washin
Tel: (b)(6); (b)(7)(C)
Fax
l(b)(6); (b)(7)(C)

www.geogroup.com
T his ema il and an y 11Ies tran smitt ed wit h it are confid ential and are int en ded solely for the use of the individual or entit y to
which the y ar e addressed . If yon are not the intended recipient or the person re sponsible for deli vering the email to the
intend ed recipient , he ad vised that your ha ve received thi s email in error and that an y use, dissemination , for wa rdin g, printin g
or copy ing of thi s email is strictl y pr ohibited. If you have receive d thi s email in error , plea se immed iatel y notify by replying to
this email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000236
2019-ICLl-00051 2281



l(b)(6), (b)(7)(C)

From :

Sent:

I

14 Oct 2018 02:14:39 +0000
l(b)(6); (b)(7)(C)

To:

b)(6); (b)(7)(C)

b)(61,i\/ilcox,
Bryan S~0 1t0 1; t0 1trJtGJ
b)(6); (b)(7)(C)

Subject:

I

Re: Declined meals

Detaineel (b)(6);(b)(7)(C)

!declined his lunch tray and stated he was starting a

hunger strike due to not being able to use the phone. Medical was notified and
requested he was escorted to medical to get his weight. Detainee l(b)(6); _
~efused. All
of the detainees commissa ry was removed from the cell. this was his first missed meal.
(b)(6); (b)(7)(C)

Lieute nant
GEO Corrections & Detention (R)
Northwest Detention Center
1623
East J Street
Tacoma , Was hingto n 98421
; (b)(7)(C)
Te l: b)(6)
Ce ll
Fax:

fb)(6); (b)(7)(C)
www.geogroup .com
This email and an y files tran smitt ed with it are confide ntial a nd are intended solely for the use of the individual or entit y to
which the y are addr essed. If you are not the intended recipient or the per son re spon sible for deli verin g the email to the
intend ed recipient , be advi sed that your have received this email in error and lhat any use, dissemination , forwarding , printing
or copyin g of this ema il is slricll y prohibited. If you have received this ema il in er ror, pleas e immediatel y notify by replying to
thi s email.

From l(b)(6); (b)(7)(C)

I

Sent: Saturday, October 13, 2018 1:54:47 PM
To: l(b)(6); (b)(7)(C)
(b)(6); (b)(7)(C)
~b)(6);(b)(7)(C)
- b)(6); (b)(7)(C)

!Bryan Wilco x f b)(6)
; (b)(7)(C)

I

I

Subject: Declined meals
As of the lunch meal on 10/13/18 , the following detainee declined their mea ls.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000237
2019-ICLl-00051 2282



D2
(b)(6); (b)(7)(C)

Med. lso
i<bl(6); (bl(7l(Cl

~ 2nd

Amar #216269802 - 157th
Info. reports submitted

lb )(6); (b)(7)(C)

Lieutenant/CERT Commander
GEO Corrections & Detention (R)
Northwest Detention Center
1623 East J Street
Tacoma, Washington 98421
Tel: (b)(6); (b)(7)(C)
Cell:
Fax:
l(b)(6); (b)(7)(C)

www.qeoqr0ap.cor11

This email and any files transmitted with it are confidential and are intended solely
for the use of the individual or entity to which they are addressed. If you are not the
intended recipient or the person responsible for delivering the email to the intended
recipient, be advised that your have received this email in error and that any use,
dissemination, forwarding, printing or copying of this email is strictly prohibited. If
you have received this email in error, please immediately notify by replying to this
email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000238
2019-ICLl-00051 2283



From :
Sent:
To:

l(b)(6); (b)(7)(C)

I

11 Oct 2018 13:59:48 +0000
(b)(6); (b)(7)(C)
ilcox Br an

b)(6); (b)(7)(C)

(b)(6); (b)(7)(C)

u Jee :

The following detainees declined the Breakfast meal on 10/11/18.
Med-lso:
Amar - #216269802- 150th missed meal.

From ~(b)(6); (b)(7)(C)

I

Sent: Wednesday, Octob er 10, 20 18 10:49:00 PM
To: Wilcox Brvan S .l(b)(6); (b)(7)(C)

r::(b-f:'.
)(6
:s':'
);'--;;
(b7,)(~7)-:':s
(C;,-a) '-'-=-'--'--""-'-""''"""-'-'--'-'--'-'--'---'-'-'----------------------,_

_j

Subject: Re: Declmed meals
Addit io nal declined meals.
D-3:
2nd missed meal
1-Ti.....-"'"',...,a.d
meal

D-1:
(b)(6); (b)(7)(C)

l....._______

1st missed meal
__, 1st missed meal

(b)(6); (b)(7)(C)

ergeant
GEO Corrections & Detention (R)
Northwest Detention Center
1623
East J Street
Tacoma Washin on 98421
Te l: (b)(6); (b}(7)(C)

Fax
b)(6); (b)(7)(C)

www.geogroup.com

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000239
2019-ICLl-00051 2284



This email and an y files transmitted wit h it are confidential and are intended solely for the use of the indi vidual or entity to
which they are addressed. If you arc not the intended recipient or the per son re sponsible for deli vering the email to the
intend ed recipient, be advised that your hav e received this email in error and that any use, disseminati on, forwarding , printing
or copying of this email is str ictly prohibit ed. If you have received this email in er ror , plea se immediately notify by replying to
thi s email.

I

From:l (b)(6); (b)(?)(C)

Sent: Wednesday , October 10 , 2018
To: Wilcox, Brvan Sfb)(6) ; (b)(?)(C)

9:05 : 15 PM

(b)(6); (b)(?)(C)

Subject:

Re: Declined

meals

Additional refusals for dinner meal.
H-seg:
~b)(6); (b)(?)(C)

I5th missed meal

I~-------~

~st missed meal

Information report submitted.
fb)(6); (b)(?)(C)
Sergeant

GEO Corrections & Detention (R)
Northwest Detention Center
1623
East J Street
Tacoma Washin ton 98421
Tel: (b)(6); (b)(?)(C)

Thi s ema il and an y files tran smitted wit h it arc confide ntial and arc intended solely for the use of the individu al or entity to
which they are addre ssed. If you ar e not the intended recipient or the person responsible for delivering th e email to the
intended recipient, be advised that your hav e received this email in error and that any use, dissemination , forwarding , printing
or copying of this email is strictly prohibited. If you have received this email in error, please immediatel y notify by repl ying to
this email.

From:

l(b)(6); (b)(?)(C)

Sent: Wednesday,
To: Wilcox, Bryan

October JO 2018 8:50:54
S; (b)(5); (b)(?)(C)

PM

b)(6); (b)(?)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000240
2019-ICLl-00051 2285



rb )(6); (b)(7)(C)

Subject: Declmed meals

The following detainees declined the dinner meal on 10/10/18.
A-2:
~l
<b_
l<6_l:_<b_
l<7_l<_c _
)

---~ll

st missed meal

Med-lso:
Amar- #216269802- 149th missed meal. D/T isn't drinking water and has no commissary
in his cell.

B-1:
7
._l
<b_l<6_l:_<b_
l<_l<_c _
) ___

_.f1st missed meal

Information reports have been submitted.
f b)(6); (b)(7)(C)

Sergeant
GEO Corrections & Detention (R)
Northwest Detent ion Center
1623
East J Street
Tacoma Washin ton 98421
Tel: (b)(6); (b)(7)(C)
Fax:
f b}(6); (b}(7)(C)

www.geogroup .com
This ema il and an y files tran smitt ed with it are confid ential and ar c intended solely for the use of the indi vidual or entit y to
which th ey ar e addr essed. If you ar e not the intended recipient or the person res ponsi ble for d eliver ing th e email to the
int ended recipient, be advised th a t your have received this email in error and that any nse, disseminati on, for wardin g, printin g
or copyin g of this email is stri ctly prohibited . If yon have received this email in error , plea se imm ediate ly notify by replying to
thi s email .

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000241
2019-ICLl-00051 2286



Fro m :

l(b)(6); (b)(7)(C)

Se nt:
ilcox Br

To:

an

S (b)(6); (b)(7)(C)

b)(6); (b)(7)(C)

u Je ct:
These detainees have refused their Breakfast mea l on 10/10/2018.
H-seg:
~[b_l<6_l;_<b_l<7_l<_ci __

~l3rd missed meal

Med -lso:
Amar #216269802- 146th missed meal
Info reports submitted

From: l(b)(6); (b)(7)(C)

I

Sent: Tuesday, October 9 2018 10:43:14 PM
To: Wilcox, B an S; (b)(6); (b)(7)(C)
b)(6); (b)(7)(C)

These detainees have refused their dinner meal on 10/9/2018.
H-seg:

f~b-H6_l;_<b_l<_7l<_c _i --~ fnd missed mea l
D-1:
(b)(6); (b)(7)(C)

t missed meal
1st missed meal
1st missed meal

Med- lso:
Amar #216269802- 145th missed mea l
Info reports submitted
f b)(6); (b)(7)(C)

Sergeant

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000242
2019-ICLl-00051 2287



GEO Corrections & Detention (R)
Northwest Detention Center
1623
East J Street
Tacoma, Washin
Tel: b)(6) ; (b)(7)(C)
Fax
fb )(6); (b)(7)(C)

www.geogroup.com
T his ema il and any 11Ies tran smitt ed with it are confid ential and are int en ded solely for the use of the indi vidual or entit y to
which they are addressed. If yon are not the int end ed recipient or the person responsible for deli ver ing the email to the
intend ed recipient , he ad vised that your ha ve received thi s email in error and that any use, dissemination , for wardin g, printin g
or copy ing of this email is strictl y pr ohibited. If you have receive d thi s email in error , please immed iatel y notify by replying to
this email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000243
2019-ICLl-00051 2288



I
I

From:

f b)(6); (b)(7)(C)

Sent :
To:
Cc:
Subject:
Attachments :

25 Nov 2018 18:45:18 +0000
~b)(6); (b)(7)(C)

Wilcox, Bryan S
RE: D/T Amar #216269802
DRAFT----Detainee Death Notification-ERO Seatt le-Mergensana A216 269 802

V7.doc

Okay, I attached the wrong file

I

t b)(6); (b)(7)(C)

Domestic Operations Desk Officer-West (Los Angeles & Seattle)
HO- Enforcement and Removal Operations
(b)(6); (b)(7)(C)
Desk
Mobile

I

(b)(6); (b)(7)(C)

Warning: This document is UNCLASSIFIEO//FOROFFICIALUSE ONLY (U//FOUO) . It conta ins information that may be exempt from public
release under the Freedom of Information Act (5 U.S.C. 552). It is to be controlled, stored, handled, transmitted, distributed, and disposed of
in accordance with OHSpolicy relating to FOUO information and is not to be released to the public or other personnel who do not have a
valid "need-to-know" without prior approval of an authorized OHS official. No portion of this report should be furn ished to the medi a, either
in written or verbal form.

Sent :

er 25, 2018 1:42 PM

To:.,_
(b-'-'-'"--'-.:..:...:."--'--....,,..,~..,,..,..=,,.,....-------.,........,
); (b)(l )(C)
Cc: Wilcox, Brya

~----------~

Subject : RE: D/T Amar #216269802
This was in the attached notice:

On XXX, at XXX PST, ERO Seattle telephonically notified the Joint Intake Center and the
Office of Professional Responsibility duty agent of AMAR's death.

~b)(6), (b)(7)(C)

I

ERO Domestic Operations - West
Unit Chief
l(b)(6); (b)(7)(C)
From:f

b)(6); (b)(7)(C)

I

Sent : Sunday, November 25, 2018 1:41 PM
To b)(6); (b)(7)(C)
Cc:Wilcox, Bryan S b)(5); (b)(l) (C)

~----------~

Subject : FW: D/T Amar #216269802

Hete tou, I rhiugh I added that on the version I sent up

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000244

2019-ICLl-00051 2289



From : Wilcox, Bryan S f b)(6); (b)(7)(C)

Date: Sunday, Nov 25, ii.-,o
...,
1..,,.
8,-, ""'
12,....
:....
41__,..P...,
M.- ___

_,

To f b)(6); (b)(7)(C)

subject: RE:D/TAmar #216269802

RE: On XXX, at XXX PST, ERO Seatt le telephon ically notified the Jo int Intake Center and
the Office of Profe ssiona l Responsibility duty agent of AMAR' s death.
On Novem ber 25, 20 18, at 09:3 0 PST, ERO Seatt le te lepho ni cally not ifi ed t h e Jo int Inta ke Cent er
and t he Offic e of Profession al Responsib ility dut y agent of AMA R's deat h.

From : W ilcox, Bryan S

Se nt : Sunday, November 25, 2018 9 :33 AM
Tol (b)(6); (b)(7)(C)

Subject: FW: D/T Amar #216269802

Se nt : un
, 2018 9 :25 AM
To : W ilcox, Bryan S fb )(6); (b)(7)(C)
b)(6); (b)(7)(C)

Subject: RE: D/T Amar #216269802
Adding a few edits on the legal side. Also to reflect Am ar's indiv idu al hearing was via VTC with a Salt
Lake IJ.

1<::~;1~~~~~c~n1er
co?tel
Seattle Office of Chief Counse l / OPLA
Tacoma sub-office
U.S. Immigration and Customs Enforcement
U.S. Department of Homeland Security
Tel: (b)(6 . b 7 C
E-ma1 : b)(6); (b)(7)(C)
*** Wa rnin g
orney 1en nv 1ege
~tt orney Work Prod uct ooo
This communication and any attachments may contain confidential and/or sensitive attorney/c lient privileged
information or attorney work product and/or law enforcement sensitive information. It is not for release, review,

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000245
2019-ICLl-00051 2290



retransmission , dissemination , or use by anyone other than the intended recipient. Please notify the sender if this
email has been misdirected and immediately destroy all originals and copies. Furthermore do not print, copy, retransmit, disseminate , or otherwise use this information. Any disclosure of this communication or its attachments
must be approved by the Office of the Principal Legal Advisor, U.S. Immigrat ion and Customs Enforcement. This
document is for INTERNAL GOVERNMENT USE ONLY and may be exempt from disclosure under the Freedom of
Information Act , 5 USC?? 552(b)(5) , (b)(7).

From : Wilcox, Bryan S
Sent : Sunday, November 25, 2018 8:40 AM
(b)(6); (b)(7)(C)

Import ance: High

All,
With AMAR's being taken off life -support last night and passing, today will likely be a busy day for us all.
See below and attached, the draft death notice that wi ll have to be refined this morning.

BW
From : Wilcox, Bryan S
Sent : Sundav. November 25 2018 8:36 AM
b)(6); (b)(7)(C)

SubJect : RE: D/T Amar #216269802
Import ance: High

Here's the latest.
It will need to be looked at by IHSChere locally for some clarity on Amar's seg status (see commen t s on
page 4).
One thing needing to be done at this point is contacting the Russian Embassy. Will that be covered by
RIO or do you want us to attempt to do that here? (and does someone have a fax number with which to
do that?)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000246
2019-ICLl -00051 2291



I

From~(b)(6); (b)(7)(C)

Sent : Sunday, November 25 2018 7:42 AM
To: Wilcox, Bryan S b)(5); (b)(?)(C)
Cc:(b)(6); (b)(7)(C)
b)(6); (b)(7)(C)
enn ings, Davi W b)(6); (b)(7)(C)
~(b)(6); (b)(7)(C)

I

~---------------~

Subject: RE: D/T Amar #216269802

Good morning Mr. Wilcox,
Mr. Jennings is inquring on the eta for the DDN? Can you provide a status?
Thank you

Fromf b)(6); (b)(7)(C)

Date: Saturday, Nov 24, 2018, 9:28 PM
To: Wilcox, Bryan S!(b)(6); (b)(7)(C)

!Jennings, David W

rb)(6); (b)(7)(C)

Subject: RE: D/T Amar #216269802
Thank you,
Please provide the upda t ed detainee death notice first thing in the AM.
If you need any additional information

please let me know,

Thanks

l(b)(6); (b)(7)(C)
Uni t Chief
Domestic Operations West
l(b)(6); (b)(7)(C)

I

Sent with BlackBerry Work
(ww w. blackberrv .com )
From: Wilcox, Bryan S l._
<b
_)(6
_)_
; (b
_)_
(7_
)(C
_)______

__,

Date: Sat urday, Nov 2.,,..
4.,_,.2,,.,.0
....,
1,..,.
8~9,..,,:
,,.,.
2_
1 _P_
M___________

_,,

To: Jennings David IJ\.fb
)(5); (b)(?)(C)

(b)(6); (b)(7)(C)

Subject: FW: D/T Amar #216269802

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000247
2019-ICLl-00051 2292



This from GEO. I am expecting the hospital should be getting in touch with IHSCshortly

Sent with BlackBerry Work
(www.blackberry.com)
From :~b)(6); (b)(7)(C)

Date :aturdav,

Nov 24, 2018, 6: 16 PM

(b)(6); (b)(7)(C)

b)(6); (b)(7)(C)

jVVIICOX,

tsryan ::,tb )(6); (b)(7)(C)

b)(6); (b)(7)(C)

I

Subjec t : D/T Amar #216269802

5

at 1754 hours i was informed b ~(bl( l ; (b)(?)(C) ~hat the hospita l staff had got
authoriza tion to remove D/T Amar from the ventilator. at approx 1805 D/T Amar
was pronounced dead by hospital staff. at approx 1810 Officer s Kbl(6); ~- pnctl(b)(6); ~- 1
were instructed to stand down the hospital watch. AW ~\
\~t-, otified by phone

b)(6); (b)(7)(C)

ergean
GEO Corrections & Detention
Northwest Detention Center
1623 East J Street
Tacoma, Washington 98421

(R)

r b)(6); (b)(7)(C)

www .geogroup .com

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000248
2019-ICLl-00051 2293



Page 2294
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000249



Page 2295
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000250



Page 2296
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000251



Page 2297
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000252



Page 2298
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000253



From :

l(b)(6); (b)(?)(C)

Sent:
To:

25 Nov 2018 18:41:38 +0000
l(b)(6); (b)(7)(C)

Cc:
Subject :

I

Wilcox, Bryan S
RE: D/T Amar #2162698 02

Sorry for the misspelling typing from my phone

From: ~b)(6); (b)(?)(C)
Date: Sunda , Nov 25 , 2018 , I :40 PM
To: b)(6); (b)(?)(C)
Cc : Wilcox , Bryan S b)(B); (b)(?)(C)
Subject: FW: D/T Atr-r:,,r-=,..,..,"?'TT"Tl'<TT-r----------'

Hete tou, I rhiugh I added that on the version I sent up

6
From: Wilcox, Bryan s l=-,l
<b...,
)(...,.
)_
; (b.,...,
)(.7)
--.<
.,....,
C,...,
).,.......
-----~
Date: Sunday , Nov 25, 2018 , 12:41 PM
T o:l (b)(6); (b)(?)(C)

Subject: RE: D/T Amar #2 16269802

On XXX, at XXX PST , ERO Seattle telephoni cally notified the Joint Intake
Center and the Office of Pro fessiona l Responsibility duty agent of AMAR's death.
RE:

On November 25, 2018, at 09 :30 PST, ERO Seatt le te lephonica lly not ified the Joint
Intake Center and the Office of Profess ional Responsibility duty agent of AMAR's death .

From: Wilcox, Bryan S

Sent: Sunday, Novem be r 25, 2018 9:33 AM
Toi (b)(6); (b)(7)(C)

Subject: FW: D/T Amar #216269802

From:l (b)(6); (b)(?)(C)

Sent: Sunday, November 25, 2018 9:25 AM

l(b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000254
2019-ICLl-00051 2299



(b)(6); (b)(7)(C)

Subject : RE: D/T Amar #216269802

Adding a few edits on the legal side. Also to reflect Amar's individual hearing was via VTCwith a
Salt Lake IJ.

l(b)(6); (b)(7)(C)

Assistant Chief Counsel
Seattle Office of Chief Counsel / OPLA
Tacoma sub-office
U.S. Immigration and Customs Enforcement
U.S. De artment of Homeland Security
Tel: b)(6); (b)(7)(C)
E-mail: (b)(6); (b)(7)(C)
*** Warn mg
ttorney
1ent Priv1 ege
Attorney Work Product***
This communication and any attachments may contain confidential and/or sensitive attorney/client privileged
information or attorney work product and/or law enforcement sensitive information. It is not for release,
review, retransmission, dissemination, or use by anyone other than the intended recipient. Please notify the
sender if this email has been misdirected and immediately destroy all originals and copies. Furthermore do
not print, copy, re-transmit, disseminate, or otherwise use this information. Any disclosure of this
communication or its attachments must be approved by the Office of the Principal Legal Advisor, U.S.
Immigration and Customs Enforcement. This document is for INTERNAL GOVERNMENT USE ONLY and
may be exempt from disclosure under the Freedom of Information Act, 5 USC?? 552(b)(5), (b)(?).

From: Wilcox, Bryan S
Sent: Sunday, November 25, 2018 8:40 AM
(b)(6); (b)(7)(C)

Subject: FW : 0/T Amar #216269802
Import ance : High

All,
With AMAR's being taken off life-support last night and passing, today will likely be a busy day
for us all.
See below and attached, the draft death notice that will have to be refined this morning.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000255
2019-ICLl-00051 2300



BW
From: Wilcox, Bryan S

Importance : High

Here's the latest.
It will need to be looked at by IHSC here locally for some clarity on Amar's seg status (see
comments on page 4).
One thing needing to be done at this point is contacting the Russian Embassy. Will that be
covered by RIO or do you want us to attempt to do that here? (and does someone have a fax
number with which to do that?)

From:l (b)(B); (b)(?)(C)
Sent: Sunday, November 25 2018 7:42 AM
To: Wilcox, Bryan S b)(B); (b)(?)(C)
b}(6); (b)(?)(C)
b)(6); (b)(?)(C)

ennings, David W

l(b)(6); (b)(7)(C)
Subject: RE: D/T Amar #216269802

Good morning Mr. Wilcox,
Mr. Jennings is inquring on the eta for the DON? Can you provide a status?
Thank you

From:Kb)(6); (b)(?)(C)
Date : Saturday, Nov 24, 2018, 9:28 PM
To: Wilcox, Bryan S b)(6); (b)(7)(C)
(b)(6); (b)(?)(C)

Jennings, David W

Subject: RE: D/T Amar #216269802

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000256
2019-ICLl-00051 2301



Thank you,
Please provide the updated detainee death notice first t hi ng in the AM .
If you need any additional

information

please let me know,

Thanks

l(b)(6); (b)(7)(C)
Un it Chief
Domestic O erations West
b)(6); (b)(?)(C)
Sent with BlackBerry Work
(www.blac kb err y .com )

From: W ilcox, Bryan S ~l
(b_)(_
6)_;(_b)_(7_)(C
_ )______
~
Date : Saturday, Nov 24, 2018, 9:21 PM
,.,,...,...,.,,,.......,,...,...,,,.,...,.,,..,---------------,
To: Jennings, David W l(b)(6); (b)(7)(C)
b)(6); (b)(7)(C)

I

Subject: FW: D/T Amar #216269802
This from GEO. I am expecting t he hos pital shoul d be getting in touch with IHSC
shortly

Sent with BlackBerry Work
(www.b lackberry.com )
From :l(b)(6); (b)(7)(C)
Date: Saturday, Nov 24, 2018, 6:16 PM
(b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000257
2019-ICLl -00051 2302



r )(6); (b)(7)(C)

Wilcox,

Bryan S j(b)(6); (b)(/)(C)

rb )(6); (b)(7)(C)

Subiect:

D/f Amar #216269802

[~;
l~l
cc)

at 1754 hour s i was infonned by D/O
hat the hospital staff had got
authorization to remove D/T Amar from the venti lator. at approx 1805 D/T
Amar was pronounced dead by hospital staff. at approx 1810 Officers
Kb)(~);_~- bndl\~1
\~L, ~ere instructed to stand down the hospital watch . AW
Scott notified by phone

b)(6); (b)(7)(C)

ergean

GEO Corrections & Detention(R)
Northwest Detention Center
1623 East J Street
Tacoma, Washington 98421
l(b)(6); (b)(7)(C)

www,qeoqroup,com
This email and any files transmitted with it are confidential and are intended
solely for the use of the individual or entity to which they are addressed. If you
are not the intended recipient or the person responsible for delivering the email to
the intended recipient, be advised that your have received this email in error and
that any use, dissemination, forwarding, printing or copying of this email is
strictly prohibited. If you have received this email in error, please immediately
notify by replying to this email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000258
2019-ICLl-00051 2303



Page 2304
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000259



Page 2305
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000260



Page 2306
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000261



Page 2307
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000262



Page 2308
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000263



From:

l(b)(6); (b)(?)(C)

Se nt:

25 Nov 2018 18:36:21 +0000
(b)(6); (b)(?)(C)
ilcox, Bryan S;~~
b-)(6
_);_(b
_l(_7l_(C
_l _______

To:
b)(6); (b)(?)(C)

Cc:

~l
<b_H6_);_<b_l<7_l<_c)_________________

Subject :
Attachments :

~I
~I

RE: D/T Amar #216269802
DRAFT----Detainee Death Notification-ERO

Seatt le-Mergensana A216 269 802

V6(MC) with IHSC edits _. doc
I put in the comment

regarding the hospital making note of Amar's "card iac" time of death after they

turned off the ventilator

and IVs. This is a different

date and time from his official death (time of brain

dea t h on Nov. 18).

IMD

~b)(6); (b)(?)(C)

Staff Physician,
ICE Hea lth Service Corps (IHSC)
Enforcement

and Removal Operations

US Imm igration Custom s Enforcement

(ERO)
(USICE)

No rthwest Detention Center
1623 E. J St. Suite liEil
Tacoma, WA 98421
Main office ~(b-)(-6)-; (-b)-(7-)(C
_)_~
Voice Mail:
Cell b)(6); (b)(?)(C)
fax

From :l(b)(6); (b)(?)(C)

I

Se nt: Sunday, November 25 2018 9:57 AM

I

To: Wilcox, Bryan S ~b)(5); (b)(?)(C)
b)(6); (b)(?)(C)

(b)(6); (b)(?)(C)

Subject : RE: D/T Amar #2 16269802
Attached is an updated draft, I responded to your questions on the IHSC side .
1 will deferthe brain / cardiacdeathauest;o
n to Dr l<bl(6l;
Pckbl{6)
1

It

From : Wilcox, Bryan S

Se nt: Sunday, November 25, 2018 9 :37 AM
Tof b)(6); (b)(?)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000264
2019-ICLl -00051 2309



(b)(6); (b)(7)(C)

Subject: RE: D/T Amar #2 16269802
Thanks
Forwarded to HQ.

I

Froml(b)(6);(b)(7)(C)

Se nt : Sunday, November 25, 2018 9 :25 AM
To: W ilcox, Brvan s ~b)(6); (b)(7)(C)
b)(6); (b)(7)(C)

Subject: RE: D/T Amar #2 16269802
Adding a few edits on the legal side. Also to reflect Am ar's indiv idual hearing was via VTC with a Salt
Lake IJ.

l(b)(6); (b)(7)(C)

I

Assistant Chief Counsel
Seattle Office of Chief Counse l / OPLA
Ta coma sub-office
U.S. Immigration and Customs Enforcement
U.S. De artment of Homeland Security
Tel: (b)(6); (b)(7)(C)
E-mail: (b)(6); (b)(7)(C)
oooWa rningooo Attorney!Client Privilegeooo Attorney Work Producto oo
This commun ication and any attachments may contain confident ial andfor sensitive attorneyfc lient privileged
information or attorney work product andfor law enforcement sensitive information. It is not for release, review,
retransmission, dissemination, or use by anyone other than the intended recipient. Please notify the sender if this
email has been misdirected and immediate ly destroy all originals and copies. Furthermore do not print, copy, retransmit, disseminate, or otherwise use this information. Any disclosure of this communication or its attachments
must be approved by the Office of the Principal Legal Advisor, U.S. Immigration and Customs Enforcement. This
document is for INTERNAL GOVERNMENT USE ONLY and may be exempt from disclosure under the Freedom of
Information Act , 5 USC?? 552(b)(5) , (b)(7).

From: W ilcox, Bryan S
Se nt : Sunday, November 25, 2018 8 :40 AM
b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000265
2019-ICLl -00051 2310



rb )(6); (b)(?)(C)

Subject: FW: D/T Amar #216269802
Importance: High

All,
With AMAR's being taken off life -support last night and passing, today will likely be a busy day for us all.
See below and attached, the draft death notice that will have to be refined this morning.

BW
From: Wilcox, Bryan S
Sent : Sunday, November 25, 2018 8:36 AM
(b)(6); (b)(?)(C)

Importance: High

Here's the latest .
It will need to be looked at by IHSChere locally for some clarity on Amar's seg status (see comments on
page 4).
One thing needing to be done at this point is contacting the Russian Embassy. Will that be covered by
RIO or do you want us to attempt to do that here? (and does someone have a fax number with which to
do that?)

From:l <b)(6); (b)(?)(C)

Sent: Sunday, November 25, 2018 7:42 AM
To: Wilcox, Bryan S fb )(6); (b)(?)(C)
b)(6); (b)(?)(C)

I

Subject: RE: D/T Amar #216269802

Good morning Mr. Wilcox,
Mr. Jennings is inquring on the eta for the DDN? Can you provide a status?

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000266
2019-ICLl-00051 2311



Thank you

Fro m : l(b)(6); (b)(7)(C)

Date: Sat urday, Nov 24, 2018, 9:28 PM
To : Wilcox, Bryan s f b)(6); (b)(?)(C)

uennings, David W

f b)(6); (b)(?)(C)
Cc :j(b)(6); (b)(?)(C)

Subject: RE:D/T Amar #216269802
Thank you,
Please provide the updated detainee death notice first thing in the AM.
If you need any addit ional information please let me know,

Thanks

(b)(6); (b)(7)(C)

1e
Domestic Operations West
Uni t

f b)(6); (b)(7)(C)

I

Sent with BlackBerry Work
(www .blackberry .com )
From : Wilcox, Bryan S l._
(b_)(6
_)_
; (b
_)_
(?_)(C
_)______

__.

Date: Sat urday, Nov 24, 2018, 9:21 PM
To: Jennings, David W f~b-)(6
_)_
; (b
- )-(7-)(C
- )------------~

Subject : FW: D/T Amar #216269802
This from GEO. I am expecting the hospital should be getting in touch with IHSCshortly

Sent with BlackBerry Work
(www .blackberry .com)
From~(b)(6); (b)(?)(C)

Date: Saturday, Nov 24, 2018, 6:16 PM

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000267
2019-ICLl -00051 2312



b)(6) ; (b)(7)(C)

!Wilcox,

b)(6); (b)(7)(C)

Bryan

~b )(5 ); (b)(?)(C)

b)(6); (b)(7)(C)

I

I

Subject: D/T Amar #216269802

at 17 54 hours i was informed by D/O ~)(~lir, hat the hospital staff had got
authoriza tion to remove D/T Amar from the ventilator. at approx 1805 D/T Amar
~!i~, an (~)(~tr,
was pronounced dead by hospital staff. at approx 1810 Officer \~/\
were instructed to stand down the ho spit al wa tch . AW ~)(~lir notified by phon e

f b)(6); (b)(?)(C)

Sergeant
GEO Corrections & Detention
Northwest Detention Center
1623 East J Street
Taco ma, Washington 98421
~T-e~
I_: - b_)(6_);_(b_)(_7)_(C_) --~

(R)

F~a
.......
x: 2 5 3 3 9 6 12 5 0

b)(6); (b)(?)(C)

www.geogroup.com
Thi s email and any files tr a nsmitted with it are confidenti al and are intended solely for the
use of the individual or entity to which they are addressed. If you are not the intended
recipient or the person responsible for delivering the email to the intended recipient, be
advised that your have received this email in error and that any use, dissemination,
forwarding , printing or copying of this email is strictly prohibited. If you have received
this email in error, please immediately notify by replying to this email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000268
2019-ICLl-00051 2313



Fro m :

fb )(6); (b)(7)(C)

Sent:

I

7 Oct 2018 13:53 :32 +0000
l(b)(6); (b)(7)(C)

To:
f b)(6); (b)(7)(C)

Wilcox, Bryan

!(b)(6); (b)(7)(C)

~(b)(6); (b)(7)(C)

I

b)(6); (b)(7)(C)

Subject:

Re: Declined Meals 10.06.18

138th
From

(b)(6); (b)(7)(C)

cto er 7, 2018 6:53:08 AM

(b)(6); (b)(7)(C)

B an S Wilco

(b)(6); (b)(7)(C)

(b)(6); (b)(7)(C)

During Breakfast chow 10.07.18 the following detainees declined the meal provided.
Med-lso
Amar# 216269802 declined his 137th provided meal due to hunger strike. Med ical was
notified and observation continued.

From:
Sent:
To b )(

(b)(6); (b)(7)(C)

cto er 6 2018 7:18:02 PM
;

b)(6); (b)(7)(C)

r an S Wilcox ; Brian

b)(6); (b)(7)(C)

b)(6);

(b)(6); (b)(7)(C)

During dinne r chow 10.06.18 the fo llow ing detainees declined the meal provided.
Med- lso
Amar# 216269802 declined his 137th provided meal due to hunger strike. Medical was
notified and observation continued.

F-3

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000269
2019-ICLl-00051 2314



._~
b_lC6_l ;_Cb_lC
_7l_cc_i ______

____.ld
eclined his 1st provided meal due to not wanting what

was on the menu.
Info reports were completed.
l(b)(6); (b)(7)(C)

I

Lieutenant
GEO Corrections & Detention (R)
Northwest Detention Center
1623
East J Street
Tacoma Washin ton 98421
Tel (b)(6); (b)(7)(C)
Ce!

Fa
(b)(6); (b)(7)(C)

www .geogroup .com
Thi s email and an y tiles tran smitted wit h it are confidential and arc intended solely for the use of the individu al or entit y to
which they ar e addre ssed. If you ar e not the intended recipient or th e person re sponsible for delivering th e email to the
intended recipient, be advised that your have received this email in error and that any use, dissemination , forwarding , printing
or copying of this ema il is str ictly prohibited. If you have received this email in error , please immediatel y notify by repl ying to
this emai l.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000270
2019-ICLl-00051 2315



Fro m :

~b)(6); (b)(7)(C)

Sent:

8 Nov 2018 14:36:04+0000

To:

l(b)(6); (b)(7)(C)

'h\/ n \. /h \/ 7 \/r.\

b)(6); (b)(7)(C)

~ilcox, Bryan S~(b)(~);___

(b)(6); (b)(7)(C)

Subject:

Re: Declined Meals 11.07.18 Dinner

The following detainees declined their breakfast for 11-08-2018 meals.
H-Unit
Amar# 216269802 declined his 37th consecutive meal (detainee accepting other
nutrition from Medical and eating fruit form his tray)
Med- lso
~eclined his 30th consecutive (Detainee is accepting other
nutrition from medical)

l<b)(6); (b)(7)(C)

From: l(b)(6); (b)(7)(C)
Se nt: Wedn esda N ov emb er 7 201 8 8:15:53 PM
o (b)(6); (b)(7)(C)
b)(6); (b)(7)(C)

ryan S Wilcox ;

(b)(6); (b)(7)(C)

b)(6); (b)(7)(C)

b)(6); (b)(7)(C)
b)(6); (b)(7)(C)

mn er

The following detainees declined their dinner mea ls.
H-Unit
Amar# 216269802 declined his 35th consecutive meal (detainee accept ing other
nutrition from Medical and eating fruit form his tray)
Med-lso
~ eclined his 29th consecutive (Detainee is accepting other
nutrition from medica l)

l(b)(6); (b)(7)(C)

G-2
b)(6); (b)(7)(C)
(b)(6); (b)(7)(C)

declined her 1st meal.
ec ined her 1st meal.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000271
2019-ICLl-00051 2316



G-4 is our only cohort at this time. 13 total cohort detainees which clear November 19th

2018.
~b)(6); (b)(?)(C)

!

Lieutenant
GEO Corrections & Detention (R)
Northwest Detention Center
1623
East J Street
Tacoma Washin!lton 98421
Tel: b)(6); (b)(?)(C)
Cell

Fax:
fb )(6); (b)(?)(C)

www .geogroup.com
Thi s email and any tiles transmitted with it are confidential and are intended solely for the use of the indi vidual or entit y to
which they arc addressed. If you are not the intend ed recipie nt or the person responsible for deli verin g the email to the
intend ed recipient , be advised that yo ur ha ve received thi s email in error and that any use, disseminati on, forwarding, printing
or copying of thi s email is strictl y prohibit ed. If you have receive d thi s email in error, plea se immediately notify by replying to
this email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000272
2019-ICLl-00051 2317



From :

Sent:
To:

t b)(6); (b)(7)(C)

22 Oct 2018 21:52:18 +0000
Wilcox, Bryan Sfb )(6); (b)(7)(C)

~----------------~

I

b)(6); (b)(7)(C)

Subject:

Re: Declined meals as of Lunch on 10/21/18

As of the lunch meal on 10/22/18, the following detainees declined their meals:

l(b)(6); (b)(7)(C)

tb )(6); (b)(7)(C)

l(b)(6); (b)(7)(C)

~1st
~1st

~ 1st

l(b)(6); (b)(7)(C)

~st

Hl - Amar #216269802 - 18th
1st

Med iso (bl( 5 ); (bl(7 l(Cl
Med iso
'>--...-----.......--Med iso b)(6); (b)(7)(C)

.......
-~

1st

I-1st

Info. reports have been submitted.

ergeant
GEO Corrections & Detention
Northwest Detention Center
1623 East J Street
Tacoma, Washington 98421
Tel: (b)(6); (b)(7)(C)
Cell:
Fax:

(R)

l(b)(6); (b)(7)(C)

www.geogroup.com
This email and any files transmitted with it are confidential and are intended solely for the use
of the individual or entity to which they are addressed. If you are not the intended recipient or
the person responsible for delivering the email to the intended recipient, be advised that your
have received this email in error and that any use, dissemination, forwarding, printing or

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000273
2019-ICLl-00051 2318



copying of this email is strictly prohibited. If you have received this email in error, please
immediately notify by replying to this email.

Sent:

18 1:54:45 PM
7)(C)

As of the lunch meal on 10/21/18, the following detainees declined their meals:
D2 _(b)(6); (b)(7)(C)
(b)(6); (b)(7)(C)
l(bl(6b (bl(7 l(C )

1st
1st
~1st

l<b)(6); (b)(7)(C)

I1st

A2 - l(b)(6); (b)(7)(C)

Fl

- l(b)(6); (b)(7)(C)

11st

I- 7th

Hl - Amar #216269802 - 15th
Med iso-

l<b)(6); (b)(7)(C)

f 1st

Info. reports have been submitted.

ergean
GEO Corrections & Detention
Nort hwest Detenti o n Center
1623 East J Stree t
Tacoma Washin t o n 9842 1
Te l : (b)(6); (b)(7)(C)
Cell:
Fax:

(R)

(b)(6); (b)(7)(C)

www .geogroup.com
This email and any files transmitted with it are confidential and are intended solely for the use
of the individual or entity to which they are addressed. If you are not the intended recipient or
the person responsible for delivering the email to the intended recipient, be advised that your

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000274
2019-ICLl-00051 2319



l(b)(6); (b)(7)(C)

Fro m :

26 Oct 2018 14:10:54 +0000

Sent:

b)(6); (b)(7)(C)

To:
b)(6); (b)(7)(C)

Re: declined meals dinner 10/25/18

Subject:

for breakfast 10-26-2018 opps

From:

i<b)(6); (b)(7)(C)

Sent: Frida , October 26, 2018 7:09:49 AM
To: b)(6); (b)(7)(C)
(b)(6); (b)(7)(C)

b)(6); (b)(7)(C)

B an S Wilco

b)(6); (b)(7)(C)

(b)(6); (b)(7)(C)

Sub ject: Re: declined meals dinner I 0/25/18
H-Seg Amar A#216269802 29th declined mea l
D-l~ b)(6); (b)(7)(C)

l<b)(6); (b)(7)(C)

11st declined mea l

b)(6); (b)(7)(C)

Subject: declin ed meal s dinner 10/25/18

G2
.._l
<b_l<6
_l ;_(b_l<_7 l_<c_) ____

_.!declined her 1st meal.

H-seg
Amar 216269802 declined his 28th meal but accepted an apple

ergean
GEO Corrections & Detention
Northwest Detention Center

(R)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000275
2019-ICLl-00051 2320



1623 East J Street
Tacoma, Washington

98421

<b=)(6~);~(b_l(_7l_(C_l _ ___......;F....;;
a;;.;..;,x:
l<b )(6); (b )(7)(C)
~T.,;...
e
~ I-'-:..,_
(b)(6); (b)(7)(C)

www .geogroup.com
This email and any files transmitted with it are confidential and are intended solely for the use
of the individual or entity to which they are addressed. If you are not the intended recipient or
the person responsible for delivering the email to the intended recipient, be advised that your
have received this email in error and that any use, dissemination, forwarding, printing or
copying of this email is strictly prohibited . If you have received this email in error, please
immediately notify by replying to this email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000276
2019-ICLl-00051

2321



l(b)(6); (b)(7)(C)

From :

11 Nov 2018 14:18:05 +0000

Sent:
To:

I

~b)(6); (b)(7)(C)

l(b)(6); (b)(7)(C)

Wilcox,

Bryan

I

S~b)(6); (b)(7)(C)

(b)(6); (b)(7)(C)

Subject:
On 11/11/18

Re: declined

meals

dinner

11-10-18

Breakfast

D/T Amar 216269802 declined 46th meal
Medical and GEO staff monitoring

the situation. E-mail, and Info rmation report

comp leted.

From (b)(6); (b)(7)(C)
Sent: a ray , ov em erl0,20189: 18:17PM
To: Alsayyid, Fahad K; Bostock , Drew H; Brent Sund ; brian.e.muirhead @ice.dhs.go; Bruce
l(b)(6); IBrvan
b)(6); (b)(7)(C)

S WilcoxKb

I

)(6); (b)(7)(C)

Sub ject : declined meals dinner 11-10-18
B2
b)(6); (b)(7)(C)

declined 1st meal
declined 1st meal

H-seg
Amar 216269802 declined 45th meal

ergeant

GEO Corrections & Detention
Northwest Detention Center
1623 East J Street
Tacoma, Washington 98421
,..;.
T_;.
e...;.I:
._b_)(6-);_(b_l(_
7l(_c_)

_

(R)

_..._..;..
F..;;.;a
.;..,
x: fb )(6); (b)(7)(C)

b)(6); (b)(7)(C)
www.geogroup

.com

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000277
2019-ICLl-00051 2322



From :

l(b)(6); (b)(7)(C)

Sent:

7 Nov 2018 05:49:28 +0000

To:

I

l(b)(6); (b)(7)(C)

b)(6); (b)(7)(C)

I

!Wilcox, Brvan SJb )(6); (b)(7)(C)

b)(6); (b)(7)(C)
b)(6); (b)(7)(C)

Subject:

I

Re: declined meals dinner 11-6-18

I

Late Entry:
F-4

~ll

~rb_)(6_)_;(b
_)_
(7_)(C
_)____

st meal declined due to menu choice.

Intake

___.l
lst

._K
b_)(6_);_(b_)(_7)_(C_) ___

meal declined due to menu choice.

l<b)(6); (b)(7)(C)

Lieutenant
GEO Corrections & Detention (R)
Northwest Detention Center
1623
East J Street
Tacoma Washington 98421
Tel: (b)(6); (b)(7)(C)
Cell
Fax
l(b)(6), (b)(7)(C)

www.geogroup.com
This ema il and any files tran smitt ed wit h it are confide ntia l a nd are intended solely for the u se of the individual or entity to
which they are addr essed. If you are not the intended recipient or the per son re spon sible for d eliverin g the email to the
int ended recip ient, be advised that your have received this email in error and that any use, dissemination, forward ing, printing
or copyin g of this ema il is strictly prohibited . If you have received this ema il in er ror, please immediatel y notify by replying to
this email.

From*

I

b)(6); (b)(7)(C)

Se nt: Tuesday, Novembe r 6, 2018 7:52 :03 PM

I

To*b )(6); (b)(7)(C)
b)(6); (b)(7)(C)
Kb)(6); (b)(7)(C)

[Bryan S W

I
i lc~x fb l(6); (b)(7)(C)

b)(6); (b)(7)(C)

Subject:

declined meals dinner 11-6- 18
.

.

I

G2
.._f
b_)(6_l;_(b_l<7
_l<_c) __

_.ldeclined her 1st meal

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000278
2019-ICLl-00051 2323



Med iso
~b)(6); (b)(7)(C)

I~-------~

Ideclined

his 1st meal

~dined his 26th meal

H-unit
Amar #216269802 Declined his 33rd meal

ergean
GEO Corrections & Detention
Northwest Detention Center
1623 East J Street
Tacoma, Washington 98421
~T_
e_l :_C
..b_lC
_6l_; C
_bl_c1_)CC
_ l__

(R)

..__F~
ax: ICb)(6); (b)(?)(C)

(b)(6); (b)(7)(C)

www.qeogroup.com
This email and any files transmitted with it are confidential and are intended solely for the use
of the individual or entity to which they are addressed. If you are not the intended recipient or
the person responsible for delivering the email to the intended recipient, be advised that your
have received this email in error and that any use , dissemination, forwarding , printing or
copying of this email is strictly prohibited. If you have received this email in error, please
immediately notify by replying to this email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000279
2019-ICLl-00051 2324



From :

Sent:

:57:03 +0000
~ilcox, Bryan

To:

b)(5 ); (b)(?)(C)

(b)(6); (b)(7)(C)

Subject:

Re: Declined meals for Dinner as of 10 8 18

Declined meals for Dinner 10/8/2018
Amar A#216269802 143rd declined meal
~l
<b_)<6_);_<b_)<_7)_<c_> ---~ll

~l
<b_)(6_);_(b_)(_7)_(C_)

----~l

st Declined meal
lst Declined meal

Thank you all in advance.
l(b)(6); (b)(7)(C)

Lieutenant

The GEO Group, Inc.(R)
Northwest Detention Center
1623 East J. Stre et
Tacoma , WA 98421
l(b)(6); (b)(7)(C)

l(b)(6); (b)(7)(C)

www .qeoq roup .com

J

From~b)(6);(b)(7)(C)
Sent: Monday, Octob""
e.,..,,
r,,.,..8...,,
. 2....,,=,1"'"'
8"'"9_:
I 5_A
~
_ M~-------------------,
To: W i lco x Brvan S~b)(5); (b)(?)(C)
b)(6); (b)(7)(C)

Subject: Declined meals for lunch as of 10/8/ 18
Declined meals for lunch
Amar A#216269802 declined his 142nd meal

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000280
2019-ICLl-00051 2325



(b)(6); (b)(7)(C)

l

~--------~

I

declined his 1st meal

l(b)(6); (b)(7)(C)

Sergeant
GEO Corrections & Detention (R)
Northwest Detention Center
1623 East J Street
Tacoma, Washington 98421
Te l : (b)(6); (b)(7)(C)
Cell
Fax
fb )(6); (b)(7)(C)

www.qeogroup.com

I

This email and any files transmitted with it are confidential and are intended solely for the use
of the individual or entity to which they are addressed. If you are not the intended recipient or
the person responsible for delivering the email to the intended recipient, be advised that your
have received this email in error and that any use, dissemination, forwarding, printing or
copying of this email is strictly prohibited . If you have received this email in error, please
immediately notify by replying to this email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000281
2019-ICLl-00051 2326



l(b)(6); (b)(7)(C)

From :

Sent :

16 Oct 2018 21:29:18 +0000

(b)(6); (b)(7)(C)

Subject :

RE: Declined meals for Lunch on 10/16/18

Just learned that following the meal tray refusal, Mr. Amar ate 100% of a sack lunch and an apple.

LCSW-C, BCD

........
--~~-~...,........,
mm1s ra or
ICE Health Service Corps
Northwest Detention Center
1623 E. J St. Suite!<b
lf6l
Tacoma, WA 98421
Office:l(b)(6); (b)(7)(Cl
I
BB: (b)(6); (b)(7)(C)
Fax
~b)(6); (b)(7)(C)

I

Warning : This document is UNCLASSIFIED //FOR OFFICIAL USE ONLY (U//FOUO). It
contains information that may be exempt from public release under the Freedom oflnformation
Act (5 U.S.C. 552). It is to be controlled, stored, handled, transmitted, distributed, and disposed
of in accordance with DHS policy relating to FOUO information and is not to be released to the
public or other personnel who do not have a valid "need-to-know" without prior approval of an
authorized DHS official. No portion of this report should be furnished to the media, either in
written or verbal form.
From~(b)(6); (b)(7)(C)

Sent : Tuesday, October 16, 2018 2:19 PM
To: Wilcox Brvan S kb)(6); (b)(7)(C)

J

(b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000282
2019-ICLl-00051 2327



r

)(6); (b)(7)(C)

Subject: Declined meals for Lunch on 10/16/18

The following detainee declined there meal tray for lunch

Ideclined his 4th tray. Detainee said he is constipated

rb )(5 ); (b)(?)(C)

that is why he is not

eating right now.-B -1
Amar A#216269802 declined his 166th tray. Med iso
7
6
f.....
b_><_>;_<b_><_><
_c _> ____

___.!d
eclined his 1st tray . F-4

l(b)(6); (b)(7)(C)

Sergeant

GEO Corrections

& Detention

(R)

Northwest Detention Center
1623 East J Street
Tacoma, Washington 98421
Tel: b)(6); (b)(7)(C)

Cell
Fax
l(b)(6); (b)(7)(C)

I

www.geogroup.com

This email and any files transmitted with it are confidential and are intended solely for the use of the
individual or entity to which they are addressed. If you are not the intended recipient or the person
responsible for delivering the email to the intended recipient, be advised that your have received this
email in error and that any use, dissemination, forwarding, printing or copying of this email is strictly
prohibited. If you have received this email in error, please immediately notify by replying to this email .

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000283
2019-ICLl-00051 2328



Fro m :

~b)(6); (b)(?)(C)

Sent:

4 Oct 2018 04:44:01 +0000
fb )(6); (b)(?)(C)

To:

Wilcox, Bryan sYbl( 6); (b)(?)(C)

b)(6); (b)(?)(C)

Subje ct:

Re: Declined meals for lunch on 10/3/18

On 3rd shift 10/3/18 the following detainees declined their dinner meal.
Amar A#216269802 - declined meal number 128 Med lso
(b)(6); (b)(?)(C)
- declined meal number 2 H-Seg
declined meal number 1 H-Seg
Thank you in advance.
~b)(6); (b)(?)(C)

!

Lieutenant

The GEO Group, Inc.(R)
Northwest Detention Center
1623 East J . Street
Tacoma, WA 98421
l(b)(6); (b)(?)(C)

fb )(6); (b)(?)(C)

www .geogrou p.com
From:

l(b)(6); (b)(?)(C)

I

Sent: Wednesday , October 3, 2018 9:39:27 AM
To: Wilcox, Bryan S j (b)(6); (b)(?)(C)

I

b)(6); (b)(?)(C)

Subject: Declined meals for lunch on 10/3/ 18
The following refused there lunch tray today
(b)(6); (b)(?)(C)

~eclined 1st tray--A-2

l---------

Ideclined

b)(6); (b)(?)(C)

--------'

1st tray-A-2

leclined 1st tray- D-2
declined 1st tray D-2

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000284
2019-ICLl-00051 2329



(b)(6); (b)(7)(C)

.__

_______

eclined 1st tray D-2
____. declined 1st tray D-2

Amar A#216269802 declined his 127th meal he ate his orange and boost- Med iso
~l
<b_
)<6_>;_(b_)<
_7>_
<c_) ---~!declined

his 1st tray- H-unit

rb )(6); (b)(7)(C)

Sergeant
GEO Corrections & Detention
Northwest Detention Center
1623 East J Street
Tacoma, Washinqton 98421
Tel : (b)(6); (b)(7)(C)
Cell:
Fax:

(R)

l(b)(6); (b)(7)(C)

www .qeogroup .com
This email and any files transmitted with it are confidential and are intended solely for the use
of the individual or entity to which they are addressed. If you are not the intended recipient or
the person responsible for delivering the email to the intended recipient, be advised that your
have received this email in error and that any use, dissemination, forwarding, printing or
copying of this email is strictly prohibited . If you have received this email in error, please
immediately notify by replying to this email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000285
2019-ICLl-00051 2330



I

l(b)(6}, (b)(7)(C)

Fro m :

Sent:

1 Nov 2018 13:46:18 +0000

I

~b}(6); (b)(7)(C)

To:
b)(6); (b)(7)(C)

~1 Wilcox, Bryan

l...,,
<b..,..
)(6=
),_(b_)(_7)_(C-r) ___________
Kb)(6);
I

Subject:

Sfb )(6); (b)(7)(C)

~--------~

I

Re: Declined meals

The following detainees declined Breakfast 11-01-2018 meal today:
H-seg:
Amar - #216269802- 16th missed meal.
Medical isolation:
l(b)(6); (b)(7)(C)

~ 9th missed mea l.

Informationa l reports submitted.

From:

b)(6); (b)(7)(C)

Se nt: Weane saay , October 3 1, 2018 I 0:26:48 PM

I

Tofb )(6); (b)(7)(C)
(b)(6); (b)(7)(C)

Sub ject: Declin ed meals
The following detainees decl ined dinner meal today:
H-seg:
Amar- #216269802- 15th missed meal.
A-2:
t b)(6); (b)(7)(C)

I1st missed

meal.

Medical isolation:
i(b)(6); (b)(7)(C)

f 1st missed meal.

Informationa l reports submitted.
b)(6); (b)(7)(C)

ergean

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000286
2019-ICLl-00051 2331



GEO Corrections & Detention (R)
Northwest Detention Center
1623
East J Street
Tacoma, Washin ton 98421
Tel: (b)(6); (b)(7)(C)

Fax
l(b)(6); (b)(7)(C)

www .geogroup .com
Thi s ema il and an y tiles tran smitt ed with it ar e confid ential and are int ended solely for the use of the indi vidu al or e ntit y to
whi ch they ar e addre ssed. If you ar e not the intend ed recipient or th e per son res ponsible for d eliverin g the email to the
int end ed r ecipient , be ad vised that your have r eceived this email in error and that an y use, disseminati on, forwarding , printin g
or copying of thi s ema il is str ictly pr ohibit ed. If you have r eceived this ema il in er ror , please imm ediatel y notify by replying to
this ema il.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000287
2019-ICLl-00051 2332



Fro m :

Wilcox, Bryan S

Sent:

19 Oct 2018 01:36:16 +0000

To:

Subje ct:

I

~b)(6); (b)(
7)(C)

RE: Detainee Amar 206269802

Thanks

Sent with BlackBerry Work
(www.blackberry .com)
From~b)(6); (b)(7)(C)
Date: Thursday, Oct 18, 2018, 5:00 PM
To: Wilcox, Bryan ~b)(6)
; (b)(
7)(C)
Subject : RE: Detaine'-e-A
~m
ar-2?~62-6-9-go-1~-----'

So he is off Hunger Strike and requested protective custody and is in SEG. We learned
this afternoon in SEG review that he has been refusing the facility meal trays but
continuing the liquid nourishment and eating fruit. We have not been getting notified by
GEO about this. Because his calorie consumption is more than adequate, he is not
considered official hunger strike.
I hope this clarifies.
V/R,
CAPT[b)(6); (b)(?)(C)
ILCSW-C, BCD
Health Services Administrator
USPHS
ICE Health Service Corps
Northwest Detention Center
5>I
1623 E. J St. Suit~<b><
Tacoma, WA 98421
Office :rb)(6); (b)(7)(C)
BB: (b)(6)
; (b)(7)(C)
Fax
b)(6);(b)(7)(C)
Warning: This document is UNCLASSIFIED//FOR OFFICIAL USE ONLY (U//FOUO).
It contains information that may be exempt from public release under the Freedom of
Information Act (5 U.S.C. 552). It is to be controlled, stored, handled, transmitted,
distributed , and disposed of in accordance with DHS policy relating to FOUO
information and is not to be released to the public or other personnel who do not have a
valid "need-to-know" without prior approval of an authorized DHS official. No portion of
this report should be furnished to the media, either in written or verbal form.
From: Wilcox, Bryan s ...
l<b
_H_
6>_
; (b
_><
_7>
_<c
_>______

__.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000288

2019-ICLl-00051 2333



Date : Thursday , Oct 18, 20 18, 4:40 PM
To:fb )(6); (b)(7)(C)

Subject:

RE: Detaine e Ama r

20626980 2

(b)(6);
/ 1,.,.\/ 7 \/r'\

So Amar is off hunger strike but still in MHU?

Sent with BlackBerry Work
(www .blackberry .com)
From: !(b)(6); (b)(7)(C)
Date: ' hursda , Oct 18, 2018 , 4:39 PM
To: b)(6); (b)(7)(C)

W ilcox ,

B

an

S

b)(6); (b)(7)(C)

Update on this patient who was taken off Hunger Strike in MHU due to adequate calorie
intake:
1. Amar is continuing to drink his usual prescribed calorie supplements of boost and
Pedialyte .
2. He has also been eating his fresh fruit from the trays even though he is refusing the rest
of the food trays.
3. His current calorie intake in segregation is the same as it was in MHU. So he continues
to not qualify as hunger strike .
4. Medical is going to cont inue monitoring his weight and vitals regularly on a weekly
basis.
5. We ask that the segregation officer continues to notate his refused trays as per GEO
pol icy, and any food that is taken off the tray to be eaten, including the ordered evening
snack.
Respectfully,

IMD

l(b}(6); (b}(7)(C)

Clinical Director
ICE Health Service Corps (IHSC)
Enforcement and Removal Operations (ERO)
US Immigration Customs Enforcement (USICE)
N o r thwest D ete n tio n Ce nt er

1623 E. J St.

Sui te

fiill)

T acoma, WA 9842 1
M ain office: ""
(b..,..,
)(=6)-; (""'b
),(7,.,..
...,,
)(""'C
,)....
--.
Vo ice M ail :
C el b)(6); (b)(7)(C)

fax
(b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000289
2019-ICLl-00051 2334



I~
From :

Se nt:

Wilcox, Bryan S
26 Nov 2018 15:27:05 +0000

)(6); (b)(7)(C)

Subject :

RE: Detainee Death Notice - Mergensana AMAR

I'l l pass that on but I think its too late.

Bryan S. Wilcox
Acting Field Office Director
ICE Enforcement & Removal O erations , Seattle, WA
b)(6); (b)(7)(C)

CONFIDENTIALITY:
This emailandattachments
are intendedfor the abovenameonlyandareconfidential.If youare notthe
intendedaddressee, or the personresponsible for delivering it to the intendedaddressee,
youmayneither copy, disseminate, nor
distributeit to anyoneelseor useit in anyunauthorizedmanner.To do so is strictly prohibited andmaybe unlawful.If youreceive
thisemail by mistake,pleaseadvisethe senderimmediately by usingthe reply facility in yourmail softwareanddeleteit fromyour
computer.
From~(b)(6); (b)(7)(C)

Se nt : Monday , November 26, 2018 6:37 AM
To : Wilcox, Bryan ~b )(6); (b)(7)(C)
(b)(6); (b)(7)(C)

I

Subject: RE: Detainee Death Notice - Mergensana AMAR
Correction needed if not too late :
On October 27 , 20 18, a p syc hi atr i st evaluated AMAR and determ i ned there was no su ic i dal
ideation , homicidal ideation , or auditory verbal hallucinat i on . AMAR rem aine d on con stantwatch.
There is no such thing as Verbal hallucinations. It should read ....aud itory or visual halluc inations

CAPT l(b)(6); (b)(?)(C)

ILCSW- C, BCD

Health Services Admin ist rator
USPHS
ICE Health Serv ice Corp s
Northwe st Detention Cente r
1623 E. J St. Suite l~b)<61
Tacoma WA 98421
Office: (b)(6); (b)(7)(C)

BB :(b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000290
2019-ICLl -00051 2335



Fax: (b)(6); (b)(7)(C)
(b)(6); (b)(7)(C)

Warning: Thi s document is UNCLASSIFIED //FOR OFFICIAL USE ONLY (U//FOUO). It
contains infonnation that may be exem pt from public release under the Freedom of Informat ion
Act (5 U.S.C. 552). It is to be controlled, stored, handled , transmitted, distributed, and disposed
of in accordance with DHS po licy relating to FOUO information and is not to be released to the
public or other personnel who do not have a valid "need-to-know" without prior approval of an
authorized DHS official. No portion of this report should be furnished to the media, either in
written or verbal form.

From: Wilcox , Bryan S
Sent: Monday , November 26, 2018 6:08 AM
(b)(6); (b)(7)(C)

Importance: High

FYSA.

I have not received permission to distribute, so please keep this with in a small circle among
your components.
Thanks
Bryan S. Wilcox
Acting Field Office Director
ICE Enforcement & Removal Operations , Seattle, WA
!(b)(6): (b)(7)(C)

CONF IDENTIALITY: This email and attachments are intended for the above name only and are confidential. If you are not the
intended addressee, or the person respons ible for deliver ing it to the intended addressee, you may neither copy, dissem inate, nor
distribute it to anyone else or use it in any unauthorized manner. To do so is strictly proh ibited and may be unlawful. If you receive
this email by mistake, please advise the sender immed iately by using the reply faci lity in your ma il software and delete it from your
computer.

Sent : on ay, ovem er 26, 2018 5:40 AM
To: Wilcox, Bryan S ~b)(6); (b)(7)(C)
b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000291
2019-ICLl-0005 1 2336



Subject: RE: Detainee Death Notice- Mergensana AMAR
Importance: High

Good morning,
The below an d the attached is the cleared version of the Detainee Death Notification . Please
copy th e below into the SEN syste m and subm it the SIR as soon as possible.
Thank you.

*******************************************************************************************
******************************************************************************************
******************************
Pursuant to ICE policy, I am providing notification of the death of an ICE detainee: Mergens ana
AMAR, A216 269 802.
ISSUE:

On November 24, 2018, U.S. Immigration and Customs Enforcement (ICE), Enforcement and
Removal Operat ions (ERO) Seattle reported the death of ICE detainee Mergensana AMAR ,
A2 l 6 269 802, a 40-year-o ld citizen of Russia , at Saint Joseph' s Hospital (SJH) in Tacom a, WA.
The medica l staff pronounced AMAR deceased on Novem ber 24, 20 18, at 6:05 p.m. PST.
Medical staff identified the preliminary cause of death as asphyxia caused by hanging from the
neck.
Cons istent with ICE pol icy, ERO Seattle notified the U.S. Department of Homeland Secur ity,
Office of Inspector General , and the ICE Office of Professional Responsibility via the Joint
Intake Center. ERO Seattle also provided telephonic message and email notification to the
Embassy of the Russian Federation in Wash ington, DC, of AMAR's death who will, in turn,
notify AMAR' s next of kin.
All media inquiries will be referred to the ICE Office of Public Affairs.

BACKGROUND:

On December 2, 20 17, AMAR applied for entry into the Un ited States via the pedestrian lanes at
the San Ysidro, CA Port Entry. AMAR presented his valid Russian passport to the primary
inspect ion Custom s & Border Protection Officer (CBPO) and reque sted asylum . U.S . Customs
and Border Protection (CBP) determined AMAR to be inadmissible and served him a Not ice and
Order of Exped ited Remova l, Form 1-860 charging inadmiss ibility pursuant to section
212(a)(7)(A)(i)(I) of the Immigration and Natural ization Act (INA), as amended , as an
immigrant without immigrant visa.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000292
2019-ICLl-00051 2337



On December 6, 2017, CBP transferred AMAR to ERO San Diego custody at the San Luis
Regional Detention Center.
On December 19, 2017, ERO San Diego transferred AMAR to ERO Seattle at the Northwest
Detention Cente r (NWDC) in Tacoma, WA to awa it a credib le fear interview with United States
Citizenship and Immi gratio n Services (USC IS) Asy lum office in San Fra ncisco, CA.
On January 3, 20 18, a USCIS San Francisco Asylum Pre-Screening Officer (APSO) conducted a
telephonic credible fear interview with AMAR in Tukwila, WA.
On January 4, 20 18, the APSO rendered a positive cred ible fear determination in AMAR's case
and served him a Notice to Appear, Form 1-862, alleg ing inadmissibility pursuant to sect ion
212(a)(7)(A)(i)(I) of the INA, as amended, as an immigrant without immigrant visa.
On February 1, 20 18, an immigration judge (IJ) in Tacoma, WA determined the court had no
juri sdiction in a custody hearing due to AMAR being an arriv ing alien .
On Feb ruary 7, 20 18, ERO Seatt le served AMAR a Paro le Adv isal and Schedu ling Notificat ion .
On February 26, 2018, ERO Seattle denied AMAR parole due to posing a risk of flight.
On August 7, 2018, an IJ in Salt Lake City, UT, appearing via video teleconferencing, denied
AMAR's app licat ion for asy lum, withhold ing under INA? 241(b)(3), and w ithhold ing of
removal under the Conve ntion Aga inst Torture (CAT), ordering AMAR removed to Rus sia.
AMAR reserved appeal, which was due by September 6, 20 18.
On August 22, 2018, AMAR declared himself to be on hunger strike and ICE Health Service
Corps (IHSC) began monitoring his meals .
On August 25, 2018, AMAR declined his ninth consec utive meal and IHSC initiate d hunger
strike protoco ls.
On September 6, 20 18, IHSC obtained an order to permit involuntary medical monitoring and
hydrat ion from a judge with the United States Di strict Cou rt for the Western District of
Was hington. When presented with the order, Amar began drinking Pedialyte and allowing
medica l monitoring.
On September 14, 2018, AMAR began drinking Boost nutritional shakes and continued to
consu me Pedialyte, and occas ionally ate pieces of fruit.
On Septe mber 19, 2018, ERO Seatt le scheduled AMAR for an esco rted comme rcial removal
with his valid Russian passport for October 24 , 2018.
By September 26, 20 18, AMAR regu larly consumed liquid nutritional supp lements, eating fruit
and taking vitamins. He had stopped losing weight and was effect ively not on hunger strike.
However , AMAR demanded to remain in the medical housing unit (MHU), threaten ing to stop
consuming the nutritional supplements and food items if returned to general populat ion. AMAR
was effectively in administrative /protective custody at this time.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000293
2019-ICLl-00051 2338



On October 1, 2018, AMAR filed an untimely notice of appeal with the Board of Immigration
Appeals (BIA). ERO Seattle cancelled AMAR's scheduled removal.
On October 16, 2018, AMAR consumed a full meal and IHSC declared an official end to hunger
strike protocols. Although AMAR was moved at his request to administrative segregation, he
wou ld continue to skip meals. IHSC made nutritional supplements and Pedialyte available to
AMAR three times daily to promote weight gain.
On October 26, 2018, GEO contract staff found a long rope made of bedding hidden under his
mattress. AMAR was re-admitted to the MHU on suic ide watch as a precaution because they
considered this a suicidal gesture, although AMAR denied it.
On October 27, 2018 , a psychiatrist evaluated AMAR and determined there was no suicidal
ideation, homicidal ideation, or auditory verbal hallucination. AMAR remained on constantwatch.
On October 29, 2018 , AMAR was transferred from the MHU to administrative segregation, but
he remained on 10-minute irregular mental health observation (MHO) checks.
On November 2, 2018 , the BIA dismissed AMAR's appeal as having been filed untimely.
On Novembe r 5, 2018, IHSC removed AMAR from MHO checks and released him to NWDC
GEO contract staff for a housing determination. AMAR requested to remain in administrative
segregation and GEO complied with that request.
On November 8, 2018 , ERO Seattle re-scheduled AMAR's removal to Rus sia for Novembe r 28,
2018.
On November 12, 2018 , AMAR began regularly eating facility provided meals and consumed a
complete lunch and dinner.
On November 14, 20 18, IHSC discontinued providing AMAR Boost and Pedialyte following his
consistent consumption of the food on his meal trays. AMAR also expressed his desire to leave
administrative seg regat ion and return to genera l popul ation.
On November 15, 2018, at approximately 3:06 p.m. PST , during a health and welfare check ,
GEO contract staff discovered AMAR hanging from a noose made of bed sheets in his cell in the
restricted housing unit. GEO con tract staff initia ted an Incident Management System (IMS) and
loosened the noo se around AMAR's neck. Staff used a life knife to cut AMAR down, and placed
him on the floor.
At approximately 3:08 p.m. PST, IHS C arrived and began administering cardiopulmonary
resuscitation (CPR) to AMAR.
At approximately 3: 10 p.m. PST, IHSC contacted emergency medical service (EMS).

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000294
2019-ICLl-00051 2339



At approximately 3: 16 p.m. PST, EMS from Tacoma Fire and Rescue arrived on scene and took
over the admini stration of CPR. GEO contract staff notified ERO Seattle that an IMS had been
called after detainee AMAR was discovered attempting self-harm by strangulation.
At approximately 3:29 p.m. PST, EMS reported that AMAR had a pulse.
At approximately 3:34 p.m. PST, EMS departed NWDC and transported AMAR to Saint
Joseph's Hospital in Tacoma, WA.
At approx imately 3:36 p.m . PST, AMAR arrived at Saint Joseph's Hospital.
At approximately 3:42 p.m. PST, ERO Seattle notified ERO HQ Field Operations of AMAR's
suicide attempt.
At approx imately 5:31 p.m. PST, Saint Joseph's Hospital admitted AMAR. IHSC notified ERO
Seattle that staff at St. Joseph's Hosp ital reported AMAR was non-responsive, had an anoxic
brain injury, possible spinal cord injury, and no apparent brain activity.
At approximately 6:03 p.m. PST, ERO Seattle notified the Joint Intake Center of AMAR's
suicide attempt.
At approx imately 7:58 p.m. PST, IH SC notified ERO Seattle that staff at St. Joseph's Hospital
reported AMAR continued to be non-responsive with no brain activity, no corneal response, and
had been intubated and moved to the intensive care unit (ICU).
On Novembe r 16, 2018, throughout the day, ERO Seatt le attempted to identify a next of kin and
made efforts to notify the embassy of Russia in Washington, DC without success .
At approximately 6:45 a.m. PST, IHSC notified ERO Seattle that AMAR's status remained
unchanged and he was on full life support.
At approx imately 2:00 p.m. PST, hospital staff conducted a neurology consult with
electroencepha lograp hy (EEG) .
On November 17, 20 18, IHSC notified ERO Seattle that the results of the EEG r showed no
brain activity. The St. Joseph's Hospital Ethics Committee reviewed the case and recommended
that AMAR be considered a do not resusc itate (DNR) case in the event of sudden cardiac arrest.
The comm ittee continued to monitor the case for future recommendatio ns on withdrawal of care.
On November 18, 20 18, hospital staff conducted a cerebral blood flow study on AMAR. The
results showed no flow to the brain. All testing indicated brain death, so the hospital declared
AMAR brain dead at 2:45 p.m. PST and notified ICE that they intended to turn off life support
unless next-of-kin cou ld be located, and they request otherwise. Hospital staff granted ERO
Seattle additional time to locate next of kin.
On November 19, 20 18, the HQEROInternational Operations Division Assistant Attache for
Removal in Warsaw, Poland provided contact information for AMAR's parents in Russia.
On Novembe r 20, 20 18, HQERO Removal and Internationa l Operations Division advised ERO
Seattle that the Russian embassy had contacted the next-of-kin in Russia and that the next of kin

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000295
2019-ICLl-00051 2340



were in contact with the hospital concerning the decision to keep or remove AMAR from life
support .
From November 20, 2018 thro ugh November 24, 2018, the hospita l staff had mult iple
conversations with the parents of AMAR, who, in the afternoon of November 24, 2018 , decided
to remove life support.
On November 24, 20 18, at approximate ly 6:00 p.m . PST, hosp ital staff removed all life support
from AMAR .
At approximately 6:05 p.m. PST , hospital staff pronounced AMAR 's cardiac death.
At approximately 6:30 p.m. PST, IHSC notified ERO Seattle of AMAR's passing.
At approximately 6:31 p.m. PST, ERO Seattle notified ERO Headqua1ters of AMAR's death .
On November 25, 2018, at 9:30 a.m . PST, ERO Seatt le telephonica lly notified the Joint Intake
Center and the Office of Professional Responsibility duty agent of AMAR's death.
At approximately 10: 15 a.m. and 10:20 a.m. PST , ERO Seattle attempted to contact the Embassy
of the Russian Federation in Washington, DC, via telephone to provide notification of AMAR's
death.
and
At approximately 10:51 a.m. PST, ERO Seattle emailed Vice-Consul b)(6 l ; (bl( 7 l(C)
provided notification of AMAR's death. ERO Seattle will continue to a emp persona
commun ication with embassy staff.
AMAR is the second deta inee to pass away in ICE custody in fiscal year 2019.

l(b)(6); (b)(7)(C)

I

Domestic Operations Desk Officer-West (Los Angeles & Seattle)
HQ- Enforcement and Removal Operations
b)(6); (b)(7)(C)
esk
obile
l(b)(6); (b)(7)(C)
Warning : This document is UNCLASSIFIED!/FOR OFFICIALUSE ONLY (U//FOUO) . It contains inform ation that may be exempt from public
rel ease under the Freedom of Information Act (S U.S.C. 552). It is to be controlled, stored, handled, transmitted, distributed, and disposed of
in accordance with DHS policy relating to FOUO information and is not to be released to the public or other personnel who do not have a
valid " need-to-know" without prior approval of an autho rized DH5 official. No portion of this report should be furnished to the media, either
in written or verbal form.

From : !(b)(6) ; (b)(7)(C)

Se nt: Monday, November 26, 2018 8:24 AM

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000296
2019-ICLl-00051 2341



I

To :l(b)(6); (b)(7)(C)

Subject: FW: Detainee Death Notice- Mergensana AMAR
Good morning,
See below . It's very close to the one we sent up Sunday AM, with just a few minor changes.
l(b)(6); (b)(?)(C)

I

ERO Domestic Operations - West
Unit Chief
l(b)(6);
(Desk) Kb)(6); - .

I

er 26, 2018 6:50 AM

Sent :
T

(b

!Mobile)

;

Cronen, C
b)(6); (b)(?)(C)
(b)( ; (b)(7)(C)
ennings , David .__)(6); (b)(?)(C)
Subject: FW: Detainee Death Notice- Mergensana AMAR
Cc )(5 ); (b)(?)(C)

,..,_~------------'
__________

___,

(b)(6);
(b)(7)(

See the cleared version below. Nathal ie worked with Wilcox on some add it ional edits.
Please save this as the Nathalie approved vers ion.
Thanks,
Sent with BlackBerry Work
(www.blackberry.com )
From* b)(6); (b)(?)(C)

Date: Sunday, Nov 25, 2018, 8:49 PM
To : #ERO Notification of Detainee Death (b)(6); (b)(7)(C)

Cc: Asher, Nathalie R (b)(6); (b)(?)(C)
Jennings, David W b)(6); (b)(?)(C)

.,,...,...,......
............
--------==--=:-=~::-=--:=-=--==-----------'
EROCHIEFSOF STAFF

b)(6); (b)(?)(C)

Subject: Detainee Death Notice - Mergensana AMAR

The message below is distributed on behalf of Acting Executive Associa te Director
Nathalie R. Asher
Pursuant to ICE policy, I am providing notification of the death of an ICE detainee: Mergensana
AMAR, A216 269 802.
ISSUE:

On November 24, 2018, U.S. Immigration and Customs Enforc ement (ICE), Enforcem ent and
Removal Operation s (ERO) Seattle reported the death of ICE detain ee Mergensana AMAR ,
A216 269 802, a 40-year-o ld citizen of Russia, at Saint Joseph 's Hospital (SJH) in Tacoma , WA.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000297
2019-ICLl-00051 2342



The medical staff pronounced AMAR deceased on November 24, 20 18, at 6:05 p.m. PST.
Medical staff identified the preliminary cause of death as asphyxia caused by hanging from the
neck.
Consistent with ICE policy , ERO Seattle notified the U.S. Department of Homeland Security ,
Office oflnspector General, and the ICE Office of Professional Responsibility via the Joint
Intake Cente r. ERO Seattle also provided telephonic message and ema il notification to the
Embassy of the Russian Federat ion in Wash ington, DC, of AMAR's death who will, in turn,
notify AMAR's next of kin.
All media inquiries will be referred to the ICE Office of Public Affairs.
BACKGROUND:
On December 2, 20 17, AMAR applied for entry into the United States via the pedest rian lanes at
the San Ys idro, CA Port Entry. AMAR presented his valid Russian passport to the primary
inspection Customs & Bord er Protect ion Officer (CBPO) and requested asylum. U.S . Customs
and Bord er Protection (CBP) determined AMAR to be inadmissible and served him a Not ice and
Order of Exped ited Removal, Form 1-860 charging inadmiss ibility pursuant to section
212(a)(7)(A)( i)(I) of the Immigration and Nat uralization Act (INA), as amended, as an
immigrant without immigra nt visa.
On December 6, 2017 , CBP transfetTed AMAR to ERO San Diego custody at the San Luis
Regional Detention Center.
On December 19, 2017, ERO San Diego transferred AMAR to ERO Seattle at the Northwest
Detention Center (NWDC) in Tacoma, WA to awa it a credib le fear interview with Un ited States
Citizenship and Immigratio n Services (USCIS) Asy lum office in San Franc isco, CA.
On January 3, 20 18, a USCIS San Francisco Asylum Pre-Screening Officer (APSO) conducted a
telephonic credible fear interview with AMAR in Tukwila, WA.
On January 4, 2018 , the APSO rendered a positive credible fear determination in AMAR's case
and served him a Not ice to Appear, Form 1-862, alleg ing inadmiss ibility pursuant to section
212(a)(7)(A)(i)(I) of the INA, as amended , as an immigran t without immigrant visa.
On February 1, 20 18, an immigration judge (IJ) in Tacoma, WA determined the court had no
jurisdiction in a custody hearing due to AMAR being an arriving alien.
On Feb ruary 7, 2018, ERO Seatt le served AMAR a Parole Adv isal and Schedu ling Notificat ion.
On February 26, 2018, ERO Seattle denied AMAR parole due to posing a risk of flight.
On August 7, 2018, an IJ in Salt Lake City, UT, appearing via video teleconferencing , denied
AMAR's app lication for asylum, withhold ing under INA? 241(b)(3) , and w ithhold ing of
removal under the Convent ion Aga inst Torture (CAT) , ordering AMAR removed to Russia.
AMAR reserved appeal, which was due by September 6, 20 18.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000298
2019-ICLl-00051 2343



On August 22, 2018, AMAR declared himself to be on hunger strike and ICE Health Service
Corps (IHSC) began monitoring his meals.
On August 25, 2018, AMAR declined his ninth consecutive meal and IHSC initiated hunger
strike protocols.
On September 6, 20 18, IHSC obtained an order to permit involuntary medical monitoring and
hydration from a judge with the United States District Court for the Western District of
Washington. When presented with the order, Amar began drinking Pedialyte and allowing
medical monitoring.
On September 14, 2018 , AMAR began drinking Boost nutritiona l shakes and continued to
consume Pedialyte, and occasionally ate pieces of fruit.
On Septembe r 19, 2018 , ERO Seatt le scheduled AMAR for an escorted commerc ial removal
with his valid Russian passport for October 24, 2018.
By September 26, 20 18, AMAR regularly consumed liquid nutritional supplements , eating fruit
and taking vitam ins. He had stopped losing weight and was effectively not on hunger strike.
However, AMAR demanded to remain in the medical housing unit (MHU), threaten ing to stop
consuming the nutritional supplements and food items if returned to general population. AMAR
was effectively in administrative /protective custody at this time.
On October l , 20 18, AMAR filed an untimely notice of appeal with the Board of Immigration
Appeals (BIA) . ERO Seattle cance lled AMAR's scheduled remova l.
On October 16, 20 18, AMAR consumed a full meal and IHSC declared an official end to hunger
strike protoco ls. Although AMAR was moved at his request to administrative segregation , he
would continue to skip meals. IHSC made nutritional supplements and Pedialyte avai lable to
AMAR three times daily to promote weight gain.
On October 26, 20 18, GEO contract staff found a long rope made of bedding hidden under his
mattress. AMAR was re-adm itted to the MHU on suicide watch as a precaution because they
conside red this a suicidal gesture , although AMAR denied it.
On October 27, 20 18, a psychiatrist evaluated AMAR and determined there was no suicidal
ideation, homicidal ideation, or auditory verbal hallucination. AMAR remained on constantwatch.
On October 29, 20 18, AMAR was transferred from the MHU to administrative segregation , but
he remained on 10-minut e irregu lar mental health observat ion (MHO) checks.
On Novembe r 2, 2018 , the BIA dismissed AMAR's appea l as having been filed untimely.
On November 5, 2018 , IHSC removed AMAR from MHO checks and released him to NWDC
GEO contract staff for a housing determination. AMAR requested to remain in administrative
segregation and GEO compl ied with that request.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000299
2019-ICLl-00051 2344



On November 8, 2018, ERO Seattle re-scheduled AMAR's removal to Russia for November 28,
2018 .
On November 12, 2018, AMAR began regularly eating facility provided meals and consumed a
complete lunch and dinner.
On November 14, 2018, IHSC discontinued providing AMAR Boost and Pedialyte following his
consistent consumption of the food on his meal trays. AMAR also expressed his desire to leave
administrative segregation and return to general population.
On November 15, 2018, at approximately 3:06 p.m . PST, during a healt h and welfare check,
GEO contract staff discovered AMAR hanging from a noose made of bed sheets in his cell in the
restricted housing unit. GEO contract staff initiated an Incident Management System (IMS) and
loosened the noose around AMAR's neck. Staff used a life knife to cut AMAR down , and placed
him on the floor.
At approximately 3:08 p.m. PST, IHSC arrived and began administering cardiop ulmonary
resuscitation (CPR) to AMAR.
At approximately 3:10 p.m. PST , IHSC contacted emergency medical service (EMS).
At approximately 3: 16 p.m. PST, EMS from Tacoma Fire and Rescue arrived on scene and took
over the administration of CPR. GEO contract staff notified ERO Seattle that an IMS had been
called after detainee AMAR was discovered attempting self-harm by strangulation.
At approximately 3:29 p.m. PST , EMS reported that AMAR had a pulse.
At approximately 3:34 p.m. PST, EMS departed NWDC and transported AMAR to Saint
Joseph's Hospital in Tacoma, WA.
At approximately 3:36 p.m. PST , AMAR arrived at Saint Joseph ' s Hospital.
At approximately 3:42 p.m. PST, ERO Seattle notified ERO HQ Field Operations of AMAR ' s
suicide attempt.
At approximately 5 :31 p.m. PST, Saint Joseph's Hospital admitted AMAR. IHSC notified ERO
Seattle that staff at St. Joseph ' s Hospital reported AMAR was non-responsive, had an anoxic
brain injury, possible spinal cord injury, and no apparent brain activity.

At approximately 6:03 p.m. PST, ERO Seattle notified the Joint Intake Center of AMAR's
suicide attempt.
At approximately 7:58 p.m. PST , IHSC notified ERO Seattle that staff at St. Joseph ' s Hospital
reported AMAR continued to be non-responsive with no brain activity, no corneal response , and
had been intubated and moved to the intensive care unit (ICU).

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000300
2019-ICLl-00051 2345



On November 16, 2018, throughout the day, ERO Seattle attempted to identify a next of kin and
made efforts to notify the embassy of Russia in Washington, DC without success .
At approximately 6:45 a.m . PST , IHSC notified ERO Seattle that AMAR's status remained
unchanged and he was on full life support.
At approximately 2:00 p.m. PST, hospital staff conducted a neurology consult with
electroencepha lograp hy (EEG) .
On November 17, 2018, IHSC notified ERO Seattle that the resu lts of the EEG r showed no
brain activity. The St. Joseph 's Hospital Ethics Committee reviewed the case and recommended
that AMAR be considered a do not resuscitate (DNR) case in the event of sudden cardiac arrest.
The committee continued to monitor the case for future recommendat ions on withdrawal of
care.
On November 18, 2018, hospital staff conducted a cerebral blood flow study on AMAR. The
results showed no flow to the brain. All testing indicated brain death, so the hospital declared
AMAR brain dead at 2:45 p.m. PST and notified ICE that they intended to turn off life support
unless next-of-kin cou ld be located, and they request othe1wise. Hospital staff granted ERO
Seattle additional time to locate next of kin.
On November 19, 20 18, the HQERO International Operations Division Assistant Attache for
Removal in Warsaw, Poland provided contact information for AMAR's parents in Russia.
On November 20, 2018, HQERO Removal and International Operations Division advised ERO
Seattle that the Russian embassy had contacted the next-of-kin in Russia and that the next of kin
were in contact with the hospital concerning the decision to keep or remove AMAR from life
support .
From November 20, 2018 through November 24, 2018, the hospital staff had multiple
conversations with the parents of AMAR, who, in the afternoon of November 24, 2018, decided
to remove life support.
On November 24, 2018, at approximate ly 6:00 p.m. PST, hospital staff removed all life support
from AMAR.
At approximately 6:05 p.m. PST , hospital staff pronounced AMAR's cardiac death.
At approximately 6:30 p.m. PST , IHSC notified ERO Seattle of AMAR's passing.
At approx imately 6:31 p.m. PST, ERO Seattle notified ERO Headquarters of AMAR's death.
On November 25, 2018, at 9:30 a.m. PST , ERO Seattle telephonically notified the Joint Intake
Center and the Office of Professional Responsibility duty agent of AMAR's death.
At approximately 10: 15 a.m. and 10:20 a.m. PST, ERO Seattle attempted to contact the Embassy
of the Russian Federatio n in Was hington, DC, via telephone to provide notification of AMAR's
death.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000301
2019-ICLl-00051 2346



At approximately 10:51 a.m. PST, ERO Seattle emailed Vice-Consu11Cb)(6); (b)(?)(C)
~nd
provided notification of AMAR's death . ERO Seattle will continue to attempt per sonal
communication with embassy staff.
AMAR is the second detainee to pass away in ICE custody in fiscal year 2019.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000302
2019-ICLl-00051 234 7



From :
Sent :

To :

Cc:
Subject:

I

fb)(6), (b)(7)(C)

28 Nov 2018 13:18:37 +0000
(b)(6); (b)(7)(C)
(b)(6); (b)(7)(C)

ilcox, Bryan S
RE: Detainee Death Review - Mergensana AMAR

10-4. Thank you. I'll await word from Mr. !(b)(6);
(b)(6);
(b)(7)(C)
from~ (b)(6); (b)(7)(C)

I

Sent : Tuesday, November 27, 2018 3:15 PM

b)(6); (b)(7)(C)
<b_)(_
6)_;(_b)_(7_)(c
_)______
ilcox, Bryan ~...
Subject : RE: Detainee Death Review - Mergensana AMAR

_.

Hello Unit Chie*b )(6); _
I am not longer assigned to NWDC. However, I am cc1 ng Mr. (b)(5); (b)(?)(C)

who is now assigned to that

facility.
Thank you,
b)(6);
b)(7)(C)

Sent with BlackBerry Work
(www .blackberry.com )
From:l(b)(6); (b)(7)(C)
Date: Tuesday, Nov 27, 2018, 11:28 AM
To : Wilcox, Bryan (b)(5 ); (b)(?)(C)
Cc b)(6); (b)(7)(C)
Subject: Detainee Death Review - Mergensana AMAR

Good afternoon,
My office will be conducting a review of the death of detainee Mergensana AMAR, who died on
November 24, 2017, at the St. Joseph's Hospital in Tacoma , WA. Our review will include an onsite visi t
at NWDC during which we'll interview security and medical staff who had contact with or knowledge of
the detainee, as well as tour the areas of the facility where the detainee was held. I'd like to tentatively
plan the onsite review for January 8-10, 2019 - can you please let me know if those dates work for your
field office and the facility? Within the next week, I'll assign a team lead for the review who will send
you a data request and provide instructions for uploading responsive records to our Sharepoint site. If
you have any questions before then, please don't hesitate to reach out to me.
Thank you in advance for your assistance.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000303
2019-ICLl-0005 1 2348



l(b)(6); (b)(7)(C)

Unit Ch ief
. ..
ICE Office of Professional Respons1b1hty
External Reviews and Analysis Unit
Offic (b)(6); (b)(7)(C)
Mobil L- ____
~

l(b)(6); (b)(7)(C)

AMEf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000304
2019-ICLl-00051 2349



From:
Sent:
To:

fb)(6); (b)(7)(C)

Cc:

(b)(6); (b)(7)(C)

30 Nov 2018 17:07:18 +0000
(b)(6); (b)(7)(C)
ilcox, Bryan Sfb)(6); (b)(7)(C)

RE: Detainee Death Review-Mergensana

Subject:

AMAR

10-4. Thank you. We' ll make it work.

Sent with BlackBerry Work
(www .blackberry .com)
Fro m:t b)(6); (b)(7)(C)

Date:nd a , Nov 30, 2018, 12:01 PM
To: b)(6); (b)(7)(C)
Cc (b)(6); (b)(7)(C)

Wilcox , Bryan S

Subject: RE: Detainee Death Review-Mergensa na AMAR

I was just about to respond to your email from yesterday morning. I had a good conversation
wit ~(b)(G); (b)(?)(C) Jyesterday. Following that discussion, I met with GEO and IHSC and discussed
gathering all the required informat ion from them as soon as possible. I will work to get
everyth ing together for you as soon as I can, but realistically we are probably looking at Tuesday
or Wednesday next week. If that gives you enough time to review the documents, then I would
say that the week of the 10th -14th would be fine.
FYSA: I wi ll be out of office on Monday.
Thanks,
l(b)(6); (b)(7)(C)
Assistant Field Office Director
OHS/ICE/ERO
Northwest Detention Center
Seattle Field Office
Desk b)(6); (b)(7)(C)
Cell :

From:l(b)(6); (b)(7)(C)

~

Sent: Friday, November 30, 2018 8:53 AM
To: 1Cb)(6); (b)(7)(C)
Subject: RE: Detainee Death Review-Mergensana

I
AMAR

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000305

20 19-ICLl-00051 2350



Good morning, Ijust wanted to confirm that we're tentatively planning for the week of the 10th.
Do you see any issues expediting the upload of records? Thanks for your flexibilityand please
let me know if you have any questions.

Sent with BlackBerryWork
(www.blackberry.com)
Froml(b)(6); (b)(7)(C)
Date : Thursday, Nov29, 2018, 10:14 AM
To: l(b)(6); (b)(7)(C)

__________________

Cc: ,....._

Subject:

___.

RE:Detainee Death Review-MergensanaAMAR

Good morning,
How about 1400 Eastern? If that works for you, would you please send me a calendar invite?
Thanks,
(b)(6); (b)(7)(C)
AFODOIC
NWDC
Seattle Field Office
From~(b)(6); (b)(7)(C)
Date : Thursday, Nov29, 2018, 06:00
~~r (6); (b)(7)(C)
Subject:

Detainee Death Review-MergensanaAMAR

Good Morning AFOD~l
(b_)(6
_),_. -~
My name isl(b)(6); (b)(7)(C) II am coo rdinatin g the upcoming QPR Death Review for
Mergensana AMAR. Pr ior to conducting the on-sight review , we will need to gather
relevant information/documen tation. I have attached an informat ion request to this ema il
which covers some of the information/documentation we need.

Are you available today or tomorrow for a quick call so we can touch base and go over a
few things? The upload process uses the QPR SharePoint platform. The AMAR folder
can be found here (there is also a link in the attached document) . I am working with IT to
give your profil e access so you can uplo ad documentation.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000306
2019-ICLl-00051 2351



V/r,

b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000307
2019-ICLl-00051 2352



l<b)(6); (b)(7)(C)

From :

Sent:

1 Dec 2018 04:30:44 +0000

To:

Wilcox, Bryan S
l(b)(6); (b)(7)(C)

Cc:
Subject:

Re: Detainee suicide

Ok, sounds good. Thank you.
Sent from my iPhone
On Nov 30, 2018 , at 7:38 PM, Wilcox , Bryan

s.....
1cb_)C
6_);_(b_)(_
7)_
(C_) _______

__.rrote:

(b)(6);
(b)(7)(C)

will be your POC for whatever you need
Much thanks ,
(b)(6);
/ h \/ 7 \/f'\

Sent with BlackBerry Work
(www.blackberry.com )
From:l (b)(6); (b)(7)(C)

Date: Friday, Nov 30, 201 8, 2:39 PM
To: Wilcox, Bryan S f"'"b.,..,
)(6
"'");"""
(b..,.
)(=7'"'"
)(C
"""
)--------.
Subject: Detainee su1c1de
Good afternoon,
I wanted to inform you that DHS OIG received the information regarding the death
of ICE detainee Mergensana Amar and we opened a case . I wanted to inquire
about getting copies of any reports/records, surveillance video, list of involved
employees to interview, etc. Should I deal d irectly with AFODf b)(6); (b)(7)(C) Ion
th is matter?
Feel free to call either Vince or myself if you have any quest ions.
Than ks (b)(6);
' h " 7 'tr '

James Cords
Special Agent
Department of Homeland Security
Office of the Inspector General
Seattle Resident Office
Phone :fb)(6); (b)(7)(C)

I

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000308
2019-ICLl-00051 2353



From:
Sent :
To:

Cc:
Subject:

fb)(6); (b)(
7)(C)
29 Nov 2018 17:13:34 +0000

fb)(6); (b)(7)(C)
Wilcox, Bryan S
RE: Documents requested by ICE/IHSCinvestigations Unit

As we gather the documents, we are saving them in a folder on our shared rive. I will make certain to
provide you with the complete folder (not to include the video footage).

ICE Health Service Corps
Northwest Detention Center
1623 E. J St. Suitel(b)(6
Tacoma, WA 98421
Office b)(6); (b)(7)(C)
BB: (b)(6); (b)(7)(C)
Fax:
(b)(
6); (b)(7)(C)
J

Warning: This document is UNCLASSIFIED //FOR OFFICIAL USE ONLY (U//FOUO). It
contains information that may be exempt from public release under the Freedom oflnformation
Act (5 U.S.C. 552). It is to be controlled, stored, handled, transmitted, distributed, and disposed
of in accordance with DH S policy relating to FOUO information and is not to be released to the
public or other personnel who do not have a valid "need-to-know" without prior approval of an
authorized DHS official. No portion of this report should be furnished to the media, either in
written or verbal form.
Fromfb)(6);(b)(
7)(C)

I

Sent : Thursday, November 29, 2018 9:09 AM

~

r )(6)
; (b)(7)(C)
Cc:Wilcox, Bryan b)(6)
; (b)(7)(C)
Subject : RE: Docum~e=n=s~re=q~u=es=e~~~~~in=v="'estigations
Unit

A lot , if not all of this, is going to be needed for additiona l investigations. Please also provide me with all
the documents that are listed below. I need the video footage ASAP.
Thanks,

(b)(6); (b)(7)(C)
AFOD OIC

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000309
2019-ICLl-0005 1 2354



NWDC
Seattle Field Office
Fromj(b)(6); (b)(7)(C)
Date: Thursday, Nov 29, 2018, 09:00
l(b)(6); (b)(7)(C)

Cc: Wilcox, Bryan 5~b)(6); (b)(7)(C)
Subject: Document1--~
...,r
e...,.
q""U.,..
e.,.,st""
e""'a..,.o""y'""IC,...,Ei:-i7rn
1H:r,se...c-.
1""'n
TTV
e""s...t,.,.1
g'""
at...10,...,r'"1
s...,o...,
r,..,11
.,..t------------Good Morning All,
We received a list yesterday of required documents that need to be gathered for the mortality review
assigned investigator who arrives next week. She would like as much of this as possible to review
ad head of time and to allow her to plan the interv iews she will need to conduct during her time here .
CDRl(b)(6); lwill be coming to work with you and or your staff to gather the requested items listed
below.
Thank you in advance for your cooperation with this task.
Items I am still pending or will need access to when I am on-site:
o
o
o
o

o
o
o

o

o
o
o

o

Mergensana AMAR's, NWDC detention file
Mergensana AMAR's alien file
All facility incident reports, staff memos/written statements, and/or investigations concerning
Mr. AMAR's death and the circumstances surrounding the death.
Post logs for medical housing unit (MHU) from August 25, 2018 to October 16, 2018, and
October 26, 2018 to November 5, 2018; H segregation from October 16, 2018 to November 5,
2018; segregation from November 5, 2019 to November 15, 2018; and medical emergency
records (housing unit, control, medical) from November 15, 2018. (I may have the area wrong,
just need to post logs for the housing units and days Mr. AMAR was on that unit)
Shift roster for November 5, 2018 to November 15, 2018.
Shift rosters for December 4 - 6, 2018 (projected site visit)
Video surveillance footage of Mr. AMAR's housing unit November 2018. Note: please ensure
any necessary proprietary software required to view the video is included on the DVD.
o Identit ies of personnel in the surveillance footage
Any video footage relevant to Mr. AMAR's medical emergency. Note : please ensure any
necessary proprietary software required to view the video is included on the DVD.
o Identit ies of personnel in the surveillance footage
Complete roster of NWDC's medical staff, includ ing full names and titles.
Complete medical staffing plan (please have available onsit e)
Training records for: (please have available onsite)
o [DOs providing care]
o [Custody Officer providing care/services]
o [Relevant medical staff]
Credentials files for: (please have available onsite)
o [Relevant medical staff]

Facility Policies:
o

Medical Policies and Procedures (please have available onsite)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000310
2019-ICLl-00051 2355



o

Facility policy and local operating procedure for medical emergencies (please have available
onsite)

V/R,
CAPT l(b)(B); (b)(?)(C)
LCSW-C, BCD
Health Services Admini strator
USPHS
ICE He alth Service Corp s
Northwe st Detention Center
1623 E. J St. Suite fbl(BI
Tacoma , WA 984 2 1
Offic e (b)(6); (b}(?)(C)
BB :(b}(6); (b)(?)(C)

I

Fax
(b)(6); (b)(?)(C)
Warning : This document is UNCLASSIFIED //FOR OFFICIAL U SE ONLY (U//FOU O) . It
contains inform ation that may be ex empt from pub lic rele ase under the Freedom oflnformation
Act (5 U.S.C. 552). It is to be controlled , stored , handled , transmitted , distribut ed, and dispo sed
of in accordance with DHS policy relating to FOUO information and is not to be relea sed to the
public or other per sonnel who do not have a valid "need-to -know" without prior approval of an
authorized DHS official. N o portion of this report should be furni shed to the media, either in
written or verbal form.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000311
2019-ICLl-00051 2356



Page 2357
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000312



Page 2358
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000313



Page 2359
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000314



Page 2360
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000315



Page 2361
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000316



Page 2362
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000317



Page 2363
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000318



From:
Sent :
To:

Cc:

Wilcox, Bryan S
20 Nov 2018 04:45:34 +0000
l(b)(6); (b)(?)(C)

~-----------~
RE: DRAFTdetainee

death notice re: AMAR
DRAFT----Detainee Death Notification-ERO Seatt le-Mergensana A216 269 802
VS(MC).doc, MEDICAL EXSUM - AMAR Mergensana.doc
Import ance:
High

Subject:
Att achments :

See mv comments in both documents.

I

(b)(5)

From~(b)(6); (b)(?)(C)

Sent : Monda , November 19, 2018 1:22 PM
To : b)(6 ); (b)(?)(C)
Wilcox, Bryan S
cc : f b)(6); (b)(?)(C)

I

SuoJect: FW: DRAFT detainee death notice re: AMAR

Good afternoon,
FYSA,we received an executive summary from the IHSC side of the house, we have
incorporated some their information onto the draft DON document you last provided on
Friday. We also sent it up to the front office acting CoS ~\}~\1.., for preliminary review.
Please see the attached, and use this version to address any comments and add any updates
from ERO Seattle.
Thank ou,
(b)(6); (b)(?)(C)

Domestic Operations Desk Officer-West (Los Angeles & Seattle)
HQ- Enforcement and Removal Operations
b)(6); (b)(?)(C)
esk
obile
(b)(6); (b)(?)(C)
Warn ing: This document is UNCLASSIFIED FOR OFFICIALUSE ONLY (U//FOUO) . It contains information that may be exempt from public
release under the Freedom of Information Act {5 U.S.C. 552) . It is to be controlled, stored, handled, transmitted , distributed, and disposed of
in accordance w ith DHS policy relating to FOUO information and is not to be released to the public or other personnel who do not have a
valid "need -to -know" without prior approval of an author ized DHS official. No portion of this report should be furn ished to the media, either
in written or verbal form.

Fro m: b)(6); (b)(?)(C)

Sent : Mon ay, November 19, 2018 3:21 PM
To:l (b)(6); (b)(?)(C)

Subject: FW: DRAFTdetainee death notice re: AMAR
Good afternoon,
See at tached from 11. Please provide to SEAto address the commen t s and for their use in updating
going forward.
Thanksfo\ /6\ (b\(7\(C\
!
ERO Domestic Operations - West

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000319
2019-ICLl-00051 2364



Uni/ Chief
!(b)(6); (b)(7)(C)

From: !(b)(6); (b)(7)(C)

Sent : Monday , November 19, 2018 3:04 PM
To~ b)(6); (b)(7)(C)

cc:1
_________________
.....

___.

Subject: RE: DRAFTdetainee death notice re: AMAR
Please see attached with edits and comments . Please use th is draft to update .
Thank ou
b)(6); (b)(7)(C)

1e o

a

Enforcement and Removal Operations
500 12th Street, SW
Washington, D.C. 20536
fo )( 6)

(bl/ 7)/Cl

!

From : l(b)(6); (b)(7)(C)

Sent: Monday, November 19, 2018 11:48 AM
Tof b)(6); (b)(7)(C)

Cc:I
Subject : DRAFTdetainee death notice re : AMAR
Good morning,
We've been monitoring this detainee's medical case closely since last week. Medical staff have declared
him brain dead and EROis attempting to locate next of kin to authorize the discontinuance of life
sustaining efforts. While we wait, please review the attached draft detainee death notification and
provide comments for anything else we ' ll need from IHSCor the field office .
Thanks,

~------------------~

Kb)(6); (b)(7)(C)

ERO Domest ic Operations - West
Uni/ Chief

Enforcement and Removal Operations
U.S. Immigration and Customs Enforcement
U.S. De artment of Homeland Securitv
b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000320
2019-ICLl-00051 2365



Page 2366
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000321



Page 2367
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000322



Page 2368
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000323



Page 2369
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000324



Page 2370
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000325



Page 2371
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000326



Page 2372
Withheld pursuant to exemption
(b)(5)
of the Freedom of Informat ion and Privacy Act

AMlf ICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000327



l(b)(6); (b)(7)(C)

From :
Sent:
To:
Subject:

25 Nov 2018 20:56:28 +0000
Wilcox, Bryan S
RE: D/T Amar #216269802

Not sure where the document is in clearing process. I will le
Thank you.

i~li~lr andle that

update.

From: Wilcox, Bryan s l(b}(6); (b}(?)(C)
Date. Suodav Nov 25 2~Q,..,.J""'8
...3=-.
...,.
49~P.,...M.,.------r )(6); (b)(?)(C)

Subject: RE: D/T Amar #216269802

One typographical error on the last line of pg.4: "At approximately
hospital staff pronounced AMAR' cardiac death."

6:05 p.m. PST,

Sent with BlackBerry Work
(www .blackberry .com)
Fromfb )(6); (b)(7)(C)
Date: Sunday, Nov 25, 2018 , 11:18 AM
,.,,....,.,,,,.,......,~,,..,.,,.,--------------,
To: Wilcox, B an S (b)(6); (b)(?)(C)
(b)(6); (b)(7)(C)

Cc b)(6); (b)(7)(C)
Subject: RE : 0 /T Amar #21626980 2
I just forwarded the attached to the front office , I'm sure they'll have some get-backs, but this is
the current version. Don't submit the SIR until the doc has been cleared by the EAD.
Thanks,

I

~b)(6); (b)(?)(C)
ERO Dom estic Operations - West
Unit Chief
l(b)(6); (b)(?)(C)

From: Wilcox , Bryan S
Sent: Sunday, November 25, 2018 2:05 PM
rb )(6); (b)(?)(C)

Subject: RE: D/T Amar #216269802

Just heard from the RACif you want to add that

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000328
2019-ICLl-00051 2373



Sent w ith BlackBerry Work
(www.blackberry.com)
From: Wilcox, Bryan s....
f b_)<_6>_; <_b)_(7_><
_c)______
Date : Sunday, Nov 25, 2018, 10:40 AM

_.

To:l (b)(6); (b)(7)(C)

Subject: RE: D/T Amar #216269802

Also, i sent IM, emai l and voice mai l on the cell phone w ith our OPR RACat 8:30 this morning

Sent w ith BlackBerry Work
(www. blackberr y.com )
Fromfb)(6);(b)(7)(C)
Date: Sunday, Nov 25, 2018, 10:34 AM
To: Wilcox, Bryan (b)(6); (b)(7)(C)
b)(6); (b)(7)(C)

Subject: RE:D/T Amar #216269802

I think we're good to go. Just need the notification to the JIC and the embassy/ consulate. If you
can only n]leave a message with the consu late, that shou ld suffice fo r now. I can art iculate that
in the notice.

perat1ons - West

From: Wilcox , Bryan S
Sent: Sunday, November 25, 2018 1:12 PM
r b)(6); (b)(7)(C)

SubJect: FW: D/T Amar

#216269802

I don' t want too many back-and forths and too much confus ion w ith multiple peop le making
simu ltaneous edits . Please see the attached, that has just been circulated among the Seatt le
peop le.
I'd suggest just looking at the changes and/or comments made by the highl ighted below

From* b)(6); (b)(7)(C)

I

Sent: Sunday, November 25, 2018 9:57 AM

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000329
2019-ICLl-00051 237 4



To : Wilcox , Bryan Sl(b)(6); (b)(7)(C)
(b)(6); (b)(7)(C)

Subject: RE: D/T Amar #216269802

Attached is an updated draft, I responded to your questions on the IHSC side.
I will defer the brain/ cardiac death quest ion to Dr.l(b)(6); (b)(?)(C) r Drl\~/\~L,
------- Don't know if we want to articulate this, but the hospital term at this point in "Cardiac
Death" as opposed to "Brain Death"

I:

From: Wilcox, Bryan S
Sent: Sunday, November 25, 2018 9:37 AM
(b)(6); (b)(7)(C)

Subject: RE: D/T Amar #216269802

Thanks
Forwarded to HQ.

Fromj(b)(6); (b)(7)(C)
Sent: Sunday, November 25, 2018 9:25 AM
To : Wilcox, Bryan Sl(b)(6); (b)(7)(C)
b)(6); (b)(7)(C)

Subject: RE: D/T Amar #216269802

Adding a few edits on the legal side. Also to reflect Amar's individual hearing was via VTC with a
Salt Lake IJ.

l(b)(6); (b)(7)(C)

I

Assistant Chief Counsel
Seattle Office of Chief Counsel / OPLA

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000330
2019-ICLl-00051

2375



Tacoma sub-office
U.S. Immigration and Customs Enforcement
U.S. De artment of Homeland Security
Tel: (b)(6); (b)(?)(C)
E-mail: (b)(6); (b)(?)(C)
***Warn ing *** Attorney/Client Privilege*** Attorney Work Product***
This communication and any attachments may contain confidential and/or sensitive attorney/client privileged
information or attorney wo rk product and/or law enforcement sensitive information . It is not for release ,
review, retransmission , dissemination , or use by anyone other than the intended recipient. Please notify the
sender if this email has been misdirected and immediately destroy all originals and copies. Furthermore do
not print, copy , re-transmit , disseminate , or otherwise use this information. Any disclosure of this
commun ication or its attachments must be approved by the Off ice of the Principa l Legal Advisor, U.S.
Immigration and Customs Enforcement. This document is for INTERNAL GOVERNMENT USE ONLY and
may be exempt from disclosure under the Freedom of Information Act, 5 USC?? 552(b)(5), (b)(?) .

From: Wilcox, Bryan S
Sent: Sunday, November 25, 2018 8:40 AM
(b)(6); (b)(?)(C)

Subject: FW: D/T Amar #216269802
Importance: High

All,
With AMAR' s being taken off life-support last night and passing, today w ill likely be a busy day
for us all.
See below and attached, the draft death notice that will have to be refined this morning.

b)(6);
b)(?)

From: Wilcox, Bryan S
Sent: Sunday, November 25, 2018 8:36 AM

Subject: RE: D/T Amar #216269802
Importance: High

Here's the latest.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000331
2019-ICLl-00051 2376



It will need to be looked at by IHSChere locally for some clarity on Amar's seg status (see
comments on page 4).
One thing needing to be done at this point is contacting the Russian Embassy. Will that be
covered by RIO or do you want us to attempt to do that here? (and does someone have a fax
number with which to do that?)

From:f b)(6); (b)(7)(C)

Sent : Sunday, November 25, 2018 7:42 AM
To : Wilcox, Bryan ~ (b)(6 ); (b)(?)(C)
b)(6); (b)(7)(C)
b)(6); (b)(7)(C)

ennin s David W

(b)(6); (b)(7)(C)

Subject : RE: D/T Amar #216269802

Good morning Mr. Wilcox,
Mr. Jennings is inqur ing on the eta for the DON? Can you provide a status?
Thank you

From:~b)(6); (b)(7)(C)

Date: Saturday, Nov 24, 2018, 9:28 PM
To: Wilcox Br an S(b)(6); (b)(7)(C)

Jennin s David W

(b)(6); (b)(7)(C)

Thank you,
Please provide the updated detainee death notice first th ing in the AM.
If you need any additional information please let me know ,

Thanks

l(b)(6); (b)(7)(C)

Unit Chief
Domestic Operations West

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000332
2019-ICLl-00051 2377



~b)(6); (b)(7)(C)
Sent with BlackBerry Work
(www.b lack berry .com )

~
Date : Saturday, Nov 24, 2018, 9:21 PM
.,,...,..,.,.,....,...,.a..,,,,...,..,,..,.------------.
To: Jennings, David W~b)(6); (b)(7)(C)
(b)(6); (b)(7)(C)
From: Wilcox, Bryan ~~
(b_)C
_l,_Cb
6
_lC
_7l_CC
_l ______

I

Subject: FW: D/T Amar #216269802

This from GEO. I am expecting the hospital should be getting in touch with IHSC
shortly

Sent with BlackBerry Work
(www.b lackberry .com )
From:1Cb)(6); (b)(7)(C)
Date : Saturday, Nov 24, 2018, 6:16 PM
b)(6); (b)(7)(C)

Wilcox, Bryan SKb)(6); (b)(7)(C)
icb)(6); (b)(7)(C)
Subject: D/T Amar #216269802

at 1754 hours i was infonned by D/O ~()~(rr.ihat the hospital staff had got
authorization to remove D/T Amar from the ventilator. at approx 1805 D/T
Amar was pro nounced dead by hosp ital staff. at approx 1810 Officers
)~~)
~~ir, n~(b)(6i; ~ere instructed to stand down the hospital watch. AW
(b)(6); notified by phone
/ h \/7\/f'

'

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000333
2019-ICLl-00051 2378



l<b)(6); (b)(7)(C)

Sergeant
GEO Corrections & Detention
Northw est Detention Center
162 3 East J Street
Tacoma, Washington 98421

(R)

rb )(6); (b)(7)(C)

www.qeoqroup .com
This email and any files transmitt e d with it are confidential and are intended
solely for the use of the individual or entity to which they are addressed. If you
are not the intended recipient or the person responsible for delivering the email to
the intended recipient, be advised that your have received this email in error and
that any use, dissemination , forwarding, printing or copying of this email is
strictly prohibited. If you have received this email in error, please immediately
notify by replying to this email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000334
2019-ICLl-00051 2379



From :

Se nt:

l(b)(6); (b)(7)(C)

25 Nov 2018 20:08:17 +0000

r )(6), (bl(7)(C)

UbJe ct :

RE: 0/ I Amar #216 26980 2

One typograph ical error on the last line of pg.4: "At approximately 6:05 p.m. PST, hospital staff
pronounced AMAR' card iac death." Otherwise, I have no suggested edits .
f b)(6); (b)(7)(C)

Assistant Chief Counsel
Seattle Office of Chief Counsel / OPLA
Ta coma sub-office
U.S. Immigration and Customs Enforcement
U.S. Department of Homeland Security
Tel: l(b)(6); (b)(7)(C)
E-m~~-____________
__.
***Warning*** Attorney/Client Privilege*** Attorney Work Product***
This communication and any attachments may contain confidential and/or sensitive attorney/client privileged
information or attorney work product and/or law enforcement sensitive information. It is not for release, review,
retransmission, dissemination, or use by anyone other than the intended recipient. Please notify the sender if this
email has been misdirected and immediately destroy all originals and copies. Furthermore do not print, copy, retransmit, disseminate, or otherwise use this information. Any disclosure of this communication or its attachments
must be approved by the Office of the Principal Legal Advisor, U.S. Immigrat ion and Customs Enforcement. This
document is for INTERNAL GOVERNMENT USE ONLY and may be exempt from disclosure under the Freedom of
Information Act, 5 USC?? 552(b)(5), (b)(7).

From : W ilcox, Bryan S

Se nt : Sunday, November 25, 2018 11:47 AM

1~)(
6);(bl(7J(CJ

Subject : FW: D/T Amar #216269802

All,
As this has already gone to the front off ice, please review, keep any corrections comments among us so
I can forward at one time.

Se nt : Sun
To: W ilcox, Bryan

er 25, 2018 11:18 AM
); (b)(7)(C)

Cc: (b)(6); (b)(7)(C)

SuoJect:

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000335
2019-ICLl -00051 2380



I just forwarded the attached to t he front office, I' m sure they' ll have some get-backs, but th is is the
current version. Don't submit the SIR until the doc has bee n cleared by the EAD.
Thanks,
rb)(6). (b)(7)(C)
1

ERO Domestic Operations- West
Unit Chief
l(b)(6); (b)(7)(C)

From : Wilcox , Bryan S
Sent : Sunday, November 25, 2018 2:05 PM

~:e
~:~.
(~(~~~
:
I A l I ldl

tt ZIOZO

~o OZ

Just heard from the RACif you want to add that

Sent with BlackBerry Work
(www. blackberry .com )
From: Wilcox, Bryan S 1-(b_)(_6)_; (_b)_(7_)(_C_) -----~
Date: Sunday, Nov 25, 2018, 10:40 AM
T of b)(6); (b)(7)(C)

Subject: RE: D/T Amar #216269802

Also, i sent IM, email and voicemail on the cell phone with our OPR RACat 8:30 this morning

Sent with BlackBerry Work
(www .blackberry.com)
Fromj (b)(6); (b)(7)(C)

Date: Sunday, Nov 25, 2018, 10:34 AM
To: Wilcox, Bryan S f"'"b-)(=
6)-; (-b)~(7~)(~
C)-----------------------~
Subject: RE: D/T Amar #216269802

I think we're good to go. Just need the notification to the JIC and the embassy/ consulate. If you can only
n]leave a message with the consulate, that should suff ice for now . I can articulate that in the notice .
rb)(6). (b)(7)(C)

1

ERO Domestic Operations - West
Unit Chief
!(b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000336
2019-ICLl -00051 2381



rb)(6); (b)(7)(C)
1

I don't want too many back-and forths and too much confusion with multiple people making
simultaneous edits. Please see the attached, that has just been circulated among t he Seattle people .
I'd suggest just look ing at the changes and/or comments made by the highlighted below

From~(b)(6); (b)(?)(C)

Sent : Sunday, November 25, 2018 9 :57 AM
To : Wilcox, Bryan Skbl(6l (bl(7l(Cl
b)(6); (b)(?)(C)

Subject : RE: D/T Amar #2 16269802
Attached is an updated draft, I responded to your questions on the IHSC side.
I will defer the brain / cardiac death question to DrJ(b)(5); (b)(?)(C) Drl(b)(6); _.

I/

I:

-------Don't know if we want to articulate this, but the hospital term at this point in "Cardiac Death" as
opposed to "Brain Death"

From : Wilcox, Bryan S

Se nt: Sunday, November 25 2018 9:37 AM
b)(6); (b)(7)(C)

Subject: RE: D/T Amar #216269802
Thanks
Forwarded to HQ.
From :fb)(6); (b)(?)(C)

Se nt: Sunday, November 25, 2018 9 :25 AM
To: Wilcox, Bryan S b)(6); (b)(?)(C)
(b)(6); (b)(?)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000337

2 019 -ICLl-00051 23 82



Adding a few edits on the legal side. Also to reflect Amar's individual hearing was via VTC with a Salt
Lake IJ.

l(b)(6); (b)(7)(C)

J

Assistant Chief Counsel
Seattle Office of Chief Counse l / OPLA
Tacoma sub-office
U.S. Immigration and Customs Enforcement
U.S. Department of Homeland Security
Tel: b)(6); (b)(7)(C)
E-mail: (b)(6); (b)(7)(C)

*** Warning *** Attorn ey/ Client Priv ile ge *** Attorn ey Work Product ***
This communication and any attachments may contain confidential and/or sensitive attorney/c lient privileged
information or attorney work product and/or law enforcement sensit ive information. It is not for release, review,
retransmission, dissemination, or use by anyone other than the intended recipient. Please notify the sender if th is
email has been misdirected and immediate ly destroy al l originals and copies. Furthermore do not print, copy, retransmit, disseminate, or otherwise use this informat ion. Any disclosure of this communication or its attachments
must be approved by the Office of the Principal Legal Advisor, U.S. Immigration and Customs Enforcement. This
document is for INTERNAL GOVERNMEN T USE ONLY and may be exempt from disclosure under the Freedom of
Information Act, 5 USC?? 552(b)(5), (b)(7).

From : Wilcox, Bryan S
Sent : Sunday, November 25, 2018 8:40 AM
(b)(6); (b)(7)(C)

Subject: FW: D/T Amar #216269802
Importance: High

All,
With AMAR's being taken off life-support last night and passing, today will likely be a busy day for us all.
See below and attached , the draft death not ice that will have to be refined th is morning .

BW
From : Wilcox, Bryan S
Sent : Sunday, November 25, 2018 8:36 AM
To: Dearauj o, Silvia <Silvia .E.Dearaujo@ice.dhs.gov>

IJenn ings, David W

Cc l(b)(6); (b)(7)(C)
~

(b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000338
2019-ICLl-00051 2383



l(b)(6); (b)(?)(C)

From :
Sent:
To:

25 Nov 2018 20:02:32 +0000
.,,..,..,.,,.,....,,..,..,,,,,.,.,,,,----------------,
Wilcox, Bryan S b)(6); (b)(?)(C)

(b)(6); (b)(?)(C)

RE: D/T Amar #216269802

Subject:
(b)(5)

Sent with BlackBerry Work
(www.blackberry.com)
From : Wilcox,
Date: Sunda

Bryan S ~(b)(6); (b)(?)(C)
No v 25 20,....,1~8~1
~I:~
4~6
------~

b)(6); (b)(?)(C)

All,
As this has already gone to the front office, please review, keep any corrections comments
among us so I can forward at one time .

From: (b)(6); (b)(?)(C)
Sent: Sun ay, Novem er 25, 2018 11:18 AM
To : Wilcox, Bryan Sf b)(6); (b)(?)(C)
l(b)(6); (b)(?)(C)

Subject: RE: D/T Amar #216269802

I just forwarded the attached to the front office, I'm sure they'll have some get-backs, but this is
the current version. Don't submit the SIR until the doc has been cleared by the EAD.
Thanks,
l(b)(6); (b)(?)(C)

I

ERO Domeslic Operations - West
Unit Chief

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000339
2019-ICLl-00051 2384



f b)(6); (b)(7)(C)

From: Wilcox, Bryan S
Sent: Sunday, Novem ber 25, 2018 2 :05 PM
(b)(6); (b)(7)(C)

Subject: RE: D/T Amar #216269802

Just heard from the RAC if you want to add that

Sent with BlackBerry Work
(www .blackberry.com)
From: Wilcox, Bryan s ...,l
(b,...,,,
)(....,..
6)-=; (....,
b),...,
(7,....
)(C
"""),.....,....,--,------'
Dat e: Sunday, Nov 25, 2018, 10:40 AM

To (b)(6); (b)(7)(C)
Subject: RE:D T Amar #216269802

Also, i sent IM, email and voice mail on the cell phone with our OPR RACat 8:30 th is morni ng

Sent with BlackBerry Work
(www .blackberry.com)
Fro mf b)(6); (b)(7)(C)

Dat e: Sunday, Nov 25, 2018, 10:34 AM
To: Wilcox, Bryan S ~(b-)(-6)-; (-b)-(7-)(_C_) -----------~
(b)(6); (b)(7)(C)

Subject : RE:D/T Amar #216269802

I think we're good to go . Just need the notification to the JIC and the em bassy/ consulate . If you
can only n]leave a message with the consulate, that should suffice for now. I can articu late that
in the notice.
l(b)(6); (b)(7)(C)

I

ERO Domestic Operations - West
Unit Chief
l(b)(6); (b)(7)(C)

From: Wilcox , Bryan S
Sent: Sunda

November 25 2018 1:12 PM

(b)(6); (b)(7)(C)

u Ject: FW: D T Amar#
(b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000340
2019-ICLl -00051 2385



I don' t want too many back-and forths and too much confusi on with mult iple people making
simultaneous edits. Please see the attached, that has just been circulated among the Seattle
people.
I'd suggest just looking at the changes and/or comments made by t he highlig hted below

Fromj (b)(6); (b)(?)(C)

Sent : Sunday, November 25, 2018 9:57 AM
To : Wilcox, Bryan S l(b)(6); (b)(?)(C)
(b)(6); (b)(?)(C)

Subject : RE: D/T Amar #216269802

Attached is an updated draft, I responded to your questions on the ,u...,.,<""'--"' ""'""'-'
I will defer the brain/ cardiac death question to q (b)(5); (b)(?)(C) VD ~~~~~ic:,
------- Don' t know if we want to art iculate th is, but the hospital term at th is point in "Cardiac
Death" as opposed to "Brain Death"

From: Wilcox, Bryan S

Sent: Sunday, November 25, 2018 9:37 AM
To : Kb)(6); (b)(?)(C)

I

(b)(6); (b)(?)(C)

Subject: RE: D/T Amar #216269802

Thanks
Forwarded to HQ.
Froml (b)(6); (b)(?)(C)

I

Sent: Sunday, November 25, 2018 9:25 AM
To : Wilcox, Bryan ~b )(6); (b)(?)(C)

I

(b)(6); (b)(?)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000341
2019-ICLl -00051 2386



l(b)(6); (b)(7)(C)

I

Subject: RE: D/T Amar #216269802

Adding a few edits on the legal side. Also to reflect Amar's individual hearing was via VTCwith a
Salt Lake IJ.

l(b)(6); (b)(7)(C)

Assistant Chief Counsel
Seattle Office of Chief Counsel / OPLA
Tacoma sub-office
U.S. Immigration and Customs Enforcement
U.S ...=
D~=~Wl..l.!..!....!...J!.l.!.!.!.=~~~..!.ll..
~
Tel: (b) ;
E-m
*** wt-::
a=
rn::-;
i:::ng
::.;i;;-.
A.-.
tt:.-:
o:-::
r=ne
=y
-:
-:-r,,;,...
lie
-::-c
n
::.t"P
"-r""
iv..,,.
il'-e-=
g-=e....,.,...,
Arlttorney Work Product ***
This communication and any attachments may contain confidential and/or sensitive attorney/client privileged
information or attorney work product and/or law enforcement sensitive information. It is not for release,
review, retransmission, dissemination, or use by anyone other than the intended recipient. Please notify the
sender if this email has been misdirected and immediate ly destroy all originals and copies. Furthermore do
not print, copy, re-transmit, disseminate, or otherwise use this information. Any disclosure of this
communication or its attachments must be approved by the Office of the Principal Legal Advisor, U.S.
Immigration and Customs Enforcement. This document is for INTERNAL GOVERNMENT USE ONLY and
may be exempt from disclosure under the Freedom of Information Act, 5 USC?? 552(b)(5), (b)(7).

From: Wilcox , Bryan S
Sent: Sunday, November 25, 2018 8:40 AM
b)(6); (b)(7)(C)

Subject: FW: D/T Amar #216269802
Importance : High

All,
With AMAR's being taken off life-support last night and passing, today w ill likely be a busy day
for us all.
See below and attached, the draft death notice that will have to be refined this morning .

BW

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000342
2019-ICLl-00051 2387



Fro m :

Sent:
To:
b)(6); (b)(7)(C)
(b)(6); (b)(7)(C)

Subject:
Attachments:

~b)(6); (b)(7)(C)

21 Nov 2018 14:55:09 +0000
l(b)(6); (b)(7)(C)

I
5>; (b)(?)(C)
}Vilcox, Bryan st ><

I

Re: D/T Amar A#216269802 Hospit al update
Detainee Amar Log 11-19 (Jackson%2c Curtis) (1).docx

Fronf b)(6); (b)(7)(C)

Se nt: Tuesdav November 20 20 I 8 2: 16:06 PM

I

To l<b)(6); (b)(7)(C)
l(b)(6); (b)(7)(C)
(b)(6); (b)(7)(C)

!W i lcox, B ryan S j(b)(6); (b)(7)(C)

I

Subject: D/T Amar A#2 l 62698 02 Hospital update
I was just no ti fied at 1412 hrs from

Office ~(b)(6); (b)(?)(C)

~t the H osp ital that the docto r

told him that they will be pu l ling the plug on deta i nee Amar A#216 2 69802
T h ey t old h i m one more day. I contac t ed Ma j or

!~l!~lcc)

o f what

tomorrow.

I was to ld .

l(b)(6); (b)(7)(C)

Sergeant
GEO Corrections & Detention
North west Dete nt ion Cente r
16 23 East J Str eet
Tacom a, Washing to n 98421
Tel : b)(6); (b)(7)(C)

(R)

Cell
Fax
l(b)(6); (b)(7)(C)

www .qeogroup .com
This email and any files transmitted with it are confidential and are intended solely for the use
of the individual or entity to which they are addressed. If you are not the intended recipient or
the pe rson responsible for delivering the em a il to the intended re cipient, be advis ed that your
have received this email in error and that any use , d issemin ation , forwarding, printing or
copying of this email is strictly prohibited . If you have received this email in error, please
immediately notify by replying to this email.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000343
2019-ICLl-00051 2388



From:

!(b)(6); (b)(?)(C)

Sent :

25 Nov 2018 17:48:25 +0000
l(b)(6); (b)(7)(C)
!Wilcox, Bryan S
Kb)(6); (b)(7)(C)
Uennings, David
RE: D/T Amar #216269802

To :

Cc:
Subject:

wj (b)(6); (b)(7)(C)

~-----------~

Just sent it.

omes 1c pera ions Desk Officer-West (Los Angeles & Seattle)
HQ- Enforcement and Removal Operations
(b)(6); (b)(?)(Cl
Desk
Mobile
b)(6); (b)(?)(C)

Warning: This document is UNCLASSIFIED//FOROFFICIALUSE ONLY (U//FOUO). It contains information that may be exempt from public
release under the Freedom of Information Act {5 U.S.C. 552). It is to be controlled, stored, handled, transm itted, distributed, and disposed of
in accordance with DHS policy relating to FOUO information and is not to be released to the public or other personnel who do not have a
valid "need -to -know" without prior approval of an authorized DHS official. No portion of this report shou ld be furn ished to the media, either
in written or verbal form.

Froni (b)(6); (b)(?)(C)

Sent : Sunday, November 25, 2018 12:46 PM
!Wilcox, Bryan

Tok bl( 6l; (bl( 7l (Cl

~ennings, David W

Cc:l(b)(6); (b)(?)(C)

(b)(6); (b)(?)(C)

b)(6); (b)(7)(C)

l(b)(6); (b)(?)(C)

Subject: RE: D/T Amar #216269802
Can you forward that?

perations - West

er 25, 2018 12:45 PM
W ilcox, Bryan S

Cc:(b)(6); (b)(?)(C)

ennings, David

b)(6); (b)(?)(C)

w (b)(6); (b)(?)(C)

b)(6); (b)(?)(C)

Subject: RE: D/T Amar #216269802

I was just sent a version perhaps using that one.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000344
2019-ICLl-00051 2389



Fr omj (b)(6); (b)(7)(C)

Date: Sunday, Nov 25, 2018, 12:41 PM
To: Wilcox, Bryan S ~l
(b-)(-6)-; (-b)-(7-)(_C_) -----------------------~

!Jennings, David W

Cc* b)(6); (b)(7)(C)
r b)(6); (b)(7)(C)

Subject: RE: D/T Amar #216269802

I'm going to start cleaning this up so we can move it forward ASAP. I'll incorporate the responses from
IHSCthat came in also. Please let me know when notification is made to the consula t e/ embassy. We'll
need a time/ date/ method.
Thanks.
!(b)(6); (b)(7)(C)

ERO Domes tic Operations - West
Unit Chief
l(b)(6); (b)(7)(C)

From: Wilcox , Bryan S

Sent : Sunday, November 25, 2018 11:36 AM
To (b)(6); (b)(7)(C)

Cc (b)(6); (b)(7)(C)

Jennings, David W

b)(6); (b)(7)(C)

Importance: High

Here's the latest.
It will need to be looked at by IHSC here locally for some clarity on Amar's seg st atus (see commen t s on
page 4).
One thing needing to be done at this point is contacting the Russian Embassy. Will that be covered by
RIO or do you want us to attempt t o do that here? (and does someone have a fax numbe r with which to
do that?)

From~(b)(6); (b)(7)(C)

Sent : Sunday, November 25, 2018 7:42 AM
To : Wilcox, Bryan S l(b)(6); (b)(7)(C)
Cd (b)(6); (b)(7)(C)
..,.
<b,..
l<..,
6l_: <__
bl..,
<7,;,;
l<..,
c ._
l _____
(b)(6); (b)(7)(C)

.._e
_n_n__,
ings, David W ....
l<b_)(_6)_; (_b)_(7_)(_C_) _____________

___,

Subject: RE: D/T Amar #216269802

Good morning Mr . Wilcox,

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000345
2019-ICLl -00051 2390



Mr. Jennings is inquring on the eta for the DDN? Can you provide a status?
Thank you

Fromf b)(6); (b)(7)(C)

Date: Sat urday, Nov 24, 2018, 9:28 PM
To: Wilcox, Bryan s JPYb)(6); (b)(7)(C)

!Jennings, David W

r b)(6); (b)(7)(C)

Subject: RE: D/T Amar #216269802
Thank you,
Please provide the updated detainee death notice first thing in the AM.
If you need any additio nal information please let me know,

Thanks

l(b)(6); (b)(7)(C)

Unit Chief
Domest ic Operations West
202 - 2otj (bl( 6l; ~.

I

Sent with BlackBerry Work
(www .blackberr y.com)

(b)(6); (b)(7)(C)

Subject: FW: D/T Amar #216269802
This from GEO. I am expecting the hospital should be gett ing in touch w ith IHSCshortly

Sent w ith BlackBerry Work
(www. blackberry .com )
Fromf b)(6); (b)(7)(C)

Date : Saturday, Nov 24 , 2018, 6:16 PM

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000346
2019-ICLl-0005 1 239 1



From:
Sent :
To:
Cc:
Subject:

ov
:47:47 +0000
Wilcox, Bryan sfb)(6); (b)(7)(C)
fb)(6); (b)(7)(C)
RE: D/T Amar #216269802

At first glance, we still need to know when the hospital tool AMAR off life support, when they
pronounced him dead and when they notified ICE. The ESjumps straight from the family authorizing
removal of life support to him being dead.
l(b)(6); (b)(7)(C)

I

ERO Domestic Operations - West
Unit Chief

fb )(6); (b)(7)(C)

From: Wilcox, Bryan S
Sent : Sunday, November 25, 2018 12:42 PM
T{ b)(6); (b)(7)(C)
ennings, David W b)(6); (b)(7)(C)

Subject: RE: D/T Amar #216269802

10-4
From~(b)(6); (b)(7)(C)
Sent : Sunday, November 25, 2018 9 :41 AM
To: Wilcox, Bryan S (b)(6); (b)(7)(C)
(b)(6); (b)(7)(C)
ennings, David Wkb\/6\ /b\/7\/C\
l(b)(6); (b)(7)(C)
Subject : RE: D/T Amar #216269802
I'm going to start clean ing this up so we can move it forward ASAP. I'll incorpo rate the responses from
IHSC that came in also . Please let me know when notification is made to the consulate/ embassy. We'll
need a time/ date/ method.
Thanks .
fb)(6); (b)(7)(C)
ERO Domesti c Operations - West
lfnit CbieC

l(b)(6); (b)(7)(C)

From: W ilcox, Bryan S
Sent : Sunday, November 25, 2018 11:36 AM
Toj (b)(6); (b)(7)(C)
Cc (b)(6); (b)(7)(C)
b)(6); (b)(7)(C)

Jennin s David W

Subject: RE: D/T Amar #2 16269802
Importance: High

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000347
2019-ICLl-0005 1 2392



From :

Wilcox, Bryan S

Sent:

25 Nov 2018 03:09:09 +0000

To:

Asher, Nathalie R
RE: D/T Amar #216269802

Subject:

??

Sent with BlackBerry Work
(www .blackbe rry.com)
From: Asher, Nathalie R fb)(6); (b)(7)(C)
Date: Saturday, Nov 24, 2tJ
t..-IrT8.-, ..,.7
:,0TT"u-nP....,., M.-----~
To: Wilcox, Bryan S _l
<b_)(6~)~
; (b_)(=7)~(C
~)~-----~
Subject : RE: D/T Amar #216269802

I did . Was very hard to leave but I'll be home for good soon!

Sent with BlackBerry Work
(www .blackben-y .com)
From : Wilcox, Bryan S ._f
b_)(6_);_(b_)(_7)_(C_) _____
Date: Saturday, Nov 24, 2018, 9:52 PM
To: Asher, Nathalie R i,.;,(b..,..,.
)(6,,.,...)
;....,.
(b?"""'
)(=
7)=
(c.,....
) --------,
Subject: RE: D/T Amar #2 16269802

___.

Yep,
I hope you had some rest and relaxation!

Sent with BlackBerry Work
(www.blackberry.com)
From : Asher, Nathalie R j{b)(6); (b)(7)(C)
Date: Saturday, Nov 24, 2.,..U..,18
....
,-.-6-.
:5..,.1..,..P""
M..------~
To: Wilcox , Bryan Sl(b)(6); (b)(7)(C)
Subject: RE: D/T Am
_a_r.....,#.,...2
T,
l 6,..,.2
..,.
6=9g
,.....,o..,.,
2,------~

Just touched down in DC. Sad but it had to come to an end.
Thx Bryan .

Sent with BlackBe n-y Work
(www .blackben-y .com)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000348
2019-ICLl-00051 2393



Fro m :

(b)(6);

Sent:

25 Nov 2018 21:38:39 +0000
rb)(6); (b)(7)(C)

To:

I

b)(6);(b)(?)(C)

(b)(6); (b)(?)(C)

tvVilcox, Bryan

----:--.===::::::;::===::::;::=:;=:============;:-----------~
S;~b)(6);(b)(?)(C)
!
Subject:

Re: D/T Amar #216269802

Approximately
1330hrs., 11 -25 - 18, I was informed by Office )~~)
~~ir., that Mr.K~.b~)<6
~);=
. ~~
had dropped off this detainees 203. Detainee was then removed from our facility head
count.

New head count is 1310. She was instructed

doing anything

with his property

by Mr.

~()~(;r,

to hold off on

at t h is time.

From: b)(6); (b)(7)(C)
Se nt:

ovember 24, 2018 6:15:39 PM

To:fb )(6); (b)(?)(C)

I

(b)(6); (b)(?)(C)

b)(6); (b)(?)(C)
t;:-b"'
)(6
");-;;:
-'.(b'.";";
)("'7
),,,
(C"")--------,_I

!Bryan S Wilcox;

___________

1\~)\~t-,I

_J

Subject: D/T Amar #2 162698 02
at 1754 hours i was informed

by D/O

~(i~(ir'.,that

the hospital staff had got authorization

to remove D/T Amar from the ventilator. at approx 1805 D/T Amar was pronounced
6);
6);
dead by hospital staff. at approx 1810 Officer (b)(
nd (b)(
ere instructed to
f h ){7\tr.\
,..._
,,7,,r-,
stand down the hospital watch . AW

~ii~i
r not ified

by phone

ergeant

GEO Corrections

& Detention

Northwest Detention
16 23 East J Street
Tacoma, Washington

(R)

Center

98421

rb)(6); (b)(7)(C)
www.geogroup.com
This email and any files transmitted with it are confidential and are intended solely for the use
of the individual or entity to which they are addressed . If you are not the intended recipient or
the person responsible for delivering the email to the intended recipient, be advised that your
have received this email in error and that any use, dissemination, forwarding, printing or
copying of this email is strictly prohibited . If you have received this email in error, please
immediately notify by replying to this email.

AMERICA~

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000349
2019-ICLl-00051 2394



From :

W ilcox, Bryan S
19 Nov 2018 16:53:24 +0000

Sent:
To :

I

l<b)(6); (b)(7)(C)

Subject :

RE: Hosp ital ICU Updat e A# : 216269802

Call logs for AMAR.
We are assuming this is current common-law wife. It seems he mostly calls from Friday
to Sunday, his longest calls were around noon or so local time.
.!4:UU

.!lb.!b\lijU.!

H:S

H. :S seg p11one 1

11/ 04/ 2018 09: 23

11, ~nuu,

uo:n

23:00

216269802

HJ

H- 3 Seg phone 1

11/04 / 2018 09:19

03:02

216269802

HJ

H-3 Seg phone 1

10/27 / 2018 19:10

24:00

216269802

Medical Medical o ISO Cordless

10/13 / 2018 19:51

00:42

216269802

Medical

Medical o ISO Cordless

10/ 13/ 2018 19:39

09:19

216269802

Medical

Medical o ISO Cordless

10/12/2018

2 1:24

13:00

216269802

Medical Medical o ISO Cordless

10/12/2018

2 1:22

01:41

216269802

Medical Medical o ISO Cordless

voice unverified

10/ 12/ 2018 21:21

01:38

216269802

Medical

Medical . ISO Cordless

voice unverified

10/12/20 18 2 1:19

01:18

216269802

Medical Medical o ISO Cordless

voice unverified

10/12/2018

2 1:17

0 1:26

216269802

Medical

Medical . ISO Cordless

voice unverified

10/ 12/ 2018 21:15

01:25

216269802

Medical

Medical . ISO Cordless

voice unverified
voice unverified

b)(6); (b)(7)(C)
no answer

no answer

l!J

j!I

'I}) Ill.

G
G
G
G
G
G
G
G
G

?I

4>>Ill.

?I

4>
) Ill.

'

4>>
4>>

G

01:56

216269802

Medical

Medicalo ISO Cordless

10/12/2018

18:59

45:00

216269802

Medical

Medical . ISO Cordless

10/ 07/ 20 18 09:07

12:00

216269802

Medical

Medical - ISO Cordless

10/ 07/ 2018 09:00

02:35

216269802

Medical

Medical o ISO Cordless

10/ 07/ 2018 08:58

01:36

216269802

10/ 07/ 20 18 08:57

00:52

216269802

10/ 07/ 2018 08:55

01:40

216269802

Medical Medical o ISO Cordless

voice unverified

Gl

10/ 07/ 2018 08:5 1

03:35

216269802

Medical

Medical o ISO Cordless

failed

G

G ~
G ?I
failed

G

Medical Medical o ISO Cordless

voice unverified

Medical

no answer

G
G

Medical - ISO Cordless

Ill.

G
G

10/ 12/2018 21:13

--

Ill.

Cl>
) !!!

4>>Ill.

10/ 07/ 2018 08:50

00:2 4

2 16269802

Medical

Medical - ISO Cordless

incomplete

G

10/ 07/ 2018 08:47

00:24

216269802

Medical

Medicalo ISO Cordless

incomplete

10/ 07/ 2018 08:44

00:25

216269802

Medical

Medical o ISO Cordless

incomplete

G
G

10/ 07/ 2018 08: 22

11:00

216269802

Medical

Medical - ISO Cordless

G

r

4>>

)9/ 30/ 2018 06:43

12:00

216269802

Medical Medical o ISO Cordless

~

4>
) Ill.

)9/ 28/ 2018 18:47

11:00

216269802

Medical

Medical o ISO Cordless

G
G

~

Ill

)9/ 28/2018 18:44

02:03

216269802

Medical

Medical - ISO Cordless

)9/ 22/2018 06:05

19:00

216269802

D3

D3. 3

)9/ 15/ 2018 07:34

04:36

216269802

Medical

Medical o ISO Cordless

)9/ 15/ 2018 07:32

02:01

216269802

Medical Medical o ISO Cordless

voice unver,fied

,voice unver>fied

Ill.

4>>

Gl

~ ?I
G ISi
~

@ Ill.

4>>

Ill

Bryan S. Wilcox
Act ing Field Office Directo r
ICE Enforcement & Removal Operations , Seattle , WA
f b)(6); (b)(7)(C)

CONFIDENTIALITY : This emai l a nd attachme nts are intended for the above name only and are confidential. l f you are not the inte nded
addres see, or the pe rson res pons ible for deliveri ng it to the intended addressee, you may neither copy, di sseminate, nor d istr ibute it to anyone

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000350
2019-ICLl-00051 2395



From :

l(b)(6); (b)(?)(C)

Se nt:

20 Nov 2018 16:53:57 +0000

To:

fb)(6); (b)(?)(C)

Cc:
Subje ct:

Wilcox, Bryan S
RE: email from IHSCHQ

I

Works for me too.

I

CAPTl(b)(6); (b)(?)(C)
LCSW-C, BCD
Health Services Administrator
USPHS
ICE Health Service Corps
Northwest Detention Center
1623 E. J St. Suitq(b)(6);1
Tacoma, WA 98421
Office (b)(6); (b)(?)(C)
BB :(b)(6); (b)(?)(C)
Fax
(b)(6); (b)(?)(C)
Warning: This document is UNCLASSIFIED //FOR OFFICIAL USE ONLY (U//FOUO) . It
contains information that may be exempt from pub lic release under the Freedom oflnfo rmation
Act (5 U.S.C. 552). It is to be controlled, stored, handled, transmitted, distributed, and disposed
of in accordance with DHS policy relating to FOUO information and is not to be released to the
public or other personnel who do not have a valid "need-to-know" without prior approval of an
author ized DHS official. No portion of this report should be furnished to the media, either in
written or verbal form.
From~(b)(6); (b)(?)(C)

Se nt: Tuesday, November 20, 2018 8:37 AM

L

T9(b)(6); (b)(7)(C)

~J

Cc: Wilcox, Bryan ~~
(0_)(6
_);_(o
_)(_r)_(C_) _______________________
Subject: RE: email from IHSCHQ
Bryan is leaving the field office around 0900 . Let's all meet in my office at 0930 if that works for you.

From~(b)(6); (b)(?)(C) I
Sent : Tuesday, November 20, 2018 8:32 AM
To: (b)(6); (b)(7)(C)
ilcox, Bryan S
b)(5); (b)(?)(C)
Subject: RE:email from IHSCHQ

b)(5); (b)(?)(C)
~---------~

I am available anytime this morn ing.
(b)(6);

(b)(?)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000351
2019-ICLl -00051 2396



From *b)(6); (b)(7)(C)

Se nt : Tuesday, November 20, 2018 8:31 AM
m:
T~o1rt:
f'."'iib
);;-;:
(6(7')
;w
(b")
(7_)(_C)_______
---,____
j(b)(6); (b)(7)(C)

~b
_)(6_);_(b_)(_7)_(C_) ______
_.1IWilcox,Bryan~.....

_,

Subject: email from IHSCHQ

All
'

(b )(6);

Please see message from Dr1h11111r.1
V/R,

below. Can we please meet ASAP!

I

CAPTl(b)(6);(b)(7)(C)
LCSW-C, BCD
Health Services Adm inistrato r
USPHS
ICE Health Service Corps
Northwest Dete ntion Cente r
1623 E. J St. Suite ~
Tacoma, WA 98421
Office (b)(6); (b)(7)(C)
BB :(b)(6); (b)(7)(C)
Fax
(b)(6); (b)(7)(C)
Warning: This document is UNCLASSIFIED //FOR OFFICIA L USE ONLY (U//FOUO) . It
contains information that may be exempt from public release under the Freedom oflnformation
Act (5 U.S.C. 552). It is to be controlled , stored , handled , transmitted, distributed, and disposed
of in accordance with DHS policy relating to FOUO information and is not to be released to the
public or other personnel who do not have a valid "need-to-know" without prior approval of an
authorized DHS official. No portion of this report should be furnished to the med ia, either in
written or verbal form.
Froml(b)(6); (b)(7)(C)

Subject : Can you call me when you can?

CAP1b)(6); (b)(7)(C)
I know you're probably finishingmorning report. I'm reviewingthe death notification draft from EROfor
Mr. Amar. I don't think Mr. Wilcox may not understand the significanceof Mr. Amar being declared
brain dead on 11/18 at 2:45 pm-that that is effectivelyhis date of death for the death cerficate.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000352
2019-ICLl -00051 2397



I know there can be some confusion with physical death (removal of life support and cessation of
breathing and heart beat) and brain death (the legal determination of the time/day of death that can
permit actions such as organ harvesting or other legal matters to proceed.
If just want to verify if EROand OCCare aware that he is "dead " for all intents and purposes? They're
just continuing life support measures for the next of kin notification .
Thanks
Fromj (b)(6); (b)(?)(C)

Sent: Monday, November 19, 2018 10:14 PM
b)(6); (b)(?)(C)

Name: Amar, Mergensana
Hospital day #5 in ICU
A#:216269802
DOB: I 0/23/ 1978
COB: Russia
DOA: 12/19/2017
Relevant Medical History: Was on self-impo sed Hunger Strike but began eating
three meals a day with liquid nutritional supplements
Reason sent to ER: CPR initiated due to asphyxiation from self harm (hanging)
and transferred to ICU when pulse achieved.
Current Status: No changes from previous update. Detainee had massive anoxic
brain injury. He was pronounced brain dead yesterday 11/ 18/18 at 1445. He
remains non-responsive and intubated with stable vital signs. He is on 1 medication
(levafed) to support his blood pressure.
Location: St. Joseph's ICU Room 6B6 #253-426-6728
Attending physician: Dr. ~=
(b)(6); __
..........
.__-~
Information received from: RN~ )(~\
CAP~(b)(6); (b)(?)(C)

IMO USPHS

Deputy Medical Directo r
ICE Health Service Corps/ERO/ICE/OHS
610 W. Ash St. b)(6): San Die o CA 92 101
(b)(6); (b)(?)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000353
2019-ICLl-00051 2398



l(b)(6); (b)(7)(C)

From :

Sent :

20 Nov 2018 18:42:15 +0000
Wilcox. Bryan S

To :

r b)(6); (b)(?)(C)

Cc:
Subject:

RE: email from IHSC HQ

Sir,
ent it up aga in. Let me see if I can get a copy right over your office to update.

,.......>-L......L...l

.................

(b)(6); (b)(?)(C)

e 10ns Desk Officer-West (Los Ange les & Seatt le)
.....,
,ent and Remova l Operat ions
Desk
Mobile

(b)(6); (b)(7)(C)

Warning : This document is UNCLASSIFIED//FOR OFFICIAL USE ONLY (U//FOUO). It contains info rmation that may be exempt from public
release under the Freedom of Infor mation Act (5 U.S.C. 552) . It is to be controlled, stored, handled, transmitted , distr ibuted, and disposed of
in accordance with OHS policy relating to FOUO information and is not to be released to the public or other personnel who do not have a
valid "need-to-know" without prior approval of an authorized OHS official. No portion of thi s report should be furn ished to the media, either
in written or verbal form.

From : Wilcox, Bryan S

Sent : Tuesday, November 20, 2018 1:37 PM
To:l (b)(6); (b)(7)(C)

Cc:
Subject : FW: email from IHSC HQ
(b)(6);
/ h\/7\/r\

Please see below.
According to IHSCand 0PLA, our detainee was officially "dead" (brain dead but on life support)
on 11/18/18 at 2:45pm.
According to our notification policy, we have to have the death notification within 48 hours of
the death. So our notice is due by 2 :45pm our time (in 4 hours). Have you worked on the
draft? We need to get that finalized and submitted.

Bryan S. Wilcox
Acting Field Office Director
ICE Enforcement & Removal 0 erations, Seattle, WA
(b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000354
2019-ICLl-00051 2399



CONF IDENTIALITY: This email and attachments are intended for the above name only and are confidential. If you are not the
intended add ressee , or the person respons ible for deliver ing it to the intended addressee, you may neither copy, disseminate, nor
distribute it to anyone else or use it in any unauthorized manner. To do so is strictly prohibited and may be unlawful. If you receive
this email by mistake, please advise the sender immediate ly by using the reply faci lity in your mail software and delete it from your
computer.

Fromf

b)(6); (b)(7)(C)

I

Sent: Tuesday, November 20, 2018 10:29 AM
To: Wilcox, Bryan S ~b)(5); (b)(?)(C)

Cc: l(b)(6); (b)(7)(C)
Subject : FW: email from IHSCHQ

Bryan,

11/18/18 is the date of death and you need to initiate the death notications.

Sent with BlackBerry Work
(www.blackberry .com )
From:f b)(6); (b)(7)(C)

Date : Tuesday, Nov 20, 2018, 10:20 AM

Subject: RE:email from IHSCHQ
(b)(6);
/ h \/ 7 \/ 1.\

(b)(5)

Add in b)(6); (b)(7)(C)

as well for fu rthe r clarification.

Thanks,
r b)(6); (b)(7)(C)

Asso ciate Legal Advisor

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000355

20 19-ICLl-00051 2400



Enfor cement Law Section
Enforce ment and Remova l Operat ions Law Division
Office of the Principa l Legal Advisor
U.S. Immigration and Customs Enforcement (ICE)
500 12th Street, S.W.
Washing ton, D.C.200 24
(b)(6); (b)(7)(C)

*** W arning *** Attorney/Client Privilege *** Atto rney Work Produ ct***
This communication and any attachments may conta in confidential and/or sensitive attorney/cl ient privileged
information or attorney work product and/or law enforcement sensitive information. It is not for release, review,
retransmission, dissem ination, or use by anyone other than the intended recipient. Please notify the sender if this
email has been misdirected and immediate ly destroy all originals and copies. Furthermore do not print, copy, retransm it, disseminate, or otherw ise use th is information. Any disclosure of th is communication or its attachments
must be approved by t he Office of the Principal Legal Advisor, U.S. Immigration and Customs Enforcement. This
document is for INTERNALGOVERNMENTUSEONLYand may be exempt from disclosu re under the Freedom of
Informat ion Act, 5 USC?? 552(b)(S), (b){7).
Froml (b)(6); (b)(7)(C)

I

Sent: Tuesday, November 20, 2018 1:07 PM

Subject: RE:ema il from IHSCHQ
(b)(6);
(b)(7)(C )

I'm meet ing with EROand IHSC.
Hospital has declared him deceased. Death cert will repo rt 11/18/18 as date of death . Hospital reports
thre has been no contact with family. Hospital is planning to turn off life support this afternoon.
(b)(S)

Sent with BlackBerry Work
(www.blackberry .com)
From :f b)(6); (b)(7)(C)

Pate: TuesdayNov 20 2018 8'40 AM
1~)
(6);
(b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000356
2019-ICLl-00051 2401



Subject: RE: email from IHSC HQ
(b)(6);
l h\( 7\fr'.\

I'll consult with OPLA but, in the interim, can we inquire as to whether the hosp ital has forma lly
pronounced the detainee as deceased? The ir determination has pr iority here.
Regards ,
r b)(6); (b)(?)(C)

Associate Legal Advisor
Enforcement Law Section
Enforcement and Removal Operations Law Division
Office of the Principal Legal Advisor
U.S. Immigration and Customs Enforcement (ICE)
500 12th Street, S.W.
Washington, D.C. 20024

1~

)(6); (b)(7)( C)

*** Warning *** Attorney/Client Privilege *** Attorney Work Product***
This communication and any attachments may contain confidential and/or sensitive attorney/client privileged
information or attorney work product and/or law enforcement sensitive information. It is not for release, review,
retransmission, dissemination, or use by anyone other than the intended recipient. Please notify the sender if this
email has been misdirected and immediately destroy all originals and copies. Furthermore do not print, copy, retransmit, disseminate, or otherwise use this information. Any disclosure of this communication or its attachments
must be approved by the Office of the Principal Legal Advisor, U.S. Immigration and Customs Enforcement. This
document is for INTERNALGOVERNMENTUSEONLYand may be exempt from disclosure under the Freedom of
Information Act, 5 USC?? 552(b){5), (b)(7).

From:l(b)(6);(b)(?)(C)

I

Sent : Tuesdav November 20 2018 11:35 AM
(b)(6); (b)(?)(C)

Subject: FW: email from IHSC HQ
Import ance: High

i~\i~\icl

Dr
is pointing out that when Amar was pronounced brain dead yesterday, that is the official
date o eat . Should ERO be using the 11/18/18 14:45 date and time as the officia l date and time of
death for all reporting purposes?
(b)(6);
f L.-.\1 "? \lr'>\

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000357
2019-ICLl -00051 2402



I

f b)(6); (b)(7)(C)

From:

29 Nov 2018 00:43:16 +0000
Wilcox, Bryan ~_ic_6J.,..
;C
_bl_c1_ic_c _i --,-...,..,.-,_ .....
RE:follow-up questions on the Northwest Detention Center

Sent:

1...

To:

Subject:

Thanks . Not unexpected . I'll make sure ADFO is aware and giv

\~!\~l;r,

heads up.

Sent with BlackBerry Work
(www .blackbe rry.com)
From: Wilcox, Bryan S l~(b~)(6~)~;(~b)~(7~)(C~)------~
Date: Wednesda: Nov 28 2018 7:35 PM

t~'::::
o::,.

rn=w-up

q~oum~

ou n~ ,ommw"'

oucmron

cunu

FYSA...
Local media gearing-up for negative coverage.

i~\i
~\cci
is checking with her leadersh ip on whether we will even try to respond to this.
It appears the reporter has documents from a FOIA... from February of this year.
Amazing how something can be taken out of context and twisted

Bryan S. Wilcox
Acting Fie ld Office Director
IC E Enforcement & Removal O erations Seattle. WA
(b)(6); (b)(7)(C)

CONFIDENTIALITY: This ema il and attachments are intended for the above name only and are confidentia l. If you are not
the intended addressee, or the person responsible for delivering it to the intended addressee , you may neither copy,
disseminate, nor distribute ii to anyone else or use ii in any unauthorized manner. To do so is strictly prohibited and may
be unlawful. If you receive this email by mistake, please advise the sender immed iately by using the reply facility in your
mail software and delete it from your computer.

Sent: e nes ay, ovember 28, 2018 4:12 PM
To: Wilcox, Bryan ib )(6); (b)(7)(C)
rb)(6); (b)(7)(C)

Subject: FW: follow-up questions on the Northwest Detention Center
Importance : High

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000358
2019-ICLl-00051 2403



FYSA
Fromj(b)(6);(b)(?)(C)
Sent: Wednesday, November 28, 2018 4:01 PM

Tq(b)(6); (b)(?)(C)
Subject: follow -up questions on the Northw est Deten tion Center

(b)(6);
(b)(?)(C)
Just tried to reach you by phone . It's taken me a while to go through various material. It would
be great to ta lk by phone . But let me lay out some questions by email:
What steps does the detention center take when it judges someone is suicidal?
Would someone be stripped of clothing?
Would someone be put in isolation?
I have seen a handwritten note from Mr. Amar saying both those things happened to him . If this
is true, could you explain the reasoning behind these measures?
I have also seen a complain to DHS's Office of Inspector General related to another case, from a
detainee claiming that he witnesses a mentally-disturbed man being pepper sprayed and
thrown into the shower with handcuffs on . I am attaching that letter, from Mi laudi Karboau. If
true, could you explain the reasoning?
I have seen an email fro~ (b)(6); (b)(?)(C)
~ryan Wilcox refe r ring to a hunger strike underway
in February. It says: "So it has pete red out to some degree and we 've narrowed down to
individual detainees who we will likely single out when they have been observed missing their
9th meals and asked to move to a cell where we can take away commissary and start a real
hunger strike protocol. "
Does th is mean peop le are being singled out to be put in isolation? If not , what does it mean
and what it the hunger strike protocol?
I am also attaching a lette r from Governor Inslee raising a number of health and safety concerns.
Can you respond to them?
Thanks,
(b)(6); (b)(?)(C)

Seattle Times reporter
tb)(6);(b)(?)(C)
J

I

Twitter : ~(b)(6); (b)(?)(C)
http://www.seatt letimes .com/autho db)(6); (b)(?)(C)

t

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000359
2019-ICLl-00051 2404



Sent :

Wilcox, Bryan S
21 Nov 2018 17:19:39 +0000

Subject :

RE: For your approval

From :

Will do
Bryan S. Wilcox

Acting Field Office Director
ICE Enforcement & Removal Operations , Seattle , WA
l(b)(6); (b)(?)(C)

CONF IDENTIALITY: This email and attachments are intended for the above name only and are confidential. If you are not the
intended addressee, or the person responsib le for delivering it to the intended addressee, you may neither copy, disseminate, nor
distribute it to anyone else or use it in any unauthorized manner. To do so is strictly prohibited and may be unlawful. If you rece ive
this email by mistake, please advise the sender im mediately by using the reply facility in your mail software and delete it from your
computer.

Froml (b)(6); (b)(?)(C)
Sent : Wednesday, November 21, 20 18 8 :52 AM
To: Wilcox , Bryan S fb)(6); (b)(?)(C)

r

)(6); (b)(7)(CJ

Subject: RE: For your approval

Thanks Bryan.

I am out on annua l leave. Can you addKb)(6); (b)(?)(C)

Ion any up dates? Thanks.

Sent with BlackBerry Work
(www.blackberry.com )
From: Wi lcox, Bryan s l(b)(B); (b)(?)(C)
Dat e:Wednesday, Nov....,..
21~,~2~0=1-s
-,=7~:3-s
~A~M
--r------'
(b)(6); (b)(?)(C)

10-4

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000360
2019-ICLl-00051 2405



Also know that both the Russian Embassy/Consulate in DC and the hospital, have been in touch
with the parents.
I received an IM at midnight last night from Dr. ~)\~)
;"' the person who will ultimately make the
decision on ending life support, advising that he had made contact (on a conference call with,
presumably, interpreters) with the parents and 11 it will take a few more conversations to
reconcile"
11

A couple hours later, I received an email from our attache in Warsaw that The consulate has
been in contact with both the parents and the common-law wife. The parents do not have the
ability to come to the United States and getting a visa can take up to 300 days. The Head
Consul stated he will give me another update soon as to the family's wishes."
So the likelihood is that a decision of life support could take a few more days as the hospital
tries to continue their conversation with the parents.

Bryan S. Wilcox
Acting Field Office Director

ICEEnforcement & Removal Operations. Seattle, WA

l(b)(6); (b)(7)(C)

CONF IDENTIALITY: This email and attachments are intended for the above name only and are confidential. If you are not the
intended addressee , or the person responsible for deliver ing it to the intended addressee, you may neithe r copy, dissem inate , nor
distribute it to anyone else or use it in any unautho rized manner. To do so is strictly proh ibited and may be unlawful. If you receive
this emai l by mistake, please advise the sende r immediate ly by using the reply faci lity in your ma il softwa re and delete it from you r
computer.

From b)(6); (b)(7)(C)

Sent : We nes ay, November 21, 2018 7:16 AM
To: Wilcox, Bryan S fb )(6); (b)(7)(C)

I

(b}(6); (b}(7)(C)

Subject : RE: For your approval

FYSA, the release won't go out unti l Amar is removed from life support .

Regards,
f b)(6); (b}(7)(C)

Public Affairs Officer/Spoke sperson
Alaska, Idaho, Orego n, Was hington State

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000361
2019-ICLl-0005 1 2406



U.S. Immi ration & Customs Enforcement
Cell: b)(6); (b)(7)(C)
From: Wilcox, Bryan S ....
~b.,,..
)(.,,..
6).,...,
; <,....
b)-=
(7....,
)(=
C....,
) ,,...,....,.-------'
Date: Tuesday, Nov 20, 20 18, 5:53 PM

l"''o

(b)(/)(C)

Subject : RE: For your approval

Nope

Sent with BlackBerry Work
(www.blackberry.com )
Fromj(b)(6); (b)(7)(C)
Date : Tuesday, Nov 20, 20 18, 4 :16 PM
To: Wilcox , Bryan K_
b_)(6
_)_;(_b)_(7_)(_
C)_______

~

Subject : RE: For your approv al

Do you have any more internal background info?
From : W ilcox, Bryan S
Sent : Tuesday, Nov ember 20, 2018 4 :04 PM
(b)(6); (b)(7)(C)

::>UoJ
ec-c r. c:: r-or your approva 1

Corrected name spelling and a few ot her things. Good to go.
Bryan S. Wi lcox
Acting Field Office Director
ICE Enforcement & Removal Operations , Seattle, WA
~b)(6); (b)(7)(C)

CONFIDENTIALITY: This email and attachments are intended for the above name only and are confidential. If you are not the
intended addressee, or the person responsible for delivering it to the intended addressee, you may neither copy, disseminate, nor
distribute it to anyone else or use it in any unauthorized manner. To do so is strictly prohibited and may be unlawful. If you receive

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000362
2019-ICLl -00051 2407



this email by mistake, please advise the sende r immediate ly by using the reply faci lity in your ma il softwa re and delete it from you r
computer.

Froml(b)(6); (b)(7)(C)
Sent: Tuesday, November 20, 2018 3:44 PM
To: Wilcox, Bryan ~ (b)(6); (b)(7)(C)

r

)(6); (b)(7)( C )

Subject: For your approval
Importance: High

Thanks again eve1yone! B1yan, for your approval. Note ..I think it's impo1tant that we say he was
in protective custody because the media has hied to spin that as if we were torturing him in seg.

ICE detainee passes away at Saint Joseph's Medical Center
(b)(5)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000363
2019-ICLl-0005 1 2408



From: Wilcox, Bryan S
Sent : Tuesday, November 20, 2018 3:33 PM

Subject: RE: Press Release info needed

I don't see the need for dates.
Bryan S. Wilcox
Acting Field Office Director
ICE Enforcement & Removal Operations , Seattle, WA
fb )(6); (b)(?)(C)

CONF IDENTIALITY: This email and attachments are intended for the above name only and are confidential. If you are not the
intended addressee, or the person respons ible for delivering it to the intended addressee, you may neither copy, dissem inate, nor
distribute it to anyone else or use it in any unauthorized manner. To do so is strictly proh ibited and may be unlawful. If you receive
this emai l by mistake , please advise the sender immediately by using the reply faci lity in your ma il softwa re and delete it from you r
computer.

Sent: ues
To: W ilc ox, Bryan

r 20, 2018 3:30 PM
; )(?)(C)

(b)(6); (b)(?)(C)

So are we good with that, or do you want dates for PC?
From: W ilc ox, Bryan S
Sent : Tuesday, November 20, 2018 3:29 PM
r )(6J; (b)(7)(C)

Subject: RE: Press Release info needed

If we even address that, I think it best to state that:
"At the time of his attempted suicide, Amar was in voluntary protective custody at his request"

At the time of his death, ICE had an administrative order of removal for Amar and was making
arrangeme nts for his repatriation to Russia per the immigration judge's order of remova l.
Departm ent of Homeland Security databases show no prior immigration history for Amar.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000364
2019-ICLl-00051 2409



Bryan S. Wilcox
Acting Field Office Director
ICE Enforcement & Removal Operations, Seattle, WA
~b)(6); (b)(7)(C)

CONFIDENTIALITY: This email and attachments are intended for the above name only and are confidential. If you are not the
intended addressee, or the person responsible for delivering it to the intended addressee, you may neither copy, disseminate, nor
distribute it to anyone else or use it in any unauthorized manner. To do so is strictly prohibited and may be unlawful. If you receive
this email by mistake, please advise the sender immediately by using the reply facility in your mail software and delete it from your
computer.

I

Froml (b)(6); (b)(7)(C)

Sent: Tuesday, November

20, 2018 3:16 PM

To: N<b)(6); (b)(?)(C)
b)(6); (b)(?)(C)

__.J
I Wilcox

[b-}/-6}_<_b_}<7-}<_c_>
tb)(6);
(b)(?)(C) ______________
....
Subject: RE: Press Release info needed
I would

think that it would

suffice to explain that in general

5

, Bryan

terms,

7

s.....
b_H_ l_; <
_b_l<_l_
<c_J_______

without

__.

citing dates.

From : l(b)(6); (b)(?)(C)

Sent: Tuesday

November

20 2018 3:15 PM

(b)(6); (b)(?)(C)

SubJect: RE: Press Release into needed
I' m not sure how you want to state this, so here it the events.
He was in the medical

housing

and no longer

to be in the MHU for medical

released

needed

to Genera l population,

unit and had been consuming
he requested

over

monitoring.

protective

custody.

1800 calories per day for several days ,

When

he was told he was going to be

He did not identify

the reason for this

request .

ILCSW-C, BCD
Health Services Admin istrator
USPHS
ICE Health Service Corp s
Northw est Detention Center
1623 E. J St. Suite~~/\~/,!
Tacoma, WA 9842 1
Office: l(b)(6); (b)(7)(C)
CAPT

l(b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000365
2019-ICLl-00051 2410



BB
Fa

(b)(6); (b)(?)(C)

(b)(6); (b)(?)(C)

Warning: This document is UNCLASSIFIE D//FOR OFFICIAL USE ONLY (U//FOUO). It
contains information that may be exempt from public release under the Freedom oflnformation
Act (5 U.S.C. 552) . It is to be controlled, stored, handl ed, transmitted , distributed , and disposed
of in accordance with DHS policy relating to FOUO information and is not to be released to the
publ ic or other personnel who do not have a valid "need-to-know" without prior approval of an
authorized DH S official. No portion of this report should be furni shed to the media, either in
written or verbal form.

Froml (b)(6); (b)(?)(C)

Sent : Tuesday, November 20, 2018 3:06 PM
(b)(6); (b)(?)(C)

_______________

(b)(6); (b)(?)(C)
....._

___,!Wilcox,

________

Bryan S j....._
(b)(6); (b)(?)(C)

I

~

Subject: RE: Press Release info needed

Thank you for your inputs everyone. Just need to know when and why he requested protective
custody and I think we are at the point we can sent to Bryan for review.

ICE detainee passes away at Saint Joseph's Medical Center
b)(5)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000366
2019-ICLl-00051

2411



(b)(5); (b)(7)(C)

From:

b)(6); (b)(7)(C)

Sent: ues
T~'!!'!')(~);~(b~)(-

S

, 2018 1:57 PM
__,c....:W..:..
i:..:..;lcox,
Bryan

________________________

(6);(b)(7)(C)

Absolutely!

ICE Health Service Corps
Northwest Detention Center
1623 E. J St. SuitJb)(6);i
Tacoma, WA 98421
Officd (b)(6); (b)(7)(C)
BB (b)(6); (b)(7)(C)
Fa
b)(6); (b)(
7)(C)
Warning: This document is UNCLASSIFIED //FOR OFFICIAL USE ONLY (U//FOUO). It
contains information that may be exempt from public release under the Freedom of Information
Act (5 U.S.C. 552). It is to be controlled, stored, handled, transmitted, distributed, and disposed
of in accordance with DHS policy relating to FOUO information and is not to be released to the
public or other personnel who do not have a valid "need-to-know" without prior approval of an
authorized DHS official. No portion of this report should be furnished to the media, either in
written or verbal form.
Fromfb)(6); (b)(7)(C)

I

Sent: Tuesday, November 20, 2018 1:57 PM

b)(6); (b)(7)(C)
Wilcox, Bryan S (b)(6); (b)(7)(C)

To:

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000367
2019-ICLl-0005 1 2412



rb)(6); (b)(7)(C)
Subject: RE: Press release info

Thank you Ma'a m
From

(b)(6); (b)(7)(C)

Sent: Tues

, 2018 1:56 PM

Tokb)(6); (b)(
S J(b)(6); (b)(7)(C)
Cc~ )(6); (b)(7)(C)

!Wilcox, Bryan

I

Su Jed: RE: Press release into
He began refus ing facility meals at lunch on 8/22/18 and began comsun ing the meal replacement drinks
along with the electrolyte fluids (Pedialyte) at lunch on 9/19/18 totaling 28 days of hunger strike .

CSW-C , BCD
mis ra or

ICE Health Service Corps
Northwest Detention Center
1623 E. J St. Suitel<b)(6>1
Tacoma , WA 98421
Office: (b)(6); (b)(7)(C)
BB (b)(6); (b)(7)(C)
Fa
l(b)(6); (b)(
7)(C)
Warning: This document is UNCLASSIFIED //FOR OFFICIAL USE ONLY (U//FOUO) . It
contains information that may be exempt from public release under the Freedom of Informat ion
Act (5 U.S.C. 552). It is to be controlled, stored, handled , transmitted, distributed, and disposed
of in accordance with DHS po licy relating to FOUO information and is not to be released to the
public or other personnel who do not have a valid "need-to-know" without prior approval of an
authorized DHS official. N o portion of this report should be furnished to the media, either in
written or verba l form.
From~(b)(6); (b)(7)(C)

Sent : Tuesday, November 20, 2018 1:51 PM

To:l(b)(6); (b)(7)(C)
Wilcox, Bryan Sj(b)(
6); (b)(
7)(C)
b)(6); (b)(7)(C)

I

Subject : RE: Press release info

Ok thank s. I'll need the dates he was on hunger strik e p lease .

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000368
2019-ICLl-0005 1 2413



Froml(b)(6); (b)(7)(C)
Sent : Tuesda , November 20, 2018 1:50 PM

(b)(6); (b)(7)(C)
S b)(6); (b)(
7)(C)
Cc:l(b)(6); (b)(7)(C)
Sub)ect: Rt: PressreleaseInto

To

)(6); (b)(7)(C)

Yes, he was

I

LCSW-C, BCD
CAP'Ifb)(5); (b)(?)(C)
Health Services Admini strator
USPHS
ICE Health Service Corps
Northwest Detention Center
1623 E. J St. Suit
Tacoma , WA 98421
Office: (b)(6); (b)(
7)(C)
BB :(b)(6); (b)(7)(C)
Fax
(b)(6); (b)(7)(C)

~ii~i;

Warning: This document is UNCLASSIFIED //FOR OFFICIAL USE ONLY (U//FOUO). It
contain s information that may be exempt from pub lic release under the Freedom oflnformation
Act (5 U.S.C. 552) . It is to be controlled , stored, handled , transmitted, distributed, and disposed
of in accordance with DHS policy relating to FOUO information and is not to be released to the
public or other personnel who do not have a valid "need-to-know" without prior approval of an
authorized DHS official. No portion of this report should be furnished to the media, either in
written or verbal form.

Sent: ues
T

(b)(6); (b)(

er 20, 2018 1:45 PM

Wilcox, Br an S (b)(5); (b)(?)(C)

b)(6); (b)(7)(C)
Subject : RE: Press release info

Thanks, Was there any time prior to 9/9/18 that he was on a legitimate hunger strike?
From:l(b)(6); (b)(7)(C)

I

Sent : Tuesday, November 20, 2018 1:22 PM

~l
....

Tofb)(6); (b)(7)(C)
'.b
-)(6-),-(b-)(-7)-(C
_)_________________________

Wilcox, Bryan

...........,I

Subject : RE: Press release info

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000369
2019-ICLl-00051 2414



(b)(5)

CAPT

~b)(6); (b)(?)(C)

ILCSW-C, BCD

Health Services Administrator
USPHS
ICE Health Service Corps
Northwest Detention Center
1623 E. J St. Suitelllii@
Tacoma , WA 98421
Offic (b)(6); (b)(?)(C)
BB:

(b)(6); (b)(?)(C)

Fax :
l(b)(6); (b)(?)(C)

Warning: This document is UNCLASSIFIED//FOR OFFICIAL USE ONLY (U//FOUO). It
contains infonnation that may be exempt from public release under the Freedom of Information
Act (5 U.S.C. 552) . It is to be controlled, stored, handled, transmitted , distributed , and disposed
of in accorda nce with DHS po licy relating to FOUO informat ion and is not to be released to the
public or other personn el who do not have a valid "need-to-know" without prior approval of an
authori zed DHS official. No portion of this report should be furnished to the media , either in
written or verba l form.

Fr o ml (b)(6); (b)(?)(C)

Se nt : Tuesday, November 20, 2018 12:47 PM
To : b)(6); (b)(?)(C)
Wilcox, Bryan S (b)(6); (b)(?)(C)
e )(6); (b)(?)(C)

Subject: RE: Press release info

ALCON:
b)(5)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000370
2019-ICLl -00051 2415



I'm getting media inquiries concerning his case again so I'm assuming the media has caught
wind of something.
From: l(b)(B); (b)(?)(C)
Sent : Tuesda November 20 2018 12:20 PM
T (b)(6); (b)(?)(C)

Cc:Wilcox , Bryan

S b)(B); (b)(?)(C)

~---------~

Subject : FW : Press release info
Importan ce: High

CAPT l(b)(6); (b)(?)(C)
Please see below for your inputs/suggestions. If you have a suggestion on how to better explain
the date of death I'm happy to have it.
From : b)(6); (b)(7)(C)
Sent : ues ay, ovem er 20, 2018 11 :27 AM
To: Wilcox, Bryans j~(b_)(6_);_(b_)(_7)_(C_) -----~
Subject : Press release info
Importance: High

Bryan, This is the press release draft. I'm in need of some info from you though. It 's been
recommended to me that we put in as much detail as possible as we will likely recommend FOIA
of additiona l questio ns.
Please see below for your inputs:

ICE detainee passes awav at Saint Joseoh 's Medical Center
(b)(S)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000371
2019-ICLl -00051 2416



b)(5)

Re ards
(b)(6); (b)(?)(C)

Public Affairs Officer/Spokesperson
Alaska, Oregon , Idaho, Washington State
U.S. Immi ration & Customs Enforcement
Cell : b)(6); (b)(?)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000372
2019-ICLl-00051 2417



From :

Sent :
To :

Subject:

!(b)(6) (b l(?l (C l

21 Nov 2018 15:39:36 +0000
Wil cox, Bryan S
RE: For yo ur appr oval

Thanks.
From : Wilcox, Bryan S
Sent : Wednes dav Novembe r 21 2018 7:38 AM
b)(6); (b)(?)(C)

Subject : RE: For you r approval
10-4
Also know that both the Russian Embassy/Consulate in DC and the hospita l, have been in touch
with the parents.

~\)~\rr.,

I received an IM at midnight last night from Dr.
the person who will ultimately make the
decis ion on ending life support, adv ising that he had made contact (on a conference call with,
presumably, interpreters) with the parents and "it will take a few more conversations to
reconcile"
A couple hours later, I received an email from our attache in Warsaw that "The consulate has
been in contact with both the parents and the common- law wife. The parents do not have the
ability to come to the United States and getting a visa can take up to 300 days. The Head
Consul stated he wi ll give me another update soon as to the family's wishes."
So the likelihood is that a decision of life support could take a few more days as the hospital
tries to continue their conversation with the parents .

Bryan S. Wilcox
Acting Field Office Director
ICE Enforcement & Removal Operations , Seattle, WA
l(b)(6); (b)(?)(C)

CONF IDENTIALITY: This email and attachments are intended for the above name only and are confidential. If you are not the
intended addressee, or the person respons ible for deliver ing it to the intended addressee, you may neither copy, dissem inate, nor
distribute it to anyone else or use it in any unauthorized manner. To do so is strictly proh ibited and may be unlawful. If you receive
this email by mistake, please advise the sender immediately by using the reply faci lity in your ma il software and delete it from your
computer.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000373
2019-ICLl-00051 2418



From~(b)(6); (b)(7)(C)
Sent : Wednesday, November 21, 2018 7:16 AM
To: Wilcox, Bryan S l(b)(6); (b)(7)(C)

SubJect: RE: For your approval

FYSA, the release won't go out until Amar is remo ved from life support.

Re ards
(b)(6); (b)(7)(C)

Public Affairs Officer/Spokesperson
Alaska, Idaho , Oregon, Washington State
U.S. Imm i ration & Customs Enforcement
Cell: (b)(6); (b)(7)(C)
From: Wi lcox, Bryan Sr b)(6); (b)(7)(C)
Date: Tuesday, Nov 20.'-,2
=0=1
-=8
,.....,5~
:5"'"'3
,....,P=
M
-a--------'

r

)(6); (b)(7 XCl

Subject: RE: For your approval

Nope

Sent with BlackBerry Work
(www.blackberry.com )
From: f b)(6); (b)(7)(C)
Date: Tuesday, Nov 20, 2018, 4:16 PM
To : Wilcox Brvan 5JPYb)(6); (b)(7)(C)

I

b)(6); (b)(7)(C)

Subject: RE: For your approval

Do you have any more internal background info?
From : Wilcox, Bryan S
Sent : Tuesday, November 20, 2018 4 :04 PM

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000374
2019-ICLl-00051 2419



j(b)(6); (b)(7)(C)

Subject : RE: For your approval

Corrected name spelling and a few other things. Good to go.

Bryan S. Wilcox
Acting Field Office Director
ICE Enforcement & Removal O erations Seattle WA
b)(6); (b)(?)(C)

CONFIDENTIALITY: This email and attachments are intended for the above name only and are confidential. If you are not the
intended addressee, or the person responsib le for delivering it to the intended addressee, you may neither copy, disseminate, nor
distribute it to anyone else or use it in any unauthorized manner. To do so is strictly proh ibited and may be unlawful. If you receive
this email by mistake , please advise the sende r immediate ly by using the reply faci lity in your ma il software and delete it from your
computer.

From* b)(6); (b)(?)(C)
Sent : Tuesday, November 20, 2018 3:44 PM
To: Wilcox, Bryan S 1:b)(6); (b)(?)(C)

I

(b)(6); (b)(?)(C)

SubJect: For you r approval
Importanc e: High

Thanks again everyone! Bryan, for your approval. Note . .! think it's important that we say he was
in protective custody because the media has tried to spin that as if we were torturing him in seg.
(b)(5)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000375
2019-ICLl -00051 2420



(b)(5)

From: W ilcox, Bryan S
Sent : Tuesday, November 20 , 2018 3:33 PM

Subject : RE: Press Release info needed

I don't see the need fo r dates.
Bryan S. Wilcox
Acting Field Office Director
ICE Enforcement & Removal Operations , Seattle, WA
l(b)(6); (b)(7)(C)

CONF IDENTIALITY: This email and attachments are intended for the above name only and are confidential. If you are not the
intended addressee , or the person respons ible for delivering it to the intended addressee, you may neither copy, disseminate, nor
distribute it to anyone else or use it in any unauthorized manner. To do so is strictly proh ibited and may be unlawful. If you receive
this emai l by mistake , please advise the sender immediate ly by using the reply faci lity in your ma il software and delete it from your
computer.

Froml(b)(6); (b)(7)(C)
Se nt: Tuesday, Nov embe r 20 2018 3:30 PM
To: W ilcox, Bryan S (b)(5); (b)(?)(C)
(b)(6); (b)(7)(C)

So are we good w ith that, or do you want dates for PC?

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000376

2019 -IC Ll-00051 242 1



From : Wilcox,

Bryan S

Sent : Tuesdav

20 2018 3:29

November

PM

(b)(6); (b)(7)(C)

Subject:

RE: Press Release

info needed

If we eve n add ress tha t , I t hink it be st to state th at :
(b)(5)

Bryan S. Wilcox
Acting Field Office Director
ICE Enfo rcement & Remova l O erat ions, Seattle, WA
b)(6); (b)(7)(C)

CONFIDENTIALITY: This email and attachments are intended for the above name only and are confidential. If you are not the
intended addressee, or the person responsible for delivering it to the intended addressee, you may neither copy, disseminate, nor
distribute it to anyone else or use it in any unauthorized manner. To do so is strictly prohibited and may be unlawful. If you receive
this email by mistake, please advise the sender immediately by using the reply facility in your mail software and delete it from your
computer.

I

Fro~ Cb)(6); (b)(7)(C)

Sent : Tuesday,

November

20, 2018 3:16

PM

=C~c.,...=i(_
b)~(6=); ~
(b~
)(7_)C
_C)___________
l(b)(6); (b)(7)(C)

Subject:
I would

RE: Press Release

think

that

November

lcox , Bryan s .._l
<b
_)(6_);_(b_)C
_7)_(C_) ______

_.

info needed

it wou ld suffice

From: l(b)(6); (b)(7)(C)

Sent : Tuesday,

~__.~i

to explain

that

in general

terms,

without

c it ing dates .

I
20, 2018 3:15

PM

b)(6); (b)(7)(C)

..,_,__---==-"=----=-..---....,.......,.-------,-----,-------'

Subject:

RE: Press Release

Wilcox,

Bryans

__.

in o needed

AMERICAr--..

pVERSIGHT

(b)(6); (b)(7)(C)

.__ __________

DHS-ICE-19-0196, 19-0197-K-000377
2019-ICLl-00051 2422



I'm not sure how you want to state this, so here it the events.
He was in the medical housing unit and had been consuming over 1800 calories per day for several days,
and no longer needed to be in the M HU for medical mon itoring. When he was to ld he was going to be
released to General populat ion, he requested protective custody. He did not ide ntify the reason for this
request .

CAP 1 b)(6); (b)(7)(C)

I

L CSW-C, BC D
Health Serv ice s Adm inistrato r
USPHS
ICE Heal th Service Corps
Nort hwe st Detentio n Cente r
1623 E. J St. Suite Kb)(6) I
Tacoma , WA 9842 1
Office (b)(6); (b)(7)(C)
BB: b)(6); (b)(7)(C)
Fax :
(b)(6); (b)(7)(C)
Wa rnin g : Thi s doc um ent is UNC LASSIFIE D//FO R OFF ICIA L U SE ONLY (U//FO UO) . It
contai ns infor mat ion that may be exempt from public relea se under the Freedom oflnfo rmation
Act (5 U .S.C. 552). It is to be controlled , stored , hand led, transmitted , distribut ed, and di spo sed
of in accordance wi th DHS po licy relat ing to FO UO information and is not to be released to the
public or other pe rsonne l who do not have a valid "need- to-know" wit hout prior approval of an
authorized DH S official. No port ion of th is repo rt should be furni shed to the med ia, either in
wri tten or verbal form.

From :~b)(6); (b)(7)(C)

Sent : Tuesdav November 20 2018 3:06 PM

(b)(6); (b)(7)(C)

Cc:fb)(6); (b)(7)(C)

r,Nilcox, Bryan Sl._
<b
_)<6
_>_
; (b
_)<
_7>
_<c_>______
1

_.1

Subject : RE: Press Release info needed

Thank yo u fo r you r inp uts everyone. Just need to know when and why he req uested pro tective
custody and I think we are at the po int we can sent to Brya n for rev iew.

ICE detainee passes away at Saint Joseph 's Medical Center
(b)(5)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000378
2019-IC Ll-0 0051 2423



(b)(5)

From : Nussbaum, Jennifer E
Sent : Tuesday, November 20, 2018 1:57 PM
To: Roman, Tanya J <Tanya.J.Roman@ice.dhs.gov >; Yi, James S <James.Yi@ice.dhs.gov >; Wilcox, Bryan
S <Bryan.S.Wilcox@ice.dhs.gov >; Lawrence, Kathlyn M <Kathlyn.M.Lawrence@ice.dhs.gov >
Cc: Hughes, Paige D <Paige.D.Hughes@ice.dhs.gov >
Subject : RE: Press release info

Absolutely!

CAPT Jennifer E. N ussbau m, LCSW-C , BCD
Health Services Administrator
USPHS
ICE Health Service Corps
Northwest Detention Cente r
1623 E. J St. Suite #4
Tacoma , WA 98421
Office: (253) 779-6052
BB : (202) 236-0218
Fax: (253) 779-6005
Jennifer.e.nussbaum @ice.dhs.gov

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000379
2019-ICLl-0 0051 2424



Warning: This document is UNCLASSIFIED //FOR OFFICIAL USE ONLY (U// FOUO). It
contain s informat ion that may be exempt from pub lic re lea se under the Freedom oflnformation
Act (5 U.S.C. 552) . It is to be controlled , stored, handled , tran smitted , distributed , and di spo sed
of in accordance with DHS policy relating to FOUO information and is not to be released to the
public or other personnel who do not have a valid "need-to-know" without prior approval of an
authorized DHS official. No port ion of this report should be furnished to the media, either in
wr itten or verba l form.
Fro m : ~b)(6); (b)(?)(C)

Se nt : Tuesda , November 20, 2018 1:57 PM
T

(b)(6); (b)(?)(C)

Wilcox, Bryan s b)(6); (b)(?)(C)

rb)(6); (b)(?)(C)
Subject: RE: Press release info

Thank you Ma'am
Fr o~ (b)(6); (b)(?)(C)

Sent : Tuesday, November 20, 2018 1:56 PM

Subject: RE: Press release info
He began refusing facility meals at lunch on 8/22/18 and began comsuning the meal replacement drinks
along with the electrolyte fluids (Pedialyte) at lunch on 9/19/18 totaling 28 days of hunger strike .

CAPT l(b)(6); (b)(?)(C)

LLCSW-C

, BCD

Health Services Administrator
USPHS
ICE Health Service Corps
Northwest Detention Center
1623 E. J St. Suite~
Tacoma , WA 98421
Office: l<b)(
6); (b)(?)(C)
BB: (b)(6); (b)(?)(C)
Fax:
(b)(6); (b)(?)(C)
Warn ing : Th is document is UNCLASSIFIED //FOR OFFICIAL USE ONLY (U// FOUO) . It
contains infonnation that may be exempt from public relea se under the Freedom oflnformation
Act (5 U.S.C. 552). It is to be controlled , stored , handled , transmitted, distributed, and disposed
of in accordance with DHS po licy re lating to FOU O information and is not to be re leased to the
pub lic or other per sonnel who do not have a valid "need -to -know" without pr ior approval of an

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000380
2019-ICLl-00051 2425



authorized DHS official. No portion of this report should be furnished to the media, either in
written or verbal form.
From~ (b)(6); (b)(7)(C)

I

Se nt: Tuesday, November 20, 2018 1:51 PM

b)(6)
; (b)(
7)(C)

(b)(6); (b)(7)(C)

Subject : RE: Press release info

Ok thanks. I'll need the dates he was on hunger strike please.
Fromf b)(6); (b)(
7)(C)

Se nt: Tuesday, November 20, 2018 1:50 PM

b)(6); (b)(7)(C)

....,,..,...,....,......,,.,......---------------------------'----,
S (b)(6); (b)(7)(C)
C

ilcox, Bryan

~----------------------------~

Subject : RE: Press release info
Yes, he was

CAP'Ifb)(5); (b)(?)(C)
ILCSW-C, BCD
Health Services Administrator
USPHS
ICE Health Service Corps
Northwest Detention Center
1623 E. J St. Suiterb)(5)1
Tacoma, WA 98421
Office: (b)(6)
; (b)(7)(C)

l(b)(6)
; (b)(7)(C)
Warning: This document is UNCLASSIFIED//FOR OFFICIAL USE ONLY (U//FOUO). It
contains information that may be exempt from public release under the Freedom oflnfo rmation
Act (5 U.S.C. 552). It is to be controlled, stored, handled, transmitted , distributed , and disposed
of in accordance with DHS policy relating to FOUO information and is not to be released to the
public or other personnel who do not have a valid "need-to-know" without prior approval of an
authorized DHS official. No portion of this report should be furnished to the media, either in
written or verbal form.
Frotj

b)(6); (b)(7)(C)

Se nt: Tuesday, November 20, 2018 1:45 PM

To:1
(b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000381
2019-ICLl -00051 2426



Wilcox, Bryan S (b)(6); (b)(7)(C)

b)(6); (b)(7)(C)
Subject: RE: Press release info

Thanks, Was there any time prior to 9/9/18 that he was on a legitimate hunger strike?
From : ~(b)(6); (b)(
7)(C)

Sent: Tuesday, November 20, 2018 1:22 PM

l(b)(6); (b)(7)(C)
--=
sr b)(6)
=========--------.1
Ct
; (b)(7)(C)

!Wilcox, Bryan

.

Subject: RE: Press re lease info
(b)(5)

CAPTl(b)(5); (b)(?)(C)
~CSW-C, BCD
Health Services Administrator
USPHS
ICE Health Service Corps
Northwest Detention Center
1623 E. J St. Suite l(b)(6I
Tacoma , WA 98421
1
Office:Kb)
(6); (b)(7)(C)
BB: (b)(
6); (b)(
7)(C)
Fax:
l(b)(6); (b)(7)(C)

I

Warning : This document is UNCLASSIFIED //FOR OFFICIAL USE ONLY (U//FOUO) . It
contains information that may be exempt from public release under the Freedom of Information
Act (5 U.S.C. 552). It is to be controlled, stored, handled , transmitted, distributed, and disposed
of in accordance with DHS policy relating to FOUO information and is not to be released to the
public or other personnel who do not have a valid "need-to-know" without prior approval of an
authorized DHS official. No portion of this report should be furnished to the media, either in
written or verba l form.
From~(b)(6); (b)(7)(C)

Sent: Tuesday, November 20, 2018 12:47 PM
To

b)(6);(b)(7)(C)

(b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000382
2019-ICLl-00051 2427



ccf (b)(6); (b)(7)(C)

Subject : RE: Press re lease info

ALCON:
b)(S)

Fromt b)(6); (b)(7)(C)
Sent: Tuesday, November 20, 2018 12:20 PM
To b)(6); (b)(7)(C)

_________

Cc: W ilcox, Bryan S .__
b)(6); (b)(7)(C)
Subject: FW: Press re lease info
Importance: High

____.

CAPT l(b)(6); (b)(7)(C)
Please see below for your inputs/suggestions. If you have a suggestion on how to better explain
the date of death I'm happy to have it.

Sent : ues ay, ovem e r 20, 2018 11:27 AM
To: W ilcox, Bryan S f._b_
)(6_);_(b_)(7
_l(_C_) ______
Subject: Press release info
Importance: High

_,

Bryan , This is the press release draft. I'm in need of some info from you though. It' s been
recommended to me that we put in as much detail as possible as we will likely recommend FOIA
of additiona l questions.
Please see below for your inputs:

ICE detainee passes away at Saint Joseph's Medical Center
(b)(S)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000383
2019-ICLl-0005 1 2428



b)(5)

Regards,
Kb)(6); (b)(7)(C)

Public Affairs Officer /Spokesperson
Alaska, Oregon, Idaho, Was hington State
U.S . Immi ration & Customs Enforcement
Cell: b)(6); (b)(?)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000384
2019-ICLl-00051 2429



Wilcox, Bryan S
21 Nov 2018 17:20:23 +0000

From:

Se nt:
l(b)(6); (b)(?)(C)

RE: For your approval

Subje ct:
Thanks

Bryan S. Wilcox
Acting Field Office Director
ICE Enforcement & Removal Operations, Seattle, WA
r b)(6); (b)(?)(C)

CONF IDENTIALITY: This email and attachments are intended for the above name only and are confidential. If you are not the
intended add ressee , or the person respons ible for deliver ing it to the intended addressee, you may neithe r copy, dissem inate , nor
distribute it to anyone else or use it in any unauthorized manner. To do so is strictly proh ibited and may be unlawful. If you receive
this emai l by mistake, please advise the sende r immediate ly by using the reply faci lity in your ma il software and delete it from your
computer.

!

I

b)(6); (b)(?)(C)

From :
Sent :ednesaa

.
y. November 21. 2018 8:55 AM

To~ (b)(6); (b)(?)(C)
!(b)(6); (b)(?)(C)

'-----.============--------------------'
Bryan SKb)(6); (b)(?)(C)

Wilcox,

Subject: RE: For your approval
D (~/(~\. ,, ailed me this morning to explain how the conversation went w ith him talking to Ama r's
parents last night. He stated they hadn't been in contact with their son for quite a whi le as he wen t
through Korea to get to the US. D (b)(6); explained medically that Amar went through the resuscitation
/h \/7 \/C:\
process at the detention center an was ransported in a comatose state to the hospital without every
achieving any consciousness. He explained how the hospital evaluated his brain and determined Amar
to have irreversible brain death. It was difficult for the parents to accept initially but they agreed for a
Buddist Priest to be involved in another phone call for this afternoon. The hosp~so
having the Life
Center organ donation people present to discuss organ harvest possibilities. D~il
l not talk about
anything transpiring at our detention center and will leave that up to ICEto convey to the family.

IMD

f b)(6); (b)(?)(C)

Clinical Director
ICE Health Service Corps (IHSC)
Enforcemen t and Removal Operat ions (ERO)
US Immigration Customs Enforceme nt (USICE)
Northwes t Detention Center
1623 E. J St. Su i td(b)(6
Tacoma, WA 98421

I

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000385
2019-ICLl -00051 2430



Main office (b)(6); (b)(7)(C)
Voice Mail :
Ce)(b)(6); (b)(7)(C)
fax
(b)(6); (b)(7)(C)

From:l (b)(6); (b)(7)(C)

Sent: Wednesdo~: November 21, 2018 7:57 AM
r )(6J; (b1(7)(C)

--

subject:rvv:ror our approva,

CAPTfb)(6); (b)(?)(C)

ILCSW-C, BCD

Health Services Administrator
USPHS
ICE Health Service Corps
Northwest

Detention Center

1623 E. J St. Suite !(b)(6I
Tacoma, WA 98421
Officefb )(6); (b)(7)(C)
BB: (b)(6);(b)(7)(C)
Fax
l(b)(6); (b)(7)(C)
Warning: This document is UNCLASSIFIED//FOR OFFICIAL USE ONLY (U//FOUO). It contains information
that may be exempt from public release under the Freedom of Information Act (5 U.S.C. 552). It is to be
controlled, stored, handled, transmitted, distributed, and disposed of in accordance with OHS policy
relating to FOUO information and is not to be released to the public or other personnel who do not have
a valid "need-to-know" without prior approva l of an authorized OHS officia l. No portion of this report
should be furnished to the media, either in written or verbal form .
From: Wi lcox, Bryan S i~
<_b)(_6)_;(_b)_(7_)(C
_ )______
Date: Wednesday, Nov 21 2018, 7:38 AM
b)(6); (b)(7)(C)

~

::,uoJec-c:
"i::: ~or your approva1

10-4

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000386
2019-ICLl-00051 2431



Also know that both the Russian Embassy/Consulate in DC and the hospital, have been in touch
with the parents.

I received an IM at midnight last night from Dr.I\~!\~!;,~, !the person who will ultimately make the
decision on ending life support, advising that he had made contact (on a conference call with,
presumably, interpreters) with the parents and "it will take a few more conversations to
reconcile"
A couple hours later, I received an email from our attache in Warsaw that "The consulate has
been in contact with both the parents and the common -law wife. The parents do not have the
ability to come to the United States and getting a visa can take up to 300 days. The Head
Consul stated he will give me another update soon as to the family 's wishes."
So the likelihood is that a decision of life support could take a few more days as the hospital
tries to continue their conversation with the parents.

Bryan S. Wilcox
Acting Field Office Director
ICE Enforcement & Removal O erat ions Seattle WA
b)(6); (b)(7)(C)

CONF IDENTIALITY: This email and attachments are intended for the above name only and are confidential. If you are not the
intended addressee, or the person responsible for delivering it to the intended addressee, you may neither copy, disseminate, nor
distribute it to anyone else or use it in any unauthorized manner. To do so is strictly prohibited and may be unlawful. If you receive
this emai l by mistake, please advise the sender immediate ly by using the reply faci lity in your mail software and delete it from your
computer.
Froml <b)(6);(b)(7)(C)

Se nt : Wednesday

, November

21, 2018 7 :16 AM

To: Wilcox , Bryan S l(b)(6); (b)(7)(C)

I

(b)(6); (b)(7)(C)

Subject : RE: For

your

approval

FYSA , the release won't go out unti l Amar is removed from life support.

Regard s,
l(b)(6); (b)(7)(C)

I

Public Affairs Officer /Spokesperson
Alaska, Idaho , Oregon , Washington State

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000387
2019-ICLl -00051 2432



U.S. Immi ration & Customs Enforcement
Cell: b)(6); (b)(7)(Cl
From : Wilcox, Bryan S j<b)(6); (b)(7)(C)
Date: Tuesdav Nov 20 ....2
""'
0...,l...,
8.......
5""'
:s-3....p
""'
M
..,....------'
(b)(6); (b)(7)(C)

ubJect : Kt: For your approval

Nope

Sent with BlackBerry Work
(www.blackberry.com )
Fro~ (b)(6); (b)(7)(C)

Dat e: 1uesaay,
l\lov20, 2018 , 4:16 Plvl

To: Wilcox, Bryan S~b)(6); (b)(7)(C)

I

b)(6); (b)(7)(C)

Subject : RE: For your approval

Do you have any more internal background info?
From : Wilcox, Bryan S
Sent : Tuesday, November 20, 2018 4 :04 PM
(b)(6); (b)(7)(C)

::>UoJ
ec-c r.c:: r-or your approva1

Corrected name spelling and a few other things. Good to go.
Bryan S. Wilcox
Acting Field Office Director
ICE Enforcement & Removal O erat ions, Seattle, WA
(b)(6); (b)(7)(C)

CONF IDENTIALITY: This email and attachments are intended for the above name only and are confidential. If you are not the
intended add ressee, or the person respons ible for deliver ing it to the intended addressee, you may neithe r copy, disseminate, nor
distribute it to anyone else or use it in any unauthorized manner. To do so is strictly proh ibited and may be unlawful. If you receive

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000388
2019-ICLl-00051 2433



this email by mistake, please advise the sender immediate ly by using the reply faci lity in your mail software and delete it from your
computer.

From *b)(6);(b)(7)(C)
Sent : Tuesday, November 20, 2018 3:44 PM
To : Wilcox, Bryan S Kb)(6); (b)(7)(C)

Subject : For your approval
Importance: High

Thanks again eve1yo ne! B1yan, for your approval. Note ..I think it's impo 1tant that we say he was
in protective custody because the media has hied to spin that as if we were torturing him in seg.

ICE detainee passes awav at Saint Joseph's Medical Center
~b )(5)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000389
2019-ICLl-00051 2434



I~

From : Wilcox,

Bryan S

Se nt: T uesday,

November

20 , 2018 3 :33 PM

)(6); (b)(7)(C)

Subject : RE:

Press Release in fo needed

I don't se e the need for date s.
Bryan S. Wilcox
Acting Field Office Director
ICE Enforcement & Removal Operations , Seattle , WA
l(b)(6); (b)(7)(C)

CONFIDENTIALITY: This email and attachments are intended for the above name only and are confidential. If you are not the
intended addressee, or the person responsible for delivering it to the intended addressee, you may neither copy, disseminate, nor
distribute it to anyone else or use it in any unauthorized manner. To do so is strictly prohibited and may be unlawful. If you receive
this email by mistake, please advise the sender immediately by using the reply facility in your mail software and delete it from your
computer.

Fronf b)(6); (b)(7)(C)

Sent : T u esday,

November

2 0, 2018 3 :30 PM

To: W i lco x, Br yan SKb)(6); (b)(7)(C)

l"'''

(b)(7)(C)

Subject : RE:

Press Re lease in fo needed

So are we good with

that, or do you want

d ates for PC?

From : W i lcox , Bryan S

Sent : Tuesday,
b)(6); (b)(7)(C)

November

20, 2018 3 :29 PM

(b)(5)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000390
2019-ICLl -00051 2435



Bryan S. Wilcox
Acting Field Office Director
ICE Enforcement & Removal O erations, Seattle, WA
(b)(6); (b)(?)(C)

CONF IDENTIALITY: This email and attachments are intended for the above name only and are confidential. If you are not the
intended addressee, or the person responsib le for deliver ing it to the intended addressee, you may neither copy, disseminate , nor
distribute it to anyone else or use it in any unauthorized manner. To do so is strictly prohibited and may be unlawful. If you receive
this email by mistake, please advise the sender immed iately by using the reply faci lity in your mail software and delete it from your
computer.

Fromf b)(6); (b)(?)(C)

Se nt : Tuesday, November 20, 2018 3:16 PM
b)(6); (b)(?)(C)

._I
C-b)~
(6-); -(b-)(7-)(_C_) ------------~~
r b)(6); (b)(?)(C)

1

Subject : RE: Press Release info needed

JNilcox, Bryan S ._
Cb_)C6
_)_
; (b_)C
_?l_<c_) ______

_.

I would think that it wou ld suffice to explain that in general terms, without citing dates.

I

From :tb )(6); (b)(?)(C)

Sent :uesday,

November 20, 2018 3:15 PM

(b)(6); (b)(?)(C)

ilcox, Bryan S

(b)(6); (b)(?)(C)

Subject : RE: Press Release info needed

(b)(6); (b)(?)(C)

~----------~

I'm not sure how you want to state this, so here it the events.
He was in the medical housing unit and had been consuming over 1800 calories per day for several days,
and no longer needed to be in the MHU for medical mon itoring. When he was to ld he was going to be
released to General population, he requested protective custody. He did not identify the reason for this
request.
CAPT

~CSW-C, BCD

l(b)(6); (b)(?)(C)

Health

Services

Administrator

USPHS
ICE

Hea lt h Serv i ce Corp

Northwest

Detentio

1623 E. J St.
Tacoma
Office

, WA

s

n Cente

I

r

Suitd Cb)(~);_

98421

l(b)(6); (b)(?)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000391
2019-ICLl -00051 2436



BB: (b)(6); (b)(?)(C)

Fax
l(b)(6); (b)(?)(C)

I

Warning: This document is UNCLASSIFIED //FOR OFFICIAL USE ONLY (U//FOUO). It
contains informat ion that may be exempt from pub lic relea se under the Freedom oflnformation
Act (5 U.S.C. 552) . It is to be controlled, stored, handled , transmitted, distributed, and disposed
of in accordance with DHS policy relating to FOUO information and is not to be released to the
public or other personnel who do not have a valid "need-to-know " without prior approval of an
authorized DHS official. No portion of this report should be furnished to the media, either in
written or verba l form.

From~ (b)(6); (b)(?)(C)

Sent : Tuesday, November 20, 2018 3:06 PM
(b)(6); (b)(?)(C)

Ccf b)(6); (b)(?)(C)

!Wilcox, Bryan S f

b)(6 ); (b)(?)(C)

~--------~

Subject : RE: Press Release info needed

I

Thank you for your inputs everyone. Just need to know when and why he requested protective
custody and I think we are at the point we can sent to Bryan for rev iew.

ICE detainee passes away at Saint Joseph's Medical Center
b)(5)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000392
20 19-ICLl-00051 2437



b)(S)

Sent: ues

, 2018 1:57 PM
Wilcox, Bryan

To
(b)(-)(,...
);7)"""'
(b)(
~b)(6,...
);-(b
(C_) ___________________________

~

Absolutely!

---~---

LCSW-C , BCD
m1ms ra
or
.........

ICE Health Service Corps
Northwest Detention Center
1623 E. J St. Suite !(b)(6)!
Tacoma WA 98421
Office: (b)(6); (b)(7)(C)
BB:

b)(6); (b)(7)(C)

Fax :
l(b)(6); (b)(7)(C)

Warning: This document is UNCLASSIFIED //FOR OFFICIAL USE ONLY (U//FOUO). It
contains information that may be exempt from public release under the Freedom of Information
Act (5 U.S.C. 552) . It is to be controlled , stored , handled , tran smitted , distributed , and disposed
of in accordance with DHS po licy relating to FOUO information and is not to be relea sed to the
public or other per sonnel who do not have a valid "need-to-know" without prior approval of an
authori zed DHS official. No portion of this report should be furnished to the media , either in
written or verbal form.

From :~b)(6); (b)(7)(C)

Sent: Tuesday, November 20, 2018 1:57 PM
To (b)(6); (b)(7)(C)
Wi cox, Bryan

(b)(6); (b)(7)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000393
2019-ICLl-00051 2438



rb)(6); (b)(7)(C)
Subject : RE: Press release info

Thank you Ma'am
From:! (b)(6); (b)(7)(C)

Sent : Tuesday, November 20, 2018 1:56 PM

Tofb)(6);(b)(7)(C)
~r )(6); (b)(7)(C)

~ ilcox, Bryan

I

Subject: RE: Press release info

He began refus ing facility meals at lunch on 8/ 22/18 and began comsuning the meal replacement drinks
along with the electrolyte fluids (Pedialyte) at lunch on 9/19/18 totaling 28 days of hunger strike .

I

CAP'Ifb)(6); (b)(?)(C)
LCSW-C , BCD
Health Services Administrator
USPHS
ICE Health Service Corps
Northwest Detention Center
1623 E. J St. Suite l(b)(I
Tacoma , WA 98421
OfficeJ(b)(6); (b)(7)(C)
BB: (b)(6); (b)(
7)(C)
Fax
(b)(6); (b)(7)(C)
Warning: This document is UNCLASSIFIED //FOR OFFICIAL USE ONLY (U//FOUO) . It
contains information that may be exempt from public release under the Freedom of Informat ion
Act (5 U.S.C. 552). It is to be controlled, stored, handled, transmitted, distributed, and disposed
of in accordance with DHS po licy relating to FOUO information and is not to be released to the
public or other personnel who do not have a valid "need-to-know" without prior approval of an
authorized DHS official. No portion of this report should be furnished to the media, either in
written or verba l form.
From' (b)(6); (b)(7)(C)

Sent : Tuesday, November 20, 2018 1:51 PM
Tof b)(6); (b)(7)(C)

Wilcox, Bryan Sf:b)
(6); (b)(
7)(C)

I

b)(6); (b)(7)(C)
Subject : RE: Press release info

Ok thank s. I' ll need the dates he was on hunger strike p lease.

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000394
2019-ICLl-0 0051 2439



From~ (b)(6); (b)(7)(C)

Sent : Tuesday, November 20, 2018 1:50 PM

Tofb)(6);(b)(7)(C)
~[..,..b!--,,
)(6,.,..
);""""
(b.,..,
)(7=)(=c,...
) ________________________

~ilcox, Bryan

...__,I

Subject: RE: Press release info
Yes, he was

CAPT fb)(5); (b)(?)(C)
ILCSW-C, BCD
Health Services Administrator
USPHS
ICE Health Service Corps
Northwest Detention Center
1623 E. J St. Suite~b)(6
Tacoma, WA 98421
OfficJ(b)(6); (b)(7)(C)
BB : b)(6); (b)(7)(C)
Fax :
(b)(6); (b)(7)(C)

I

Warning: This document is UNCLASSIFIED //FOR OFFICIAL USE ONLY (U//FOUO). It
contains information that may be exempt from public release under the Freedom oflnformation
Act (5 U.S.C. 552). It is to be controlled, stored, handled , transmitted, distributed, and disposed
of in accordance with DHS policy relating to FOUO information and is not to be released to the
public or other personnel who do not have a valid "need-to-know" without prior approval of an
authorized DHS official. No portion of this report should be furnished to the media, either in
written or verbal form.

Sent : ues

er 20, 2018 1:45 PM

To (b)( ; (b)(

Wilcox, Bryan

s (b)(6); (b)(7)(C)

b)(6)
; (b)(
7)(C)
Su ject : RE: Press re ease in o

Thanks, Was there any time prior to 9/9/18 that he was on a legitimate hunger strike?
Fromfb)(6)
; (b)(
7)(C)
Sent : Tuesday, November 20, 2018 1:22 PM

To:l
(b)
("6)
;)(
(b)(
7"'""'"
)()C)
~f..,,...b...,.
)(
6");""
(b
""
..,..
=7")(C
___________________________

I....____,I
Wilcox, Bryan

Subject : RE: Press release info

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000395
2019-ICLl-00051 2440



b)(5)

ILCSW-C, BCD
CAPT l(b)(6); (b)(?)(C)
Health Services Administrator
USPHS
ICE Health Service Corps
Northwest Detention Center
1623 E. J St. Suite fb)(BI
Tacoma, WA 98421
Office: ~b)(6); (b)(?)
(C)
BB: b)(6); (b)(?)(C)
Fax :
rb)(6)
; (b)(
?)(C)
Warning: This document is UNCLASSIFIED //FOR OFFICIAL USE ONLY (U//FOUO). It
contains infonnation that may be exempt from public release under the Freedom of Information
Act (5 U.S.C. 552) . It is to be controlled, stored, handled, transmitted, distributed, and disposed
of in accordance with DHS po licy relating to FOUO information and is not to be released to the
public or other personnel who do not have a valid "need-to-know" without prior approval of an
authorized DHS official. No portion of this report should be furnished to the media, either in
written or verbal form.
From:l(b)(6);(b)(?)(C)
Sent : Tuesda , November 20, 2018 12:47 PM
To:

b)(6)
; (b)(?)(C)

Wilcox, Bryan S (b)(B); (b)(?)(C)

r )(6)
; (b)(?)
(C)
Subject: RE: Press release info

ALCON:
b)(5)
; (b)(?)(C)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000396
2019-ICLl-0005 1 244 1



I'm getting media inquiries concerning his case again so I'm assuming the media has caught
wind of something.
FromJPYb)(6);(b)(7)(C)
Sent : Tuesday, November 20, 2018 12:20 PM
To b)(6); (b)(7)(C)

Cc:Wilcox , Bryan s b)(6);(b)(7)(C)
~---------~
Subject : FW : Press release info
Importan ce: High
CA PT l(b)(6); (b)(7)(C)

I

Please see below for your inputs/suggestions. If you have a suggest ion on how to better explain
the date of death I'm happy to have it.
From!rb\/6\ /b\/7\/C\
I
Sent : Tuesday, November 20, 2018 11:27 AM
To: Wilcox , Bryan sfb
....
_)(6_l:_<b_l<_7_
l<c
_) ______
Subject : Press release info
Importance: High

_.

Bryan, This is the press release draft. I'm in need of some info from you though. It's been
recommended to me that we put in as much detail as poss ible as we will likely recommend FOIA
of additiona l questio ns.
Please see below for your inputs:

ICE detainee passes awav at Saint Joseoh 's Medical Center
b)(5)

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000397
2019-ICLl -00051 2442



b)(5)

Regards,
fb )(6); (b)(?)(C)

b

Public Affairs fficer/Spokesperson
Alaska, Oregon , Idaho, Washington State
U.S. Immigration & Customs Enforcement
Cell

:wb)(6); (b)(?)(C)

n

AMERICAr--..

pVERSIGHT

DHS-ICE-19-0196, 19-0197-K-000398
2019-ICLl-00051 2443



Erica Lai 
Cohen & Gresser LLP 
2001 Pennsylvania Ave. NW 
Suite 300 
Washington, DC 20006 
October 7, 2020 
RE: American Oversight v ICE,. 19-cv-01817-RCL 
ICE FOIA Case Number 2019-ICLI-00051 
Second Interim Release 
Dear Ms. Lai, 
Ofjice of lf'/fhrmation Governance and Privacy 
U.S. Department of Homeland Security 
500 12th St., SW 
Washington, D.C. 20536 
U.S. Immigration 
and Customs 
Enforcement 
This is the second interim response to your client's Freedom oflnformation Act (FOIA) requests 
to U.S. Immigration and Customs Enforcement (ICE), dated June 21, 2018, given the tracking 
number 2019-ICLI-00051. Your clients are seeking the following: 
• A copy oflCE's initial report on the May 2018 death oflCE detainee Roxana Hernandez 
(also listed in DHS records as Jeffry Hernandez), which ICE was required to publish by 
June 24, 2018. 
• A copy oflCE's final report on the May 2018 death oflCE detainee Roxana Hernandez 
(also listed in DHS records as Jeffry Hernandez), which ICE was required to publish by 
July 24, 2018. 
• Responsive records include, but are not limited to, records related to the care, treatment, 
discipline, and abuse of Ms. Hernandez, as well as reports or reviews of Ms. Hernandez's 
death. The records containing the factual information relied upon for ICE's public 
statements regarding Ms. Hernandez's death and detention are also responsive. 
• A copy oflCE's initial report on the November 2018 death oflCE detainee Mergensana 
Amar. 
• A copy ofICE's final report on the November 2018 death of ICE detainee Mergensana 
Amar. 
• Responsive records include, but are not limited to, records related to the care, treatment, 
discipline, forced-feeding, and involuntary hydration of Mr. Amar, as well as reports or 
reviews of Mr. Amar's death. The records containing the factual information relied upon 
for ICE's public statements regarding Mr. Amar's death and detention are also 
responsive. Please provide all responsive records from March 1, 2018, through the date of 
the search. 
www.ice.gov 

Page 2 of3 
ICE has considered this request under the FOIA, 5 U.S.C. § 552, and processed 532 pages of 
potentially responsive records. ICE has determined that 3 pages were deemed non-responsive. 
ICE has further determined that 4 pages will be released in full and portions of 493 pages will be 
withheld pursuant to Exemptions 6, 7(C), and 7(E) of the FOIA, 5 U.S.C. § 552 as described 
below. 
ICE has applied FOIA Exemptions 6 and 7(C) to protect from disclosure the names, e-mail 
addresses, and phone numbers of ICE and DHS employees contained within the documents, as 
well as the names, and other personally identifiable information of other individuals contained 
within the records. 
FOIA Exemption 6 exempts from disclosure personnel or medical files and similar files the 
release of which would cause a clearly unwarranted invasion of personal privacy. This requires a 
balancing of the public's right to disclosure against the individual's right to privacy. The privacy 
interests of the individuals in the records you have requested outweigh any minimal public 
interest in disclosure of the information. Any private interest you may have in that information 
does not factor into the aforementioned balancing test. 
FOIA Exemption 7(C) protects records or information compiled for law enforcement purposes 
that could reasonably be expected to constitute an unwarranted invasion of personal privacy. 
This exemption takes particular note of the strong interests of individuals, whether they are 
suspects, witnesses, or investigators, in not being unwarrantably associated with alleged criminal 
activity. That interest extends to persons who are not only the subjects of the investigation, but 
those who may have their privacy invaded by having their identities and information about them 
revealed in connection with an investigation. Based upon the traditional recognition of strong 
privacy interest in law enforcement records, categorical withholding of information that 
identifies third parties in law enforcement records is ordinarily appropriate. As such, I have 
determined that the privacy interest in the identities of individuals in the records you have 
requested clearly outweigh any minimal public interest in disclosure of the information. Please 
note that any private interest you may have in that information does not factor into this 
determination. 
The ICE FOIA Office applied FOIA Exemption (b )(7)(E) to protect from disclosure an internal 
law enforcement sensitive investigative technique. The release of this information would 
disclose investigative techniques and procedures, and could be reasonably expected to risk 
circumvention of the law. 
FOIA Exemption 7(E) protects records compiled for law enforcement purposes, the release of 
which would disclose techniques and/or procedures for law enforcement investigations or 
prosecutions, or would disclose guidelines for law enforcement investigations or prosecutions if 
such disclosure could reasonably be expected to risk circumvention of the law. I have determined 
that disclosure of certain law enforcement sensitive information contained within the responsive 
records could reasonably be expected to risk circumvention of the law. Additionally, the 
techniques and procedures at issue are not well known to the public. 

Page 3 of3 
If you have any questions about this letter, please contact Assistant U.S. Attorney Benton 
Peterson at Benton.Peterson@.usdoj.gov or 202-252-2534. 
Enclosure: 497 pages 
Sincerely, 
FERNANDO 
PINEIRO JR 
Digitally signed by 
FERNANDO PINEIRO JR 
Date: 2020. t0.29 
15:22:33 -04'00' 
Fernando Pineiro Jr. 
(A)FOIA Officer 

DHS-ICE-19-0196, 19-0197-N-000001
J 
Address 
Patient Vaccine Administration Record 
No of Immunizations 0 
Vaccine Date Given Dose Location Lot No Manufacturer Exp Date Given By 
Record generated by eChnicalWorks EMR/PM Software (www echnicalworks com) 
2019-ICLl-00051 2820 

DHS-ICE-19-0196, 19-0197-N-000002
12/17/2018 
........ 
Boost Plus: diarrhea: Side Effects 
U.S. Immigration 
and Customs 
Enforcement 
AMAR, MERG~SANA 
A:216269802b )(6 ); I 
Facility Code : CSONVWA Housing Area: H 
Acca.nt ~ber(bX6); 40Yad~~E:: 
1623 E J STREET, T 
Appoirimert Facility: Northwest Detertion Certer 
Reason for Appointment 
1. Weekly weight and ,Hals 
Appointment Provider. Tacoma Provide r 
Appointment Provider: Tacoma Provider 
Electronically signed by Tacoma Provider on 11/16/2018 at 07:24 MST 
Sign off status: Pending 
Northwest Detention Center 
1623 E J STREET 
TACOM,W~ 
Tel:253-779~ 
Fax: 
Patl-t: AMAR, MERGENSANA DOB: 10/23/1978 p,_... Note: T- Pnmcler 12/17/2018 
/lkxe generated by eC/inica/Wcrl.s a.RIPM Sottv.ere ("""'eC/inica/Works .com) 
2019-ICLl-00051 2821 

DHS-ICE-19-0196, 19-0197-N-000003
12 /12/2018 
....... . Boost Plus: diarrhea: Side Effects 
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA A:21626980 2 Su:llD:!/b)/6): ! 
Facility Code : CSONVWA Housing Area : H 
40Y old Mal~, · AccOl.l"II llunber (b )(6): 
1623 E J STREET, T 
Appoirimert Facility: Northwest Detertion Certer 
Rea son for Appointment 
1. /lnnual Dental Exam 
Appointme nt Prolli der. _!(b- )_(6_): __ ~pos 
Appointment Provlcle ~(b)(6); (b)(7)(C) IDS 
Electro ni ca ll y signed by k.._b.... ).._(6""' );"--_-' pos on 11/16/2018 at 07:24 MST 
Sign off status: Pe nding 
Northwest Detention Center 
1623 E J STREET 
T WA 8421 
Tel /b)/6): 
x: 
Patie nt: AMAR, MERGENSANA DOB: 10/2 3/1978 Progro .. No~ (b )(6); ~. I DDS 12/12/2018 
/lkxe generated by eC/inica/Wcrl.s a.RIPM Sottv.ere (""""eC/inica/Works.com) 
2019-ICLl-00051 2822 

DHS-ICE-19-0196, 19-0197-N-000004
12/10/2018 
........ 
Boost Plus: diarrhea: Side Effects 
U.S. Immigration 
and Customs 
Enforcement 
Reason for Appointment 
1. Weekly weight and ,Hals 
Appointment Provider. Tacoma Provide r 
AMAR,MERGENSANA A: 216269802 Su:llc:f h \/R\ ! 
Facility Code : CSONVWA Housing Area: A 40 Y old Male, ~-1QOJ(1928 
AccOl.l"II ~tie,f bl(6l: 1623 E J STREET, TACOMA,~W""A-9,:.:,,..,84~2=1,........ 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Provider: Tacoma Provider 
Electronically signed by Tacoma Provider on 11/16/2018 at 07:24 MST 
Sign off status: Pending 
Northwest Detention Center 
1623 E J STREET 
T WA98421 
Te /h\/n\· x: 
Patl-t: AMAR, MERGENSANA DOB: 10/23/1978 p,_... Note: T- Pnmcler 12/10/2018 
/lkxe generated by eC/inica/Wcrl.s a.RIPM Sottv.ere ("""'eC/inica/Works .com) 
2019-ICLl-00051 2823 

DHS-ICE-19-0196, 19-0197-N-000005
12103/2018 
........ 
Boost Plus: diarrhea: Side Effects 
U.S. Immigration 
and Customs 
Enforcement 
Reas on for Appointment 
1. Weekly weight and ,Hals 
Appointment Provider. Tacoma Provide r 
AMAR,MERGENSANA A:216269802 Su:llD:!/b)/ 6) ! 
Facility Code : CSONVWA Housing Area: A 
40 Y old Male, DClB: 10/23/1978 
AccOllll lunbed lh \/R\· I 1623 E J STREET, TACOMA, WA-98421 
Appoimnert Facility: Northwest Detertion Certer 
Appointm e nt Provid er: Tac oma Provider 
Electronically signed by Tacoma Provider on 11/16/2018 at 07 :24 MST 
Sign off status: Pending 
Northwest Detention Center 
1623 E J STREET 
TACOMA, WA98421 
Tel: 253•77*b )/6):! 
Fax: 
Patl-t: AMAR, MERGENSANA DOB: 10/23/1978 p,_... Note: T- Pnmcler 12/03/2018 
/lkxe generated by eC/inica/Wcrl.s a.RIPM Sottv.ere ("""'eC/inica/Works .com) 
2019-ICLl-00051 2824 

DHS-ICE-19-0196, 19-0197-N-000006
1112612018 
........ 
Boost Plus: diarrhea: Side Effects 
U.S. Immigration 
and Customs 
Enforcement 
Reason for Appointment 
1. Weekly weight and ,Hals 
Appointment Provider. Tacoma Provide r 
AMAR,MERGENSANA A: 216269802 Su:llol (b )(6 ): 
Facility Code : CSONVWA Housing Area: A 40 Y old Male, DOB: 10/23/1978 
AccOl.lll lunber:~ 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Provider: Tacoma Provider 
Electronically signed by Tacoma Provider on 11/16/2018 at 07 :24 MST 
Sign off status: Pending 
Northwest Detention Center 
1623 E J STREET 
T WA 8421 
Te (b)(6); 
Patl-t: AMAR, MERGENSANA DOB: 10/23/1978 p,_... Note: T- Pnmcler 11/fl/2018 
/lkxe generated by eC/inica/Wcrl.s a.RIPM Sottv.ere ("""'eC/inica/Works .com) 
2019-ICLl-00051 2825 

DHS-ICE-19-0196, 19-0197-N-000007
11/19/2018 
........ 
Boost Plus: diarrhea: Side Effects 
U.S. Immigration 
and Customs 
Enforcement 
Reas on for Appointment 
1. Weekly weight and ,Hals 
Appointment Provider. Tacoma Provide r 
AMAR,MERGENSANA . . A:216269802 Su:i10-fb)(6); I 
Facility Code: CSOINNA t-tcx.!n g A ea. n 40 Y old Male, DOB: 10/23/1978 
AccOl.l"II ~ber1 (b )(6) . I 
1623 E J STREET, T ACOM ,.. ,'. 
Appoirimert Facility. Northwest Detertion Certer 
Appointm e nt Provider: Taco ma Provider 
Electronically signed by Tacoma Provider on 11/16/2018 at 07:25 MST 
Sign off status: Pending 
Northwest Detention Center 
1623 E J STREET 
T WA98421 
Tel: /h\/R\· 
x: 
Patl-t: AMAR, MERGENSANA DOB: 10/23/1978 p,_... Note: T- Pnmcler 11/19/2018 
/lkxe generated by eC/inica/Wcrl.s a.RIPM Sottv.ere ("""'eC/inica/Works .com) 
2019-ICLl-00051 2826 

DHS-ICE-19-0196, 19-0197-N-000008
11/18/2018 
........ 
Boost Plus: diarrhea: Side Effects 
U.S. Immigration 
and Customs 
Enforcement 
Reas on for Appointment 
1./lnnua l PE 
Appointment Provider. Tacoma Provide r 
AMAR,MERGENSANA . . A:216269802 Su:llt!li, b)(6); I 
Facility Code: CSOINNA II g A ea. n 
40 Y old Male,~ 1Q/2J119ZB 
AccOllll lunber: b)/6): I 
1623 E J STREET, TACOMA, WA-98421 
Appoirimert Facility: Northwest Detertion Certer 
Appointm e nt Provider: Tac oma Provider 
Electronically signed by Tacoma Provider on 11/16/2018 at 07:25 MST 
Sign off status: Pending 
Northwest Detention Center 
1623 E J STREET T~~r98421 i=:i:0~1-I 
Patl-t: AMAR, MERGENSANA DOB: 10/23/1978 p,_... Note: T- Pnmcler 11/18/20 18 
/lkxe generated by eC/inica/Wcrl.s a.RIPM Sottv.ere ("""'eC/inica/ Works.com) 
2019-ICLl-00051 2827 

DHS-ICE-19-0196, 19-0197-N-000009
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A:216269802 Su:ll~(b)(6); I 
Facility Code : CSONVWA Housing Area: A 
40 Y old Male, DOB: 10/23/1978 
AccOllll lunber j /h \/R\· I 
1623 E J STREET, TACOMA, WA-98421 
Appoimnert Facility: Northwest Detertion Certer 
11 /15/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Fiber625 t..GTablet2tab letas needed BID,stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11116/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes. Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
........ s 
Boost Plus: diarrhea: Side Effects 
Reason for Aflpolntment 
1.lfv'S 
History of Present Illness 
Narrati'"': 
Aflpolntment Provlcler:l (b)(6) ; (b)(?)(C) rA 
lfv'S called approx 1507 hours, self harm in Hseg. I arri'"'d with the initial medical response team and equipment to Hseg 
approx 1509, 40 'fo male was la)ing unresponsi'"' and not breathing on the floor. I checked his airway for obstruction, ga'"' a 
sternal rub without response, no carotid pulse found, I immediately began CPR chest compressions and called to the nurse and 
assisting GEO officers to dial 911. /ldditional medical responders arri'"'d pro\iding assistance. The medical team with the help 
of a couple of GEO officers completed 4-5 cy:les of CPR using the PED when the Bv6 team arril<!d and assumed treatment of 
the patient The patient was then e,aruated to St Josephs Hospital. 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: CXher 
Describe: GEO Officers provided pallent infonnallon 
Chaperone Present? No 
Wiat language do }OU speak? __ 
Interpretation pro\ided? No interpreter utilized 
Urgent or emergent care: Emergent care Pallent unresponsive 
Explain Use Notes Section 
Pain />6sessment 
Pain 
ke }OU ru rrentlyin pain? No 
Ex amination 
General B<amination: 
GENERl>l !>PPE.ARPNCE: Uuesponsi'"'· not breathing, and no detectable pulse. 
Appoinbnent Providerb)(6); (b)(?)(C) FA 
Confinmatory sign off: 
i(b)(6); (b)(?)(C) J 1/ 15/2018 09:23:54 PM 
(b)(6); (b)(?)(C) 
o.:..-;;.;.. .... --.L..A~on 11/151201817:23:35 (Pacific Standard Time) 
Electr onically co-signed b C MD on 11/1512018 at 09:23 PM MDT 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREET 
T WA98421 
Te (b)(6); 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 P......,.. ~ (b)(6); (b)(?)(C) !PA 11/15/2011 
Ncte generaled by eC/inica!Wcxi<s EM<IPM Sottve,-e (""'"'eC/inica/Works.com) 
2019-ICLl-00051 2828 

DHS-ICE-19-0196, 19-0197-N-000010
Cunent -dlcatlons 
Taking 
U.S. Immigration 
and Customs 
Enforcement 
Reason for Appointment 
1. DC calorie supplements 
• Prenatal \Atamin Filed Dose Tablet 1 , KOP: Yes, Drug Source: 
Treatment Pharmacy 1. Others 
AMAR,MERGENSANA A: 216269802 Su:lltb )(6): J 
Facility Code : CSONVWA Housing Area: 
40 Y old Male, DOB: 10/23/1978 
AccOl.lll lunber~ 
1623 EJ STREET, T~ 
• Fiber625 M3Tablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy Stop Pedial>4e Soluton,-, 1, Orally, BID, 90 days, 1, KOP: Yes, Drug Source: In House Pharmacy 
• /lcetaminophen 500 M3 Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra;el 
• Pedial>4e- Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 M3Tablet2tab letas needed BID,stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for trawl 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, schedule for am and pm PL 
• Boost\+IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• /lcetaminophen 500 M3 Tablet 1 tablets as needed BID, stop 
date 11124/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra;el 
Past Medical History 
Hunger strike 
Allergles 
Boost Plus: diarrhea: Side Effects 
Stop Boost Glucose Control Liquid, -, 1, Orally, BID, 30 days, 1, KOP: No, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, schedule for am and pm PL 
Tel: 
Fax: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progress Note: 
/lkte generated by eC/inica/lM:xi<s ElvRIPM &Jt,,ere ("""'eC/inlca/Works .com) 
2019-ICLl-00051 2829 

DHS-ICE-19-0196, 19-0197-N-000011
U.S. Immi gration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:llu: jth \/ "\· I 
Facility Code : CSONVWA Housing Area: A 40 Y old Male, DOB: 10/23/1978 
AccOl.lll lunber:~ 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
11 /15/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID,stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• .Acetaminophen 500 t,,G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allerglss 
Boost Plus: diarrhea: Side Effects 
Reason for Aflpolntment 
1. 30 Day M-1 SEG'RHU Reliew 
Examination 
General Elo!mination: 
Aflpolntment Prov1c10,f b)(6) ; (b)(7)(C) 
A30day , incremental mental health segregation (Restricted Housing Unit-RHU) reliewwas oompleted on detainee. 
~csw 
-It is oonfirmed this detainee gets regular RN and Mmtal Health rounds; is assessed for mental health issues on a regular 
basis. 
-This detainee oontinues to be housed in RHU Setting at this time. 
-AM!mo to the J>FOD and Warden was oompleted for this reliew and will be disrussed at the weekiyRHU Reliew 
Committee. 
Appointment Provide1 (b)(6) ; (b)(7)(C) t, LCSW 
(b)(6); (b)(7)(C) 
Bectronically signed b)(6); (b)(7)(C) 
Sign off status: Comp! 
CSW on 11/1512018 10:26:09 (Pacific Standard lime) 
Northwest Detention Center 
1623 E J STREET 
TACOMA, WA98421 
Telj1h1m1 - I Fax: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 LCSW 11/15/2018 
Note generated by eOinica/Wcxi<s EM</FM Sofl"8re ("""' ,,.c 
2019-ICU-00051 2830 

DHS-ICE-19-0196, 19-0197-N-000012
11 /15/2018 
Past Medical History 
Hunger strike 
Alla ..... 
Boost Plus: diarrhea: Side Effects 
U.S. Immigration 
and Customs 
Enfor cement 
Reason for Appointment 
1. RN Daily Seg Rounds 
History of Pre se nt Illne ss 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Viral language do }OU speak? English 
AMAR,MERGENSANA . . A: 216269802 Su:llfa ><6>; I 
Facility Code: CSOINNA t-tol:isn g A ea. n 40 Y old Male, DOB: 10/23/1978 
AccOl.l'II lll.mbd'-'h.,_, \,_,, /R._, \_· ---' 
1623 E J STREET, TACOMA, WA-98421 
Appoirime rt Facility. Northwest Detertion Cert er 
App ointm ent Prov1c1e1 b)(6) ; (b)(?)(C) r" 
Interpretation pro\aded? Pallent speaks English fluenUy /Detainee able to make needs know, in English 
Segregation: 
Segregation Rounds 
ke }OU currentlylhinking about killing or harming }Ourself? No 
Do}Ou haw any medical complainls or concems at this time? No 
Was referral made to d inical sen.1ces (lvOIM.P, Dental, M-t, Sick Call)? No 
Examination 
Segregation: 
Segregation Evaluation: Patient has spontaneous speech and ansWE!fS questions appropriately, in no acute distress, 
well de\eoped , well nourished, Patient appears to be v.ithin normal limits of beha"or, affect, and cogniti1.e functioning, 
Patient does not appear to ha,e any acute or unresol\ed medical conditions that may worsen in segregation, Patient does 
not appear to ha'-"! acti,e psychosis, mania, suicidal idealions or l'Klmicidal ideations. 
As sessment s 
Health M!intenance Related to Segregation Placement 
Appoi nbnent Provider:l(b)(6); ~-
Electronically signed (b)(6); / h \/ 7 \/r'\ 
Sign off status: Completed 
on 11/1512018 at 09:58 MST 
Northwest Detention Center 
1623 E J STREET 
T~WA984 21 ,, fa , I Fax: 
Patient: AMAR, MERGENSANA DOB: 10/23/19 78 p,_.... ~ 11/15/201 8 
/lkie generaled by eClirica/Wcrks EM<IPM Soltv,ere (""""eClinica/Works.com) 
2019-ICLl-00051 2831 

DHS-ICE-19-0196, 19-0197-N-000013
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 2832 
AMAR,MERGENSANA 
A:216269802 Su:i1ol(b)( 6 ): ! 
Facility Code : CSONVWA Housing Area: A 
40 Y old Male, DOB: 10/23/1978 
Acc01.111 lffl1~ (6); I 
1623 E J STREET,· VVA9842 I

DHS-ICE-19-0196, 19-0197-N-000014
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 21626980 2 Su:llOl/b )/6) ! 
Facility Code: CSONVWA Housing Area: A 
kcOU11~ber(bX6 C ! 40 Y ad~~ E:: 11 /14/2018 
Curnont Medication s 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID,stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlc al History 
Hunger strike 
Allergles 
Boost Plus: diarrhea: Side Effects 
1623 E J STREET, T 
Appoimnert Facility: Northwest Detertion Certer 
Reason for Appointment 
1. RN Daily Seg Rounds 
History of Pre se nt Illne ss 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do you speak? English 
App ointm ent Provld er:i(b)(6) ; ~-
Interpretation pro\aded? Pallent speaks English fluenUy /Detainee able to make medical needs knov.n in English 
Segregation: 
Segregation Rounds 
ke you rurrentlythinking about killing or harming yourself? No 
Do you ha'"' any medical complaints or concerns at this time? No 
Was referral made to d inical sen.1ces (lvOIM.P, Dental, M-t, Sick Call)? No 
Examination 
Segregation: 
Segregation Evaluation: Patient has spontaneous speech and ansWE!fS questions appropriately, in no acute distress, 
weU de\eloped , well nourished, Patient appears to be v.ithin normal limits of beha"or, affect, and cogniti,e functioning, 
Patient does not appear to ha,e any acute or unresol\ed medical conditions that may worsen in segregation, Patient does 
not appear to ha\e acti,e psychosis, mania, suicidal idealions or txlmicidal ideations. 
As se ssm e nt s 
Health M!intenance Related to Segregation Placement 
Tr eatm ent 
1. Others 
Clinical Notes: GEO reports detainee is continuing to eat all meals - has not refused a tray in 3 days 
He also continues to aw il himself to rec time - mostly in the later part of the day 
He refused PM rec yesterday but went to afternoon rec- Normal pattern. 
Appointment Provide1(b)(6) ; __ 
Bectronically signed b b)(6); h\/ 7\ /r'\ 
Sign off status: Complete 
on 11/1412018 at 09:35 MST 
Northwest Detention Center 
1623 E J STREET 
T~t A9842l Te(bK6\ _ I 
Patien1: AMAR, MERGENSANA DOB: 10/23/1 978 p,__ Notej(b)(6); -· IRN 11/14/2018 
/lkxe generated bye0irica/Wc11<s El>R'PM So/rv.ere /w.w,eQinica/Wc.-ks.com/ 
2019-ICLl-00051 2833 

DHS-ICE-19-0196, 19-0197-N-000015
U.S. Immi gration 
and Customs 
Enfor cement 
AMAR,MERGENSANA A:21626980 2 Su:i1oj(b)(6); J 
Facility Code : CSONVWA Housing Area: 
40 Y old Male, DOB: 10/23/1978 
AccOl.lll lunbe ~ 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Cert er 
11 11312018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID,stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• .Acetaminophen 500 t,,G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allerglss 
Boost Plus: diarrhea: Side Effects 
Reason for Appointment 
1. tvH SEG rounds 
History of Present Illness 
Patient Identification: 
Patient Identification 
Appointment Provldef b)(6); (b)(7)(C) 
Patient properly identified by2 sources induding: ID Badge, Picture, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEO Seg Officer 
Wiat language do }OU speak? English 
Interpretation pro\aded? Yes, Interpreter Name 
Name Use notes field 
Language Russian Declined opfon of Russian Int. 
Reoord re\aew conducted: Yes 
Clinical Segregation: 
-M-Mlarwas l}ing in bed as this pro1.1der approached his door. He looked up briefly and denied anymental health 
issues/concerns. Pt then refused to further engage with this pro1.1der. Pt turned awayfrom pro1.1der. 
-GEO SEGoflicer denied any current tvH concerning beha1.1ors for this detainee. Per GEO staff, pt is said to engage custody 
staff, ask for pri\aleges to indude tele1.1sion and if he doesn1 get what he wants has put in grie'8nce to GEO staff. 
Data Checkiist 
1. Does the patient ha'"' a Mlntal Health (tvH) DSMS diagnosis? No 
5. Is the patient currently engaging in any dangerous or disrupti'"' adi1.1tythat would render his/her return to the general 
population a threat to the patient or the safel)lsecurityof the facility? No 
7. ls the patientfrequentlyfollowed up bymedical personnel (other than tvH)? Yes 
Please state frequency Pt is seen daily by nursing staff during daily nursing rounds 
8. ls the patient frequentlyfollowed up bytvH personnel? Yes 
Please state the frequency: Pt is seen v.eekly during SEG M-1 rounds 
9. Has there been deterioration on the patients condition while in segregation? No 
10. ls the patient im,ol'"'d in acti1o1ties while he/she is in segregation? Yes 
/lcti1o1tes Recreaaon (outside the ce/1),Books or reading material, Television 
Please describe: music, jail mail-email service, law library, communicanon v.ith staff and other detainees 
Suicide Risk Inquiry 
Does the patient ha'"' thoughts of harming him or herself or committing suicide? No 
M,ntal Status Exam 
/l!)pearance: ~II groomed,NeaUy dressed .NOTE: Appearance defaults to "'Ae/1 groomed, Ne a Uy dressed" for the drop 
doVltl opaon of this assessment. Hov.ever, a more accurate descripUon of this detainee's appearance is: • AtJequatel y groorned 
and nourished, dressed in dean uniform of the day.· 
Le'"' I of alertness: Consdous 
Describe: NOTE: ''Consdous· is the drop dDVltl option of this quesaon. A more accurate description of this detainee is: "Pt is 
alerl and responding to interaction of today's round appropriately" 
Speech : Is it normal in tone, ,olume and quantity? Yes 
Beha1.10~ Cooperaave,Appropriate for the parlicular situation 
Oientation: They knowllf>ere they are and llf>at they are doing here NOTE: "They knowllf>ere they are and llf>at they are 
doing here"is a default ansv.erforthe drop dDVltl option of this assessment. Hov.ever, a more accurate description of the 
detainee's OientaYon is: Oiented adequately to person, place, situation; considering brief nature of round. 
II/bod: happy 
Describe: NOTE: ''Happy" defaults for the drop dDVltl opnon of this note. Hov.ever, a more accurate description of this 
detainee's mood is ''not impaired" and "of normal range·. 
/lffect: Appropriate 
Thought process: Logical and presented in an organized fashion considering brief nature of round. 
Thought content not paranoid 
Describe: No obvious paranoia sxs presented during brief round 
Judgment Insightful 
Describe: v.ith consideration of brief nature ofroundlinteradion. 
Assessments 
No current tvH diagnosis. 
Preventive Medicine 
~ert Wedical/Custodyoflicer if pt has medical or tvH emergency for immediate access to M,dical for assess ment/Ix. 
Engage in acti,..ties of daily 1i1.1ng to continue good mental and phy.,ical health. 
Appointment Provide'kb)(6); (b)(7)(C) !LCSW 
Bectronically signed b1 b)(6); (b)(7)(C) ~CSW on 11/13/201817:00:49 (Pacific Standard Time) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREET 
T WA 8421 
Tel (b)(6): 
x: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progre .. N-f b )(6); (b )(7)(C) I LCSW 11/13/2018 
2019-ICLl-00051 2834 

DHS-ICE-19-0196, 19-0197-N-000016
NcJ.e general.ed by eC/inica/Wa1<s a.RIPM S:f/"'8re (w.w.1eC/inica/Works.C00"9 
2019-ICLl-00051 2835 

DHS-ICE-19-0196, 19-0197-N-000017
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA . . A: 216269802 Su:i1ot(b )(~ I 
Facility Code : CSONVWA Housing ea: A 
40 Y old Male, DOB: 10/23/1978 
Acc01.111 ~ <6); I 
11 /13/ 2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID. stop date 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
Ira'"' · schedule for am and pm PL • Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required forlra\el, for the noon PL pass 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Past Medlc a l History 
Hunger strike 
Allergles 
Boost Plus: diarrhea: Side Effects 
1623 E J STREET,·, VVM842 I 
Appoimnert Facility: Northwest Detertion Certer 
Reas on for Appointment 
1. RN Daily Seg Rounds 
History of Pre se nt Illn ess 
Patient Identification: 
Patient Identification 
App oint ment Provlde1 (b)(6) ; (b)(?)(C) plN 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do you speak? English 
Interpretation pro\aded? Pallent speaks English fluenUy Detainee able to comunicate needs in English 
Segregation: 
Segregation Rounds 
ke you ru rrentlythinking about killing or harming yourself? No 
Do you ha'"' any medical complaints orconcems at this time? No 
Was referral made to d inical sen.1ces (lvOIM.P, Dental, M-t, Sick Call)? No 
Examination 
Segregation: 
Segregation Evaluation: Patient has spontaneous speech and ansWE!fS questions appropriately, in no acute distress, 
weU de\eloped , well nourished, Patient appears to be v.ithin normal limits of beha"or, affect, and cogniti,e functioning, 
Patient does not appear to ha,e any acute or unresol\ed medical conditions that may worsen in segregation, Patient does 
not appear to ha\e acti,e psychosis, mania, suicidal idealions or l'Klmicidal ideations. 
Assessments 
Health M!intenance Related to Segregation Placement 
Tr eat ment 
1. Others 
Notes: GEO reports detainee ate all of his meals ,esterdayand his Breakfast this l>M 
He has been attending Rec in the afternoon. 
Appointment Provide (b)(6); /h \/7\//"'.\ 
Bectronically signed b* b)(6); 
Sign off status: Completed 
IRN on 11/13/2018 07:57:13 (Pacific Standard Time) 
Northwest Detention Center 
1623 E J STREET T~~r98421 Te(b)~\~- I 
Patien1: AMAR, MERGENSANA DOB: 10/23/197 8 p,__ ~ 11113/2018 
NcJ.e generated oye0irica/Wcv1<s 8"R/PM Sottv.ere (w.w,eQinica/Works.co«4 
2019-ICLl-00051 2836 

DHS-ICE-19-0196, 19-0197-N-000018
11 /12/2018 
........ 
Boost Plus: diarrhea: Side Effects 
U.S. Immigration 
and Customs 
Enforcement 
Reas on for Appointment 
1. Weekly weight and ,Hals 
Appointment Provide[ b)(6); -· 
b)(6); (b)(7)(C) 
AMAR,MERGE~ A: 216269802 Si.ti1 ,b )(6); ~, Facility Code : CSONVWA . 
40 Y old Male, DOB: 10/23/1978 
AccOl.l'II lunberF5i76i:7 
1623 E J STREET, T~ 
Appoirimert Facility: Northwest Detertion Certer 
Appointment Provld e , (b)(6 ); (b)(7)(C) I RN 
Electronically signed b~._b_)_(6_); __ __.FN on 11/16/2018 at 07 :25 MST 
Sign off status: Pending 
Pati-t: AMAR, MERGENSANA DOB: 10/23/1978 p,_.... N 
/lkxe generated by eC/inica/Wcrl.s a.RIPM Sottv.ere ("""' 
2019-ICLl-00051 2837 
Northwest Detention Center 
1623 E J STREET T®~ ~!A 98421 ,0i~(. I 
11/12/2018 

DHS-ICE-19-0196, 19-0197-N-000019
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:llol lh \In\ ! 
Facility Code : CSONVWA Housing Area: H 
40 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunber~ 
1623 E J STREET, T~ 
Appoirimert Facility: Northwest Detertion Cert er 
11 /11/2018 
Cunont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID, stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allorglos 
Boost Plus: diarrhea: Side Effects 
Reason for Appointment 
1. SEGREG\llON ROUNDS 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? No 
Wiat language do you speak? English 
Interpretation pro\aded? Pallent speaks English fluenUy 
Segregation: 
Segregation Rounds 
ke you ru rrentlythinking about killing or harming yourself? No 
Do you ha'"' any medical complaints orconcems at this time? No 
Appointment Provldei b)(6) ; (b)(7)(C) I RN 
Was referral made to d inical sen.1ces (lvOIM.P, Dental, M-t, Sick Call)? No 
Examination 
Segregation: 
Segregation Evaluation: Patient has spontaneous speech and ansWE!fS questions appropriately, in no acute distress, 
weU de\eloped , well nourished, Patient appears to be v.ithin normal limits of beha"or, affect, and cogniti,e functioning, 
Patient does not appear to ha,e any acute or unresol\ed medical conditions that may worsen in segregation, Patient does 
not appear to ha\e acti,e psychosis, mania, suicidal idealions or txlmicidal ideations. 
Assessments 
Health M!intenance Related to Segregation Placement 
Preventive Medicine 
Patient educated on how to access medical / mental health/ dental care while in Segregation. 
Notes: Per H-Segregation Unit GEO officer, detainee has missed his 46th meal traywith breakfast this morning. 
Appointment Provide~ .. (b_)_(6_); __ _.I RN 
l(b)(6); (b)(7)(C) 
Electronically signed b~'-' (b....;)..;. (6.;.);.. ; ---'fN on 11/11/2018 08:35:14 (Pa cific Standard lime) 
Sign off status: Completed 
Northviest Detention Center 
1623 E J STREET 
T~r9842] Tel~1 
Patient: AMAR, MERGENSANA DOIi: 10/23/1 978 P- N~ 11111/2018 
Ncte generated byeOinica!Wai<s EJvR/PM &ltwiJre ("""'eO inica/Works.com) 
2019-ICLl-00051 2838 

DHS-ICE-19-0196, 19-0197-N-000020
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA . . A:21626980 2 Su:llt!li,b)(6); I 
Facility Code: CSOINNA II g A ea. n 
40Y old Mal~,· AccOl.l'II llunbe b 6 · 
11 /10/2018 
Cunont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID, stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a cup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required forlra\el, for the noon PL pass 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Past Medlcal Hletory 
Hunger strike 
Allorglos 
Boost Plus: diarrhea: Side Effects 
1623 E J STREET, T ' 
Appoirimert Facility. Northwest Detertion Certer 
Reason for Appointment 
1. SEGREG\llON ROUNDS 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? No 
Wiat language do you speak? English 
Interpretation pro\aded? Pallent speaks English fluenUy 
Segregation: 
Segregation Rounds 
ke you currentlythinking about killing or harming yourself? No 
Do you ha'"' any medical complaints orconcems at this time? No 
Appointment Provlder:k b)(6) ; (b)(7)(C) f RN 
Was referral made to d inical sen.1ces (lvOIM.P, Dental, M-t, Sick Call)? No 
Examination 
Segregation: 
Segregation Evaluation: Patient has spontaneous speech and ansWE!fS questions appropriately, in no acute distress, 
weU de\eloped , well nourished, Patient appears to be v.ithin normal limits of beha-.ior, affect, and cogniti,e functioning, 
Patient does not appear to ha,e any acute or unresol\ed medical conditions that may worsen in segregation, Patient does 
not appear to h8'e acti,e psychosis, mania, suicidal idealions or l'Klmicidal ideations. 
Assessments 
Health M!intenance Related to Segregation Placement 
Preventive Medicine 
Patient educated on how to access medical / mental health/ dental care while in Segregation. 
Notes: Per H-Segregation Unit GEO officer, detainee has missed his 43rd meal with breakfast this morning. 
Appointment Provide (b )(6); / h \/ 7 \tr:I 
b)(6); (b)(7)(C) 
Electronically signed b (b)(6); f l,-,.\/ 7 \lf""\ 
Sign off status: Comple 
RN 
on 11/10/2018 09:52:39 (Paci fic Standard lime) 
Northviest Detention Center 
1623 E J STREET 
21 
Patient: AMAR, MERGENSANA DOIi: 10/23/1978 P..,.... N-t;~/\~! ;,~, IRN 11110/2018 
Ncte generated byeOinica!Wai<s EJvR/PM &ltwiJre ("""'eO inica/Works.com) 
2019-ICLl-00051 2839 

DHS-ICE-19-0196, 19-0197-N-000021
U.S. Immigration 
and Customs 
Enforcement 
AMAR, MERGEN _~ 
Facility~~~~~ 40 YAcca.nt ad ~=1~ ~be l§)@C :~ I 
11 109/2018 
Curnont Medication s 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID.stop date 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required forlra\el, for the noon PL pass 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Past Medlc a l History 
Hunger strike 
Allergles 
Boost Plus: diarrhea: Side Effects 
1623 E J STREET, T v 
Appoirimert Facility. Northwest Detertion Certer 
Reas on for Appointm ent 
1. RN Daily Seg rounds 
History of Prese nt Illne ss 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? English 
App o intm ent Provld e 1 b)(6) ; __ 
Interpretation pro\aded? Pallent speaks English fluenUy Detainee able to comunicate needs in English 
Segregation: 
Segregation Rounds 
ke }OU rurrentlythinking about killing or harming }Ourself? No 
Do}Ou ha'"' any medical complaints orconcems at this time? No 
Was referral made to d inical sen.1ces (lvOIM.P, Dental, M-t, Sick Call)? No 
Ex amin ation 
Segregation: 
Segregation Evaluation: Patient has spontaneous speech and ansWE!fS questions appropriately, in no acute distress, 
weU de\eloped , well nourished, Patient appears to be v.ithin normal limits of beha"or, affect, and cogniti,e functioning, 
Patient does not appear to ha,e any acute or unresol\ed medical conditions that may worsen in segregation, Patient does 
not appear to ha\e acti,e psychosis, mania, suicidal idealions or txlmicidal ideations. 
As se ssm e nt s 
Health M!intenance Related to Segregation Placement 
Tr ea tm ent 
1. Others 
Notes: Documentation of him going to rec 10sterday-he refuses in the /lM-Goes in the PM 
GEOreporls did not ha'"' any solid foods )eslerday-Continues to consume liquid supplement 
Still refusing tray meals (#40 at breakfast today by GEO count). 
Appo intment Provi de1(b)(6) ; fN 
Bectro nicall y signed b* b)(6) ; ~- IRN on 11109/2018 08:05:31 (Pacific Standard Time) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREET 
T~ WA984?1 
Tel(b)(6); 1 t-ax: 
Patien1: AMAR, MERGENSANA DOB: 10/23/1 978 p,__ Note:~kb~}_(6~); __ ~r" 11/09/2018 
/lkxe generated bye0irica/Wc11<s El>R'PM So/rv.ere {WINleOinica/Wc.-ks.com/ 
2019-ICLl-00051 2840 

DHS-ICE-19-0196, 19-0197-N-000022
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A:216269802 Su:llc:(b)(6); I 
Facility Code : CSONVWA Housing Area: A 
40 Y old Male, DOB: 10/23/1978 
AccOl.lll lunbe~ 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Cert er 
11 108/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID, stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allergles 
Boost Plus: diarrhea: Side Effects 
Reason for Appointment 
1. RN Daily Seg rounds 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do you speak? English 
Appointment Provid e (b )(6); 
/h\/ 7\IC:\ 
Interpretation pro\aded? Pallent speaks English fluenUy Detainee able to comunicate needs in English 
Segregation: 
Segregation Rounds 
ke you ru rrentlythinking about killing or harming yourself? No 
Do you ha'"' any medical complaints orconcems at this time? No 
Was referral made to d inical sen.1ces (lvOIM.P, Dental, M-t, Sick Call)? No 
Examination 
Segregation: 
RN 
Segregation Evaluation: Patient has spontaneous speech and ansWE!fS questions appropriately, in no acute distress, 
weU de\eloped , well nourished, Patient appears to be v.ithin normal limits of beha"or, affect, and cogniti,e functioning, 
Patient does not appear to ha,e any acute or unresol\ed medical conditions that may worsen in segregation, Patient does 
not appear to ha\8 acti,e psychosis, mania, suicidal idealions or txlmicidal ideations. 
Assessments 
Health M!intenance Related to Segregation Placement 
Treatment 
1. Others 
Notes: GEO Officers able toshowdorumentation of him going to rece,erdayth is week-he refuses in the /lM-Goes in the PM 
GEO reporls he ate an orange last night 
Still refusingtraymeals. 
Appointment Provide~ /b)/6) !RN 
Bectronically signed b (b)( 6); RN on 11108/2018 06:45:47 (Pacific Standard Time) lh\/ 7 \lr\ 
Sign off status: Complete 
Northwest Detention Center 
1623 E J STREET 
l'. WA98421 
Tel (b)(6) ; 
Patien1: AMAR, MERGENSANA DOB: 10/23/1978 p,__ ~ 11/0l/2018 
/lkxe generated bye0irica/Wc11<s El>R'PM So/rv.ere (w.w,eQinica/Wc.-ks.com/ 
2019-ICLl-00051 2841 

DHS-ICE-19-0196, 19-0197-N-000023
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA . . A: 216269802 Su:lli!:lb )(6); _ ~ Facility Code : CSONVWA 11g 14 ea. 
40 Y old Male, ~- 1Q/2J119ZB AccOllll lunbe /h\/R\ · 
11 107/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID. stop date 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018 , KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/20 18, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/20 18, KOP: Yes. Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlc a l History 
Hunger strike 
Allergles 
Boost Plus: diarrhea: Side Effects 
Reas on for Appointment 
1. RN Daily Seg rounds 
History of Pre se nt Illn ess 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do you speak? English 
1623 E J STREET, TACOMA, WA-98421 
Appoirimert Facility: Northwest Detertion Certer 
Appointment Provlder:~!(b_,)_.(6-')'-; __ _.! RN 
Interpretation pro\aded? Pallant speaks English fluenUy Detainee able to comunicate needs in English 
Segregation: 
Segregation Rounds 
ke you ru rrentlythinking about killing or harming yourself? No 
Do you ha'"' any medical complaints orconcems at this time? No 
Was referral made to d inical sen.1ces (lvOMP , Dental, M-t, Sick Call)? No 
Examination 
Segregation: 
Segregation Evaluation: Patient has spontaneous speech and ansWE!fS questions appropriately, in no acute distress, 
weU de\eloped , well nourished, Patient appears to be v.ithin normal limits of beha"or, affect, and cogniti,e functioning, 
Patient does not appear to ha,e any acute or unresol\ed medical conditions that may worsen in segregation, Patient does 
not appear to ha\e acti,e psychosis, mania, suicidal idealions or l'Klmicidal ideations. 
Assessments 
Health M!intenance Related to Segregation Placement 
Tr eat ment 
1. Others 
Notes: GEO Officers able toshowdorumentation of him going to rece,erdayth is week- he refuses in the /lM-Goes in the PM 
GEO reporls he ate an apple last night 
Still refusingtraymeals. 
Appointment Provide b )(6); RN =h"'\/..:.7..e \/ccr_,.___, 
Bectronically signed bj""(b...;)..:. (6...;).:.. ; ----'~ on 11107/2018 08:58:42 (Pacific Standard Time) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREET 
T~~A9842l 0¾¾ I 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 p,__ Not.l..,(ba..).(6'-" )._: __ _.!RN 11/07/2018 
/lkxe generated bye0irica/Wc11<s El>R'PM So/rv.ere (w.w,eQinica/Wcrks.com/ 
2019-ICLl-00051 2842 

DHS-ICE-19-0196, 19-0197-N-000024
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A:216269802 Su:l1Dt (b)(6): ! 
Facility Code : CSONVWA Housing Area: A 
40 Y old Male, DOB: 10/23/1978 
AccOl.lll lunber~ 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Cert er 
11 106/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019 , KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID, stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018 , KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/20 18, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/20 18, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allergles 
Boost Plus: diarrhea: Side Effects 
Reason for Appointment 
1. RN Daily Seg rounds 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do you speak? English 
Appointment Provlder:j ~(b--')-'-(6-'-)"-; __ _.I RN 
Interpretation pro\aded? Pallent speaks English fluenUy Detainee able to comunicate needs in English 
Segregation: 
Segregation Rounds 
ke you ru rrentlythinking about killing or harming yourself? No 
Do you ha'"' any medical complaints orconcems at this time? No 
Was referral made to d inical sen.1ces (lvOIM.P, Dental, M-t, Sick Call)? No 
Examination 
Segregation: 
Segregation Evaluation: Patient has spontaneous speech and ansWE!fS questions appropriately, in no acute distress, 
weU de\eloped , well nourished, Patient appears to be v.ithin normal limits of beha"or, affect, and cogniti,e functioning, 
Patient does not appear to ha,e any acute or unresol\ed medical conditions that may worsen in segregation, Patient does 
not appear to ha\8 acti,e psychosis, mania, suicidal idealions or txlmicidal ideations. 
Assessments 
Health M!intenance Related to Segregation Placement 
Treatment 
1. Others 
Notes: GEO Officers had no dorumentation of him going to rec ,<a>sterday , he is dedined for today 
GEO reporls he ate his PM snack 
Still refusingtraymeals. 
Appointment Provide~(b)(6); __ 
Bectronically signed b* b)(6); ~-
Sign off status: Completed 
~ on 11106/2018 08:28:38 (Pacific Standard Time) 
Northwest Detention Center 
1623 E J STREET 
TACOMA, WA98421 
Tell b )(6): I 
,ax. 
Patien1: AMAR, MERGENSANA DOB: 10/23/1978 p,__ Notef"'b"')""- (6"') ... : __ _,!RN 11/08/2018 
/lkxe generated bye0irica/Wc11<s El>R'PM So/rv.ere (w.w,eQinica/Wc.-ks.com/ 
2019-ICLl-00051 2843 

DHS-ICE-19-0196, 19-0197-N-000025
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:ll*b )/6) ! 
Facility Code : CSONVWA Housing Area: A 
40 Y old Male, DOB: 10/23/1978 
AccOl.llt funber lth\ 1a ,. I 
11 /05/2018 
Current Medications 
Taking 
• Prenatal \.itamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 M3Tablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• A:etamioophen 500 M3 Tablet 1 tablets as needed OD PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial~ - Solution 1 BID, stopdate01 /10/2019, KOP:Yes, Drug 
Source: In House Pharmacy 
• Fiber625 M3Tablet2tab letas needed BID,stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra~ I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra~ I. schedule for am and pm PL 
• Boost\A-IC- Liquid 1 along with a cup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the ooon PL pass 
• Fiber625 M3 Tablet 1 tablet as needed c»-iS, stop date 
11A'.l8/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra~ I 
• A:etamioophen 500 M3 Tablet 1 tablets as needed BID, stop 
date 11124/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra~ I 
Past Medlcal History 
Hunger strike 
Allergles 
Boost Plus: diarrhea: Side Effects 
Reason for Appointment 
1. A:lmin M-iU DIC oote 
History of Present Illness 
Patient Identification: 
Patient Identification 
1623 E J STREET, TACOMA, WA-98421 
Appoimnert Facility: Northwest Detertion Cert er 
Appointment Provider: b)/6): (b)/7)/C) LCSW 
Supervising Provide (b)(6) ; (b)(?)(C ) D 
Patient properly identified by2 sources induding: Picture, Verbally ADMN NOTE. SEE M-1 Note today for more details. 
Chaperone Present? YesADMN NOTE SEE M-1 Note today for more details. 
Chaperone Name: SEG GEO officer 
Wiat language do )OU speak? English 
Interpretation pro\<ded? Patient speaks English fluenUy ADMN NOTE. SEE M-1 Note today for more details. 
Patient was referred by: Custody 
Patient was referred for. Creating a 6 foot rope that potentially could be used for self harm 
Record re\<ew conducted: Yes 
Pain Assessment 
Pain 
l're)Oucurrently in pain? NoADMNNOTE SEEM-/Note today for more details. 
fv'edical Housing Unit 
Discha,ye 
Discha,ye Diagnosis and status: Ox: Traits of an Adjustment DO. Pt displays safe behaviors, reports future focus, sense of 
resiliency and belief system that discourages suicide. Agrees to commitment of Tx Pian and safety plan. 
Summary of M-iU stay: Admitted to M-IU for suicide ootch. Dov.ngraded to M-/U OJservation v.ith 10 min irregular checks. 
Cngoing safe behaviors observed/reported. Asses.sed for risk vs protective factors. Pt currenUy at low acute suicide risk. Least 
restrictive environment is General Population housing. 
fv'edication orders: No changes to current orders. 
Special Diet CXher: Return to previous diet 
Special instructons/precautions/alergies: Yes. see orders Pt to engage in Treatment Pian skills and behavior induding 
Safety Pian behaviors as indicated in today's Tx Pian. 
l'(:ti\aties: As tolerated 
CafeterialW:>rk Clearance: Mly return to v.orl< 
Date of Discharge: 111!)5/2018 
Time of Discharge (Hours and minutes} : 14:30 PM 
Total number of days in infirmary 12 
Disposition: Release to custody for housing 
Follow up plan (including ne>d appoinlment}: Followvp tomorrow 
Asses sments 
Traits of an A:ljustrnent Disorder. 
Appointment Provide (b)(6) ; (b)(?)(C) csw 
Confinnatory sign off: 
~~b-)(_
6)_; (_b)_(?_)(_C) __ _.l 11/08/2018 093 0:00 AM 
Electronically signed b (b)(6); (b)(?)(C) LCSW on 11/05/ 201815 :31:47 (Pacific Standard Time) 
Electronically co-signed b (b)(6 ); (b)(?)(C) Don 11/08/2018 at 09:30 AM MDT 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREET 
T~EA98421 ~1 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progre .. N-j (b)/6) (b )/7)/C) !LCSW 11/0512018 
/licJ.e generated oye0irica/Wcv1<s a,,R/PM Sotrv.ere (w.w,eOinica/Wcx-ks .COl"r4 
2019-ICLl-00051 2844 

DHS-ICE-19-0196, 19-0197-N-000026
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A:216269802 Su:i1ol(b)( 6): 7 
Facility Code : CSONVWA Housing Area: H 
40Y old Mal~,· AccOllll l'unbe b )(6); 
11 10512018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID.stop date 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• .Acetaminophen 500 t,,G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes. Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allergles 
Boost Plus: diarrhea: Side Effects 
1623 E J STREET, T 
Appoimnert Facility: Northwest Detertion Certer 
History of Present Illness 
Patient k:lentification: 
Patient k:lentification 
Aflpolntment Provlclert' b)(6): (b)(7)(C) 
Patient properly identified by2 sources induding: ID Badge, Picture, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEO Seg C1ficer 
IMlat language do )OU speak? English 
Interpretation pro;;ded? Yes, Interpreter Name 
Name Use notes field 
Language Russian Declinedopfon of Russian Int. 
Record re,;ew conducted: Yes 
Clinical Segregation: 
!LCSW 
-M-Pmar denied mental health issues/concerns. Denied Si. Pt then refused to further engage with pro,;der, would not say 
whether he wanted a word search puzzle that was offered or not Pt went to his bunk, laid down and turned awayfrom pro.ider. 
This author then slipped the puzzle under his door in case he would like it for later. 
-GEO SEGoflicer \Mi ite denied any current M-i concerning beha.iors for this detainee. She reported pt often will be rude and 
abrupt with medical and mental health staff, refusing to answer their questions. /Iller medical staff lea'"', pt is said to then 
engage rustodystaff, ask for pri.ileges to indude tele.ision and if he doesnt get what he wants has put in grievance to GEO staff. 
Data Checklist 
1. Does the patient ha'"' a M,ntal Health (M-i) DSMSdiagnosis? No 
5. Is the patient currently engaging in any dangerous or disrupti'"' acti.itythat would render his/her return to the general 
population a threat to the patient or the safet)l'securityof the facility? No 
7. ls the patientfrequentlyfollowed up bymedical personnel (other than M-i)? Yes 
Please state frequency: Pt is seen daily by nursing sraff during daily nursing rounds 
8. ls the patient frequentlyfollowed up byM-i personnel? Yes 
Please state the frequency: Pt is seen v,eekly during SEG M-1 rounds 
9. Has there been deterioration on the patients condition while in segregation? No 
10. ls the patient im,ol'"'d in acti.ities while he/she is in segregation? Yes 
1'<:ti;;tes Recreation (outside the ce/1),Books or reading material, Television 
Please describe: music, jail mail-email service, lawlibra,y, communica#on >lith staff and other detainees 
Suicide Risk Inquiry 
Does the patient ha'"' thoughls of harming him or herself or committing suicide? No 
Mantal Status El<am 
/l!)pearance: Vlei/ groomed,NeaUy dressed .NOTE: /l{)pearance defaults to ",\el/ groomed, NeaYy dressed" for the drop 
dowi option of this assessment. Hooever, a more accurate description of this detainee's appearance is: • Adequately groomed 
and nourished, dressed in dean uniform of the day.• 
Le'"' I of alertness: Conscious 
Describe: NOTE: "Conscious• is the drop dOWI op#on of this question. A more accurate description of this detainee is: "Pt is 
alert and responding to interaction of today's round appropriately" 
Speech : Is it normal in tone, \Olume and quantity? Yes 
Beha.ior. Cooperative,Appropriate for the particular situation 
0-ientation: They knowv.here they are and v.hat they are doing here NOTE: "They knowv.here they are and v.hat they are 
doing here" is a default ansv,er for the drop do'M1 option of this assessment. Hooever. a more accurate description of the 
detainee's Orientation is: Oriented adequately to person, place, situation; considering brief nature of round. 
llibod: happy 
Describe: NOTE: "Happy" defaults for the drop dov,n op#on of this note. Hooever. a more accurate description of this 
detainee's mood is "not impaired" and "of normal range•. 
Meet: Appropriate 
Thought process: Logical and presented in an organized fashion considering brief nature of round. 
Thought content: not paranoid 
Describe: No obvious paranoia sxs presented during brief round 
Judgment Insightful 
Describe: >lith consideration of brief nature ofroundAnteraction. 
Assess ments 
No rurrent M-t diagnosis. 
Prevent ive Medic ine 
~ert Wedical/Custodyoflicer if pt has medical or M-i emergency for immediate access to Madi cal for assessment/Ix. 
Engage in acti,;ties of daily li,;ng to continue good mental and phy.;ical health. 
Appoinbnent Provide r:l(b)(6) ; (b)(7)(C) ILCSW 
b)(6) ; 
h\/7\lt.\ 
Bectronically signed b1 b)(6) ; (b)(7) (C) ~CSW on 11/05/2018 13:17:28 (Pacific Standard Time) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREET T~H'A98d21 mfai~~ ;, 
Patient: AMAR, MERGENSANA DOB: 10/2 311978 Prog19M Notej(b)(6); (b)(7)(C) ILCSW 11/0512018 
2019-ICLl-00051 2845 

DHS-ICE-19-0196, 19-0197-N-000027
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 51.tillfo )(6) ! 
Facility Code: CSONVWA Housing Area: A 
40 Y old Male, DOB: 10/23/1978 
Acc01.111 lunberfr5i(6i:7 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
11 /05/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018 , KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID,stopdate 
04/15/2019 , KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018 , KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018 , KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allerglss 
Boost Plus: diarrhea: Side Effects 
Review of Systems 
Unable to assess due to Pt's refusal to respond to questions. 
Appointment Provlde, (b)(6) ; (b)(?)(C) 
Reason for Appointment 
1. tvH follow up on Pt in the tvHU on 10 min. M-tO 
History of Present Illness 
Narrati'"': 
Pt spoke:()() Fluent English; [)Spanish;()() Oher, Lionbridge # 
Re'"ewed Record [>l 
Pt IDed byname, Ml, picture 
Session chaperoned by GEO M!dical Oficer, obsen.ing direcilyfrom outside large office window. 
CURRENT COl'vf'l..PjNT/CONCERN: 
Pt continues to refuse to respond to this pro,.ders questions about his Mlntal Status. Pt was la,;ng in bed when this pro,.der 
approached his SEGcell and asked to ha'"' the ruff port opened. Pt immediately put his head under the co'"'rs in his bed. Pt 
would not respond to any requests for information about his mental state. This pro,.der, utili2ing a Russian interpreter made 
numerous attempts to engage fvt. !>mar but he continues to refuse to respond. During M-t SEG rounds today, Pt did respond (per 
chart note) to Glenn-Reller LCSW, that he is not e~riendng any St/HI or AIA-I. SEG GEO staff report that Pt, on two oocasions 
has gone to REC )0rd with another detainee and interacted appropriately for well o'"'r 30 minutes. Further SEG GEO staff report 
that Pt has not presented any mental health concerns. He has gone to the Rec )0rd when a1,0ilable but has refused to shower for 
the past four days. Pt has also refused se'"'ral meals. He refused breakfast this morning. Pt does aocept Pedial)(e and boost 
and >MIi eat fruit when pro,.ded. This Pt's case has been re'"ewed by the M-t team. Since Dr. jth ""'· I chart notes indicate that 
this Pt does not ha'"' anyM-t issues and since all staff that ha'"' been able to interact>Mth this Pt ha'"' reported that Pt does not 
endorse any SI/HI or AIA-I, the M-t team conduded that this Pt can be released from M-t observation and discharged from the 
tvHU. AtvH follow up appointment is scheduled for tomorrow. 
Examination 
rv'ental Status: 
!>PPEJ>RANCE: 
Segregation Cell is clean, items are in order, room is picked up. 
Assessments 
Traits of an Mjustment Disorder. 
Appoinbnent Provide (b)(6); (b)(?)(C) LCSW 
Bectronically signed b)(6); (b)(?)(C) CSW on 11l05/2018 15:30:58 (Pacific Standard Time) 
Sign off status: Complete 
Northwest Detention Center 
1623 E J STREET 
T WA98421 
Tel (b)(6); 
Patient: AIIAR, MERGENSANA DOB: 10/23/1978 CSW 11/05/2018 
Ncie generated by eClinica/Wcri<s EJvRIPM Scllwi,re (""""' \,r-,"""'"""""",.-,,""',-.....1 
2019-ICLl-00051 2846 

DHS-ICE-19-0196, 19-0197-N-000028
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A:216269802 Su:llDtl h\/R\ · I 
Facility Code : CSONVWA Housing Area: H 
40 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunber~ 
1623 E J STREET, T~ 
Appoirimert Facility: Northwest Detertion Cert er 
11 /05/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID,stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allergles 
Boost Plus: diarrhea: Side Effects 
Reason for Appointment 
1. RN Daily Seg rounds 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do you speak? English 
Appointment Provid e (b )(6); lh\ f 7 \l r\ 
Interpretation pro\aded? Pallent speaks English fluenUy Detainee able to comunicate needs in English 
Segregation: 
Segregation Rounds 
ke you ru rrentlythinking about killing or harming yourself? No 
Do you ha'"' any medical complaints orconcems at this time? No 
Was referral made to d inical sen.1ces (lvOIM.P, Dental, M-t, Sick Call)? No 
Examination 
Segregation: 
RN 
Segregation Evaluation: Patient has spontaneous speech and ansWE!fS questions appropriately, in no acute distress, 
well_ de\eloped , well nourished, Patient appears to be v.ithin normal limits of beha-.ior, affect, and cogniti1.e functioning, 
Patient does not appear to ha,e any acute or unresol\ed medical conditions that may worsen in segregation, Patient does 
not appear to h8'e acti,e psychosis, mania, suicidal idealions or l'Klmicidal ideations. 
Assessments 
Health M!intenance Related to Segregation Placement 
Treatment 
1. Others 
Notes: GEO Officers had no dorumentation of him going to rec ,<a>sterday , he is signed up for today 
GEOreporls heatean/>pple last night and his PMsnack 
Still refusingtraymeals. 
Appointment Provide,fb)(6); ~- I RN 
Bectronically signed b* b)(6); IRN on 11105/2018 06:32:26 (Pacific Standard Time) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREET 
T~~A98421 
Teii§x6(_ I 
Patien1: AMAR, MERGENSANA DOB: 10/23/1978 P,__ Not.j~(b_)~(6_)_; --~!RN 11/05/2018 
/lkxe generated bye0irica/Wc11<s El>R'PM So/rv.ere (w.w,eQinica/Wc.-ks.com/ 
2019-ICLl-00051 2847 

DHS-ICE-19-0196, 19-0197-N-000029
U.S. Immigration 
and Customs 
Enfor cement 
AMAR, MERGEN~ 
A:216269802 Si.ti1 b)(6); 
Facility Code : CSONVWA Housing ea: 
40Y old Mal~,· AccOl.lll llunbe b 6 · 
11 104/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID,stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allergles 
Boost Plus: diarrhea: Side Effects 
1623 E J STREET, T ' 
Appoimnert Facility: Northwest Detertion Cert er 
Reason for Appointment 
1. tvHU RN NIGHT ROUNDSIM-lO H-SEG 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEO OFFICER ON DUTY 
Wiat language do }OU speak? English, Russian 
Interpretation pro\aded? Pallent speaks English fluenUy 
Pain l>ssessment 
Pain 
/>,e }OU ru rrentlyin pain? No 
Narrati'"': 
Appointment Provld ei (b)(6) ; ~-
ENCOUNTERED PT DURING ROUNDS. PT DENIED SIA-IVA\H DENIED PNYP/IIN ffi DISCCtvFffiT. DID NOT WPNT TO 
T/11..K PT ATE />N /IPPLE />ND PMSN/ICK I.AST E\iENING. RERJSED BREl'l<FAST. 
Examination 
General Examination: 
GENER/II.. PPPEl'R/>NCE: in oo acute distress, well de\eloped , well oourished. 
EXTREMTIES: full range of motion. 
PSYCH: affect restricted. 
Assessments 
1. lneffectl'"' Coping [00069]- ND00069 (Primary) 
Treatment 
1. lneffectiw Coping [00069) 
Notes: Pro" de~s orders re,..ewed and '"'rified. 
Nursing to round as needed , dorument beha"or, '"'rbali,ations, and displayof emotions. 
Establish a working relationship with Pl 
Pro"de opportunities for Pt to e~ress oonoems, fears, feelings, e~ c:lations. 
l>ssess for specificstressors. 
Discuss available or useful past ooping mechanisms. 
Reduoe stimuli in their en,..ronmenl 
Instruct Pt to notify Offioer or Nurse if needing assistance or if there is a change in their health status. 
Mm inister medications as ordered. 
Fresh drinking water in oell, encourage Ptto drink 3-4L of water daily. 
11/onitor Pt's oral intake for adequate nutrition and h)dration. 
Encourage eiercise in oell or Recreation Yard if allowed. 
Obserw for statements/beha"ors indicating harm to self or others. 
Pt to remain in tvHU until discharge byPro"der. 
Pt '"'rba liied understanding of care plan. 
Disposition: Mm itted to tvHU until medicallye1,0luated 
Appointment Providef b)(6); ~-
Electronically signed b~(b)(6); 
Sign off status: Completed 
~ on 11105/2018 06:06:19 (Pacific Standard Time) 
Northwest Detention Center 
1623 E J STREET 
TACOMA, WA98421 
Telj(b /L6J; I 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 P.....,.. ~ 11/04/201 8 
Nr:te genertK8d by eC/inica!Wcxi<s EM<IPM Soflve,-e (""'"'eC/inica/Warks.com) 
2019-ICLl-00051 2848 

DHS-ICE-19-0196, 19-0197-N-000030
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:i1c:t:b )(61 I 
Facility Code : CSONVWA Housing ea: A 
40 Y old Male, DOB: 10/23/1978 
AccOl.lll lunbe~ 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
11 104/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID, stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allergles 
Boost Plus: diarrhea: Side Effects 
Reason for Appointment 
1. tvHU RN 2ND 1 /2 SHIFT 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEO OFFICER ON DUTY 
Wiat language do }OU speak? English, Russian 
Interpretation pro\aded? Pallent speaks English fluenUy 
Pain l>ssessment 
Pain 
/>,e }OU ru rrentlyin pain? No 
Narrati'"': 
Appointment P1'ovlde'1~(b-'-)-'-(6""' );'--- _ ___.plN 
ENCOUNTERED PT DURING ROJNDS. PT DENIED SIA-IVA\H DENIED PNYP/IIN ffi DISCC'tvFffiT. DID NOT WPNT TO 
T/11..K TOOK M:DICAll ON /IIIID BOOST. 
Examination 
General Examination: 
GENER/II.. />PPEPR/IIIICE: in oo acute distress, well de\eloped , well oourished. 
EXTREMllES: full range of motion. 
PSYCH: affect restricted. 
Assessments 
1. lneffecti'"' Coping [00069]- ND00069 (Primary) 
Treatment 
1. lneffectiw Coping [00069) 
Notes: Pro" de~s orders re,..ewed and '"'rified. 
Nursing to round as needed , dorument beha"or, '"'rbali,ations, and displayof emotions. 
Establish a working relationship with Pt. 
Pro"de opportunities for Pt to e~ress oonoems, fears, feelings, e~ c:lations. 
l>ssess for specificstressors. 
Discuss available or useful past ooping mechanisms. 
Reduoe stimuli in their en,..ronmenl 
Instruct Pt to notify Offioer or Nurse if needing assistance or if there is a change in their health status. 
Mm inister medications as ordered. 
Fresh drinking water in oell, encourage Ptto drink 3-4L of water daily. 
11/onitor Pt's oral intake for adequate nutrition and h)dration. 
Encourage eiercise in oell or Recreation Yard if allowed. 
Obserw for statements/beha"ors indicating harm to self or others. 
Pt to remain in tvHU until discharge byPro"der. 
Pt '"'rba liied understanding of care plan. 
Disposition: Mm itted to tvHU until medicallye1,0luated 
Appointment Provider:!( b)(6) : !RN 
Electronically signed b* b)(6); ~- IRN on 11104/2018 23:18:57 (Pacific Standard Time) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREET T~:r 98421 4&3I-. I 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 P.....,.. 11/04/201 8 
Nr:te genertK8d by eOinica!Wcxi<s EM<IPM Soflve,-e (""'"' 
2019-ICLl-00051 2849 

DHS-ICE-19-0196, 19-0197-N-000031
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGV'ks.coojl 
2019-ICLl-00051 2850 
AMAR,MERGENSANA . . A:21626980 2 Su:ll~ b)(6); _ Facility Code: CSOINNA HJJ A ea: n 
40 Y old Male, DOB: 10/23/1978 
AccOl.l'II ~be~ 
1623 EJ STREET, T~ 

DHS-ICE-19-0196, 19-0197-N-000032
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 2851 
AMAR,MERGENSANA A:216269802 Su:llD:Vh\/R\· ! 
Facility Code : CSONVWA Housing Area: A 
40Y kcOUll ad ~1~i/C:: 
~ Jf@f ! 1623 E J STREET, T 

DHS-ICE-19-0196, 19-0197-N-000033
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA . . A:21626980 2 Su:i1~)<6); I 
Facility Code: CSOINNA II g A ea. n 
40 Y old Male, DOB: 10/23/1978 
1623 E J 
AccOl.l'II 
STREET, 
llunber: 
T~ 
~ 
Appoirimert Facility. Northwest Detertion Certer 
11 104/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID.stop date 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a cup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required forlra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes. Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Past Medlc al History 
Hunger strike 
Allerglss 
Boost Plus: diarrhea: Side Effects 
Review of Systems 
Unable to assess due to Pt's refusal to respond to questions. 
Reas on for Appointment 
1. tvH tvHU rounds 
History of Pres ent Illn ess 
Narrati'"': 
Appointment Provlder:l (b)(6 ); (b)(?)(C) f LCSW 
Pt spoke:()() Fluent English; [) Spanish; ()() Oher, Lionbridge # 
Re'"ewed Record [>l 
Pt IDed byname, Ml, picture 
Session chaperoned by GEO M!dical Oficer, obsen.ing direcilylrom outside large office window. 
CURRENT COl'vf'l..PjNT/CONCERN: 
Pt continues to refuse to respond to questions about his l\lental Status. Pt was sitting at the table in his room when this 
pro,.der approached his door. /16 soon as Pt saw me he jumped up and went under the oo'"'rs in his bed. Pt would not respond 
to any request for information about his mental state. This pro,.der, utili.zing a Russian interpreter made numerous attempts to 
engage M'. J>mar but he oontinues to refuse to respond. SEG GEO staff report that Pt has not presented any mental health 
ooncerns. He has gene to the Reqard when a"'i lable but has refused to shower/or the past four day.;. Pt has also refused 
se'"'ral meals. He refused breakfast this morning. Since Pt is not responding to any questions about his mental state, refuses to 
respond to questions regarding suicidalityand not presenting anyoonsistent stable beha,.or, he will remain on M-iOwith 10 
minute irregular custody checks. Pt case will be re'"ewed by the l\lental Health team tomorrow for disposition input 
Examination 
11/ental Status: 
PPPEPRl>NCE: 
Segregation Cell is clean, items are in order, room is picked up. 
Appointment Provider:l(b) (6) ; (b)(?)(C) I LCSW 
Electronically signed b (b)(6); (b)(?)(C) CSW on 11/04/20 1814 :20:12 (Pacific Standard Time) 
Sign off status: Complete 
Northviest Detention Center 
1623 E J STREET 
T~WA98421 Te1ffiffi3f I 
Patient: AMAR, MERGENSANA DOB: 10/2 3/19 78 LCSW 11/04/2018 
Ncte generated by eOinica/Wcxi<s E1vRIFM &ilw!Jl'e ("""' 
2019-ICLl-00051 2852 

DHS-ICE-19-0196, 19-0197-N-000034
11104/2018 
........ 
Boost Plus: diarrhea: Side Effects 
U.S. Immigration 
and Customs 
Enforcement 
Reason for Appointment 
1. Weekly weight and ,Hals 
Appointment Provider. Tacoma Provide r 
AMAR,MERGENSANA A:216269802 Si.tlll(b)(6k I 
Facility Code : CSONVWA Hcius1ng ea: A 
40 Y old Male, DOB: 10/23/1978 
AccOl.lll ~ber~ 
1623 EJ STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Provider: Tacoma Provider 
Electronically signed by Tacoma Provider on 11/16/2018 at 07:25 MST 
Sign off status: Pending 
Northwest Detention Center 
1623 E J STREET 
T WA98421 
Tel (b)(6); 
Patl-t: AMAR, MERGENSANA DOB: 10/23/1978 p,_... Note: T- Pnmcler 11/04/2018 
/lkxe generated by eC/inica/Wcrl.s a.RIPM Sottv.ere ("""'eC/inica/ Works.com) 
2019-ICLl-00051 2853 

DHS-ICE-19-0196, 19-0197-N-000035
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA A:21626980 2 Su:i1ol(b)(6): ! 
Facility Code : CSONVWA Housing Area: A 40 Y old Male, DOB: 10/23/1978 
AccOl.lll lunbe~ 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
11 104/2018 
Cunont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID, stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlc a l History 
Hunger strike 
Allorglos 
Boost Plus: diarrhea: Side Effects 
Reas on for Appointment 
1. SEGREG\llON ROUNDS 
History of Pre se nt Illn ess 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? No 
Wiat language do you speak? English 
Interpretation pro\aded? Pallent speaks English fluenUy 
Segregation: 
Segregation Rounds 
ke you ru rrentlythinking about killing or harming yourself? No 
Do you ha'"' any medical complaints orconcems at this time? No 
Appointment Provld e 1(b)( 6); (b)(7)(C) rN 
Was referral made to d inical sen.1ces (lvOIM.P, Dental, M-t, Sick Call)? No 
Examination 
Segregation: 
Segregation Evaluation: Patient has spontaneous speech and ansWE!fS questions appropriately, in no acute distress, 
weU de\eloped , well nourished, Patient appears to be v.ithin normal limits of beha-.ior, affect, and cogniti,e functioning, 
Patient does not appear to ha,e any acute or unresol\ed medical conditions that may worsen in segregation, Patient does 
not appear to h8'e acti,e psychosis, mania, suicidal idealions or txlmicidal ideations. 
Assessments 
Health M!intenance Related to Segregation Placement 
Preve nt ive Medic ine 
Patient educated on how to access medical / mental health/ dental care while in Segregation. 
Notes: Per H-Segregation GEO officer, detainee refused his lunch )eSterday, howe'"'r, it is documented that detainee ate 50%. 
Appointment Providef b)(6 ); - · 
b)(6); (b)(7)(C) 
Electronically signed (b)(6); (b)(7)(C) on 11/04/2018 09:18:11 (Pa cific Standard lime) 
Sign off status: Comple 
Northviest Detention Center 
1623 E J STREET 
T~WA98421 
Te~r_ I 
Patient: AMAR, MERGENSANA DOIi: 10/23/1978 P..,.... Noto:l(b)(6); r" 11/04/2018 
Ncte generated byeOinica!Wai<s EJvR/PM &ltwiJre ("""'eQ inica/Works.com) 
2019-ICLl-00051 2854 

DHS-ICE-19-0196, 19-0197-N-000036
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:llQ/h \/ R\ 
Facility Code : CSONVWA Housing Area: A 
40 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunbe~ 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
11 104/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID, stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a ru p of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlc al History 
Hunger strike 
Allerglss 
Boost Plus: diarrhea: Side Effects 
Review of Systems 
~ : Puditory1,1sual hallucinations denies. Homicidal 
Thoughts denies. Suicidal thoughts denies. 
Appointment Provlde1 (b)(6) ; (b) (?)(C) f RN 
Reas on for Appointment 
1. RN 1/\EEKEND 12 HO.JR SHIFT: lvHO Q 10 MNUTE IRREG CHECK 
History of Pres ent Illn ess 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do you speak? English, Russian 
Interpretation pro\aded? Pallent speaks English fluenUy 
Pain Assessment 
Pain 
ke you ru rrentlyin pain? No 
Narrati'"': 
Mim ing M-tU RN rounds: Detainee seen in H-Seg forlvHU o'"'rflow RN day rounds on Mlntal Health Observation 10 min 
irregular checks. Detainee given am boost and Pedial)le and returned to bed. Denies SI/HVA\A-t. Per GEO patient ate an apple for 
lunch. 
Memoon update: Detainee gi'"'n PMpedial)le and denied SI/HVA\A-t. Per officer. WII continue to monitor. 
PM update: Patient refused dinner. Refusal form completed and submitted to Mld ical Records. 
Yitai Signs 
16/ min 
66.Sin 
Ex amin ation 
General Examination: 
RR 
11/04/201806:0 1:42 PM 
H 
11/04/201806:01:42 PM 
GENER/ll !>PPEPRANCE: in no acute distress, well del.eloped, well nourished. 
(b )(6); 
(b)( ?)(C) 
MUSCULOSKELET/ll : normal, normal gait, no deformities, full range of motion, good strength and equal bilaterally. 
Assessment s 
1. Readiness for enhanced coping - ND00158 (Primary) 
Tr eat ment 
1. Readiness fo, enhanced coping 
N 
---N 
Notes: W II continue in M-tU o'"'rflow to monitor per protocol Continue with current plan of care. Instructed on proper hand wash 
technique Pro"ded with water pitcher, instructed to drink 3-4UdayEncouraged to recreate outside, Instructed to notify nurse or 
serurity staff if needed assistance. WII continue to monitor and maintain health and safety standards while in lvHU Pt educated 
on plan, v;,ioes no concerns; verbalized understanding Pt will remain in lvHU o'"'rflow until discharge byprol,jder. 
Appointment Provide~ (b)( 6); (b) (?)(C) !RN 
Bectronically signed bi)~/)~/;cc> 
Sign off status: Comp leted 
r, RN on 11l04/20181 7:44:56 (Pacific Standard Time ) 
Northwest Detention Center 
1623 E J STREET 
T--:"""""'-'""'-""'"6..!. 
Patient: AMAR, IIERGENSANA DOB: 10/2 311978 ProgreH Note1~(b_)_(6_)_; __ __.! RN 11/04/2 018 
/lkxe generated byeC/irical'M11<s affPM ~e (w.w,eC/inicliWorks.ccm) 
2019-ICLl-00051 2855 

DHS-ICE-19-0196, 19-0197-N-000037
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA . . A:216269802 Su:lli-!lrb)(6); I 
Facility Code: CSOINNA II g A ea. n 
40 Y old Male, DOB: 10/23/1978 
AccOl.l'II lunbe ~ 
1623 E J STREET, T~ 
Appoirimert Facility. Northwest Detertion Cert er 
11 10 3/ 2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID. stop date 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a cup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes. Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allergles 
Boost Plus: diarrhea: Side Effects 
Reason for Appointment 
1. tvHU RN NIGHT ROUNDSIM-lO H-SEG 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEO OFFICER ON DUTY 
Wiat language do you speak? English, Russian 
Interpretation pro\aded? Pallant speaks English fluenUy 
Pain l>ssessment 
Pain 
ke you currently in pain? No 
Narrati'"': 
Appointment Provide (b)(6); (b)(7)(C) N 
ENCOUNTERED PT DURING NIGHT ROUNDS. PT DENIED St/l-lVA\/1-t . DENIED PNYPl'IN OR DISCa.50RT. DID NOT 
WPNTTOTJ>LK REFUSED BREJll<FAST. 
Examination 
General Examination: 
GENERJ>l PPPEl'R/>NCE: in oo acute distress, well de\eloped , well oourished. 
EXTREMTIES: full range of motion. 
PSYCH: affect restricted. 
Assessments 
1. lneffectl'"' Coping [00069]- ND00069 (Primary) 
Treatment 
1. lneffectiw Coping [00069) 
Notes: Pro" de~s orders re,..ewed and '"'rified. 
Nursing to round as needed , document beha"or, '"'rbali,ations, and displayof emotions. 
Establish a working relationship with Pl 
Pro"de opportunities for Pt to e~ress oonoems, fears, feelings, e~ c:lations. 
l>ssess for specificstressors. 
Discuss available or useful past ooping mechanisms. 
Reduoe stimuli in their en,..ronmenl 
Instruct Pt to notify Offioer or Nurse if needing assistance or if there is a change in their health status. 
Mm inister medications as ordered. 
Fresh drinking water in oell, encourage Ptto drink 3-4L of water daily. 
11/onitor Pt's oral intake for adequate nutrition and h)dration. 
Encourage eiercise in oell or Recreation Yard if allowed. 
Obserw for statements/beha"ors indicating harm to self or others. 
Pt to remain in tvHU until discharge byPro"der. 
Pt '"'rba liied understanding of care plan. 
Disposition: Mm itted to tvHU until medicallye1,0luated 
b)(6); Appointment Provide b)(?)(C) 
Electr onically signed b~(b)(6); 
Sign off status: Completed 
~ on 11104/2018 06:07:55 (Pacific Standard Time) 
Northwest Detention Cente r 
1623 E J STREET 
TACOMA, WA98421 
T"k'b)/6): ! rax. 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 P.....,.. Note: b)(6); RN 11/03/201 8 
Nr:te genertK8d by eOinica!Wcn<s EJ.fi'PM Soflvere {IWM<eC/ini ~;~[s ~ 
2019-ICLl-00051 2856 

DHS-ICE-19-0196, 19-0197-N-000038
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: A11AR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGV'ks.coojl 
2019-ICLl-00051 2857 
AMAR,MERGENSANA . . A:216269802 Su:ll~ b)(6);__ I 
Facility Code : CSOM/WA 11,g,. ea. 11 
40 Y old Male, DOB: 10/23/1978 
AccOl.l'II lunber:~ 
1623 EJ STREET, T~ 

DHS-ICE-19-0196, 19-0197-N-000039
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:lld lh \/R \ I 
Facility Code : CSONVWA Housing Area: H 
40 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunber:~ 
1623 E J STREET, T~ 
Appoirimert Facility: Northwest Detertion Certer 
11 10 3 /2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID,stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy , 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• .Acetaminophen 500 t,,G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allergles 
Boost Plus: diarrhea: Side Effects 
Review of Systems 
General/Constitutional: 
Chills denies. Fe'"'r denies. 
~ : ,<>ru;etydenies. Puditor)l'l,isual hallucinations denies. 
Delusions denies. Depressed mood denies. Suicidal 
thoughts denies. 
Reason for Appointment 
1. tvHU EVENING ROONDS 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: Picture, Verbally 
Chaperone Present? Yes 
Chaperone Name: Detention officer 
Wiat language do }OU speak? English, Russian 
Interpretation pro\aded? Patient speaks English fluenUy 
Pain l>ssessment 
Pain 
/>,e }OU ru rrently in pain? No 
Narrati'"': 
Appointm ent Provld e~(b) (6) ; _ _ I RN 
Patient seen in SEGfor tvHU e'"'ning rounds. Mikes no requests. Denies SVPHM-t , am,ety, depression. makes no 
requests. 
Yitai Signs 
deferred. 
Examination 
General E>amination: 
GENER/ll l>PPE.ARMICE: in no acute distress, well de\eloped, well nourished, male, cooperati1o0. 
HEJID: norrnocephalic. 
LUNGS: No laborious breathing noted. 
CHEST: normal shape and expansion. 
PSYCH: alert, oriented, speech clear, thought content without suicidal ideation, delusions, no auditory or '-'Sual 
hallucinations, thought process logical, goal directed. 
Assessment s 
1. Imbalanced nutrition: Less than body requirements [00002] - ND00002 (Primary) 
2. lneffecti'"' Coping [00069] - ND00069 
Treatment 
1. Imbalanced nutrnion: Less than bod; req..iremerts (00002] 
Clinical Notes: Continue monitoring for meal and fluid consumption and weight as applicable 
Continuing tvHU/SEGadmission until further notice. 
2. lneffecthle Coping (00069] 
Clinical Notes: Continue monitoring for coping stalus changes 
Continuing tvHU admission until further notice. 
3. Others 
Clinical Notes: Water available in cell; 
Nursing care pfO'-'ded per care plan; 
/ldmitted to tvHU?SEG until further notice; 
Patient may contact detention officer or medical staff if further assistance is required; 
Patient understands plan of care, '"'rbali,es understanding. 
Notes: Continuing tvHU/SEGadmission until furthernotice 
Appointment Provide,:Kb )(6); 
(b )(6); 
(b)(?)(C) 
Electronically signed b~(b)(6): 
Sign off status: Completed 
~ on 11/04,'2018 01:38:25 (Pacific Daylight Time) 
Northviest Detention Center 
1623 E J STREET 
l'. 21 
Patient: AMAR, MERGENSANA DOB: 10/23/1971 P..,.... ~ RN 11/03/2018 
Ncte genersled byeClinica!Worl<s BvRIFM Softw!,-e ("""'eC/inica/Worl<s.com) 
2019-ICLl-00051 2858 

DHS-ICE-19-0196, 19-0197-N-000040
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA A: 216269802 Su:i1D:kb)(6): 
Facility Code : CSONVWA Housing Area: A 
40 Y old Male, DOB: 10/23/1978 
AccOl.lll lunbe~ 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Cert er 
11 10 3 /2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID, stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allergles 
Boost Plus: diarrhea: Side Effects 
Review of Systems 
~ : Puditoryl,isual hallucinations denies. Homicidal 
Thoughts denies. Suicidal thoughts denies. 
Appointment Provlde~~(b-'-)_,_(6-'-),'-· __ _.! RN 
Reason for Appointment 
1. Rn e'"'n ing shift first 1/2 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do you speak? English, Russian 
Interpretation pro\aded? Pallent speaks English fluenUy 
Pain Assessment 
Pain 
ke you ru rrentlyin pain? No 
Narrati'"': 
Went to enooutnerwith pt for e'"'ning rounds about 16:43, per officer pt is in 1Asitwith his atomey. WII check again later. Pt 
18:15 went again to H seg, per officer pt didnt return from atomey1Asit )'! ~ he is waiting are. This nurse went to waiting area and 
met >Mth pt Pt denied SIIHVA\.1-i, admited weakness, a little lightheaded. This nurse instructed pt to let know officer if he feel 
lightheaded and cannot walk. aticer from waiting area instructed about pt needs and to call imediat medical unit and inform for 
further acction. Pt and officer verbali2Bd understanding to instruction given by this nurse. Pt admited to drink water. Detainee in H￾Seg for M-tU overflow on tv'ental Health Oiservation 10 min irregular checks. WII continue to monitor. 
Yitai Signs 
16/ min 
66.Sin 
Ex amination 
General Examination: 
RR 
11/03/201806:50:29 PM 
H 
11/03/2018 06:50:29 PM 
GENERN. JIPPEPRANCE: in no acute distress, well del.eloped, well nourished. 
HEAD: norrnocephalic. 
MUSCULOSKELET/ll : noonal, noonal gait, no deformities, full range of motion,. 
Assessments 
1. Readiness for enhanced coping - ND00158 (Primaryj 
Treatment 
1. Readiness for enhanced coping 
(b )(6); 
(b)(?)(C) ~ 
,-
RN 
Notes: W II continue in M-tU o'"'rflow to monitor per protocol Continue >Mlh current plan of care. Instructed on proper hand wash 
technique Pro"ded with water pitcher, instructed to drink 3-4UdayEncouraged to recreate outside, Instructed to notify nurse or 
security staff if needed assistance. WII continue to monitor and maintain health and safety standards while in M-iU Pt educated 
on plan, ") ices no concerns; '"'rbalized understanding Ptwill remain in M-iU o'"'rflow until discharge bypro,,;der. 
Appoinbnent Provide~b)(6); RN 
&~-"~ '~'"' ~'~'~"~'---'' 
Bectronically signed ~ (b)(6); fN on 11l03/2018 18:50:42 (Pacific Daylight Time) 
Sign off status: Comple~te-d----~ 
Northwest Detention Center 
1623 E J STREET 
T~r98421 "~= 1 
P-11ent: AMAR, IIERGENSANA D08: 10/23/1978 Progr9ss Note RN 11/03/2018 
/lkie generate,d by eOirica/Wcrlcs aR/PM ~e r-ea 
2019-ICLl-00051 2859 

DHS-ICE-19-0196, 19-0197-N-000041
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:llol(b )(6 ): 
Facility Code : CSONVWA Housing Area: A 
40 Y old Male, DOB: 10/23/1978 
AccOl.lll lunber~ 
1623 EJ STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
11 103/2018 
Cunont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019 , KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID, stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018 , KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el , for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/20 18, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allorglos 
Boost Plus: diarrhea: Side Effects 
Reason for Appointment 
1. SEGREG\llON ROUNDS/ t,,E/ll lvOJITCRING 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? No 
Wiat language do you speak? English 
Interpretation pro\aded? Pallent speaks English fluenUy 
Segregation: 
Segregation Rounds 
ke you ru rrentlythinking about killing or harming yourself? No 
Do you ha'"' any medical complaints orconcems at this time? No 
Appointment Provider: b)(6); (b)(7)(C) RN 
Was referral made to din ical sen.1ces (lvOIM.P, Dental, M-t, Sick Call)? No 
Examination 
Segregation: 
Segregation Evaluation: Patient has spontaneous speech and ansWE!fS questions appropriately, in no acute distress, 
weU de\eloped , well nourished, Patient appears to be v.ithin normal limits of beha-.ior, affect, and cogniti,e functioning, 
Patient does not appear to ha,e any acute or unresol\ed medical conditions that may worsen in segregation, Patient does 
not appear to h8'e acti,e psychosis, mania, suicidal idealions or txlmicidal ideations. 
Assessments 
Health M!intenance Related to Segregation Placement 
Preventive Medicine 
Patient educated on how to access medical / mental health/ dental care while in Segregation. 
Notes: Per H-Segregation Unit GEO officer, detainee has missed his 22nd meal with breakfast this morning. 
Appointment Provide,¥1,;,b..;. ).;.. (6.;..; ); __ ....JI RN 
(b)(6); (b)(7)(C) 
Electronically signed (b)(6); RN on 11/03/201810:32:09 (Pacific Daylight lime) 
Sign off status: Comple•"' 1
i:':h 1
irI7-'-1
"'1
r.'--.-'-1 ----' 
Northviest Detention Center 
1623 E J STREET 
T~~rr.A98421 Tol(b~1~ - I 
Patient: AMAR, MERGENSANA DOIi: 10/23/1978 P..,.... N4 (b)(6); (b)(7)(C) IRN 11/03/2018 
Ncte generated byeOinica!Wai<s EJvR/PM &ltwiJre ("""'eQ inica/Works.com) 
2019-ICLl-00051 2860 

DHS-ICE-19-0196, 19-0197-N-000042
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA . . A:216269802 Su:lli!l(b )(6); _ I 
Facility Code: CSOINNA IIJJAea . H 
40Y old Mal~,· AccOl.l'II llunbe b 6 · 
11 103/2018 
Cunont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy , 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID, stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy , Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy , Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a cup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy , 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy , Notes: 
Not required for tra'"' I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes, Drug Source: In House Pha rmacy, 
Notes: Not required for tra\el 
Past Medlc a l Hletory 
Hunger strike 
Allorglos 
Boost Plus: diarrhea: Side Effects 
Review of Systems 
~ = Puditoryl,isual hallucinations denies. Homicidal 
Thoughts denies. Suicidal thoughts denies. 
1623 E J STREET, T ' 
Appoirimert Facility. Northwest Detertion Certer 
Reas on for Appointment 
1. RNdayround/SEG / M-IO 10' 
History of Pres ent Illn ess 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do you speak? English, Russian 
Interpretation pro\aded? Pallent speaks English fluenUy 
Pain Assessment 
Pain 
ke you currently in pain? Yes 
The pain is located : muscle pain 
The se'"' rityof pain is rated at 3/10 
The se'"' rityof the pain is mild 
The pain began 3-4 months ago 
The character of the pain is aching 
The associated symptoms are v.eakness 
The pain is aggravated by other 
Describe: not eallng 
The pain is reliel<!d by res/ 
Narrati'"': 
Appointment Provlcle~ (b)(6) ; ~-
Detainee seen in H-Seg for M-iU o'"'rflow RN day rounds on Wental Health Oiservation 10 min irregular checks. Detainee 
refused 1o1tals, took am boost and Pedial)le and returned to bed. Detainee need for PRN pain meds. Denies St/HVAl,H Refused 
to allow nurse to assess him. 
Memoon update: Detainee continues to deny any medical needs, gi'"'n afternoon boost denied St/HVAvH Stated that his 
tooth e>!raction side is healing well, but didn't allowed to check. and refused 1,$ and assessment again. Per officer pt drank one 
j uice, two milks, and an apple for lunch time, which is about 50% of lunch. WII continue to monitor. 
Vital Signs 
16/ min 
66.5 in 
Pt refused 1,$ and assess ment 
Examination 
General Examination: 
RR 
11/03/2018 11:15:00MI 
H 
11/03/20181 1:15:00MI 
GENER/ll !>PPEAA.ANCE: in no acute distress , well del.eloped, well nourished. 
(b)( 6); 
(b )(7) (C ) 
MJSCULOSKELET/ll : noonal, noonal gait, no deformities, full range of motion, good strength and equal bilaterally. 
Assessment s 
1. Readiness for enhanced coping - ND00158 (Primary) 
Tr eatment 
1. Readiness for enhanced coping 
I￾RN 
I-
,_ 
RN ,_ 
Notes: W II continue in M-tU o'"' rflow to monitor per protocol Continue with current plan of care. Instructed on proper hand wash 
technique Pro"ded with water pitcher, instructed to drink 3-4UdayEncouraged to reo-eate outside, Instructed to notify nurse or 
security staff if needed assistance. W II continue to monitor and maintain health and safety standards while in M-iU Pt educated 
on plan, w ices no concerns; '"'rbalized understanding Ptwill remain in M-iU o'"'rflow until discharge byprol,jder. 
Appointment Provide1 b)(6); ~- ! RN 
Bectronically signed b~(b)(6); ~- IRN on 11l03/20181 3:06:57 (Pacific Daylight Time) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREET 
T~WA98421 
Te(b}(6); I 
tiix: 
ont: AMAR, IIERGENSANA D08: 10/23/1978 Progrees Notej(b)(6); _. I RN 11/03/2018 
/lkie generated byeOirica/Wc,;cs EM>IPM Sot,-e (w.w,eOinicl'i Wtxks.ccm) 
2019-ICLl-00051 2861 

DHS-ICE-19-0196, 19-0197-N-000043
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA A:21626980 2 Su:llDtlh\/R\ · i 
Facility Code : CSONVWA Housing Area: H 
40 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunber~ 
1623 E J STREET, T~ 
Appoirimert Facility: Northwest Detertion Certer 
11 103/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID,stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t,,G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allergles 
Boost Plus: diarrhea: Side Effects 
Review of Systems 
~ : Prn<ietydenies. Puditor)l'l,isual hallucinations denies. 
Delusions denies. Depressed mood denies. Diffirulty 
sleeping denies. Homicidal Thoughts denies. Inability to 
concentrate denies. Loss of appetite denies. 11/ental or Ph),Sical 
abuse denies. Stressors Immigration legal problems . Substance 
abuse denies. Suicidal thoughts denies. 
Reason for Appointment 
1. tvH tvHU rounds 
History of Present Illness 
Narrati'"': 
11/ental Health Follow-up /l!)pointrnent 
-Pt spoke: [ l\] English; [] Spanish; [ ] Oher, lnterpretalk # 
-Pt identified by NI, name, ID picture 
-Re;iewed Record [>\] 
Appointment Provlde~ (b)(6) ; (b)( 7)(C) 
-Session obserl<!d byGEOl\/edical Cfficeroutside large office window. 
-CURRENT PRCGRESSIC~NT: 
Pt. seen in RHU, remains on mental health obser,ation with q 10 minute irregular checks. He was reported refusing his 
dinner and breakfast but ate e'"'ning snack. No self-harm beha;ior obserl<!d nor suicidal ideation e~ressed per staff. Wien 
seen, pt denied hallucinations, delusion, suicidal or homicidal ideations. Wien asked why he is not eating his meals, he just 
stated" Refused'' without elaborating on it He reported good sleep and appetite and denied adi'"' mental health issues. Plan: 1. 
Continue mental health obser,ation with q 10 minute irregular rustodychecks. 2. Follow-up as scheduled. 
Examination 
11/ental Status: 
J>Pf'E.l'RPNCE:wel l-groomed, well-nourished, dressed in clean unilorm of the day. 
RELATEDNESS: friendly. 
ATTmJDE: cooperatil.8. 
SPEECH/l.JINGUPGE: nonnal rate, mythm, \Olume. 
/IFFECT: appropriate, full range. 
THOUGHT PROCESS: linear, logical, goal directed. 
THOUGHT CONTENT: de\Oid of delusion content. 
PERCEPTU/IL DISORDERS: no perceptual disorder noted. 
PS'YCHOM)TCJR /ICTMTY: v.ithin nonnal range. 
KNCMlEDGE - INTELLECTU/IL FUNCTIQ\I: No oo.ious impairment. 
DEGREE OF AWAAENESS: v.ithin normal limijs_ 
ORIENTATIQ\I: person, place, day. 
CURRENT SUICID/IL POTENTI/IL: no to ICM/ acute Si risk. 
CURRENT HOMCID/IL PCTENTI/IL: no to ICMI acute risk. 
Assessment s 
Pt. endorsed no acti'"' mental health issues curren~y. No mental health dx at this time. 
PreventlY e Medicine 
Pl.JIN: 
Due to the unpredictable nature of the immigration process inciuding length of detention stay, the purpose of ps\Chological 
interwntion will be the stabiliiation of presenting s)!llptoms, arute crisis interwntion, and brief supporti,e/solution-focused 
psychotherapy 
Disrussed following Plan with pt to address 1\/ental Health (M-i) issues. Pt '"'rbali219d agreement with Plan: 
Yes/ No 
[ l\] Yes [] No: Continue mental health obser,ation with q 10 minute irregular checks in RHU. 
[x] Yes[] No: Continue pt's rurrentTxPlan with currentM-i prO\<der(s) 
[x] Yes[] No: Ps\Chiatry. Follow-up in 1 day. 
[x] Yes [] No: Do not engage in any self-harm beha~or. Continue to forus on short/long term goals, reasons for li~ng, why 
suicide is against pt's belief S),Stem, resilient problem-sol~ng skills - all to aid in reducing risk of suicide and ultimatelyto 
achie'"' pro-social, pro-indi~dual / familygoals. 
[x] Yes [] No: ff at A'IYtime pt has any thought intent or plan of suicide, pt must alert rustodyofficer for emergent aocess to 
medical for further evaluation/Ix. Pt agreed and denied communication and stigma barriers to alerting staff for emergencies. 
[x] Yes [] No: Continue daily routine with meaningful, purposeful adi~ty. regular exercise, socialiiation, engagement in social 
support network, use of Jaillli'ail Email sy.;tem, engagement in religious customs/rituals, pleasurable acti~ties; pt to consider the 
work program locally-all to aid in coping and good mental health. 
[x] Yes [] No: Begin to seek out attorney, ICE, Law Library and Detainee Handbook to aid in proadi'"' problem-sol~ng - to aid in 
coping 
[x] Yes[] No: Continue attention to h19iene: shower, teeth, grooming to aid in coping 
[x] Yes [] No: Continue eating/h)(lrating at each meal. 
Follow Up 
/>s scheduled 
Appoinbnent Providef b)(6) ; (b)(7)(C) 
Electr onically signed b~ b)(6) ; (b)( 7)(C) ~Don 11103/2018 09:47:57 (Pacific Daylight Time) 
Sign off status: Completed 
Addendum : --------
11/03/2018 09:49 , (b)(6) ; (b )(7)(C) I> Correction: Utili219d Russian interpreter Lionbridge # 11600126 
2019-ICLl-00051 2862 
Northwest Detention Center 
1623 E J STREET 
TACOMA, WA98421 

DHS-ICE-19-0196, 19-0197-N-000044
Te (b)(6); / h \1 7 \tr'\ 
Pati-t: AMAR, -RGENSANA DOB: 10/23/1978 p ........ N b)(6); (b)(7)(C) MD 11/03/2018 
Ncl.e genera,.ed bye0inica/'Na1<s BvR'PM Sottv.ere ('"""m=rm:i=mu -~ 
2019-ICLl-00051 2863 

DHS-ICE-19-0196, 19-0197-N-000045
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 2864 
AMAR,MERGENSANA 
A:216269802 Su:lloj(b)( 6): ! 
Facility Code : CSONVWA Housing Area: A 
40 Y old Male, DOB: 10/23/1978 
AccOl.l"II tunbe,fh \lR\· I 
1623 E J STREET, TACOMA, WA98421 

DHS-ICE-19-0196, 19-0197-N-000046
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:llWh \(R\ 
Facility Code : CSONVWA Housing Area: H 
40 AccOl.lll Y ad ~:3fi~:: lffllbe ji }(6); 
11 102/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID.stop date 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes. Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allergles 
Boost Plus: diarrhea: Side Effects 
1623 E J STREET, T • 
Appoirimert Facility: Northwest Detertion Certer 
Reason for Appointment 
1. tvHU RN SPLrT SHIFT & NIGIHT ROONDS/M-1O 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEO OFFICER ON DUTY 
Wiat language do }OU speak? English, Russian 
Interpretation pro\aded? Pallent speaks English fluenUy 
Pain l>ssessment 
Pain 
/>,e }OU ru rrently in pain? No 
Narrati'"': 
Appointment Provid e b)(6); (b)(7)(C) N 
ENCOONTERED PT DURING NIGIHT ROONDS. PT DENIED St/l-lVA\/1-t. DENIED /INYP/IIN CR DISCa.5CRT. RERJSED 
BRE/IKFPST. 
Examination 
General Examination: 
GENER/IL />PPEPR/>NCE: in oo acute distress, well de\eloped, well oourished. 
MJSCULOSKELETi'l: oorrnal gait. 
EXTREMTIES: full range ci molion. 
PSYCH: alert, Oliented, cooperati\e with exam, cogniti\e function intact, thought content without suicidal ideation, 
delusions. 
Assessments 
1. lneffecti'"' Coping [00069]- ND00069 (Primary) 
Treatment 
1. lneffecthle Coping [00069) 
Notes: Pro\ade~s orders re,..ewed and '"'rified. 
Nursing to round as needed, document beha~or, '"'rbalizations, and displayof emotions. 
Establish a working relationship with Pl 
Pro"de opportunities for pt to e,press oonoems, fears, feelings, e,peclations. 
l>ssess for specificstressors. 
Disruss available or useful past ooping mechanisms. 
Reduoe stimuli in their en,..ronmenl 
Instruct pt to notify Officer or Nurse if needing assistanoe or if there is a change in their health status. 
Mm inister medications as ordered. 
Fresh drinking water in cell, enoourage ptto drink 3-4L of water daily. 
11/onitor Pt's oral intake for adequate nutrition and h)dration. 
Enoourage eiercise in cell or Recreation Yard if allowed. 
Obserw for statementslbeha~ors indicating harm to self or others. 
pt to remain in tvHU until discharge byPro~der. 
pt '"'rbali,ed understanding of care plan. 
Disposition: Mm itted to tvHU until medicaly evaluated 
Appointment Provide (b)(6); fh\/ 7 \/{'\ 
Electronically signed l(b)(6); IRN on 11107/2018 00:15:52 (Pacific Standard Time) 
,..11,1J b.lL1..1UC11V.L.C ..1.. } ---'· 
Sign off status: Compfetell 
Northviest Detention Center 
1623 E J STREET 
T~WA9 8421 
Teffii(~r_ 
Patient: AMAR, MERGENSANA DOIi: 10/23/1978 p,_... Notot::~ b_)_(6_)_; ___ IRN 11/02/2018 
Neta generated by eOinica/Wai<s EJvR/PM ~ ("""'eOinictiWorks .com) 
2019-ICLl-0005 1 2865 

DHS-ICE-19-0196, 19-0197-N-000047
U.S. Immi gration 
and Customs 
Enfor cement 
AMAR,MERGENSANA . . A:216269802 Su:llt!li,b)(6); I 
Facility Code: CSOINNA II g A ea. n 
40 Y old Male, DOB: 10/23/1978 
AccOl.l'II ~be~ 
1623 E J STREET, T~ 
Appoirimert Facility. Northwest Detertion Certer 
11 102/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID.stop date 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a cup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required forlra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t,,G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes. Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Past Medlcal History 
Hunger strike 
Allergles 
Boost Plus: diarrhea: Side Effects 
Review of Systems 
~ = Puditoryl,isual hallucinations denies. Homicidal 
Thoughts denies. Suicidal thoughts denies. 
Reason for Appointment 
1. tvHU Day Nurse Rounds 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do you speak? English, Russian 
Interpretation pro\aded? Pallant speaks English fluenUy 
Pain Assessment 
Pain 
ke you currently in pain? No 
Narrati'"': 
Appointment Provlde1 (b)(6) ; (b)(7)(C) r" 
Detainee seen in 1-1-Seg for M-iU o'"'rflow RN day rounds on Mlntal Health OiseM1tion 10 min irregular checks. Detainee 
refused \atals, took am boost and Pedial)le and returned to bed. Detainee denies pain or need for PRN pain meds. Denies 
S1/HVA\IH. Refused to allow nurse to assess oral ca\aly- detainee post tooth e>dradion )"Sterday. 
Memoon update: Detainee continues to deny any medical needs, gi'"'n afternoon boost denied SIIHVA\IH. 
Examination 
General El<amination: 
GENER/IL />PPEPRPNCE: inno acute distress, well de\eloped , well oourished. 
MJSCULOSKELETl'l: nonnal, nonnaJ gait, no defomlities, full range of motion, good strergth and equal bilaterally. 
Assessment s 
1. Readiness for enhanced coping - ND00158 (Primary) 
Treatment 
1. Readiness for enhanced coping 
Notes: W II oontinue in tvHU o'"'rflow to monitor per protocol Continue with current plan of care. Instructed on proper hand wash 
technique Pro"ded with water pitcher, instructed to drink 3-4UdayEnoouraged to reO'eate outside, Instructed to notify nurse or 
security staff if needed assistance. WII oontinue to monitor and maintain health and safety standards while in M-iU Pt educated 
on plan, \Oices no ooncems; '"'rbalized understanding Ptwill remain in M-iU 01erflow until discharge byprol,jder. 
Appoin1ment Provide1(b)( 6); RN "'-' h""l""n .... ,_,r ....... , __ _.I 
Bectronically signed b~(b)(6); -· 
Sign off status: Completed 
fN on 11/02/20 18 at 16:01 MST 
Northwest Detention Center 
1623 E J STREET 
TACOMA, WA98421 
1
"Vblll?;l I x: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progress No 11/02/2018 
/lk:xe generated by eOinica/Wcrks EM<IPM Soft"8re {IWM< 
2019-ICLl-00051 2866 

DHS-ICE-19-0196, 19-0197-N-000048
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA . . A: 216269802 Su:lltt1b)(6); I 
Facility Code : CSOM/WA 11,g,. ea. 11 
40 Y old Male, DOB: 10/23/1978 
1623 E J~ ~= I~ 
11 102/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/20 19, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID.stop date 
04/15/2019 , KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/20 18, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/20 18, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required forlra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018 , KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• .Acetaminophen 500 t,,G Tablet 1 tablets as needed BID, stop 
date 11/24/20 18, KOP: Yes. Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Past Medlc al History 
Hunger strike 
Allerglss 
Boost Plus: diarrhea: Side Effects 
Review of Systems 
~ : Prn<ietydenies at this time. /!odito')(l,isual 
hallucinations denies at this time . Delusions not endorsed . 
Depressed mood denies at this time . Diffirulty sleeping denies 
at this time . Homicidal Thoughts denies at this time . Inability 
to ronoentrate denies at this time . Loss of appetite denies at 
this time . IVental or Physical abuse denies current . 
Stressors immigration legal/detention stressors .. Substance 
abuse denies current . Suicidal thoughts denies at this time. 
Appoirimert Facility: Northwest Detertion Cert er 
Reas on for Appointment 
1. tvH tvHU rounds 
History of Pre se nt Illn ess 
Patient Identification: 
Patient Identification 
Appointm ent Provld e1(b)(6) ; (b)(7)(C) 
Patient properly identified by2 sources induding: ID Badge, Picture, Verbally 
Chaperone Present? Yes 
Chaperone Name: Use Notes Section Session chaperoned by GEO aficer in unit 
Wiat language do }OU speak? Russian 
IPsy.D. 
Interpretation pro\aded? Yes, Interpreter Number-Assessment w,s conducted in Russian utilizing interpreter, REF#: 
11598596 (844) 456-3639; LIOOBRIDGE. 
Number : 11598596 
Language Russian 
Reoord re\aew ronducted: Yes 
Patient was sitting on his bed when this pro.ider approached, and he was attenti'"' initiallyto the ron'"'rsati on. Pt was 
reading his book again while sitting in his bed. Pt smiled again and shook his head "no" once again when asked if he had any 
tvH ro mplaints or SI at this time. Pt again would not answer anymore of the questions asked by this prmider and he turned .may 
from this pro\ader to face the wall. This pro.ider again attempted to ask further questions to pt in a supporti'"' caring manner, 
although pt would not tum back around to face this pro.ider. The session was ended at that time. Patient was gi'"'n support and 
enoouragementand he was instructed to notify mental health or medical if he has any issues. M-t to rontinue to monitor pl 
-GEO RHU/segregation staff said pt went outside for recreation today and he was sociali2ing with another detainee who was 
out for recreation at the same time. Custody staff report that they ha'"' not had any issues with pl 
Ex amination 
rv'ental Status: !>PPE.ARJlNCE:welliJroomed, well-nourished, dressed in clean unifoon of the day. 
RELATEDNESS: friendly at first and then uncooperati'"'. 
ATTITUDE: cooperati'"' at first and then uncooperati'"' . 
SPEECH/1...ANGU!'ClE : normal rate, rhythm, l.olume . . 
J>FFECT: appropriate. 
THOUGHT PROCESS: intact. 
THOUGHT CONTENT: unremal1<able. 
PERCEPTU/IL DISORDERS: no AVOThalluc inations e;ident at this time; did not endorse perceptual disturbances. 
PS'YCHOM)TOR /ICTMTY: v.ithin normal range. 
KNOM..EDGE - INTELLECTU/IL FUNCll~ : No oo.ious impairment . 
DEGREE OF AWAAENESS: v.ithin l'()ITllal limits. 
ORIENTATION: unable to assess; pt uncooperati'"' . 
CURRENT SUICID/IL POTENTl/ll: ICM/ acute Si risk. 
CURRENT HOMCID/IL POTENTl/ll: no to ICM/ acute risk. 
Assessment s 
- No rurrent tvH diagnosis. 
Tre atm ent 
1. Others 
Notes: lnterwntions Utili2Bd: 
[ Xi Supporti'"' Psychotherapy 
[ Xi Treatment Planning. 
Preventive Medicine 
Due to the unpredictable nature of lhe immigration process induding lenglh of detention stay, lhe purpose of ps)Chological 
interwntion will be the stabilization of presenting S)lllptoms, acute crisis interwntion, and brief supporti\e/solution-forused 
psychotherapy Discussed following Plan v.ilh pt to address M-t issues. f't 1.erbali,ed agreementv.ilh Plan: 
Yes / No 
[)(I/ [) Remain in M-tU on mental heallh obsen.ation wilh 10 minute irregular custody checks. 
[)(I/ [) Do not engage in any self-harm behal,ior, Continue to torus on shortnong tenn goals, reasons for lil,ing, why suicide is 
against pt's belief system, resilient problem-soll,ing skills - all to aid in reducing risk of suicide and ultimatelyto achie1.e pro￾social, pro-indi,..dual / familygoals. 
[XI/ [) ff at!'NY time pt has anylhoughl intent or plan of suicides/he musta lertcustodyofficerfor immediate access to medical 
for further evaluatioMX. Pl agreed and denied rommunication and stigma barriers to alerting staff to Si. 
[Xi/ [) Fol low-up with tvH tomorrow. 
[Xi/ [) Jllert fv'edical/Custodyofficer immediately if pt has a M-t issue lhat is an emergency-for immediate access to M-t sen.ices 
[Xi/ [) Continue daily routine: exercise, engage in religious customs/rituals, pleasurable aclil,ities - all to aid in roping and mental 
health. 
[Xi/ [) Continue, \Asualization, Progressi'"' MJsde Relaxation Skills - to aid mood/roping. Ps)Choeducation gi1.en, 
[Xi/ [) Continue in Stress llfgt Skills; Ps)Choeducation gi'"'n , 
[Xi/ [) Continue to engage in Sleep H)!liene Skills - Ps)Choeducation gi1.en, 
[Xi/ [) Continue attention to h)!liene: shower, teelh, grooming to aid in coping 
[Xi/ [) Continue eating/h)drating at each meal to aid in general physical/mental heallh 
[Xi/ [] Chaplain Sen.ices/Jlccess ~ lained for further support 
Appointment Providerf b)(6); (b)(7)(C) rsy, D. 
Electronically signed b~(b)(6); (b)(7)(C) ~syD on 11/02/2018 16:56:51 (Pacific Daylight Tim e) 
Sign off status: Completed 
2019-ICLl-00051 2867 

DHS-ICE-19-0196, 19-0197-N-000049
Northwest Detention Center 
1623 E J STREET 
T~WA984 21 Te1Jill6f ! 
Patie nt: AMAR, IIERGENSANA DOB: 10/23/1978 ProgN u Nol8kb)(6); (b)(7)(C) !Pay. D. 11/02/2018 
NCl.e general.ed byeC/inica/'Na1<s EM>/PM Sottv.ere (,w,weC/inica/WGYks.coojl 
2019-ICLl-00051 2868 

DHS-ICE-19-0196, 19-0197-N-000050
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGE~~ 
Facility~~~~~ 
40 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunbe~ 
1623 E J STREET, T~ 
Appoirimert Facility. Northwest Detertion Certer 
11102/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID,stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allergles 
Boost Plus: diarrhea: Side Effects 
Reason for Appointment 
1. RN Daily Seg rounds 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do you speak? English 
Appointment Provldei b)(6 ); (b)(?)(C) t" 
Interpretation pro\aded? Pallant speaks English fluenUy Detainee able to comunicate needs in English 
Segregation: 
Segregation Rounds 
ke you ru rrentlythinking about killing or harming yourself? No 
Do you ha'"' any medical complaints orconcems at this time? No 
Was referral made to d inical sen.1ces (lvOIM.P, Dental, M-t, Sick Call)? No 
Examination 
Segregation: 
Segregation Evaluation: Patient has spontaneous speech and ansWE!fS questions appropriately, in no acute distress, 
weU de\eloped , well nourished, Patient appears to be v.ithin normal limits of beha"or, affect, and cogniti,e functioning, 
Patient does not appear to ha,e any acute or unresol\ed medical conditions that may worsen in segregation, Patient does 
not appear to ha'-"! acti,e psychosis, mania, suicidal idealions or txlmicidal ideations. 
Assessments 
Health M!intenance Related to Segregation Placement 
Treatment 
1. Others 
Notes: Noted Detainee did go to rec for 1 hour )eslerday￾GEO reporls he ate an />pple last night - He is scheduled for rec today as well 
Still refusingtraymeals. 
Appointment Provide1 (b)(6) ; fN 
Bectronically signed b* b)(6); ~ - Fon 11102/2018 08:00:07 (Pacific Daylight lime) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREET 
l'. WA98421 
Tel b)(6); 
Patien1: AMAR, MERGENSANA DOB: 10/23/1978 p,__ Note: j(b)(6) ; _ _ I RN 11/02/2018 
/lkxe generated bye0irica/Wc11<s El>R'PM So/rv.ere (w.w,eQinica/Wc.-ks.com/ 
2019-ICLl-00051 2869 

DHS-ICE-19-0196, 19-0197-N-000051
U.S. Immi gration 
and Customs 
Enfor cement 
AMAR, MERGEN~ 
A:216269802 Si.ti1 b)(6); 
Facility Code : CSONVWA Housing ea: 
40 Y old Male, DOB: 10/23/1978 
AccOl.l"II l'unbe1b)(6) I 
1623 E J STREET, TMD,a, .; · '..-, 
11 102/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID,stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t,,G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allerglss 
High calorie boost: diarrhea: $de Effects 
Appoimnert Facility: Northwest Detertion Certer 
Reason for Appointment 
1. Noc nurse rounds. 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEO OFFICER ON DUTY 
VIM! language do }OU speak? English, Russian 
Interpretation pro\aded? Pallent speaks English fluenUy 
Pain l>ssessment 
Pain 
/>,e }OU ru rrently in pain? No 
Narrati'"': 
Appointment Provld e"l~(_b)_(6_)_; -~I KN 
Pt =ke and appearred to look at nurse during rounds, but did not make any requests. Skipped breakfas~ his 19th meal. 
Pass down gi'"'n at momi ng report 
Examination 
General Examination: 
GENER/IL />PPEPR/>NCE: in oo acute distress, well de\eloped , well oourished. 
EXTREMTIES: full range of molion. 
PSYCH: affect restricted. 
Assessments 
1. lneffecti'"' Coping [00069]- ND00069 (Primary) 
Treatment 
1. lneffectiw Coping [00069) 
Notes: Pro"de~s orders re,..ewed and '"'rified. 
Nursing to round as needed , dorument beha"or, '"'rbali,ations, and displayof emotions. 
Establish a = rl<ing relationship with Pt. 
Pro"de opportunities for Pt to e~ress oonoems, fears, feelings, e~c:lations. 
l>ssess for specificstressors. 
Discuss available or useful past ooping mechanisms. 
Reduoe stimuli in their en,..ronmenl 
Instruct Pt to notify Offioer or Nurse if needing assistance or if there is a change in their health status. 
Mm inister medications as ordered. 
Fresh drinking water in oell, encourage Ptto drink 3-4L of water daily. 
11/onitor Pt's oral intake for adequate nutrition and h)dration. 
Encourage eiercise in oell or Recreation Yard if allowed. 
Obserw for statements/beha"ors indicating harm to self or others. 
Pt to remain in M-tU until discharge byPro"der. 
Pt '"'rba liied understanding of care plan. 
Appointment Provide (b )(6); 
/h\171 /rl 
Bectronically signed ~(b)(6); ~ -
Sign off status: Completed 
~ on 11102/2018 07:06:31 (Pacific Daylight Time) 
Northwest Detention Center 
1623 E J STREET 
T~~ ½®\ r.A 98421 I 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 Progrees N-i (b)(6); __ IRN 11/02/2018 
Ncte generated byeOirica/Wcrks EM<IPM Sotr,.ere (w.w,eOinica/Works.corr4 
2019-ICLl-00051 2870 

DHS-ICE-19-0196, 19-0197-N-000052
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 2871 
AMAR, MERGEN~ 
A:216269802 Si.ti1 (b)(6); 
Facility Code : CSONVWA Housing ea : 
40 Y old Male, DOB: 10/23/1978 
1623E~~::=1~~ <~/ ~?)tifa. I 

DHS-ICE-19-0196, 19-0197-N-000053
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA A:21626980 2 &ti1ot(b)(6): ! 
Facility Code : CSONVWA Housing Area: A 
40 AccOl.lll Y ad~~ ~beb)(6t m::: 11 101/2018 
Current Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID.stop date 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• .Acetaminophen 500 t,,G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes. Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allergles 
High calorie boost : diarrhea: $de Effects 
1623 E J STREET, T 
Appoimnert Facility: Northwest Detertion Cert er 
Appointment Provid e r: Geneva P Hoskins-Do rse y, RN 
Reason for Appointment 
1. PM SHIFT NOTE 
History of Present Illness 
Narrati'"': 
Upon encounter detainee was out at rec yard and stated that he was feeling okay. Detainee denied any pain on assessment 
and medications will be gi'"'n as needed/ordered. No other concerns \Oioed at this time. Detainee was gi'"' n his Pedial)te and 
did eat an apple for dinner. W II continue to monitor. 
Pain /'6sessment 
Pain 
ke )OU ru rrentlyin pain? No 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes SEG GEOCFFICER 
VIM! language do )OU speak? English 
Interpretation pro\aded? Pallent speaks English fluenUy 
Yitai Signs 
Temp 
97.7F 11/01/201806:34:08 PM 
IR 
59/min 11/01/201806:34:08 PM 
EP 
111174mm Hg 11/01/201806:34:08 PM 
RR 
16/ min 11/01/201806:33:37 PM 
H 
66.Sin 11/01/201806:33:37 PM 
Assessments 
1. Imbalanced nutrition: Less than body requirements [00002] - ND00002 (Primary) 
Treatment 
1. Imbalanced nutrttion: Less than body req.iremerts (00002] 
b)(6); 
b)(?)(C) 
Notes: W II continue to monitor in M-IU per protocol, continue with current plan of care, instructed on proper hand washing 
technique, encouraged to drink 3-4Uday, encouraged to recreate outside, instructed to notify nurse or security staff if needed 
assistance, will continue to monitor and maintain health and safety standards while in M-IU. Detainee educated on plan, \Oioes 
no concerns; '"'rba li;,ed understanding, will remain in M-IU until discharged bypro\ider. 
Appointment Providetb)(6); (b)(?)(C) 
Electronically signed by ~b)(6); (b)(?)(C) 
Sign off status: Completed 
jN on 11101/201818 :39:24 (Pacific Daylig ht Time) 
Northwest Detention Center 
1623 E J STREET 
T 21 
Pati ent: AMAR, MERGENSANA DOB: 10/23/1978 P.....,.. Notej(b)(6); (b)(?)(C) 
/lk:ie generaled byeClinica/Wcrks Bi,R/PM $oltv.ere (w.w,eC/inicliWorks.con1 
11/01/2018 
2019-ICLl-00051 2872 

DHS-ICE-19-0196, 19-0197-N-000054
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:lllfb )(6): ! 
Facility Code : CSONVWA Housing Area: A 
40 Y old Male, DOB: 10/23/1978 
Acc01.111 tunbe rf h \/RI I 
11 101/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID, stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allergles 
Boost Plus: diarrhea: Side Effects 
1623 E J STREET, TACOMA, WA-98421 
Appoimnert Facility: Northwest Detertion Cert er 
Reason for Appointment 
1. RN Daily Seg rounds 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do you speak? English 
Appointment Provid e (b )(6); 
(b)(?)(C) 
Interpretation pro\aded? Pallent speaks English fluenUy Detainee able to comunicate needs in English 
Segregation: 
Segregation Rounds 
ke you ru rrentlythinking about killing or harming yourself? No 
Do you ha'"' any medical complaints orconcems at this time? No 
Was referral made to d inical sen.1ces (lvOIM.P, Dental, M-t, Sick Call)? No 
Examination 
Segregation: 
RN 
Segregation Evaluation: Patient has spontaneous speech and ansWE!fS questions appropriately, in no acute distress, 
weU de\eloped , well nourished, Patient appears to be v.ithin normal limits of beha"or, affect, and cogniti,e functioning, 
Patient does not appear to ha,e any acute or unresol\ed medical conditions that may worsen in segregation, Patient does 
not appear to ha\8 acti,e psychosis, mania, suicidal idealions or txlmicidal ideations. 
Assessments 
Health M!intenance Related to Segregation Placement 
Treatment 
1. Others 
Notes: Noted Detainee did go to rec for 1 hour )eslerday￾GEO Log notes changed o'"' might - no records of meals eatten -
Still refusingtraymeals. 
Appointment Providerf"-b-'-)(.:.... 6:.:. ); _---J! RN 
Bectronically signed b* b)(6); 
Sign off status: Completed 
~ on 11101/2018 10:32:49 (Pacific Daylight lime) 
Northwest Detention Center 
1623 E J STREET 
T=WA98421 Tel(b)(6); I t-ax: 
Patien1: AMAR, MERGENSANA DOB: 10/23/1978 p,__ ~ 11/01/2018 
/lkxe generated bye0irica/Wc11<s El>R'PM So/rv.ere (w.w,eQinica/Wc.-ks.com/ 
2019-ICLl-00051 2873 

DHS-ICE-19-0196, 19-0197-N-000055
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA . . A: 216269802 Su:,IJlli ><6>; 1 
Facility Code: CSOINNA II g A ea. n 40 Acca.nt Y ad~~'!: lffllbeb }(6); :: 
11 101/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019 , KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID.stop date 
04/15/2019 , KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018 , KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a cup of water Daily Noon, stop 
date 11/16/20 18, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required forlra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018 , KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• .Acetaminophen 500 t,,G Tablet 1 tablets as needed BID, stop 
date 11/24/20 18, KOP: Yes. Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Past Medlcal Hletory 
Hunger strike 
Allergles 
Boost Plus: diarrhea: Side Effects 
Review of Systems 
~ = Prn<ietydenies at this time. /!odito')(l,isual 
hallucinations denies at this time . Delusions not endorsed . 
Depressed mood denies at this time . Difficulty sleeping denies 
at this time . Homicidal Thoughts denies at this time . Inability 
to oonoentrate denies at this time . Loss of appetite denies at 
this time . IVental or Physical abuse denies current . 
Stressors immigration legal/detention stressors .. Substance 
abuse denies current . Suicidal thoughts denies at this time. 
1623 E J STREET, T v 
Appoirimert Facility. Northwest Detertion Cert er 
Appointm ent Provlder:K b)(6); (b)(7)(C) 
Reason for Appointment 
1. tvH follow up for Pt in the tvHU o'"'rflow on tvHOwith 10 minute irregular custody checks. 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture, Verbally 
Chaperone Present? Yes 
Chaperone Name: Use Notes Section Session chaperoned by GEO aficer in unit 
Wiat language do you speak? Russian 
I Psy. D. 
Interpretation pro\aded? Yes, Interpreter Number-Assessment w,s conducted in Russian utilizing interpreter, REF#: 
11593138 (844) 456-3639; LIOOBRIDGE. 
Number : 11593138 
Language Russian 
Record re\aew oonducted: Yes 
Patient looked at this pro\aderwhen approached, as he was reading a book l)ing in his bed. Pt smiled and shook his head 
"no" when asked if he had anytvH oomplaints or SI at this time. Pt would not answer anymore of the questions asked bythis 
pro\ader and he turned away from this pro\ider to face the wall. This pro\ider again attempted to ask further questions to pt in a 
supporti'"' caring manner, although pt would not tum back around to face this pro\ider. The session was ended at that time. 
Custody staff report that they ha'"' not had any issues with pl Patient was gi'"' n support and encouragement and he was 
instructed to notify mental health or medical if he has any issues. tvH to continue to monitor pl 
Examination 
IVental Status: 
!>PPE.AR.ANCE:welliJroomed, well-nourished, dressed in clean uniform of the day. 
RELATEDNESS: friendly at first and then uncooperati'"'. 
ATTITUDE: cooperati'"' at first and then uncooperati'"' . 
SPEECH/LANGUl'£3E: normal rate, rhythm, l.olume . . 
A"FECT: appropriate. 
THOUGHT PROCESS: intact. 
THOUGHT CONTENT: unremarkable. 
PERCEPTU/IL DISORDERS: no AVOTha llucinations e\ident at this time; did not endorse perceptual disturbances. 
PSYCHOM)TOR /ICTMTY: v.ithin normal range. 
KNOM..EDGE - INTELLECTU/IL FUNCTIQ\I: No oo.ious impairment . 
DEGREE OF AWAAENESS: v.ithin normal limijs. 
ORIENTATION: unable to assess; pt uncooperati'"' . 
CURRENT SUICID/IL POTENTl/ll: ICM/ acute Si risk. 
CURRENT HOMCID/IL POTENTl/ll: no to ICMI acute risk. 
Assessment s 
- No current tvH diagnosis. 
Treatm ent 
1. Others 
Notes: lnterwntions Utili>ed: 
[ Xi Supporti'"' Psychotherapy 
[ Xi Treatment Planning. 
Preventive Medicine 
Due to the unpredictable nature of the immigration process induding length of detention stay, the purpose of psy:hological 
interwntion will be the stabilization of presenting S)lllptoms, acute crisis interwntion, and brief supporti\e/solution-focused 
psychotherapy Discussed following Plan with pt to address M-i issues. Pl 1.erbali,ed agreement with Plan: 
Yes / No 
[Xi/ [) Remain in M-iU on mental health obsen.ation with 10 minute irregular custody checks. 
[Xi/ [) Do not engage in any self-harm behal,ior; Continue to focus on shortnong term goals, reasons for lil,ing, why suicide is 
against pt's belief system, resilient problem-soll,ing skills - all to aid in reducing risk of suicide and ultimatelyto achie1.e pro￾social, pro-indi,..dual /fa milygoals. 
[Xi/ [) ff at .ANY time pt has anythoughl intent or plan of suicides/he must alert custody officer for immediate access to medical 
for further evaluatioMX. Pl agreed and denied communication and stigma barriers to alerting staff to Si. 
[Xi/ [) Fol low-up with M-i tomorrow. 
[Xi/ [)Jllert IVedical/Custodyofficer immediately if pt has a M-i issue that is an emergency-for immediate access to M-i seNces 
[Xi/ [) Continue daily routine: exercise, engage in religious customs/rituals, pleasurable acti\ities - all to aid in coping and mental 
health. 
[Xi/ [) Continue, \Asualization, Progressi1.e MJsde Relaxation Skills - to aid mood/coping. Psy:hoeducation gi1.en, 
[Xi/ [) Continue in Stress rJgt Skills; Psy:t,oeducation gi'"' n, 
[Xi/ [) Continue to engage in Sleep H)!liene Skills - Psy:t,oeducation gi1.en, 
[Xi/ [) Continue attention to h)!liene: shower, teeth, grooming to aid in coping 
[Xi/ [) Continue eating/h)drating at each meal to aid in general physical/mental health 
[Xi/ [) Chaplain SeNoes/Axes s E>plained for further support 
Appointment Provide1 b)(6); (b)(7)(C) fsy. D. 
Electronically signed b1 b)(6); (b)(7)(C) fsyD on 11/01/201817 :19 :37 (Pacific Daylight nme) 
Sign off status: Completed 
2019-ICLl-00051 2874 
NorthlYest Detention Center 
1623 E J STREET 

DHS-ICE-19-0196, 19-0197-N-000056
1: WA98421 
Tel b)(6); 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 ProgN u Noe.j(b)(6); (b)(7)(C) I Pay. D. 11/01/2018 
Ncl.e generated by eC/inica/'Na1<s EJvR/PM Sottv.ere (,w,weC/inica/WGYks.COOjl 
2019-ICLl-00051 2875 

DHS-ICE-19-0196, 19-0197-N-000057
U.S. Immigration 
and Customs 
Enfor cement 
11 101 /2018 
Cunont Medication s 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID. stop date 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required forlra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t,,G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes. Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Past Med lca l History 
Hunger strike 
Allo rglo s 
Boost Plus: diarrhea: Side Effects 
App oin tment Provlcle 1(b)(6) ; (b)(? )(C) pDs 
Reas on for Appo intm ent 
1. den: xx/115- "rd like my broken tooth taken out' points to #15 
History of Prese nt Illness 
Dental: 
Dental (Subjecti'"') 
Location of Evaluation PaUent evaluated in clinic 
ke you ru rrentlyin pain? No 
Patient Identification: 
Patient Identification Chapeel Patient properly identified by2 sources induding: ID Badge.Picture 
Yes 
ROH: b}(6); Wiatl u speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number 
Number 11590146 
Language Russian 
Yit ai Sign s 
97.7F 
59/min 
111174mm Hg 
16/ min 
145.8 lbs 
63.Sin 
25.42 Index 
Ex amin at ion 
General Examination: 
Temp 
11/01/2018 09:39:37 PM 
HR 
11/01/2018 09:39:37 PM 
EP 
11/01/2018 09:39:37 />M 
RR 
11/01/2018 09:39:37 />M 
Wt 
11/01/2018 09:39:37 />M 
H 
11/01/2018 09:39:37 />M 
BMI 
11/01/2018 09:39:37 />M 
(b)(6) ; 
(b)(7)(C) 
Problem focused re-evalm, med hx completed by patient re1.1ewed, NKDA Tooth #15 has gross caries extending into neM 
and appears to ha'"' had pre,..ous RCTtx. 1 PAre1.1ewed bypro1.1der. Periapical radiolucencynoted. No signs of acute dislress or 
swelling noted. Class 1 mobility, dinical crown fractured due to caries. Tooth is non response to cold stimuli. Percussion and 
palpation were V\,l\ll. Poor oral h19iene noted. 
Assess ment s 
Tooht 15- RCT treated, asymptomatic apical periodontitis. 
Treatmen t 
1. Others 
Notes: Discussed findings w/ patient recommended extradion tooth #15 due to the extent of decay. Patient 1.erbali>ed 
understanding and consents to the proposed care. Confirmed tooth #15 as planned for extradion using marked radiograph and 
d inical confirmation by dentist assistant and patient I'll in agreement Bevator/rorceps deli1.ery#15, irrigate w/ saline, gau,e w/ 
pressure. Good hemostasis. lMitten and oral post-op instrudions. Dispensed 1/2 ounce table salt for 110 saline rinse 
preparation and use beginning tomorrow after meals. Re1.1ewed med use and oral h19iene instrudions. Used 20% be1120caine 
topical and 68mg articaine 0.017 mg epi infiltration 30 short. Patient gi1.en 3 day.; of pureed diet Re1.1ewed signs and symptoms 
of post-op infection/complications. Patient 1.erbal i>ed understanding of discussion and instrudions. Pl has e~sting pain 
medicine rx 
Proc edure Cod es 
00170 RE-EVl'lUAllON - LTD PRCBLEMFCX::USED 
01330 OR/>l HYGIENE INSTRUCTIO>JS 
07140 EXIRPC ERUPTED TOOTH/EXPOSED ROOT 
09215 LOCJ>l PNES-SEE l'lSO COOE 90784 
Appointment Provider. (b}(6); DDS / h\/7\/r\ 
Bectron ically signed b* b)(6); ~ - IDDS on 11/0112018 11:00:55 (Pacific Daylight Time) 
Sign off status: Completed 
2019-ICLl-00051 2876 

DHS-ICE-19-0196, 19-0197-N-000058
Northwest Detention Center 
1623 E J STREET 
1: WA98421 
Tel (b)(6); 
P•li-t: AMAR, -RGENSANA IIOll= 10/23/1978 p,.,._. ~ (b)(6); (b)(?)(C)IDOS 11/01/2018 
NCl.e general.ed byeC/inica/'Na1<s EM>/PM Sottv.ere (,w,weC/inica/WGYks.coojl 
2019-ICLl-00051 2877 

DHS-ICE-19-0196, 19-0197-N-000059
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA . . A: 216269802 Su:ll .j\ b )(6); I 
Facility Code : CSONVWA " -:,~"~' 
40 Y old Male, DOB: 10/23/1978 
AccOl.l'II l'unbe~ b ~(~ I 1623 E J STREET, Tm...;,41042 1 
11 101/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID.stop date 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a ru p of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required forlra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t,,G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes. Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Past Medlcal History 
Hunger strike 
Allergles 
Boost Plus: diarrhea: Side Effects 
Review of Systems 
~ : Puditoryl,isual hallucinations denies. Homicidal 
Thoughts denies. Suicidal thoughts denies. 
Reason for Appointment 
1. tvHU Day Nurse Rounds 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do you speak? English, Russian 
Interpretation pro\aded? Pallant speaks English fluenUy 
Pain Assessment 
Pain 
ke you ru rrentlyin pain? No 
Narrati'"': 
Appoimnert Facility: Northwest Deterti on Cert er 
Appointment Prov1c1ej(b}(6) ; (b}(7)(C) rN 
Detainee seen in H-Seg for M-iU o'"'rflow RN day rounds on Mlntal Health OiseM1tion 10 min irreggluar checks. Detainee 
refused \atals, took am boost and pedial)le and returned to bed. Detainee denies pain or need for PRN pain meds. Denies 
S1/HVA\IH. 
Memoon update: Detainee continues to deny any medical needs, gi'"'n afternoon boost denied Sil/HVA\IH. 
Examination 
General El<amination: 
GENER/IL />PPEPRPNCE: inno acute distress, well de\eloped , well oourished. 
MJSCULOSKELETl'l: nonnal, nonnaJ gait, no defomlities, full range of motion, good strergth and equal bilaterally. 
Assessment s 
1. Readiness for enhanced coping - ND00158 (Primary) 
Treatment 
1. Readiness for enhanced coping 
Notes: W II continue in tvHU o'"'rflow to monitor per protocol Continue with current plan of care. Instructed on proper hand wash 
technique Pro"ded with water pitcher, instructed to drink 3-4UdayEncouraged to reO'eate outside, Instructed to notify nurse or 
serurity staff if needed assistance. WII continue to monitor and maintain health and safety standards while in M-iU Pt educated 
on plan, \Oices no concerns; '"'rbalized understanding Ptwill remain in M-iU 01erflow until discharge bypro\ider. 
Appoin1ment Provide b)(6); RN h\/ 7 \fr'\ 
Bectronically signed bfi:.. b..:.).;.. (6..:.; );'-----'fN on 11/01/201814 :11:59 (Pacifi c Daylight Ti me) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREET 
1: WA98421 
Tel (b)(6): x: 
Patie nt: AMAR, MERGENSANA DOB: 10/23/1978 Progress No~ (b)(6); _. IRN 11/01/2018 
N<:xe generated by eOinica/Wcrks EM<IPM Soft"8re {VNN<eOinica/Wcrks.corrv 
2019-ICLl-00051 2878 

DHS-ICE-19-0196, 19-0197-N-000060
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA . . A:21626980 2 Su:lli;'ib)/6): ! 
Facility Code : CSOM/WA 11,g,. ea. 11 
40 Y old Male, DOB: 10/23/1978 
1623EJ~~=I~ 
10 131/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID. stop date 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes. Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allergles 
Boost Plus: diarrhea: Side Effects 
Reason for Appointment 
1. tvHU RN NIGHT ROUNDSIM-lO 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEO OFFICER ON DUTY 
Wiat language do }OU speak? English, Russian 
Interpretation pro\aded? Pallent speaks English fluenUy 
Pain l>ssessment 
Pain 
/>,e }OU ru rrentlyin pain? No 
Narrati'"': 
Appoirimert Facility: Northwest Detertion Certer 
Appointment P1'ovlde1 b)(6); ~· 
ENCOUNTERED PT DURING NIGI T ROUNDS. PT DENIED St/l-lVA\/1-t . DENIED /INYP/IIN CR DISCa.5CR T. RERJSiED 
BRE/IKFPST. 
Examination 
General Examination: 
GENER/IL PPPEl'R/>NCE: in oo acute distress, well de\eloped , well oourished. 
MJSCULOSKELETl'l : oorrnal gait. 
EXTREMTIES: full range ci molion. 
PSYCH: alert, Oliented, cooperati\e with exam, cogniti\e function intact, thought content without suicidal ideation, 
delusions. 
Assessment s 
1. lneffecti'"' Coping [00069]- ND00069 (Primary) 
Treatment 
1. lneffecthle Coping [00069) 
Notes: Pro\,de~s orders re\iewed and '"'rified. 
Nursing to round as needed, document beha\ior, '"'rbalizations, and displayof emotions. 
Establish a working relationship with Pl 
Pro\ide opportunities for pt to e,press oonoems, fears, feelings, e,peclations. 
l>ssess for specificstressors. 
Disruss available or useful past ooping mechanisms. 
Reduoe stimuli in their en\ironmenl 
Instruct pt to notify Offioer or Nurse if needing assistanoe or if there is a change in their health status. 
Mm inister medications as ordered. 
Fresh drinking water in oell, enoourage ptto drink 3-4L of water daily. 
11/onitor Pt's oral intake for adequate nutrition and h)dration. 
Enoourage eiercise in cell or Recreation Yard if allowed. 
Obserw for statementslbeha\iors indicating harm to self or others. 
pt to remain in tvHU until discharge byPro\ider. 
pt '"'rba li,ed understanding of care plan. 
Disposition: Mm itted to tvHU until medically evaluated 
Appointment Provide~ b)(6); bN 
'[ .. ~:~=- '-''..:.7.:..: ".:.. ~'-''----''-· 
Electronically signed b~(b)(6); 
Sign off status: Completed 
~ on 11101/2018 23:54 :21 (Pacific Daylight lime) 
Northviest Detention Center 
1623 E J SmEEr 
T~A9842l T0\ili61 I 
Patient: AMAR, MERGENSANA DOIi; 10/23/1978 p,_... ~ 10/31/2018 
Neta generated by eOinica/ Wai<s ElvRIPM ~ (l<MMleOinicti Works.com) 
2019-ICLl-00051 2879 

DHS-ICE-19-0196, 19-0197-N-000061
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 2880 
AMAR,MERGENSANA A: 216269802 Su:llq(b )(6); I 
Facility Code : CSONVWA Housing Area: A 
40 Y old Male, DOB: 10/23/1978 
AccOl.lll llunber : mi\i6i:7 1623 EJ STREET, T~ 

DHS-ICE-19-0196, 19-0197-N-000062
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA A:21626980 2 Su:llU: !/h \/R\· ! 
Facility Code : CSONVWA Housing Area: A 
40 Y old Male, DOB: 10/23/1978 
Acc01.111 tunbe ,f h\ lR\· I 
10 131/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID, stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t,,G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlc al History 
Hunger strike 
Allergles 
Boost Plus: diarrhea: Side Effects 
Review of Systems 
DENIED />NY M:DICll>l, DENT!>l, OR M: NT!>l HE/>l TH ISSUES 
ATTHISTIM: . 
1623 E J STREET, TACOMA, WA-98421 
Appoimnert Facility: Northwest Detertion Certer 
Appointment P1'ovlde~(b) (6) ; (b) (?)(C) !RN 
Reas on for Appointment 
1. tvHU RN Rounds 
History of Pl'ese nt Illn ess 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do you speak? English, Russian 
Interpretation pro\aded? Pallent speaks English fluenUy 
Pain Assessment 
Pain 
ke you ru rrentlyin pain? No 
Narrati'"': 
Detainee denied SIIHVA\A-1, no other complaints or issues stated or noted at this time, drank pedial)le and glucose control 
boost, refused dinner. \MIi continue to monitor. 
Yitai Signs 
16 /min 
63.Sin 
Ex amina tion 
General Examination: 
RR 
10/31/201806:23:30 PM 
H 
10/31/201806 :23:30 PM 
GENER!>l JIPPEPRANCE: in no acute distress, well del.eloped, well nourished. 
HEAD: norrnocephalic. 
E'l'ES: pupils equal, round, reacti'"' to light and accommodation. 
OR!>l CA\ATY: norrnal, mucosa moist. 
EXTREMTIES: norrnal. 
b)(6); 
b)(?)(C) 
PS'YCH: alert, oriented, cooperati'"' with exam, cogniti'"' function intact , trough! content without suicidal ideation, 
delusions. 
Assess ment s 
1. lneffecti'"' Coping [00069]- ND00069 (Prmary) 
Traatment 
1. lnelfectiYe Coping (00069] 
RN 
~ 
Notes: Irregular 10 min checks per custodystaff, bed at lowest position and locked, water a1o0ilable in cell, refer to nursing care 
plan for on-going inteiwntions, detainee encouraged to .erbali:re needs and feelings, detainee ,erbali:red understanding. 
Nursing to round as needed , document beha,..or, .erbali:zations, and displayof emotions. Establish a worl<ing relationship with 
Pl Pro"de opportunities for pt to e~ress concerns, fears, feelings, e~ctations. Assess forspecificstressors. Discuss 
a1,0ilable or useful past coping mechanisms. Reduce stimuli in their en,..ronmenl Instruct pt to notifyalicer or Nurse if needing 
assistance or if there is a change in their health status. Bed in lowest and locked position. Rails up "2. Call bell within reach. 
i>dminister medications as ordered. Fresh drinking water in cell, encourage pt to drink 2-3L of water daily. M:lnitor Pt's oral intake 
for adequate nutrition and h)dration. Encourage eiercise in cell or Recreation Yard if allowed. Olseiw for statementsibehal.iors 
indicating harm to self or others. pt to remain in M-IU o.erflow in H Seg unit until discharge byPro,..der. pt .erbali:red 
understanding of care plan. 
Notes: tvHU H-seg o'"' rflow until Mldical & M-1 determination 
Appointment Provicle,:K~b_)(_6)_; --~IRN 
Bectronically signed (b )(6); 
Sign off status: Campi t h \l ? \fr \ 
RN on 10/31/2018 18:25:44 (Pacific Daylight Time) 
Northwest Detention Center 
1623 E J STREET 
T~~A98421 
Telfl S6C- I 
Pati-t: AMAR, MERGENSANA DOB: 10/23/1978 p__, Ncmj(b)(6) ; (b)(?)(C) It" 10/31/2018 
/lkxe generated by eOirica/Wcrks EM<IPM Sofrl<ere (w.w,eQirica/Wcrks.COfT'4 
2019-ICLl-00051 2881 

DHS-ICE-19-0196, 19-0197-N-000063
U.S. Immigrat ion 
and Customs 
Enforcement 
AMAR, MERGENEJ 
A: 216269802 Si.ti1 (b )(~); _ Facility Code: CSONVWA Housing ea: 
40 Y old Male, DOB: 10/23/1978 
AccOllll lunbe d /h \/R \· I 1623 E J STREET, TACOMA, WA-98421 
Appoimnert Facility: Northwest Detertion Certer 
10 131/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018 , KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019 , KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID, stopdate 
04/15/2019 , KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018 , KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018 , KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018 , KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018 , KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allerglss 
Boost Plus: diarrhea: Side Effects 
Review of Systems 
Unable to assess due to Pt's refusal to respond to questions. 
Reason for Appointment 
1. tvH follow up for Pt in the tvHU on M-10 
History of Present Illness 
Narrati'"': 
Appointment Provlde, (b)(6) ; (b)(? )(C) 
Pt spoke: ()() Fluent English; [) Spanish; ()() Oher, Lionbridge # 
Re'"ewed Record [>l 
Pt IDed byname, Ml, picture 
Session chaperoned by GEO M!dical Oficer, obsen.ing direcilylrom outside large office window. 
CURRENT COl'vf'l..PjNT/CONCERN: 
Pt continues to refuse to respond to questions about his l\lental State. Pt would only respond" no" and co1.er his head when 
asked to come to the cuff port to speak with this pro,.der. Today, Pt did respond no, when asked if he was ha'"ng a thoughts of 
suicide. Due to poor communication, an assessment could not be completed. Ptwill remain on M-iOwith 10 minute irregular 
rustodycihecks. Pt status will be reassessed tomorrow for disposition. The M-i team today agreed that since Pt. is non￾communiti'"' he should remain on M-i observation with 10 minute irregular rustodycheck to assure safety. The concern for this 
Pt's safety, stems from his recent making of a 6 foot rope and hiding it in his cell. Pt does continue to eat and drink the food 
pro'"ded him. SEG GEO officer reports no acilng out beha1.ioral concerns. 
Examination 
11/ental Status: 
/>PPEPRl>NCE: 
Segrega ti on Cell is clean, items are in order, roo m is pi cked up. 
Appointment Provide~(b)(6); (b)(? )(C) !LCSW 
Bectronically signed b~(b)(6); (b)(? )(C) ~CSW on 10/31/20 18 15:58:28 (Pacific Daylight Time) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREET 
T WA98421 
Tel (b)/6) 
x: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progrwss No, (b)(6); (b)(? )(C) ~CSW 10/31/2018 
Ncte generated byeClinica/Wcxi<s EJvRIFM Soflw!Jre (""'"'eC/inica/Wc.-ks.com) 
2019-ICLl-00051 2882 

DHS-ICE-19-0196, 19-0197-N-000064
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA . . A:21626980 2 Su:llctb}(6); Facility Code: CSOINWA HotE'"ii'"",Y"Aire"'d'" ."H-' 
40 Y old Male, DOB: 10/23/1978 
AccOl.l'II lunber~ 
1623 E J STREET, T~ 
Appoirimert Facility. Northwest Detertion Cert er 
10 131/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID. stop date 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a cup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required forlra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• .Acetaminophen 500 t,,G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes. Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Past Medlcal History 
Hunger strike 
Allergles 
Boost Plus: diarrhea: Side Effects 
Review of Systems 
~ = Puditoryl,isual hallucinations denies. Homicidal 
Thoughts denies. Suicidal thoughts denies. 
Reason for Appointment 
1. tvHU RN day Rounds 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do you speak? English, Russian 
Interpretation pro\aded? Pallant speaks English fluenUy 
Pain Assessment 
Pain 
ke you currently in pain? No 
Narrati'"': 
Appointment Provldef b)(6) ; (b)(7)(C) f" 
Detainee seen in 1-1-Seg for M-iU o'"'rflow RN day rounds on Mlntal Health OiseM1tion 10 min irreggluar checks. Detainee 
refused \atals, took am boost and pedial)le and returned to bed. Detainee denies pain or need for PIRN pain meds. Denies 
S1/HVA\IH. 
Memoon update: Detainee continues to deny any medical needs, gi'"'n afternoon boost denied SIIHVA\IH. 
Examination 
General El<amination: 
GENER/IL />PPEPRPNCE: in no acute distress, well de\eloped , well oourished. 
MJSCULOSKELETl'l : nonnal, nonnaJ gait, no defomlities, full range of motion, good strergth and equal bilaterally. 
Assessment s 
1. Readiness for enhanoed coping - ND00158 (Primary) 
Treatment 
1. Readiness for enhanced coping 
Notes: W II oontinue in tvHU o'"'rflow to monitor per protocol Continue with current plan of care. Instructed on proper hand wash 
technique Pro"ded with water pitcher, instructed to drink 3-4UdayEnoouraged to reO'eate outside, Instructed to notify nurse or 
security staff if needed assistance. WII oontinue to monitor and maintain health and safety standards while in M-iU Pt educated 
on plan, \Oices no ooncems; '"'rbalized understanding Ptwill remain in M-iU 01erflow until discharge bypro\ider. 
Appointment Provide (b)(6); l k \ 17\lr\ 
Bectronically signed~ \~/\~/;,~ , 
Sign off status: Completed 
IRN on10/31/201814 :03:42 (Pacifi c Daylight Time) 
Northwest Detention Center 
1623 E J STREET 
T~!.498421 ~L 1 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progress Note: b)(6); 10/31/2018 
h\/7\/1.\ 
/lk:xe generated by eOinica/Wcrks EM<IPM Soft"8re {IWNieOl1>c 
2019-ICLl-00051 2883 

DHS-ICE-19-0196, 19-0197-N-000065
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA . . A:21626980 2 Su:lli-!lrb)(6); I 
Facility Code: CSOINNA II g A ea. n 
40Y old Mal~,· 
AccOl.l'II llunbe b 6 · 
10 131/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID, stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a cup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal Hletory 
Hunger strike 
Allergles 
Boost Plus: diarrhea: Side Effects 
1623 E J STREET, T ' 
Appoirimert Facility. Northwest Detertion Certer 
Reason for Appointment 
1. RN Daily Seg rounds 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do you speak? English 
Appointment Provlde! (b)(6); (b)(7)(C) ~N 
Interpretation pro\aded? Pallent speaks English fluenUy Detainee able to comunicate needs in English 
Segregation: 
Segregation Rounds 
ke you currentlythinking about killing or harming yourself? No 
Do you ha'"' any medical complaints orconcems at this time? No 
Was referral made to d inical sen.1ces (lvOIM.P, Dental, M-t, Sick Call)? No 
Examination 
Segregation: 
Segregation Evaluation: Patient has spontaneous speech and ansWE!fS questions appropriately, in no acute distress, 
weU de\eloped , well nourished, Patient appears to be v.ithin normal limits of beha"or, affect, and cogniti,e functioning, 
Patient does not appear to ha,e any acute or unresol\ed medical conditions that may worsen in segregation, Patient does 
not appear to ha\e acti,e psychosis, mania, suicidal idealions or l'Klmicidal ideations. 
Assessments 
Health M!intenance Related to Segregation Placement 
Treatment 
1. Others 
Notes: Noted Detainee did go to rec for 1 hour )eslerday￾GEO Log notes Detainee to ha'"' eaten an orange last night 
Appointment Providef b)(6); ~ -
Bectronically signed b~(b)(6); 
Sign off status: Completed 
!RN on 10/31/2018 08:27:15 (Pacific Daylight lime) 
Northwest Detention Center 
1623 E J STREET 
T WA98421 
Tel: bl/6): 
x: 
Patien1: AMAR, MERGENSANA DOB: 10/23/197 8 p,__ ....., \~/\~/;,._, ~ 10/31/2018 
NcJ.e generated oye0irica/Wcv1<s 8"R/PM Sottv.ere /w.w,eQinica/Works.co«4 
2019-ICLl-00051 2884 

DHS-ICE-19-0196, 19-0197-N-000066
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA . . A:21626980 2 Su:ll~b)(6); I 
Facility Code : CSONVWA n,gHca . ,, 
40 Y old Male, DOB: 10/23/1978 
Acc01.111 ~ <6): I 
10 131/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID. stop date 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required forlra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes. Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Past Medlcal History 
Hunger strike 
Allergles 
Boost Plus: diarrhea: Side Effects 
1623 E J STREET, T WA-911421 
Appoimnert Facility: Northwest Detertion Cert er 
Reason for Appointment 
1. tvHU RN NIGHT ROUNDS/H-SiEG M-1O 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEO OFFICER ON DUTY 
Wiat language do }OU speak? English, Russian 
Interpretation pro\aded? Pallant speaks English fluenUy 
Pain l>ssessment 
Pain 
ke }OU ru rrentlyin pain? No 
Narrati'"': 
Appointment Provlder:t~(b'-")"-(6"')'-: __ _.! RN 
ENCOUNTERED PT DURING NIGHT ROUNDS. PT DENIED St/l-lVA\/1-t . DENIED PNYPl'IN OR DISCa.50RT. RERJSiED 
BRE/IKFPST. 
Examination 
General Examination: 
GENER/IL PPPEl'R/>NCE: in oo acute distress, well de\eloped , well oourished. 
MJSCULOSKELETl'l : oorrnal gait. 
EXTREMTIES: full range ci molion. 
PSYCH: alert, Oliented, cooperati\e with exam, cogniti\e function intact, thought content without suicidal ideation, 
delusions. 
Assessment s 
1. lneffecti'"' Coping [00069]- ND00069 (Primary:) 
Treatment 
1. lneffecthle Coping [00069) 
Notes: Pro\ade~s orders re,..ewed and '"'rified. 
Nursing to round as needed, document beha~or, '"'rbalizations, and displayof emotions. 
Establish a working relationship with Pl 
Pro" de opportunities for pt to e,press oonoems, fears, feelings, e,peclations. 
l>ssess for specificstressors. 
Disruss available or useful past ooping mechanisms. 
Reduoe stimuli in their en,..ronmenl 
Instruct pt to notify Officer or Nurse if needing assistanoe or if there is a change in their health status. 
Mm inister medications as ordered. 
Fresh drinking water in cell, enoourage ptto drink 3-4L of water daily. 
11/onitor Pt's oral intake for adequate nutrition and h)dration. 
Enoourage eiercise in cell or Recreation Yard if allowed. 
Obserw for statementslbeha~ors indicating harm to self or others. 
pt to remain in tvHU until discharge byPro~der. 
pt '"'rba li,ed understanding of care plan. 
Disposition: Mm itted to tvHU until medically evaluated 
Appointment ProvideJ(b)( 6); ~ lfblf7l/Cl r· 
Electronically signed b (b)(6); RN on 11101/2018 23:55:15 (Pacific Daylight lime) 
Sign off status: Comple f h\f7\fr\ 
Northviest Detention Center 
1623 E J STREET 
T WA98421 
Tel b)(6); h " 7 \lf' ' \ 
Patient: AMAR, MERGENSANA DOIi; 10/23/1978 p,_... u_.J'b)(6); IRN 10/31/2018 ~ h \/ 7 \/r \ . 
Neta generated by eOinica/ Wai<s ElvRIPM ~ (l<MMleOinicti Works.com) 
2019-ICLl-00051 2885 

DHS-ICE-19-0196, 19-0197-N-000067
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 2886 
AMAR,MERGENSANA A:216269802 Su:i1c:f: b)(6); I 
Facility Code : CSONVWA Housing Area: A 
40 Y old Male, DOB: 10/23/1978 
1623 EJ 
AccOl.lll 
STREET, 
llunber
T~ 
: ~ 

DHS-ICE-19-0196, 19-0197-N-000068
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A:216269802 Su:llOllh \/R\· i 
Facility Code : CSONVWA Housing Area: H 
40 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunber: ITTimi'i:7 
1623 E J STREET, T~ 
Appoirimert Facility: Northwest Detertion Cert er 
10 130/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID. stop date 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes. Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allergles 
Boost Plus: diarrhea: Side Effects 
Review of Systems 
DENIED />NY M:DICll>l, DENT!>l, OR M: NT!>l HE/>l TH ISSUES 
ATTHISTIM: . 
Reason for Appointment 
1. tvHU RN El<!ning Rounds - tvHO 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do you speak? English, Russian 
Interpretation pro\aded? Pallent speaks English fluenUy 
Pain Assessment 
Pain 
ke you ru rrentlyin pain? No 
Narrati'"': 
Appointment Provlclej (b)(6) ; ~-
Detainee denied SIIHVA\A-1, denied any pain. Detainee cooperati'"' with exam and answered all question. Detainee denied 
any other concerns and all his questions was answered. VIAii continue to monitor. 
Examination 
General Examination: 
GENER!>l>PPEl'RPNCE: in oo acute distress, well de\eloped , well oourished. 
HEPD: nonnocephalic. 
EYES: pupils equal, round, reacti-.e to light and accommodation. 
OR!>l CA\/ITY: normal, mucosa moist. 
EXTREMTIES: normal. 
PSYCH: alert, oriented, cooperati'"' with exam, cogniti'"' function intact, thought content without suicidal ideation, 
delusions. 
Asses sments 
1. lneffecti'"' Coping [00069] - ND00069 (Primary:l 
Treatment 
1. lneffecthle Coping [00069] 
Notes: Irregular 10 min checks per custodystaff, bed at lowest position and locked, water available in cell, refer to nursing care 
plan fororl-i)Oing interwntions, detainee encouraged to -erbali,e needs and feelings, detainee -erbali,ed understanding. 
Nursing to round as needed, document beha~or, -erbalizations, and displayof emotions. Establish a worl<ing relationship with 
Pl Pro~de opportunities for pt to e,q:,ress concerns, fears, feelings, e,q:,edations. Assess for specific stressors. Discuss 
a'-<!ilable or useful past coping mechanisms. Reduce stimuli in their en~ronment Instruct pt to notifyCXlicer or Nurse if needing 
assistance or if there is a change in their health starus. Bed in lowest and locked position. Rails up "2. Call bell within reach . 
.Administer medications as ordered. Fresh drinking water in cell, encourage pt to drink 2-3L of water daily. M:>nitor Pl's oral intake 
for adequate nutrition and h)(!ration. Encourage el<lrcise in cell or Recreation Yard if allowed. Obserw for statements/beha~ors 
indicating harm to self or others. pt to remain in M-IU o-erflow in H Seg unit until discharge byPro~der. pt,erba li,ed 
understanding of care plan. 
Appoinbnent Providei b)(6); fN 
Bectronically signed by (b)(6); , RN on 10/30/20181 7:37:31 (Pacific Daylight Time) / h \/ 7 \tr ' \ 
Sign off status: Complete 
Northwest Detention Center 
1623 E J STREET 
T WA98421 
" b\/ 6\: 
x: 
Patie nt: AMAR, MERGENSANA DOB: 10/23/1978 Progresa Notel (b)(6) ; !RN 10/30/2018 
Ncie generated by eC/irica/Wcrl<s aR'PM $otlv,ere (1W.WeC/ inica/Works.com) 
2019-ICLl-00051 2887 

DHS-ICE-19-0196, 19-0197-N-000069
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA . . A:216269802 Su:l1Dl{b)(6); I 
Facility Code : CSOINNA Hex.in g A ea. n 40 Y old Male, DOB: 10/23/1978 
AccOl.l'II llunber!'i!rh...,l:;.;ln 'f'),,.· ~..,..... 1623 E J STREET, TACOMA, WA-98421 
Appoirimert Facility. Northwest Detertion Cert er 
10 130/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID. stop date 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a cup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t,,G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes. Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allergles 
High calorie boost: diarrhea: $de Effects 
Review of Systems 
~ = Puditory,isual hallucinations denies. Homicidal 
Thoughts denies. Suicidal thoughts denies. 
Reason for Appointment 
1. tvHU Day Nurse Rounds 
History of Present Illness 
Patient Identification: 
Patient Identification 
Appointment Prov1c1e9(b)(6) ; (b)(7)(C) rN 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
VIM! language do you speak? English, Russian 
Interpretation pro\aded? Pallant speaks English fluenUy 
Pain Assessment 
Pain 
ke you currently in pain? No 
Narrati'"': 
Detainee seen in 1-1-Seg for M-iU o'"'rflow RN day rounds on Mlntal Health OiseM1tion 10 min irreggluar checks. Detainee 
refused \atals, took am boost and pedial)le and returned to bed. Detainee denies pain or need for PRN pain meds. Denies 
SIIHVA\11-1. 
Memoon update: Detainee continues to deny any medical needs, gi'"'n afternoon boost 
Yitai Signs 
refused "ta ls. 
Examination 
General E>amination: 
GENER/II.. !>PPE.ARl'NCE: in no acute distress, well del,eloped, well nourished. 
MJSCULOSKELET/ll : normal, normal gait, no deformities, full range cl. motion, good strength and equal bilaterally. 
Assessment s 
1. Readiness for enhanced coping - ND00158 (Primary) 
Treatment 
1. Readiness for enhanced coping 
Notes: W II continue in M-IU o'"'rflow to monitor per protocol Continue with current plan of care. Instructed on proper hand wash 
technique Pro"ded with water pitcher, instructed to drink 3-4UdayEncouraged to recreate outside, Instructed to notify nurse or 
security staff if needed assistance. W II continue to monitor and maintain health and safety standards while in M-iU Pt educated 
on plan, \Oices no concerns: '"'rbali,ed understanding Ptwill remain in M-iU 01erflow until discharge bypro\ider. 
Appointment Provide.-L'b )(6); bN '1\~-~~-~r· 
Electronically signed ~ (b)(6) ; ~-
Sign off status: Completed 
!RN on 10/30/2018 13:45:28 (Pacific Daylight Time) 
NorthYlest Detention Center 
1623 E J STREET 
TACOMA, WA98421 
Tel!(b)/6) I 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 Prog,. .. Notet (b)(6): (b)(?)(C) fN 10/30/2018 
/lkte generated byeC/inica/Wcxi<s e.RIPM &itl,e/r, ("""'eC/inica/Works.com) 
2019-ICLl-00051 2888 

DHS-ICE-19-0196, 19-0197-N-000070
U.S. Immigrat ion 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A:216269802 Su:llD:!/b)/6) ! 
Facility Code: CSONVWA Housing Area: A 
40 Y old Male,~- 1QOJ(1928 
Acc01.111 ~be b)/6): I 
10 130/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018 , KOP: Yes, Drug Source: In House Pharmacy , 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019 , KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID. stop date 
04/15/2019 , KOP: Yes, Drug Source: In House Pharmacy , Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018 , KOP: 
No, Drug Source: In House Pharmacy , Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy , 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018 , KOP: Yes, Drug Source: In House Pharmacy , Notes: 
Not required for tra'"' I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018 , KOP: Yes. Drug Source: In House Pharmacy , 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allerglss 
High calorie boost : diarrhea: $de Effects 
Review of Systems 
Unable to assess due to Pt's refusal to respond to questions. 
Reason for Appointment 
1623 E J STREET, TACOMA, WA-98421 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Prov1c1e9(b)(6) ; (b)(7)(C) 
1. tvH follow up for Pt on tvHOw/10 mnute irregular rustodychecks 
History of Present Illness 
Narrati'"': 
Pt spoke: [] Fluent English; [) Spanish; [X] ahe r, Lionbridge # n tiana 1349 
Re'"ewed Record [>l 
Pt IDed byname, Ml, picture 
Session chaperoned by GEO M!dical Oficer, obsen.ing direcilylrom outside large office window. 
CURRENT COl'vf't..PjNT/CONCERN: 
Pt continues to refuse to respond to questions about his l\lental State. Pt would only respond" no" and co'"'r his head when 
asked to come to the cuff port to speak with this pro,.der. Today, Pt did respond no, when asked if he was ha'"ng a thoughts of 
suicide. Due to poor communication, an assessment could not be completed. Ptwill remain on tvHOwith 10 minute irregular 
rustodycihecks. Pt status will be reassessed tomorrow for disposition. The tvH team today agreed that since Pt. is non￾communiti'"' he should remain on tvH observation with 10 minute irregular rustodycheck to assure safety. The concern for this 
Pt's safety, stems from his recent making of a 6 foot rope and hiding it in his cell. Pt does continue to eat and drink the food 
pro'"ded him. SEG GEO officer reports no acilng out beha1.ioral concerns. 
Examination 
11/ental Status: 
/>PPEPRl>NCE: 
Segrega ti on Cell is clean, items are in order, roo m is pi cked up. 
Appointment Provide!(b)(6); (b)(7)(C) I LCSW 
Bectronically signed ~(b)(6); (b)(7)(C) ~CSW on 10/30/2018 13:03:49 (Pacific Daylight Time) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREET 
TACOMA, WA98421 
Tef'b)/6): ! rax. 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progrwss No, (b)(6); (b)(7)(C) ILCSW 10/30/2018 
Ncte generated by eClinica/Wcxi<s EJvRIFM Soflw!Jre /w,,,weC/inica/Wc.-ks.com) 
2019-ICLl-00051 2889 

DHS-ICE-19-0196, 19-0197-N-000071
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:llQ(b )(6): 7 
Facility Code : CSONVWA Housing Area: H 
40 Y old Male, DOB: 10/23/1978 
AccOl.lll lunber: !(h \In\ 
1623 E J STREET, TACOMA, WA-98421 
Appoimnert Facility: Northwest Detertion Cert er 
10 130/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID,stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allergles 
High calorie boost: diarrhea: $de Effects 
Reason for Appointment 
1. RN Daily Seg rounds 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
VIM! language do you speak? English 
Appointment Provid e r:! ~(b~)~(6~);~_ ~- ..... r" 
Interpretation pro\aded? Pallent speaks English fluenUy Detainee able to comunicate needs in English 
Segregation: 
Segregation Rounds 
ke you ru rrentlythinking about killing or harming yourself? No 
Do you ha'"' any medical complaints orconcems at this time? No 
Was referral made to d inical sen.1ces (lvOIM.P, Dental, M-t, Sek Call)? No 
Examination 
Segregation: 
Segregation Evaluation: Patient has spontaneous speech and ansWE!fS questions appropriately, in no acute distress, 
weU de\eloped , well nourished, Patient appears to be v.ithin normal limits of beha"or, affect, and cogniti,e functioning, 
Patient does not appear to ha,e any acute or unresol\ed medical conditions that may worsen in segregation, Patient does 
not appear to ha'-"! acti,e psychosis, mania, suicidal idealions or l'Klmicidal ideations. 
Assessments 
Health M!intenance Related to Segregation Placement 
Treatment 
1. Others 
Notes: Noted Detainee is on not on schedule today for Rec- refused ,esterdayas well 
GEO Log notes Detainee to ha'"' eaten a Pll,lsnack last night 
Appointment Provider.l(b)(6); ~-
Bectronically signed bi b)(6); ~-
Sign off status: Comple d 
I on 10/30/2018 09:00:23 (Pacific Daylight lime) 
Northwest Detention Center 
1623 E J STREET 
TACOMA, WA98421 
Telj(b /LBJ: 
Patien1: AMAR, MERGENSANA DOB: 10/23/197 8 p,__ Notef:._.b~)=(6~);~_ ~-IRN 10/30/2018 
NcJ.e generated oy e0irica/Wcv1<s 8"R/PM Sottv.ere (w.w,eQinica/Works.co«4 
2019-ICLl-00051 2890 

DHS-ICE-19-0196, 19-0197-N-000072
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA . . A:216269802 Su:lli;'ib)/6\: ! 
Facility Code: CSOINNA II g A ea. n 
1623 E 
40 J~~=1~i;e;{b]@C Y ad ~:a'~!::: : I 
10 130/2018 
Cunont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID.stop date 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
Ira'"' · schedule for am and pm PL • Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required forlra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes. Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Past Medlcal History 
Hunger strike 
Allorglos 
High calorie boost: diarrhea: $de Effects 
Review of Systems 
DENIED />NY M:DICll>l, DENT!>l, OR M:NT!>l HE/>l TH ISSUES 
ATTHISTIM:. 
Appoirimert Facility. Northwest Detertion Certer 
Appointment Provlcle~ (b)( 6) ; (b)(7)(C) 
Reason for Appointment 
1. tvHU NIGHT RN ROUNDS/ tvt-lO 010 MN IRREG CHECKS 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
VIM! language do you speak? English, Russian 
Interpretation pro\aded? Pallent speaks English fluenUy 
Pain Assessment 
Pain 
ke you ru rrentlyin pain? No 
Narrati'"': 
Detainee denied SIIHVA\A-1, denied any pain. Detainee was ccoperati'"' with nursing exam. Refused breakfast W II continue 
to monitor. 
Examination 
General Examination: 
GENER!>l>PPEl'RPNCE: in oo acute distress, well de\eloped, well oourished. 
HEPD: nonnocephalic. 
EYES: pupils equal, round, reacti-.e to light and accommooation. 
OR!>l CA\/ITY: normal, mucosa moist. 
EXTREMllES: normal. 
PSYCH: alert, oriented, cooperati'"' with exam, cogniti'"' function intact, thought content without suicidal ideation, 
delusions. 
Assessments 
1. lneffecti'"' Coping [00069] - ND00069 (Prmary:l 
Treatment 
1. lneffecthle Coping [00069] 
Notes: Irregular 10 min checks per rustodystaff, bed at lowest position and locked, water available in cell, refer to nursing care 
plan foron-i)Oing interwntions, detainee encouraged to -erbali,e needs and feelings, detainee -erbali,ed understanding. 
Nursing to round as needed, dorument beha~or, -erbalizations, and displayof emotions. Establish a worl<ing relationship with 
Pl Pro~de opportunities for pt to e,q:,ress concerns, fears, feelings, e,q:,edations. Assess for specific stressors. Discuss 
a'-<!ilable or useful past coping mechanisms. Reduce stimuli in their en~ronment lnslruct pt to notifyCXlicer or Nurse if needing 
assistance or if there is a change in their heallh starus. Bed in lowest and locked position. Rails up "2. Call bell wilhin reach . 
.Administer medications as ordered. Fresh drinking water in cell, encourage pt to drink 2-3L of water daily. M:>nitor Pl's oral intake 
for adequate nutrition and h)(!ration. Encourage el<lrcise in cell or Recreation Yard if allowed. Obserw for statementsfoeha~ors 
indicating harm to self or others. pt to remain in tvt-lU until discharge byPro~der. pt -erbali>ed understanding of care plan. 
Disposition: .Admitted to tvHU until medically evaluated 
Appointment Provide r:l(b)(6) ; (b)(7)(C) r 
Bectronicaily signed ~(b)(6) ; (b)(7)(C) Fon 10/30/2018 06:36:38 (Pacific Dayligh t Time) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREEr 
T~WA9 8421 Tejb@f I 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progre .. Note (b)(6); (b)(7)(C) !RN 10/30/2018 
Ncte generated by eC/inica/Wrxi<s a.R/PM Softw3re /"""'eC/inlcal'M:Yks.com) 
2019-ICLl-00051 2891 

DHS-ICE-19-0196, 19-0197-N-000073
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 ProgN U Nola: 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""1eC/inica'WGYks.coojl 
2019-ICLl-00051 2892 
AMAR,MERGENSANA A:216269802 Su:llol(b)( 6 ); ! 
Facility Code : CSONVWA Housing Area: A 40 Y old Male, DOB: 10/23/1978 
Acc01.1111'Un~1r61 I 1623 E J STREET, T WA98421 

DHS-ICE-19-0196, 19-0197-N-000074
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:,10:j,o_ HM. 
Facility Code : CSONVWA Housing Area: H 
40 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunbe ~ 
1623 E J STREET, T~ 
Appoirimert Facility: Northwest Detertion Cert er 
10 12912018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID, stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allergles 
High calorie boost : diarrhea: $de Effects 
Review of Systems 
DENIED />NY M:D ICll>l, DENT!>l, OR M: NT!>l HE/>l TH ISSUES 
ATTHISTIM: . 
Reason for Appointment 
1. tvHU RN El<!ning Rounds - tvHO 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
VIM! language do you speak? English, Russian 
Interpretation pro\aded? Pallent speaks English fluenUy 
Pain Assessment 
Pain 
ke you ru rrentlyin pain? No 
Narrati'"': 
Appointment Prov1c1e9(b)(6) ; ~-
Detainee denied SIIHVA\A-t , denied any pain. Detainee cooperati'"' with exam and answered all question. Detainee denied 
any other concerns and all his questions was answered. VIAii continue to monitor. 
Examination 
General Examination: 
GENER!>l l>PPEl'RPNCE: in oo acute distress, well de\eloped , well oourished. 
HEPD: norrnocephalic. 
EYES: pupils equal, round, reacti-.e to light and accommodation. 
OR!>l CA\/ITY: normal, mucosa moist. 
EXTREMllES: normal. 
PSYCH: alert, oriented, cooperati'"' with exam, cogniti'"' function intact, thought content without suicidal ideation, 
delusions. 
Assessments 
1. lneffecti'"' Coping [00069]- ND00069 (Prmary:l 
Treatment 
1. lneffecthle Coping [00069] 
I" 
Notes: Irregular 10 min checks per custodystaff, bed at lowest position and locked, water available in cell, refer to nursing care 
plan fororl-i)Oing interwntions, detainee encouraged to -erbali,e needs and feelings, detainee -erbali,ed understanding. 
Nursing to round as needed, document beha~or, -erbalizations, and displayof emotions. Establish a worl<ing relationship with 
Pl Pro~de opportunities for pt to e,q:,ress concerns, fears, feelings, e,q:,ectations. Assess for specific stressors. Discuss 
a'-<!ilable or useful past coping mechanisms. Reduce stimuli in their en~ronment Instruct pt to notifyCXlicer or Nurse if needing 
assistance or if there is a change in their health status. Bed in lowest and locked position. Rails up "2. Call bell within reach. 
/>dminister medications as ordered. Fresh drinking water in cell, encourage pt to drink 2-3L of water daily. M:>nitor Pl's oral intake 
for adequate nutrition and hydration. Encourage el<lrcise in cell or Recreation Yard if allowed. Obserw for statementsfoeha~ors 
indicating harm to self or others. pt to remain in M-IU until discharge byPro~der. pt -erbali>ed understanding of care plan. 
Appoinbnent Provide (b)(6); RN 
f h\/7\tr\ 
Bectronically signed ~(b)(6); 
Sign off status: Completed 
Add endum : 
10/29/2018 08:36 P (b)(6); l h \/ 7 \tr\ 
fN, RN on 10/29/201816 :38:30 (Pacific Daylight Time) 
0% of supper, drank 1 liter of pedial)le, ate PM snack, drank his boost 
Northwest Detention Center 
1623 E J STREET 
1:~ oi!!!!:1,.!!,~~ 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 Progre8S Notef b)(6) ; jRN 10/29/2018 
/lkte generated by eClinica/Wai<s ElvRIPM S::ltYHe (""""eC/inica/Works.com) 
2019-ICLl-00051 2893 

DHS-ICE-19-0196, 19-0197-N-000075
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:llnl ln ,m, I 
Facility Code : CSONVWA Housing Area: H 
40 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunber: Fn ""'· 
10 12912018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pha rmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pha rmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy , 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID,stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy , 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allerglss 
High calorie boost : diarrhea: $de Effects 
Review of Systems 
Unable to assess due to Pt's refusal to respond to questions. 
Reason for Appointment 
1. tvH follow up for Pt in the tvHU on M-1O 
History of Present Illness 
Narrati'"': 
1623 E J STREET, TACOMA, WA-98421 
Appoirimert Facility: Northwest Detertion Cert er 
Appointment Provlderj (b)(6) ; (b)(?)(C) 
Pt spoke: [] Fluent English; [) Spanish; [X] aher, Lionbridge # ntiana 1349 
Re'"ewed Record [>l 
Pt IDed byname, Ml, picture 
Session chaperoned by GEO M!dical Oficer, obsen.ing direcilylrom outside large office window. 
CURRENT COl'vf't..PjNT/CONCERN: 
Pt continues to refuse to respond to questions about his l\lental State. Pt would only respond" no" and co'"'r his head when 
asked to come to the cuff port to speak with this pro,.der. Due to poor communication, an assessment could not be completed. 
Pt will remain on tvHOwith 10 minute irregular custody checks. Pt status will be reassessed tomorrow for disposition. The M-i 
team today agreed that sinoe Pt. is non-communiti'"' he should remain on M-i observation with 10 minute irregular custody 
check to assure safety. Pt does continue to eat and drink the food pro\ided him. SEG GEO officer reports no acilng out beha\ioral 
ooncems. 
Examination 
11/ental Status: 
/>PPE./>RPNCE: 
Segregation Cell is clean, items are in order, room is picke d up. 
Appointment Provide (b)(6); (b)(?)(C) CSW 
Electronically signed b~(b)(6); (b)(?)(C) ~CSW on 10/29/201816 :32:56 (Pacific Daylight Time) 
Sign off status: Completed 
Northviest Detention Center 
1623 E J STREET T®~:A 98423 1 x: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progrwss Not-!(b)/6): (b )(?)(Cl ! LCSW 10/29/2018 
Ncte genersled by eClinica/Worl<s EJvRIFM Softw!Jre ("""'eC/inica/Worl<s.com) 
2019-ICLl-00051 2894 

DHS-ICE-19-0196, 19-0197-N-000076
1012912018 
........ 
High calorie boost : diarrhea: !'.de Effects 
U.S. Immigration 
and Customs 
Enforcement 
Reason for Appointment 
1. Weekly weight and ,Hals 
Appointment Provider. Tacoma Provide r 
AMAR,MERGENSANA A:216269802 Su:lloj(b)(6); J 
Facility Code : CSONVWA Housing Area: 
40Y old Mal~,· AccOllll l'unbe b )(6); 1623 E J STREET, T 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Provider: Tacoma Provider 
Electronically signed by Tacoma Provider on 11/16/2018 at 07:25 MST 
Sign off status: Pending 
Northwest Detention Center 
1623 E J STREET 
T WA 8421 
Tel (b)(6); 
Patl-t: AMAR, MERGENSANA DOB: 10/23/1978 p,_... Note: T- Pnmcler 10/29/2018 
/lkxe generated by eC/inica/Wcrl.s a.RIPM Sottv.ere ("""'eC/inica/Works .com) 
2019-ICLl-00051 2895 

DHS-ICE-19-0196, 19-0197-N-000077
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:i1c:t:b )(61 I 
Facility Code : CSONVWA Housing ea: A 
40 Y old Male, DOB: 10/23/1978 
AccOl.ri tunbed/b\16\ · 
10 12912018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID, stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• .Acetaminophen 500 t,,G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allergles 
High calorie boost : diarrhea: $de Effects 
Reason for Appointment 
1. tvHU Day Nurse Rounds 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
VIM! language do you speak? English, Russian 
Interpretation pro\aded? Pallent speaks English fluenUy 
Pain Assessment 
Pain 
ke you ru rrentlyin pain? No 
Narrati'"': 
1623 E J STREET, TACOMA, WA-98421 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Provide (b)(5); (b)(?)(C) RN 
Detainee seen in H-Seg for tvHU o\erflow RN day rounds on Mlntal Health OiseM1tion 10 min irreggluar checks. Detainee 
refu8sed \atals, took am boost and pedial)le and returned to bed. Detainee denies pain or need for PRN pain meds. 
Yitai Signs 
refused. 
Examination 
General EJ<amination: 
GENER/ll J>PPE.AR.6NCE: in no acute distress, well del.e!oped, well nourished. 
MJSCULOSKELETJ>l: normal, normal gait, no deformities, full range cl motion, good strength and equal bilaterally. 
Assessment s 
1. Readiness for enhanced coping - ND00158 (Primary) 
Treatment 
1. Readiness for enhanced coping 
Notes: W II continue in tvHU o\erflow to monitor per protocol Continue with current plan of care. Instructed on proper hand wash 
technique Pro"ded with water pitcher, instructed to drink 3-4UdayEncouraged to recreate outside, Instructed to notify nurse or 
security staff if needed assistance. WII continue to monitor and maintain health and safety standards while in tvHU Pt educated 
on plan, \Oices no concerns: \erbali,ed understanding Ptwill remain in tvHU o\erflow until discharge bypro\ider. 
Appointment Provide! ""(b-'-)(_6-'-); __ _,!RN 
Bectronically signed bt b)(6); ~-
Sign off status: Comple d 
~ on 10/2912018 13:53:10 (Pacific Daylight Time) 
Northwest Detention Center 
1623 E J STREET 
T WA 8421 
Tel (b)(6); 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 Prog,. .. No, (b)(6); (b)(7)(C)jt" 10/29/2018 
Ncte generated byeC/inica/Wai<s a.R/PM &Jti,ere ("""'eC/inlca/Works.com) 
2019-ICLl-00051 2896 

DHS-ICE-19-0196, 19-0197-N-000078
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA A:21626980 2 Su:lloj(b)(6); I 
Facility Code : CSONVWA Housing Area: A 
40 Y old Male, DOB: 10/23/1978 
Acc01.111 ~ ><6> ; I 
10 12912018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID. stop date 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..G Tablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes. Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allergles 
High calorie boost: diarrhea: $de Effects 
1623 E J STREET,· , VVM842 I 
Appoimnert Facility: Northwest Detertion Certer 
Reason for Appointment 
1. RN Daily Seg rounds 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
VIM! language do you speak? English 
Appointment Provlderf b )(6); ~. 
Interpretation pro\aded? Pallent speaks English fluenUy Detainee able to comunicate needs in English 
Segregation: 
Segregation Rounds 
ke you ru rrentlythinking about killing or harming yourself? No 
Do you ha'"' any medical complaints orconcems at this time? No 
Was referral made to d inical sen.1ces (lvOIM.P, Dental, M-t, Sek Call)? No 
Examination 
Segregation: 
Segregation Evaluation: Patient has spontaneous speech and ansWE!fS questions appropriately, in no acute distress, 
weU de\eloped , well nourished, Patient appears to be v.ithin normal limits of beha"or, affect, and cogniti,e functioning, 
Patient does not appear to ha,e any acute or unresol\ed medical conditions that may worsen in segregation, Patient does 
not appear to ha\e acti,e psychosis, mania, suicidal idealions or txlmicidal ideations. 
Assessments 
Health M!intenance Related to Segregation Placement 
Treatment 
1. Others 
Notes: Noted Detainee is on schedule todayfor Red 
GEO Log notes Detainee did eat an Qange at HS and to ha'"' eaten a PM snack. 
Appointment Provide b)(6); RN '-'-' h \.,,_l.,_7.,,_\ l,_r....,_\ _ __, 
Bectronically signed bf b)(6); __ 
Sign off status: Completed 
~ on 10/29/2018 06:42:34 (Pacific Daylight lime) 
Northwest Detention Center 
1623 E J STREET T*1~r9842 0§/~f_ 1 
Patien1: AMAR, MERGENSANA DOB: 10/23/1978 p,__ Note:l(b)(6); ~ - IRN 10/29/2018 
NcJ.e generated oy e0irica/Wcv1<s 8"R/PM Sottv.ere (w.w,eQinica/Works.co«4 
2019-ICLl-00051 2897 

DHS-ICE-19-0196, 19-0197-N-000079
U.S. Immi gration 
and Customs 
Enfor cement 
AMAR,MERGENSANA A:21626980 2 Si.tll1.J1/h \lf; \ -
Facility Code : CSONVWA Housing Area: A 
40 Y old Male, DOB: 10/23/1978 
AccOl.lll lunber~ 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
10 12812018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID,stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allergles 
High calorie boost: diarrhea: $de Effects 
Review of Systems 
DENIED />NY M:DICll>l, DENT!>l, OR M:NT!>l HE/>l TH ISSUES 
ATTHISTIM:. 
Reason for Appointment 
1. tvHU RN El<!ning Rounds - tvHO 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
VIM! language do you speak? English, Russian 
Interpretation pro\aded? Pallent speaks English fluenUy 
Pain Assessment 
Pain 
ke you ru rrentlyin pain? No 
Narrati'"': 
Appointment Provlde'1"-(b-'-)-'-(6""' ); __ _,~N 
Detainee denied SIIHVA\A-t , denied any pain. Detainee cooperati'"' with exam and answered all question. Detainee denied 
any other ooncems and all his questions was answered. VIAii continue to monitor. Frank DiConstan20 \a sited with detainee and 
mol<!d the detainee to segregation tvHU o'"'rflow. Detainee ate an orange for supper, but drank his pedial)le and boost 
Examination 
General Examination: 
GENER!>l PPPEl'R/>NCE: in oo acute distress, well de\eloped , well oourished. 
HEPD: nonnocephalic. 
EYES: pupils equal, round, reacti-.e to light and accommooation. 
OR!>l CA\/ITY: normal, mucosa moist. 
EXfREMTIES: normal. 
PSYCH: alert, oriented, cooperati'"' with exam, cogniti'"' function intact, trough! content without suicidal ideation, 
delusions. 
Assessments 
1. lneffecti-.e Coping [00069] - ND00069 (Primary:l 
Treatment 
1. lneffecthle Coping (00069] 
Notes: Irregular 10 min checks per custodystaff, bed at lowest position and locked, water available in cell, refer to nursing care 
plan for on-going interventions, detainee encouraged to -erbalize needs and feelings, detainee '"'rbalized understanding. 
Nursing to round as needed , document beha~or, -erbali:,ations, and displayof emotions. Establish a working relationship with 
Pl Pro~de opportunities for pt to e,q:,ress concerns, fears, feelings, e,q:,eciations. Assess for specific stressors. Discuss 
a'-<!ilable or useful past roping mechanisms. Reduce stimuli in their en~ronment Instruct pt to notifyCXlicer or Nurse if needing 
assistance or if there is a change in their health status. Bed in lowest and locked position. Rails up x2. Call bell wi1hin reach. 
/>dminister medications as ordered. Fresh drinking water in cell, encourage pt to drink 2-3L of water daily. M:>nitor Pl's oral intake 
for adequate nutrition and hydration. Encourage exercise in cell or Recreation Yard if allowed. Observe for statementsfoeha~ors 
indicating harm to self or others. pt to remain in tvHU until discharge byPro~der. pt -erbalized understanding of care plan. 
Appoinbnent Provide1 b)(6); ~- I RN 
Bectronically signed (b)(6) ; , RN on 10/28/2018 20:30:22 (Pacific Daylight Time) 
Sign off status: Compl /h\/7\ff":\ 
Addendum : 
10/28/2018 10:43 P* b)(6); Detainee ate an orange for supper and ate his PM snack. 
Northwest Detention Center 
1623 E J STREET 
1: WA98421 
Tel (b)(6) ; 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progress Note: _l(b_)_(6_),_· ---'~ 10/28/2018 
/lkte generated by eOinica/Wcxi<s ElvRIPM &itl,ere ("""'eC/ inicl!iW<:Yks.com) 
2019-ICLl-00051 2898 

DHS-ICE-19-0196, 19-0197-N-000080
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A:216269802 Su:ll01/h\/R\· I 
Facility Code : CSONVWA Housing Area: A 40 Y old Male, DOB: 10/23/1978 
1623 E J 
AccOl.lll 
STREET, 
llunber: 
T~ 
~ 
Appoimnert Facility: Northwest Detertion Cert er 
10 12812018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID, stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• .Acetaminophen 500 t,,G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allerglss 
High calorie boost : diarrhea: $de Effects 
Reason for Appointment 
1. tvH follow up for pt in the tvHU on M-iO 
History of Present Illness 
Narrati'"': 
Appointment Provlder:l (b)(6 ); (b)(?)(C) ILCSW 
Pt spoke: [] Fluent English; [) Spanish; [X] aher, Lionbridge # ntiana 1349 
Re'"ewed Record [>l 
Pt IDed byname, Ml, picture 
Session chaperoned by GEO M!dical Oficer, obsen.ing direcilylrom outside large office window. 
CURRENT COl'vf't..PjNT/CONCERN: 
Pt refused to respond to questions about his Mlntal State. Pt would only respond" no" and co'"'r his head when asked 
mental status questions. due to poor communication, an assessment could not be completed. 
Appointment Provide~(b)(6) ; (b)(?)(C) I LCSW 
Electronically signed bJ(b)(6); (b)(?)(C) ~CSW on 10/28/2018 16:31:55 (Pacific Daylight Time) 
Sign off status: Completed 
Northviest Detention Center 
1623 E J STREET 
T~i~6r 081?1 i a . 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 CSW 10/28/2018 
Ncte generaled by eOinica!Wcxi<s ElvRIFM &,11,,e,-e ("""' ,,.c 
2019-ICLl-00051 2899 

DHS-ICE-19-0196, 19-0197-N-000081
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 51.tillfo )(6) ! 
Facility Code : CSONVWA Housing Area: A 
40 Y old Male, DOB: 10/23/1978 
AccOl.llt ~berl/ 1.. " ~' · 
1012812018 
Cunont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID, stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a ru p of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• .Acetaminophen 500 t,,G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlc a l History 
Hunger strike 
Allorglos 
High calorie boost : diarrhea: $de Effects 
Review of Systems 
Patient denied pain. would not come to door. 
Reas on for Appointment 
1. Nursing rounds-day 
History of Pres ent Illn ess 
Patient Identification: 
Patient Identification 
1623 E J STREET, TACOMA, WA-98421 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Provlcle ~(b)(6 ); (b)(7)(C) !RN 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: Use Notes Section geo officer 
Wiat language do }OU speak? Russian Interpretation pro\aded? Pallent speaks English fluenUy 
Pain l>ssessment 
Pain 
/>,e }OU ru rrentlyin pain? No 
11/edical Housing Unit 
Nursing Rounds 
Le'"' I of Care required: Madical Level 1 
11/edication orders: No 
Diagnostic Tests/Treatment orders: No 
Diet Cxders: No 
/lcti\aties or Restriction orders: activity as tolerated 
Narrati'"': 
Ml le patient in M-tU for mental health observation 10 minute irregular checks. Patient would not get out of bed. refused l>itals. 
Denied any pain. Left pediali!e and boost in room. 
0945 Patient up and wathing telel>ision. 
1100 Patient l)' ng on bed watching telel>ision. 
1200 Patient ate apple, 2 carrot sticks, and his boost as ordered for lunch. 
1250 Patient resting/l)'ng down on his bed. 
Vit a l Signs 
Patient refused " tals. 
Examination 
General E><amination: 
GENER/IL /IPPEJIRIINCE: in no acute distress, well del.eloped, well nourished. 
Assessment s 
1. lneffecti'"' Coping [00069]- ND00069 (Primary) 
Tre a tm ent 
1. Ineffective Coping [00069] 
Notes: Nursing rounds as needed, dorumenting behal>ior, 1.erbalizations and displayofe motions: actil>ity, recreation yard with 
observation, Geo rounds irregular q 10 minute checks: obserw for statements/behal>ior reflecting a desire to harm self or others: 
Establish a working relationship with patient Prol>ide opportunities for patient to e~re ss concerns, fears, feelings, e~ectations: 
l>ssess for specifics tressors. Discuss available or past coping mechanisms. Reduce stimuli in enl>ironmenl Mmitorpatients 
food and liquid intake for adequate nutrition. Ensure water available in cell and bed is in locked position with call bell in reach. 
Disposition: /ldmitted to M-IU until medically evaluated 
Appointment Providerb)(6); (b)(7)(C) ~ 
Electronically signed bJ,. (b_)_(6_)_; ----'~ on 10/28/2018 14:59:27 (Pacific Dayligh t Time ) 
Sign off status: Comp leted 
Northwest Detention Center 
1623 E J STREET 
TACOMA, WA98421 
Tet'bl(6) ! 
Fax: 
Patient: AMAR, MERGENSANA DOB: 10/2 3/19 78 Progreu Nobt: t b)(6); ~- IRN 10/28/201 8 
/lk:Je generaled by eC/irica/ Wcrks Bi,R/PM $oltv,ere (""""eC/inica/Works.com) 
2019-ICLl-00051 2900 

DHS-ICE-19-0196, 19-0197-N-000082
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA . . A: 216269802 Su:ll~b )(6k, I 
Facility Code : CSONVWA Housing ea: A 
kcOl.lll ~ber(b )!5C I 40 Y ad ~:a,~:: 
10 12812018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID. stop date 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC • Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required forlra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes. Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Past Medlcal History 
Hunger strike 
Allergles 
High calorie boost: diarrhea: $de Effects 
Review of Systems 
DENIED />NY M:DICI.Ol, DENT!>l, OR M: NT!>l HE/>l TH ISSUES 
ATTHISTIM: . 
1623 E J STREET, T v 
Appoimnert Facility: Northwest Detertion Cert er 
Appointment ProvldeJ (b)(6) ; I RN 
·1~., "="""' "'"'""",... ""' ''----'r 
Reason for Appointment 
1. tvHU RN NIGHT ROUNDSIM-lO 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEO OFFICER ON DUTY 
VIM! language do }OU speak? English, Russian 
Interpretation pro\aded? Pallent speaks English fluenUy 
Pain l>ssessment 
Pain 
/>,e }OU ru rrentlyin pain? No 
Narrati'"': 
ENCOUNTERED PT DURING NIGHT ROUNDS. PT DENIED St/l-lVA\/1-t . DENIED /INYP/IIN OR DISCa.50R T. PT STATED 
HE SLEPT VIELL. 
Examination 
General Examination: 
GENER!>l PPPEl'R/>NCE: in oo acute distress, well de\eloped , well oourished. 
MJSCULOSKELET!>l: nonnal gait. 
EXTREMTIES: full range ci molion. 
PSYCH: alert, oliented, cooperati\e with exam, cogniti\e function intact, thought content without suicidal ideation, 
delusions. 
Assessments 
1. lneffecti'"' Coping [00069]- ND00069 (Primary) 
Treatment 
1. lneffecthle Coping [00069) 
Notes: Prolide~s orders re1Aewed and '"'rified. 
Nursing to round as needed, dorument beha1Aor, '"'rbalizations, and displayof emotions. 
Establish a working relationship with Pl 
Pro1Ade opportunities for pt to e,press oonoems, fears, feelings, e,peclations. 
l>ssess for specificstressors. 
Disruss available or useful past ooping mechanisms. 
Reduoe stimuli in their en1Aronmenl 
Instruct pt to notify Offioer or Nurse if needing assistanoe or if there is a change in their health status. 
Bed in lowest and locked position. Rails up x2. 
Call bell within reach. 
Mm inister medications as ordered. 
Fresh drinking water in oell, enoourage ptto drink 3-4L of water daily. 
M:>nitor Pt's oral intake for adequate nutrition and h)dration. 
Encourage eiercise in cell or Recreation Yard if allowed. 
Obserw for statements/beha1Aors indicating harm to self or others. 
pt to remain in tvHU until discharge byPro1Ader. 
pt '"'rba li,ed understanding of care plan. 
Disposition: Mm itted to M-IU until medically evaluated 
Appointment Provide1 (b)(6) ; ~ - r 
Bectronically signed b* b)(6); ~- ~ on 10/28/2018 05:26:02 (Pacific Daylight lime) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREET 
TACOMA, WA98421 
Telj(b )(6): I 
,ax. 
Patient: AMAR, MERGENSANA DOIi; 10/23/1978 p,_... ~ 10/28/2018 
Neta generated byeOinica!Wcxi<s ElvR'PM &JtvBe ("""'eC/inica/Wc.-ks.com) 
2019-ICLl-00051 2901 

DHS-ICE-19-0196, 19-0197-N-000083
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 2902 
AMAR,MERGENSANA 
A:216269802 Su:i10:fb)(6); 7 
Facility Code : CSONVWA Housing Area: A 
40 Y old Male, DOB: 10/23/1978 
AccOl.ri tunberltb\/6\ · I 
1623 E J STREET, TACOMA, WA98421 

DHS-ICE-19-0196, 19-0197-N-000084
U.S. Immigration 
and Customs 
Enfor cement 
AMAR, MERGEN~ 
A:216269802 Si.ti1 b)(6); 
Facility Code : CSONVWA Housing ea: 
40 Y old Male, DOB: 10/23/1978 
AccOl.llt ~be ~,1.-. \le,. 
10 127/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID, stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allergles 
High calorie boost : diarrhea: $de Effects 
Review of Systems 
DENIED />NY M:D ICll>l, DENT!>l, OR M: NT!>l HE/>l TH ISSUES 
ATTHISTIM: . 
Reason for Appointment 
1. tvHU RN El<!ning Rounds - tvHO 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
VIM! language do you speak? English, Russian 
Interpretation pro\aded? Pallent speaks English fluenUy 
Pain Assessment 
Pain 
ke you ru rrentlyin pain? No 
Narrati'"': 
1623 E J STREET, TACOMA, WA-98421 
Appoimnert Facility: Northwest Detertion Cert er 
Appointment Provlder:j~(b~)~(6~)~; -~~N 
Detainee denied SIIHVA\A-t , denied any pain. Detainee cooperati'"' with exam and answered all question. Detainee denied 
any other ooncems and all his questions was answered. VIAii continue to monitor. 
Examination 
General Examination: 
GENER!>l l>PPEl'RPNCE: in oo acute distress, well de\eloped , well oourished. 
HEPD: norrnocephalic. 
EYES: pupils equal, round, reacti-.e to light and accornroodation. 
OR!>l CA\/ITY: oorrnal, mucosa moist. 
EXTREMTIES: oorrnal. 
PSYCH: alert, oriented, cooperati'"' with exam, cogniti'"' function intact, thought content without suicidal ideation, 
delusions. 
Assessments 
1. lneffecti'"' Coping [00069] - ND00069 (Prma ry:l 
Treatment 
1. lneffecthle Coping [00069] 
Notes: Irregular 10 min checks per custodystaff, bed at lowest position and locked, water available in cell, refer to nursing care 
plan fororl-i)Oing interl<!ntions, detainee encouraged to l<lrbali,e needs and feelings, detainee l<lrbali,ed understanding. 
Nursing to round as needed, document beha~or, l<lrbalizations, and displayof emotions. Establish a worl<ing relationship with 
Pl Pro~de opportunities for pt to e,q:,ress concerns, fears, feelings, e,q:,edations. Assess for specific stressors. Discuss 
a'-<!ilable or useful past rop ing mechanisms. Reduce stimuli in their en~ronment Instruct pt to notifyCXlicer or Nurse if needing 
ass istance or if there is a change in their health status. Bed in lowest and locked position. Rails up "2. Call bell within reach . 
.Administer medications as ordered. Fresh drinking water in cell, encourage pt to drink 2-3L of water daily. M:>nitor Pl's oral intake 
for adequate nutrition and hydration. Encourage el<lrcise in cell or Recreation Yard if allowed. Obserl<! for statementsfoeha~ors 
indicating harm to self or others. pt to remain in M-IU until discharge byPro~der. pt l<lrbali>ed understanding of care plan. 
Appointment Providerf b)(6); ~ - r 
Bectronically signed ~ (b)(6); ~- ~ . RN on 10/27/2018 18:52:19 (Pacific Daylight Time) 
Sign off status: Completed 
Addendum : 
10/27/2018 08:48 P b)(6); 10/27/201809 :30P h\(7\ (C:\ 
Detainee refused supper, but drank 1 L of pedial)le. one carton of boost glucose control. 
ATE PMSN/!CK OF ABO..CGNAS/INDVIICH. 
Northwest Detention Center 
1623 E J STREET 
T~!A9 8421 
Tel:§!¥~ - I 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progress Notel(b )(6); ~- IRN 10/27/2018 
/lkte generated by eOinica/Wcxi<s ElvRIPM &itl,ere ("""'eC/ inica/Wc.-ks.com) 
2019-ICLl-00051 2903 

DHS-ICE-19-0196, 19-0197-N-000085
10 127/2018 
....... . High calorie boost : diarrhea: !'.de Effects 
U.S. Immigration 
and Customs 
Enforcement 
Rea son for Appointment 
1. RN first 1/2 even round 
Appo intme nt Provide 1(b)(6); F 
AMAR,MERGENSANA 
A: 216269802 Su:i1c:t: b )(61 I 
Facility Code : CSONVWA Housing ea: A 
40 Y old Male, DOB: 10/23/1978 
AccOl.lll lunber~ 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Provld e 1 (b)(6) ; ~-
Electro nica lly signed by!(b )(6 ); ~- fN on 11/16/2018 at 07:25 MST 
Sign off status: Pe nding 
Northwest Detention Center 
1623 E J STREET 
TACOMA, WA98421 
Tel: l(b ),I~_); I 
Patient: AMAR, MERGENSANA DOB: 10/23/ 19 78 Progre es Nole j(b)(6 ); pt" 10/27 /2018 
/lkxe generated by eC/inica/Wcrl.s a.RIPM Sottv.ere ("""'eC/inica/ Works.com) 
2019-ICLl-00051 2904 

DHS-ICE-19-0196, 19-0197-N-000086
U.S. Immigration 
and Customs 
Enfor cement 
AMAR, MERGEN!O 
A: 216269802 Si.ti1 (b )(~); _ Facility Code : CSONVWA Housing ea: 
40 Y old Male, DOB: 10/23/1978 
AccOl.lll lunber:~ 
1623 EJ STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
10 127/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID, stopdate 
04/15/2019 , KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018 , KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018 , KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/20 18, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allergles 
High calorie boost : diarrhea: $de Effects 
Reason for Appointment 
1. tvHU-SRA 
History of Present Illness 
Patient Identification: 
Patient Identification 
Appointment Provlder:K b)/6): (b)/7)/C) 
Patient properly identified by2 sources induding: Picture, Verbally ADMN NOTE See M-1 Note today /or more info 
Chaperone Present? No ADMN NOTE. See M-1 Note today /or more info 
Interpretation pro\aded? Provider fluent in detainee's nallve language ADMN NOTE. See M-1 Note today /or more info 
Pain Assessment 
Pain 
keyoururrently in pain? NoADMNNOTE. See M-/Note today/or more info 
11/edical Housing Unit 
Nursing Rounds 
Diagnosis/Reason for admission to tvHU: M-1 Oiservallon v.ith 10 min irregular custody checks. Found v.ith a handmade 
rope under mattress. pt denied suiddal or homiddal ideallons. 
Da~me for admission : 10/27/2018 9:59am 
Le'"' I of Care required: Manta/ Health Level 2 
Care needed: M-1 symptom management 
Frequencyofnurs ingchecks: Qshift 
Frequencyof\atal signs: Qday 
11/edication orders: No 
Diagnostic Tests/Treatment orders: No 
Diet 0-ders: No 
11<:ti"ties or Restriction orders: activity as tolerated, attomeyvisits N, X-Box, music allov.ed. Encourage recreation, self￾carelhygiene. Mly make supportive phone calls; may have personal property in room. Follow-up plan (frequency of pro\ider rounds): Provider round q day 
Patient education: See Tx Ffan in M-1 Note today /or full Pt Education. 
Discharge plan: Discharge ooen pt demonstrates continued stability of mood, safe behaviors and has medicallon 
managed/adjusted. 
Examination 
General Examination: 
GENERl>l !>PPE.AR.ANCE: 
HE.ART: 
LUNGS: 
PSYCH: 
Assessments 
NotvHdx. 
Appoinbnent Provide,¥b )(6); (b)(7)(C) I MD 
Confirmatory sign off: 
-Kb __ )(_6)~; (-'- b ) __ (7'--)(C-'-) _ ___.ll/0 1/20 I 8 I I :03 :30 PM 
Bectronically signed ~(b )(6); (b )(7)(C) ~Don 10/27/2018 10:15:48 (Pacific Daylight Time) 
Bectronically co-signed b~(b)(6); (b)(7)(C) rD on 11101/2018 at 11:03 PM MDT 
Sign off status: Completed 
Norttt.vest Detention Center 
1623 E J STREET 
T 21 
Pati-t: AMAR, IIERGENSANA DOIi: 10/23/1 978 P.....,.. Note:j(b)(6); (b)(7)(C) I MD 10/27/2018 
N(xe generaled byeOinicalWcxi<s BvR'PM Soflv.ere (""""'eOinica/Wcn<s.com) 
2019-ICLl-00051 2905 

DHS-ICE-19-0196, 19-0197-N-000087
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:i1ollh \I n \ I 
Facility Code : CSONVWA Housing Area: H 
40 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunber j /h \In\· 
10 127/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID,stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a cup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t,,G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal History 
Hunger strike 
Allergles 
High calorie boost: diarrhea: $de Effects 
1623 E J STREET, TACOMA, WA-98421 
Appoirimert Facility: Northwest Detertion Cert er 
Appointment Provlde~~(b_)(_6_); __ _.! RN 
Reason for Appointment 
1. RN day round/ SW to M'IO 1 O' 
History of Present Illness 
Narrati'"': 
Pt in M-IU M::D 1 for SW, encountered together with M-IP Zarigo2a. Pt denied St/HVAl.+i , denied any pain. Ptcooperati'"' with 
e,am and answered all question to pro>ider. Stated that he did that rope because he has nothing to do else. Pl. 10:00 per pro>ider 
order pt status change from Suicidal watch to M-iO 10 min irregular check. Mer pt receil<!d his dothes and bed, he took a 
shower about 11:00. Pt refused to eat his lunch, but he take his Pedial)te and boost Pt denied anyotherconcems and all his 
questions was answered. Pt refused V.S and refused, and ph~ica l assessment and to sign refusal form. \MIi continue to 
monitor. 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do you speak? Russian 
Interpretation pro>ided? Provider fluent in pallenrs nallve language 
Pain Assessment 
Pain 
ke you currently in pain? No 
Yitai Signs 
16/ min 
63.5in 
Pt refused V.S. 
Ex amination 
General Examination: 
RR 
10/27/2018 11 :59:55 PM 
H 
10/27/2018 11 :59:55 PM 
GENER/ll Jlf'PEPRANCE: chaperone present in room, alert, well hydrated, in no distress. 
HEAD: normocephalic. 
ENT: EYES: , normal. 
EXTREMTIES: normal. 
NEUROLOGIC: sensory exam intact, normal strength, tone and reflexes. 
PSYCH: thought content Vlithout suicidal ideation, delusions, SMILES Af\O LOO<S AWAY. 
Assessments 
1. lneffecti'"' Coping [00069] - ND00069 (Primary) 
2. Risk prone health beha\<or - ND00188 
3. Risk for\Aolence, Self-Directed [00140] - ND00140 
Treatment 
1. Others 
(b )(6); N 
(b)(?)(C) -
-
N 
Notes: 1) Chart and Pro,.ders Oders Re,.;ewed and lierified. 2) Nursing Care Plan and tv'edical Pro\<ders Oders re\<ewed. 3) 
One-Ch-One Wectical Officer Observation continued and DIHS Form 835 being is completed. 4 ) Documentation of 
observation/assessment e'"'ry2 hrs or as ordered by the pro~der. 5) Diet ordered as per pro,.;der - Finger Food Tray for safety of 
Detainee." 6) Room remol<!d of an)thing that Detainee can use to self-harm. 7) Detainee pro,.;ded a mattress, smock dothing 
and smock blanket. 8) Discussed new medication and new medication regimen. 9) Pdequate supply of drinking water and other 
be'"'rages as ordered by pro,.;der available. 10) Detainee '"'rbali>ed an understanding of education ancl/or treatment. lroices no 
other concern. 
Appoinbnent Provide~ b )(6); RN 
·t"'-'""'" '-''7-'- '-''-' ~Cl. '--'r￾Bectronically signed ~(b)(6); __ 
Sign off status: Completed 
~ on 10/27/2018 12:09:59 (Pacific Daylight Time) 
Northwest Detention Center 
1623 E J STREET 
TACOMA, WA98421 
Tel: j(b )(6); j 
Patient: AMAR, IIERGENSANA 008: 10/23/1978 Prognoss Notej"(b-')-'-(6-'-)-'-- ; ---'~ 10/27/2018 
N(xe generaled byeOinica/Worl<s BvR'PM Solfv.ere (""""'e0inic8/Worl<s.com) 
2019-ICLl-00051 2906 

DHS-ICE-19-0196, 19-0197-N-000088
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA . . A:216269802 Si.tllU' -l(h\/n\· ! 
FacdityCode:CSOINNA ~IIJJAGd .H 40 Y old Ma'=~ -,~~l/1:Z: 
1623E J~=/~~ b~t~::: I 
10 127/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID.stop date 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes. Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlc al History 
Hunger strike 
Allergles 
High calorie boost: diarrhea: $de Effects 
Review of Systems 
~= Prn<ietydenies. Puditor)l'l.isual hallucinations denies. 
Delusions denies. Depressed mood denies. Diffirulty 
sleeping denies. Homicidal Thoughts denies. Inability to 
concentrate denies. Loss of appetite denies. 11/ental or Ph),Sical 
abuse denies. Stressors Immigration legal problems . Substance 
abuse denies. Suicidal thoughts denies. 
Appoirimert Facility. ~est Dete.=tion Cert er 
Appointmen t Provlder:K b)(6) ; (b)(7)(C) 
Reas on for Appointment 
1.SRA 
History of Pre se nt Illn ess 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge,Picture, Ve!bally 
Chaperone Present? Yes 
Chaperone Name: GEO M3dical CXficer, observing directly 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Name Lidia, RN 
Name Use notes field Lidia, RN. 
Language Russian 
Patient was referred by: medical 
Patient was referred for. found v.ith a long(approx. 6 feet) handmade rope under mattress 
Record re\aew conducted: Yes 
[x] No. [] Yes. -Has the detainee attempted suicide in last 24 hrs? tt )<lS, stabili2e - consider immediate transport to 
emergency department 
Pt 
Record 
seen fo
Re\aewed. r the first time in M-iUwi ~ (b)(~); who did Russian interpretation. He was put on suicide watch on 10/26/2018 
due to an apprrn<imately6-foot long han ma e rope that was found under his mattress, potential for suicide. He was seen by Dr. 
!lh \(n\ · ~terdaywho plaoe him on suicide watch. No self-harm beha\aor noted not suicidal ideation e~ressed per staff. Pt was 
'"'ryoooperati'"', pleasant iMth lair e)<l contact. He reported good sleep and appetite. He denied hallucination, delusions, 
suicidal or homicidal ideations. \Mien asked about why he made a rope, he replied" I had nothing to do". He was reminded that 
it is unsafe to be making a rope and hiding it under his mattress as it can be stolen by someone and can be used for suicide 
attempt as well as hurting someone. He e~ressed understanding. Pt denied hxof ps)Chiatric hospitalization, outpatient 
ps)Chiatric treatment or counseling, drug or alcohol abuse, lamilyhxof mental illness. He denied acli1.e mental health issues 
including hxof suicide attempts., depression or ps)Chosis. Plan: 1. Discontinue suicide watch. 1. Place him on mental health 
observation iMth q 10 minute irregular custody checks. 2. Follow-up as scheduled. 
Ex amination 
rv'ental Health Evaluation: 
Suicide RiskJ>Gsessment 
\Mio referred patient? M,dical Staff 
Wiat led to referral and other Pertinent Information? Pl. v.as found v.ith long handmade rope under mattress 
Wiat was the concern/complaint that led to the referral? Pl. v.as found v.ith long handmade rope under mattress 
Is the referral information correct? Yes 
In the recent pasl ha'"' }Ou had thoughts of suicide? No 
Do}Ou ha'"'cu rrentthoughts about killing )Ourself? No 
Do }Ou ha'"' a desire and/or intent to die? No 
Do}Ou ha'"' a plan to kill )Ourself? No 
IM>re other concerns e~ressed? No 
Impact of any pertinent phy.,ical conditions on mental health? No 
Is there an;thing that could keep }Ou from harming }Ourself (family, etc) Yes 
Is there something that would change }Our plan? Has v.i/e and 2 daughters ages 8 and 10 
Do }Ou rv::,w or ha'"' }Ou e1.er heard 1.0ices that other people don1 hear? No 
Do }Ou rv::,w or ha'"' }Ou e1.er felt others were 11,ing to harm }Ou for no logical or apparent reason? No 
Ha1.e}Oue1.erlriedtokill }Ourself? No 
Ha1.e }Ou e1.er been diagnosed "'th a mental illness or ha1.e }Ou e1.er been hospitali>ed for ps)Chiatric reasons? No 
Has anymemberof}Ourfami lydied in the last3-5 )ears? No 
Has any member of }Our family or dose friends killed themseh.,:,s? No 
Detainee is rurrently: Manied 
Does detainee ha'"' children? Yes 
Describe relationship(s) good 
Do }Ou ha'"' outside support from family, friends, or religious groups? Yes 
Do }Ou ha'"' a history of j)jcohol or Substance /ll:luse/Dependence? No 
Do}Oudrink aloohol? No 
Ha1.e }OU 01.er been oom.icled for dril.ing under the influence of alcohol? No 
Is detainee rurrently housed in Segregation or Isolation? Yes 
Is detainee rurrently into>icated or in iMthdrawal from a substance? No 
Has detainee e~ rienced any significant loss recently,' No 
Do}Ou ha'"'fee lings of general hopelessness? No 
/lre }Ou currently in pain or do }Ou ha1.e any medical issues that are not being addressed? No 
\MIi }OU engage or continue )Our mental health treatment here? NIA 
Do}Ou ha'"' plans for}Ou future? Yes 
Do }Ou find support and hope through }Our religious customs/rituals? Not asked 
How hopeful are }OU on a scale of O - 10 (O=no hope and 1 O=fullye~ct positi1.e resolution of problems) that }OU ,,.,11 
resolve prolAems associated "'th )Our current situation? Denied hopelessness 
Has ps)Chotropic medication been helpful to }Ou now or in the past in managing how )Ou feel and deal "'th situations? 
NIA 
How long ha'"' }OU been in the US? 1 year 
Describe }Ourworl< history Not asked 
Do}OU ha'"' any difficulty learning new things? No 
Do }OU ha'"' legal support for }Our current situation? Not asked 
Ha1.e }OU been imoll<!d in the worl< program? No 
Risk for Suicide: Low Risk: M3ntal Health CtJservaffon wm 15 minute irregular custody checks Deemed Least restrictive 
environment given risk~proteclive factors assessed. 
Patient ,,.,11 be scheduled for follow-up "'th mental health prol.ider. TomOITOW 
Risk Factors (Initial) 
1. Current thoughts of suicide: absent 
2. Current suicidal intent absent 
3. Current suicidal plan: absent 
4. Feelings of hopelessness / helplessness: absent 
5. Feeling like a burden to others: absent 
6. Fear for own safety: absent 
7. Recent significant loss: absent 
8. Social isolation: no 
9. Current ph),Sical pain: 0/10 
10. Sleep problems: absent 
11. !>gitation (e.g., restlessness. irritability, an>ious, increased ps)Chomotor adil.ity, etc): absent 
12. Current lnto>ication or in iMthdrawal from a substance: absent 
13. Mjustmentto ICE detention (adequate/inadequate): present 
Describe: Adjustement to ICE detenffon is reported to be adequate 
14. Problem soll.ing deficits (e.g., rash decision making, inadequate strategies to get needs mel impulsi,,ity, etc.): absent 
15. Uncontrolled mental health s~ptoms : absent 
16. Non-compliance "'th mental health treatment absent 
2019-ICLl-00051 2907 

DHS-ICE-19-0196, 19-0197-N-000089
17. Chronic medical condition: absent 18. History of self-injury or suicidal beha,ior. absent 19. Familyh istoryofsu icide: absent 
20. Historyof,io lent beha,ior. absent 21. History of mental illness: absent 
22. History of inpatient ps){fl iatric hospitalizations: absent 
23. History of childhood abuse (phy.;ical/se><Jal ): absent 
Protective Factors 
25. /Ible to identify reasons for li,ing: present 
26. Denial of suicidal ideations: present 
27. Fearof death: present 
28. Future orientation (e.g., plans for the future, etc.): present 
29. /ldequate problem sol,ing skills: present 
30. Religious beliefs against suicide: nla 31. Social support in detention center. nla 
32. Supportive family relationships: present 
33. W llingness to engage in mental health treatment nla 
Protective Factors Comments: has v.ife and 2 daughters ages 8 and 10 - OlHER RISK FPCTORS: 
[x] No.[] Yes. Do }OU have oommunication/stigma barriers to seeking M-1 care and alerting Custodyof M-1 emergency in 
future? 
[] No. [x] Yes. Is detainee a male? (statistical risk factor) 
[x] No.[] Yes. l'<e }OU single? (statistical risk factor) 
[ xj No. [] Yes. l'lcohol or Substance Use Disorder Hx 
[ xj No. [] Yes. History of Impairment in learning/ Special Education 
- OlHER PROTECTl\iE F/!CTORS: 
[]No.[] Yes. W II }OU engage or oontinue }OUr mental health treatment here? NIA 
[]No.[] Yes. Do }OU find support and hope through }OUrreligious rustoms/rituals? NIA 
[] No. [x]Yes. Do}Ou believe it is okayto ask for mental health and medical help? 
[] No. [x] Yes. Do }OU know how to access to dinical care for mental health and phy.;ical needs? 
[] No. [x] Yes. Do }OU know how to access to support sen.ices: M!dical, ICE oonsultation, attomeyoonsultation, Law Library? 
[] No. [x] Yes. Do }OU have children (statistical protective factor)? 
[] No. [x] Yes. he }OU in a supportive marriage (statistical protective factor)? 
[] No. [x] Yes. Do }OU feel hopeful }OU can work to resolve }OUr problems/slressors? 
[] No. [] Yes. [x] NIA Has ps){flolropic medication been helpful to }OU now or in the past in managing mood, coping, etc? 
[] No. [ xj Yes. Do }OU normally get along well with }OUr dormitory-mates 
[] No. [x] Yes. Do }OU normally/eel safe in }OUr dormitory? 
[] No. [x] Yes. Do }OU normallyha1.e an active dailyroutine in this facility,' 
[x] No.[] Yes. Do }OU normallyha1.e a i.oluntaryjob in this facility. 
lli'ental Status: 
JIPPEJ>RANCE: adequately-groomed, well-rourished, dressed in clean suicide prevention smock . 
RELATEDNESS: friendly. 
ATTITUDE: cooperative. 
SPEECt-lil.J'NGU/>GE: normal rate, mythm, \Olume . . 
A"FECT: appropriate, full range. 
THOUGHT PROCESS: linear and goal directed . 
THOUGHT CO'ITENT: no delusional content . 
PERCEPTU/ll DISORDERS: no perceptual disorder noted. 
PSYCHOM)TOR /!ClMTY: v.ithin normal range. 
KNOM.EDGE - INTELLECTU/ll RJNCll~ : No obl.ious impairment . 
DEGREE CF AW!>RENESS: IMthin normal limijs. 
ORIENTA~ : person, place, lime. 
CURRENT SUICID/ll POTENll/ll : low acute Si risk. 
CURRENT HOMCID/ll POTENll/ll : no to low acute risk. 
Assessments 
No Diagnosis. 
Preventive Medicine 
Due to the unpredictable nature of the immigration process induding length of detention stay, the purpose of ps){flo logical 
inter1.ention will be the stabilization of presenting s)!Tlptoms, aCllte crisis inter1.ention, and brief supportileisolution•fOClJsed 
ps){flctherapy. Discussed following Plan \Mth pt to address rv'ental Health (M-1) issues. 
·Pt verbal iald agreement with Plan: 
[x] No.[] Yes. Ps){fl iatric Hospitalization required. Transported to Emergency Department for further evaluation 
[ x] No. []Yes.Beg in/ Continue Suicide Watch Prevention: 1 :1 Watch deemed least restrictive en,ironment given risks. 
[l No. [xl Yes. Begin rv'ental Health Olservationwith 10 IRREQJL!>R rustodychecks (See Special Needs for more Info) 
[xl No. 11 Yes. Detainee released back to dormitory 
[ x] No. [ l Yes. Issue 24 Hr i>ccess Card with Special Needs to POD Olicer and detainee 
[l No. [xl Yes. Low bunk, Low lier Special Needs Issued. 
[ l No. [xl Yes. Follow-up with me in [ 1) day.;, [ ) 1 week after discharge, [ ) 1 mo after discharge, II 2 mo after discharge 
11 No. [x] Yes. Ps){fl iatryReferral 
[ l No. [ l Yes. Do not engage in any self-harm beha,ior, Continue to fOClJs on short/long term goals, reasons for li,ing, why 
suicide is against pt's belief sy.;tem, resilient problem-sol,ing skills· all to aid in reducing risk of suicide and ultimatelyto 
achieve pro-social, pro-indi,idual / familygoals. 
[l No. [l Yes.] ff ati>NYtime pt has anythought intent or plan of suicide, ptmusta lertrustodyofficerforemergentaccess to 
medical for furtiher evaluation/I)< Pt agreed and denied communication and stigma barriers to alerting staff for emergencies. 
[ l No. [ x] Yes. Engage M!dical Sick Call process if s)!Tlptoms worsen before next session and are NOT of an emergent nature 
I x] No. I I Yes. ROI for pre-..ous reoords 
[l No. [x] Yes. Tele Encounter to rv'edical Pro,ider 
[x] No. []Yes Referral to Chaplain 
[ x] No.[) Yes. Engage in Sieep H,giene Skills· Ps){floeducation gi1.en, Handout pro,ided in: English/ Spanish 
[ x] No. [)Yes.Begin Breathing, \Asualization, Progressive M.Jsde Relaxation Skills to aid mood/coping. Ps){floeducation given, 
Instruction handout pro-..ded in English / Spanish I Olher 
[ l No. [x] Yes. Seek out NWRP, ICE, Law Library, and Detainee Handbook to aid in proactive problem-resolution to aid in roping 
[l No. [x] Yes. Utili,e Jail Wail sy.;tem (or paper kite process) to access facilitysupport, resources, and other sen.ices· to further 
proactive problem sol,ing and healthycoping 
[l No. [ x] Yes. Begin/Continue dailyroutine: exercise, socialization, religious rustoms/rituals, pleasurable acti,ities to aid in 
coping 
[l No. [x] Yes. Begin/Continue attention to h,giene: shower, teeth, grooming to aid in coping 
[l No. [x] Yes. Begin/Continue eatingih,<:lrating at each meal to further phy.;ical/mental health. 
[ l No. [ x] Yes. Consider i.oluntarywork program to aid in coping/mood mgt 
[ x] No.[) Yes. Engage in Stress Wgt Sikills; Ps){floeducation given, Instruction handout pro,ided in English/ Spanish 
POST SESSt~ : Updated HSI\ /\HSAs, CD, M-1 Team, M-IU Lead RN and GEO Slaff on assessment and Plan. 
Appointment Provider:!(b)(6); (b)(7)(C) !MD 
2019-ICLl-0005 1 2908 

DHS-ICE-19-0196, 19-0197-N-000090
Electronically signed by (b)( 6); (b)(7)(C) Don 10/27/201810 :46 :12 (Pacific Daylight Time) 
Sign off status: Complete 
Northwest Detention Center 
1623 E J STREEr 
T~rr.A9S421 
~ - 1 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 P......- Notef h\16} /h\17\/C\ 
/lk:l.e general.ed byeC/irica/Wa1<s af</PM Soft,.,.ere (\'MWeC/inica'li\lcYks.coojl 
IMD 10/27/2018 
2019-ICLl-00051 2909 

DHS-ICE-19-0196, 19-0197-N-000091
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:llo'h \In\· 
Facility Code : CSONVWA Housing Area: H 
40Y ad~~)~~=:: 
1623E J~~ = l~be :p;; 
10127/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID.stop date 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \A-IC - Liquid 1 along with a rup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required fortra\el , for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed QI-IS, stop date 
1 M)S/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t,,G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes. Drug Source: In House Pharmacy, 
Notes: Not required for tra\el 
Past Medlcal Hletory 
Hunger strike 
Allergles 
High calorie boost: diarrhea: $de Effects 
Reason for Appointment 
1. NOC NURSE ROUNDS s,/11 
History of Present Illness 
Narrati'"': 
Appoirimert Facility: Northwest Detertion Cert er 
Appointment Provider: (b)(6); fh\17\lr\ 
N 
Pt encounter initiated with Russian translator. Pt reacted to the question of, ' do )OU feel like hurting )Ourself', with smiling 
face and small laugh, then looked away from nurse and phone. He was asked a second time before nurse left the room and he 
appeared to react exactly the same. ~I other attempts at disrussing other issues were not successful with this pt to engage in 
anycon'"'rsation. Me r lea\Ong the room, pt began to stop keeping his head and neck unco'"'red, a rule on SWthat staff ha'"' 
been consistant in ensuring for pt own safety. Despite this, the pt continued to required many rues and prompts to encourage 
compliance. 
Examination 
General Examination: 
GENER/IL PPPEPRPNCE: chaperone present in room, alert, well hydrated, in no distress. 
HEPO: nonnocephalic. 
ENT: EYES:, normal. 
EXTREMTIES: normal. 
NEUROLOGIC: senso,,y exam intact, nom,aJ strength, tone and reflexes. 
PSYCH: thought content v.ithout suicidal ideation, delusions, SMILES AJ\IJ LOOKS AWAY. 
Assessments 
1. lneffecti'"' Coping [00069]- ND00069 (Prmary) 
2. Risk prone health beha,.or - ND00188 
3. Risk for\Aolence, Self-Directed [00140] - ND00140 
Treatment 
1. Others 
Notes: 1) Chart and Pro,.ders Oders Re,.ewed and Verified. 2) Nursing Care Plan and tvta,dical Pro"ders Oders re,.;ewed. 3) 
Ole-Ch-One Wedical Officer Observation continued and DIHS Form 835 being is completed. 4) Dorumentation of 
observation/assessment e'"'ry2 hrs or as ordered by the pro,.;der. 5) Diet ordered as per pro,.;der-Finger Food Tray for safety of 
Detainee." 6) Room remol<!d of an~ing that Detainee can use to self-harm. 7) Detainee pro,.ded a mattress. smock dothing 
and smock blanket. 8) Disrussed new medication and new medication regimen. 9) Me quate supply of drinking water and other 
be'"'rages as ordered by pro,.der available. 10) Detainee '"'rbali>ed an understanding of education and/or treatment. Voices no 
other concern. 
Appoinbnent Provide (b)(6); 
/b)/7)/C) 
Bectronically signed b (b)(6); 
RN 
Sign off status: Comple·J,/,~='-'------' 
10/28/2018 07:03:17 (Pacific Daylight Time) 
Northwest Detention Center 
1623 E J STREEr 
T~A98421 
Te1j§i{6f ! 
Patient: AMAR, IIERGENSANA OOB: 10/2311978 Progreu Notai (b )(6); _. I RN 10/2712018 
/lkie generate,d byeOirica/Wo-lcs e.R/PM ~e {WNNeC/inicliWtxks.Cf:KJ1 
2019-ICLl-00051 2910 

DHS-ICE-19-0196, 19-0197-N-000092
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGV'ks.coojl 
2019-ICLl-00051 2911 
AMAR,MERGENSANA . . A:216269802 Su:i1Dt( b)(6); 
Facility Code : CSONVWA HoJs,.;n ,Y"'M.....,ea -. ,-, -' 
40 Y old Male, DOB: 10/23/1978 
AccOl.l'II lunbe~ 
1623 EJ STREET, T~ 

DHS-ICE-19-0196, 19-0197-N-000093
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:llQ/h \/ R\ ! 
Facility Code : CSONVWA Housing Area: A 
kcOU11 ~ber(bX6C ! 40Y ad ~a!t:: 
10 12612018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/0 500-200 11,G-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KOP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>rure order 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID. stop date 
04/15/2019, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16f2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I· sdledule for am and pm PL 
• Boost \iHC - Liquid 1 along with a cup of water Daily Noon, stop 
date 11 /16f2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed OHS, stop date 
11/08/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes. Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Past Medlc al History 
Hunger strike 
Allergles 
High calorie boost: diarrhea: $de Effects 
1623 E J STREET, T 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Provlde1 b)(6 ); (b)(7)(C) 
Reas on for Appointment 
1. /IOMT M-IU-SUICIDE WATCH 
History of Pres ent Illn ess 
Patient Identification: 
DETAINEE DEl'vEJINOR- SMLED THE ENTIRE M-IU/ SUICIDE WATCH /IOMSS O>J PROCESS. 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes 1:1 GEOa=F/CER 
What language do }OU speak? English, Russian L/00 BRIDGE-RUSSIAN-# 2963 
Interpretation pro\aded? Pallent speaks English fluenUy 
Pain l>ssessment 
Pain 
/>,e }OU currently in pain? No 
11/edical Housing Unit 
Admission 
i><!mitting Pro\ader. SHEN, PHO 
i><!mitting Diagnosis: Manta/ Health SU/CIDEWATCH-LOOG HAND-M4DE RCPE M4DECEBEDDINGFCXJND IN RCI0\1 
POSSIBLE SUICIDAL GESTURE. 
How long ha'"' }OU had the problem? Days TOOAY 
Ha'"' }OU receil<!d treatment for this in the past? No 
Do }OU ha'"' any other medical, mental health or dental conditions? No 
What language is best to communicate with }OU about }OUr health care? English 
Can }OU read in that language? Yes 
What methods of learning do }OU prefer? Verbal 
Ne }OU able to perform /IOLs? Yes 
/lnyspecial needs we should know about? No 
Vital Signs 
16/ min 
63.5in 
Assessments 
1. Impaired resilience- ND00210 (Primary) 
Treatmen t 
1. Impaired resilience 
RR 
10/26/201807:28:48 PM 
H 
10/26/201807:28:48 PM 
b)(6); (b)(7)(C) 
Notes: /l<!mitted to M-IU on suicide watch. Nursing Care Plan and ~dica l Pro"ders Oders initiated. Ole-Ch-Ole 11/edical 
Officer O)servation initiated, documentation of observation/assessment as ordered by the pro"der. Diet ordered as per pro"der -
Finger Food Traylo r safety of Detainee. Room remol<!d of an)4hing that Detainee can use to self-harm. Detainee pro"ded a 
mattress. smod< dothing and smod< blanket i><!equate supply of drinking water and other be-erages as ordered bypro" der 
a,eilable. Detainee-erbali>ed an understanding of education and/or treatment Detainee IA)ices no other concerns at this time. 
Appointment Providei b )(6); (b )(7)(C) 
Electronically signed tryf'b)(6); (b)(7)(C) 
Sign off status: Completed 
Addendum : 
fN on 10/26/201819:33:58 (Pacific Daylight Time) 
10f26f201809:18 PM!thllRI· l h\17 \trl !> OETAINEEATE 100% 0:HIS S/!CKM:/!L/!ND ISCURRENTL Y 
VIORKING ON /IN /IPPLE /IND HIS PMSN/!CK S/IND\/1/lCH. 
North\Nest Detention Center 
1623 E J STREET 
TACOMA, WA9842 1 
Tel: l<b )/6) I 
,ax. 
Pati-t: AMAR, MERGENSANA DOB: 10/23/1978 p..,_ ""', (b)(6); (b)(7)(C) 
/1/cte generated byeC/inica!Wcxi<s ElvRIPM &Jtoore /....weC/inica/Works.com) 
~ 10/2e/2018 
2019-ICLl-00051 2912 

DHS-ICE-19-0196, 19-0197-N-000094
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Si.tll(b)/6) : Facility Code : CSONVWA Hous._.;-111--;gk-e-a""': A..,... 
40 Y old Male, DOB: 10/23/1978 
AccOl.l"II lfflllJ<tb)/6) 
10 12612018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/0 500-200 l\iG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I • Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I • Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KOP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>rure older 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID.stop date 
04/15/2019, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16f2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for Ira'"' '· sdledu le for am and pm PL • Boost \iHC - Liquid 1 along with a cup of water Daily Noon, stop 
date 11 /16f2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed OHS, stop date 
11/08/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes. Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Past Medlcal History 
Hunger strike 
Allergles 
High calorie boost : diarrhea: $de Effects 
Reason for Appointment 
1. RN Daily Seg rounds 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient property identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
VIM! language do }OU speak? English 
1623 E J STREET, •,,.,;;cm,i, VVA-98421 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Provlde'l b)(6) ; (b)(?)(C) ~N 
Interpretation pro\aded? Pallent speaks English fluenUy Detainee able to comunicate needs in English 
Segregation: 
Segregation Rounds 
ke }OU currentlythinking about killing or harming }Ourself? No 
Do}Ou ha'"' any medical complainls orconcems at this time? No 
Was referral made to d inical ser.ices (lvOIM.P, Dental, M-t, Sek Call)? No 
Examination 
Segregation: 
Segregation Evaluation: Patient has spontaneous speech and ansWE!fS questions appropriately, in no acute distress, 
weU de\eloped , well nourished, Patient appears to be v.ithin normal limits of beha"or, affect, and cogniti,e functioning, 
Patient does not appear to ha,e any acute or unresol\ed medical conditions that may worsen in segregation, Patient does 
not appear to ha\e acti,e psychosis, mania, suicidal idealions or txlmicidal ideations. 
Assessments 
Health M!intenance Related to Segregation Placement 
Treatment 
1. Others 
Notes: Confirmed Detainee went to Rec Yesterday-is on schedule today as well 
Reported to ha'"' eaten an /lpple at HS and was noted to ha'"' eaten a PM snack. 
Appointment Provide~ (b)(6) ; ~ -
Bectronically signed by b)(6) ; 
Sign off status: Comple 
on 10/26/2018 at 13:21 MST 
Northwest Detention Center 
1623 E J STREET 
T b)(6) ; 
" h\/7\/C:\ 
Patien1: AMAR, MERGENSANA DOB: 10/23/197 8 p,__ :lb )(6); (b)(7)(C)r 10/26/2018 
Nci.e generated byeCJiricalWcrks Bi.,RIPM &:ltw:lre (www ltNC&VVt»kS.WIV 
2019-ICLl-00051 2913 

DHS-ICE-19-0196, 19-0197-N-000095
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A:216269802 Su:i10:kb)(6): ! 
Facility Code : CSONVWA Housing Area: H 
40 Y old Male, ~- 1Q{2J119ZB 
AccOUll l'unber lb l/6): I 
10 12612018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/0 500-200 11,G.UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KOP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>rure order 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID.stop date 
04/15/2019, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16f2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I· schedule for am and pm PL 
• Boost \iHC - Liquid 1 along with a cup of water Daily Noon, stop 
date 11 /16f2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed OHS, stop date 
11/08/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes. Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Past Medlcal History 
Hunger strike 
Allerglss 
High calorie boost : diarrhea: $de Effects 
Reason for Appointment 
1. tvHU RN NIGHT ROUNDS/LOSS CT' />PPETITE 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEO OFFICER ON DUTY 
VIM! language do }OU speak? English 
Interpretation pro\aded? Pallent speaks English fluenUy 
Segregation: 
Segregation Rounds 
ke }OU currentlythinking about killing or harming }Ourself? No 
Do}Ou ha'"' any medical complaints or concerns at this time? No 
1623 E J STREET, TACOMA, WA-98421 
Appoirimert Facility: Northwest Detertion Cert er 
Appointment Provld e 1(b)(6) ; _. 
Was referral made to d inical ser.ices (lvOIM.P, Dental, M-t, Sek Call)? No NIA 
Narrati'"': 
Pt asleep during noc rounds. Refused breakfast tray- his 29th meal. 
Examination 
Segregation: 
Segregation Evaluation: Patient has spontaneous speech and answeJS questions appropriately, in no acute distress, 
well de\eloped , well nourished, Patient appears to be v.ithin normal limits of beha,.jor, affect, and cogniti1.e functioning. 
Patient does not appear to ha,e any acute or unresol\ed medical conditions that may worsen in segregation. Patient does 
not appear to hme acti'"' psychosis, mania, suicidal ideations or tun icidal ideations. 
Assessment s 
Health M!intenance Related to Segregation Placement 
Treatment 
1. Others 
Notes: Prolide~s orders reliewed and '"'rified. 
Nursing to round as needed, document behalior, '"'rbali,ations, and displayof emotions. 
Establish a working relationship with Pt. 
Proli de opportunities for Pt to e~ress concerns, fears, feelings, e~ dations. 
/lssess for specificstressors. 
Discuss available or useful past coping mechanisms. 
Reduce stimuli in their enlironmenl 
Instruct Pt to notify Officer or Nurse if needing assistance or if there is a change in their health status. 
/ldminister medications as ordered. 
Fresh drinking water in cell, encourage Ptto drink 3-4L of water daily. 
M:mitor Pt's oral intake for adequate nutrition and h)dration. 
Encourage eiercise in cell or Recreation Yard if allowed. 
Obserw for statementslbehaliors indicating harm to self or others. 
Pt to remain in tvHU until discharge byProlider. 
Pt '"'rba li,ed understanding of care plan. 
Appointment Provide b )(6); RN h \/ 7 \/t"'\ 
Bectronically signed b~(b)(6); ~. FN on 10/26/2018 07:07:42 (Pacific Daylight Time) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREET 
T WA98421 
Tel (b)(6); 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progrees Not.: ._! (b __ ) __ (6__ ) __ ;_ _.pH 10/26/2018 
NcJ.e generated oy e0irica/Wcv1<s 8'R/PM So/Iv.ere (w.w,eQinica/Wcx-ks.C0/'1'4 
2019-ICLl-00051 2914 

DHS-ICE-19-0196, 19-0197-N-000096
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA . . A:21s2s9so 2 Su:llj,6> <6>; I 
Facility Code: CSOINNA II g A ea. n 
40 Y old Male, DOB: 10/23/1978 
AccOl.l'II lunber~ 
1623 E J STREET, T~ 
Appoirimert Facility. Northwest Detertion Cert er 
10 /25/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/0 500-200 11,G.UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KOP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>rure order 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID. stop date 
04/15/2019, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16f2018, KOP: 
No, Drug Souroe: In House Pharmacy, Notes: Not required for Ira'"' '· schedule for am and pm PL • Boost \iHC - Liquid 1 along with a cup of water Daily Noon, stop 
date 11 /16f2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el, for the noon PL pass 
• Fiber625 t..GTablet 1 tablet as needed OHS, stop date 
11/08/2018, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"' I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed BID, stop 
date 11/24/2018, KOP: Yes. Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Past Medlc al History 
Hunger strike 
Allergles 
High calorie boost : diarrhea: $de Effects 
Appointment Provlde1 (b)(6 ); (b)(7)(C) 
Reas on for Appointment 
1. PM SHIFT NOTE 
History of Pre se nt Illn ess 
Narrati'"': 
Upon encounter detainee was sitting at his table reading a book. Detainee stated that he was feeling "so-so" and "refuse" 
when asked for 1Atals and weights. Detainee denied any pain on assessment and medications gi'"' n as needed/ordered. No 
otherooncems \Oiced at this time. Detainee did eat an apple for dinner and has gone back to reading his book. \MIi oontinue to 
monitor. 
Pain Assessment 
Pain 
ke )OU currently in pain? No 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes SEG GEOa=F/CER 
VIM! language do )OU speak? English 
Interpretation pro1Aded? Pallant speaks English fluenUy 
Yitai Signs 
RR 
16 /min 10/25/201809:36:08 PM 
H 
66.Sin 10/25/201809:36:08 PM 
Assessments 
1. Imbalanced nutrition: Less than body requirements [00002] - ND00002 (Primary) 
Treatment 
1. Imbalanced nutrijion: Less than body req.i remerts (00002] 
(b )(6) ; 
(b)( 7)(C) 
Notes: \MIi oontinue to monitor in M-iU per protoool, oontinue with current plan of care, instructed on proper hand washing 
technique, encouraged to drink 3-4Uday, enoouraged to recreate outside, instructed to notify nurse or security staff if needed 
assistance, will oontinue to monitor and maintain health and safety standards while in M-iU. Detainee educated on plan, 1.0ioes 
no ooncems; '"'rba li,ed understanding, will remain in M-iU until discharged bypro"der . 
Appoinbnerrt Providef b)(6) ; (b)(7)(C) 
Bectronically signed j (b)(6) ; (b)( 7)(C) 
Sign off status: Comp ! mo 
r on 10/2512018 21:40:55 (Pacific Daylig ht Time) 
Northwest Detention Center 
1623 E J STREET 
T=WA984 21 TeM(6) I 
Fax: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 P.....,.. itotej (b)( 6); (b)( 7)(C) 
Ncie generaled byeOinica/Wcrks EM</PM $:}(,-~ {"""'e'-'liiiC& H(Jk$.C(Jlji 
10/25/201 8 
2019-ICLl-00051 2915 

DHS-ICE-19-0196, 19-0197-N-000097
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA . . A:216269802 Su:lli-!J(b)(6); I 
Facility Code: CSOINNA II g A ea. n 
40 Y old Male, DOB: 10/23/1978 
AccOl.l'II lunbe ~ 
1623 E J STREET, T~ 
Appoirimert Facility. Northwest Detertion Certer 
10 12512018 
Cunont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/0 500-200 11,G.UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KOP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>rure order 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID. stop date 
04/15/2019, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16f2018, KOP: 
No, Drug Souroe: In House Pharmacy, Notes: Not required for Ira'"' '· schedule for am and pm PL • Boost \iHC - Liquid 1 along with a cup of water Daily Noon, stop 
date 11 /16f2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el, for the noon PL pass 
Past Medlc al History 
Hunger strike 
Allorglos 
High calorie boost: diarrhea: $de Effects 
Review of Systems 
Hunger Strike: 
Headache denies. Lightheadedness admits. Wl ight 
loss admits. Wlakness admits. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. l't>dominal Pain denies. Diarrhea denies. 
Nausea denies. \bm itting admits. MJsde cramps admits. Skin 
breakdown denies. Difficulty thinking denies. 
Appointment Provide (b)(6); f h \ 17 \f r\ 
RN 
Reas on for Appointment 
1. tvHU RN day round/ SEG 
History of Pre se nt Illn ess 
Narrati'"': 
ENCOUNTERED PT DURING DAYROJNDS. PT REFUSED TO HAI.E \/ITl'l SIGNS ffi IAEJGIHT ~RED. REFUSED 
ASSESSM::NT. />OrvtTED PAIN IN HIS LEG MJSCLES 5110, /!CHING, REFUSED PAIN WEDS. \1"1LL Ca-JllNUE TO M:X-,IITffi, 
STATED THAT HE \1"1LL GOTO RECKYPRD PFTER THIS ENCOJNTER 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: OFFICER ON DUTY 
Wiat language do }OU speak? Russian, __ 
Interpretation pro\aded? Provider fluent in pallenrs nallve language 
Pain />ssessment 
Pain 
ke }OU currently in pain? Yes 
The pain is located : LEG'S MJSCLE 
The se'"'rityof pain is rated at 5'10 
The se'"'rityof the pain is mild to moderate 
The pain began 1-2 months ago 
The character of the pain is aching 
The associated symptoms are v.eakness 
The pain is aggravated by other 
Describe: NOTEAT1NGPRCPERLY 
The pain is reliel<!d by rest 
Vital Signs 
16/ min 
66.Sin 
Examination 
Segregation: 
RR 
10/25/201804:38:03 PM 
H 
10/25/201804:38:03 PM 
b)(6); (b)(7)(C) 
Segregation Evaluation: Patient has spontaneous speech and answers questions appropriately, in no acute distress, 
well deleloped , well nourished, Patient appears to be v.ithin normal limits of beha"or, affect, and cogniti'"' functioning. 
Patient does not appear to ha~ any acute or unresohed medical conditions that may =en in segregation. Patient does 
not appear to ha'-'l acti'"' psychosis, mania, suicidal ideations or homicidal ideations. 
Assessments 
Health M!intenanoe Related to Segregation Plaoemenl 
Tre atmen t 
1. Others 
Notes: Prolide~s orders re,..ewed and ~rified. 
Nursing to round as needed, document beha"or, ~rba li:,ations, and displayof emotions. 
Establish a m rking relationship with Pl 
Pro" de opportunities for pt to e~ress concerns, fears, feelings, e~Cla tions. 
Alsess for specificstressors. 
Discuss available or useful past coping mechanisms. 
Reduce stimuli in their en,..ronment 
Instruct pt to notify Offioer or Nurse if needing assistance or if there is a change in their health status. 
/>dminister medications as ordered. 
Fresh drinking water in oell, encourage ptto drink 3-4L of water daily. 
rvbnitor Pt's oral intake for adequate nutrition and h)dration. 
Encourage eiercise in oell or Recreation Yard if allowed. 
())serw for statementsibeha,..ors indicating harm to self or olhers. 
Appointmerrt Provide (b)(6); / h \17\lr.\ 
Bectronically signed h>! \~/\~L, 
Sign off status: Completed 
RN 
fN on 10/25"2018 16:46:04 (Pacific Daylight Time) 
Northwest Detention Center 
1623 E J STREET 
TACOMA, WA98421 
'i b)(6): ! FdX, 
I 
Patient: AMAR, IIERGENSANA 008: 10/2 3/1978 Prog .... N;L(b_)_(6_)_; __ ....JI RN 10/2512018 
2019-ICLl-00051 2916 

DHS-ICE-19-0196, 19-0197-N-000098
U.S. Immigration 
and Customs 
Enfor cement 
AMAR, MERGEN~ 
A: 216269802 Si.ti1 (b )(6); 
Facility Code : CSONVWA Housing ea: 
40 Y old Male, DOB: 10/23/1978 
Acc01.111 ~be~) (6)· 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
10 /25/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/0 500-200 11,G-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KOP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>rure older 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes. Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID.stop date 
04/15/2019, KCP: Yes. Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16f2018, KOP: 
No. Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I· schedule for am and pm PL 
• Boost \iHC - Liquid 1 along with a cup of water Daily Noon. stop 
date 11 /16f2018, KOP: No. Drug Source: In House Pharmacy, 
Notes: Not required for lra\el, for the noon PL pass 
Past Medlcal History 
Hunger strike 
Allergles 
High calorie boost: diarrhea: $de Effects 
Reason for Appointment 
1. RN Daily Seg rounds 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
VIM! language do }OU speak? English 
Appointment Provld e 1 b)(6 ); ~ -
Interpretation pro\aded? Pallent speaks English fluenUy / Detainee able to express medical needs in English 
Segregation: 
Segregation Rounds 
ke }OU currentlythinking about killing or harming }Ourself? No 
Do}Ou ha'"' any medical complainls orconcems at this time? No 
Was referral made to d inical ser.ices (lvOIM.P, Dental, M-t, Sek Call)? No 
Examination 
Segregation: 
Segregation Evaluation: Patient has spontaneous speech and ansWE!fS questions appropriately, in no acute distress, 
well_ de\eloped , well nourished, Patient appears to be v.ithin normal limits of beha"or, affect, and cogniti1.e functioning, 
Patient does not appear to ha,e any acute or unresol\ed medical conditions that may worsen in segregation, Patient does 
not appear to ha\e acti,e psychosis, mania, suicidal idealions or txlmicidal ideations. 
Assessments 
Health M!intenance Related to Segregation Placement 
Appoinbnerrt Providerf b )(6); __ 
Electronically signed by (b)(6); on 10/2512018 at 08:59 MST 
Sign off status: Comple t h
"
7
'"' ' 
Addendum : 
10/26/2018 09:10 '°4b )(6); ~- I> Detainee on Rec Schedule - no reports of food consumption 
Northwest Detention Center 
1623 E J STREET 
TACOMA, WA98421 
Tell(b )(6): I ,ax . 
Pati-t: AMAR, MERGENSANA DOB; 10/23/1978 p,_... Note:f b)(6); ~ - IRN 10/25/2018 
/lkte generated by eC/inica/Wai<s ElvRIPM &ltw3re ("""'eC/ inlcl'rW<:.-ks.com) 
2019-ICLl-00051 2917 

DHS-ICE-19-0196, 19-0197-N-000099
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA . . A:216269802 Su:lli::.tb)(6); I 
Facility Code: CSOINNA II g A ea. n 
40 Y old Male, DOB: 10/23/1978 
AccOl.l'II lunber :~ 
1623 E J STREET, T~ 
Appoirimert Facility. Northwest Detertion Certer 
10 /25/2018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/0 500-200 11,G.UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KOP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>rure order 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID. stop date 
04/15/2019, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16f2018, KOP: 
No, Drug Souroe: In House Pharmacy, Notes: Not required for Ira'"' '· schedule for am and pm PL • Boost \iHC - Liquid 1 along with a cup of water Daily Noon, stop 
date 11 /16f2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el, for the noon PL pass 
Past Medlc al History 
Hunger strike 
Allergles 
High calorie boost: diarrhea: $de Effects 
Reas on for Appointment 
1. tvHU RN NIGHT ROUNDS/LOSS CT' />PPETITE 
History of Pre se nt Illn ess 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEO OFFICER ON DUTY 
VIM! language do }OU speak? English 
Interpretation pro\aded? Pallant speaks English fluenUy 
Segregation: 
Segregation Rounds 
ke }OU currentlythinking about killing or harming }Ourself? No 
Do}Ou ha'"' any medical complainls orconcems at this time? No 
AppolntmentProv~er.~! /b~)~/6~)~: __ ~!RN 
Was referral made to d inical ser.ioes (lvOIM.P, Dental, M-t, Sek Call)? No NIA 
Narrati'"': 
ENCOUNTERED PT DURING NIGHT ROUNDS. PT REFUSED TO HAI.£ \/tT/ll SIGNS ffi 1',EJGHT fv'EASURED. REFUSED 
TOT/llK TO NURSE. PT REAJSED BREl'l<FAST. 
Examination 
Segregation: 
Segregation Evaluation: Patient has spontaneous speech and ansWE!fS questions appropriately, in no acute distress, 
weU de\eloped , well nourished, Patient appears to be v.ithin normal limits of beha"or, affect, and cogniti,e functioning. 
P;:it,ent does not appear to ha'"' any acute or unresoll<!d medical conditions th.JI may VIA'.l!Sen in segregation. Patient does 
not appear to time acti'"' psychosis, mania, suicidal ideations or homicidal ideations. 
Assessments 
Health M!intenance Related to Segregation Plaoement 
Tr eat ment 
1. Others 
Notes: Prolide~s orders reliewed and '"'rified. 
Nursing to round as needed, document behalior, '"'rbaliiations, and display of emotions. 
Establish a working relationship with Pl 
Proli de opportunities for Pt to e~ress conoems, fears, feelings, e~ c:tations. 
/lssess for specificstressors. 
Discuss available or useful past coping mechanisms. 
Reduce stimuli in their enlironmenl 
Instruct Pt to notify Officer or Nurse if needing assistance or if there is a change in their health status. 
/ldminister medications as ordered. 
Fresh drinking water in oell, encourage Ptto drink 3-4L of water daily. 
11/onitor Pt's oral intake for adequate nutrition and h)dration. 
Encourage eiercise in oell or Recreation Yard if allowed. 
Obserw for statementslbehaliors indicating harm to self or others. 
Pt to remain in M-IU until discharge byProlider. 
Pt '"'rba li,ecl understanding of care plan. 
Disposition: /ldmitted to tvHU until medically evaluated 
Appointment Provide!.._(b)"-- (6""); __ _.~ 
Electronically signed b~(b)(6); 
Sign off status: Completed 
~ on 10/25/2018 06:38:26 (Pacific Daylight Time) 
Northviest Detention Center 
1623 E J STREET 
l::--1=.....,.==.,, 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 •- Notef b)(6); I RN 10/25/201 8 
Ncte generated byeClinica!Wcxi<s BvRIFM S::ilv.ere (w,,,weC//nica/Wc.-ks.com) 
2019-ICLl-00051 2918 

DHS-ICE-19-0196, 19-0197-N-000100
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:llc:t h \/R\ ! 
Facility Code : CSONVWA Housing Area: H 
40 Y old Male, DOB: 10/23/1978 
AccOl.l"II lun berfi5ii6i:7 
1623 E J STREET, T~ 
Cunent -dlcatlons 
Taking 
• Prenatal \Atamin Filed Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 M3Tablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/0 500-200 M3-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra;el 
• Fiber625 M3Tablet 1 tablet as needed BID,stopdate 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for trawl 
• Cholecalciferol 2000 UNIT Tablet 1 tablet ()-IS, stop date 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for trawl 
• Boost Glucose Control - Liquid 0.5 ser.ing mi-i TIO, stop date 
10/26/2018, KOP: No, Drug Source: In House Pharmacy, Notes: Not 
required for trawl, see attached ser.ing mildure order 
• /lcetaminophen 500 M3 Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra;el 
• Pedial>4e- Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 M3Tablet2tab letas needed BID,stopdate 
04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for trawl 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, schedule for am and pm PL 
• Boost \iHC- Liquid 1 along with a cup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required for tra;el, for the noon PL pass 
Past Medical Hlatory 
Hungersb'ike 
Allergles 
High calorie boost : diarrhea: $de Effects 
Reason for Appointment 
1. Wedication issue 
Treatment 
1. Others 
Stop /lcetaminophen Tablet, 500 M3, 1 tablets as needed, Oa lly, QID PRN, 90 days, 1, KOP: Yes, Drug Source: In House 
Pharmacy, Notes: Not required for trawl 
Stop Fiber Tablet, 625 M3, 2 tablet as needed, Oa lly, BID, 180 days, 720 Tablet, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for trawl 
StartFiberTablet, 625 M3, 1 tablet as needed, Oal ly, QI-IS, 14 days, 1, KOP: Yes, Drug Source: In House Pharmacy, Notes: Not 
required for trawl 
Start /lcetaminophen Tablet, 500 M3, 1 tablets as needed, Oa lly, BID, 30 days, 60 Tablet, KOP: Yes, Drug Source: In House 
Pharmacy, Notes: Not required for trawl 
Tel: 
Fax: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progress Note: 
/lkte generated by eC/inical\M:xi<s ElvRIPM &Jtv.ere ("""'eC/inlca/ Works.com) 
2019-ICLl-00051 2919 

DHS-ICE-19-0196, 19-0197-N-000101
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""' eC/inica'WGYks.coojl 
2019-ICLl-00051 2920 
AMAR,MERGENSANA A:216269802 Su:llD:!/h\/R\ ! 
Facility Code : CSONVWA Housing Area: A 
40 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunber:~ 
1623 EJ STREET, T~ 

DHS-ICE-19-0196, 19-0197-N-000102
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA . . A: 216269802 Si.tlltti ii 6i: I 
Facility Code: CSOINNA II g A ea. n 
40 Y old Male, DOB: 10/23/1978 
AccOl.llt ~ber: 111-" ,:,., . 
1623 E J STREET, TACOMA, WA-98421 
Appoirimert Facility. Northwest Detertion Certer 
10 12412018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/0 500-200 11,G.UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KOP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>rure order 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID.stop date 
04/15/2019, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16f2018, KOP: 
No, Drug Souroe: In House Pharmacy, Notes: Not required for Ira'"' '· sdledu le for am and pm PL 
• Boost \iHC - Liquid 1 along with a cup of water Daily Noon, stop 
date 11 /16f2018, KOP: No, Drug Source: In House Pharmacy , 
Notes: Not required for lra\el, for the noon PL pass 
Past Medlc al History 
Hunger strike 
Allergles 
High calorie boost: diarrhea: $de Effects 
Reas on for Appointment 
1. PM SHIFT NOTE 
History of Pre se nt Illn ess 
Narrati'"': 
Appointment Provlde1 (b)(6) ; (b)(?)(C) 
Upon encounter detainee was sitting on the edge of his bed listening to his headphones. Detainee stated that he was feeling 
good and refuses lita ls and weights. Detainee denied any pain on assessment and medications gi'"'n as needed/ordered. No 
other ooncems \Oiced at this time. Detainee did eat an apple for dinner and went back to listening to his headphones. Vlilll 
oonti nue to monitor. 
Pain Assessment 
Pain 
ke )OU currently in pain? No 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes 
Vlillat language do )OU speak? English 
Interpretation prolided? Pallant speaks English fluenUy 
Yitai Signs 
RR I 
16/ min 10/24/201810:49:48 PM (b)(6) ; (b)(7)(C) 
H 
66.Sin 10/24/201810:49:48 PM 
Assessments 
1. Imbalanced nutrition: Less than body requirements [00002] - ND00002 (Primary) 
Treatment 
1. Imbalanced nutrijion: Less than body req.i remerts (00002] 
Notes: Vlilll oontinue to monitor in M-iU per protoool, oontinue with current plan of care, instructed on proper hand washing 
technique, encouraged to drink 3-4Uday, enoouraged to recreate outside, instructed to notify nurse or security staff if needed 
assistance, will oontinue to monitor and maintain health and safety standards while in M-iU. Detainee educated on plan, \Oioes 
no ooncems; '"'rba li,ed understanding, will remain in M-iU until discharged byprolider. 
Appoinbnerrt Providej (b)(6) ; (b)(?)(C ) r 
Bectronically signed ,~ (~b)~(6_)_; _(b-)(_7_)(_C_) __ _.r on 10/24/2018 23:07:40 (Pacific Daylig ht Time) 
Sign off status: Comp le..ca · 
Northwest Detention Center 
1623 E J STREET 
T WA98421 
Tel (bl(6l: x: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 P.....,.. Notef b)(6) : (b)(?)(C) 
Ncie generaled byeOinica/Wcrks EM<IPM $oltv.ere (w.w,eQinicliWorks.CCXJ1 
1 RN 10/24/201 8 
2019-ICLl-00051 2921 

DHS-ICE-19-0196, 19-0197-N-000103
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:llC/h 1/R\· I 
Facility Code: CSONVWA Housing Area: H 
40 Y old Male,~- 1Q{2J119ZB 
AccOUll l'unbe b )(6): I 
10 12412018 
Cunont Medication s 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/0 500-200 11,G.UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KOP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>rure order 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes. Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID.stop date 
04/15/2019, KCP: Yes. Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16f2018, KOP: 
No. Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I· schedule for am and pm PL 
• Boost \iHC - Liquid 1 along with a cup of water Daily Noon. stop 
date 11 /16f2018, KOP: No. Drug Source: In House Pharmacy, 
Notes: Not required for lra\el, for the noon PL pass 
Pas t Medlc a l History 
Hunger strike 
Allorglo s 
High calorie boost: diarrhea: $de Effects 
Review of Syste ms 
patient refused to answer any questions. 
Rea son for Appointment 
1. Nursing rounds-day 
History of Pre se nt Illne ss 
Narrati'"': 
1623 E J STREET, TACOMA, WA-98421 
Appoirimert Facility: Northwest Detertion Certer 
Appointment Provld e 1 b)(6 ); (b)(7)(C) rN 
Patient refused to get \<tals or weight checked. He went back to sitting on his bed reading. He shook his head no when asked 
if any pain, not sure if he meant he was not in pain or he wasn1 going to answer any questions. aticer reports he ate an apple at 
lunch. 
Yitai Sign s 
refused \<tals. 
Ex amination 
General EJ<amination: 
GENER/ll J>PPE.AR.6/IICE: in no acute distress, well del.e!oped, well nourished. 
Assessm ent s 
1. lneffecti'"' Coping [00069]- ND00069 (Primary) 
Tr e atm ent 
1. Ineffective Coping (00069] 
Notes: Patient encouraged to eat meals and drink 8-10 glasses of water per day. Patient encouraged to communicate his needs 
to officer or medical. Segregation rounds completed. No distress noted. No sick call requests made at this time. \/viii continue to 
offer medical aooess dailywhile in Segregation. Detainee remains in segregation cell. 
Disposition: Pdmitted to M-IU until medically evaluated 
Appoinbnent Provide~(b)( 6); (b)(7)(C) jlN 
Be ctronically signed ~(b)(6); ~· 
Sign off status: Completed 
IRN on 10/241201813:14:53 (Pacific Dayli ght Time) 
Northwest Detention Center 
1623 E J STREET 
T~====:,,.; 
Patie nt: AMAR, MERGENSANA DOB: 10/23/1978 Progress Nob!/h\(R\ · /h\/ 7\/C:\ !RN 10/2412018 
Ncie generaled byeOirica/Wcrlcs EM<IPM Sohwi1re (w.w,eQinicEiWorks.CCXJ1 
2019-ICLl-00051 2922 

DHS-ICE-19-0196, 19-0197-N-000104
U.S. Immigrat ion 
and Customs 
Enforcement 
AMAR,MERGE~ 
Fa ·1· CodeA: 2
~~~~~!.,Si.tll ,? )\~\-, Clity , ""'-''ffnvA . 
40 Y ad ~:3· 1~~r:::: 
1623 E J~~=l~be :~ ff~;:: I 
10 12412018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/0 500-200 11,G.UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15 , stop date 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KOP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>rure order 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID. stop date 
04/15/2019, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16f2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I· schedule for am and pm PL 
• Boost \iHC - Liquid 1 along with a cup of water Daily Noon, stop 
date 11 /16f2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el, for the noon PL pass 
Past Medlcal History 
Hunger strike 
Allerglss 
High calorie boost : diarrhea: $de Effects 
Appoimnert Facility. Northwest Detertion Certer 
Reason for Appointment 
1. tvH Hunger Strike Fol low-up 
History of Present Illness 
Narrati'"': 
Appointment Provlde1 b)(6 ); (b )(7) (C ) ~csw 
AtvH hunger strike assessment could not be completed for this Pt today due to his refusal to respond the mental status 
questions ask of him. Utili2ing an interpreter, this pro,ider made numerous attempts to engage this Pt. Each attempt was met 
with the word "refuse". Mer se'"'ral attempts, Pt completely stopped talking. AM-t hunger strike assessment with this Pt, be 
scheduled again in one week. 
Appointment Provider:! (b)(6): (b)(7)( C) I LCSW 
Electronically signed b (b)(6); (b)(7)(C) LCSW on 10/241201815 :05:42 (Pacific Daylight Time) 
Sign off status: Comple 
Northviest Detention Center 
1623 E J SmEEr 
TACOMA, WA98421 
Tel:Vh I/ RI· 
Fax: 
Patient: AMAR, MERGE NS.ANA DOB: 10/23/1978 Progrwss Notej (b )(6); (b )(7)( C) I LCSW 10/24/2018 
Ncte generated byeOinica/Wcxi<s ElvR!'PM &,flv.ere (w.w,eCJinictiWorks.COfr9 
2019-ICLl-00051 2923 

DHS-ICE-19-0196, 19-0197-N-000105
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA A:21626980 2 Su:lll.J1/h\/R\· ! 
Facility Code: CSONVWA Housing Area: A 
40Y Acc01.111 ad ~=E ~be )b\i$L :: I 
10 12412018 
Curnont Medication s 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/0 500-200 11,G-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\e l 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KOP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\e l, see attached ser.ing mi>rure older 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\e l 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID.stop date 
04/15/2019, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16f2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I· schedule for am and pm PL 
• Boost \iHC - Liquid 1 along with a cup of water Daily Noon, stop 
date 11 /16f2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el, for the noon PL pass 
Past Medlc al History 
Hunger strike 
Allergls s 
High calorie boost : diarrhea: $de Effects 
1623 E J STREET, T 
Appoimnert Facility: Northwest Detertion Certer 
Reason for Appointment 
1. tvH SEG rounds 
History of Pre se nt Illne ss 
Patient Identification: 
Patient Identification 
Appointmen t Provld e 1(b)/6): (b)(?)(C) 
Patient properly identified by2 sources induding: ID Badge, Picture, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEO Seg Officer 
VIM! language do }OU speak? English 
Interpretation pro\aded? Yes, Interpreter Name 
Name Use notes field 
Language Russian Uonbridge Oga 11552016 
Reoord re\aew conducted: Yes 
Clinical Segregation: 
-M" Mlarrefused to speak with this pro.ider. Pt refused numerous attempt to engage Pt and would only state, " refuse" when 
asked mental health status questions. 
-GEO SEGoflicer denied any current tvH concerning beha.iors for this detainee. SEG officer reported that Pt has been angry 
about not letting him continue his hunger strike in the tvHU. Staff reports that Pt has on se'"'ra l occasions, asked to be placed 
back in the tvHU. 
Data Checkiist 
1. Does the patient ha'"' a Mmtal Health (tvH) DSM5 diagnosis? No 
5. Is the patient currently engaging in any dangerous or disrupti'"' adi\atythat would render his/her return to the general 
population a threat to the patient or the safet)l'securityof the facility? No 
7. Is the patient frequently followed up by medical personnel (other than tvH)? Yes 
Please state frequency Pt is seen daily by nursing staff during daily nursing rounds 
8. ls the patient frequentlyfollowed up bytvH personnel? Yes 
Please state the frequency: Pt is seen v.eekly during SEG M-1 rounds 
9. Has there been deterioration on the patients condition while in segregation? No 
10. ls the patient im.ol'"'d in adi 1,1ties while he/she is in segregation? Yes 
/1£:ti1,1tes RecreaUon (outside the ce/1),Books or reading material, Television 
Please describe: music, jail mail-email service, law library, communicaflon v.ith staff and other detainees 
Suicide Risk Inquiry 
Does the patient ha'"' thoughts of harming him or herself or committing suicide? No 
rvt.ntal Status Exam 
/l!)pearance: V...11 groomed,NeaUy dressed .NOTE: Appearance defaults to "\!\ell groomed, NeaUy dressed" for the drop 
do"'1 opUon of this assessment. Hov.ever, a more accurate descripUon of this detainee's appearance is: • AtJequatelygroomed 
and nourished, dressed in dean unifonn of the day.· 
Le'"' I of alertness: Conscious 
Descnbe: NOTE: ''Conscious· is the drop d0"'1 option of this question. A more accurate description o/this detainee is: "Pt is 
alerl and responding to interaction of today's round appropriately" 
Speech : Is it normal in tone, ,olume and quantity? Yes 
Beha1.10~ CooperaUve,Appropriate for the parlicular situation 
Oie ntation: They knowllf>ere they are and llf>at they are doing here NOTE: "They knowllf>ere they are and llf>at they are 
doing here"is a default ansv.erforthe drop d0"'1 option olthis assessment. Hov.ever, a more accurate description o/the 
detainee's OientaUon is: Oiented adequately to person, place, situation; considering brief nature of round. 
II/bod: happy 
Descnbe: NOTE: ''Happy" defaults for the drop d0"'1 opflon of this note. Hov.ever, a more accurate description of this 
detainee's mood is ''not impaired" and "of normal range". 
/llfect: Appropriate 
Thought process: Logical and presented in an organized fashion considering brief nature of round. 
Thought content not paranoid 
Descnbe: No obvious paranoia sxs presented during brief round 
Judgment Insightful 
Descnbe: v.ith consideraflon of brief nature olroundlinteradion. 
Assessme nt s 
No current tvH diagnosis. 
Prev entiv e Medic ine 
~e rt M'>dical/Custodyofficer if pt has medical or tvH emergency for immediate access to M'>dical for assess mentltx. 
Engage in acti"ties of daily li"ng to continue good mental and phy.,ical health. 
Appointment Provide1(b)(6); (b)(7)(C) ~csw 
Bectro nicall y signed (b)(6); (b)(7)(C) LCSW on 10/24'2018 13:47:37 (Pacific Daylight lime) 
Sign off status: Compl 
2019-ICLl-00051 2924 
Northwest Detention Center 
1623 E J STREET 
T WA98421 
" (b)/6): 

DHS-ICE-19-0196, 19-0197-N-000106
Patient: A111AR, IIERGENSANA DOB: 10/2311978 Prog,.u Nota (b )/6): /b )/7)/ C) I LCSW 10/24/2018 
Nd.e general.ed by eOinica/W<n<s EJvRIPM Sottw,re (""""eC/inica/WOrks .com) 
2019-ICLl-00051 2925 

DHS-ICE-19-0196, 19-0197-N-000107
10 12412018 
Past Medical History 
Hunger strike 
Alla ..... 
U.S. Immigration 
and Customs 
Enfor cement 
Reason for Appointment 
1. RN Daily Seg rounds 
AMAR,MERGENSANA . . A:216269802 Su:lllJl(b\/6\: Facility Code: CSOINWA HoJs .. niil,g'i,A"e"'d ... H ...... 
40 Y old Male, DOB: 10/23/1978 
AccOl.ri funbe./b\/6\ · 
1623 E J STREET, TACOMA, WA-98421 
Appoirimert Facility. Northwest Detertion Certer 
Appointment Provlder:l (b)(6 ); (b)(7)(C)~N 
High calorie boost : diarrhea: Side Effects 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? English 
Interpretation pro\aded? Pallent speaks English fluenUy- Detainee able to make medical needs know, in English 
Segregation: 
Segregation Rounds 
ke }OU currentlythinking about killing or harming }Ourself? No 
Do}Ou haw any medical complainls orconcems at this time? No 
Was referral made to d inical sen.1ces (fvOIM_P, Dental, M-t, Sick Call)? No 
Examination 
Segregation: 
Segregation Evaluation: Patient has spontaneous speech and ansWE!fS questions appropriately, in no acute distress, 
well de\eoped , well nourished, Patient appears to be v.ithin normal limits of beha-.ior, affect, and cogniti1.e functioning, 
Patient does not appear to ha,e any acute or unresol\ed medical conditions that may worsen in segregation, Patient does 
not appear to h8'e acti,e psychosis, mania, suicidal idealions or l'Klmicidal ideations. 
Assessments 
Health M!intenance Related to Segregation Placement 
Treatment 
1. Others 
Notes: Continuing to monitor detainee food intake and rec attendance. 
Appointment Provider. (b )(6); / h\ / 7\/f""\ 
Bectronically signed b1(b)(6); r on 10/26/2018 13:25:28 (Pacific Daylight lime) 
Sign off status: Completeiea-----' 
Northwest Detention Center 
1623 E J STREET 
T WA98421 
Tel b)(6); 
Patien1: AMAR, MERGENSANA DOB: 10/23/1978 p,__ ~ 10/24/2018 
/lkxe generated by eOirica/Wcxi<s 8"R/PM Sotr.ere /w.w,eOinice/Works.corrv 
2019-ICLl-00051 2926 

DHS-ICE-19-0196, 19-0197-N-000108
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 &tll , .. o'-'-h"' \l-'-R"-1· __ _. 
Facility Code : CSONVWA Housing Area: H 
40 Y old Male, [W· 1QOJ(19ZB 
AccOUll l'unbe~)(6 ): I 
10 12412018 
Curnont Medications 
Taking 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/0 500-200 11,G.UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KOP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>rure order 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes. Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Fiber625 t..GTablet2tab letas needed BID. stop date 
04/15/2019, KCP: Yes. Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16f2018, KOP: 
No. Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I· schedule for am and pm PL 
• Boost \iHC - Liquid 1 along with a cup of water Daily Noon. stop 
date 11 /16f2018, KOP: No. Drug Source: In House Pharmacy, 
Notes: Not required for lra\el, for the noon PL pass 
Past Medlcal History 
Hunger strike 
Allergles 
High calorie boost : diarrhea: $de Effects 
Reason for Appointment 
1. tvHU RN NIGHT ROUNDS/LOSS CT' />PPETITE 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEO OFFICER ON DUTY 
VIM! language do }OU speak? English 
Interpretation pro\aded? Pallent speaks English fluenUy 
Segregation: 
Segregation Rounds 
ke }OU currentlythinking about killing or harming }Ourself? No 
Do}Ou ha'"' any medical complainls or concerns at this time? No 
1623 E J STREET, TACOMA, WA-98421 
Appoirimert Facility: Northwest Detertion Cert er 
Appointment P1'ovlde~ (b)(6) ; (b)(7)(C) ~N 
Was referral made to d inical ser.ices (lvOIM.P, Dental, M-t, Sek Call)? No NIA 
Narrati'"': 
ENCOUNTERED PT DURING NIGHT ROUNDS. PT REFUSED TO HAI.£ \/tT/ll SIGNS ffi 1',EJGHT fv'EASURED. 
Examination 
Segregation: 
Segregation Evaluation: Patient has spontaneous speech and answeJS questions appropriately, in no acute distress, 
weU de\eloped , well nourished, Patient appears to be v.ithin normal limits of beha,.jor, affect, and cogniti,e functioning. 
Patient does not appear to ha,e any acute or unresol\ed medical conditions that may worsen in segregation. Patient does 
not appear to hme acti'"' psychosis, mania, suicidal ideations or tun icidal ideations. 
Assessments 
Health M!intenance Related to Segregation Placement 
Treatment 
1. Others 
Notes: Prolide~s orders reliewed and '"'rified. 
Nursing to round as needed, document behalior, '"'rbali,ations, and displayof emotions. 
Establish a working relationship with Pl 
Proli de opportunities for pt to e~ress concerns, fears. feelings, e~ dations. 
/lssess for specificstressors. 
Discuss available or useful past coping mechanisms. 
Reduce stimuli in their enlironmenl 
Instruct pt to notify Officer or Nurse if needing assistance or if there is a change in their health status. 
/ldminister medications as ordered. 
Fresh drinking water in cell, encourage ptto drink 3-4L of water daily. 
M:mitor Pt's oral intake for adequate nutrition and h)dration. 
Enoourage eiercise in cell or Recreation Yard if allowed. 
Obse"'3 for statementslbehaliors indicating harm to self or others. 
pt to remain in M-IU until discharge byProlider. 
pt '"'rba li,ed understanding of care plan. 
Disposition: /ldmitted to tvHU until medically evaluated 
Appointment Provide1 b)(6 ); ~ -
Bectronically signed b* b)(6); _ 
Sign off status: Completed 
fN 
IRN on 10/2412018 05:26:02 (Pacific Daylight Time) 
Northwest Detention Center 
1623 E J STREET 
TACOMA, WA98421 
,e!(b)(6); 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 P.....,.. ~ RN 10/2A/2018 
Ncte general.ad by eClinica!Wtxi<s EJvR'PM Soflw!Jre (""'"'eC/ inica/WcYks.com) 
2019-ICLl-00051 2927 

DHS-ICE-19-0196, 19-0197-N-000109
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 ProgN U Nola: 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 2928 
AMAR, MERGEN~ 
A:216269802 Su:llD: b)(6); 
Facility Code : CSONVWA Housing ea: 
40 Y old Male, tqi:.JJ!q3/:.l.9ZlL, 
AccOl.lll l'unber (b )(6); 
1623 E J STREET, T ti..\f r \f r-, 

DHS-ICE-19-0196, 19-0197-N-000110
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 Prog N U Nola : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 2929 
AMAR,MERGENSANA A: 216269802 Su:lloj(b ><2: I 
Facility Code : CSONVWA Housing ea: A 
40 Y old Male, DOB: 10/23/1978 
Acc01.111 lunber :lrh\ lf; \- I 
1623 E J STREET, TACOMA, WA98421 

DHS-ICE-19-0196, 19-0197-N-000111
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 2930 
AMAR,MERGENSANA A: 216269802 Su:i1olrh \I n \ I 
Facility Code : CSONVWA Housing Area: H 
40 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunbe~ 
1623 EJ STREET, T~ 

DHS-ICE-19-0196, 19-0197-N-000112
Past lledlcal History 
Hunger strike 
......... 
High calorie boost : diarrhea: Side Effects 
U.S. Immigration 
and Customs 
Enforcement 
Reas on for Appointment 
1. Wedication Refusal 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 ProgNss Nola: 
Ncl.e generated by eC/inica/lM:n<s 8'R/PM Sottv.ere (w.w,eC/inica/Works.~ 
2019-ICLl-00051 2931 
AMAR,MERGENSANA A:216269802 Su:llol(b)/6): ! 
Facility Code : CSONVWA Housing Area: H 
40 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunbe~ 
1623 EJ STREET, T~ 

DHS-ICE-19-0196, 19-0197-N-000113
U.S. Immigrat ion 
and Customs 
Enforcement 
Cunent -dlcatlons 
Taking 
• Calcium 500/0 500-200 M:;.UNITTablet 1 tablet with food Oice 
a day, KOP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Filed Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 M3Tablet 1 tablet as needed Four times a day, KOP: 
Re a son for Appointm ent 
1. Wedication Refusal 
Assa ssm e nt s 
1. Starvation, subsequent encounter - T73.0X)q) (Primary) 
Tr e atm e nt 
1. Starvation, subsequent encOl.l'ller 
AMAR,MERGENSANA . . A:216269802 Su:lli:-,((b)(6); ! 
Facility Code: CSOINNA II g A ea. n 
40 Y old Male, DOB: 10/23/1978 
AccOl.l'II lunber:~ 
1623 EJ STREET, T~ 
Yes, Drug Source: Pharmacy 
• Calcium 500/0 500-200 M:;.UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra;el 
Stop Calcium 500/0 Tablet, 500-200 M,. UNIT, 2 tablet with food, Oa lly, Daily Noon, 90 days, 1, KOP: Yes, Drug Source: In 
House Pharmacy 
• Fiber625 M3Tablet 1 tablet as needed BID, stopdate 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for trawl 
• Cholecalciferol 2000 UNIT Tablet 1 tablet a-IS , stop date 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for trawl 
• Boost Glucose Control - Liquid 0.5 ser.ing mi-i TIO, stop date 
10/26/2018, KOP: No, Drug Source: In House Pharmacy, Notes: Not 
required for trawl, see attached ser.ing mildure order 
• /lcetaminophen 500 M3 Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra;el 
• Pedial>4e- Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Calcium 500/0 500-200 M:;.UNITTablet 2 tablet with food Daily 
Noon, stop date 01/10/2019, Ka>: Yes, Drug Source: In House 
Pharmacy 
• Prenatal \Atamin Fi-i Dose Tablet 1 Daily Noon, stop date 
01/10/2019, Ka>: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for trawl 
• Fiber625 M3Tablet2tab letas needed BID. stop date 
04/15/'2019, Ka>: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for trawl 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
travel, schedule for am and pm PL 
• Boost\iHC - Liquid 1 along with a cup of water Daily Noon, stop 
date 11/16/2018, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required for tra;el, for the noon PL pass 
Past Medic a l Hlatory 
Hungersb'ike 
Allerg ■s 
High calorie boost: diarrhea: $de Effects 
Stop Prenatal \Atamin Tablet, Fi,ed Dose, 1, Oall y, Daily Noon, 90 days, 1, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for trawl 
2. Others 
Stop Calcium 500/0 Tablet, 500-200 M,. UNIT, 1 tablet with food, Oa lly, ()ice a day, KOP: Yes, Drug Source: Pharmacy 
Tel: 
Fax: 
Patient: AMAR, MERGENSANA DOB: 10/2 3/1978 Progress Note: 
/lkte generated by eC/inical\M:xi<s ElvRIPM &Jtv.ere ("""'eC/ inlca/Works.com) 
2019-ICLl-00051 2932 

DHS-ICE-19-0196, 19-0197-N-000114
1012312018 
........ 
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:lltfb )(6): ~ Facility Code : CSONVWA Housing Area: 
40 Y old Male, DOB: 10/23/1978 
AccOl.lll~ \/R\· 
1623 E J STREET, T WA-911421 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Provlde';' hl/R\· /h\/ 7 \W \ I'<'" 
High ca lorie boost : diarrhea: !'.de Effects 
Reason for Appointment 
1. Weight and \itals 
Appointment Provider:fb)(6); (b)(7)(C) F 
Electronically signed b~._b_)_(6_); __ _.~ , RN on 11/16/2018 at 07:26 MST 
Sign off status: Pending 
Northwest Detention Center 
1623 E J STREET 
T WA98421 
Tel (b)(6); /h \/ 7 \/r'\ 
Patlent:AMAR, MERGENSANA DOB: 10/2311978 Progress N-!( b)(6): (b)(7)(C) !RN 10/23/2018 
/lkxe generated by eC/inica/Wcrl.s a.RIPM Sottv.ere ("""'eC/inica/Works .com) 
2019-ICLl-00051 2933 

DHS-ICE-19-0196, 19-0197-N-000115
1012312018 
Past Medical History 
Hunger strike 
Alla ..... 
U.S. Immigration 
and Customs 
Enfor cement 
Reason for Appointment 
1. RN Daily Seg rounds 
AMAR,MERGENSANA 
A: 216269802 Su:ll*b )(6); I 
Facility Code : CSONVWA Housing Area: A 
40 Y old Male, DOB: 10/23/1978 
Acc01.111~ )(6): 1623 E J STREET, T VVA-9642 I 
Appoimnert Facility: Northwest Detertion Cert er 
Appointment Provlcle1 (b) (6); (b)(7)(C) rN 
High calorie boost : diarrhea: Side Effects 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? English 
Interpretation pro\aded? Pallent speaks English fluenUy /Detainee is able to communicate need for medical inte/1/enllon in 
English 
Segregation: 
Segregation Rounds 
ke }OU currentlythinking about killing or harming }Ourself? No 
Do}Ou haw any medical complainls orconcems at this time? No 
Was referral made to din ical sen.1ces (lvOIM.P, Dental, M-t, Sick Call)? No NIA 
Examination 
Segregation: 
Segregation Evaluation: Patient has spontaneous speech and ansWE!fS questions appropriately, in no acute distress, 
well de\eloped, well nourished, Patient appears to be v.ithin normal limits of behmior, affect, and cogniti1.e functioning. 
Patient does not appear to ha,e any acute or unresol\ed medical conditions that may worsen in segregation. Patient does 
not appear to ha\e acti,e psychosis, mania, suicidal idealions or homicidal ideations. 
Assessments 
Health M!intenance Related to Segregation Placement 
(b)(6); Appoinbnent Provide t hl/7 \/f'I 
Bectronically signed byl \~/\~/;c, ~ on 10/23/2018 at 09:14 MST 
Sign off status: Completed 
Northwest Detention Center 
1623 E J $TREE" 
TACOMA, WA98421 
•ej(b)(6); I 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 p,_.... "-f:~ b_)(_6_); __ ~1RN 10/23/2018 
/lkie generated by eClinica/Wcrks EJvRIPM So/fv.ere ("'""'eClinica/Wcrks.com) 
2019-ICLl-00051 2934 

DHS-ICE-19-0196, 19-0197-N-000116
U.S. Immigration 
and Customs 
Enfor cement 
AMAR, MERGEN _~ 
Facility~~~~~ 
39 Y old Male, ~hifR~/1 978 
AccOllll lunber: / · I 
10 12212018 
Curnont Medication s 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing miied TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KCP: Yes, Drug 
Source: In House Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 2 tablet with food Daily 
Noon, stop date 01/10/2019, KCP: Yes, Drug Source: In House 
Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 Daily Noon, stop date 
01/10/2019, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Fiber625 t..GTablet2tab letas needed BID.stop date 
04/15/2019, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/'2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, sdledu le for am and pm PL 
• Boost \iHC - Liquid 1 along with a cup of water Daily Noon, stop 
date 11 /16/'2018, KCP: No, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el, for the noon PL pass 
Past Medlc al History 
Hunger strike 
1623 E J STREET, TACOMA, WA-98421 
Appoirimert Facility: Northwest Detertion Certer 
Aflpolntment Provld e 1(b)(6) ; (b)(7)(C) IMD 
Reas on for Aflpolntm ent 
1. \Asit in H Seg 
History of Pre se nt Illne ss 
Pain /'6sessment 
Pain 
ke )OU currently in pain? No 
Patient Identification: 
Pt seen for refusal to come to medical for evaluation. He has not been consistent in drinking his boost and is now refusing to 
drink it in front of the nurse. Pt states he is feeling ok but with some dry mouth. He is told that D3 was dosed so that is why he 
was placed in H seg, for his protedi'"' custody. Pt is refusing to ha'"' BP check or weight A1d, while he takes the pedial)le it is 
not documented as witnessed for him to drink it Pt has been taking fresh fruit off the tray.; to eat so it appears he is following the 
same pattern of eating/drinking as in M-tU. Pt had no questions to discuss. 
Patient Identification 
Patient property identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do )OU speak? Russian 
Interpretation pro\aded? Pallant speaks English fluenUy 
Yitai Sign s 
refused. 
Ex amination 
General E>amination: 
GENER/II.. !>PPE.ARl'NCE: in no acute distress, well del,eloped, well nourished. 
EYES: pur;>ls equal, round, reacti'"' to light and accomrmda tion. 
NECK/THYROID: normal, neck supple, full range of motion. 
EXTREMTIES: no edema, full range of motion, no clubbing, cyanosis, or edema 
PSYCH: alert, oriented. 
Ass essm ents 
Pt choosing not to eat from the food tray.; and refuses medical monitoring. 
Tr eatm ent 
1. Others 
Notes: will continue to check the Mir for his acceptance of the boost and pedialyte. 
Follow Up 
3-4 Day.;, pm 
Appointment Provider:l(b)(6); (b)(7)(C) j MD 
Allergle s 
High calorie boost : diarrhea: $de Effects 
(b)(6); (b)(7)(C) 
Electro nically signed b (b)(6); (b)(7 )(C) Don 10/23/2018 12:56:4 1 (Pacific Daylight Time) 
Sign off status: Comple,rmr-----~ 
Northwest Detention Center 
1623 E J STREET 
TACOMA, WA98421 
Tel1(h\lR\ I 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2 3/1978 Prog reea Ncmi /h\(R\ · /h \/7\(C:\ 11111D 10/22/2018 
/lkte generated by eOinica/Wai<s ElvRIPM &Jt,,ere (....weC/inica/Works.com) 
2019-ICLl-00051 2935 

DHS-ICE-19-0196, 19-0197-N-000117
10 12212018 
Past Medical History 
Hunger strike 
Alla ..... 
U.S. Immigration 
and Customs 
Enfor cement 
Re a son for Appointment 
1. RN D/IIL Y SEGREC'All()II ROONDS 
AMAR,MERGENSANA . . A: 216269802 Su:lloj(b )(~ J 
Facility Code : CSONVWA Housing ea: 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll lunber:~ 
1623 E J STREET, T~ 
Appoimne rt Facility: Northwest Detertion Cert er 
App o intm e nt Provld e r:""l (b-")-'-(6""' ); __ __.! RN
High calorie boost : diarrhea: Side Effects 
History of Pre se nt Illne ss 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? English 
Interpretation pro\aded? Pallent speaks English fluenUy /Detainee able to inform of medical needs in English 
Segregation: 
Segregation Rounds 
ke }OU currentlythinking about killing or harming }Ourself? No 
Do}Ou haw any medical complainls or concems at this time? No 
Was referral made to d inical sen.1ces (lvOIM.P, Dental, M-t, Sick Call)? No 
Examination 
Segregation: 
Segregation Evaluation: Patient has spontaneous speech and ansWE!fS questions appropriately, in no acute distress, 
well de\eoped , well nourished, Patient appears to be v.ithin normal limits of behmior, affect, and cogniti1.e functioning, 
Patient does not appear to ha,e any acute or unresol\ed medical conditions that may worsen in segregation, Patient does 
not appear to h8'e acti,e psychosis, mania, suicidal idealions or l'Klmicidal ideations. 
As se ssment s 
Health M!intenance Related to Segregation Placement 
Ap poinbnent Provider. Kb)(6); _. fN 
Ele ctronically signe d bJ!..._ (b_._)(.._6,..); _ __.fN on 10/22/2018 at 13:48 MST 
Sign off status: Com pleted 
Patient: AMAR, MERGENSANA DOB: 10/23/19 78 p,_.... 
/lkie generaled by eClirica/Wcrks EM<IPM Soltv,ere ("""" 
2019-ICLl-00051 2936 
Northwest Detention Center 
1623 E J STREET 
T WA98421 
Tel: (b)(6); 
RN 10/22/201 8 

DHS-ICE-19-0196, 19-0197-N-000118
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGV'ks.coojl 
2019-ICLl-00051 2937 
AMAR,MERGENSANA . . A: 216269802 Su:lli-J£)(6); I 
Facility Code: CSOINNA II g A ea. n 
39 Y old Male, DOB: 10/23/1978 
AccOl.l'II lunber~ 
1623 EJ STREET, T~ 

DHS-ICE-19-0196, 19-0197-N-000119
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:lld(b )(6): ! 
Facility Code: CSONVWA Housing Area: H 
39Y old Male,~·1 QOJ(1928 
AccOUll l'un /b )/6): I 
10 12112018 
Curnont Medication s 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing miied TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KCP: Yes, Drug 
Source: In House Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 2 tablet with food Daily 
Noon, stop date 01/10/2019, KCP: Yes, Drug Source: In House 
Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 Daily Noon, stop date 
01/10/2019, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Fiber625 t..GTablet2tab letas needed BID.stop date 
04/15/2019, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/'2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, sd'ledule for am and pm PL 
• Boost \iHC - Liquid 1 along with a cup of water Daily Noon, stop 
date 11 /16/'2018, KCP: No, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el, for the noon PL pass 
Past Medlc a l History 
Hunger strike 
Allorglo s 
High calorie boost: diarrhea: $de Effects 
Rea son for Appointment 
1. SEGREG\TlON ROUNDS/ t,,E/ll lvOJITCRING 
History of Pre se nt Illne ss 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? No 
Viral language do }OU speak? English 
Interpretation pro\aded? Pallent speaks English fluenUy 
Segregation: 
Segregation Rounds 
ke }OU currentlythinking about killing or harming }Ourself? No 
Do}Ou ha'"' any medical complaints orconcems at this time? No 
1623 E J STREET, TACOMA, WA-98421 
Appoirimert Facility: Northwest Detertion Certer 
Appointment Provld e r:j(b)(6): (b)(7)(C) fN 
Was referral made to d inical ser.ices (lvOIM.P, Dental, M-t, Sek Call)? No 
Examination 
Segregation: 
Segregation Evaluation: Patient has spontaneous speech and ansWE!fS questions appropriately, in no acute distress, 
weU de\eloped , well nourished, Patient appears to be v.ithin normal limits of beha"or, affect, and cogniti,e functioning, 
Patient does not appear to ha,e any acute or unresol\ed medical conditions that may worsen in segregation, Patient does 
not appear to ha'-"! acti,e psychosis, mania, suicidal idealions or l'Klmicidal ideations. 
As se ssment s 
Health M!intenance Related to Segregation Placement 
Pre vent ive Medic ine 
Patient educated on how to access medical / mental health/ dental care while in Segregation. 
Notes: PER H-SEGREG\TlON GEO a=ACER, DET!'lNEE MS$ED HIS 14TH t,,E/ll WTH BREJ!KFASTHIS ~NING. 
Ap pointment Provi (b)(6); (b)(7)(C) RN 
(b)(6); (b)(7)(C) 
Electro ni call y signed b~(b)(6); __ 
Sign off status: Completed 
fN on 10/21/2018 09:22:53 (Pacific Dayl igh t lime) 
Northviest Detention Center 
1623 E J STREET 
T WA98421 
Tel b)(6); 
Patient: AMAR, MERGENSANA DOIi: 10/23/1 978 P- N~ 10/2 1/2018 
Ncte generated byeOinica!Wai<s E1vRIPM &ltwiJre /"""'eO inica/Works.com) 
2019-ICLl-00051 2938 

DHS-ICE-19-0196, 19-0197-N-000120
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICU-00051 2939 
AMAR,MERGENSANA A: 216269802 Su:lldtn 1/R\ · I 
Facility Code : CSONVWA Housing Area: H 
39 Y old Male, DOB: 10/23/1978 
AccOUll l'iln~ /b)/6) I 1623 E J STREET, TM, HA 9642 I 

DHS-ICE-19-0196, 19-0197-N-000121
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A:216269802 Su:lloj(b)(6); I 
Facility Code : CSONVWA Housing Area: A 
39 Y old Male, C:QP003(1928 
AccOl.lll lunbe d!!1:.a l h-'-\::.a /R-'-\'-· ----' 
1623 E J STREET, TACOMA, WA-98421 
Appoimnert Facility: Northwest Detertion Certer 
10 12012018 
Cunont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15 , stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing miied TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KCP: Yes, Drug 
Source: In House Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 2 tablet with food Daily 
Noon, stop date 01/10/2019, KCP: Yes, Drug Source: In House 
Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 Daily Noon, stop date 
01/10/2019, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Fiber625 t..GTablet2tab letas needed BID. stop date 
04/15/2019, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/'2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, sdledule for am and pm PL 
• Boost \iHC - Liquid 1 along with a cup of water Daily Noon, stop 
date 11 /16/'2018, KCP: No, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el, for the noon PL pass 
Past Medlcal History 
Hunger strike 
Allorglos 
High calorie boost: diarrhea: $de Effects 
Reason for Appointment 
1. SEGREG\TlON ROUNDS/ t,,E/ll lvOJITCRING 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? No 
Viral language do }OU speak? English 
Interpretation pro\aded? Pallent speaks English fluenUy 
Segregation: 
Segregation Rounds 
ke }OU currentlythinking about killing or harming }Ourself? No 
Do}Ou ha'"' any medical complaints orconcems at this time? No 
Appointment Provld e ,f b)/6): (b)(7)(C) plN 
Was referral made to d inical ser.ices (lvOIM.P, Dental, M-t, Sek Call)? No 
Examination 
Segregation: 
Segregation Evaluation: Patient has spontaneous speech and ansWE!fS questions appropriately, in no acute distress, 
weU de\eloped , well nourished, Patient appears to be v.ithin normal limits of beha-.ior, affect, and cogniti,e functioning, 
Patient does not appear to ha,e any acute or unresol\ed medical conditions that may worsen in segregation, Patient does 
not appear to h8'e acti,e psychosis, mania, suicidal idealions or txlmicidal ideations. 
Assessments 
Health M!intenance Related to Segregation Placement 
Preventive Medicine 
Patient educated on how to access medical / mental health/ dental care while in Segregation. 
Notes: PER H-SEGREG\TlON GEO a=ACER, DET!'lNEE MS$ED HIS 11 TH t,,E/ll WTH BREJ!KFAST THIS ~NING. 
Appointment Provide r: (b )(6); /1,.,.\(""7\(,,....\ 
(b)(6); (b)(7)(C) 
Electronically signed b (b)(6); 
Sign off status: Comple th " 7 "r' 
RN 
on 10/20/201811 :52:07 (Pacific Daylight lime) 
Northviest Detention Center 
1623 E J STREET 
l'. WA98421 
Tel /b)/6) x: 
Patient: AMAR, MERGENSANA DOIi: 10/23/1 978 P..,.... N-f: b)(6); ~· IRN 10/20/2018 
Ncte generated byeOinica!Wai<s E1vRIPM &ltwiJre ("""'eO inica/Works.com) 
2019-ICLl-0005 1 2940 

DHS-ICE-19-0196, 19-0197-N-000122
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A:216269802 Su:ll~(b)(6); 7 
Facility Code : CSONVWA Housing Area: A 
39 Y old Male, DOB: 10/23/1978 
AccOl.llt ~be rj,1_ \/,,...\. 
10 /19/2018 
Cunont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\e l 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing miied TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\e l, see attached ser.ing mi>l!ure older 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\e l 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KCP: Yes, Drug 
Source: In House Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 2 tablet with food Daily 
Noon, stop date 01/10/2019, KCP: Yes, Drug Source: In House 
Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 Daily Noon, stop date 
01/10/2019, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Fiber625 t..GTablet2tab letas needed BID.stop date 
04/15/2019, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/'2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, sdledu le for am and pm PL 
• Boost \iHC - Liquid 1 along with a cup of water Daily Noon, stop 
date 11 /16/'2018, KCP: No, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el, for the noon PL pass 
Past Medlc al History 
Hunger strike 
Allorglos 
High calorie boost: diarrhea: $de Effects 
1623 E J STREET, TACOMA, WA-98421 
Appoimnert Facility: Northwest Detertion Cert er 
Appointment Provld e 1 (b)(6) ; (b)(7)(C) pDs 
Reas on for Appointment 
1. DEN: toothache "fv'\,tooth is sensiti'"' to chewing." 0/10 pain 
History of Pre se nt Illness 
Dental: 
Dental (Subjecti'"') 
Location of Evaluation PaUent evaluated in clinic 
ke )OU currently in pain? No 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: Wist Band,ID Badge,Picture 
Chaperone Present? Yes 
ROH: !(b)/6): J CDR 
Wiat language )OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number 
Number 11528095 
Language Russian 
Yitai Signs 
97.9F 
71 /min 
100/66mm Hg 
16/ min 
147 lbs 
66.Sin 
23.37 Index 
Ex amination 
General Examination: 
Temo 
10/1912018 09:04:25 PM 
HR 
10/1912018 09:04:25 PM 
BP 
10/19/2018 09:04:25 PM 
RR 
10/1912018 09:04:25 PM 
Wt 
10/1912018 09:04:25 PM 
H 
10/19/2018 09:04:25 PM 
BMI 
10/1912018 09:04:25 PM 
(b)(6); 
(b)(7)(C) 
Limited problem focused e,am. Mldical historyre~ewed, NKDA Bowel irritation to high calorie boost Re~ewed digital 
radiograph on file. Tooth#15 has endodontic obturation with onlybuccal cusps remaining. Peri apical radiolucencypresenl 
Tooth#15 is tender to percussion and palpation. Gingiva appears normal in color and texture. 
Assess ments 
Tooth#15, secondary canal reinfection, broken tooth. 
Treatmen t 
1. Others 
Notes: Clinical findings were explained to patient and appointment was made fore>dradion oftooth#15. Oal h)Qiene 
instructions were gi'"'n. Patient was instructed to contact dental sick call if S)Olptoms worsen. 
Proc edures 
Dental Evaluation: 
Radiograph: Tooth #15, re,.iewed digital radiograph on file. 
~OS 
-
-,os 
--)OS 
-
-)OS 
-
-,os 
-
-)OS 
-
-
)OS 
-
Dental faa luation: Limited problem focused oral exam completed. Dental medical history form re,.iewed . Ciscussed 
findings and options wt h patient and reappointed for treatment. 
Education: Oral hygiene instructions gi1.er1. 
Disposition: Patient instructed to notify dental through sick call if symptoms \I\OISen. Patient l.elbalizes understanding 
of all instructions. 
Procedure Codes 
D0140 LTD ClRl>l_ EV/llUATlON - PROOLEMFOCUS 
D1330 ClRl>l_ HYGIENE INSTRUCTIONS 
Appointment Provider:l(b)(6); ~-
Bectronically signed t,i,.,_ (b~}c:.. (6::}.:.. ; __ _.posn 10/1912018 09:10:57 (Pacific Daylight Time) 
Sign off status: Comp leted 
2019-ICLl-00051 2941 
Northwest Detention Center 
1623 E J STREET 
TACOMA, WA98421 
Tel: !lh \/R\ I FdX. 

DHS-ICE-19-0196, 19-0197-N-000123
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Prog,_u No 10/19/2018 
Nd.e general.eel by eC/irdcal.Wm<s B,RIPM Softvere {lw.W 
2019-ICLl-00051 2942 

DHS-ICE-19-0196, 19-0197-N-000124
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA A:21626980 2 Su:ll...:fb)(6)· Facility Code: CSONVWA s ' 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunber~ 
1623 E J STREET, T~ 
Appoirimert Facility: Northwest Detertion Certer 
10 /19/2018 
Curnont Medication s 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing miied TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KCP: Yes, Drug 
Source: In House Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 2 tablet with food Daily 
Noon, stop date 01/10/2019, KCP: Yes, Drug Souroe: In House 
Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 Daily Noon, stop date 
01/10/2019, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Fiber625 t..GTablet2tab letas needed BID.stop date 
04/15/2019, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/'2018, KCP: 
No, Drug Souroe: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \iHC - Liquid 1 along with a cup of water Daily Noon, stop 
date 11 /16/'2018, KCP: No, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el, for the noon PL pass 
Past Medlc a l History 
Hunger strike 
Allergle s 
High calorie boost: diarrhea: $de Effects 
Rea son for Appointment 
1. RN D/IIL Y SEGREC'All()II ROONDS 
History of Pre se nt Illne ss 
Patient Identification: 
Patient Identification 
Patient property identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Viral language do }OU speak? English 
App o intm ent Provld e 1 (b)(6) ; (b)(?)(C) f" 
Interpretation pro\aded? Pallant speaks English fluenUydetainee able to respond in English as to their medical condillon 
1'm good" or ''Doing Ane"to more colorful/ language 
Segregation: 
Segregation Rounds 
ke }OU currentlythinking about killing or harming }Ourself? No 
Do}Ou ha'"' any medical complaints or concerns at this time? No 
Was referral made to d inical ser.ioes (lvOIM.P, Dental, M-t, Sek Call)? No 
Examination 
Segregation: 
Segregation Evaluation: Patient has spontaneous speech and ansWE!fS questions appropriately, in no acute distress, 
well_ de\eloped , well nourished, Patient appears to be v.ithin l"<lllTlalimits of beha"or, affect, and cogniti1.e functioning, 
Patient does not appear to ha,e any acute or unresol\ed medical conditions that may worsen in segregation, Patient does 
not appear to ha\e acti,e psychosis, mania, suicidal idealions or homicidal ideations. 
Asse ssment s 
Health M!intenanoe Related to Segregation Plaoement 
Tre a tment 
1. Others 
Notes: Refused his tray this morning -Jllso has a kite in for dental pain -
Reported to ha'"' eaten an orange last night at dinner along with his pill line supplements. 
Appointment Provider: (b )(6); / h \/ 7 \ff'\ 
Bectronically signed b (b)(6); 
Sign off status: Comple / h ,n,rr 1 
on 10/19/2018 at 12:36 MST 
Northwest Detention Center 
1623 E J STREET 
T~~A 98421 
Telfac~f I 
Patien1: AMAR, MERGENSANA DOB: 10/23/1 978 p,__ ~ RN 10/19/2018 
/lkxe generated bye0irica/Wc11<s El>R'PM So/rv.ere (w.w,eQinica/Wcrks.com/ 
2019-ICLl-00051 2943 

DHS-ICE-19-0196, 19-0197-N-000125
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:llDtl h \/R\ ! 
Facility Code: CSONVWA Housing Area: A 
39Y old Mal~, AccOllll l'unbe b )(6); 
10 /18/2018 
Curnont Medication s 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing miied TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KCP: Yes, Drug 
Source: In House Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 2 tablet with food Daily 
Noon, stop date 01/10/2019, KCP: Yes, Drug Source: In House 
Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 Daily Noon, stop date 
01/10/2019, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Fiber625 t..GTablet2tab letas needed BID.stop date 
04/15/2019, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 1 BID, stop date 11/16/'2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I, schedule for am and pm PL 
• Boost \iHC - Liquid 1 along with a cup of water Daily Noon, stop 
date 11 /16/'2018, KCP: No, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el, for the noon PL pass 
Past Medlc a l History 
Hunger strike 
Allergle s 
High calorie boost : diarrhea: $de Effects 
1623 E J STREET, T 
Appoimnert Facility: Northwest Detertion Certer 
Rea son for Appointment 
1. RN D/IIL Y SEGREC'All()II ROONDS 
History of Pre se nt Illne ss 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Viral language do }OU speak? English 
App o intm ent Provid e b)(6); 
bl(? )(C) 
Interpretation pro\aded? Pallent speaks English fluenUy Detainee able to express medical needs in English -
Segregation: 
Segregation Rounds 
ke }OU currentlythinking about killing or harming }Ourself? No 
Do}Ou ha'"' any medical complainls or concerns at this time? No 
Was referral made to d inical ser.ices (lvOIM.P, Dental, M-t, Sek Call)? No 
Examination 
Segregation: 
RN 
Segregation Evaluation: Patient has spontaneous speech and ansWE!fS questions appropriately, in no acute distress, 
weU de\eloped , well nourished, Patient appears to be v.ithin normal limits of beha"or, affect, and cogniti,e functioning, 
Patient does not appear to ha,e any acute or unresol\ed medical conditions that may worsen in segregation, Patient does 
not appear to ha'-"! acti,e psychosis, mania, suicidal idealions or txlmicidal ideations. 
As se ssment s 
Health M!intenance Related to Segregation Placement 
Tr e atm ent 
1. Others 
Notes: It was noted that as of this mornings breakfast he has missed 6 meals. 
Ap pointment Provi de (b)(6); lh\/ 7 \tr\ 
B ectro ni call y signed b* b)(6) ; ~· 
Sign off status: Completed 
r on 10/18/2018 at 08:29 MST 
Northwest Detention Center 
1623 E J STREET 
T~~[ 00{F : ~8421 1 
Patien1: AMAR, MERGENSANA DOB: 10/23/1 978 p,__ "°1~/~~/ ;,_, I RN 10/18/2018 
/lkxe generated by eOirica/Wcxi<s 8"R/PM Sotr.ere (w.w,eQinice/Works.con1 
2019-ICLl-00051 2944 

DHS-ICE-19-0196, 19-0197-N-000126
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA A: 216269802 Su:llDt(b \/6\ 
Facility Code : CSONVWA Housing Area : D 
39 Y ad ~l e, iJt::: 
1623 E ~= ~~ ~ = I 
Cunent -dlcatlons 
Taking 
• Calcium 500/0 500-200 M:;-UNITTablet 1 tablet with food Oice 
a day, KOP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Filed Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 M3Tablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/0 500-200 M:;-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra;el 
• Fiber625 M3Tablet 1 tablet as needed BID,stopdate 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for traw l 
• Cholecalciferol 2000 UNIT Tablet 1 tablet ()-IS, stop date 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for traw l 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed no, stop date 
10/26/2018, KOP: No, Drug Source: In House Pharmacy, Notes: Not 
required for traw l, see attached ser.ing mildure order 
• fl<:etaminophen 500 M3 Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra;el 
• Pedial>4e- Solution 1 BID, stop date 01/10/2019, KOP: Yes, Drug 
Source: In House Pharmacy 
• Calcium 500/0 500-200 M:;-UNITTablet 2 tablet with food Daily 
Noon, stop date 01/10/2019, Ka>: Yes, Drug Source: In House 
Pharmacy 
• Fiber625 M3Tablet 1 tablet as needed BID,slopdate 
01/10/2019, Ka>: Yes, Drug Source: In House Pharmacy 
• Boost Glucose Control - Liquid 1/2 boxmi>ed no, stop date 
12/11/2018, Ka>: No, Drug Source: In House Pharmacy 
• Boost \iHC- Liquid 112 boxmi>ed no, stop date 12/11/2018, 
KOP: No, Drug Source: In House Pharmacy 
• Ensure High Protein- Liquid 1 a-IS, slop date 10/22/2018, KOP: 
No, Drug Source: In House Pharmacy 
• Prenatal \Atamin Fi>ed Dose Tablet 1 Daily Noon, slop date 
01/10/2019, Ka>: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for traw l 
Past Medical Hlatory 
Hungersb'ike 
All rgl■s 
High calorie boost : diarrhea: $de Effects 
Reason for Appointment 
1. Clarify nutritional supplements for segregation 
Treatment 
1. Others 
Stop Fiber Table~ 625 M3, 1 tablet as needed, Oal ly, BlD, 90 day.;, 180 Table~ KOP: Yes, Drug Source: In House Pharmacy 
Stop Boost Glucose Control Liquid, -, 1/2 box mixed, Oally, no, 60 day.;, 1, KOP: No, Drug Source: In House Pharmacy 
Stop Boost'vHC Liquid,-, 1/2 box mixed, Oally, no, 60 day.;, 1, KOP: No, Drug Source: In House Pharmacy 
Stop Ensure High Protein Liquid, -, 1, Oally, a-IS, 10 day.;, 1, KOP: No, Drug Source: In House Pharmacy 
Start Fiber Table~ 625 M3, 2 tablet as needed, Oal ly, BlD, 180 day.;, 720 Table~ KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for traw l 
Start Boost Glucose Control Liquid, -, 1, Oally, BlD, 30 day.;, 1, KOP: No, Drug Source: In House Pharmacy, Notes: Not required 
for traw l, schedule for am and pm Pl 
Start Boost 'vHC Liquid,-, 1 along with a cup of water, Oa lly, Daily Noon, 30 day.;, 1, KOP: No, Drug Source: In House Pharmacy, 
Notes: Not required for traw l, for the noon Pl pass 
Tel: 
Fax: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progress Note: 
Ncte generated byeC/inical\M:xi<s a.R/PM &Jt,,ere /"""'eC/ inlca/Works.com) 
2019-ICLl-00051 2945 

DHS-ICE-19-0196, 19-0197-N-000127
10/17/2018 
........ 
High calorie boost : diarrhea: !'.de Effects 
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGE~ A: 216269802 Si.ti1 ,b )(6); ~, Facility Code : CSONVWA . 
~ 
Reason for Aflpolntment 
1. Daily rounds 
Appointment Providefb )(6); (b)(7)(C) ro 
39Y ad ~:ic:: 1623 E J~~=I~ Ji)j= I 
Appoirimert Facility: Northwest Detertion Certer 
Aflpolntment Provider: Sheri lllalakllova, MD 
b)(6); (b)(7)(C) 
Electronically signed b~(b)(6); (b)(7)(C) r,10 on 11/1612018 at 07:27 MST 
Sign off status: Pending 
Northwest Detention Center 
1623 E J STRE£r 
TACOMA, WA98421 
Tel~b)(6); j 
Patient: AMAR, IIIERGENSANA DOB: 10/2311978 111D 10/17/2018 
Nole generated by eC/inica/Wcrl.s a.RIPM Sottv.ere ("""' tl>C 
2019-ICLl-00051 2946 

DHS-ICE-19-0196, 19-0197-N-000128
U.S. Immigrat ion 
and Customs 
Enforcement 
AMAR, ~2~!~2~l!~! 
Facility Code: CSONVWA Housing ea: 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll lunbe~ 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
10 /17/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Fi>ed Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15 , stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KCP: Yes, Drug 
Source: In House Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 2 tablet with food Daily 
Noon, stop date 01/10/2019, KCP: Yes, Drug Source: In House 
Pharmacy 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
01/10/2019, KCP: Yes, Drug Source: In House Pharmacy 
• Boost Glucose Control - Liquid 1/2 boxmi>ed TIO, stop date 
12/11/2018, KCP: No, Drug Source: In House Pharmacy 
• Boost\iHC - Liquid 1/2 boxmi>ed TIO, stop date 12/11/2018, 
KCP: No, Drug Source: In House Pharmacy 
• Ensure High Protein- Liquid 1 QI-IS, stop date 10/22/2018, KCP: 
No, Drug Source: In House Pharmacy 
• Prenatal \Atamin Fi>ed Dose Tablet 1 Daily Noon, stop date 
01/10/2019, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
Past Medlc al History 
Hunger strike 
Allergles 
High calorie boost: diarrhea: $de Effects 
Reas on for Aflpolntment 
1. RN D/IIL Y SEGRECATI()II ROONDS 
History of Pres ent Illn ess 
Patient Identification: 
Patient Identification 
Aflpolntment Prov1c1e 9 (b) (6) ; (b)(7)(C) I RN 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? English Detainee able to express medical needs adequately 
Interpretation pro\aded? Pallent speaks English fluenUy 
Segregation: 
Segregation Rounds 
ke }OU currentlythinking about killing or harming }Ourself? No 
Do}Ou ha'"' any medical complaints orconcems at this time? No 
Was referral made to d inical ser.ices (lvOIM.P, Dental, M-t, Sek Call)? No 
Examination 
Segregation: 
Segregation Evaluation: Patient has spontaneous speech and ansWE!fS questions appropriately, in no acute distress, 
weU de\eloped , well nourished, Patient appears to be v.ithin normal limits of beha"or, affect, and cogniti,e functioning, 
Patient does not appear to ha,e any acute or unresol\ed medical conditions that may worsen in segregation, Patient does 
not appear to ha'-"! acti,e psychosis, mania, suicidal idealions or txlmicidal ideations. 
Assessments 
Health M!intenance Related to Segregation Placement 
Appoinbnent Provide~(b)(6); (b)(7)(C) I RN 
Electronically signed (b)(6); 
Sign off status: Comple.'r.h.;';:.' ..:.71.::. 1:... r ..:. 1 __ _, 
on 10/17/2018 09:38:08 (Pacific Daylight Time) 
Northwest Detention Center 
1623 E J STREET 
TACOMA, WA98421 
,e!(b)(6); (b)(7)(C) ! 
Patient: AMAR, MERGENSANA DOB: 10/2311978 Prog .... Ncmij(b)(6); (b)(7)(C) I RN 10/17/2018 
/lkie generaled by eClirica/ Wcrks EM</PM Soltv,ere (""""eClinica/Works.com) 
2019-ICLl-00051 2947 

DHS-ICE-19-0196, 19-0197-N-000129
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A:216269802 Su:llol(b)/6): ! 
Facility Code: CSONVWA Housing Area: M 
39 Y AccOI.D ad Ma~'!::: lffllj,e{§ )(6); 
10 /16/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Fi>ed Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KCP: Yes, Drug 
Source: In House Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 2 tablet with food Daily 
Noon, stop date 01/10/2019, KCP: Yes, Drug Source: In House 
Pharmacy 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
01/10/2019, KCP: Yes, Drug Source: In House Pharmacy 
• Boost Glucose Control - Liquid 1/2 boxmi>ed TIO, stop date 
12/11/2018, KCP: No, Drug Source: In House Pharmacy 
• Boost\iHC- Liquid 1/2 boxmi>ed TIO, stop date 12/11/2018, 
KCP: No, Drug Source: In House Pharmacy 
• Ensure High Protein- Liquid 1 OliS, stop date 10f22f2018, KCP: 
No, Drug Source: In House Pharmacy 
• Prenatal \Atamin Fi>ed Dose Tablet 1 Daily Noon, stop date 
01/10/2019, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
Past Medlcal History 
Hunger strike 
Allergles 
High calorie boost: diarrhea: Side Effects 
Review of Systems 
General/Constitutional: 
Fe'"'r denies. Headache denies. Lighlheadedness denies. 
Sleep disturbance denies. 
1623 E J STREET, T v 
Appoirimert Facility: Northwest Detertion Certer 
Reason for Appointment 
1. SEG CLE/IRl>NCE 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: Cff/C ERfilill] 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Name 
Name: 
Language Russian Cff/CE 4(b \/6 I 
Pain Assessment 
Pain 
ke }OU currently in pain? No 
Segregation: 
Segregation Clearance 
Evaluated for Segregation Placement on: 10/16/2018 
ke }OU currentlythinking about killing or harming }Ourself? No 
Do}Ou ha'"' any medical complaints prior to going into segregation? No 
ChartRe\aew 
Appointment Provlder:t b)(6) ; - · 
History of mental illness or ha'"' any mental health encounters at current facility? No 
Unresoll<!d or acute medical problems that contraindicate Segregation housing? No 
klions Taken 
/l!)pointment created or telephone encounter assigned to l\0 /PPP, Dental, M-1, or SC? No 
Vital Signs 
REFUSED. 
Ex amination 
Segregation: 
Segregation Evaluation: Patient has spontaneous speech and answers questions appropriately, in no acute distress, 
v.eU de\eloped , v.ell nourished, Patient appears to be \l.ithin normal limits of behal.ior, affect, and cogniti'"' functioning, 
Patient does not appear to ha'"' any acute or unresol~ medical conditions that may IM'.lrSen in segregation, Patient does 
not appear to ~ acti'"' psychosis, mania, suicidal ideations or tximicidal ideations. 
Time at which re\aew for segregation was completed: 1625. 
Assessments 
Health Maintenance Related to Segregation Placement 
Treatment 
1. Others 
Notes: ResidenVdetainee placed in segregation by ICE/security. IVedical chart re"ewed and no contraindications found at this 
time. No special accommodations required. VS taken. Patient assessed and denies any medical needs or injuries at this time. , 
IVedications placed on pill line - Pt educated on how to access medical/mental health/dental care while in Segregation, PT 
'"'rba liied understanding. 
Procedu re Codes 
T1013 Sign Lang/0-al Interpreter 
Disposition: IVedicallydeared for custody 
Appointment Provide~(b)(6) ; IRN 
Electronically signed ~ (b)(6); _. F, RN on 10/16/2018 16:33:52 (Pacific Daylight Time) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREET 
T~!A9 842i Tel: §~6[ __ 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 Progresa Note{b)(6); ~ 10/18/2018 
/lk:ie generaled by eC/irica/ Wcrks aR/PM $oltv.ere ("""'eC/inica/Works.com) 
2019-ICLl-0005 1 2948 

DHS-ICE-19-0196, 19-0197-N-000130
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A:216269802 Su:l1D: !(b)(6); I 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll lunber~ 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Cert er 
10 11612018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Fi>ed Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KCP: Yes, Drug 
Source: In House Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 2 tablet with food Daily 
Noon, stop date 01/10/2019, KCP: Yes, Drug Source: In House 
Pharmacy 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
01/10/2019, KCP: Yes, Drug Source: In House Pharmacy 
• Boost Glucose Control - Liquid 1/2 boxmi>ed TIO, stop date 
12/11/2018, KCP: No, Drug Source: In House Pharmacy 
• Boost\iHC- Liquid 1/2 boxmi>ed TIO, stop date 12/11/2018, 
KCP: No, Drug Source: In House Pharmacy 
• Ensure High Protein- Liquid 1 QI-IS, stop date 10/22/2018, KCP: 
No, Drug Source: In House Pharmacy 
• Prenatal \Alamin Fi>ed Dose Tablet 1 Daily Noon, stop date 
01/10/2019, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
Past Medlcal History 
Hunger strike 
Allergles 
High calorie boost : diarrhea: Side Effects 
Review of Systems 
General/Constitutional: 
Fe'"'r denies. Headache denies. Lighlheadedness denies. 
Sleep disturbance denies. 
Reason for Appointment 
1. tvHU - Discha,ye from tvHU 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: Oncerftiil 
Viral language do }OU spe~ Russian 
Interpretation p!T ? Yes, Interpreter Name 
Name : Oncer b )( 
Language Ru 
Pain Assessment 
Pain 
ke }OU currently in pain? No 
11/edical Housing Unit 
Discha,ye 
Special Diet Yes, see Special Needs 
/lcti"ties : As tolerated 
CafeteriaMb rk Clearance: Mly return to oorl< 
Date of Discha,ye: 10/16'2018 
Ti me of Discha,ye (Hours and minutes) : 1630 
Total number of da)S in irrfirmary 43 
Disposition: Release to custody for housing 
Vital Signs 
REFUSED. 
Ex amination 
General Examination: 
Appointment Provlde,+::._~--')..,_(6-'-).,_; _ ___.! RN 
GENERl>l !>PPE.ARl'NCE: in no acute distress, well del,eloped, well nourished. 
HE.ART: no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, nowieezes , rales, rhonchi. 
PSYCH: alert, oriented. 
Assessment s 
1. Imbalanced nutrition: Less than body requirements [00002] - ND00002 (Primary) 
Treatment 
1. Imbalanced nutr~ion: Less than bo<tj requiremerts (00002] 
Notes: Instructed on health maintenance, access to medical program using sick call slips. Instructed to eat 3 meals per day as 
pro'-'ded, drink 2-3 liters fluid per day, h19iene and prel<:!ntion of spread of infections. Detainee '"'rbalized understanding. 
Procedure Codes 
T1013 Sign Lang/0-al Interpreter 
Disposition: 11/edicallydeared for custody 
Appointnnent Provid1(b)(6); ~· I RN 
Bectronically signed b~ b)(6); 
Sign off status: Completed 
~ , RN on 10/16/2018 16:29:21 (Pacific Daylight Time) 
Northwest Detention Center 
1623 E J STREET 
TACOMA, WA98421 
Tell /h \(n\ I FaX. 
Patie nt: AMAR, MERGENSANA DOB: 10/23/1978 ProgreH Notei(b)(6); I RN 10/18/2018 
/lkie generated byeOirica/Wcrlcs aR/PM ~ e {WNNeC/inicEiWorks .Cf:NT9 
2019-ICLl-00051 2949 

DHS-ICE-19-0196, 19-0197-N-000131
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
.. A:216269802 Su:ll~b )(6); J 
Fac1lrtyCode:CSOINWA ng ,c;ea.1 
39 Y old Male, DOB: 10/23/1978 
AccOllll lunber irh\/R\· I 
10 /16 /2018 
Cunont Medication s 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Fi>ed Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KCP: Yes, Drug 
Source: In House Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 2 tablet with food Daily 
Noon, stop date 01/10/2019, KCP: Yes, Drug Souroe: In House 
Pharmacy 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
01/10/2019, KCP: Yes, Drug Souroe: In House Pharmacy 
• Boost Glucose Control - Liquid 1/2 boxmi>ed TIO, stop date 
12/11/2018, KCP: No, Drug Source: In House Pharmacy 
• Boost\iHC- Liquid 1/2 boxmi>ed TIO, stop date 12/11/2018, 
KCP: No, Drug Souroe: In House Pharmacy 
• Ensure High Protein- Liquid 1 QI-IS, stop date 10/22/2018, KCP: 
No, Drug Souroe: In House Pharmacy 
• Prenatal \Atamin Fi>ed Dose Tablet 1 Daily Noon, stop date 
01/10/2019, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"' I 
Past Medlc a l History 
Hunger strike 
Allorglos 
High calorie boost : diarrhea: Side Effects 
Review of Syst ems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness admits. 
Sleep Disturbanoe denies. \r\leighlloss admits. Dry 
M:>uth denies. \r\leakness admits. Cough denies. Shortness of 
breath at rest denies. Palpitations denies. /lodominal 
Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \bm itting denies. Painful urination denies. 
Decreased urine output denies. MJsde aches denies. MJscie 
cramps denies. Skin breakdown denies. Difficulty thinking denies. 
1623 E J STREET, TACOMA, WA-98421 
Appoirimert Facility. Northwest Detertion Certer 
Reas on for Appointm ent 
1. RN day round/hunger strike 
History of Prese nt Illne ss 
Fiowsheets (M-tU): 
Hungerstrike M:>nitoring Form 
Day. 10/16/2018 
Shift: AM 
Intake PO(in ml): 2700 
Intake r.J- Normal Saline (in ml): 0 
Intake r.J- LR (in ml): 0 
Intake NG(in ml): 0 
QJlput Urine (in ml): 2500 
QJlput Bowel M:>'"'ments (in ml): 1 
Comments: PT A TE 100% SUCK LUNCH AND c»JE APPLE 
Initials: LM 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEOCEF/CER 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Provider fluent in pallenrs nallve language 
Pain Assessment 
Pain 
/l<e }OU currently in pain? Yes 
The pain is located .-back and legs 
The se'"'rityof pain is rated at 2110 
The se'"' rityof the pain is moderate 
The pain began 4-5 v.eeksago 
The character of the pain is aching 
The associated S}'llploms are v.eakness 
The pain is aggravated by other hunger strike 
The pain is reliel<!d by other 
Describe: pt refused medication treatment 
Narrati'"': 
Appointment Provld e rf b)(6) ; ~-
Patient is oonsidered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observation, and monitoring. 
_ Pl was in M-IU IIIED 2 Upon enoounter detainee was resting quietly in bed. Detainee reported weakness, lightheaded, and 
pain on his legs and back , but refused PRN pain meds.11/edication oomplianl \MIi oontinue to monitor. 
Pl refused lunch tray, BUT 11-ilS NURSE BR()JGIHT FRCMINT/!KE SUCK LUNCH, />ND PT ATE 100% $/!CK LUNCH IN 
\M-IICH WPS OR/INGE, mo PllDffi(X,j/!lL Y PN PPPLE. Pl asked if eating suck lunch will take him out of hunger strike, this 
nurse e,q:,lained to pt that eating a fruit will not take him away from hunger strike, but the nurse doesnt hase information about 
eating whole sack lunch. Memoon pt went to re~rd . pt refused wheelchair. \MIi oontinue to monitor. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
\Mien did the official hunger strike begin? 08/25'2018 
Date of last meal oonsumed: 08/22/2018 
Last meal oonsumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wcints to be released from custody 
/ldequate supply of drinking water and other beserages available: Yes 
Three meals deli'"'red per day to detainee: Yes 
Lunch 100% oonsumed SACK LUNCH 
/lnyunauthoriiedfood inroom? No 
Ha'"' dailyorthostatic lial signs been oompleted? Yes 
Has input and output been documented on the M-IU Hunger Strike M:>nitoring Smart Form? Yes 
Vit a l Sign s 
97.7F 
standing:80 
silling:69 
supine:50 
standing:93/63 
sitting:91/55 
supine:97/58 
16 /min 
142.6 lbs 
66.Sin 
22.67 Index 
Examina tion 
General Examination: 
Tern~ 
10/16/2018 09:08:55 PM 
HR 
10/16/2018 09:08:55 /lM 
10/16/2018 09:08:55 /lM 
10/16/2018 09:08:55 /lM 
BP 
10/16/2018 09:08:55 /lM 
10/16/2018 09:08:55 /lM 
10/16/2018 09:08:55 /lM 
RR 
10/16/2018 09:08:55 /lM 
1M 
10/16/2018 09:08:55 /lM 
H 
10/16/2018 09:08:55 /lM 
BMI 
10/16/2018 09:08:55 /lM 
GENER/II.. !>PPEl>Rl'NCE: in no acute distress, well del.eloped, well nourished. 
HEJ>D: normocephalic. 
SKIN: normal, no rashes, no suspicious lesions. 
HEART: no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilate,ally, nowieezes, rales, rhonchi. 
CHEST: normal, no gross rib deformity, normal shape and expansion. 
JIBDO'vEN: normal, boNel sounds present, soft, nontender, nondistended. 
MJSCULOSKELET/ll : normal, normal gait, no deformities, full range of motion, . 
(b )(6); 
(b)(?)(C) 
NEUROLOGIC: alert and oriented, cooperatise with exam, , gait normal, neck supple, no rigidity, no tremor. 
2019-ICLl-00051 2950 
~ N I￾I￾RN 
RN 
RN 
I￾I￾RN 
RN 
RN 
-
~ 
-I￾RN 
-
~ I-
~ 

DHS-ICE-19-0196, 19-0197-N-000132
PSYCH: alert, Oliented, cogniti\El function intact, cooperati\El v.ith exam, good eye contact, judgement and insight 
good, mood/affect full range, no auditory or \isual hallucinations, speech clear, thought content v.ithout suicidal ideation, 
delusions, thought process logical, goal directed. 
Assessments 
Ill-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: 1. Continue with Othostatic 'vltal Signs e\Elryday, Intake and Qnput M>nitoring e1.eryshift; Dailyweights; 2. kl adequate 
supply of drinking water and other be1.erages are available to patient at all times. 3. Three meals per day are deli1.ered to the 
patient and deli\Elryof meals is documented. 4. ~I food not authoriied byCDiPhy.;iclan is remo\Eld from patienfs room. 5. Patient 
is not allowed to purchase food from commissary\ending machine while on hunger strike. 6. Patient will only be released from 
hunger strike treatment/monitoring by CD or phy.;iclan order. 7. Patient counseled regarding the medical risks of continuing the 
hunger strike. 8. Enoouraged to terminate the hunger strike and eat/drink as normal. Continue hunger strike protocol, encourage 
po food/fluids, enoourage 1.erbali:zation offeelings. Encourage to allow staff to monitor intake and output, lital signs, wt Instructed 
to seek staff with any needs. Verbaliied understanding. Detainee offered three meals perdayand lea1.e in room for20 to 30 
minutes. Enoourage dailyo ral/phy.;ical h:,giene care. Change of clothing/bedding . Offer BCX)ST and Pedil)le as ordered. Patient 
educated to possible Side Effeds of going for long period of time without food. Patient 1.erbaliies understanding of rurrent Plan of 
Care. Patient 1.erbali,es his option to refuse food. 
Appointment Provlderf b )(6): I RN 
Electronically signed bi<b)(6); ~- fN on 10/16/201814:22:10 (Pacific Daylight Tlme) 
Sign off status: Completed 
Northwest Detention Center 
1623 E. J STREEr 
T WA9842 1 
Tel (b)(6): 
P.tlent: AMAR, IIERGENSANA DOB: 10/23/1978 Progr9as No (b)(6); RN 10/16/2018 lh\/ 7 \/r"'\ 
Ncxe generated byeOirica/Wo-lcs EM>IPM ~e (w.w,eQiniceiWtxks.Cf:N11 
2019-ICLl-00051 2951 

DHS-ICE-19-0196, 19-0197-N-000133
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:llC/h \/R \· i 
Facility Code : CSONVWA Housing Area: D 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunbe~ 
1623 E J STREET, T~ 
Appoirimert Facility: Northwest Detertion Cert er 
10 /16/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Fi>ed Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KCP: Yes, Drug 
Source: In House Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 2 tablet with food Daily 
Noon, stop date 01/10/2019, KCP: Yes, Drug Source: In House 
Pharmacy 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
01/10/2019, KCP: Yes, Drug Source: In House Pharmacy 
• Boost Glucose Control - Liquid 1/2 boxmi>ed TIO, stop date 
12/11/2018, KCP: No, Drug Source: In House Pharmacy 
• Boost\iHC- Liquid 1/2 boxmi>ed TIO, stop date 12/11/2018, 
KCP: No, Drug Source: In House Pharmacy 
• Ensure High Protein- Liquid 1 QI-IS, stop date 10/22/2018, KCP: 
No, Drug Source: In House Pharmacy 
• Prenatal \Atamin Fi>ed Dose Tablet 1 Daily Noon, stop date 
01/10/2019, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
Past Medlcal History 
Hunger strike 
Allergles 
High calorie boost : diarrhea: Side Effects 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fe'"'r denies. Headache denies. Lighlheadedness denies. Night 
sweats denies. Sleep disturbance denies. 1/Veight gain denies. 
1/Veight loss denies. 
Gastrointestinal: 
Constipation denies. Diarrhea denies. Difficulty 
swallowing denies. Heartburn denies. Nausea denies. 1/Veight 
loss denies. 
Mlsru loskeletal: 
Joint stiffness denies. M.Jsde aches denies. Painful 
j oints denies. 
Aflpolntment Provlde1 b)(6) ; (b)(7)(C) 
Reason for Aflpolntment 
1. Daily rounds 
History of Present Illness 
Patient Identification: 
Pt has continued to drink boost and pedial)le. Mer refusing lunch tray he then ate complete lunch snack. Pt would not admit 
to gi\<ng up his hunger strike but could not explain whyhe was eating the snack. He is wanting to be able to eat/drink adequate 
calories and stay on hunger strike. But he no longer qualifies as being on official hunger strike. He is told he does not need to be 
housed in M-tU for any medical reason and was asked about his preference in housing after discharge. He has asked to be 
mol<!d to D3 segregation rather than go to general population for undisdosed reasons. i't this time, his boost will not be OC'd . 
\Ille will waitto see if he continues to eat 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? Russian 
Interpretation pro\<ded? Yes, Interpreter Number 
Number : Uonbridge at 14:45 
Language Russian 
Pain Assessment 
Pain 
/>,e }OU currently in pain? No 
Narrati'"': 
Official Hunger Strike Report: 
Diagnosis: End of Hunger Strike 
Mssed meals monitoring initiated: 08/2212018 
Official hunger strike date: 08/25/2018 
Date last meal consumed: 10/16/2018 
Last meal consumed: Full Sack Lunch including eldra frui~ and calorie supplement drinks 
Reason for Hunger Strike: Wants to be released from custody 
# of days missed meal monitoring: 52 
# of days on hunger strike: 51 
Initial weight at missed meal monitoring: 163.0 LBS 
Date of initial weight 08/2212018 
Date of current weight 10/16/2018 
Currentweighli n pounds: 142.6 LBS 
Total weight loss: 18 LBS. 
Vit a l Signs 
97.7F 
69/min 
91/55 mm Hg 
16/ min 
142 lbs 
Ex amination 
General Examination: 
Temo 
10/17/2018 08:44:28 />M 
HR 
10/17/2018 08:44:28 />M 
BP 
10/17/2018 08:44:28 />M 
RR 
10/17/2018 08:44:28 />M 
wt 
10/17/2018 08:44:28 />M 
GENER/ll /IPPE/IRANCE: in no acute distress, well del.eloped, well nourished. 
SKIN: good turgor. 
HE.ART: regular rate and rhyttm 
LUNGS: good air mowment. 
(b)(6); (b)(7)(C) 
EXTREMTIES: good capilla,y refill in nail beds, no clubbing, cyanosis, or edema, full range of motion. 
PSYCH: cogniti'"' function intact, mood/affect full range, no auditory or -.isual hallucinations, speech clear, thought 
content 1Mthout suicidal ideation, delusions, pt 1o09ue as far as his logic and goals. He may be hesitant in wanting to 
re,.eal his intentions . . 
Assessments 
1. Encounter for general adult medical examination without abnormal findings - Z00.00 (Prmary) 
Pt has been on a dedared hunger strike as a protest but his actions of eating a sack lunch and being compliant with eating fruit 
and drinking supplemental caloric shakes and other fluids ha'"' put an end to current requirements of an official hunger strike. 
Pt has refused labs but they ha-e been normal in the recent past 
He has requested to be in segregation and there are no concerns with his current health for being cleared for that purpose. 
Treatment 
1. Encounter for general adult rne<ical examination witholt abnormal firdngs 
Notes: Special needs has been updated for discharge of patient from M-iU after end of official hunger strike. GEO has been 
contacted to wo rk with the detainee on his request to be housed in D3 segregation unit He will ha'"' nursing segregation rounds 
per our usual policy. No changes to his meds, supplements will be made at this time. 
Follow Up 
pm, pill line and the segregation nurse will keep medical posted on this detainee's condition. 
Notes: M3dication and Treatment Plan Re~ewed. Education pro~ded on Wedication and Treatment Patient ad~sed to notify 
rounding segregation nurse for anymedical concerns. Pl not willing to-erbali,e his understanding of his change in hunger strike 
designation. But he is pleased to go to D3. 
Appoinbnent Provide (b)(6); (b)(7)(C) MD 
2019-ICLl-0005 1 2952 

DHS-ICE-19-0196, 19-0197-N-000134
(b)(6); (b)(7)(C) 
Electronically signed by (b)(6); (b)(7)(C) Don 1<W17/2018 09:40:15 (Pacific Daylight Tlme) 
Sign off status: Complete 
Northwest Detention Center 
1623EJSTREI" 
l'. WA98421 
Tel: (b)/6) x: 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 ProgN u Not8fb )(6); (b)(7)(C) ~D 10/18/2018 
Nd.e general.ed by eOinica/W<n<s B>RIPM Sottw,re (""""eC/inica/works.CtJm) 
2019-ICLl-00051 2953 

DHS-ICE-19-0196, 19-0197-N-000135
U.S. Immi gration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
.. A:216269802 Su:ll~b)(6) ; _ J 
Facility Code: CSOINWA liiQked . I 
Acca.nt lffllber(b@C I 39Yad~~E :: 
10 /16/2018 
Cunont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Fi>ed Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KCP: Yes, Drug 
Source: In House Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 2 tablet with food Daily 
Noon, stop date 01/10/2019, KCP: Yes, Drug Source: In House 
Pharmacy 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
01/10/2019, KCP: Yes, Drug Source: In House Pharmacy 
• Boost Glucose Control - Liquid 1/2 boxmi>ed TIO, stop date 
12/11/2018, KCP: No, Drug Source: In House Pharmacy 
• Boost\iHC- Liquid 1/2 boxmi>ed TIO, stop date 12/11/2018, 
KCP: No, Drug Source: In House Pharmacy 
• Ensure High Protein- Liquid 1 QI-IS, stop date 10f22f2018, KCP: 
No, Drug Source: In House Pharmacy 
• Prenatal \Alamin Fi>ed Dose Tablet 1 Daily Noon, stop date 
01/10/2019, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
Past Medlcal Hletory 
Hunger strike 
Allorglos 
High calorie boost: diarrhea: Side Effects 
Review of Systems 
General/Constitutional: 
Fe'"'r denies. Headache denies. Lighlheadedness denies. 
Sleep disturbance denies. 
1623 E J STREET, T 
Appoirimert Facility. Northwest Detertion Certer 
Reason for Appointment 
1. tvHU NIGHT RN ROUNDS 
History of Present Illness 
Patient Identification: 
Patient Identification 
Appointment Provlde1 b)(6) ; (b)(7)(C) 
Patient property identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes 
Chaperone Name: GEOOl'FICER~ 
Wiat language do }OU speak? English, Russian 
Interpretation pro\aded? Pallent speaks English fluenUy 
Pain l>ssessment 
Pain 
ke }OU currently in pain? Yes 
The pain is located : Generalized 
The se'"'rityof pain is rated at 3/10 
The se'"'rityof the pain is mild 
The pain began 1-2daysago 
The character of the pain is aching 
The associated simptoms are none 
The pain is aggrawted by none 
The pain is reliel<!d by otherREFUSEDPAINIIEDICAT/00 
Fiowsheets (tvHU): 
Hungerstrike Mlnitoring Form 
Day 10/15/2018 
Shi~ Night 
Intake PO(in ml): 0 
()Jtput Urine (in ml): 0 
Hunger Strike: 
Nursing Ewluation 
Date missed meals monitoring initiated: 08/22/2018 
\M1en did the official hunger strike begin? 08125l2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: W.,nts to be released from custody 
/1<:!equate supply of drinking water and other be'"'rages a.ail able: Yes 
Three meals deli'"'red per day to detainee: Yes 
Breakfast 0% consumed 
Other meal/nutritional supplement Qher has pedialyte bid, boost bid, ensure hs 
/lnyunauthori>edfood inroom? No 
Ha'"' dailyorthostatic "al signs been completed? Yes 
Has input and output been documented on the M-IU Hunger Strike Mlnitoring Smart Form? __ Discontinued per 
provider. 
Narrati'"': 
Patient seen in M-IU for night RN rounds. Patient rested in bed most of the night and was obseMd oocasionalywalking in 
room to toilel He do of minor weakness and 3/10 pain. Patient dedined to take medication for pain. Patient refused breakfast 
(165th meal). 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
obserwtion, and monitoring. 
Ex amination 
General Examination: 
GENERl>l !>PPE.ARANCE: in no acute distress, well del.e!oped, well noorished. 
CHEST: normal, no gross rib defoon~y. normal shape and expansion. 
MJSCULOSKELET/ll : full range ci motion, no defoonities. 
PSYCH: alert, oriented. 
Assessment s 
1. lmbalanoed nutrition: Less than body requirements [00002] - ND00002 
Treatment 
1. Others 
Notes: /In adequate supply of drinking water and other be'"'rages are a.ail able to patient always. Three meals per day are 
deli'"'red to the patient and deli'"'ryof meals is documented. No food allowed in patienfs room not authori>ed byCD!Physician. 
Patient is not allowed to purchase food from commissarjll.ending machine while on hunger strike. Patient will only be released 
from hunger strike treatment/monitoring by CD or physician order. Patient counseled regarding the medical risks of continuing 
the hunger strike. Encouraged to terminate the hunger strike and eat/drink as normal. Pl '"'rbali,ed understanding of care plan. 
Continue HUNGER STRIKE protocol. Encourage intake of food/fluids. Encourage '"'rbali,ation of feelings. Encourage to allow 
staff to monitor intake and output >ital signs, wt lnstruded to seek staff with any needs or change in medical/mental health 
status. Call bell within reach, bed in lowest and locked position. 
Refer to nursing care plan for on-going inteMn tions. Encourage dailyoral/physical h19iene care. Detainee '"'rbalized an 
understanding of education and/or treatment 
Disposition: /ldmitted to M-IU until medicallye.aluated 
Appointment Provide,f b)(6) ; (b)(7) (C) IRN 
Electronically signed byl(b)(6) ;_ _ _ !RN on 10/16/2018 06:17:04 (Pacific Daylight lime) 
Sign off status: Completed 
2019-ICLl-00051 2954 

DHS-ICE-19-0196, 19-0197-N-000136
Northwest Detention Center 
1623EJSmEEr 
T~iE$tA98421 Tel R\ I x: 
Patient: AIIAR, IIERGENSANA DOB: 10/2 3/1978 Prog,. .. Nota:! (b )(6); (b )(?)(C) ! RN 10/18/2018 
Nd.e general.ed by eC/inica/WCJ1<s BvRIPM Softv.ere (VMWeC/inica/W<rks.COOJI 
2019-ICLl-00051 2955 

DHS-ICE-19-0196, 19-0197-N-000137
U.S. Immigration 
and Customs 
Enfor cement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inic a'WGYks.coojl 
2019-ICLl-00051 2956 
AMAR,MERGENSANA 
.. A:216269802 Su:ll~(b)(6); I 
Fac1lrtyCode:CSOINWA ng,c;ea .lfi 
kc01.111 ~ber{ijx6)= I 39 Y ad ~l~!t::: 
1623 E J STREET, T 

DHS-ICE-19-0196, 19-0197-N-000138
U.S. Immigration 
and Customs 
Enfor cement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inic a'WGYks.coojl 
2019-ICLl-00051 2957 
AMAR,MERGENSANA A: 216269802 Su:lltb )(6): J 
Facility Code: CSONVWA Housing Area : 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll lunbe~ 
1623 EJ STREET, T~ 

DHS-ICE-19-0196, 19-0197-N-000139
U.S. Immi gration 
and Customs 
Enfor cement 
10 /15/2018 
Curnont Medication s 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Fi>ed Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le - Solution 1 BID, stop date 01/10/2019, KCP: Yes, Drug 
Source: In House Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 2 tablet with food Daily 
Noon, stop date 01/10/2019, KCP: Yes, Drug Source: In House 
Pharmacy 
• Fiber625 t..G Tablet 1 labletas needed BID, stop date 
01/10/2019, KCP: Yes, Drug Source: In House Pharmacy 
• Boost Glucose Control - Liquid 1/2 boxmi>ed TIO, stop date 
12/11/2018, KCP: No, Drug Source: In House Pharmacy 
• Boost\iHC- Liquid 1/2 boxmi>ed TIO, stop date 12/11/2018, 
KCP: No, Drug Source: In House Pharmacy 
• Ensure High Protein- Liquid 1 QI-IS, stop date 10f22f2018, KCP: 
No, Drug Source: In House Pharmacy 
• Prenatal \Alamin Fi>ed Dose Tablet 1 Daily Noon, stop date 
01/10/2019, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
Past Medlc a l History 
Hunger strike 
Allerg le s 
High calorie boost: diarrhea: Side Effects 
Review of System s 
General/Constitutional: 
Fe'"'r denies. Headache denies. Lighlheadedness denies. 
Sleep disturbance denies. 
Rea son for Appointment 
1. tvHU RN El<!ning Rounds - Hunger Strike 
History of Pre se nt Illne ss 
Patient Identification: 
Patient Identification 
Patient property identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes 
Chaperone Name: Oncer~ Wiatlanguage do }OU s pea . uss,an 
Interpretation pro\aded? Yes, Interpreter Number 
Number : 11506502 
Language Russian 
Pain Assessment 
Pain 
/>,e }OU currently in pain? No 
Fiowsheets (tvHU): 
Hungerstrike Mlnitoring Form 
Day. 10/1412018 
Shift: PM 
Intake PO(in ml): 1480 
Intake r.J- Normal Saline (in ml): 0 
Intake r.J- LR (in ml): 0 
Intake NG(in ml): 0 
Appoin t ment Provld er:l/b)/6): 
()Jtput Urine (in ml): UNABLETOM=ASUREPATIENTIMLL NOT URINATE IN URINAL 
Initials: SVB 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 081221.W18 
\Mien did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 081221.W18 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wcints to be released from custody 
/ldequate supply of drinking water and other be1.erages available: Yes 
Three meals deli1.ered per day to detainee: Yes 
Dinner 0"/4 consumed Ate 1 apple 
CXher meal/nutritional supplement Qher has pedialyte bid, boost bid, ensure hs 
/lnyunauthori>edfood inroom? No 
Ha1.e dailyorthostatic lial signs been completed? Yes 
Has input and output been documented on the M-iU Hunger Strike Mlnitoring Smart Form? __ DC'd continued by PCP 
Narrati'"': 
Detainee alert and awake, has newspaper, drank 480 ml BOOST and 1 liter of pedial)le. /wake and briefly to toilet at least 
twice during the shill Vient to REC this shift ambulating. Detainee denied any other issues or complaints at time of assessment 
Detainee refused to eat supper, the 164th meal missed. Patient ate 1 apple for supper. 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observation, and monitoring. 
Ex amina tion 
General Examination: 
GENER/IL /IPPE/IR.ANCE: in no acute distress. 
OR/ll CA\AlY: normal, mucosa moist. 
SKIN: good turgor. 
MJSCULOSKELET/11. : full range of motion, good strength and equal bilaterally, good capillary refill in nail beds, 
neurovascular intact, good capillary refill in nail beds. 
EXIREMTIES: full range of motion. 
PSYCH: alert, oriented. 
Ass e ssm ents 
1. Self neglect- ND00193 (Primary) 
/II-Risk for imbalanced nutrition: Less than body requirements. 
Trea tment 
1. Self neglect 
Notes: Intake and ()Jtput Mlnitoring e1.eryshifl; /In adequate supply of drinking water and other be1.erages are a,ailable to patient 
alway.,. Three meals per day are deli'"'red to the patient and deli'"'ry of meals is documented. No food allowed in patienrs room 
not authori>ed byCD/Phy.,ician. Patient is not allowed to purchase food from commissar)(l.ending machine while on hunger 
strike. Patient will only be released from hunger strike treatment/monitoring by CD or phy.,ician order. Patient counseled 
regarding the medical risks of continuing the hunger strike. Encouraged to terminate the hunger strike and eaUdrink as normal. 
Pt 1.erbali>ed understanding of care plan. Continue HUNGER STRIKE protocol. Encourage intake offoodllluids. Encourage 
1.erbaliiation of feelings. Encourage to allow staff to monitor intake and output ~tal signs, wt 
Instructed to seek staff with any needs or change in medical/mental health status. 
Call bell within reach, bed in lowest and locked position. 
Refer to nursing care plan for oniJ()ing inter1.entions. Detainee offered three meals per day and lea1.e in room for at least 20 
minutes. /ldequate supply of drinking water and other be1.erages as ordered byprolidera,a ilable. Encourage dailyoral/phy.,ical 
higiene care. Change of dolhingA)edding offered M [ ] -W[ ] - F [ ]. Detainee 1.erbali>ed an understanding of education and/or 
treatrnenl 
Clinical Notes: Patient ate 1 apple for supper. 
Proc edu re Cod es 
T1013 Sign Lang/0-al Interpreter 
Appointment Provide { ~/\ ~/: ~ , I RN 
2019-ICLl-00051 2958 

DHS-ICE-19-0196, 19-0197-N-000140
Electronically signed by!(b)(6); 
Sign off status: Completed 
Addendum : 
IN, RN on 10/15'201818 :05:27 (Pacific Daylight Time) 
10/15/2018 08:12 PM Burt RN, Stuart> Detainee accepted his e1.ening medication and ensure, bringing his total fluids for this 
shift to 1720 ml. 
Northwest Detention Center 
1623 E J STREB' 
TACOMA, WA98421 
Tel'kb )(6); I ,ax. 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 ProgN u Nota:f h\/R\· !RN 10/15/2018 
Ncl.e general.ed by eC/inica/Wa1<s aR'PM Safl,,ere (WNNeC/inicliWorks.COff9 
2019-ICLl-00051 2959 

DHS-ICE-19-0196, 19-0197-N-000141
Cunent -dlcatlons 
Taking 
U.S. Immigration 
and Customs 
Enforcement 
Reason for Appointment 
1. Wedication Re"ew 
• Calcium 500/0 500-200 M:;-UNITTablet 1 tablet with food Oice 
a day, KOP: Yes, Drug Source: Pharmacy Treatment 
1. Others 
AMAR, MERGEN~ 
A:216269802 Si.ti1 (b)(6); 
Facility Code: CSCN/1/WA Housing ea: 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll lunber~ )/6)· 1623 E J STREET, T~ hA564Z I 
• Prenatal \Atamin Filed Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy Stop Pedial>4e Solution,-, 1 boWe three times a day, Crally, no , 30 day.;, 1, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
• Fiber625 M3Tablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/0 500-200 M:;-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra;el 
• Fiber625 M3Tablet 1 tablet as needed BID, stopdate 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for trawl 
• Cholecalciferol 2000 UNIT Tablet 1 tablet a-IS , stop date 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for trawl 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed no, stop date 
10/26/2018, KOP: No, Drug Source: In House Pharmacy, Notes: Not 
required for trawl, see attached ser.ing mildure order 
• Pedial>4e- Solution 1 boWe three times a dayn D, stop date 
10/28/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for trawl 
• fl<:etaminophen 500 M3 Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra;el 
• Pedial>4<' - Solution 1 BID, stop date 01/10/2019, Ka>: Yes, Drug 
Source: In House Pharmacy 
• Calcium 500/0 500-200 M:;-UNITTablet 2 tablet IMth food Daily 
Noon, stop date 01/10/2019, Ka>: Yes, Drug Source: In House 
Pharmacy 
• Fiber625 M3Tablet 1 tablet as needed BID, stopdate 
01/10/2019, Ka>: Yes, Drug Source: In House Pharmacy 
• Boost Glucose Control - Liquid 1/2 boxmi>ed n o, stop date 
12/11/2018, Ka>: No, Drug Source: In House Pharmacy 
• Boost\iHC - Liquid 1/2 boxmi>ed n o, stop date 12/11/2018, 
KOP: No, Drug Source: In House Pharmacy 
• Ensure High Protein- Liquid 1 Q-1S, stop date 10/22/2018, KOP: 
No, Drug Source: In House Pharmacy 
• Prenatal \Atamin Fi>ed Dose Tablet 1 Daily Noon, stop date 
01/10/2019, Ka>: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for trawl 
Past Medical History 
Hungersb'ike 
Allergles 
High calorie boost: diarrhea: $de Effects 
Not required for trawl 
Tel: 
Fax: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progress Note: 
/lkte generated by eClinica/Works e.RIPM &Jt,,ere ("""'eC/ inica/Works.com) 
2019-ICLl-00051 2960 

DHS-ICE-19-0196, 19-0197-N-000142
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:,ld lh \/R\ · ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.ri tunbe ll/b\/G\· 
10 /15/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Fi>ed Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• Pedial)le - Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le-So lution 1 BID, stopdate0 1/10/2019, KCP: Yes, Drug 
Source: In House Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 2 tablet with food Daily 
Noon, stop date 01/10/2019, KCP: Yes, Drug Souroe: In House 
Pharmacy 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
01/10/2019, KCP: Yes, Drug Souroe: In House Pharmacy 
• Boost Glucose Control - Liquid 1/2 boxmi>ed TIO, stop date 
12/11/2018, KCP: No, Drug Source: In House Pharmacy 
• Boost\iHC- Liquid 1/2 boxmi>ed TIO, stop date 12/11/2018, 
KCP: No, Drug Souroe: In House Pharmacy 
• Ensure High Protein- Liquid 1 QI-IS, stop date 10/22/2018, KCP: 
No, Drug Souroe: In House Pharmacy 
• Prenatal \Alamin Fi>ed Dose Tablet 1 Daily Noon, stop date 
01/10/2019, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"'I 
Past Medlc a l History 
Hunger strike 
Allorglos 
High calorie boost: diarrhea: Side Effects 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness admits. 
Sleep Disturbanoe denies. 11\eight loss admits. Dry 
M:>uth denies. 11\eakness admits. Cough denies. Shortness of 
breath at rest denies. Palpitations denies. /lodominal 
Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \bm itting denies. Painful urination denies. 
Decreased urine output denies. MJsde aches denies. MJscie 
cramps denies. Skin breakdown denies. Difficultythinking denies. 
1623 E J STREET, TACOMA, WA-98421 
Appoirimert Facility: Northwest Detertion Cert er 
Reas on for Appointment 
1. RN day round/hunger strike 
History of Pre se nt Illness 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Time: 1500 
INPUT PO: 1000 
OUTPUT Urine 1000 
OUTPUTBM 1 
NetGain: 0 
Initials: LM 
Hungerstrike M:>nitoring Form 
Day. 10/15/2018 
Shift: AM 
Intake PO(in ml): 1000 
Intake rl/- Normal Saline (in ml): 0 
Intake rl/- LR (in ml): 0 
Intake NG(in ml): 0 
OJtput Urine (in ml): 1000 
OJtput Bowel M:>'"'ments (in ml): 
Initials: LM 
Patient Identification: 
Patient Identification 
Patient propeMyidentified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEO OFFICER 
IM1at language do )OU speak? Russian 
Interpretation pro\<ded? Provider fluent in patient's native language 
Pain l'ssessmen t 
Pain 
Ne )OU currently in pain? Yes 
The pain is located .-back and legs 
The se'"'rityof pain is rated at 3110 
The se'"'rityof the pain is moderate 
The pain began 4-5 l\eeksago 
The character of the pain is aching 
The associated simptoms are l\eakness 
The pain is aggravated by other hunger slJike 
The pain is reliel<!d by other 
Describe: pt refused medication treatment 
Narrati'"': 
Appointment Provlde~ (b)(6) ; ~-
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observation, and monitoring. 
Pl was in M-IU IIIED 2 Upon encounter detainee was resting quietly in bed. Detainee reported weakness and pain on his 
legs and back , but refused PRN pain meds. M,dication compliant VIAii continue to monitor. 
Pl refused lunch, this is missed meal #163. Memoon pt went to reck)ard, pt refused wheelchair. VIAii continue to monitor. 
Hunger Strike: 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
\/\hen did the official hunger strike begin? 08/25/2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wants to be released from custody 
Pdequate supply of drinking water and other be1.erages a,ailable: Yes 
Three meals deli1.ered per dayto patient Yes 
Lunch deli'"'red during current shift 0% consumed 
Pny unauthoriied food in room? No 
Ha1.e dailyorthostatic \<lal signs been completed? Yes 
Has input and output been documented on the the M-iU Hunger Strike M:>nitoring Smart Form? Yes. 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/2212018 
\/\hen did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/2212018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: W.,nts to be released from custody 
Pdequate supply of drinking water and other be1.erages available: Yes 
Three meals deli'"'red per day to detainee: Yes 
Lunch 0% consumed 
Pny unauthoriied food in room? No 
Ha'"' dailyorthostatic \<al signs been completed? Yes 
Has input and output been documented on the M-iU Hunger Strike M:>nitoring Smart Form? Yes 
Vital Signs 
Temp 
98.6F 10/15/201810:14:00 /'M 
HR 
standing:91 10/15/201810:14:00 /'M 
silling:84 10/15/201810:14:00 /'M 
supine:58 10/15/201810:14:00 /'M 
BP 
standing:92/63 10/15/201810:14:00 /'M 
silli ng:98/60 10/15/201810:14:00 /'M 
supine:100/63 10/15/201810:14:00 /'M 
RR 
16 /min 10/15/201810:14:00 /'M 
WI 
145 lbs 10/15/201810:14:00 /'M 
H 
2019-ICLl-00051 2961 
(b)(6); RN 
(b)(7)(C ) I￾I￾RN 
RN 
RN 
I-
~ 
RN 
N 
I￾I￾RN 
I-
~ 

DHS-ICE-19-0196, 19-0197-N-000143
l66.5 in 10/15/201810:14:00PM b)(6); 
lt----------------:: BM::-:lc---------f'b)(7)(C) 
I 23.05 Index 
Examination 
General El<amination: 
10/15/2018 10:14:00 PM 
GENER/IL PPPEAAPNCE: in no acute distress, well de\eloped , well nourished. 
HEPD: nonnocephalic. 
SKIN: noonal, no rashes, no suspicious lesions. 
HEl'RT: no murmurs, regular rate and rhythm, S 1, S2 nonnal. 
LUNGS: noonal, clear to auscultation bilaterally, no w,eezes, rales, rhonchi. 
CHEST: noonal, no gross rib deformity, noonal shape and expansion. 
/18D0\,EN: noonal, bowel sounds present, soft, nontender, nondistended. 
M.JSCULOSKELET.i>l: normal, normal gait, no deformities, full range cl motion, . 
NEUROLOGIC: alert and oriented, cooperati-e Vloith exam, , gait normal, neck supple, no rigidity, no tremor. 
PSYCH: alert, oriented, cogniti-e function intact, cooperati-e Vloith exam, good eye contact, judgement and insight 
good, mood/affect full range, no auditory or l.isual hallucinations, speech clear, thought content Vloithout suicidal ideation, 
delusions, thought process logical, goal directed. 
Assessment s 
/II-Risk for imbalanced nutrition: Less than body requirements. 
Treatm e nt 
1. Others 
Notes: 1. Continue with 01hostatic \.ital Signs e'-'!ryday, Intake and Oitput Mmitoring e'-'!ryshift; Dailyweights; 2. "'1 adequate 
supply of drinking water and other be'-'!rages are ai,ailable to patient at all times. 3. Three meals per day are deli'-'lred to the 
patient and deli'-'lryof meals is documented. 4. ~ I food notauthori2ed by CD/Physician is remo'-'ld from patienfs room. 5. Patient 
is not allowed to purchase food from oommissary,ending machine while on hunger strike. 6. Patient will only be released from 
hunger strike treatment/monitoring by CD or physician order. 7. Patient oounseled regarding the medical risks of oontinuing the 
hunger strike. 8. Enoouraged to terminate the hunger strike and eat/drink as normal. Continue hunger strike protoool, enoourage 
po food/!luids, enoourage '-'!rbali,ation offeelings. Enoourage to allow staff to monitor intake and output, IAtal signs, wt. Instructed 
to seek staff with any needs. Verbali2"d understanding. Detainee offered three meals perdayand lea'-'! in room for20 to 30 
minutes. Enoourage dailyoral/physical h19iene care. Change of clothing/bedding . a!er BCXlST and Pedil)le as ordered. Patient 
educated to possible Side Effects of going for long period of time without food. Patient '-'!rbali2es understanding of current Plan of 
Care. Patient '-'!rbali2es his option to refuse food. 
Appointment Provider:"-! (b...:. }(;.. 6:.:. ); _ __,fN 
Electronically signed b~,__ (b ) __ (6 __ ), __ ·_ __.fN on 10/15120181 5:05:42 (Pacific Daylight Time) 
Sign off status: Completed 
Northwest Detention Cente r 
1623 E J SmEEr 
TACOMA, WA98421 
Tell /h \/RI I 
Fax: 
Patient: AMAR, MERGENSANA DOB: 10/2 3/19 78 Progrw .. Notet b)(6); Kl 10/15/2018 ~ h\/ 7 \I/""\ r￾Ncie generaled byeC/inica!Wcn<s EM<IPM Soflvere (""""eC/inica/Wcn<s.com) 
2019-ICLl-00051 2962 

DHS-ICE-19-0196, 19-0197-N-000144
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A:216269802 Su:l1D: !(b)(6): J 
Facility Code: CSONVWA Housing Area: 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll lunberfrti"ii6i:7 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Cert er 
10 /15/2018 
Curnont Medication s 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Fi>ed Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Pedial)le - Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le-So lution 1 BID, stopdate0 1/10/2019, KCP: Yes, Drug 
Source: In House Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 2 tablet with food Daily 
Noon, stop date 01/10/2019, KCP: Yes, Drug Source: In House 
Pharmacy 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
01/10/2019, KCP: Yes, Drug Source: In House Pharmacy 
• Boost Glucose Control - Liquid 1/2 boxmi>ed TIO, stop date 
12/11/2018, KCP: No, Drug Source: In House Pharmacy 
• Boost\iHC- Liquid 1/2 bcxmi>ed TIO, stop date 12/11/2018, 
KCP: No, Drug Source: In House Pharmacy 
• Ensure High Protein- Liquid 1 QI-IS, stop date 10/22/2018, KCP: 
No, Drug Source: In House Pharmacy 
• Prenatal \Alamin Fi>ed Dose Tablet 1 Daily Noon, stop date 
01/10/2019, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
Past Medlc a l History 
Hunger strike 
Allergle s 
High calorie boost: diarrhea: Side Effects 
Revie w of Syste ms 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fe'"'r denies. Headache denies. Lighlheadedness denies. Night 
sweats denies. Sleep disturbance denies. 1/Veight gain denies. 
1/Veight loss denies. 
Gastrointestinal: 
Constipation denies. Diarrhea denies. Difficulty 
swallowing denies. Heartburn denies. Nausea denies. 1/Veight 
loss denies. 
Mlsru loskeletal: 
Joint stiffness denies. M.Jsde aches denies. Painful 
j oints denies. 
Aflpolntment Provld e 1(b)(6 ); (b)(7)(C ) IMD 
Rea son for Aflpolntment 
1. Daily rounds 
History of Pre se nt Illne ss 
Patient Identification: 
No change in patient condition. Continues to drink calorie supplemenls. He is well h)drated and has gained a small amount 
of weight His mental health is fine. He refuses to eat the food offered on meal tray.; buteals the whole fruit He walks to rec. yard 
regularly. There is no need to force him to ha'"' lab testing at this time. 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Pallant speaks English fluenUy 
Pain Assessment 
Pain 
ke }OU currently in pain? No 
Narrati'"': 
Current status: Losing weight and strength 
Mssed meals monitoring initiated: 08/22/2018 
Official hunger strike date: 08/25/2018 
Date last meal consumed: 8/22/2018 
Last meal consumed: Breakfast 
Reason for Hunger Strike: Wants release from custody 
Drinking fluids: Yes: PEDll'l YTE, BCX)ST, Ensure supplements 
# of da}'> missed meal monitoring: 51 
# of da}'> on hunger strike: 50 
# of missed meals (Total): 163 as of Lunch (10/12/2018). 
Initial weight at missed meal monitoring: 163.0 LBS 
Date of initial weight 08/22/2018 
Date of current weight 10/10/2018 
Currentweighlin pounds: 145 LBS 
Total weight loss: 18 LBS 
Pl refused: F(X)[) TRAY, e>eept for an occasional fresh fruit 
Vit a l Sign s 
98.6F 
84/min 
98/60 mm Hg 
16/ min 
145 lbs 
Ex amina tio n 
General Examination: 
Tern~ 
HR 
BP 
RR 
Wt 
10/16/201804:34:09 PM 
10/16/201804:34:09 PM 
10/16/201804:34:09 PM 
10/16/201804:34:09 PM 
10/16/201804:34:09 PM 
GENER/ll !>PPEAA.ANCE: in no acute distress, well del.eloped, well nourished. 
SKIN: good turgor. 
HE.ART: regular rate and rhyttm 
LUNGS: good air rt1<M!ment. 
EXTREMTIES: good capilla,y refill in nail beds, no clubbing, cyanosis, or edema, full range of motion. 
(b)(6); 
(b)(7)(C) 
PSYCH: cogniti'"' function intact, mood/affect full range, no auditory or -.isual hallucinations, speech clear, thought 
content w thout suicidal ideation, delusions, thought process logical, goal directed. 
Assess ment s 
1. Starvation, subsequent encounter - T73.0Xl<D (Primary) 
2. Imbalanced nutrition: Less than bodyrequiremenls [00002] - ND00002 
Self-imposed hunger strike, has been drinking supplemental caloric shakes and other fluids. 
Tre a tment 
1. Starvation, subsequent encOl.lller 
Notes: W II DC VO measuremenls. UAwill be on PRN basis. Pl is refusing blood draw but if he is stable and dinicallystable will 
hold off on getting a court order for now. 
Fo llow Up 
daily by nursing staff and e'"',y 2-3 day.; bypro1,1ders 
Notes: Education pro"ded on M>dication and Treatment Patientl.<lrbali,ed understanding of all inslrUctions 
Appoinbnent Provide1 (b)(6) ; (b)(7)(C) IMD 
b)(6); (b)(7)(C) 
Be ctronically signed ~ (b)(6); (b)(7)(C) I MD on 10/16/201816:35:18 (Pacific Daylight Time) 
2019-ICLl-00051 2963 

DHS-ICE-19-0196, 19-0197-N-000145
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREEr 
l'. WA98421 
Tel: b)(6): 
x: 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 ProgNu No181(b)(6); (b)(?)(C) !11D 10/15/2018 
Nd.e genertl.ed by eOinicaf'Mrts a.R'PM Sottoore (,w.weC/inica/Works.com) 
2019-ICLl-00051 2964 

DHS-ICE-19-0196, 19-0197-N-000146
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
.. A:216269802 Su:ll~b )(6); I 
Fac1lrtyCode:CSOINWA ng,c;ea .lfi 
39 Y old Male, DOB: 10/23/1978 
Acc0U11~ 11"1- I 
10 /14/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Fi>ed Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for lral<!I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for lral<!I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlral.el, see attached ser.ing mi>l!ure order 
• Pedial)le - Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for lral<!I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le -So lution 1 BID, stopdate0 1/10/2019, KCP: Yes, Drug 
Source: In House Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 2 tablet with food Daily 
Noon, stop date 01/10/2019, KCP: Yes, Drug Souroe: In House 
Pharmacy 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
01/10/2019, KCP: Yes, Drug Souroe: In House Pharmacy 
• Boost Glucose Control - Liquid 1/2 boxmi>ed TIO, stop date 
12/11/2018, KCP: No, Drug Source: In House Pharmacy 
• Boost\iHC- Liquid 1/2 boxmi>ed TIO, stop date 12/11/2018, 
KCP: No, Drug Souroe: In House Pharmacy 
• Ensure High Protein- Liquid 1 QI-IS, stop date 10/22/2018, KCP: 
No, Drug Souroe: In House Pharmacy 
• Prenatal \Atamin Fi>ed Dose Tablet 1 Daily Noon, stop date 
01/10/2019, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for lral<!I 
Past Medlcal History 
Hunger strike 
Allergles 
High calorie boost: diarrhea: Side Effects 
Review of Systems 
General/Constitutional: 
Fel<!r denies. Headache denies. Lighlheadedness denies. 
Sleep disturbanoe denies. 
1623 E J STREET, T WA-98421 
Appoirimert Facility. Northwest Detertion Cert er 
Reason for Appointment 
1. tvHU RN NIGHT ROUNDS/HUNGER STRIKE 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes 
Chaperone Name: GEO OFFICER ON DUTY 
Viral language do }OU speak? English, Russian 
Interpretation pro\aded? Pallant speaks English fluenUy 
Pain l>ssessment 
Pain 
ke }OU currently in pain? No 
Fiowsheets (tvHU): 
lnput/OJtput Fiowsheet 
Time: 2300 
AppolntmentProv~er.~l <~b)~(6~)~; __ _.!RN 
INPUT PO: 1480 PED/AL YTE, 2 BtX>ST, WATER AMYJNTUNKNCMN 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT Other. 0 
INPUT SUBTOT/11.. : 1480 
Ot.JliPUT Urine voiding throughout shifts, refuses urinal 
Initials: LDM 
Hungerstrike M'.lnitoring Form 
Day: 10/14/2018 
Shift Night 
Intake PO (in ml): 1480 PED/AL YTE, 2 BlX>ST, WATER AMYJNTUNKNCMN 
Intake 1\/-Normal Saline (in ml): 0 
Intake 1\/-LR (in ml): 0 
Intake NG(in ml): 0 
OJ!put Urine (in ml): UNABLETOM=ASUREPATIENTIMLL NOT URINATE IN URINAL 
Initials: LDM 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
\M1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: 11\ants to be released from custody 
/1<:!equate supply of drinking water and other be-erages available: Yes 
Three meals delil<!red per day to detainee: Yes 
Other meal/nutritional supplement Qherhaspedialyte Ud, boost bid, ensure hs 
/lnyunauthori>edfood inroom? No 
Hal<! dailyorthostatic " al signs been completed? Yes 
Has input and output been documented on the M-IU Hunger Strike M'.lnitoring Smart Form? Yes 
Narratiw: 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observation, and monitoring. 
Ex amlinatlon 
General B<amination: 
GENER/II.. !>PPE.ARANCE: in no acute distress. 
OR.Al CA\AlY: normal, mucooa moist. 
SKIN: good turgor. 
MJSCULOSKELET/11.. : full range of motion, good strength and equal bilaterally, good capillary refill in nail beds, 
neurovascular intact, good capillary refill in nail beds. 
PSYCH: alert, oriented. 
Assessments 
/>I-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: 1. Continue with \Alai Signs e-eryshift; Intake and OJtput M'.lnitoring e-eryshift; Dailyweights; Dailyorthostatic ,ital signs. 
2. /In adequate supply of drinking water and other be-erages are available to patient at all times. 
3. Three meals per day are deli-ered to the patient and deli-eryof meals is documented. 
4. />I food not authori>ed by CD/Phy.,ician is remo\ed from patienrs room. 
5. Patient is not allowed to purchase food from oommissar)/1.ending machine while on hunger strike. 
6. Patient will only be released from hunger strike treatment/monitoring byCD or phy.,ician order. 
7. Patient counseled regarding the medical risks of continuing the hunger strike. 
8. Encouraged to terminate the hunger strike and eat/drink as normal. 
9. pt -erbali,ed understanding of care plan. 
Clinical Notes: Continue HUNGER STRIKE protocol. 
Encourage intake of food/fluids. 
Encourage l<!rbaliiation offeelings. 
Encourage to allow staff to monitor intake and output, ,ital signs, wt. 
Instructed to seek staff with any needs or change in medical/mental health status. 
Call bell within reach, bed in lowest and locked position with rails up ><2. 
Refer to nursing care plan for on-going inten.entions. Detainee offered three meals per day and lease in room for at least 20 
minutes. 
/1<:!equate supply of drinking water and other be-erages as ordered bypro,ider available. 
Encourage dailyoral/phy.,ical h)9iene care. Change of dothing/bedding offered M[] -W[] - F [ ]. Detainee -erbali,ed an 
understanding of education and/or treatment 
pt 1.0ices no other conoerns. 
Disposition: Jldmitted to M-IU until medically evaluated 
Appointment Provide1~ /\~k. ,, I RN 
2019-ICLl-00051 2965 

DHS-ICE-19-0196, 19-0197-N-000147
Electronically signed b~/b\/ 6\: ~ on 10/15/2018 05:18:39 (Pacific Daylight Time) 
Sign off status: Completed 
Northwest Detention Center 
1623EJSTREI" 
l'. WA98421 
Tel /h\ffi\ · 
x: 
P•ll-t: AMAR, MERGENSANA DOB: 10/23/1978 P ........ ~ RN 10/1'1/2018 
Nd.e general.ed by eOinica/W<n<s B>RIPM Sottw,re (""""eC/inica/works.CtJm) 
2019-ICLl-00051 2966 

DHS-ICE-19-0196, 19-0197-N-000148
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 2967 
AMAR,MERGENSANA .. A:21626980 2 Su:ll~ b)(6); J 
Fac1lrtyCode:CSOINWA ng ,c;ea.1 
39Y old Mal~, · AccOl.rll llunbe b 6 · 1623 E J STREET, T , 

DHS-ICE-19-0196, 19-0197-N-000149
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:i1ot(b )(~; I 
Facility Code: CSONVWA Housing ea: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll lunber:fti\/6\:7 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
10 /14/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Fi>ed Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Pedial)le - Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le-So lution 1 BID, stopdate01/10/2019, KCP: Yes, Drug 
Source: In House Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 2 tablet with food Daily 
Noon, stop date 01/10/2019, KCP: Yes, Drug Source: In House 
Pharmacy 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
01/10/2019, KCP: Yes, Drug Source: In House Pharmacy 
• Boost Glucose Control - Liquid 1/2 boxmi>ed TIO, stop date 
12/11/2018, KCP: No, Drug Source: In House Pharmacy 
• Boost\iHC- Liquid 1/2 boxmi>ed TIO, stop date 12/11/2018, 
KCP: No, Drug Source: In House Pharmacy 
• Ensure High Protein- Liquid 1 QI-IS, stop date 10/22/2018, KCP: 
No, Drug Source: In House Pharmacy 
• Prenatal \Atamin Fi>ed Dose Tablet 1 Daily Noon, stop date 
01/10/2019, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
Past Medlcal History 
Hunger strike 
Allergles 
High calorie boost: diarrhea: Side Effects 
Review of Systems 
General/Constitutional: 
Fe'"'r denies. Headache denies. Lighlheadedness denies. 
Sleep disturbance denies. 
Appointment Provide (b )(6); 
Reason for Appointment 
1. tvHU RN El<!ning Rounds - Hunger Strike 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient property identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes 
Chaperone Name: Once,ft5ii6i:7 Viral language do }OU spe~n 
Interpretation pro\aded? Yes, Interpreter Number 
Number : 11499363 
Language Russian 
Pain Assessment 
Pain 
/>,e }OU currently in pain? No 
Fiowsheets (tvHU): 
lnput/OJtput Fiowsheet 
Time: 1900 
INPUT PO: 480 Boost, water 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT Other. 0 
INPUT SUBTOT/ll: 480 
OJTPUT Urine voiding throughout shifts, refuses urinal 
Initials: SVB 
Hungerstrike M:mitoring Form 
Day: 10/14/2018 
Shi~ PM 
Intake PO(in ml): 480 
Intake II/- Normal Saline (in ml): 0 
Intake II/- LR (in ml): 0 
Intake NG(in ml): 0 
OJ!put Urine (in ml): UNABLETOM=ASUREPATIENTIMLL NOT URINATE IN URINAL 
Initials: SVB 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
\Mien did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wcints to be released from custody 
/ldequate supply of drinking water and other be1.erages available: Yes 
Three meals deliwred per day to detainee: Yes 
Other meal/nutritional supplement Qher has pedialyte lid, boost bid, ensure hs 
/lnyunauthoriiedfood inroom? No 
Haw dailyorthostatic lial signs been completed? Yes 
Has input and output been documented on the M-iU Hunger Strike lvbnitoring Smart Form? Yes 
~ : 
/h\/7\/t'\ 
RN 
Detainee alert and awake, has newspaper, drank 480 ml BOOST. /wa ke and briefly to toilet at least twice during the shill 
Wint to REC this shift ambulating. Detainee denied any other issues or complaints at time of assessment Detainee refused to 
eat supper, the 161 st meal missed. Patient ate 2 apples for supper. 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observation, and monitoring. 
Ex amination 
General B<amination: 
GENER/ll /IPPE.ARANCE: in no acute distress. 
OR/ll CA\AlY: normal, mucooa moist. 
SKIN: good turgor. 
MJSCULOSKELET/ll : full range of motion, good strength and equal bilaterally, good capillary refill in nail beds, 
neurovascular intact, good capillary refill in nail beds. 
EXIREMTIES: full range of motion. 
PSYCH: alert, orented. 
Assessments 
/II-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: Intake and OJtput lvbnitoring e1.eryshift; M adequate supply of drinking water and other be,erages are available to patient 
alway.,. Three meals per day are deliwred to the patient and deliwryof meals is documented. No food allowed in patienrs room 
not authoriied by CD/Phy.,ician. Patient is not allowed to purchase food from commissar)l'l.ending machine while on hunger 
strike. Patient will only be released from hunger strike treatment'monitoring by CD or phy.,ician order. Patient counseled 
regarding the medical risks of continuing the hunger strike. Encouraged to terminate the hunger strike and eat'drink as normal. 
Pl 1.erbaliied understanding of care plan. Continue HUNGER S1RIKE protocol. Encourage intake of food/fluids. Encourage 
1.erbali,ation of feelings. Encourage to allow staff to monitor intake and output, \ital signs, wt 
Instructed to seek staff with any needs or change in medical/mental health status. 
Call bell within reach, bed in lowest and locked position. 
Refer to nursing care plan for on-going interwntions. Detainee offered three meals per day and lea1.e in room for at least 20 
minutes. /ldequate supply of drinking water and other be,erages as ordered byprolideravailable. Encourage dailyoral/phy.,ical 
h19iene care. Change of dothing,bedding offered M(] -W[ ] - F [ ]. Detainee 1.erbaliied an understanding of education and/or 
treatment 
Clinical Notes: Patient ate 2 apples for supper. 
Appoinbnent Providefb)(6); ~- fN 
2019-ICLl-0005 1 2968 

DHS-ICE-19-0196, 19-0197-N-000150
Electronically signed b¥b)( 6); _. ~ , RN on 10/14/201818:59:53 (Pacific Daylight Time) 
Sign off status: Completed 
Northwest Detention Center 
1623EJSTREI" 
T~~r98421 Tul(b}~~ ; ~- I 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 Progreu NoJ (b)(6); au 10/14/2018 7/h \/ 7 \/r'-\ ! Nd.e general.ed by eOinica/W<n<s B>RIPM Sottw,re (""""eC/inica/works.CtJm) 
2019-ICLl-00051 2969 

DHS-ICE-19-0196, 19-0197-N-000151
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""1eC/inica'WGYks.coojl 
2019-ICLl-00051 2970 
AMAR,MERGENSANA A: 216269802 Su:lld(b )(6): ! 
Facility Code: CSONVWA Housing Area : M 
39 Y old Male,~- 1Q/2J119ZB 
AccOUll l'unbe b )(6): I 1623 E J STREET, TACOMA, WA98421 

DHS-ICE-19-0196, 19-0197-N-000152
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:lld/h \In\ ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunberfTtiii6i:7 
1623 E J STREET, T~ 
Appoirimert Facility: Northwest Detertion Certer 
10 /14/2018 
Curnont Medication s 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Fi>ed Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15 , stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• Pedial)le - Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le -So lution 1 BID, stopdate01 /10/2019, KCP: Yes, Drug 
Source: In House Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 2 tablet with food Daily 
Noon, stop date 01/10/2019, KCP: Yes, Drug Souroe: In House 
Pharmacy 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
01/10/2019, KCP: Yes, Drug Souroe: In House Pharmacy 
• Boost Glucose Control - Liquid 1/2 boxmi>ed TIO, stop date 
12/11/2018, KCP: No, Drug Source: In House Pharmacy 
• Boost\iHC- Liquid 1/2 bcxmi>ed TIO, stop date 12/11/2018, 
KCP: No, Drug Souroe: In House Pharmacy 
• Ensure High Protein- Liquid 1 QI-IS, stop date 10/22/2018, KCP: 
No, Drug Souroe: In House Pharmacy 
• Prenatal \Alamin Fi>ed Dose Tablet 1 Daily Noon, stop date 
01/10/2019, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"' I 
Past Medlc a l History 
Hunger strike 
Allergls s 
High calorie boost : diarrhea: Side Effects 
Review of Syste ms 
General/Constitutional: 
Fe'"'r denies. Headache denies. Lighlheadedness denies. 
Sleep disturbanoe denies. 
Appointm ent Provld e f b)(6) ; (b)(?)(C) I RN 
Reas on for Appointm ent 
1. RN DAYS: HUNGER STRIKE 
History of Pre se nt Illne ss 
Patient Identification: 
Patient Identification 
Patient property identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEOCXficer 
Viral language do }OU speak? English, Russian 
Interpretation pro\aded? No interpreter available during visit 
Pain Assessment 
Pain 
ke }OU currently in pain? No 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Time: 1500 
INPUT PO: 480 Boost, water 
OUTiPUT Urine voiding throughout shifts 
Initials: KM,! 
Hungerstrike Mln itoring Form 
Shift: AM 
lntakePO( in ml): 480M..BOOST 
OJ!put Urine (in ml): UNABLETOI.IEASUREPAnENTV>.ALL NOT URINATE IN URINAL 
Initials: KM,! 
Hunger Strike: 
Nursing E1181uation 
Date missed meals monitoring initiated: 081221.W18 
\M1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 081221.W18 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wcints to be released from custody 
/1<:!equate supply of drinking water and other be'"'rages a1,0ilable: Yes 
Three meals deli'"'red per day to detainee: Yes 
CXher meal/nutritional supplement Qherhaspedialyte Ud, boost bid, ensure hs 
/lnyunauthori>edfood inroom? No 
Ha'"' dailyorthostatic li al signs been completed? Yes 
Has input and output been documented on the M-IU Hunger Slrike Mlnitoring Smart Form? Yes 
Narrati'"': 
Detainee alert and awake, has newspaper, drank 480 ml B(X)ST, one Liter bottle of Pedial)le. /wake and briefly to toilet at 
least twioe during the shill Went to REC this shift ambulating. Detainee denied any other issues or complaints at time of 
assessmenl /ll. 0940 patient went to REC, while at REC he )elled at 2 female officers in D~ they had his books. He took 3 
books off book cart there and put them in his pants. Wlen he returned to M-IU GEO Cftioer~ k the 3 books from patients 
bed and returned them to D3. Detainee refused to eat lunch, the 160th meal missed. 
Patient ate 2 apples for lunch. 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observation, and monitoring. 
Vit a l Sign s 
97.6F 
62/min 
100/64mm Hg 
16 /min 
149.2 lbs 
66.Sin 
23.72 Index 
Ex aminat ion 
General Examination: 
GENER.Al PPPEPRPNCE: in no acute distress. 
OR/ll... CAvflY: normal, mucosa moist. 
SKIN: good turgor. 
Temo 
10/14/201801:37:06 PM (b)(6); 
HR (b)(?)(C) 
10/14/201801:37:06 PM 
BP 
10/14/201801:37:06 PM 
RR 
10/14/201801:37:06 PM 
wt 
10/14/201810:54:24 /lM 
H 
10/14/201810:54:24 /lM 
BMI 
10/14/201810:54:24 /lM 
MJSCULOSKELET/ll...: full range or motion, good strength and ecual bilaterally, good capillary refill in nail beds, 
neurc>1eScular intact, good capillary refill in nail beds. 
EXIREMTIES: full range or motion. 
PSYCH: alert, oriented. 
Ass e ssm ents 
/ll.-Risk for imbalanoed nutrition: less than body requirements. 
Tr ea tm ent 
1. Others 
qN 
-
~ 
--
RN 
-,_ 
RN ,_ 
~ 
-
RN 
--,_ 
RN 
,_ 
Notes: Intake and OJ!put Mlnitoring e'"'ryshifl; Dailyweights; Dailyorthostatic li tal signs. /In adequate supply of drinking water 
and other be'"'rages are a\18ilable to patient alway.;. Three meals per day are deli'"'red to the patient and deli'"'ryof meals is 
documented. No food allowed in patients room not aulhori,ed byCD/Phy.;ician. Patient is not allowed to purdlase food from 
commissaryvending machine while on hunger strike. Patient will only be released from hunger strike treatment/monitoring by 
CD or phy.;ician order. Patient counseled regarding the medical risks of continuing the hunger strike. Encouraged to terminate 
the hunger strike and eat/drink as normal. Pt -.erbali>ed understanding of care plan. Continue HUNGIER STRIKE protocol. 
Encourage intake offood/lluids. Encourage '"'rbali,ation of feelings. Encourage to allow staff to monitor intake and outpul li tal 
signs, wt. 
Instructed to seek staff with any needs or change in medical/mental health status. 
Call bell within reach, bed in lowest and locked position. 
Refer to nursing care plan for on-going inteMntions . Detainee offered three meals per day and lea'"' in room for at least 20 
minutes. /1<:!equate supply of drinking water and other be-.erages as ordered byprolidera1,0ilable. Encourage dailyoral/phy.;ical 
2019-ICLl-00051 2971 

DHS-ICE-19-0196, 19-0197-N-000153
h)'Jiene care. Change of dothing,bedding offered M[] -W[] - F [ ]. Detainee i,erbali2!ld an understanding of education and/or 
treatmen t 
Clinical Notes: Patient ate 2 apples for lunch. 
Appointment Provider:l(b)(6); (b)(?)(C) ~ 
Electronically signed b~,.,_(b_,_).._(6_,_),._· ---'~ , RN on 10/14/201813 :37:42 (Pacific Daylight Time) 
Sign off status: Comp leted 
Northwest Detention Center 
1623 E J smEEr 
t WA98421 
Tel: (b )(6); 
Patient: AMAR, MERGENSANA DOB: 10/2 3/19 78 Progrw .. Not,,l(b)(6); (b)(?)(C) !RN 10/14/2018 
N(te generaled byeClinica!Wcn<s E!vR'FM Soflvere (WWol(eC//nica/Works .com) 
2019-ICLl-00051 2972 

DHS-ICE-19-0196, 19-0197-N-000154
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA A:21626980 2 Su:i1D:kb)(6): ! 
Facility Code: CSONVWA Housing Area: M 
39Y old Mal~,· AccOl.lll llunber b 6 · 
10 /14/2018 
Curnont Medication s 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Fi>ed Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Pedial)le - Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le-So lution 1 BID, stopdate0 1/10/2019, KCP: Yes, Drug 
Source: In House Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 2 tablet with food Daily 
Noon, stop date 01/10/2019, KCP: Yes, Drug Source: In House 
Pharmacy 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
01/10/2019, KCP: Yes, Drug Source: In House Pharmacy 
• Boost Glucose Control - Liquid 1/2 boxmi>ed TIO, stop date 
12/11/2018, KCP: No, Drug Source: In House Pharmacy 
• Boost\iHC- Liquid 1/2 boxmi>ed TIO, stop date 12/11/2018, 
KCP: No, Drug Source: In House Pharmacy 
• Ensure High Protein- Liquid 1 QI-IS, stop date 10/22f2018, KCP: 
No, Drug Source: In House Pharmacy 
• Prenatal \Atamin Fi>ed Dose Tablet 1 Daily Noon, stop date 
01/10/2019, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
Past Medlc a l History 
Hunger strike 
Allergle s 
High calorie boost: diarrhea: Side Effects 
Revie w of Syste ms 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. 11\eight loss denies. Dry M>uth denies. 
11\eakness denies. Cough denies. Shortness of breath at 
rest denies. Chest pain at rest denies. Palpitations denies. 
J>l:>dominal Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \bm itting denies. Painful urination denies. 
Decreased urine output denies. MJsde adhes denies. MJscie 
cramps denies. Skin breakdown denies. Difficultythinking denies. 
1623 E J STREET, T ' 
Appoimnert Facility: Northwest Detertion Cert er 
Appointment Provld e 1(b )(6); (b )(7)(C) 'NP 
Rea son for Appointment 
1. Daily Rounds 
History of Pre se nt Illne ss 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number 
Number : 11498689 
Language Russian 
Pain .1>6sessment 
Pain 
ke }OU currently in pain? No 
Narrati'"': 
(0746) Patient in M-tU for hunger strike. Patient has been eating fruit, but refuses the rest of the meals. States has no 
intention of resuming eating regularly. 
Official Hunger Strike Report 
Diagnosis: Official Hunger Strike 
Current status: Losing weight and strength 
Mssed meals monitoring initiated: 08/22/2018 
Official hunger strike date: 08f25f2018 
Date last meal consumed: 8/22/2018 
Last meal consumed: Breakfast 
Reason for Hunger Strike: Wants to be released from custody 
Drinking fluids: YES PEDIPL YrE, B(X)ST, Ensure supplements 
# of days missed meal monitoring: 53 
# of days on hunger strike: 50 
#of missed meals (Total):# 160 as of LUNCH 10/14/18 
Initial weight at missed meal monitoring: 163.0 LBS 
Date of initial weight 08f22f2018 
Date of current weight 10/14/2018 
Currentweighli n pounds: 149.2 LBS 
Total weight loss: 13.8 LBS 
Pl refused: FCOD TRAY, e,o:;ept for fresh fruit most meals, 2 apples at dinner last night 
Vit a l Signs 
Temp 
97.6F 10/14/2018 11:08:51 /WI 
1-R 
standing:69 10/14/2018 11 :08:51 /WI 
silting:71 10/14/2018 11:08:51 /WI 
supine:62 10/14/201811:08:51 /WI 
BP 
sitting:105./70 10/14/2018 11 :08:51 /WI 
supine:100/64 10/14/201811:08:51 /WI 
RR 
16/m in 10/14/2018 11 :08:51 /WI 
Wt 
149.2 lbs 10/14/201811:08:51 /WI 
H 
66.5in 10/14/201811:08:51 /WI 
BMI 
23.72 Index 10/14/2018 11 :08:51 /WI 
Ex amination 
General Examination: 
GENER/II.. N'PEARANCE: in no acute distress, well del.eloped, well nourished. 
ORl>L CA\ATY: mucosa moist, no lesions, gums noonal. 
SKIN: good turgor. 
HEAAT: no murmurs, regular rate and rhythm, S 1, S2 noonal. 
LUNGS: normal, clear to auscultation bilaterally, no wheezes, rales, rhonchi. 
PBDONEN: normal, bowel sounds present, soft, nontencer, nondistenced. 
b)(6); 
b)(7)(C) 
MJSCULOSKELETPl : nomial, noonal gait, no deformities, full range r:l motion, good strergth and equal bilaterally. 
Assessme nts 
1. Starvation, subsequent encounter - T73.0JO<D (Primary) 
Tr ea tm ent 
1. Starvation, subsequent encOl.lller 
Notes: Discussed with patient will continue with current plan of care. Patient \Oiced understanding and agreement 
Fo llow Up 
inam 
Appoinbnent Provide (b)(6); 
/h\/7\/C:\ 
(b)(6); (b)(7)(C) 
2019-ICLl-00051 
"" 
2973 
IP 
-
-
µp 
µp 
JP 
-
w 
JP 
-
-
JP 
-
-
~p 
-,-
µp 
,-
,-
~p 
,-

DHS-ICE-19-0196, 19-0197-N-000155
Electronically signed b~~(b_)_(6_); __ ~~ on 10/14/201811:12:17 (Pacific Daylight Time) 
Sign off status: Completed 
Northwest Detention Center 
1623E.JSTRB 
TACOMA, WA98421 
Telfo)~~: I 
P-nt: AMAR, MERGENSANA DOB: 10/23/1978 ProgNu Noa.i""b"'")(.,.6-"' ): __ _.!NP 10/1<112018 
Nd.e generu.ed byeC/irrca/W<Yks a.RIPM Sottw;re (l'M.WeClilica/ works.coojl 
2019-ICLl-00051 297 4 

DHS-ICE-19-0196, 19-0197-N-000156
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA A:216269802 &ti1ot(b)(6): ! 
Facility Code : CSONVWA Housing Area: A 
39Y old Mal~,· 
Acc01.111 ~ber: b)(6); 
10/13/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Fi>ed Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el , see attached ser.ing mi>l!ure older 
• Pedial)le - Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le-So lution 1 BID, stopdate0 1/10/2019, KCP: Yes, Drug 
Source: In House Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 2 tablet with food Daily 
Noon, stop date 01/10/2019, KCP: Yes, Drug Source: In House 
Pharmacy 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
01/10/2019, KCP: Yes, Drug Source: In House Pharmacy 
• Boost Glucose Control - Liquid 1/2 boxmi>ed TIO, stop date 
12/11/2018, KCP: No, Drug Source: In House Pharmacy 
• Boost\iHC- Liquid 1/2 bcxmi>ed TIO, stop date 12/11/2018, 
KCP: No, Drug Source: In House Pharmacy 
• Ensure High Protein- Liquid 1 QI-IS, stop date 10/22f2018, KCP: 
No, Drug Source: In House Pharmacy 
• Prenatal \Atamin Fi>ed Dose Tablet 1 Daily Noon, stop date 
01/10/2019, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
Past Medlcal History 
Hunger strike 
Allerglss 
High calorie boost: diarrhea: Side Effects 
Review of Systems 
General/Constitutional: 
Fe'"'r denies. Headache denies. Lighlheadedness denies. 
Sleep disturbance denies. 
1623 E J STREET, T 
Appoimnert Facility: Northwest Detertion Cert er 
Reason for Appointment 
1. NOC NURSING ROUNDS HUNGl'R STRIKE. 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient property identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEOCXficer 
Viral language do }OU speak? English, Russian 
Interpretation pro\aded? No interpreter available during visit 
Pain Assessment 
Pain 
/>,e }OU currently in pain? No 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Time: 00.01 
INPUT PO: 550 Pedialyte, Ensure, Boost, water 
OUTiPUT Urine 500 voiding throughout shifts 
Initials: DL T 
Hungerstrike Mlnitoring Form 
Shift: Night 
Intake PO (in ml): appx 35() cc Pedialyte 
OJtput Urine (in ml): Appx 500 cc urine output 
Initials: DL T 
Hunger Strike: 
Nursing E118Iuation 
Date missed meals monitoring initiated: 081221.W18 
\M1en did the official hunger strike begin? 08125'2018 
Date of last meal consumed: 081221.W18 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wcints to be released from custody 
/ldequate supply of drinking water and other be'"'rages a1,0ilable: Yes 
Three meals deli'"'red per day to detainee: Yes 
Appointment Provld, (b)(6) ; (b)(7)(C) ~N 
CXher meal/nutritional supplement Qherhaspedialyte Ud, boost bid, ensure hs 
/lnyunauthori>edfood inroom? No 
Haw dailyorthostatic lia l signs been completed? Yes 
Has input and output been documented on the M-IU Hunger Slrike Mlnitoring Smart Form? Yes 
Narratiw: 
Detainee alert and awake, requested newspaper, took all scheduled medications, drank 8 oz Ensure and gi,en fresh Liter 
bottle of Pedialjle. Allake and briefly to toilet at least twice during the shift. Detainee denied any other issues or complaints at 
time of assessment. Detainee refused to eat dinner and breakfast the 159th meal. 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observation, and monitoring. 
Examination 
General B<amination: 
GENER.Al /IPPE.ARMICE: in no acute distress. 
OR/ll CA\A'TY: normal, mucooa moist. 
SKIN: good turgor. 
MJSCULOSKELET/ll : full range of motion, good strength and equal bilaterally, good capillary refill in nail beds, 
neuro\escular intact, good capillary refill in nail beds. 
EXTREMTIES: full range of motion. 
PS'YCH: alert, oriented. 
Assessments 
/II-Risk for imbalanced nutrition: Less than body requirements. 
Treat men t 
1. Others 
Notes: Intake and OJtput Mlnitoring e,eryshift; Dailyweights; Dailyorthostatic ~tal signs. /In adequate supplyof drinking water 
and other bewrages are all8ilable to patient alwa)>S. Three meals per day are deli,ered to the patient and deli,eryof meals is 
documented. No food allowed in patienfs room not authori>ed byCD/Ph)>Sician. Patient is not allowed to purchase food from 
commissary,ending machine while on hunger strike. Patient will only be released from hunger strike treatment/monitoring by 
CD or ph)>Sician order. Patient counseled regarding the medical risks of continuing the hunger strike. Encouraged to terminate 
the hunger strike and eat/drink as normal. Pl ,erbali>ed understanding of care plan. Continue HUNGIER STRIKE protocol. 
Enoourage intake of food/fluids. Encourage ,erbali,ation offeelings. Encourage to allow staff to monitor intake and output ~tal 
signs, wt 
Instructed to seek staff with any needs or change in medical/mental health status. 
Call bell within reach, bed in lowest and locked position with rails up iQ. 
Refer to nursing care plan for on-going inten.entions. Detainee offered three meals per day and lea,e in room for at least 20 
minutes. /ldequate supply of drinking water and other be,erages as ordered byprolider a,ailable. Encourage dailyoral/ph)>Sical 
h>9iene care. Change of dothinglbedding offered M(] -W[ ] - F ( ]. Detainee ,erbali>ed an understanding of education and/or 
treatment 
Appoinbnent Provider:l(b)(6); ~- fN 
Bectronically signed bJ!(b)(6); ~- r on 10/20/2018 01:08:23 (Pacific Daylight Time) 
Sign off status: Completed 
2019-ICLl-00051 2975 

DHS-ICE-19-0196, 19-0197-N-000157
Northwest Detention Center 
1623EJSTRB" 
T~WA98421 
TelM R\· I 
Fax: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Prog,. u Note: ,..!(b"")"-/ 6"")"-: _ __.!IN 10/13/2018 
Nd.e general.ed by eC/irdcaW<rks BvRIPM Sottw,re ("""" eC/inica/works .CtJm) 
2019-ICLl-00051 2976 

DHS-ICE-19-0196, 19-0197-N-000158
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s BvR'PM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 2977 
AMAR,MERGENSANA 
A: 216269802 Su:,10,,,_ " " ' - i 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.ri tunberltb\/6\· 
1623 E J STREET, TACOMA, WA98421 

DHS-ICE-19-0196, 19-0197-N-000159
U.S. Immigration 
and Customs 
Enfor cement 
AMAR, MERGEN~ 
A: 216269802 Si.ti1 (b )(6); 
Facility Code: CSCN/1/WA Housing ea: 
39 Y old Male, DOB: 10/23/1978 
AccOUll~ru 
10 /13/2018 
Cunont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Fi>ed Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Pedial)le - Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le-So lution 1 BID, stopdate0 1/10/2019, KCP: Yes, Drug 
Source: In House Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 2 tablet with food Daily 
Noon, stop date 01/10/2019, KCP: Yes, Drug Source: In House 
Pharmacy 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
01/10/2019, KCP: Yes, Drug Source: In House Pharmacy 
• Boost Glucose Control - Liquid 1/2 boxmi>ed TIO, stop date 
12/11/2018, KCP: No, Drug Source: In House Pharmacy 
• Boost\iHC- Liquid 1/2 boxmi>ed TIO, stop date 12/11/2018, 
KCP: No, Drug Source: In House Pharmacy 
• Ensure High Protein- Liquid 1 QI-IS, stop date 10/22/2018, KCP: 
No, Drug Source: In House Pharmacy 
• Prenatal \Alamin Fi>ed Dose Tablet 1 Daily Noon, stop date 
01/10/2019, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
Past Medlcal History 
Hunger strike 
Allorglos 
High calorie boost : diarrhea: Side Effects 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness admits. 
Sleep Disturbance denies. 11\eight loss admits. Dry 
M:>uth denies. 11\eakness admits. Cough denies. Shortness of 
breath at rest denies. Palpitations denies. /lodominal 
Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \bm itting denies. Painful urination denies. 
Decreased urine output denies. MJsde aches denies. MJscie 
cramps denies. Skin breakdown denies. Difficultythinking denies. 
1623 E J STREET, TA-911421 
Appoimnert Facility: Northwest Detertion Certer 
Reason for Appointment 
1. RN first1/2 e'"'n ing shift round 
History of Present Illness 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Time: 1900 
INPUT PO: 650 
OUTPUT Urine 650 
OUTPUTBM 0 
NetGain: 0 
Initials: LM 
Hungerstrike M:>nitoring Form 
Day: 10/13/2018 
Shift: PM 
Intake PO(in ml): 650 
Intake rl/- Normal Saline (in ml): 0 
Intake rl/- LR (in ml): 0 
Intake NG(in ml): 0 
OJtput Urine (in ml): 650 
OJtput Bowel M:>'"'ments (in ml): 0 
Initials: LM 
Patient Identification: 
Patient Identification 
Patient propeMyidentified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEO OFFICER 
IM1at language do )OU speak? Russian 
Interpretation pro\<ded? Provider fluent in patient's native language 
Pain l'ssessmen t 
Pain 
Ne )OU currently in pain? Yes 
The pain is located : back and legs 
The se'"' rityof pain is rated at 3110 
The se'"' rityof the pain is moderate 
The pain began 4-5 l\eeksago 
The character of the pain is aching 
The associated simptoms are l\eakness 
The pain is aggravated by other hunger slJike 
The pain is reliel<!d by other 
Describe: pt refused medication treatment 
Narrati'"': 
Appointment Provlde1 (b)(6) ; ~-
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observation, and monitoring. 
Pl was in M-IU IIIED 2 Upon encounter detainee was resting quietly in bed and reading book Detainee reported weakness 
and pain on his legs and back, but refused PRN pain meds. M:ldication compliant VIAii continue to monitor. 
Pl refused dinner, this is missed meal #158. VIAii continue to monitor. 
Hunger Strike: 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
\/\hen did the official hunger strike begin? 08/25/2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wants to be released from custody 
Pdequate supply of drinking water and other be\erages available: Yes 
Three meals deli'"'red per dayto patient Yes 
Lunch deli'"'red during current shift 0% consumed 
Priy unauthoriied food in room? No 
Ha'"' dailyorthostatic \<lal signs been completed? Yes 
Has input and output been documented on the the M-iU Hunger Strike M:>nitoring Smart Form? Yes. 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/2212018 
\/\hen did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/2212018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: W.,nts to be released from custody 
Pdequate supply of drinking water and other be\erages available: Yes 
Three meals deli'"'red per day to detainee: Yes 
Lunch 0% consumed 
Priy unauthoriied food in room? No 
Ha'"' dailyorthostatic \<al signs been completed? Yes 
Has input and output been documented on the M-iU Hunger Strike lvbnitoring Smart Form? Yes 
Ex amination 
General Examination: 
GENER/II. !>PPE.ARANCE: in no acute distress, well del.eloped, well noorished. 
HEJlD: normocephalic. 
SKIN: normal, no rashes, no suspicious lesions. 
HEPRT: no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, no Vvheezes, rales, rhonchi. 
CHEST: normal, no gross rib defoonity, normal shape and expansion. 
PBDOl'vEN: normal, bowel sounds present, soft, nontender, nondistended. 
MJSCULOSKELETJ>l: normal, normal gait, no defonnities, full range o( motion, . 
NEUROLOGIC: alert and oriented, cooperati,e V11th exam, , gait normal, neck supple, no rigidity, no tremor. 
PSYCH: alert, oriented, cogniti,e function intact , cooperati\e V11th exam, good eye contact, judgement and insight 
good,_ mood/affect full range, no auditory or 1<sual hallucinations, speech clear, thought content V11t hout suicidal ideation, 
delusions, thought process logical, goal directed. 
Assess ment s 
/II-Risk for imbalanoed nutrition: Less than body requirements. 
Treatment 
1. Others 
2019-ICLl-0005 1 2978 

DHS-ICE-19-0196, 19-0197-N-000160
Notes: 1. Continue with Othostatic \.ital Signs ei,eryday, Intake and OJ!put Mmitoring ei,eryshift; Dailyweights; 2. "'1 adequate 
supply of drinking water and other bei,erages are available to patient at all times. 3. Three meals per day are delii,ered to the 
patient and delii,eryof meals is documented. 4. ~ I food not authori2Bd by CD/Physician is remo'-'ld from patienfs room. 5. Patient 
is oot allowed to purchase food from commissaryi,ending machine while on hunger strike. 6. Patient will only be released from 
hunger strike treatment/monitoring by CD or physician order. 7. Patient counseled regarding the medical risks of continuing the 
hunger strike. 8. Encouraged to terminate the hunger strike and eat/drink as normal. Continue hunger strike protocol, encourage 
po foodl!luids, encourage i,erbaliiation offeelings. Encourage to allow staff to monitor intake and output, '1tal signs, wt. lnslrucled 
to seek staff with any needs. Verbali21ld understanding. Detainee offered three meals perdayand leai,e in room for20 to 30 
minutes. Encourage dailyoral/physical h19iene care. Change of dothing/bedding . Ofer BOJST and Pedil)le as ordered. Patient 
educated to possible Side Effects of going for long period of time without food. Patient i,erbali2es understanding of airrent Plan of 
Care. Patient i,erbali,es his option to refuse food. 
Appointment Providej(b)(6); ~-
Electronically signed ~ b)(6); ~-
Sign off status: Completed 
fN on 10/13/201819 :03:42 (Pacifi c Daylig ht Time) 
Northwes t Detention Cente r 
1623 E J STREEr 
T~WA98421 Te1]Aff I 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progrw .. Nototj: b)(6); ~- IRN 10/13/2018 
N(xe generaled by eClinica!Wcn<s E!vR'FM Soflv.e,-e {WMl<eC/inica/Works .com) 
2019-ICLl-00051 2979 

DHS-ICE-19-0196, 19-0197-N-000161
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:llDtl h \/R\ ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOllll lunber l/h \/R\· I 
1623 E J STREET, TACOMA, WA-98421 
Appoimnert Facility: Northwest Detertion Certer 
10 /13/2018 
Cunont Medication s 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Fi>ed Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Pedial)le - Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le-So lution 1 BID, stopdate01/10/2019, KCP: Yes, Drug 
Source: In House Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 2 tablet with food Daily 
Noon, stop date 01/10/2019, KCP: Yes, Drug Source: In House 
Pharmacy 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
01/10/2019, KCP: Yes, Drug Source: In House Pharmacy 
• Boost Glucose Control - Liquid 1/2 boxmi>ed TIO, stop date 
12/11/2018, KCP: No, Drug Source: In House Pharmacy 
• Boost\iHC- Liquid 1/2 boxmi>ed TIO, stop date 12/11/2018, 
KCP: No, Drug Source: In House Pharmacy 
• Ensure High Protein- Liquid 1 Q-1S, stop date 10/22/2018, KCP: 
No, Drug Source: In House Pharmacy 
• Prenatal \Alamin Fi>ed Dose Tablet 1 Daily Noon, stop date 
01/10/2019, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
Past Medlc a l History 
Hunger strike 
Allorglo s 
High calorie boost: diarrhea: Side Effects 
Review of Syste ms 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness admits. 
Sleep Disturbance denies. 11\eight loss admits. Dry 
M:>uth denies. 11\eakness admits. Cough denies. Shortness of 
breath at rest denies. Palpitations denies. /lodominal 
Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \bm itting denies. Painful urination denies. 
Decreased urine output denies. MJsde aches denies. MJscie 
cramps denies. Skin breakdown denies. Difficultythinking denies. 
Appointment Provld e 1(b)(6 ); (b)(7)(C) ~N 
Reas on for Appointm ent 
1. RN day round/hunger strike 
History of Pre se nt Illne ss 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Time: 1500 
INPUT PO: 2100 
OUTPUT Urine 1100 
OUTPUTBM 0 
Net Gain: 1000 
Initials: LM 
Hungerstrike M:>nitoring Form 
Day: 10/13/2018 
Shift: AM 
Intake PO(in ml): 2100 
Intake rl/- Normal Saline (in ml): 0 
Intake rl/- LR (in ml): 0 
Intake NG(in ml): 0 
OJtput Urine (in ml): 1100 
OJtput Bowel M:>'"'ments (in ml): 0 
Initials: LM 
Patient Identification: 
Patient Identification 
Patient propeMyidentified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEO OFFICER 
IM1at language do )OU speak? Russian 
Interpretation pro\<ded? Provider fluent in patient's native language 
Pain l'ssessmen t 
Pain 
Ne )OU currently in pain? Yes 
The pain is located : back and legs 
The se'"'rityof pain is rated at 3110 
The se'"'rityof the pain is moderate 
The pain began 4-5 l\eeksago 
The character of the pain is aching 
The associated simptoms are l\eakness 
The pain is aggravated by other hunger slJike 
The pain is reliel<!d by other 
Describe: pt refused medication treatment 
Narrati'"': 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observation, and monitoring. 
Pl was in M-IU IIIED 2 Upon encounter detainee was resting quietly in bed. Detainee reported weakness and pain on his 
legs and back , but refused PRN pain meds. M,dication compliant VIAii continue to monitor. 
Pl refused lunch, this is missed meal #157. Memoon pt went to reck)ard, pt refused wheelchair. VIAii continue to monitor. 
Hunger Strike: 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
\/\hen did the official hunger strike begin? 08/25/2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wants to be released from custody 
Pdequate supply of drinking water and other be1.erages a,ailable: Yes 
Three meals deli1.ered per dayto patient Yes 
Lunch deli'"'red during current shift 0% consumed 
Pny unauthoriied food in room? No 
Ha1.e dailyorthostatic \<lal signs been completed? Yes 
Has input and output been documented on the the M-iU Hunger Strike M:>nitoring Smart Form? Yes. 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/2212018 
\/\hen did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/2212018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: W.,nts to be released from custody 
Pdequate supply of drinking water and other be1.erages available: Yes 
Three meals deli'"'red per day to detainee: Yes 
Lunch 0% consumed 
Pny unauthoriied food in room? No 
Ha'"' dailyorthostatic \<al signs been completed? Yes 
Has input and output been documented on the M-iU Hunger Strike M:>nitoring Smart Form? Yes 
Vit a l Signs 
Temp 
97.9F 10/13/2018 09:20:58 /'M 
HR 
supine:60 10/13/2018 09:20:58 /'M 
silling:75 10/13/2018 09:20:58 /'M 
standi ng:98 10/13/2018 09:20:58 /'M 
BP 
supine:101/62 10/13/2018 09:20:58 /'M 
silling:103/66 10/13/2018 09:20:58 /'M 
standi ng:94/63 10/13/2018 09:20:58 /'M 
RR 
16/ min 10/13/2018 09:20:58 /'M 
WI 
143.6 lbs 10/13/2018 09:20:58 /'M 
H 
2019-ICLl-00051 2980 
b)(6); RN 
b)(7)(C) I￾I￾RN 
RN 
RN 
I￾I￾N 
RN 
RN 
-
-N 
--N 

DHS-ICE-19-0196, 19-0197-N-000162
l66.5 in 10/13/201809:20:58/>M b)(6); lt----------------:: BM::-:lc----------1;b) (7)(C) 
I 22.83 Index 
Exa mina tion 
General El<amination: 
10/13/2018 09:20:58 PM 
GENER/IL PPPEAAPNCE: in no acute distress, well de\eloped , well nourished. 
HEPD: nonnocephalic. 
SKIN: noonal, no rashes, no suspicious lesions. 
HEl'RT: no murmurs, regular rate and rhythm, S 1, S2 nonnal. 
LUNGS: noonal, clear to auscultation bilaterally, no w,eezes, rales, rhonchi. 
CHEST: noonal, no gross rib deformity, noonal shape and expansion. 
/18D0\,EN: noonal, bowel sounds present, soft, nontender, nondistended. 
M.JSCULOSKELET.i>l: normal, normal gait, no deformities, full range cl motion, . 
NEUROLOGIC: alert and oriented, cooperati-e Vloith exam, , gait normal, neck supple, no rigidity, no tremor. 
PSYCH: alert, oriented, cogniti-e function intact, cooperati-e Vloith exam, good eye contact, judgement and insight 
good, mood/affect full range, no auditory or l.isual hallucinations, speech clear, thought content Vloithout suicidal ideation, 
delusions, thought process logical, goal directed. 
Assess ment s 
/II-Risk for imbalanced nutrition: Less than body requirements. 
Tr eat me nt 
1. Others 
Notes: 1. Continue with 01hostatic \.ital Signs e'-'!ryday, Intake and Oitput Mmitoring e'-'!ryshift; Dailyweights; 2. "'1 adequate 
supply of drinking water and other be'-'!rages are ai,ailable to patient at all times. 3. Three meals per day are deli'-'lred to the 
patient and deli'-'lryof meals is documented. 4. ~ I food notauthori2ed by CD/Physician is remo'-'ld from patienfs room. 5. Patient 
is not allowed to purchase food from oommissary,ending machine while on hunger strike. 6. Patient will only be released from 
hunger strike treatment/monitoring by CD or physician order. 7. Patient oounseled regarding the medical risks of oontinuing the 
hunger strike. 8. Enoouraged to terminate the hunger strike and eat/drink as normal. Continue hunger strike protoool, enoourage 
po food/!luids, enoourage '-'!rbali,ation offeelings. Enoourage to allow staff to monitor intake and output, IAtal signs, wt. Instructed 
to seek staff with any needs. Verbali2"d understanding. Detainee offered three meals perdayand lea'-'! in room for20 to 30 
minutes. Enoourage dailyoral/physical h19iene care. Change of clothing/bedding . a!er BCXlST and Pedil)le as ordered. Patient 
educated to possible Side Effects of going for long period of time without food. Patient '-'!rbali2es understanding of current Plan of 
Care. Patient '-'!rbali2es his option to refuse food. 
Appointment Provide b)(6); RN 
h \/7\/r.\ 
Electronically signed b b)(6); on 10/13/201815:00:19 (Pacific Daylight Time) h\/ 7 \fr\ 
Sign off status: Complete 
Northwest Detention Center 
1623 E J SmEEr 
T~WA98421 Te1Jix~t I 
Patient: AMAR, MERGENSANA DOB: 10/23/19 78 Progrwas Note!\~/\~/;,_, ~ 10/13/2 018 
Ncie generaled by eOinica!Wcn<s EM<IPM Soflvere (w.w,eQinictiWcn<s.corrv 
2019-ICLl-00051 2981 

DHS-ICE-19-0196, 19-0197-N-000163
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA . . A: 216269802 Su:ll,.J;6 )(6); _ 1 
Facility Code: CSOINWA liiQked . lfl 
39 Y old Male, DOB: 10/23/1978 
AccOl.rllunberlibii6i:7 
1623 E J STREET, T~ 
Appoirimert Facility. Northwest Detertion Certer 
10 /13/2018 
Curnont Medication s 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Fi>ed Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• Pedial)le - Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le-So lution 1 BID, stopdate01/10/2019, KCP: Yes, Drug 
Source: In House Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 2 tablet with food Daily 
Noon, stop date 01/10/2019, KCP: Yes, Drug Souroe: In House 
Pharmacy 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
01/10/2019, KCP: Yes, Drug Souroe: In House Pharmacy 
• Boost Glucose Control - Liquid 1/2 boxmi>ed TIO, stop date 
12/11/2018, KCP: No, Drug Source: In House Pharmacy 
• Boost\iHC- Liquid 1/2 boxmi>ed TIO, stop date 12/11/2018, 
KCP: No, Drug Souroe: In House Pharmacy 
• Ensure High Protein- Liquid 1 QI-IS, stop date 10/22/2018, KCP: 
No, Drug Souroe: In House Pharmacy 
• Prenatal \Atamin Fi>ed Dose Tablet 1 Daily Noon, stop date 
01/10/2019, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"' I 
Past Medlc a l History 
Hunger strike 
Allergle s 
High calorie boost : diarrhea: Side Effects 
Review of Syste ms 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbanoe denies. 11\eight loss denies. Dry M>uth denies. 
11\eakness denies. Cough denies. Shortness of breath at 
rest denies. Chest pain at rest denies. Palpitations denies. 
J>l:>dominal Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \bm itting denies. Painful urination denies. 
Decreased urine output denies. MJsde aches denies. MJscie 
cramps denies. Skin breakdown denies. Difficultythinking denies. 
Appointm e nt Pl'ovld e (~b~)('-6-'-' ); __ __.I NP
Reas on for Appointm ent 
1. Daily Rounds 
History of Pre se nt Illne ss 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? Russian 
lnterpre!og prm,i¢d? Yes, Interpreter Name 
Name @}~6 ): J RN Language uss,an Pain .1>6sessment 
Pain 
ke }OU currently in pain? No 
Narrati'"': 
Patient in M-tU for hunger strike. Patient has been eating fruit but refuses the rest of the meals. States has no intention of 
resuming eating regularly. 
Official Hunger Strike Report 
Diagnosis: Official Hunger Strike 
Current status: Losing weight and strength 
Mssed meals monitoring initiated: 08/22/2018 
Official hunger strike date: 08/25/2018 
Date last meal oonsumed: 8/22/2018 
Last meal oonsumed: Breakfast 
Reason for Hunger Strike: Wants to be released from custody 
Drinking fluids: YES PEDIPL YrE, B(X)ST, Ensure supplements 
# of days missed meal monitoring: 48 
# of days on hunger strike: 48 
# of missed meals (Total): #156 as of breakfast this am 
Initial weight at missed meal monitoring: 163.0 LBS 
Date of initial weight 08/22/2018 
Date of current weight 10/12/2018 
Currentweighli n pounds: 142.0 LBS 
Total weight loss: 21.0 LBS 
Pl refused: FCOD TRAY, e,o:;ept for fresh fruit most meals, 2 apples at dinner last night 
Vit a l Signs 
98.0F 
supine:80 
sitting:75 
standi ng:98 
supine:101/62 
sitting:103166 
standi ng:94/63 
66.5in 
Ex aminatio n 
General El0mination: 
Temp 
10/13/201812:33:35 PM 
HR 
10/13/2018 12:33:35 PM 
10/13/201812:33:35 PM 
10/13/2018 12:33:35 PM 
BP 
10/13/201812:33:35 PM 
10/13/201812:33:35 PM 
10/13/201812:33:35 PM 
H 
10/13/201812:33:35 PM 
GENERJ>l /lPPEAAPNCE: in no acute distress, well deleloped, well r<JO.Jrished. 
ORPl. CA\/ITY: mucosa moist, no lesions, gums normal. 
SKIN: good turgor. 
HEPRT: no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, no\Okleezes, rales, rhonchi. 
!>BDOIVEN: normal, bowel sounds present, soft, nontender, nor-distended. 
(b)(6); 
(b)( 7)(C) 
MJSCULOSKELET/>L: normal, normal gait, no deformities, full range cl motion, good strength and equal bilaterally. 
Assessme nt s 
1. Star.ation, subsequent encounter - T73.0X><D (Primary) 
Trea tment 
1. Starvation, subsequent encOl.rller 
Notes: Discussed with patient will oontinue with current plan of care. Patient l()iced understanding and agreement 
Fo llow Up 
inam 
Ap pointment Provi der. l(b)(6) ; ~· 
b)(6) ; (b)(7)(C) 
Electro ni cally signed b b) (6); on 10/13/2018 12:36:49 (Pacific Dayli ght lime) 
Sign off status: Comple•mi nof" -'7
-'"'"'r_,:.__...J 
2019-ICLl-00051 2982 
~ 
-
~p 
~p 
~p 
-
~ 
~p 
~p 
-
-
~p 
-

DHS-ICE-19-0196, 19-0197-N-000164
Northwest Detention Center 
1623EJ~ 
TACOMA, WA98421 
TeL'h\/ R\· I 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 ProgN u No, (b)(6); ~- INP 10/13/2018 
Nd.e general.ed by eClinica/Wm<s B-,RIPM Softvere (1W.WeClinica/WOrks.Ctlm) 
2019-ICU-00051 2983 

DHS-ICE-19-0196, 19-0197-N-000165
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA . . A: 216269802 Su:ll,.J,6 )(6); 1 Fac1lrtyCode:CSOINWA ng ,c;ea.lfi 
39 Y old Male, DOB: 10/23/1978 
AccOl.rll lunberlibii6i:7 
1623 E J STREET, T~ 
Appoirimert Facility. Northwest Detertion Certer 
10 /13/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Fi>ed Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• Pedial)le - Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le-So lution 1 BID, stopdate0 1/10/2019, KCP: Yes, Drug 
Source: In House Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 2 tablet with food Daily 
Noon, stop date 01/10/2019, KCP: Yes, Drug Souroe: In House 
Pharmacy 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
01/10/2019, KCP: Yes, Drug Souroe: In House Pharmacy 
• Boost Glucose Control - Liquid 1/2 boxmi>ed TIO, stop date 
12/11/2018, KCP: No, Drug Source: In House Pharmacy 
• Boost\iHC- Liquid 1/2 boxmi>ed TIO, stop date 12/11/2018, 
KCP: No, Drug Souroe: In House Pharmacy 
• Ensure High Protein- Liquid 1 QI-IS, stop date 10/22/2018, KCP: 
No, Drug Souroe: In House Pharmacy 
• Prenatal \Alamin Fi>ed Dose Tablet 1 Daily Noon, stop date 
01/10/2019, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"'I 
Past Medlcal History 
Hunger strike 
Allerglss 
High calorie boost: diarrhea: Side Effects 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbanoe denies. 11\eight loss denies. Dry M>uth denies. 
11\eakness denies. Cough denies. Shortness of breath at 
rest denies. Chest pain at rest denies. Palpitations denies. 
J>l:>dominal Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \bm itting denies. Painful urination denies. 
Decreased urine output denies. MJsde aches denies. MJscie 
cramps denies. Skin breakdown denies. Difficultythinking denies. 
Reason for Appointment 
1. NURSE ROUNDS HUNGER STRIKE 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient property identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEOCXficer 
Viral language do }OU speak? English, Russian 
Interpretation pro\aded? No interpreter available during visit 
Pain Assessment 
Pain 
ke }OU currently in pain? No 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Time: 0600 
INPUT PO: 350 approximate intake, Pedialyte 
Ot.JliPUT Urine 500 approximate voided x 2 in urinal 
Initials: DL T 
Hungerstrike M>nitoring Form 
Shift: Night 
Intake PO (in ml): appx 35() cc Pedialyte 
OJtput Urine (in ml): Appx 500 cc urine output 
Initials: DL T 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 081221.W18 
\M1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 081221.W18 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wcints to be released from custody 
/ldequate supply of drinking water and other be'"'rages a11ailable: Yes 
Three meals deli'"'red per day to detainee: Yes 
Appointment Provld,aj~(b_)_(6_),_· __ _.I RN 
CXher meal/nutritional supplement Qherhaspedialyte Ud, boost bid, ensure hs 
/lnyunauthori>edfood inroom? No 
Ha'"' dailyorlhostatic lia l signs been completed? Yes 
Has input and output been documented on the M-IU Hunger Slrike M>nitoring Smart Form? Yes 
Narrati'"': 
Detainee appeared to sleep but was also awake and brieflyto toilet at least lwioe during the shift. Detainee denied anyother 
issues or complaints at time of assessment Detainee refused to eat breakfas~ missed 156th meal. 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observation, and monitoring. 
Ex amination 
General B<amination: 
GENER.Al !>PPE.ARPNCE: in no acute distress, slow rnoi,ing. 
OR.Al CA\AlY: normal, mucooa moist. 
SKIN: good turgor. 
MJSCULOSKELET/ll : full range of motion, good strength and equal bilaterally, good capillary refill in nail beds, 
neuro\E!Scular intact, good capillary refill in nail beds. 
EXTREMTIES: full range of motion. 
PSYCH: alert, oriented. 
Assessments 
/II-Risk for imbalanoed nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: Intake and OJtput M>nitoring e\Alryshift; Dailyweights; Dailyorthostatic \ital signs. /In adequate supplyof drinking water 
and other be'"'rages are available to patient alwai,s. Three meals per day are deli\Alred to the patient and deli\Alryof meals is 
documented. No food allowed in patienfs room not authori,ed byCD/Phi,sician. Patient is not allowed to purchase food from 
commissar)ll<!nding machine while on hunger strike. Patient will only be released from hunger strike treatment/monitoring by 
CD or phi,sician order. Patient counseled regarding the medical risks of continuing the hunger strike. Encouraged to terminate 
the hunger strike and eat/drink as normal. Pl \Alrbali>ed understanding of care plan. Continue HUNGIER STRIKE protocol. 
Encourage intake of food/fluids. Encourage \Alrbali,ation offeelings. Encourage to allow staff to monitor intake and outp~ ~tal 
signs.wt 
Instructed to seek staff with any needs or change in medical/mental health status. 
Call bell within reach, bed in lowest and locked position with rails up iQ_ 
Refer to nursing care plan for on-going inten.entions. Detainee offered three meals per day and lea\Al in room for at least 20 
minutes. /ldequate supply of drinking water and other be\Alrages as ordered byprolider a,ailable. Encourage dailyoral/phi,sical 
h>9iene care. Change of dothing,bedding offered M(] -W[ ] - F ( ]. Detainee \Alrbali>ed an understanding of education and/or 
treatment 
Appoinbnent Provider:!(b)(6); 
Bectronicall y signed on 10/13/2018 05:05:27 (Pacific Daylight Time) 
2019-ICLl-0005 1 2984 

DHS-ICE-19-0196, 19-0197-N-000166
Northwest Detention Center 
1623EJ~ 
l'.~~WA9 8421 ,@(6)£ I 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 Progre u Nota ~.,., (b"')"'(6a..: ).. : _ _.!RN 10/13/2018 
Nd.e general.ed by eClinica/Wm<s 8"R'PM Softvere (1W.WeClinica/WOrks.Ctlm) 
2019-ICLl-00051 2985 

DHS-ICE-19-0196, 19-0197-N-000167
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A:216269802 Su:l1D: !(b)(6); I 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll lunbe~ 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Cert er 
10 /12/2018 
Curnont Medication s 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Fi>ed Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Pedial)le - Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Pedial)le -So lution 1 BID, stopdate0 1/10/2019, KCP: Yes, Drug 
Source: In House Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 2 tablet with food Daily 
Noon, stop date 01/10/2019, KCP: Yes, Drug Source: In House 
Pharmacy 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
01/10/2019, KCP: Yes, Drug Source: In House Pharmacy 
• Boost Glucose Control - Liquid 1/2 boxmi>ed TIO, stop date 
12/11/2018, KCP: No, Drug Source: In House Pharmacy 
• Boost\iHC- Liquid 1/2 boxmi>ed TIO, stop date 12/11/2018, 
KCP: No, Drug Source: In House Pharmacy 
• Ensure High Protein- Liquid 1 QI-IS, stop date 10/22/2018, KCP: 
No, Drug Source: In House Pharmacy 
• Prenatal \Alamin Fi>ed Dose Tablet 1 Daily Noon, stop date 
01/10/2019, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
Past Medlc a l History 
Hunger strike 
Allergle s 
High calorie boost : diarrhea: Side Effects 
Revie w of Syste ms 
Hunger Strike: Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. 11\eight loss admits. Dry 
M:>uth denies. 11\eakness denies. Cough denies. Slhortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. l't>dominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. \Qmitling denies. Painful 
urination denies. Decreased urine output denies. MJsde 
aches denies. M.lsde cramps denies. Skin breakdown denies. 
Difficulty thinking denies. 
Appoin t ment Provld e 1 (b)(6) ; (b)(7)(C) 
Rea son for Appointment 
1. PM SHIFT NOTE. Hunger Strike Nursing Ev.iluation 
History of Pre se nt Illne ss 
Patient Identification: 
Upon encounter detainee was resting quiefly in bed. Detainee reported feeling "so-so" and accepted his 16:30 boost mix. 
Detainee has his water cup av.iii able and Hhas also drank his Pedial)le, Boost and Ensure. Detainee reported no pain and 
medications will be gi'"'n as needed/ordered. Detainee has chosen to miss his 155th meal this e'"'ning but did eat 2 apples 
instead. Detainee is has been using the tvl-iU tabletquiefly in his room. \MIi continue to monitor. 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes 
Viral language do }OU speak? English 
Interpretation pro\aded? Pallant speaks English fluenUy 
Pain />ssessment 
Pain 
ke }OU currenflyin pain? No 
Narrati'"': 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
obser10tion, and monitoring. 
Hunger Strike: 
Hunger Strike Nursing Evaluation 
Wien did the official hunger strike begin? 08/2512018 
Drinking Fluids: Yes DETAINEE/$ DRINKING WA7ER, PED/AL Y7E, BOOST & ENSURE 
Fluid !)pa : IMlter, Nutlitional supplement, Cral electrolyte solution 
l\i'eals deli'"'red during shi~ Dinner 
lnput/OJtput Use Procedures to enter hunger sllike monitoring input/output INPUT/ CIJ7PUT RECORDED ON HUNGER 
SffilKEFORMIN 
Vit a l Sign s 
97.8F 
sitting:71 
standi ng:83 
supine:56 
sitting:84161 
standing:89/62 
supine:96/70 
16/ min 
142.0 lbs 
66.5in 
22.57 Index 
Ex aminat ion 
General Examination: 
Temo 
10/12/201806:52:57 PM 
1-R 
10/12/201807:01:42 PM 
10/12/201807:01:42 PM 
10/12/201807:01:42 PM 
BP 
10/12/201807:01:42 PM 
10/12/201807:01:42 PM 
10/12/201807:01:42 PM 
RR 
10/12/201806:52:57 PM 
wt 
10/12/201807:01:42 PM 
H 
10/12/201806:52:57 PM 
BMI 
10/12/201807:01:42 PM 
GENERJ>l J>PPEAAPNCE: in no acute distress, well deleloped, well OOJrished. 
PSYCH: alert, oriented. 
Assess ment s 
/>I-Risk for imbalanced nutrition: Less than body requirements. 
Trea tmen t 
1. Others 
(b )(6); 
(b)(7)(C) 
Notes: 1. Continue with \Atal Signs e'"'rys hift; Intake and OJtput M:>nitoring e1.eryshift; Dailyweights; Dailyor1hostatic I.ital signs. 
2. l'n adequate supply of drinking water and other be1.erages are av.iii able to patient at all times. 
3. Three meals per day are deli1.ered to the patient and deli'"'ryo f meals is documented. 
4. ~ I food not authoriied by CD~y.,ician is remo1.ed from patienrs room. 
5. Patient is not allowed to purchase food from commissary'l.ending machine while on hunger strike. 
6. Patient will only be released from hunger strike lrealment/monitoring byCD or phy.,ician order. 
7. Patient counseled regarding the medical risks of continuing the hunger strike. 
8. Encouraged to terminate the hunger strike and eat/drink as normal. 
Appointment Provider: f b)(6); (b)(7)(C) 
2019-ICLl-00051 2986 

DHS-ICE-19-0196, 19-0197-N-000168
Electronically signed b1 b)(6); (b)(7)(C) 
Sign off status: Completed 
IRN on 10/12/2018 22:14:34 (Pacific Daylight nme) 
Northwest Detention Center 
1623EJSTREI" 
TACOMA, WA98421 
Telkbl(6); ! aax. 
P• tl-t: AMAR, MERGENSANA DOB: 10/23/1978 p..._. "'"4 (b)(6); (b)(7)(C) 
Nd.e general.ed by eOinica/W<n<s B>RIPM Sottw,re (1W,WeG/inica/works.CtJm) 
2019-ICLl-00051 2987 
10/12/2018 

DHS-ICE-19-0196, 19-0197-N-000169
U.S. Immigrat ion 
and Customs 
Enforcement 
Cunent -dlcatlons 
Taking 
• Calcium 500/0 500-200 M:;-UNITTablet 1 tablet with food Oice 
a day, KOP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Filed Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 M3Tablet 1 tablet as needed Four times a day, KOP: 
Reason for Appointment 
1. Clarify meds 
Assassments 
1. Starvation, subsequent encounter - 173 .QX)q) 
Treatment 
1. Starvation, subsequent encOlrter 
AMAR,MERGENSANA A: 216269802 Su:ll~(b )(6 ): J 
Facility Code: CSONVWA Housing Area: 
AccOlrt ~t,eb)@C I 39Y ad ~l~!t:: 
1623 E J STREET, T 
Yes, Drug Source: Pharmacy 
• Calcium 500/0 500-200 M:;-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra;el 
Stop Prenatal 19 Chewable Tablet Chewable, Fi>ed Dose, 1, Oall y, Daily Noon, 90 da)S, 1, KOP: Yes, Drug Source: In House 
Pharmacy 
• Fiber625 M3Tablet 1 tablet as needed BID, stopdate 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for trawl 
• Cholecalciferol 2000 UNIT Tablet 1 tablet a-IS , stop date 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for trawl 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed no , stop date 
10/26/2018, KOP: No, Drug Source: In House Pharmacy, Notes: Not 
required for trawl, see attached ser.ing mildure order 
• Pedial>4e- Solution 1 boWe three times a dayn D, stop date 
10/28/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for trawl 
• J'l<:etaminophen 500 M3 Tablet 1 tablets as needed QID PRN, 
stop date 12/30/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra;el 
• Pedial>4<' - Solution 1 BID, stop date 01/10/2019, Ka>: Yes, Drug 
Source: In House Pharmacy 
• Calcium 500/0 500-200 M:;-UNITTablet 2 tablet IMth food Daily 
Noon, stop date 01/10/2019, Ka>: Yes, Drug Source: In House 
Pharmacy 
• Fiber625 M3Tablet 1 tablet as needed BID. stop date 
01/10/2019, Ka>: Yes, Drug Source: In House Pharmacy 
• Prenatal 19 Chewable Filed Dose Tablet Chewable 1 Daily 
Noon, stop date 01/10/2019, Ka>: Yes, Drug Source: In House 
Pharmacy 
• Boost Glucose Control - Liquid 1/2 boxmi>ed n o. stop date 
12/11/2018, Ka>: No, Drug Source: In House Pharmacy 
• Boost\iHC - Liquid 1/2 boxmi>ed n o. stop date 12/11/2018, 
KOP: No, Drug Source: In House Pharmacy 
• Ensure High Protein- Liquid 1 Q-1S, stop date 10/22/2018, KOP: 
No, Drug Source: In House Pharmacy 
Past Medical History 
Hungersb'ike 
Allergles 
Boost plus: diarrhea: Side Effects 
Start Prenatal \Atamin Table~ Fi,ed Dose, 1, Oall y, Daily Noon, 90 da)S, 1, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for trawl 
Tel: 
Fax: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progress Note: 
/lkte generated byeOinicai'M:xi<s e.RIPM &Jtv.ere ("""'eC/inica/Works.com) 
2019-ICLl-00051 2988 

DHS-ICE-19-0196, 19-0197-N-000170
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 2989 
AMAR,MERGENSANA A:216269802 Su:llD:fb)/6): ! 
Facility Code: CSONVWA Housing Area : M 
39 Y AccOUll ad ~le, ~be ~!f §(6J~:: C I 1623 E J STREET, TACO 

DHS-ICE-19-0196, 19-0197-N-000171
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
.. A:216269802 Su:ll~b )(6); I 
Fac1lrtyCode:CSOINWA ng ,c;ea.lfi 
39 Y old Male, DOB: 10/23/1978 
AccOl.rll lunbe~ 
1623 E J STREET, T~ 
Appoirimert Facility. Northwest Detertion Certer 
10 /12/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• Pedial)le - Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Past Medlcal History 
Hunger strike 
Allergles 
Boost plus: diarrhea: Side Effects 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fe'"'r denies. Headache denies. Lighlheadedness denies. Night 
sweats denies. Sleep disturbance denies. 1/Veight gain denies. 
1/Veight loss denies. 
Gastrointestinal: 
Blood in stool denies. Constipation denies. Nausea denies. 
MJsruloskeletal: 
MJScie aches denies. 1/Veakness admits. 
Aflpolntment Provlder:l (b) (6) ; (b) (?)(C) l•D 
Reason for Aflpolntment 
1. tvHU hunger strike rounds 
History of Present Illness 
Patient Identification: 
Pt has resumed drinking water, other fluids such as pedial)(e and boost He has continued to walk to the rec yard. He agreed 
to urine testing but refused lab draw. Mmtation is fine and his BP and weight ha'"' impro'"'d since Tuesday. 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Pallant speaks English fluenUy 
Pain .1>6sessment 
Pain 
ke }OU currently in pain? No 
Narrati'"': 
Current status: Losing weight and strength 
Mssed meals monitoring initiated: 081221'2018 
Official hunger strike date: 08125/'2018 
Date last meal consumed: 81221'2018 
Last meal consumed: Breakfast 
Reason for Hunger Strike: Wants release from custody 
Drinking fluids: Yes: PEDll'l YTE, BCX)ST, Ensure supplements 
# of da)S missed meal moni1oring: 50 
# of da)S on hunger strike: 47 
# of missed meals (Total): 154 as of Lunch (10/121'2018). 
Initial weight at missed meal monitoring: 163.0 LBS 
Date of initial weight 08/221'2018 
Date of current weight 10/10/2018 
Currentweighli n pounds: 142 LBS 
Total weight loss: 21 LBS 
Pl refused: FCX)[) TRAY, e>eept for an occasional fresh fruit 
Vit al Signs 
97.8F 
83/min 
84/61 mm Hg 
16/ min 
142 lbs 
Ex amination 
General Examination: 
Temo 
HR 
BP 
RR 
wt 
10/13/2018 07:41:06 />M 
10/13/2018 07:41 :06 />M 
10/131201807:41 :06 />M 
10/13/2018 07:41 :06 />M 
10/13/2018 07:41 :06 />M 
GENER/ll JIPPEPRANCE: in no acute distress, well del.eloped, well nourished. 
SKIN: good turgor. 
HE.ART: regular rate and rhyttm 
LUNGS: good air mowment. 
(b)(6) ; 
(b)(?)(C) 
EXTREMTIES: good capilla,y refill in nail beds, no clubbing, cyanosis, or edema, full range of motion. 
PSYCH: cogniti'"' function intact, mood/affect full range, no auditory or -.isual hallucinations, speech clear, thought 
content 1Mthout suicidal ideation, delusions, thought process logical, goal directed. 
Ass ess ment s 
1. Starvation, subsequent encounter - T73.0X)<I) (Pr mary) 
2. Imbalanced nutrition: Less than body requirements [00002]- ND00002 
Self-imposed hunger strike, has been drinking supplemental caloric shakes and other fluids. 
Treatment 
1. Starvation, subsequent encOl.rller 
Start Pedial)le Solution,-, 1, Oa lly, BID, 90 da)S, 1, KCP: Yes, Drug Source: In House Pharmacy 
Start Calcium 500/D Tablel 500-200 11,G-UNI T, 2 tablet with food, Oa lly, Daily Noon, 90 da)S, 1, KCP: Yes, Drug Source: In 
House Pharmacy 
Start FiberTablel 625 M3, 1 tablet as needed, Oal ly, BID, 90 da)S, 180Tablel KCP: Yes, Drug Source: In House Pharmacy 
Stop Prenatal 19 Chewable Tablet Chewable, Rxed Dose, 1, Oa lly, Daily Noon, 90 da)S, 1, KCP: Yes, Drug Source: In House 
Pharmacy 
Start Boost Glucose Control Liquid,-, 1/2 box mixed, Oal ly, TIO, 60 da)S, 1, KCP: No, Drug Source: In House Pharmacy 
Start Boost \A-IC Liquid,-, 1/2 box mixed, Oally, TIO, 60 da)S, 1, KCP: No, Drug Source: In House Pharmacy 
Start Ensure High Protein Liquid,-, 1, Qally, Ol-iS, 10 da)S, 1, KCP: No, Drug Source: In House Pharmacy 
Notes: Pt is oooperati'"' e>eept for lab draw. He do ha'"' a normal urine. He is able to walk to rec yard. He may need a court order 
to get lab testing. He has gained some of his weight back and is normal emotionally. 
2. Others 
Notes: Cancel Rx Response got l'pprol<!d on 2018-10-12 15:56:38 for 'Prenatal 19 Chewable Fixed Dose Tablet 
Chewable'Pharmacy Notes: Cancel Rx l'pprol<!d. 
Follow Up 
daily by nursing staff and e'"',y 2-3 da)S bypro1,1ders 
Notes: M)dication and Treatment Plan Re1,1ewed, Discussed medication use and side effects with patienl Patient '-"'rbali,ed 
understanding of all instructions 
Appoinbnent Provide~ (b)(6) ; (b)(?)(C) IMO 
2019-ICLl-0005 1 2990 

DHS-ICE-19-0196, 19-0197-N-000172
(b)(6); (b)(7)(C) 
Electronically signed b* b)(6); (b)(7)(C) ro on1CW13/2018 07:49:34 (Pacific Daylight Tlme) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREEr 
TACOMA, WA98421 
Telj(b )(6): l Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 ProgNu Not.i(b)(6) ; (b)(7)(C) rD 10/12/2018 
Nd.e general.ed by eOirica/W<n<s B>RIPM SottY.ere (""""eC/inica/works.com) 
2019-ICLl-00051 2991 

DHS-ICE-19-0196, 19-0197-N-000173
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A:216269802 Su:lloj(b)(6): ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, 
AccOllll l'unbe b)(6); 
10 /12/2018 
Curnont Medication s 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Pedial)le - Solution 1 bottle three times a dayllD, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Pas t Med lca l History 
Hunger strike 
Allergle s 
High calorie boost : diarrhea: Side Effects 
Review of Syste ms 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness admits. 
Sleep Disturbance denies. lr'lleight loss admits. Dry 
M:>uth denies. lr'lleakness admits. Cough denies. Shortness of 
breath at rest denies. Palpitations denies. /lodominal 
Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \bm itting denies. Painful urination denies. 
Decreased urine output denies. MJsde aches denies. MJscie 
cramps denies. Skin breakdown denies. Difficultythinking denies. 
1623 E J STREET T h \/7\/f"'\ 
Appoimnert Facility: ~est Detertion Certer 
Appointment Provld e'i(~b_)_(6_); __ __.! RN 
Reas on for Appointm ent 
1. RN day round/hunger strike 
History of Pre se nt Illne ss 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Time: 1310 
INPUT PO: 2650 
OUTPUT Urine 2000 
OUTPUTBM 0 
Net Gain: 650 
Initials: LM 
Hungerstrike M:>nitoring Form 
Day: 10/12/2018 
Shift: AM 
Intake PO(in ml): 2650 
Intake rl/- Normal Saline (in ml): 0 
Intake rl/- LR (in ml): 0 
Intake NG(in ml): 0 
OJtput Urine (in ml): 2000 
OJtput Bowel M:>'"'ments (in ml): 0 
Initials: LM 
Patient Identification: 
Patient Identification 
Patient propeMyidentified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEO OFFICER 
IM1at language do )OU speak? Russian 
Interpretation pro\<ded? Provider fluent in patient's native language 
Pain l'ssessment 
Pain 
Ne )OU currently in pain? Yes 
The pain is located : back and legs 
The se'"' rityof pain is rated at 3110 
The se'"' rityof the pain is moderate 
The pain began 4-5 l\eeksago 
The character of the pain is aching 
The associated simptoms are l\eakness 
The pain is aggravated by other hunger slJike 
The pain is reliel<!d by other 
Describe: pt refused medication treatment 
Narrati'"': 
Patient is oonsidered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observation, and monitoring. 
Pl was in M-IU IIIED 2 Upon enoounter detainee was resting quietly in bed. Detainee reported weakness and pain on his 
legs and back , but refused PRN pain meds. M,dication oomplianl Right after enoounter pt went to reck)ard. VIAii oontinue to 
monitor. 
Upon returned from reck)ard, enoountered with pt and M) Welakho1,0, pt admited some chest disoomfort. Pt refused labs. 
e'"'nt this nurse asked se'"'ral times to draw the labs, he stated each time, let judge gi1e order. 
Detainee has missed his meal 154 this lunch. Pt denied to ha1e BMtoday. WII oontinue to monitor. 
Pl 1310 pt went to meet his atomey. VIAii oontunie to monitor pt as he will returned from his atomeymeeting. 
Hunger Strike: 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/2212018 
\/\hen did the official hunger strike begin? 08/25/2018 
Date of last meal oonsumed: 08/2212018 
Last meal oonsumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wants to be released from custody 
Pdequate supply of drinking water and other be1erages a1,0ilable: Yes 
Three meals deli'"'red per dayto patient Yes 
Lunch deli'"'red during current shift 0% oonsumed 
Pny unauthoriied food in room? No 
Ha'"' dailyorthostatic \<lal signs been oompleted? Yes 
Has input and output been documented on the the M-iU Hunger Strike M:>nitoring Smart Form? Yes. 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
\/\hen did the official hunger strike begin? 08/25'2018 
Date of last meal oonsumed: 08/22/2018 
Last meal oonsumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wclnls lo be released from custody 
Pdequate supply of drinking water and other be1erages a1,0ilable: Yes 
Three meals deli'"'red per day to detainee: Yes 
Lunch 0% oonsumed 
Pny unauthoriied food in room? No 
Ha'"' dailyorthostatic \<al signs been oompleted? Yes 
Has input and output been documented on the M-iU Hunger Strike M:>nitoring Smart Form? Yes 
Vit a l Signs 
Temp 
97.8F 10/12/201801:18:57 PM 
HR 
supine :56 10/12/201801:18:57 PM 
sitting:71 10/12/201801:18:57 PM 
standi ng:83 10/12/201801:18:57 PM 
BP 
supine:96170 10/12/201801:18:57 PM 
sitting:84/61 10/12/201801:18:57 PM 
standing:89/62 10/12/201801:18:57 PM 
H 
66.5in 10/12/201801:18:57 PM 
2019-ICLl-00051 2992 
(b)(6); 
(b)(7)(C) 
RN 
--
RN 
RN 
RN 
--
RN 
RN 
RN 
--
~ 
RN 

DHS-ICE-19-0196, 19-0197-N-000174
Examination 
General El<amination: 
GENERl>l /IPPEAAJ>NCE: inno acute distress, well del.eloped, well nourished. 
HEPD: noonocephalic. 
SKIN: normal, no rashes, no suspicious lesions. 
HEPRT: no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, no v.tleezes, rales, rhonchi. 
CHEST: normal, no gross rib deformity, normal shape and expansion. 
/18D0\iEN: normal, bowel sounds present, soft, nontender, nondistended. 
MJSCULOSKELET/ll : normal, normal gait, no defonTiities, full range cl motion, . 
NEUROLOOC: alert and oriented, cooperati1e with exam, , gait normal, neck supple, no rigidity, no tremor. 
PSYCH: alert, oriented, cogniti\e function intact, cooperati1e with exam, good eye contact, judgement and insight 
good, mood/affect full range, no auditory or llsual hallucinations, speech clear, thought content without suicidal ideation, 
delusions, thought process logical, goal directed. 
Assessments 
~ -Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: 1. Continue with Othostatic \Atal Signs ei,eryday, Intake and OJtput Mmitoring ei,eryshift; Dailyweights; 2. "'1 adequate 
supply of drinking water and other bei,erages are a1,0ilable to patient at all times. 3. Three meals per day are delii,ered to the 
patient and delii,eryof meals is documented. 4. ~ I food not authori,e d byCDiPhysician is remo\ed from patienfs room. 5. Patient 
is not allowed to purchase food from oommissari",ending machine while on hunger strike. 6. Patient will only be released from 
hunger strike treatment/monitoring by CD or physician order. 7. Patient oounseled regarding the medical risks of oontinuing the 
hunger strike. 8. Encouraged to terminate the hunger strike and eat/drink as normal. Continue hunger strike protoool, enoourage 
po food/!luids, encourage 1.erbalizati on offeel ings. Enoourage to allow staff to monitor intake and output 1.1tal signs, wt. lnslrucled 
to seek staff with any needs. Verbali2ed understanding. Detainee offered three meals perdayand leai,e in room for20 to 30 
minutes. Encourage dailyoral/physical h19iene care. Change of dothing/bedding . Cller BCXlST and Pedil)!e as ordered. Patient 
educated to possible Side Effects of going for long period of time without food. Patient 1.erbali2es understanding of current Plan of 
Care. Patient 1.erbali2es his option to refuse food. 
Appointment Provider:l(b)(6); ~- IRN 
Electronically signed b (b)(6); on 10/12/201813:19:14 (Pacific Daylight Time) lh\/ 7 \/r'\ 
Sign off status: Complete 
Northwest Detention Center 
1623E. J SmEEr 
T=WA98421 
Tel:j\( 6): J 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 Progre .. Notej(b)(6); __ I RN 10/12/2018 
N(te generaled byeOirica/Worl<s EM>/PM S:Jtvere {ww.<leC/ inica/Works.com) 
2019-ICLl-00051 2993 

DHS-ICE-19-0196, 19-0197-N-000175
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 2994 
AMAR,MERGENSANA .. A:216269802 Su:ll~ b)(6); _ I 
Facility Code: CSOINWA liiQked . lfl 
39Y old Mal~,· 
AccOl.rll llunber b 6 · 1623 E J STREET, T , 

DHS-ICE-19-0196, 19-0197-N-000176
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:llDt(b )/6) ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll lunber:~ 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Cert er 
10 /12/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Pedial)le - Solution 1 bottle three times a dayllD, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• .Acetaminophen 500 t..G Tablet 1 tablets as needed QID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Past Medlcal History 
Hunger strike 
Allerglss 
High calorie boost: diarrhea: Side Effects 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. lr'lleight loss denies. Dry M>uth denies. 
lr'lleakness denies. Cough denies. Shortness of breath at 
rest denies. Chest pain at rest denies. Palpitations denies. 
J>l:>dominal Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \bm itting denies. Painful urination denies. 
Decreased urine output denies. MJsde adhes denies. MJscie 
cramps denies. Skin breakdown denies. Difficultythinking denies. 
Reason for Appointment 
1. NURSE ROUNDS HUNGER STRIKE 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient property identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEOCXficer 
Wiat language do }OU speak? English, Russian 
Interpretation pro\aded? No interpreter available during visit 
Pain Assessment 
Pain 
ke }OU currently in pain? No 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Time: 0600 
INPUT PO: 0 NO INTAKE REPORTED OR SEEN 
Ot.JliPUT Urine O REFUSES TOIIEASURE'MTH URINAL 
Initials: DL T 
Hungerstrike M>nitoring Form 
Shift: Night 
Intake PO(in ml): NOPOINTAKEREPORTEDOR SEEN 
Appointment Provld e,t._~'"" )..,_(6"")'-; _ ___.! RN 
OJtput Urine (in ml): DETAINEE NOTUS/NG URINAL Fa'/ IIEASURENENT 
Initials: DL T 
Hunger Strike: 
Nursing Ewluation 
Date missed meals monitoring initiated: 081221.W18 
\M1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 081221.W18 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wcints to be released from custody 
/ldequate supply of drinking water and other be'"'rages a.ail able: Yes 
Three meals deli'"'red per day to detainee: Yes 
Other meal/nutritional supplement Qherhaspedialyte Ud, boost bid 
/lnyunauthori>edfood inroom? No 
Ha'"' dailyorlhostatic lia l signs been completed? Yes 
Has input and output been documented on the M-IU Hunger Slrike M>nitoring Smart Form? Yes 
Narrati'"': 
Detainee appeared to sleep in bed during whole shift. W:lke pt up for lab draw, but he refused. Detainee denied anyother 
issues or complaints at time of assessment Detainee refused to eat breakfas~ missed 153rd meal. 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observation, and monitoring. 
Ex amination 
General B<amination: 
GENER.Al !>PPE.ARPNCE: in no acute distress , well del.eloped, well noorished. 
PSYCH: alert, oriented. 
Assessments 
/>I-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: Intake and OJtput M>nitoring e'"'ryshift; Dailyweights; Dailyorthostatic ~tal signs. /In adequate supplyof drinking water 
and other be'"'rages are aw ilable to patient alway.;. Three meals per day are deli'"'red to the patient and deli'"'ryof meals is 
documented. No food allowed in patients room not authori,ed byCDIPhy.;ician. Patient is not allowed to purchase food from 
commissar\ilend ing machine while on hunger strike. Patient will only be released from hunger strike treatment/monitoring by 
CD or phy.;ician order. Patient counseled regarding the medical risks of continuing the hunger strike. Encouraged to terminate 
the hunger strike and eat/drink as normal. Pt >erbali>ed understanding of care plan. Continue HUNGER STRIKE protocol. 
Encourage intake of food/fluids. Encourage '"'rbalization of feelings. Encourage to allow staff to monitor intake and outpul ~tal 
signs, wt. 
Instructed to seek staff with any needs or change in medical/mental health status. 
Call bell within reach, bed in lowest and locked position with rails up x2. 
Refer to nursing care plan for on-9oing inten.entions. Detainee offered three meals per day and lea'"' in room for at least 20 
minutes. /ldequate supply of drinking water and other be,erages as ordered byproliderava ilable. Encourage dailyoral/phy.;ical 
h)giene care. Change of dothing/bedding offered M[ ] -W[ ] - F [ ]. Detainee >erbali>ed an understanding of education and/or 
treatment 
Appoin1ment Provider:l (b) (6) ; ~- r 
Bectronically signed b* b)(6) ; ~- r on 10/12/2018 06:16:37 (Pacific Daylight Time) 
Sign off status: Completed 
2019-ICLl-0005 1 2995 
Northwest Detention Center 
1623 E J STREET 
TACOMA, WA98421 

DHS-ICE-19-0196, 19-0197-N-000177
Telt/h\lR\ 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 Prog .. u Note: !(b )(6): 
Ncl.e general.ed by eC/inica/'Na1<s BvR'PM Sottv.ere (,w,weC/inica/W<Yks.COOjl 
2019-ICLl-00051 2996 
IRN 10/12/2018 

DHS-ICE-19-0196, 19-0197-N-000178
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 2997 
AMAR,MERGENSANA 
A:216269802 Su:i1D:kb)( 6 ): J 
Facility Code: CSONVWA Housing Area: 
39 Y old Male, DOB: 10/23/1978 
AccOl.ri funber : ilb\/6\ · 
1623 E J STREET, TACOMA, WA98421 

DHS-ICE-19-0196, 19-0197-N-000179
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 2998 
AMAR,MERGENSANA A: 216269802 Su:llcf~h~\f~R~\ ·_~ 
Facility Code: CSONVWA Housing Area : M 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II ~berfti'ii6i:7 1623 EJ STREET, T~ 

DHS-ICE-19-0196, 19-0197-N-000180
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A:216269802 Su:llD:f b\/6\ J 
Facility Code: CSONVWA Housing Area: 
39 Y old Male, DOB: 10/23/1978 
Acc01.111 ~be~) (6)· 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Cert er 
10 /11/2018 
Curnont Medication s 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Past Medlc a l History 
Hunger strike 
Allerg le s 
High calorie boost: diarrhea: Side Effects 
Review of System s 
Hunger Strike: Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. \r\leightloss admits. Dry 
M:>uth denies. \r\leakness denies. Cough denies. Slhortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. l't>dominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. \Qmitting denies. Painful 
urination denies. Decreased urine output denies. MJsde 
aches denies. M.lsde cramps denies. Skin breakdown denies. 
Difficulty thinking denies. 
Appoin t ment Provld e r:l/b\/ 6 \: (b\(7\(C\ 
Reas on for Appointm ent 
1. PM SHIFT NOTE. Hunger Strike Nursing Ev.iluation 
History of Pre se nt Illne ss 
Patient Identification: 
Upon encounter detainee was resting quietlyin bed. Detainee reported feeling "so-so" and accepted his 16:30 boost mix. 
Detainee has his water cup av.iii able and will also be offered his usual Pedial)4e and Boost Detainee reported no pain and 
medications gi'"'n as needed/ordered. Detainee has chosen to miss his 152nd meal this e'"'ning- dinner. Detainee is resting 
quietly in his room. W II continue to monitor. 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes 
Wiat language do }OU speak? English 
Interpretation pro\aded? Pallant speaks English fluenUy 
Pain />ssessment 
Pain 
ke }OU currently in pain? No 
Narrati'"': 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
obser10tion, and monitoring. 
Hunger Strike: 
Hunger Strike Nursing Evaluation 
Wien did the official hunger strike begin? 08/2512018 
Drinking Fluids: Yes 10DAY DETAINEE ISB4CK TODRINK!NG WA1ER, PED/AL Y1EAND B(X)ST 
Fluid !)pa : IMlter, Nutlitional supplement, Cral electrolyte solution 
l\i'eals deli'"'red during shift Dinner 
lnput/OJtput Use Procedures to enter hunger sllike monitoling input/output INPUT/ CIJ7PUT RECORDED ON HUNGER 
SffilKE FORM IN ''PRCCEDURES" 
Vit a l Sign s 
97.8F 
standing:111 
sitting:93 
supine:64 
standing:108170 
sitting:101/67 
supine:89/62 
16/ min 
145.0 lbs 
66.5in 
23.05 Index 
Ex aminatio n 
General Examination: 
Temo 
10/11/2018 06:59:48 PM 
1-R 
10/11/201808:17:36 PM 
10/11/201808:17:36 PM 
10/11/201808:17:36 PM 
BP 
10/11/201808:17:36 PM 
10/11/201808:17:36 PM 
10/11/201808:17:36 PM 
RR 
10/11/2018 06:59:48 PM 
wt 
10/11/201808:17:36 PM 
H 
10/11/2018 06:59:48 PM 
BMI 
10/11/201808:17:36 PM 
GENERJ>l J>PPEAAPNCE: in no acute distress, well deleloped, well r<lllrished. 
PSYCH: alert, oriented. 
Assess ment s 
/>I-Risk for imbalanced nutrition: Less than body requirements. 
Trea tmen t 
1. Others 
(b)(6) ; 
(b)(7)(C) 
Notes: 1. Continue 1Mth \Atal Signs e'"'rys hift; Intake and OJtput M:>nitoring e1.eryshift; Dailyweights; Dailyor1hostatic I.ital signs. 
2. l'n adequate supply of drinking water and other be1.erages are av.iii able to patient at all times. 
3. Three meals per day are deli1.ered to the patient and deli'"'ryo f meals is documented. 
4. ~ I food not authoriied by CD~y.,ician is remo1.ed from patienrs room. 
5. Patient is not allowed to purchase food from oommissary\ending machine while on hunger strike. 
6. Patient will only be released from hunger strike treatment/monitoring byCD or phy.,ician order. 
7. Patient counseled regarding the medical risks of continuing the hunger strike. 
8. Encouraged to terminate the hunger strike and eat/drink as normal. 
Appointment Provide 1<bl/6\ /bl/7\ /Cl 
2019-ICLl-00051 2999 

DHS-ICE-19-0196, 19-0197-N-000181
Electronically signed b~(b)(6); (b)(7)(C) 
Sign off status: Completed 
Addendum : 
10/11/2018 11:09 P~ )(6) : (b)/7)/C) WATER, CUTPUT U7<NOOVN. 
fN on 10/11/2018 23:05:13 (Pacific Daylight nme) 
t ATE 2 J>f>PLES, 1 LITER PEDll'I.. YTE, 8 OX BCOST MX, UNKNOV'uN 
Northwest Detention Center 
1623 E J STRE£T 
l'. WA98421 
Tel /b\/6\ 
x: 
Pali-I: AMAR, MERGENSANA l>Olk 10/23/1978 P ....... -1: )(6); (b)(7)(C) 
/1/cle generated by eC/inica/'Na1<s Bvr>IPM Sottv.ere ( eamc a1 wms.coojl 
10/11/2018 
2019-ICLl-00051 3000 

DHS-ICE-19-0196, 19-0197-N-000182
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A:216269802 Su:ll01/h\/R\· I 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll ~be~ 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
10 /11/2018 
Cunont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"' I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Past Medlcal History 
Hunger strike 
Allorglos 
High calorie boost : diarrhea: Side Effects 
Review of Systems 
General/Constitutional: 
Chills denies. Fatigue denies. Fe'"'r denies. 
Headache denies. Night sweats denies. 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness rarely. 
Sleep Disturbanoe denies. ~ ight loss admits due to hunger 
strike. DryM>uthdenies. ~ kness admits, that is mild, that is 
generalized. Cough denies. Slhortness of breath at rest denies. 
Chest pain at rest denies. Palpitations denies. l'bdominal 
Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \A:>mitting admits. Painful urination denies. 
Decreased urine output denies. MJsde aches admits MJsde 
cramps denies. Skin breakdown denies. Difficultythinking denies. 
Cardi0\0Scula~ 
Dizziness denies. ~kness admits, that is mild. 
.s!sin: 
Rash denies. Skin lesion(s) denies. 
Appointment Provld e 'k b)(6) ; (b)(7)(C) ~N 
Reason for Appointment 
1. RN Rounds day 
History of Present Illness 
Narrati'"': 
08 Male patient here in M-tU on hunger strike. Patient gi'"'n calcium, fiber, IAtamin d, acetaminophen and pedial)4e. Patient 
taking shower at 0900. Patient went to rec at 1100. Drank pedial)4e, boos~ water, and ate orange for lunch. 
1430 Patient reading on bed at this time, no complaints at this time. 
Yitai Signs 
98.0F 
standing:111 
sitting:93 
supine:64 
standing:108170 
sitting:101/67 
supine:89/62 
18/ min 
145 1b0oz 
66.5in 
23.05 Index 
Examination 
General Examination: 
Temp 
10/1112018 08:51 :05 PM 
HR 
10/11/2018 08:51:05PM 
10/1112018 08:51 :05 PM 
10/1112018 08:51 :05 PM 
BP 
10/11/2018 08:51:05 PM 
10/11/2018 08:51 :05 PM 
10/11/2018 08:51 :05 PM 
RR 
10/11/2018 10:00:02 PM 
wt 
10/1112018 10:00:02 PM 
H 
10/11/2018 08:51 :05 PM 
BMI 
10/11/2018 10:00:02 PM 
GENERJ>l PPPEAAPNCE: in no acute distress, well deleloped, well noorished. 
HEPD: norrnocephalic. 
SKIN: normal, no rashes, no suspicious lesions. 
HEl'RT: S1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, nowieezes, rales, rhonchi. 
PSYCH: alert, oriented. 
Assessment s 
1. Imbalanced nutrition: Less than body requirements [00002] - ND00002 (Primary) 
Treatm ent 
1. Imbalanced nutrition: Less than body requiremerts [00002] 
b)(6); 
b)(7)(C) 
Notes: Detainee'"'rba liied understanding of plan of care and denies questions/concerns. Continue hunger strike protocol, 
enoourage po food/fluids, encourage '"'rbalization offeelings. Staff to monitor intake and outp~ IAtal signs, wt. Instructed to seek 
staff'Mth any needs. Verbaliied understanding. Nursing Care Plan present Detainee '"'rbaliied an understanding of education 
and/or treatment. \A:>ioes no other concerns. 
Disposition: Pdmitted to M-tU until medicallye"81uated 
Appoinbnent Providet b)(6) ; (b)(7)(C) r 
Electronically signed bW,.. b.,_).,(6 .. ):~--'~ on 10/11/201814 :28:32 (Pacific Daylight Time) 
Sign off status: Completed 
2019-ICLl-0005 1 3001 
Northwest Detention Center 
1623 E J STREET 
T WA98421 
Tel (b)/6) x: 

DHS-ICE-19-0196, 19-0197-N-000183
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progre u Notoj(b}(6}; (b}(7}(C} I'" Nd.e general.ed by eClinical.Worl<s a.RJPM Softvere (,w,weC/inica/Works.com) 
2019-ICLl-00051 3002 
10/11/2018 

DHS-ICE-19-0196, 19-0197-N-000184
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA . . A: 216269802 Su:llJlb )(6); _ I 
Facility Code: CSCN/1/WA 119,. ea . 1t1 
39 Y old Male, DOB: 10/23/1978 
AccOUll lunbedh \/R\· I 
1623 E J STREET, TACOMA, WA-98421 
Appoimnert Facility: Northwest Detertion Certer 
10 /11/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Past Medlcal History 
Hunger strike 
Allergles 
NKDA 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fe'"'r denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbance denies. 1/Veight gain denies. 
1/Veight loss denies. 
Gastrointestinal: 
Blood in stool denies. Constipation denies. Nausea denies. 
MJsruloskeletal: 
M.oscie aches denies. 1/Veakness admits. 
Aflpolntment Provlde1 (b)(6) ; (b)(7)(C ) I MD 
Reason for Aflpolntment 
1. DJ>JL YROIJNDS 
History of Present Illness 
Patient Identification: 
Pt has resumed drinking water, other fluids such as pedial)(e and boost He has continued to walk to the rec yard. He agreed 
to urine testing but refused lab draw. Mmtation is fine and his BP and weight ha'"' impro'"'d since Tuesday. 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Pallent speaks English fluenUy 
Pain .1>6sessment 
Pain 
ke }OU currently in pain? No 
Narrati'"': 
Currentstatius: Losing weight and strength 
Mssed meals monitoring initiated: 081221'2018 
Official hunger strike date: 08125/'2018 
Date last meal consumed: 81221'2018 
last meal consumed: Breakfast 
Reason for Hunger Strike: Wants release from custody 
Drinking fluids: Yes: PEDll'l YTE, BCXlST, Ensure supplements 
# of da)S missed meal moni1oring: 49 
# of da)S on hunger strike: 46 
#of missed meals (Total): 148 as of Lunch (10/11/2018). 
Initial weight at missed meal monitoring: 163.0 LBS 
Date of initial weight 08/221'2018 
Date of current weight 10/10/2018 
Currentweighti n pounds: 145 LBS 
Total weight loss: 18 LBS 
Pt refused: FCX)[) TRAY, e>eept for an occasional fresh fruit 
Vit a l Signs 
98F 
93/min 
101167mm Hg 
16/ min 
145 lbs 
Ex amination 
General Examination: 
Temo 
HR 
BP 
RR 
wt 
10/121'2018 08:22:58 />M 
10/121'2018 08:22:58 />M 
10/121'2018 08:22:58 />M 
10/121'2018 08:22:58 />M 
10/121'2018 08:22:58 />M 
GENER/ll JIPPEPRANCE: in no acute distress, well del.eloped, well nourished. 
SKIN: good turgor. 
HE.ART: regular rate and myttm 
LUNGS: good air ll10\llment. 
EXTREMTIES: good capilla,y refill in nail beds, no clubbing, cyanosis, or edema, full range of motion. 
b )(6); 
b)(7)(C) 
PSYCH: cogniti'"' function intact, mood/affect full range, no audito,y or -.isual hallucinations, speech clear, thought 
content 1Mthout suicidal ideation, delusions, thought process logical, goal directed. 
Ass ess ment s 
1. Starvation, subsequent encounter - T73.0X)<I) (Pr mary) 
Self-imposed hunger strike, has been drinking supplemental caloric shakes and other fluids. 
Treatment 
1. Starvation, subsequent encOUller 
Stop Calcium 500/D Tablet 500-200 lliG-UNIT, 1 tablet with food, Oa lly, BID, 30 da)S, 60 Tablet KCP: Yes, Drug Source: In 
House Pharmacy, Notes: Not required for tra'"'I 
Stop Fiber Tablet 625 M3, 1 tablet as needed, Oal ly, BID, 30 da)S, 60 Tablet KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra'"'I 
Stop Cholecalciferol Tablet 2000 UNIT, 1 tablet Oally, Ol-iS, 30 da)S, 1, KCP: Yes, Drug Source: In House Pharmacy, Notes: Not 
required for lra'"'I 
Stop Boost Glucose Control Liquid,-, 0.5 ser.ing mixed, Oa lly, TIO, 30 da)S, 1, KCP: No, Drug Source: In House Pharmacy, 
Notes: Not required for tra'"'I, see attached ser.ing mildure order 
Stop Ensure High Protein Liquid,-, 1, Oally, Ol-iS, 14 da)S, 1, KCP: No, Drug Source: In House Pharmacy, Notes: Not required for 
tra'"'I 
Stop Boost \AiC Liquid,-, 0.5 ser.ing each mealtime, Oa lly, TIO, 14 da)S, 1, KCP: No, Drug Source: In House Pharmacy, Notes: 
Not required fortra'"' I, please mixwith 4 ounces of water 
Stop Pedial)4e Solution,-, 1 boWe three times a day, Oally, TIO, 30 da)S, 1, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
Follow Up 
daily by nursing staff and e'"',y2 -3 da)S bypro1,1ders 
Notes: pt has been tolerating the current calorie supplements without diarrhea. \MIi reorder 
Appoinbnent Providef b)(6); (b)(7)(C ) IMO 
2019-ICLl-0005 1 3003 

DHS-ICE-19-0196, 19-0197-N-000185
b)(6); (b)(7)(C) 
Electronically signed b (b)(6); (b)(7)(C) MD on 1<W12/2018 08:29:49 (Pacific Daylight Tlme) 
Sign off status: Complete 
Northwest Detention Center 
1623EJSTREI" 
T~WA98421 
Tel)b5t R\· 
Fax: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Prog,. .. Not8f b)(6); (b)(7)(C) I •o 1ot1112018 
Nd.e general.ed by eOinica/W<n<s B>RIPM Sottw,re (""""eC/inica/works.CtJm) 
2019-ICLl-00051 3004 

DHS-ICE-19-0196, 19-0197-N-000186
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A:21626980 2 Su:llU:Vh\/R\· ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunbe ~/hl/RI· I 
10 /11/2018 
Curnont Medication s 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"'I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Past Medlc a l History 
Hunger strike 
Allerg le s 
High calorie boost: diarrhea: Side Effects 
Review of System s 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbanoe denies. lr'lleight loss denies. Dry M>uth denies. 
lr'lleakness denies. Cough denies. Shortness of breath at 
rest denies. Chest pain at rest denies. Palpitations denies. 
J>l:>dominal Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \bm itting denies. Painful urination denies. 
Decreased urine output denies. MJsde aches denies. MJscie 
cramps denies. Skin breakdown denies. Difficultythinking denies. 
1623 E J STREET, TACOMA, WA-98421 
Appoimnert Facility: Northwest Detertion Certer 
Rea son for Appointment 
1. tvHU RN NIGHT ROUNDS/HUNGIER STRIKE 
History of Pre se nt Illne ss 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEOO'licerftijl 
Wiat language do }OU speak? Engli~an 
Interpretation pro\aded? Pallant speaks English fluenUy 
Pain Assessment 
Pain 
ke }OU currently in pain? No 
Fiowsheets (tvHU): 
lnput/OJtput Fiowsheet 
Ti me: 2300 (SHIFT 10/09/2018 2300 -10/10/2018 0700) 
Appointment Provid e (b )(6); 
/h\(7)/C:\ 
INPUT PO: DETAINEE REPCRTSHE HASN'TDRANKANYR.UIDS DURING NOC SHIFT BUT HE WAS SEEN 
DRINKING PED/AL YTE, BOOST, AND WA7ER. 
OUTiPUTUrine 0DETAINEEDIDNOTVQDDURING1HESHIFT 
OUTiPUT SUBTOT/>l: 0 
Initials: LDM 
Hungerstrike M>nitoring Form 
Day. 10/09/2018 
Shift: Night (SHIFT 10/09/2018 2300 - 10/10/2018 0700) 
Intake PO(in ml): DETAINEE REPCRTS HE HASN'T DRANK ANY R.UIDS DURING NOC SHIFT BUT HE WAS SEEN 
DRINKING PED/AL YTE, BOOST, AND WA7ER. 
OJtput Urine (in ml): 0 DETAINEE DID NOTVOID DURING 17-IE SHIFT 
Initials: LDM 
Hunger Strike: 
Nursing E118Iuation 
Date missed meals monitoring initiated: 08/22/2018 
\M1en did the official hunger strike begin? 08125'2018 
Date of last meal ccnsumed: 08/22/2018 
Last meal ccnsumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: W.,nts to be released from custody 
/ldequate supply of drinking water and other be'"'rages a\18ilable: Yes 
Three meals deli'"'red per day to detainee: Yes 
/lnyunauthori>edfood inroom? No 
Ha'"' dailyorlhostatic lial signs been ccmpleted? Yes 
Has input and output been documented on the M-iU Hunger Strike M>nitoring Smart Form? Yes 
Narrati'"': 
Detainee slept during whole shift, woke up to 1.0id >G1 as obsen.ed. Detainee reports he slept "okay." Detainee denied any 
other issues or ccmplaints at time of assessment Detainee refused to eat brealdas~ missed 144th meal but ate 2 oranges. 
Patient is ccnsidered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observation, and monitoring. 
Ex amlinatlon 
General Examination: 
GENER/>l !>PPE.ARANCE: in no acute distress, well del.eloped, well noorished. 
PSYCH: alert, oriented. 
Asse ssment s 
/>I-Risk for imbalanoed nutrition: Less than body requirements. 
Tre a tment 
1. Others 
RN 
Notes: 1. Continue with \Atal Signs e'"'ryshift; Intake and OJtput M>nitoring e'"'rysh ift; Dailyweights; Dailyorthostatic \ital signs. 
2. /In adequate supply of drinking water and other be'"'rages are available to patient at all times. 
3. Three meals per day are deli'"'red to the patient and deli'"'ryo f meals is documented. 
4. ~ I food not authori>ed by CD/Phy.,ician is remo'"'d from patienfs room. 
5. Patient is not allowed to purchase food from ccmmissary\ending machine while on hunger strike. 
6. Patient will only be released from hunger strike treatment/monitoring byCD or phy.,ician order. 
7. Patientccunseled regarding the medical risks ofccntinuing the hunger strike. 
8. Enccuraged to terminate the hunger strike and eat/drink as normal. 
9. Pt '"'rba li>ed understanding of care plan. 
Continue HUNGER STRIKE protoccl. 
Enccurage intake of food/fluids. 
Enccurage '"'rba lization of feelings. 
Enccurage to allow staff to monitor intake and output, " tal signs, wt. 
Instructed to seek staff with any needs or change in medical/mental health status. 
Call bell within reach, bed in lowest and locked position with rails up >'1. 
Refer to nursing care plan for on-9oing inten.entions. Detainee offered three meals per day and lea'"' in room for at least 20 
minutes. 
/ldequate supply of drinking water and other be'"'rages as ordered bypro,..der available. 
Enccurage dailyoral/phy.,ical h)!liene care. Change of dothing/bedding offered M[] -W[ ] - F [ ]. Detainee '"'rbali>ed an 
understanding of education and/or treatment 
Disposition: /!dmitted to tvHU until medicallye\18Iuated 
Appointment Provideq~ /\~L, I RN 
Electronically signed b*b )(6); IRN on 10/11/2018 05:49:35 (Pacific Daylight Time) 
2019-ICLl-00051 3005 

DHS-ICE-19-0196, 19-0197-N-000187
Sign off status: Completed 
Northwest Detention Center 
1623 E. J STREEr 
TACOMA, WA98421 
Teljlh \/R\ I 
Fax: 
P•tl-t: AMAR, MERGENSANA DOlk 10/23/1978 P ...... ~ 10/11/2018 
11/d.e genera1.e<1 byeC/inica/W<rts EJ.RIPM Soft"8re (1W.WeC/inica/WcYks.coojl 
2019-ICLl-00051 3006 

DHS-ICE-19-0196, 19-0197-N-000188
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3007 
AMAR,MERGENSANA .. A:216269802 Su:llO-j(b)(6); I 
Facility Code: CSOINWA Houdn g ,c; ea. lfi 
39 Y old Male, DOB: 10/23/1978 
Acc01.r11 l'ilnbej/b)/6): 1623 E J STREET, TPCOlllilAA,..,,,fV'lrA""964'11r7"21.----' 

DHS-ICE-19-0196, 19-0197-N-000189
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 21626980 2 Su:,ld lh \ / R\ · 
Facility Code: CSONVWA Housing Area: M 
39 Y Acca.nt ad Ma~'!: lffllbeb }(6); :: 
10 /10/2018 
Curnont Medication s 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"' I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Allergie s 
NKDA 
Review of Syste ms 
Hunger Strike: Fatigue denies. Headache denies. Lighlheadedness denies. 
Sleep Disturbanoe denies. Weightloss admits. Dry 
M::>uth denies. Weakness denies. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. Abdominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. 1,1:>mitting denies. Painful 
urination denies. Decreased urine output denies. MJsde 
aches denies. MJsde cramps denies. Skin breakdown denies. 
Difficulty thinking denies. 
1623 E J STREET, T v 
Appoirimert Facility: Northwest Detertion Cert er 
Appoin t ment Provld e ~(b}(6) ; (b)(7 )(C) 
Reas on for Appointm ent 
1. PM SHIFT NOlE. Hunger Strike Nursing E1o0luation 
History of Pre se nt Illne ss 
Patient Identification: 
Upon enoounter detainee had just returned from rec ),0rd was resting quietiyin bed. Detainee reported feeling "so-so" and 
refused his 16:30 boost mix IMlen asked why detainee was refusing what he normally accepted detainee simply stated "refuse", 
with a smile. Detainee has his water cup a1o0ilable and was/will also be offered his usual Pedial)4e, Boost and Ensure. Detainee 
reported no pain and will reoei'"' medications as needed/ordered if he will accept Detainee has chosen to miss his 149th meal 
this e'"'n ing-dinner. Detainee is resting quietiyin his rocm. WII continue to monitor. 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes 
Wiat language do }OU speak? English 
Interpretation pro\aded? Pallant speaks English fluenUy 
Pain />ssessment 
Pain 
ke }OU currentiyin pain? No 
Narrati'"': 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose super.ision, 
obser10tion, and monitoring. 
Hunger Strike: 
Hunger Strike Nursing Elo0Iuation 
IMlen did the official hunger strike begin? 08/25'2018 
Drinking Fluids: Yes DETAINEE HAS WA1ER, PED/AL YTE, B(X)ST AND ENSURE AVAILABLE 10HIMBUTHAS BEEN 
RERJSINGALLSOFARTHISSHIFT 
Fluid !)1:>e: Wciter, Nutritional supplement, Cral electrolyte solution 
Meals deli'"'red during shift Dinner 
lnpuVOutput Use Prooedures to enter hunger sl!ike monitoring input/output 
Vit a l Signs 
97.8F 
standing:102 
sitting:67 
supine:55 
standing:87/60 
sitting:83/54 
supine:94/57 
16/ min 
140.8 lbs 
66.5in 
22.38 Index 
Ex amination 
General Examination: 
Temo 
10/10/201807:04:35 PM 
1-R 
10/10/201807:04:35 PM 
10/10/201807:04:35 PM 
10/10/201807:04:35 PM 
BP 
10/10/201807:04:35 PM 
10/10/201807:04:35 PM 
10/10/201807:04:35 PM 
RR 
10/10/201807:04:35 PM 
WI 
10/10/201807:04:35 PM 
H 
10/10/201807:04:35 PM 
BMI 
10/10/201807:04:35 PM 
GENERJ>l /lPPEAAPNCE: in no acute distress, well deleloped, well OOJrished. 
PSYCH: alert, oriented. 
Assess ments 
/>I-Risk for imbalanoed nutrition: Less than body requirements. 
Tr ea tm ent 
1. Others 
b) (6); (b)( 7)(C) 
Notes: 1. Continue 1Mth \Atal Signs e'"'rys hift; Intake and Output M::>nitoring e1.eryshift; Dailyweights; Dailyor1hostatic I.ital signs. 
2. l'n adequate supply of drinking water and other be1.erages are a1o0ilable to patient at all times. 
3. Three meals per day are deli1.ered to the patient and deli'"'ryo f meals is documented. 
4. ~ I food not authoriied by CD~y.,idan is remo1.ed from patienrs rocm. 
5. Patient is not allowed to purchase food from commissar)l'\ending machine while on hunger strike. 
6. Patient will only be released from hunger strike lrealment/monitoring by CD or phy.,ician order. 
7. Patient counseled regarding the medical risks of continuing the hunger strike. 
8. Enoouraged to terminate the hunger strike and eat/drink as normal. 
Appointment Provider: l(b)(6) ; (b)( 7)(C) 
2019-ICLl-00051 3008 

DHS-ICE-19-0196, 19-0197-N-000190
Electronically signed b (b)(6); (b)(7)(C) 
Sign off status: Comple 
Addendum : 
RN on 10/11l/2018 19:05:01 (Pacific Daylight nme) 
10/10/2018 10:56 PM Hoskins-Dorsey RN, Geneva P > OETj>jNEE WPS C8SER\,ED DRINKING 1 CUP~ WA1ER TI·IIS 
E\iENING. NO OUTPUT OBSER\,ED. 
Northwest Detention Center 
1623 E J STRE£T T~~r98421 Tol(b~)_ ; -· I 
Pali-I: AMAR, MERGENSANA DOB: 10/23/1978 P ....... ...., (b)(6); (b)(7)(C) 
/1/cle generated by eC/inica/'Na1<s Bvr>IPM Softv.ere ("""'eC/inic a'WGv-ks.COOjl 
~ RN 10/1Q.l2018 
2019-ICLl-00051 3009 

DHS-ICE-19-0196, 19-0197-N-000191
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3010 
AMAR,MERGENSANA A:216269802 Su:llD:!lh\/R) I 
Facility Code: CSONVWA Housing Area : M 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunbe " "- " ~'· 1623 E J STREET, TACOMA, WA98421 

DHS-ICE-19-0196, 19-0197-N-000192
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""1eC/inica'WGYks.coojl 
2019-ICLl-00051 3011 
AMAR,MERGENSANA 
A:216269802 Su:llD:!/b)/6): ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOUll lunben rh 11,;,1- I 
1623 E J STREET, TACOMA, WA98421 

DHS-ICE-19-0196, 19-0197-N-000193
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
.. A:216269802 Su:lljib)\~);___ I 
Facility Code: CSCN/1/WA 119,. ea. 1t1 
39 Y old Male, DOB: 10/23/1978 
AccOl.rll lunbe~ 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
10 /10/2018 
Curnont Medication s 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Past Medlc a l History 
Hunger strike 
Allerg le s 
High calorie boost : diarrhea: Side Effects 
Review of System s 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue admits. 
Fe'"'r denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbance denies. 1/Veight gain denies. 
1/Veight loss denies. 
Gastrointestinal: 
Blood in stool denies. Constipation denies. Nausea denies. 
MJsruloskeletal: 
M.oscie aches denies. 1/Veakness admits. 
Aflpolntment Provld e ri{ b)(6) ; (b)(7)(C) ~D 
Rea son for Aflpolnt111ent 
1. Daily rounds 
History of Pre se nt Illne ss 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Pallent speaks English fluenUy 
Pain Assessment 
Pain 
/>,e }OU currently in pain? No 
Narrati'"': 
Pt is on his second dayof not drinking anyfluids or calories. He still was able to walk to the rec. yard. He will not explain why 
he has quit taking in any calories. He ob\aouslybelie'"'s this tactic will get him released to the USA 
Current status: Losing weight and strength 
Mss ed meals monitoring initiated: 081221'2018 
Official hunger strike date: 08125/'2018 
Date last meal oonsumed: 81221'2018 
Last meal oonsumed: Breakfast 
Reason for Hunger Strike: Wants release from custody 
Drinking fluids: NO 
# of da)S missed meal monitoring: 48 
# of da)S on hunger strike: 45 
#of missed meals (Total): 148 as of Lunch (10/10/2018). 
Initial weight at missed meal monitoring: 163.0 LBS 
Date of initial weight 08/221'2018 
Date of current weight 10/10/2018 
Currentweightin pounds: 140.8 LBS 
Total weight loss: 222 LBS 
Pt refused: PEDIAL YTE, BCXlST, FOCD TRAY, and TO DRINK WATER e,o::ept for just a few ounces. 
Vit a l Signs 
97.8F 
67 /min 
83/54 mm Hg 
16/ min 
140.8 lbs 
66.5in 
22.38 Index 
Ex amination 
General Examination: 
Temp 
10/10/201810:35:19 PM 
HR 
10/10/201810:35:19 PM 
BP 
10/10/201810:35:19 PM 
RR 
10/10/201810:35:19 PM 
wt 
10/10/201810:35:19 PM 
H 
10/10/201810:35:19 PM 
BMI 
10/10/201810:35:19 PM 
GENER/IL /IPPEAAl>NCE: in no acute distress, well de1€1oped, well rKllJrished. 
SKIN: good turgor. 
HEAAT: no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, no wheezes, rales, rhonchi. 
(b)(6); 
(b)(7)(C) 
/IBDOMEN: normal, bowel sounds present, soft, nontencer, nondistenced, no hepatosplenomegaly, no guarding or 
rigidity. 
MJSCULOSKELET/ll : ' no deformities, full range of motion, equal strength without deficit but there is large muscle 
atrophy of the legs without some reduced strength compared to his baseline .. 
NEURQOGIC: alert and oriented, cooperati'"' with exam, normal tone and reflexes, senscxy intact. 
PSYCH: cogniti'"' function intact, mood/affect full range, no auditcxy or l.isual hallucinations, speech clear, thought 
content without suicidal ideation, delusions, thought process logical. goal directed. 
pt with low BP but no S}ffiptoms of fainting. 
Asse ssme nt s 
1. Starvation, subsequent encounter - T73.0JO<D (Primal)') 
Self-imposed hunger strike, has been drinking supplemental caloric shakes and other fluids. 
Tr ea tm ent 
1. Starvation, subsequent encOl.rller 
L.A8: Urinalw is Dipstick /Cxdered for 1011012018) 
L.A8: Comprehensi1.e 11/etabolicPanel /14) ClvP-322000 /Cxdered for 10/10/2018) 
L.A8: Prealbumin -0 16931 (Cxdered for 10/10/2018) 
Notes: Pt will need IVh}dration soon if he will not drink liquids. I will order labs to indude prealbumen and UA He has lost 14% 
of his bodyweight since the start of meal monitoring, and e,en more when oompared to his admission weight to the facility. 
Fo llow Up 
daily by nursing staff and e'"'ry2-3 da)S bypro~ders 
Notes: rv'edication and Treatment Plan Re~ewed. Wedication risks, benefits, altemati'"'s discussed, Patient '"'rbali:zed 
understanding of all instructions 
2019-ICLl-00051 3012 

DHS-ICE-19-0196, 19-0197-N-000194
Appointment Provlder:l(b)(B); (b)(?)(C) I MD 
(b)(6); (b)(?)(C) 
Electronically signed b~(b)(6); (b)(?)(C) ~Don 10/10/2018 22:41:30 (Pacific Daytight Time) 
Sign off status: Completed 
Northwest Detention Center 
1623EJSTier 
TACJ:MA, WA98421 
TelJ(b )(6); _ j 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 Progre ss Notf b)(6); (b)(?)(C) l•D 10/10/2018 
NcJ.e genermed by eC/inica/Wm<s a.RJPM S:fl"'8re (w.w.1eC/inica/Works.caT9 
2019-ICLl-00051 3013 

DHS-ICE-19-0196, 19-0197-N-000195
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGEN~ A:216269802 Su:llD: (b)(6); 
Facility Code: CSCN/1/WA Housing ea: 
39 Y old Male,~ 1QOJ(1928 
Acc01.111 ~ber: b)(6): ! 
10/10 /20 18 
Cuno nt Me dica tions 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\e l, see attached ser.ing mi>l!ure older 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Alle rg ies 
NKDA 
Review of Sys te ms 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness admits. 
Sleep Disturbance denies. Weightloss admits. Dry 
M::>uth denies. Weakness admits. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. Abdominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. 1,1:>mitting denies. Painful 
urination denies. Decreased urine output denies. MJsde 
aches denies. MJsde cramps denies. Skin breakdown denies. 
Difficulty thinking denies. 
1623 E J STREET, TACOMA, WA-98421 
Appoimnert Facility: Northwest Detertion Certer 
App ointm ent Prov ide (b)(6); 
/h\/7\/r\ 
Reas on for Appo intm ent 
1. RN day round/hunger strike 
History of Prese nt Illness 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Time: 1430 
INPUTPO: 50 
OUTPUT Urine 100 
OUTPUTBM 0 
NetGain: 50 
Initials: LM 
Hungerstrike Mln itoring Form 
Day: 10/10/2018 
Shift: AM 
Intake PO(in ml): 50 
Intake rl/- Normal Saline (in ml): 0 
Intake rl/- LR (in ml): 0 
Intake NG(in ml): 0 
OJtput Urine (in ml): 100 
OJtput Bowel Ml'"'ments (in ml): 0 
Initials: LM 
Patient Identification: 
Patient Identification 
Patient propeMyidentified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEO OFFICER 
IM1at language do )OU speak? Russian 
Interpretation pro\<ded? Provider fluent in patient's native language 
Pain l'ssessment 
Pain 
Ne )OU currently in pain? Yes 
The pain is located .-back and legs 
The se'"' rityof pain is rated at 3110 
The se'"' rityof the pain is moderate 
The pain began 4-5 l\eeksago 
The character of the pain is aching 
The associated simptoms are l\eakness 
The pain is aggravated by other hunger slJike 
The pain is reliel<!d by other 
Describe: pt refused medication treatment 
Narrati'"': 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observation, and monitoring. 
Pl was in M-IU II/ED 2 Upon encounter detainee was resting quietly in bed. Detainee reported weakness and pain on his 
legs and back , but refused any medical treatment Pt refused morning and afternoon meds. He refuse to drink and eat VIAii 
continue to monitor. 
Detainee has missed his meal 148 this lunch. Pt stated that he drink just a little water. about 50ml. Pt denied to ha1.e BM 
today. VIAii continue to monitor. 
fl/. 1440 pt went to reek yard, he refused wheelchair. 
Hunger Strike: 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08122!2018 
'M1en did the official hunger strike begin? 08125/2018 
Date of last meal consumed: 08122!2018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wants to be released from custody 
/!dequate supply of drinking water and other be1.erages available: Yes 
Three meals deli'"'red per dayto patient Yes 
Lunch deli'"'red during current shift 0% consumed 
Pny unauthoriied food in room? No 
Ha'"' dailyorthostatic \<lal signs been completed? Yes 
Has input and output been documented on the the M-iU Hunger Strike Mlnitoring Smart Form? Yes. 
Nursing Evaluation 
Date missed meals moniloring initiated: 08/2212018 
'M1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/2212018 
Last meal consumed: Breakfast 
Drinking Fluids: No 
Reason for hunger strike: Wclnls lo be released from custody 
/!dequate supply of drinking water and other be1.erages available: Yes 
Three meals deli'"'red per day to detainee: Yes 
Lunch 0% consumed 
Pny unauthoriied food in room? No 
Ha'"' dailyorthostatic lial signs been completed? Yes 
Has input and output been documented on the M-iU Hunger Strike Mlnitoring Smart Form? Yes 
Vit al Signs 
Temp 
97.8F 10/10/2018 10:42:46 /'M 
1-R 
standing :102 10/10/2018 10:42:46 /'M 
sitting:67 10/10/2018 10:42:46 /'M 
supine:55 10/10/2018 10:42:46 /'M 
BP 
standing :87/60 10/10/2018 10:42:46 /'M 
sitting:83/54 10/10/2018 10:42:46 /'M 
supine:94/57 10/10/2018 10:42:46 /'M 
RR 
16 /min 10/10/2018 10:42:46 /'M 
1M 
2019-ICLl-00051 3014 
(b)(6); 
(b)(7)(C) 
RN 
N 
-
-
N 
N 
~ 
-
-
N 
~ 
N 
-
-
N 

DHS-ICE-19-0196, 19-0197-N-000196
140.8 lbs 
66.5in 
22.38 Index 
Examination 
General El<amination: 
10/10/2018 10:42:46 PM 
It 
10/10/201810:42:46/>M 
BMI 
10/10/201810:42:46/>M 
GENER/IL />PPEPRl>NCE: in no acute distress, well del.eloped, well nourished. 
HEPD: nonnocephalic. 
SKIN: nomnal, no rashes, no suspicious lesions. 
HEl'RT: no murmurs, regular rate and rhythm, S 1, S2 nomial. 
LUNGS: nomnal, clear to auscultation bilaterally, no wieezes, rales, rhonchi. 
CHEST: nomnal, no gross rib deformity, nomnal shape and expansion. 
J>SDO\,EN: nomnal, bowel sounds present, soft, nontender, nondistended. 
M.JSCULOSKELET.i>l: normal, normal gait, no deformities, full range cl motion, . 
(b)(6) ; 
(b)(7)(C ) 
NEUROLOGIC: alert and oriented, cooperati-e Vloith exam, , gait normal, neck supple, no rigidity, no tremor. 
PSYCH: alert, oriented, cogniti-e function intact, cooperati-e Vloith exam, good eye contact, judgement and insight 
-
RN 
--RN 
-
-
RN 
good, mood/affect full range, no auditory or l.isual hallucinations, speech clear, thought content Vloithout suicidal ideation, 
delusions, thought process logical, goal directed. 
Assessments 
/II-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: 1. Continue with Othostatic \.ital Signs ei,eryday, Intake and Oitput Mmitoring ei,eryshift; Dailyweights; 2. "'1 adequate 
supply of drinking water and other bei,erages are available to patient at all times. 3. Three meals per day are delii,ered to the 
patient and delii,eryof meals is documented. 4. ~ I food not authori,ed by CD/Physician is remo'-'ld from patienfs room. 5. Patient 
is not allowed to purchase food from commissaryi,ending machine while on hunger strike. 6. Patient will only be released from 
hunger strike treatment/monitoring by CD or physician order. 7. Patient counseled regarding the medical risks of continuing the 
hunger strike. 8. Enoouraged to terminate the hunger strike and eat/drink as normal. Continue hunger strike protocol, encourage 
po food/!luids, enoourage i,erbali2ation offeelings. Encourage to allow staff to monitor intake and output, '1tal signs, wt. lnslrucled 
to seek staff with any needs. Verbali,ed understanding. Detainee offered three meals perdayand leai,e in room for20 to 30 
minutes. Enoourage dailyoral/physical h19iene care. Change of clothing/bedding . a!er BCXlST and Pedil)le as ordered. Patient 
educated to possible Side Effects of going for long period of time without food. Patient i,erbali,es understanding of current Plan of 
Care. Patient i,erbali,es his option to refuse food. 
Appointment Provide r:l(b)(6) ; ~- I RN 
Electron icall y signed b )(6); h\f?\ / ("'\ 
Sign off status: Comple 
on 10/10/2018 14:43:45 (Pacific Daylig ht Time) 
Northwest Detention Center 
1623 E J STREEr 
T WA98421 
Tel (b)(6) ; 
Patient: AMAR, MERGENSANA DOB: 10/2 3/19 78 Progrw .. Notoj ... ~b_)_(6_)_; __ _.IRN 10/10/2018 
/lkie generaled byeOinica!Wcn<s EM</FM Sottv.e,-e (""""eC/inica/Works.com) 
2019-ICLl-00051 3015 

DHS-ICE-19-0196, 19-0197-N-000197
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA A:21626980 2 Su:ll~b)(6); I 
Facility Code· . ~~~ 'll' ... YYY .,A " h "'9 -ACU" ~' . lfl 
39 Y old Male, DOB: 10/23/1978 
AccOl.ri funber: kb\/6\· 
1623 E J STREET, TACOMA, WA-98421 
Appoirimert Facility. Northwest Detertion Certer 
10 110 12018 
Curnont Medication s 
Taking 
• Calcium 500/D 500-200 11,G.UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 11,G.UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"'I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Allergie s 
NKDA 
Review of Syste ms 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbanoe denies. Weight loss denies. Dry M:>uth denies. 
Weakness denies. Cough denies. Shortness of breath at 
rest denies. Chest pain at rest denies. Palpitations denies. 
J>lxlominal Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \.l:>mitting denies. Painful urination denies. 
Decreased urine output denies. MJsde aches denies. MJscie 
cramps denies. Skin breakdown denies. Difficultythinking denies. 
Reas on for Appointm ent 
1. tvHU RN NIGHT ROUNDS/HUNGER STRIKE 
History of Prese nt Illne ss 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEOO'li'ceJf9JLt\L 
Wiatlanguage do }OU speak? Engli , 'an 
Interpretation pro\aded? Pallant speaks English fluenUy 
Pain Assessment 
Pain 
ke }OU currently in pain? No 
Fiowsheets (tvHU): 
lnput/OJtput Fiowsheet 
Ti me: 2300 (SHIFT 10/09/2018 2300 -10/10/2018 0700) 
Appointment P1'ovlde~(b)(6) ; _. 
INPUT PO: DETAINEE REPCRTSHE HASN'TDRANKANYR.UIDS DURING NOC SHIFT 
OUTiPUT Urine O DETAINEE DID NOTVQD DURING 77-IE SHIFT 
OUTiPUT SUBTOT/>l: 0 
Initials: LDM 
Hungerstrike M:>nitoring Form 
Day: 10/09/2018 
Shift: Night (SHIFT 10/09/2018 2300 - 10/10/2018 0700) 
Intake PO(in ml): DETAINEE REPCRTS HE HASN'T DRANK ANY R.UIDS DURING NOC SHIFT 
OJ!put Urine (in ml): 0 DETAINEE DID NOTVQD DURING 77-IE SHIFT 
Initials: LDM 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 081221.W18 
\Mien did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 081221.W18 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wcints to be released from custody 
/ldequate supply of drinking water and other be1.erages available: Yes 
Three meals deli'"'red per day to detainee: Yes 
/lnyunauthori2edfood inroom? No 
Ha'"' dailyorthostatic lial signs been completed? Yes 
Has input and output been documented on the M-IU Hunger Strike M:>nitoring Smart Form? Yes 
Narrati'"': 
Detainee slept during whole shift, woke up to 1.0id x2 as obsen.ed. Detainee reports he slept "okay." Detainee denied any 
other issues or complaints at time of assessment Detainee refused to eat breakfas~ missed 144th meal but ate 2 oranges. 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observation, and monitoring. 
Examlinatlon 
General B<amination: 
GENER/>l !>PPE.ARMICE: in no acute distress, well 00\.eloped, well noorished. 
PSYCH: alert, oriented. 
Assessme nt s 
/>I-Risk for imbalanoed nutrition: Less than body requirements. 
Tre atment 
1. Others 
Notes: Nursing to assess h)dration status: skin turgor, mucous membranes, blood pressure, heart rate, intake & output W II 
continue to encourage detainee to eat all meals deli1.ered to him and to drink fluids. Detainee has aooess to drinking water 
inside of oell. Detainee educated on possible risks to health if he continues to miss meals. Detainee educated on risks of not 
drinking adequate amount of fluids. Detainee educated to drink at least 8-10 cups of liquids per day.Detainee educated on 
possible medical risks of continuing to refuse meals. Detainee instructed to inform nursing stafl/offioers if synptoms discussed 
begins, or if ha"ng continues or becomes worse. Detainee also instructed to let offioer know if he wants a tray to consume. 
Detainee '"'rba li2ed understanding of all instructions and did not ha,e anyadditional questions. Detainee to remain in M-IU/seg 
until will only released from hunger strike treatment/monitoring byphy.;ician. Detainee 1.erbali2ed understanding of all 
instructions. 
Disposition: /!dmitted to tvHU until medically evaluated 
Appointment Provider."' !(b"")"-' (6"")'-: _ __,FN 
Electronically signed b~(b)(6): 
Sign off status: Completed 
2019-ICLl-00051 
!RN on 10/10/2018 05:44:39 (Pacific Daylight Time) 
3016 
NorthlYest Detention Center 
1623 E J STREET 
TACOMA, WA98421 
Te!/h\/n\ I 
Fax: 

DHS-ICE-19-0196, 19-0197-N-000198
Patient: AMAR, MERGENSANA DOB; 10/23/1978 P ......... ~ RN 10/10/2018 
Nd.e general.ed by eClinical.Worl<s a.RJPM Softvere (,w,weC/inica/Works.com) 
2019-ICLl-00051 3017 

DHS-ICE-19-0196, 19-0197-N-000199
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3018 
AMAR,MERGENSANA A: 216269802 Su:ll~b )(6): ! 
Facility Code: CSONVWA Housing Area : M 39 Y old Male, DOB: 10/23/1978 
AccOl.lll lunber~ 
1623 EJ STREET, T~ 

DHS-ICE-19-0196, 19-0197-N-000200
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA .. A:21626980 2 Su:ll,_!)(6); _ 1 
Facility Code: CSOINWA 11\J k ea. lfi 
39 Y old Male, DOB: 10/23/1978 
AccOl.rll l'unbe1b) (6); I 1623 E J STREET, Tm...; HA'564Z I 
Appoimnert Facility. Northwest Detertion Certer 
10 109/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018 , KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/20 18, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"'I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Allergies 
NKDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness admits. 
Sleep Disturbanoe denies. Weightloss admits. Dry 
M::>uth denies. Weakness admits. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. Abdominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. 1,1:>mitting denies. Painful 
urination denies. Decreased urine output denies. MJsde 
aches denies. MJsde cramps denies. Skin breakdown denies. 
Difficulty thinking denies. 
Reason for Appointment 
1. E'"'ning shift rounds 
History of Present Illness 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Time: 2300 
Appointment Provider.K b )(6); 
INPUT PO: 0 Pt re potted that he did not drink anything during evening shifl, and this v.riter has not v.itness pt drinking any 
fluid. 
OUTPUT Urine Opt reported that he did not urinated O time during evening shifl. 
OUTPUT BM Opt reported no bm during evening shifl 
NetGain: 0 
Initials: mkv 
Hungerstrike M::>nitoring Form 
Day. 10/09/.2018 
Shift: PM 
Intake PO(in ml): 000 
Intake r.J- Normal Saline (in ml): 0 
Intake r.J- LR (in ml): 0 
Intake NG(in ml): 0 
OJtput Urine (in ml): 000 
OJtput Bowel M::>'"'ments (in ml): 0 
Initials: mkv 
Patient Identification: 
Patient Identification 
Patient propenyidentified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEO OFFICER 
\Mat language do )OU speak? English, Korean, Russian 
Interpretation pro\aded? Yes, Interpreter Name RN M3tes, this v.riter 
Name Use notes field 
Language Russian 
Pain /!ssessment 
Pain 
Ne )OU currently in pain? No 
Narrati'"': 
" I will not drink or eat..." repeatlyasked why he will not eat or drink as eanytodayam but did not offer any answer. Denied 
pain. pt is on hunger strike missed 145 meal traybut has been drinking pediol)4e, boost and a few apples daily until today am 
but stop suddenly. pt is on M-IU for hunger strike monitoring. 
Hunger Strike: 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/2212018 
'M1en did the official hunger strike begin? 08/25/2018 
Date of last meal oonsumed: 08/2212018 
Last meal oonsumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wants to be released from custody 
Pdequate supply of drinking water and other be\erages available: Yes 
Three meals deli\ered per dayto patient Yes 
Lunch deli'"'red during current shift 0% oonsumed 
Anyunauthoriied food in room? No 
Ha'"' dailyorthostatic \alal signs been oompleted? Yes 
Has input and output been documented on the the M-IU Hunger Strike M::>nitoring Sman Form? Yes. 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/2212018 
'M1en did the official hunger strike begin? 08/25'2018 
Date of last meal oonsumed: 08/2212018 
Last meal oonsumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: W..nts to be released from custody 
Pdequate supply of drinking water and other be\erages available: Yes 
Three meals deli'"'red per day to detainee: Yes 
Lunch 0% oonsumed 
Dinner 0"/4 oonsumed 
Other meal/nutritional supplement 0"/4 oonsumed 
Any unauthoriied food in room? No 
Ha'"' dailyonhostatic lia l signs been oompleted? Yes 
Has input and output been documented on the M-IU Hunger Strike M::>nitoring Smart Form? Yes 
Ex amlinatlon 
General B<amination: 
GENER;ll !>PPE.AR.ANCE : in no acute distress, well del.eloped, well noorished. 
HEJlD: norrnocephalic. 
SKIN: normal, no rashes, no suspicious lesions. 
HEPRT: no murmurs, regular rate and ihythm, S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, no wheezes, rales, ihonchi. 
CHEST: normal, no gross rib deformity, normal shape and expansion. 
J>BDOM:N: normal, bowel sounds present, soft, nontender, nondistended. 
MJSCULOSKELETPL: normal, normal gait, no deformities, full range of motion, . 
NEUROLOOC: alert and oriented, cooperati,e with exam, , gait normal, neck supple, no rigidity, no tremor. 
PSYCH: alert, oriented, cogniti,e funclion intact, cooperati\e with exam, good eye contact, judgement and insight 
good , mood/affect full range, no auditory cr >Asual hallucinations, speech clear, thought content wilhout suicidal ideation, 
delusions. thought process logical, goal directed. 
Assess ment s 
/II-Risk for imbalanoed nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: 1. Continue with Othostatic 'vltal Signs e\eryday, Intake and QJ!put M::>nitoring e\eryshift; Dailyweights: 2. An adequate 
supply of drinking water and other be\erages are available to patient at all times. 3. Three meals per day are deli\ered to the 
patient and deli'"'ryof meals is documented. 4. ~ I food not authori,ed byCD/Phy.,idan is remo\ed from patients room. 5. Patient 
is not allowed to purchase food from oommissa")l\ending machine while on hunger strike. 6. Patient will only be released from 
hunger strike treatment/monitoring by CD or phy.,idan order. 7. Patient oounseled regarding the medical risks of oontinuing the 
hunger strike. 8. Enoouraged to terminate the hunger strike and eat/drink as normal. Continue hunger strike protoool, encourage 
2019-ICLl-00051 3019 

DHS-ICE-19-0196, 19-0197-N-000201
po foodl!luids, encourage \e rbali,ation offeelings. Enoourage to allow staff to monitor intake and output, '1tal signs, wt. lnslrucled 
to seek staff with any needs. Verbali,ed understanding. Detainee offered three meals perdayand lea\e in room for20 to 30 
minutes. Encourage dailyoral/physical h19iene care. Change of dothingibedding . Ofer BCX)ST and Pedil)le as ordered. Patient 
educated to possible Side Effects of going for long period of time without food. Patient \erbali,es understanding of rurrent Plan of 
Care. Patient \erbali,es his option to refuse food. 
Appointment Provi (b)(6); /h\/7\ff'\ , RN 
(b)(6); (b)(7)(C) 
Electronically signed b~(b)(6); ~ - I RN on 1Cll09/2018 22:28:45 (Pacific Daylight Time ) 
Sign off status: Completed 
Northwes t Detention Cente r 
1623 E. J smEEr 
T~WA9842 1 
,, b)(6\: I Ai. 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 P•-•5i (b)(6); (b)(7)(C) IRN 10/09/2018 
N(ie gener8led byeOinica!Wcxi<s ElvR'PM Softvere (ww.l(eC//nica/Wcn<s .com) 
2019-ICLl-00051 3020 

DHS-ICE-19-0196, 19-0197-N-000202
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
.. A:216269802 Su:lli-:J;b)(6); I 
Facility Code: CSONVWA u og,. ea. 1t1 
39 Y old Male, DOB: 10/23/1978 
AccOl.rll lunber:~ 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
10 109/2018 
Curnont Medication s 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Allergie s 
NKDA 
Review of Syste ms 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness admits. 
Sleep Disturbance denies. Weightloss admits. Dry 
M::>uth denies. Weakness admits. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. Abdominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. 1,1:>mitting denies. Painful 
urination denies. Decreased urine output denies. MJsde 
aches denies. MJsde cramps denies. Skin breakdown denies. 
Difficulty thinking denies. 
Appointment Provld e ik_b_)_(6_)_; --~RN I_h\/7\/r\ r￾Rea son for Appointment 
1. RN day round/hunger strike 
History of Pre se nt Illne ss 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Time: 1500 
INPUTPO: 1500 
OUTPUT Urine 1500 
OUTPUTBM 0 
NetGain: 0 
Initials: LM 
Hungerstrike M::>nitoring Form 
Day: 10/09/.2018 
Shift: AM 
Intake PO(in ml): 1500 
Intake rl/- Normal Saline (in ml): 0 
Intake rl/- LR (in ml): 0 
Intake NG(in ml): 0 
OJtput Urine (in ml): 1500 
OJtput Bowel M::>'"'ments (in ml): 0 
Comments: HE HAS BEEN DRINKING PED/AL YTE, boost, and drinking water in the morining before he talk to provider. 
Initials: LM 
Patient Identification: 
Patient Identification 
Patient prope~yidentified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEO OFFICER 
\Mat language do )OU speak? Russian 
Interpretation pro\aded? Provider fluent in pa vent's native language 
Pain 1'6sessment 
Pain 
Ne )OU currently in pain? Yes 
The pain is located .-back and legs 
The se'"' rityof pain is rated at 3110 
The se'"' rityof the pain is moderate 
The pain began 4-5 v.eeksago 
The character of the pain is aching 
The associated simptoms are v,eakness 
The pain is aggravated by other hunger strike 
The pain is reliel<!d by other 
Describe: pt refused medica#on treatment 
Narrati'"': 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observation, and monitoring. 
Pl was in M-IU IIIED 2 Upon encounter detainee was resting quietly in bed. Detainee reported weakness and pain on his 
legs and back , but refused any medical treatment He has been drinking Pedial)4e and Boost WII continue to monitor. 
Detainee has missed his meal 145 this lunch. Pt refused, his medication at noon: boost and pedial)4e. M::>st of the day pt 
was reading and resting. Mer lunch pt went to reckiard. Mer he came from red< )0rd Ml talk to pl He stated that he refuse to 
drink and eatan}tl1ing. W II continue to monitor. 
Hunger Strike: 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08122!2018 
'M1en did the official hunger strike begin? 08125/2018 
Date of last meal consumed: 08122!2018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wants to be released from custody 
/!dequate supply of drinking water and other be1erages a,ailable: Yes 
Three meals deli'"'red per dayto patient Yes 
Lunch deli'"'red during current shift 0% consumed 
Priy unauthoriied food in room? No 
Ha'"' dailyorthostatic \atal signs been completed? Yes 
Has input and output been documented on the the M-IU Hunger Strike M::>nitoring Smart Form? Yes. 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/2212018 
'M1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/2212018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wclnls lo be released from custody 
/!dequate supply of drinking water and other be1erages a,ailable: Yes 
Three meals deli'"'red per day to detainee: Yes 
Lunch 0% consumed 
Priy unauthoriied food in room? No 
Ha'"' dailyo~stat ic \<al signs been completed? Yes 
Has input and output been documented on the M-IU Hunger Strike M::>nitori ng Smart Form? Yes 
Vit al Sign s 
Temp 
98.0F 10/09/201812:04:04 PM 
HR 
standing:96 10/09/201812:04:04 PM 
sitting:75 10/09/201812:04:04 PM 
supine:50 10/09/201812:04:04 PM 
BP 
standing:92/64 10/09/201812:04:04 PM 
sitting:98/67 10/09/201812:04:04 PM 
supine:100/62 10/09/201812:04:04 PM 
RR 
16 /min 10/09/201812:04:04 PM 
wt 
2019-ICLl-00051 3021 
(b )(6); N 
(b)(?)(C) -
-
N 
~ 
~ 
-
-
~ 
~ 
N 
-
-
~ 

DHS-ICE-19-0196, 19-0197-N-000203
142.8 lbs 
66.5in 
22.70 Index 
Examination 
General El<amination: 
10/09/201812:04:04 PM 
H 
10/09/201812:04:04 PM 
BMI 
10/09/201812:04:04 PM 
GENERt>l /IPPE.ARANCE: in no acute distress, well del.eloped , well nourished. 
HE/ID: nonnocephalic. 
SKIN: normal, no rashes, no suspicious lesions. 
HEPRT: no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, no ...tleezes, rales, rhonchi. 
CHEST: normal, no gross rib deformity, normal shape and expansion. 
/IBDOM:N: normal, bowel sounds present, soft, nontender, nondistended. 
MUSCULOSKELETPl: normal, normal gait, no defonTlities, full range r:;; motion, . 
(b)(6); 
(b)(7)(C) 
NEUROLOGtC: alert and oriented, cooperati\El with exam, , gait normal, neck supple, no rigidity, no tremor. 
PSYCH: alert, oliented, cogniti\El function intact, cooperati\El with exam, good eye contact, judgement and insight 
N 
-
-
N 
-
N 
-
good, mood/affect full range, no auditory or \isual hallucinations, speech clear, thought content without suicidal ideation, 
delusions, thought process logical, goal directed. 
Assessments 
/'I-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: 1. Continue with 01hostatic \Atal Signs e;eryday, Intake and OJtput Mmitoring e,erysh ift; Dailyweights; 2. l'<1 adequate 
supply of drinking water and other be;erages are available to patient at all times. 3. Three meals per day are deli;ered to the 
patient and deli,eryof meals is documented. 4. ~ I food not authoriied by CD/Physician is remo\Eld from patienfs room. 5. Patient 
is not allowed to purchase food from commissary,ending machine while on hunger strike. 6. Patient will only be released from 
hunger strike treatment/monitoring by CD or physician order. 7. Patient counseled regarding the medical risks of continuing the 
hunger strike. 8. Encouraged to terminate the hunger strike and eat/drink as normal. Continue hunger strike protocol, encourage 
po foodffluids, encourage ;erbali,ation offeelings. Encourage to allow staff to monitor intake and output, 1.1tal signs, wt Instructed 
to seek staff with any needs. Verbaliied understanding. Detainee offered three meals perdayand lea,e in room for20 to 30 
minutes. Encourage dailyoral/physical h>9iene care. Change of dothing/bedding . Clfer BOOST and Pedil)le as ordered. Patient 
educated to possible Side Effecis of going for long period of time without food. Patient -.erbali,es understanding of current Plan of 
Care. Patient ,erbali,es his option to refuse food. 
Appointment Provide1(b)(6); ~-
8 ctr . II . d (b)(6) e ornca y ggne /b)/?)(C) 
Sign off status: Comple 
on 10/09/20181 5:30:49 (Paci fic Daylig ht Time ) 
Northwest Detention Center 
1623 E. J STREEr 
T~[A98421 "Y86.iS. I 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Prog'9aa Note:fb)(6); ~- IRN 10/09/2018 
11/cie generaled by eC/irica/Wcrlcs aR'PM Soflwill (""""eC/inica/Works.com) 
2019-ICLl-0005 1 3022 

DHS-ICE-19-0196, 19-0197-N-000204
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Si.tllq(b )(6) ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll lunber~ 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
10 109/2018 
Curnont Medication s 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Past Medlc al History 
No Pvt,dical History. 
SUrglc al Histo ry 
Denies Past Surgical History 
Allergle s 
NKDA 
Review of Syste ms 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue admits. 
Fe'"'r denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbance denies. ~ ight gain denies. 
~ ight loss denies. 
Gastrointestinal: 
Blood in stool denies. Constipation denies. Nausea denies. 
Mlsru loskeletal: 
MJScie aches denies. ~kness admits. 
Aflpolntment Provld e ~(b)(6) ; (b)(7)(C) I MD 
Reas on for Aflpolntm ent 
1. Daily Rounds 
History of Pre se nt Illne ss 
Patient Identification: 
Pt is seen and has been doing well. He is getting about 1800 calories with his current regimen and not losing weight He is 
able to walk to the reC)ard and has been eating fruit off his tray. I ha'"' '° iced myooncem to him about large mus de weakness 
and his limited acth,tywhile being housed in M-tU. He should be doing more exercises, and walking through out the day. I ha'"' 
offered him to be returned to GP and if he wants to oontinue refusing meals in protest! would oontinue to order the calorie 
supplement which he oould recei'"' by walking to pill line. I ha'"' reminded him that he may ha'"' easier oommunication with 
others as he works through his appeal. Pt decided he did not want to go off hunger strike and does not want to be released from 
M-tU. 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number 
Number : 11473792 
Language Russian 
Pain />ssessment 
Pain 
ke }OU currently in pain? No 
Narrati'"': 
(0800) Patient still does not wish to resume eating meals. has been drinking boost and pedial)4e. Denies pain. 
Current status: Stable 
Mss ed meals monitoring initiated: 08/2212018 
Official hunger strike date: 08/25/2018 
Date last meal oonsumed: 8/2212018 
Last meal oonsumed: Breakfast 
Reason for Hunger Strike: Wants release from custody 
Drinking fluids: Yes. Boosl Ensure and Pedial)4e 
# of da~ missed meal monitoring: 47 
# of da~ on hunger strike: 44 
# of missed meals (Total): 94 (as of 09/2212018: Lunch) 
Initial weight at missed meal monitoring: 163.0 LBS 
Date of initial weight 08/2212018 
Date of current weight 10/09/2018 
Currentweighti n pounds: 142.8 LBS 
Total weight loss: 20.8 LBS 
Patient refused: food at breakfast 
Vit al Signs 
98F 
75/min 
98/67 mm Hg 
16/ min 
142.8 lbs 
66.Sin 
22.70 Index 
Temp 
10/10/201812:54:36 PM 
HR 
10/10/201812:54:36 PM 
BP 
10/10/2018 12:54:36 PM 
RR 
10/10/201812:54:36 PM 
wt 
10/10/2018 12:54:36 PM 
H 
10/10/2018 12:58:46 PM 
BMI 
10/10/201812:58:46 PM 
\Monadm 1ss 1on to NVIOC 172#; \Ma tbeg,nning of meal monitonng 163#. 
Ex aminat ion 
General Examination: 
GENER.Al JIPPEAAPNCE: in no acute distress, well de1€1oped, well r<lllrished. 
ORM. CAvlTY: mucosa moist, no lesions. 
SKIN: good turgor. 
HEAAT: no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, no wheezes, rates, rhonchi. 
b)(6); (b)(7)(C) 
!>BDOMcN: normal, l:x.J>Mll sounds present, soft, nontender, r<Jl1ci istended, no hepatosplenomegaly, no guarding or 
rigidity. 
MJSCULOSKELET/>L: , no deformities, full range of motion, equal strength v,ithout deficit but there is large muscle 
atrophy of the legs v,ithout some reduced strength compared to his baseline .. 
NEURQ OOC: alert and oriented, coope,ati'"' v,ith exam, normal tone and reflexes, senscxy intact. 
PSYCH: cogniti'"' function intact, mood/affect full range, no auditcxy or 1,1sual hallucinations, speech clear, thought 
content v,ithout suicidal ideation. delusions, thought process logical, goal directed. 
Assess ment s 
1. Stal\0tion, subsequent encounter - T73.0JO<D (Primary) 
Self-imposed hunger strike, has been drinking supplemental caloric shakes and other fluids. 
Tr ea tm ent 
1. Starvation, subsequent encOl.lller 
Notes: Mer our morning oon'"'rsation about mo~ng to GIP, patient stopped accepting the boost and water. He states he wants to 
stayon official hunger strike in the M-tU. 
Fo llow Up 
2019-ICLl-00051 3023 

DHS-ICE-19-0196, 19-0197-N-000205
daily by nursing staff and e\ery2 -3 day.; byprmiders 
Notes: Education prm,;ded on Madication and Treatment Patient 1.erbalL2ed understanding of all instructions 
Appointment Prov1<1efb)(6); (b)(7)(C) ro 
b)(6); (b)(7)(C) 
Electronically slgned b (b)(6); (b)(7)(C) Don 10/10/201813 :05:41 (Pacific Daytlght Time) 
Sign off status: Comple 
Northwest Detention Center 
1623 E J STREEr 
TACOMA, WA98421 
Tell(b)(6): 
,ax. 
Patient: AMAR, IIERGENSANA DOB: 10/2 311978 Progre ss No• f bl/6) : (b)/7)/C) l"D 10I09/2018 
Ncte generated byeOinica/Wcrks El>R'PM s:itt.ere {IWNleOinici>Works.com) 
2019-ICLl-00051 3024 

DHS-ICE-19-0196, 19-0197-N-000206
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
.. A:216269802 Su:ll~b )(6); I 
Fac1lrtyCode:CSOINWA ng ,c;ea.lfi 
39 Y old Male, DOB: 10/23/1978 
AccOl.rll lunberfTtiii6f"""7 
1623 E J STREET, T~ 
Appoirimert Facility. Northwest Detertion Certer 
10 109/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"'I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Allergies 
NKDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbanoe denies. Weight loss denies. Dry M:>uth denies. 
Weakness denies. Cough denies. Shortness of breath at 
rest denies. Chest pain at rest denies. Palpitations denies. 
J>lxlominal Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \.l:>mitting denies. Painful urination denies. 
Decreased urine output denies. M.Jsde aches denies. M.Jscie 
a-amps denies. Skin breakdown denies. Difficultythinking denies. 
Reason for Aflpolntment 
1. tvHU NOC NSG RDS 
History of Present Illness 
Patient Identification: 
Patient Identification 
Aflpolntment Provlder:t b)(6) ; (b)(7)(C) I RN 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEOO'licer ~b)(6! 
Wiat language do }OU speak? Russia 
Interpretation pro\aded? Yes, Interpreter Number 
Number Use notes ffeld 
Language Russian 
Pain .1>6sessment 
Pain 
ke }OU currently in pain? No 
Fiowsheets (tvHU): 
lnput/OJtput Fiowsheet 
Ti me: 2300 (SHIFT 10/08/2018 2300 -1009/2018 0700) 
INPUTPO: DETAINEE REPORTSHEHASN'TDRANKANYFLUIDSDURINGNOC SHIFT, NOTED mBEDRINKING 
FROM 71-/E CELL FOUNTAIN X1 
OUTPUT Urine O DETAINEE REPORTS HE'S VOIDED 1XDURING SHIFT, DETAINEE WAS ~RVED mHAVE USED 
71-/E TOILET A TLEAST2X DURING SHIFT. 
OUTPUT SUBTOT/11..: 0 
Initials: RK 
Hungerstrike M:>nitoring Form 
Day: 10/08/2018 
Shift Night (SHIFT10/08/2018 2300-1009/2018 0700) 
Intake PO(in ml): DETAINEE REPORTS HE HASN'T DRANK ANY FLUIDS DURING NOC SHIFT, NOTED roBE 
DRINKING FROMn-tE CELL FOUNTAIN X1 
OJtput Urine (in ml): 0 DETAINEE REPORTS HE'S VCXDED 1X DURING SHIFT, DETAINEE WAS ~RVED roHAVE 
USED 71-/E TOILET A TLEAST2X DURING SHIFT. 
Initials: RK 
Hunger Strike: 
Nursing E1181uation 
Date missed meals monitoring initiated: 08/22/2018 
\M1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: W.,nts to be released from custody 
Pdequate supply of drinking water and other be'"'rages a1,0ilable: Yes 
Three meals deli'"'red per day to detainee: Yes 
/lnyunauthori>edfoodinroom? No 
Ha'"' dailyorlhostatic lial signs been completed? Yes 
Has input and output been documented on the M-IU Hunger Strike M:>nitoring Smart Form? Yes 
Narrati'"': 
Detainee slept during whole shift, woke up to 1.0id >G1 as obsen.ed. Detainee reports he slept "okay." Detainee denied any 
other issues or complaints at time of assessment Detainee refused to eat brealdas~ missed 144th meal but ate 2 oranges. 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observation, and monitoring. 
Ex amlinatlon 
General Examination: 
GENER/II.. !>PPE.ARANCE: in no acute distress, well del.eloped, well noorished. 
PSYCH: alert, oriented. 
Assessment s 
/>I-Risk for imbalanoed nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: Nursing to assess h)dration status: skin turgor, mucous membranes, blood pressure, heart rate, intake & output WII 
continue to encourage detainee to eat all meals deli'"'red to him and to drink fluids. Detainee has access to drinking water 
inside of oell. Detainee educated on possible risks to health if he continues to miss meals. Detainee educated on risks of not 
drinking adequate amount of fluids. Detainee educated to drink at least 8-10 cups of liquids per day.Detainee educated on 
possible medical risks of continuing to refuse meals. Detainee instructed to inform nursing staff/offioers if s,mptoms discussed 
begins, or if ha"ng continues or becomes worse. Detainee also instructed to let offioer know if he wants a tray to consume. 
Detainee '"'rba li>ed understanding of all instructions and did not ha,e anyadditional questions. Detainee to remain in M-IU/seg 
until will only released from hunger strike treatment/monitoring byphy.;ician. Detainee ,erbali>ed understanding of all 
instructions. 
Procedu re Codes 
T1013 Sign Lang/0-al Interpreter 
Notes: Detainee to remain in M-IUA-iunger Strike 
Appointment Providej(b)(6); (b)(7)(C) I RN 
Bectronically signed b~,._ (b~)~(6=)~; ~--'~ on 10/09/2018 06:47:17 (Pacific Daylight Time) 
Sign off status: Completed 
2019-ICLl-0005 1 3025 

DHS-ICE-19-0196, 19-0197-N-000207
Northwest Detention Center 
1623EJ~ 
1'. WA98421 
Tel: bl/6): 
x: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progreu Nota: kb)(6); (b)(7)(C) !RN 10/09/2018 
Ncl.e generated by eClinica/Wm<s 8"R'PM Softv.ere (WNNeC/inica/WOrks.C001 
2019-ICLl-00051 3026 

DHS-ICE-19-0196, 19-0197-N-000208
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA A: 216269802 Si.tllq(b )(6): ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, ~- 1QOJ(1928 AccOllll l'unbe (b)(6): ! 
10 108/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Allergies 
NKDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. Weight loss denies. Dry M:>uth denies. 
Weakness denies. Cough denies. Shortness of breath at 
rest denies. Chest pain at rest denies. Palpitations denies. 
J>lxlominal Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \.l:>mitting denies. Painful urination denies. 
Decreased urine output denies. M.Jsde adhes denies. M.Jscie 
cramps denies. Skin breakdown denies. Difficultythinking denies. 
1623 E J STREET, TACOMA, WA-98421 
Appoimnert Facility: Northwest Detertion Certer 
Aflpolntment Prov1c1ef b)(6 ); (b)(7)(C) f RN 
Reason for Aflpolntment 
1. tvHU 2ND H.ALF EVE NSG RDS 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sourcel(b. )(,6),.. -~ID rdge Pfi re Chaperone Present? Yes GEOO'licei , _ PN b)(6); Wlatlanguage do }OU speak? Russian . . . -
Interpretation pro\aded? Yes, Interpreter Number 11470705 
Number Use notes ffeld 
Language Russian 
Pain .1>6sessment 
Pain 
ke }OU currently in pain? No 
Fiowsheets (tvHU): 
lnput/OJtput Fiowsheet 
Time: 1900(SHIFT1008/20181900-1008/2018 2300) 
INPUT PO: DETAINEE REF'a?TSHE DRANK 1 CUPCX:: WA'IER, WAS NOTED THRCXJGH THE VIDEOCIWERA a= 
DRINKINGFR01AWA'IERFOUNTAJN3X 
INPUT Other. 237 ENSURE 
INPUT SUBTOT/11.. : 237 
OUTPUT Urine O DETAINEE REF'a?TSHE'S VOIDED 1XDURING SHIFT, DETAJNEEWAS a3SERVED mHAVE USED 
THE TOILET A TLEAST3X DURING SHIFT. 
OUTPUT SUBTOT/11.. : 0 
Initials: RK 
Hungerstrike M:>nitoring Form 
Day: 1 OA'.)9/2018 
Shi~ PM(SHIFT1008120181900- 1008/2018 2300) 
Intake PO (in ml): 237 237M. a= ENSURE DETAJNEE REPORTS HE DRANK 1 CUPCX:: WA'IER, WAS NO'IED 
THROJGHVIDEOCAM=RA<Y=DRINKINGFRCl\.1WA'IERFCUNTAINATLEAST3XDURINGSHIFT. 
OJtput Urine (in ml): 0 DETAJNEE REPORTS HE'S V(XDED 1X DURING SHIFT, DETAJNEEWAS a3SERVED roHAVE 
USED THE TOILET A TLEAST3X DURING SHIFT. 
Initials: RK 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
\Mien did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wcints to be released from custody 
/ldequate supply of drinking water and other be1.erages available: Yes 
Three meals deli'"'red per day to detainee: Yes 
/lnyunauthori>edfood inroom? No 
Ha'"' dailyorthostatic lia l signs been completed? Yes 
Has input and output been documented on the M-iU Hunger Strike M:>nitoring Smart Form? Yes 
Narratiw: 
Detainee was noted sleeping, la~ng in bed during initial rounds, does not appear to be in anydislress and noted normal rise 
and fall of chesl Detainee was compliant during nursing assessment reports he is doing "so-so" but denies he's in any pain or 
forms of discomfort. Detainee refused he needed an)ltling from the nurse at the time of assessment \MIi continue to monitor. 
Detainee compliant with his ordered Ensure at HS. Detainee was noted doing his nightlyh:,giene practice by the sink, brushing 
his teeth and washing his face. Detaineew as also obsen.ed to ha1.e been drinking fluids from his cell fountain and \Oiding freely 
at least 3xduring shift. \MIi continue to monitor. 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observation, and monitoring. 
Ex amina tion 
General B<amination: 
GENER.Al !>PPE.AR.ANCE : in no acute distress, well del.eloped, well noorished. 
PSYCH: alert, oriented. 
Assessment s 
/>I-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: Nursing to assess h)dration status: skin turgor, mucous membranes, blood pressure, heart rate, intake & output \MIi 
continue to encourage detainee to eat all meals deli'"'red to him and to drink fluids. Detainee has access to drinking water 
inside of cell. Detainee educated on possible risks to health if he continues to miss meals. Detainee educated on risks of not 
drinking adequate amount of fluids. Detainee educated to drink at least 8-10 cups of liquids per day.Detainee educated on 
possible medical risks of continuing to refuse meals. Detainee instructed to inform nursing staff/officers if s)fTlptoms discussed 
begins, or if ha"ng continues or becomes worse. Detainee also instructed to let officer know if he wants a tray to consume. 
Detainee '"'rba li>ed understanding of all instructions and did not ha1.e anyadditional questions. Detainee to remain in M-iU/seg 
until will only released from hunger strike treatment/monitoring byphy.;ician. Detainee 1.erbali,ed understanding of all 
instructions. 
Procedu re Codes 
T1013 Sign Lang/0-al Interpreter 
Disposition:---
Notes: Detainee to remain in M-IU.1-i unger Strike 
Appointment Provider:! (b)(6) ; (b)( 7)(C) !RN 
2019-ICLl-0005 1 3027 

DHS-ICE-19-0196, 19-0197-N-000209
Electronically signed bf._b...;. )-'-(6""); __ __.fN on 10/09/2018 01:29:10 (Pacific Daylight nme) 
Sign off status: Completed 
Northwest Detention Center 
1623EJSffiEEJ 
l'. WA98421 
Tel: b)(6) ; 
Patient: AMAR, MERGENSANA DOB: 10/2 3/19 78 Progre u Nota l(b)(6); (b)(? )(C) !RN 10/08/2018 
Nd.e general.ed by eClinica/Wm<s 8"R'PM Sattv.ere (IW.WeCiinica/Works.com) 
2019-ICLl-00051 3028 

DHS-ICE-19-0196, 19-0197-N-000210
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3029 
AMAR,MERGENSANA .. A:21626980 2 Su:ll~(b )(6); J 
Fac1lrtyCode:CSOINWA ng ,c;ea.1 
39 kc01.111 v a d ~'~E ~ber}f@£ :: ! 1623 E J STREET, T 

DHS-ICE-19-0196, 19-0197-N-000211
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA A: 216269802 Su:ll~b )(61, I 
Facility Code: CSONVWA Housing ea: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll lunber:~ 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
10 108/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"'I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Allergies 
NKDA 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fe'"'r denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbanoe denies. Weight gain denies. 
Weight loss denies. 
Appointment Provid e r: Kb)(6); (b)(7)(C) ~N 
Reason for Appointment 
1. RN E\€NING SPLIT SHIFT: HUNGER SlRIKE 
History of Present Illness 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Time: 1730 
INPUT PO: 240 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT Other. 0 
INPUT SUBTOT/11.. : 0 
OUTiPUT Urine 0 
OUTiPUT Emesis 0 
OUTiPUTBM 0 
OUTiPUT a. Wet Diaper Weight 0 
OUTiPUT b. D,y Diaper Weight 0 
OUTiPUTTotal Diaper Weight output (calculate a-b) 0 
OUTiPUTDrain: 0 
OUTiPUT SUBTOT/11.. : 0 
NetGain: 0 
Netloss: 19 
Initials: KM,! 
Patient Identification: 
Patient is 39 }ear old male from Russia, in M-IU for Hunger Slrike. W,en asked how he feels he 1<Jrbali2es inEnglish "weak". 
Patient is instructed that if he eats his strength should increase. />I. dinner patient refused M)ST a= meal 143. Patient ate 2 
oranges. His weight this morning was 144.0 pounds. this shift patient has been up and alert and has also spent time sleeping in 
bed. Rise and fall of chest was " sualiied when sleeping. The only item refused this shift was dinner tray. Refusal sheet was 
completed and submitted to Medical Records. 
Patient Identification 
Patient propeMyidentified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
11\,t,at language do )OU speak? English, Russian, __ 
Interpretation pro,..cJed? No interpreter available during visit 
Pain /!ssessment 
Pain 
Ne )OU currently in pain? No 
Vit al Signs 
16/ min 
66.5in 
Ex amination 
General Examination: 
RR 
H 
10/08/201805:23:09 PM 
10/08/201803:51:24 PM 
GENER/II.. !>PPEAA.ANCE: in no acute distress, well del.eloped, well nourished. 
(b )(6); N 
(b)(7)(C) -
-
N 
NEURQOOC : alert and oriented. cooperati'"' with exam, molar strength normal upper and I°""" ex1rernities, normal 
exam, normal strength, tone and reflexes, sensory exam intact. 
Assessments 
1. lneffecti'"' health maintenanoe - ND00099 (Primary) 
2. lneffecti'"' health management - ND00078 
Treatment 
1. Ineffective health maintenance 
Notes: Continue hunger strike protocol, encourage po foodllluids, encourage 1<Jrbali2ation offeelings. Encourage to allow staff to 
monitor intake and output, "ta l signs, wt. lnstruded to seek staff with any needs. Verbaliied understanding. Detainee offered 
three meals per day and leave in room for 20 to 30 minutes. A:lequate supply of drinking water and other bel<:!rages as ordered 
bypro,..der available. Encourage dailyoral/phy.;ical h,giene care. Change of dothing/bedding. Ofer BOOST and Pedil)te as 
ordered. Do orthostatic "ta ls daily. Patient educated to possible Side Effects of going for long period of time without food. Patient 
'"'rba li,es understanding of current Plan of Care. Patient l<:!rbali,es his option to refuse food. 
2. Others 
Notes:l'l.dinnerpatient refused M)STO: meal 143. Patient ate two oranges. Patient still considered hunger strike until Dr. 
rv'alakhova remo'"'5 patient from hunger strike. Report gil<:!n to oncoming RN, Dr. Walakhova and A:lmin notified. 
Appointment Provider: (b )(6); 
/h\ /7\/C:\ 
RN 
Bectronically signed b~,.;, ~b..;)..;,, (6-'-),;... · ----'~ , RN on 10/08/2018 17:44:27 (Pacific Daylight Time) 
Sign off status: Completed 
2019-ICLl-0005 1 3030 
Northwest Detention Center 
1623 E J STREET 
TACOMA, WA9842 1 

DHS-ICE-19-0196, 19-0197-N-000212
Te!Kb)(6); 
Fax: 
P-nt: AMAR, IIERGENSANA DOB: 10/23/1978 Prog,. .. No~ (b)(6) ; (b)(7)(C) I RN 10/08/2018 
Ncl.e general.ed by eC/inica/'Na1<s BvR'PM Sottv.ere (l'N.WeC/inica/W<Yks.coojl 
2019-ICLl-00051 3031 

DHS-ICE-19-0196, 19-0197-N-000213
U.S. Immigration 
and Customs 
Enfor cement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inic a'WGYks.coojl 
2019-ICLl-00051 3032 
AMAR,MERGENSANA 
A:216269802 Su:l1D: !(b)(6); I 
Facility Code: CSONVWA Housing Area : M 
Acc0Ull ~beb){6)C ! 39 Y ad ~l~i::: 
1623 E J STREET, T 

DHS-ICE-19-0196, 19-0197-N-000214
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGE~~ 
Facility~~~~~ 
Acca.nt ~ Jb)@1 39Y ad ~:ic:: 
10 108/2018 
Cunont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Past Medlcal Hletory 
No Pvt,dical History. 
Allorglos 
NKDA 
Review of Systems 
Hunger Strike: 
Fatigue admit& Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. \r\leightloss admit& Dry 
M:>uth denies. \r\leakness admits, that is generalized. 
Cough denies. Shortness of breath at rest denies. Chest pain at 
rest denies. Palpitations denies . .Abdominal Pain denies. 
Constipation denies. Diarrhea denies. Nausea denies. 
I.omitting admits. Painful urination denies. Decreased urine 
output denies. M.Jsde aches denies. M.Jsde cramps denies. Skin 
breakdown denies. Difficultythinking denies. 
1623 E J STREET, T 
Appoirimert Facility. Northwest Detertion Certer 
Appointment Prov1c1erf b)(6) ; (b)(7)(C) ~P 
Rea son for Appointment 
1. Daily rounds 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: Picture, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number 
Number : 11468537 
Language Russian 
Pain .1>6sessment 
Pain 
/>,e }OU currently in pain? No 
Narrati'"': 
39 yo male on hunger strike, in MiU. He refused his breakfast and lunch tra)>S today and ss of lunch today he has missed 
142 meals. He did eat2 apples at breakfast and 2 apples at lunch. He is also drinking water, Boost and Ensure. There is no 
mailable Pedial)4e this weekend, but prior to this weekend he was also drinking Pedial)le. He has been notified by nursing staff 
that after the holidayweekend when pharmacystaff is on-site again, he will be able able to recei'"' more Pedial)4e. He states he 
is urinating without difficulty and that he had a BM this PM He do feeling "weak.". 
Patient is oonsidered to be on official hunger strike and was referred for e1,0luation. 
Hunger Strike: 
Pvt,dical Elaluation 
Date missed meals monitoring initiated: 081221.W18 
\Mien did the official hunger strike begin? 08/25'2018 
Date of last meal oonsumed: 081221.W18 
Last meal oonsumed: Breakfast 
Drinking fluids: Yes 
# of dai,s on hunger slri ke: 43 
Total \/\eight loss in pounds: 20.2 
Reason for hunger strike: Wcints to be released from custody 
Housing/Isolation Location: M,dical Housing Unit 
Reason for Isolation F1acement For dose supervision, obse,vation, and monitoling 
Re"ew of the Housing Placement Review housing every 24 hours 
Vit a l Sign s 
Temo 
98.0F 10/08/201801:16:07 PM 
HR 
62/m in 10/08/201801:16:07 PM 
BP 
95'59 mm Hg 10/08/201801:16:07 PM 
RR 
16/ min 10/08/201801:16:07 PM 
WI 
142.8 lbs 10/08/20180 1:16:07 PM 
H 
66.5in 10/08/201801:16:07 PM 
BMI 
22.70 Index 10/08/201801:16:07 PM 
BP 95'59. Pl denies d1221ness, but states he feels weak. I enoouraged h,m to dnnk plenflyofwater. 
Ex amination 
General Examination: 
GENER/IL /IPPE/IR/INCE: in no acute distress, under-nourished. 
ORPl CAvlTY: nonnal, mucosa moist. 
SKIN: pale, no rashes, no suspicious lesions. 
HEl'RT: no murmurs, regular rate and rhythm, S 1, S2 nonnal. 
LUNGS: nonnal, clear to auscultation bilaterally, nowieezes, rales, rhonchi. 
/IBDOIVEN: flat, tx:Mel sounds present, soft, nontender, nondistended. 
MJSCULOSKELET/IL: full range cl motion, no deformities, sitting upright at bedside. 
PERIPHER/ll PULSES: 2+ radial. 
NEURQOOC : alert and oriented, cooperati'"' with exam. 
PSYCH: alert, oriented, good eye contact, speech clear. 
Assessment s 
1. Starvation, subsequent encounter - T73.0JO<D (Primary) 
Treatment 
1. Starvation, subsequent enca.nter 
Notes: Encouraged fluid intake. Enoouraged oontinued oonsumption of fresh fruit from tray. 
2. Others 
Notes: HOJSING RESTRICTIO>J ~DERS : 
1. Patient is oonsidered to be on hunger strike and will be isolated from other detainees for 
dose super.ision, observation, and monitoring. 
2. Patient will be placed in restricted housing, based on his or her medical oondition, until 
medical personnel authoriie mo'"'ment of the patient to a less restricti'"' en~ronment 
or the patient is transferred to a hospital. 
3. ~ I food not authorized by CD/ph)>Sician will be remol<!d from the patienfs room 
4. Patient is not allowed to purchase food from oommissar)ll,ending machine while on hunger strike. 
5. Re~ew of the housing placement will be documented e'"'ry72 hours or less 
6. Patient will only be released from hunger strike treatment/monitoring by CD or ph)>Sician order 
NURSING ~DERS : 
1. Document the daily monitoring of patienfs: Intake, OJ1put, \/\eight and 01hostatic 
\/Ital Signs on the Hunger Strike M:>nitoring Smart Form 
2. Complete urinal)>Sis and other labs ifordered 
(b )(6); 
(b)(7)(C) 
3. Ensure an adequale supply of drinking water, or other be.erages, and three meals per day are deli'"'red to the patient 
4. Documentdeli'"'ryo f meals 
PSYCHIAlRIC EV/ILUATIO>J: 
2019-ICLl-00051 3033 
NP 
>--
NP 
,-
,-
NP 
-
~ ,-
>--
~p 
>--
>--
~p 
-
NP 

DHS-ICE-19-0196, 19-0197-N-000215
1. BHP wi ll ew luate patient to assess for possib le ps)!fliatric causes for the hunger strike, 
and to prolide supporti"3 counse ling that mayhe lp end the hunger strike. 
EDUCAllCN: 
1. Patient counse led regarding the medical risks of continuing the hunger strike and 
encouraged to terminate the hunger strike. 
Follow Up 
pm, daily rounds 
Appointment Provide (~/\~!;,., 
b)(6); Electronically signed b b)(?)(C) 
Sign off status: Comple 
on 11l/08,/201813:35 :59 (Pacific Daytlght Time) 
Northwest Detention Cente r 
1623 E J STREEr 
T~A98421 Te1j§){6f ! 
Pati-1: AMAR, IERGENSANA DOIi: 10/23/1978 p._... Not.k.._b'"'}.,_(6'"'}._; __ _.! NP 10/08/2018 
/lk:ie generaled by eOirica/Wcrlcs a,,RIPM Sottvqe ("'"""eC/inica/ Works.com) 
2019-ICLl-00051 3034 

DHS-ICE-19-0196, 19-0197-N-000216
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: A11AR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3035 
AMAR,MERGENSANA . . A: 216269802 Si.tll~ )(6);_ . 1 
Facility Code: CSONVWAn og,. ea. 1t1 
39 Y old Male, DOB: 10/23/1978 
1623 EJ 
AccOl.rll 
STREET, 
llunber
T~ 
: ~ 

DHS-ICE-19-0196, 19-0197-N-000217
U.S. Immigration 
and Customs 
Enforcement 
AMAR, MERGEN.,.....,.~..., 
A: 216269802 Si.ti1 (b )(6); 
Facility Code: CSOilNWA t1...' r n ,,. , ' 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II ~be ,f h\rR\ 
10 108/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e- Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"'I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Allergies 
NKDA 
Review of Syste ms 
General/Constitutiona l: Change in appetite denies. Chills denies. Fatigue denies. 
Fe'"'r denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbanoe denies. Weight gain denies. 
Weight loss denies. 
1623 E J STREET, TACOMA, ~ W;-,'A-9 "=84~2~1..., 
Appoirimert Facility. Northwest Detertion Certer 
Appointment Provld e r:l(b)( 6); (b)( 7)(C) r" 
Reason for Appointment 
1. RN DAYS: HUNGER STRIKE 
History of Present Illness 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Time: 1500 
INPUTPO: 480 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT Other. 0 
INPUT SUBTOT/11..: 0 
OUTiPUT Urine 0 
OUTiPUT Emesis 0 
OUTiPUTBM 0 
OUTiPUT a. Wet Diaper Weight 0 
OUTiPUT b. Dry Diaper Weight 0 
OUTiPUTTotal Diaper Weight output (calculate a-b) 0 
OUTiPUTDrain: 0 
OUTiPUT SUBTOT/11.. : 0 
NetGain: 0 
NetLoss: 19 
Initials: KM,! 
Patient Identification: 
Patient is 39 }ear old male from Russia, in M-IU for Hunger Slrike. Patient became '"'rydemanding today and kept tapping 
on window to get GEOalioers attention when GEO alioer '"'ryb usy, patient wanted dean dothes and GEO alicer had already 
told him it would be a few minutes, and aboute'"'rytwo minutes he would start tapping on window again. Patient was then told of 
an attomey,..sit and went in shower after he was told this, when he came out of shower facilitywas in count and he was asking to 
go to attomey\<Si~ but had to wait now. Patient refused REC this />M Wien asked how he feels he 1.ertali,es in English ''Weak". 
Patient is instructed that if he eats his strength should increase. />I. lunch patient refused M:'.lST OF meal 142. Patient ate 2 
apples. He had eaten two apples this morning off breakfast tray also. His weight this morning was 144.0 pounds. this shift 
patient has been up and alert and has also spent time sleeping in bed. Rise and fall of chest was l.isuali,ed when sleeping. The 
only items refused this shift was lunch tray and REC. Refusal sheet was completed and submitted to Ml dical Records. 
Patient Identification 
Patient propeMyidentified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
\Mlat language do )OU speak? English, Russian, __ 
Interpretation pro\aded? No interpreter available during visit 
Pain /!ssessment 
Pain 
Ne )OU currently in pain? No 
Vit al Signs 
98F 
standing:60 
sitting:58 
supine:59 
standing:89/60 
sitting:88158 
supine:95159 
16/ min 
144.0 lbs 
66.5in 
22.89 Index 
Ex amination 
General Examination: 
Temo 
HR 
BP 
RR 
1M 
It 
BMI 
10/08/201803:46:34 PM 
10/08/201803:46:34 PM 
10/08/201803:46:34 PM 
10/08/201803:46:34 PM 
10/08/201803:46:34 PM 
10/08/201803:46:34 PM 
10/08/201803:46:34 PM 
10/08/201803:46:34 PM 
10/08/201803:46:34 PM 
10/08/201803:46:34 PM 
10/08/201803:46:34 PM 
GENER/II.. !>PPE.ARPNCE: in no acute distress, well del.eloped, well rKJUrished. 
b)(6); RN 
b)(7)(C) --
RN 
RN 
RN 
--
RN 
RN 
RN ,_ 
,_ 
RN ,_ 
-
RN 
-,_ 
RN ,_ 
-
RN ,_ 
NEUROLOGIC: alert and oriented, cooperati1.e with exam, motor strength normal upper and ICJlll'ef ex1remities, normal 
exam, normal strength, tone and reflexes, sensory exam intact. 
Asses sm ent s 
1. lneffecti'"' health maintenanoe - ND00099 (Primary) 
2. lneffecti'"' health management - ND00078 
Treatment 
1. lneffecti\le health maintenance 
Notes: Continue hunger strike protocol, encourage po food/lluids, encourage 1.ertaliiation offeelings. Encourage to allow staff to 
monitor intake and outp~ I.ital signs, wl Instructed to seek staff with any needs. Vertal i>ed understanding. Detainee offered 
three meals per day and lea'"' in room for 20 to 30 minutes. J>dequate supply of drinking water and other be1.erages as ordered 
by pro\ader available. Encourage dailyoral/phy.,ical h19iene care. Change of dothing,bedding . Ofer BCX)ST and Pedil)4e as 
ordered. Do orthostatic l.itals daily. Patient educated to possible Side Effects of going for long period of time without food. Patient 
'"'rba li,es understanding of current Plan of Care. Patient 1.ertali,es his option to refuse food. 
2. Others 
Notes: />I. lunch patient refused M:'.lST OF meal 142. Patient ate two apples. Pati1
nt still rnosi~~red hunger strike until Dr. 
Kb )(6);_ _ I remo'"'5 patient from hunger strike. Report gi,en to oncoming RN, D!(b )(6); pnd J>dmin notified. 
Appointment Provider: (b )(6); RN /1,.,.\/ "7 \tr-\ 
2019-ICLl-0005 1 3036 

DHS-ICE-19-0196, 19-0197-N-000218
Electronically slgned b~~(b~)~(6~),~· _ __.!RN, RN on 10/08/201815:46:53 (Pacific Daylight Time) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREEr 
TACOMA, WA98421 
Telj(bl/6) I 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 ProgNu Nota:""l (b..;.).;.(6.;. )';... . __ __,IRN 10Al8/2018 
NcJ.e general.eel by eC/inica/Wa1<s af</PM SofMere (WNNeC/inic;iWorks.COff9 
2019-ICLl-00051 3037 

DHS-ICE-19-0196, 19-0197-N-000219
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:lld/h \In \ ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunberll-.b.,,_)w'6c..)i,;.· __ _. 
1623 E J STREET, TACOMA, WA-98421 
Appoirimert Facility: Northwest Detertion Certer 
10107/2018 
Cunont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Review of Systems 
Hunger Strike: Fatigue denies. Headache denies. Ughtheadedness denies. 
Sleep Disturbance denies. Wa>ight loss denies. Dry M:>uth denies. 
Wa>akness admits Cough denies. Slhortness of breath at 
rest denies. Chest pain at rest denies. Palpitations denies. 
i>odominal Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \om itting denies. Painful urination denies. 
Decreased urine output denies. MJsde adhes denies. MJscie 
cramps denies. Skin breakdown denies. Difficulty thinking denies. 
~ 
Cough denies. Slhortness of breath 1Mth e>ertion denies. 
Mlsru loskeletal: 
MJscie adhes denies. Wi>akness admits, that is mild. 
~ : 
Rash denies. 
~ : 
Headache denies. Pain denies. 
Rea son for Appointment 
1. E'"'nir-glnight rounds 
History of Present Illness 
Narrati'"': 
Appointment Provld e rf b)(6) ; (b)(7)(C) rN 
2000 Ml le patient here in M-iU for hunger strike. Patient is med compliant Denies any pain at this time. resting in bed. 
0136 Patientis sleeping in his bed at this time. 
0300 Patient is still currentlyslepping in his bed at this time. 
0530 Patient refused breakfast 141 st meal. Patient requested apples be left in room to eat 
0620 Patient has not eaten his apples at this time. Encouraged pt to drink eldra water today since we do not ha'"' access to 
pediali!e until tomorrow am. 
Patient is considered to be on official hunger strike and IMII be isolated from other detainees for dose super.is ion, 
obser10tion, and monitoring. 
Patient Identification: 
Patient Identification 
Patient property identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do )OU speak? English, Russian 
Interpretation pro\aded? Pallant speaks English fluenUy 
Pain />ssessment 
Pain 
ke )OU currently in pain? No 
Hunger Strike: 
Nursing Eleluation 
Date missed meals monitoring initiated: 081221.W18 
\Mien did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 081221.W18 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wcints to be released from custody, __ 
/ldequate supply of drinking water and other be'"'rages a.ail able: Yes 
Three meals deli'"'red per day to detainee: Yes 
Breakfast 0% consumed 
Other meal/nutritional supplement 100%consumed 
/lnyunauthori>edfood inroom? No 
Ha'"' dailyorthostatic "a l signs been completed? Yes 
Has input and output been documented on the M-iU Hunger Slrike M:>nitoring Smart Form? No; WI/ complete before the 
end of the current shift 
Exam ina tion 
General Examination: 
GENERl>l !>PPE.AR.ANCE: in no acute distress, well del.e!oped, well noorished. 
HEAD: norrnocephalic. 
OR.Al CAvfTY: normal, mucosa moist. 
SKIN: normal, no rashes, no suspicious lesions. 
HE.ART: no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, no Vvheezes, rales, rhonchi. 
Assessments 
1. Imbalanced nutrition: Less than body requirements [00002] - ND00002 (Primary) 
Ill-Risk for imbalanced nutrition: Less than body requirements. 
Treatm ent 
1. Imbalanced nutrition: Less than body requiremerts [00002] 
Notes: Detainee'"'rba li>ed understanding of plan of care and denies questions/concerns. Continue hunger strike protocol, 
encourage po food/lluids, encourage '"'rbali,ation offeelings. Encourage to allow staff to monitor intake and output. ,;1a1 signs, 
wt. Instructed to seek staff1Mth any needs. \krba liied understanding. Care Plan present Refer to nursing care plan for on-going 
inteMntions. Detainee offered three meals per day and lea'"' in room for at least 20 minutes. A:lequate supply of drinking water 
and other be'"'rages as ordered bypro,;der a,ailable. Encourage dailyoral/phy.,ical h)Qiene care. Detainee '"'rbali>ed an 
understanding of education and/or treatment Voices no other concerns. 
2. Others 
Notes: 1. Continue 1Mth \Atal Signs e'"'ryshifl; Intake and QJtput M:>nitoring e'"'rysh ifl; Dailyweights: Dailyorthostatic ,;1a1 signs. 
2. /In adequate supply of drinking water and other be'"'rages are a.ail able to patient at all times. 
3. Three meals per day are deli'"'red to the patient and deli'"'ryof meals is documented. 
4. ~ I food not authori>ed by CD/Phy.,ician is remo'"'d from patienrs room. 
5. Patient is not allowed to purchase food from commissary\ending machine while on hunger strike. 
6. Patient will only be released from hunger strike treatment/monitoring byCD or phy.,ician order. 
7. Patient counseled regarding the medical risks of continuing the hunger strike. 
8. Encouraged to terminate the hunger strike and eat/drink as normal. 
Disposition: A:lmitted to M-IU until medicallye,a luated 
Appointment Provid1(b)(6): (b)(7)(C) fN 
Bectronically signed ~"-b-'-)-'-(6-"),'-- · _ __.!RN on 10/08/2018 06:19:51 (Pacific Daylight Time) 
Sign off status: Completed 
2019-ICLl-00051 3038 

DHS-ICE-19-0196, 19-0197-N-000220
Northwest Detention Center 
1623 E J STREET 
1: WA98421 
Tel (b)(6): 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 Progre u Notel"' (b"')"-' (6"")'-: __ __.!RN 10/07/2018 
NCl.e general.ed by eC/inica/'Na1<s BvR'PM Sottv.ere (l'N.WeC/inica/W<rks.coojl 
2019-ICLl-00051 3039 

DHS-ICE-19-0196, 19-0197-N-000221
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3040 
AMAR,MERGENSANA A: 216269802 Su:i1olh \In \ I 
Facility Code: CSONVWA Housing Area : M 
39 Y ad Male, ~Jf !::: 
1623E~~::= 1~~~1= I 

DHS-ICE-19-0196, 19-0197-N-000222
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3041 
AMAR,MERGENSANA .. A:216269802 Su:ll~ b)(6); I 
Fac1lrtyCode:CSOINWA ng,c;ea .lfi 
39 Acca.nt v ad ~'~E:: lffllber:(bj@ 1623 E J STREET, T 

DHS-ICE-19-0196, 19-0197-N-000223
U.S. Immi gration 
and Customs 
Enforcement 
AMAR, MERGEN,;;11a ......., A:216269802 Su:llD: b)(6); 
Facility Code: CSCN/1/WA h \f ?\tr , 
39 Y old Male, DOB: 10/23/1978 
AccOl.llt funber ~I'~'-~"~"~'---~ 
10107/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\e l 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\e l, see attached ser.ing mi>l!ure order 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\e l 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Allergies 
NKDA 
vlew of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fe'"'r denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbance denies. Weight gain denies. 
Weight loss denies. 
1623 E J STREET, TACOMA, WA-98421 
Appoirimert Facility: Northwest Detertion Certer 
Appointment Provld e~ /b)/6): /b)/7)/C) !RN 
Reason for Appointment 
1. RN E\€NING SPLIT SHIFT: HUNGER SlRIKE 
History of Present Illness 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Time: 1500 
INPUT PO: 240 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT Other. 0 
INPUT SUBTOT/11.. : 0 
OUTiPUT Urine 0 
OUTiPUT Emesis 0 
OUTiPUTBM 0 
OUTiPUT a. Wet Diaper Weight 0 
OUTiPUT b. Dry Diaper Weight 0 
OUTiPUTTotal Diaper Weight output (calculate a-b) 0 
OUTiPUTDrain: 0 
OUTiPUT SUBTOT/11.. : 0 
NetGain: 0 
Net Loss: 20.2 
Initials: KM,! 
Patient Identification: 
Patient is 39 }ear old male from Russia, in M-IU for Hunger Slrike. W,e n asked how he feels he 1<Jrbali2es in English "weak". 
Patient is instructed that if he eats his strength should increase. />I dinner patient refused M)ST a= meal 140. Patient ate 2 
apples. His weight this morning was 142.8 pounds. this shift patient has been up and alert and has also spent time sleeping in 
bed. Rise and fall of chest was "s ualiied when sleeping. The only item refused this shift was dinner tray. Refusal sheet was 
completed and submitted to Medical Records. 
Patient Identification 
Patient propeMyidentified by2 sources ind uding: ID Badge, Verbally 
Chaperone Present? No 
11\,t,at language do )OU speak? English, Russian, __ 
Interpretation pro,..ded? No interpreter available during visit 
Pain /!ssessmen t 
Pain 
Ne )OU currently in pain? No 
Vital Signs 
16/min 
66.5 in 
Examination 
General Examination: 
RR 
H 
10/07/201806:22:29 PM 
10/07/201806:22:29 PM 
GENER/II.. !>PPE/IRANCE: in no acute distress, well del.eloped, well nourished. 
(b )(6); N 
(b)(?)(C) -
-
N 
NEURQOOC : alert and oriented. cooperati'"' with exam, molar strength normal upper and I°""" ex1rernities, normal 
exam, normal strength, tone and reflexes, sensory exam intact. 
Assessments 
1. lneffecti1.0 health maintenance - ND00099 (Primary) 
2. lneffecti1.0 health management - ND00078 
Treatment 
1. Ineffective health maintenance 
Notes: Continue hunger strike protocol, encourage po foodllluids, encourage 1<Jrbali2ation offeelings. Encourage to allow staff to 
monitor intake and output, "ta l signs, wt. Instructed to seek staff with any needs. Verbaliied understanding. Detainee offered 
three meals per day and lea1.0 in room for 20 to 30 minutes. A:lequate supply of drinking water and other bel<:!rages as ordered 
bypro,..der available. Encourage dailyoral/phy.;ical h,giene care. Change of d othing/bedding. Ofer BOOST and Pedil)te as 
ordered. Do orthostatic "ta ls daily. Patient educated to possible Side Effects of going for long period of time without food. Patient 
1.0rbali,es understanding of current Plan of Care. Patient '"'rbali,es his option to refuse food. 
2. Others 
Notes: />I lunch patient refused tvOST a= meal 139. Patient ate two apples. Patient still considered hunger strike until Dr. 
rv'alakhova remo\.8S patient from hunger strike. Report gi'"'n to oncoming RN, Dr. Walakhova and A:lmin notified. 
Appointment Provi (b)(B); (b)(?)(C) RN 
Bectronically signed b (b)(6); , RN on 10/07/201818 :22:59 (Pacific Daylight Time) /h \/ 7\ / r'\ 
Sign off status: Completed 
2019-ICLl-00051 3042 
Northwest Detention Center 
1623 E J STREET 
TACOMA, WA98421 

DHS-ICE-19-0196, 19-0197-N-000224
Te1J(b )(6); 
Fax: 
P-nt: AMAR, IIERGENSANA DOB: 10/23/1978 Prog,. .. No~(b)(6); (b)(7)(C) IRN 10/07/2018 
Ncl.e general.ed by eC/inica/'Na1<s BvR'PM Sottv.ere (l'N.WeC/inica/W<Yks .coojl 
2019-ICLl-00051 3043 

DHS-ICE-19-0196, 19-0197-N-000225
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
.. A:216269802 Su:lltt:1b}(6); I 
Fac1lrtyCode:CSOINWA ng,c;ea .lfi 
39Y old Male,~·1Q{2J119ZB 
AccOllll l'un /b)/6) I 
10 107/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"'I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
vlew of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fewr denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbanoe denies. Weight gain denies. 
Weight loss denies. 
1623 E J STREET, TACOMA, WA-98421 
Appoirimert Facility. Northwest Detertion Cert er 
Appointment Provld e1(b)(6) ; (b)(7) (C) IRN 
Reas on for Appointm ent 
1. RN DAYS: HUNGER STRIKE 
History of Pre se nt Illness 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Time: 1500 
INPUTPO: 480 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT Other. 0 
INPUT SUBTOT/11.. : 0 
OUTPUT Urine 0 
OUTPUTEmesis 0 
OUTPUTBM 0 
OUTPUT a. Wet Diaper Weight 0 
OUTPUT b. Dry Diaper Weight 0 
OUTPUT Total Diaper Weight output (calculate a-b) 0 
OUTPUTDrain: 0 
OUTPUT SUBTOT/11.. : 0 
NetGain: 0 
Net Loss: 20.2 
Initials: KM,! 
Patient Identification: 
Patient is 39 }ear old male from Russia, in M-IU for Hunger Slrike. W,en asked how he feels he 1<Jrbali2es inEnglish "weak". 
Patient is instructed that if he eats his strength should increase. />I. lunch patient refused M:'.lST CF meal 139. Patient ate 2 
apples. His weight this morning was 142.8 pounds. this shift patient has been up and alert and has also spent time sleeping in 
bed. Rise and fall of chest was "s ualiied when sleeping. patient went to REC at 1400, he was offered a wheelchair two times by 
GEO Offioer in nurses hearing and patient deciined use of wheelchair '"'rbali2ing in English "I dont need a wheel chair." The only 
item refused this shift was lunch tray. Refusal sheet was completed and submitted to M,dical Records. 
Patient Identification 
Patient propeMyidentified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
IM1at language do )OU speak? Russian, __ 
Interpretation pro\<ded? No interpreter available during visit 
Pain l'ssessmen t 
Pain 
Ne )OU currently in pain? No 
Vital Sign s 
97.4F 
standing:87 
sitting:65 
supine:53 
standing:94/66 
sitti ng:98/66 
supine:99164 
16 /min 
142.8 lbs 
66.5in 
22.70 Index 
Examination 
General El<>mination: 
Temo 
HR 
BP 
RR 
WI 
H 
BMI 
10/07/201802:12:37 PM 
10/07/201802:12:37 PM 
10/07/201802:12:37 PM 
10/07/201802:12:37 PM 
10/07/201802:12:37 PM 
10/07/201802:12:37 PM 
10/07/201802:12:37 PM 
10/07/201802:12:37 PM 
10/07/201802:12:37 PM 
10/07/201802:12:37 PM 
10/07/201802:12:37 PM 
GENER/II.. />PPEAAPNCE: in no acute distress, well del.eloped, well nourished. 
(b)(6); ~N 
(b)(7)(C) -
~ 
~N 
~N 
-
-
~N 
~N 
~N 
,-
~N 
,-
~N 
,-
,-
~N ,-
~N 
NEUROLOGIC: alert and oriented, cooperati'"' wth exam, motor strength normal upper and ICM>er extremities, normal 
exam, normal strength, tone and reflexes, sensory exam intact. 
Assessment s 
1. lneffecti'"' health maintenanoe - ND00099 (Primary) 
2. lneffecti'"' health management - ND00078 
Tr ea tm ent 
1. lneffectiYe health maintenance 
Notes: Continue hunger strike protocol, encourage po food/lluids, encourage l<:!rbali,ation of feelings. Encourage to allow staff to 
monitor intake and output, \<lal signs, wt. Instructed to seek staff with any needs. lkrbaliied understanding. Detainee offered 
three meals per day and lea'"' in room for 20 to 30 minutes. /ldequate supply of drinking water and other be'"'rages as ordered 
bypro\<der available. Encourage dailyoral/phy.;ical h)Qiene care. Change of dothing,bedding. ater B<XJST and Pedil)4e as 
ordered. Do orthostatic \<lals daily. Patient educated to possible Side Effects of going for long period of time without food. Patient 
'"'rba li,es understanding of current Plan of Care. Patient '"'rbali,es his option to refuse food. 
2. Others 
~ nch patient refused M:'.lST CF meal 139. Patient ate two apples. Patient still considf red hunger strike until Dr. 
~ emows patient from hunger strike. Report gi'"'n to oncoming RN, Dr. l(b )(6) ; __ . d /ldmin notified. 
Appo intment Provide 1(b)(6) ; (b)( 7)(C ) r 
2019-ICLl-0005 1 3044 

DHS-ICE-19-0196, 19-0197-N-000226
Electronically signed by!(b)(6); (b)( 7)(C) iRN on 10/07/201814:13:03 (Pacific Daylight Time) 
Sign off status: Completed 
Northwest Detention Center 
1623EJSTREI" 
TACOMA, WA98421 
Teifh \/ R\· I 
Fax: 
Patient: A111AR, IIERGENSANA DOB: 10/23/1978 Prog,.u Not.f'.b)(6 ); (b)(7)(C) r" 10/07/2018 
Nd.e general.ed by eOinica/W<n<s B>RIPM Sottw,re (""""eC/inica/works.CtJm) 
2019-ICLl-00051 3045 

DHS-ICE-19-0196, 19-0197-N-000227
U.S. Immi gration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:llct b )/6\ ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOllll lunber: f h \/R I· I 
1623 E J STREET, TACOMA, WA-98421 
Appoimnert Facility: Northwest Detertion Certer 
10 106/2018 
Cunont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Review of Systems 
General/Constitutional: 
Headache denies. Lightheadedness denies. Night 
sweats denies. 
ENI: 
~ 
Dry mouth denies. 
Cough denies. Sputum production denies. 
Gastrointestinal: 
Diarrhea denies. Hematemesis denies. 
MJsculoskeletal: 
MJScie aches admits. Vleakness admits, that is 
generalized, that is mild. 
.s!sin: 
Rash denies. Skin lesion(s) denies. 
~ : ,<>ru;etydenies. Puditory,sua l hallucinations denies. 
Delusions denies. Depressed mood denies. Suicidal 
thoughts denies. 
Reason for Appointment 
1. E'"'nir-g'Night nursing rounds 
History of Present Illness 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Time: 0630 
INPUTPO: 43 
Initials: sac 
Narrati'"': 
Appointment Provlderj (b)(6) ; (b)(7)(C) rN 
2050 Patient resting in bed reading. Madi cations gi'"'n. no questions at this time. Patient pleasant and cooperati'"' with 
assessment 
2348 Patient asleep in bed at this time. 
Patient is oonsidered to be on official hunger strike and will be isolated from other detainees for ciose super.is ion, 
obser10tion, and monitoring. 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: Use Notes Section Geo officer 
Wiat language do }OU speak? English, Russian, __ 
Interpretation pro\aded? No interpreter utilized 
Explain Use Notes Section Pallant speaks limited English 
Pain />ssessment 
Pain 
Ne }OU currently in pain? No 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 081221.W18 
\Mien did the official hunger strike begin? 08/25'2018 
Date of last meal oonsumed: 081221.W18 
Last meal oonsumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wcints to be released from custody 
/ldequate supply of drinking water and other be1.erages available: Yes 
Three meals deli'"'red per day to detainee: Yes 
CXher meal/nutritional supplement 100% oonsumed pedialyte no, BID boost and hs Ensure. 112 carlon of boost gluoose 
oontrol and half very high cal mixed togetherv.ith 4 oz 110/er. 
/lnyunauthori>edfood inroom? No 
Ha'"' dailyorthostatic lial signs been oompleted? No; WI/ oomplete before the end of the current shifl Day shift v.i/1 do 
orlhostaacs 
Has input and output been documented on the M-iU Hunger Slrike lvbnitoring Smart Form? No; WI/ oomplete before the 
end of fhe current shill 
Ex amination 
General B<amination: 
GENERl>l !>PPE.ARPNCE: in no acute distress, well del.eloped, well noorished . 
HEAD: normocephalic. 
OR.Al CA\ATY: normal, mucosa moist. 
SKIN: normal, no rashes, no suspicious lesions. 
HE.ART: regular rate and rhyttm, S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, no Vvheezes, rales, rhonchi. 
Assessment s 
1. Imbalanced nutrition: Less than body requirements [00002] - ND00002 (Primaryj 
Ill-Risk for imbalanced nutrition: Less than body requirements. 
Treatm ent 
1. Imbalanced nutrition: Less than body requiremerts [00002] 
Notes: Detainee'"'rba li>ed understanding of plan of care and denies questions/oonoems. Continue hunger strike protoool, 
enoourage po food/lluids, encourage 1.erbalization offeelings. Enoourage to allow staff to monitor intake and output. \ital signs, 
wt. Instructed to seek stafflMth any needs. \/erbali,ed understanding. Nursing Care Plan present Refer to nursing care plan for 
on-going inter-entions. Detainee offered three meals per day and lea1.e in room for at least 20 minutes. Pdequate supplyof 
drinking water and other be1.erages as ordered byprolider available. 
2. Others 
Notes: 1. Continue 1Mth \Atal Signs e1.eryshifl; Intake and Q.Jtput lvbnitoring e1.eryshifl; Dailyweights: Dailyorthostatic \ital signs. 
2. /In adequate supply of drinking water and other be1.erages are available to patient at all times. 
3. Three meals per day are deli'"'red to the patient and deli'"'ryof meals is documented. 
4. ~ I food not authori>ed by CD/Phy.;ician is remo1.ed from patienrs room. 
5. Patient is not allowed to purchase food from oommissary\ending machine while on hunger strike. 
6. Patient will only be released from hunger strike treatment/monitoring by CD or phy.;ician order. 
7. Patientoounseled regarding the medical risks of oontinuing the hunger strike. 
8. Enoouraged to terminate the hunger strike and eat/drink as normal. 
Disposition: Pdmitted to M-IU until medically evaluated 
Appoinbnent Providet~ /\~/;c, 
Bectronically signed by k~b~)~(6~);~-~~ on 10/07/2018 06:38:37 (Pacific Daylight Time) 
Sign off status: Completed 
2019-ICLl-0005 1 3046 

DHS-ICE-19-0196, 19-0197-N-000228
Northwest Detention Center 
1623EJSTREEI" 
TACOMA, WA98421 
Telj(b ((!lJ.; I 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 ProgN u Nota: ... !(b""\.,_, /6'-"\:~ _ _,IRN 10/08/2018 
Nd.e generated by eOirdca/WOO<s BvRIPM Softv.ere (w.w,eC/irdcaJworks.CQn1 
2019-ICLl-00051 3047 

DHS-ICE-19-0196, 19-0197-N-000229
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Si.tll*b )(6); I 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
Acc01.111 ~1ietJ <6); I 1623 E J STREET, TICJ:P VVA-9642 I 
Appoimnert Facility: Northwest Detertion Certer 
10106/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Allergies 
NKDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness admits. 
Sleep Disturbance denies. Weightloss admits. Dry 
M::>uth denies. Weakness admits. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. Abdominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. 1,1:>mitting denies. Painful 
urination denies. Decreased urine output denies. MJsde 
aches denies. MJsde cramps denies. Skin breakdown denies. 
Difficulty thinking denies. 
Appointment Provlde'1~<b~)~(6~):~-~I RN 
Reason for Appointment 
1. RN e'"'ning round first 112 shift 
History of Present Illness 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Time: 1900 
INPUT PO: 650 pt ate one apple during the dinner 
OUTPUT Urine 300 
OUTPUTBM 1 
Net Gain: 350 
Initials: LM 
Hungerstrike M::>nitoring Form 
Day: 1006/.2018 
Shift: PMRNeveningroundfirst 112 shifl 
Intake PO (in ml): 650 pt was ob served to drink water from pitch 
Intake rl/- Normal Saline (in ml): 0 
Intake rl/- LR (in ml): 0 
Intake NG(in ml): 0 
OJtput Urine (in ml): 300 
OJtput Bowel M::>'"'ments (in ml): 0 
Comments: HE HAS BEEN DRINKING PED/AL YTE, boost, and drinking water. Pt ate one apple 
Initials: LM 
Patient Identification: 
Patient Identification 
Patient prope~yidentified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEO OFFICER 
\Mat language do )OU speak? Russian 
Interpretation pro\aded? Provider fluent in pa vent's native language 
Pain 1'6sessment 
Pain 
Ne )OU currently in pain? Yes 
The pain is located .-back and legs 
The se'"' rityof pain is rated at 3110 
The se'"' rityof the pain is moderate 
The pain began 4-5 v.eeksago 
The character of the pain is aching 
The associated simptoms are v,eakness 
The pain is aggravated by other hunger strike 
The pain is reliel<!d by other 
Describe: pt refused medica#on treatment 
Narrati'"': 
Patient is oonsidered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observation, and monitoring. 
Pl was in M-IU II/ED 2 Upon enoounter detainee was resting quietly in bed and watching lV. Detainee reported weakness 
and pain on his legs and back, but refused any medical treatment He has been drinking Pedial)4e and Boost In the morning he 
went to reck)0rd. lMII oontinue to monitor. 
Detainee has missed his 137 meal this DINNER Pt ate an apple from meal trail, but refused the Dinner. pt was watching lV 
and resting and reading book. \MIi oontinue to monitor. 
Hunger Strike: 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/2212018 
IM1en did the official hunger strike begin? 08/2512018 
Date of last meal oonsumed: 08/2212018 
Last meal oonsumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wants to be released from custody 
/!dequate supply of drinking water and other be1erages a,ailable: Yes 
Three meals deli'"'red per dayto patient Yes 
Lunch deli'"'red during current shift 0% oonsumed 
Priy unauthoriied food in room? No 
Ha'"' dailyorthostatic \atal signs been oompleted? Yes 
Has input and output been documented on the the M-iU Hunger Strike M::>nitoring Smart Form? Yes. 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
IM1en did the official hunger strike begin? 08/25'20 18 
Date of last meal oonsumed: 08/22/2018 
Last meal oonsumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wcints to be released from custody 
/!dequate supply of drinking water and other be1erages available: Yes 
Three meals deli'"'red per day to detainee: Yes 
Lunch 0% oonsvmed pt ate an apple 
Dinner 0% oonsvmed 
Priy unauthoriied food in room? No 
Ha'"' dailyorthostatic \<al signs been oompleted? Yes 
Has input and output been documented on the M-iU Hunger Strike M::>nitoring Smart Form? Yes 
Vital Signs 
16/ min 
66.5in 
Examination 
General Examination: 
RR 
10/06/201803:58:47 PM 
H 
10/06/201803:58:47 PM 
GENERN. JIPPEAA.ANCE: in no acute distress, well del.eloped, well nourished. 
HEAD: norrnocephalic. 
SKIN: nomial, no rashes, no suspicious lesioos. 
HE.ART: no murmurs, regular rate and rhythm, S 1, S2 nom,al. 
LUNGS: nomial, clear to auscultatioo bilaterally, no Vl>lleezes, rales, rhonchi. 
CHEST: nomial, no gross rib deformity, nom,al shape and expansioo. 
PBDO\,EN: nomial, bowel sounds present, soft, nontender, nondistended. 
2019-ICLl-00051 3048 
(b)(6); ~ 
(b)(7)(C) -
-
~ 

DHS-ICE-19-0196, 19-0197-N-000230
MJSCULOSKELETl'l : nonnal, nonnal gait, no defonnities, full ranged motion, . 
NEUROLOOC: alert and oriented, cooperati1e with exam, , gait nonnal, neck supple, no rigidity, no tremor. 
PSYCH: alert, oliented, cogniti1e function intact, cooperati1e with exam, good eye contact, judgement and insight 
good, mood/affect full range, no auditory or \lsuaJ hallucinations, speech clear, thought content without suicidal ideation, 
delusions, thought process logical, goal directed. 
Assessments 
It -Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: 1. Continue with Orthostatic \Atal Signs e1eryday, Intake and Oltput Mmitoring e1.eryshifl; Dailyweights; 2. l'<l adequate 
supply of drinking water and other be1.erages are available to patient at all times. 3. Three meals per day are deli1.ered to the 
patient and deli1.eryof meals is documented. 4. ~I food not authori,ed byCDiPhy.;ician is remo\ed from patienfs room. 5. Patient 
is not allowed to purchase food from oommissari",ending machine while on hunger strike. 6. Patient will only be released from 
hunger strike treatment/monitoring by CD or phy.;ician order. 7. Patient oounseled regarding the medical risks of oontinuing the 
hunger strike. 8. Enoouraged to terminate the hunger strike and eat/drink as normal. Continue hunger strike protoool, enoourage 
po food/!luids, enoourage 1.erbalization offe elings. Enoourage to allow staff to monitor intake and output, 1.1tal signs, wt Instructed 
to seek staff with any needs. Verbali,ed understanding. Detainee offered three meals perdayand lea1.e in room for20 to 30 
minutes. Enoourage dailyora l/phy.;ical h>9iene care. Change of dothing/bedding . Clfer BOJST and Pedil)!e as ordered. Patient 
educated to possible Side Effects of going for long period of time without food. Patient 1.erbali2es understanding of current Plan of 
Care. Patient 1.erbali,es his option to refuse food. 
Appointment Provide~ (b)( 6); ! RN 
Electronically signed (b)(6) ; on 10/06/201819:00:12 (Paci fic Daylight Time) lh\1 7 \11.\ 
Sign off status: Comple 
Northwest Detention Center 
1623 E J STREEr 
T WA98421 
Tel: /h\ff\\· 
x: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progr9aa No, ~/\~L, r" 10/06/2018 
Ncie generaled by eC/irica/Wcrks EJvRIFM Soltwi1re (""""'eC/inica/Works.com) 
2019-ICLl-0005 1 3049 

DHS-ICE-19-0196, 19-0197-N-000231
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
.. A:216269802 Su:ll~b)(6 ); I 
Facility Code: CSCN/1/WA 1119,. ea. 1t1 
39 Y old Male, DOB: 10/23/1978 
AccOl.rll lunber: f h \/RI· 
1623 E J STREET, TACOMA, WA-98421 
Appoimnert Facility: Northwest Detertion Certer 
10 106/2018 
Curnont Medication s 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Allergie s 
NKDA 
Review of Syste ms 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness admits. 
Sleep Disturbance denies. Weightloss admits. Dry 
M::>uth denies. Weakness admits. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. Abdominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. 1,1:>mitting denies. Painful 
urination denies. Decreased urine output denies. MJsde 
aches denies. MJsde cramps denies. Skin breakdown denies. 
Difficulty thinking denies. 
Appointment Provld e 1"-(b-'-)('-6'--'- ); __ _.I RN 
Reas on for Appointm ent 
1. RN day round/hunger strike 
History of Pre se nt Illne ss 
Fiowsheets (II/HU): 
lnput/OJtput Fiowsheet 
Time: 1515 
INPUT PO: 2000 pt ate one apple during the lunch 
OUTPUT Urine 1500 
OUTPUTBM 1 
Net Gain: 500 
Initials: LM 
Hungerstrike M::>nitoring Form 
Day: 1006/.2018 
Shift: AM 
Intake PO (in ml): 2000 pt v.as observed to drink v.aterlrom pitch 
Intake rl/- Normal Saline (in ml): 0 
Intake rl/- LR (in ml): 0 
Intake NG(in ml): 0 
OJtput Urine (in ml): 1500 
OJtput Bowel M::>'"'ments (in ml): 1 
Comments: HE HAS BEEN DRINKING PED/AL YTE, boost, and drinking v.ater. Pt ate one apple 
Initials: LM 
Patient Identification: 
Patient Identification 
Patient prope~yidentified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEO OFFICER 
\Mat language do )OU speak? Russian 
Interpretation pro\aded? Provider fluent in pa vent's native language 
Pain 1'6sessment 
Pain 
Ne )OU currently in pain? Yes 
The pain is located _. back and legs 
The se'"' rityof pain is rated at 3110 
The se'"' rityof the pain is moderate 
The pain began 4-5 v.eeksago 
The charader of the pain is aching 
The associated simptoms are v,eakness 
The pain is aggravated by other hunger strike 
The pain is reliel<!d by other 
Describe: pt refused medica#on treatment 
Narrati'"': 
Patient is oonsidered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observation, and monitoring. 
Pl was in II/HU II/ED 2 Upon enoounter detainee was resting quietly in bed and reading book. Detainee reported weakness 
and pain on his legs and back, but refused any medical treatment He has been drinking Pedial)4e and Boost In the morning he 
went to reck)0rd. lMII oontinue to monitor. 
Detainee has missed his 136 meal this lunch. Pt ate an apple from meal trail, but refused the lunch. M::>stof the day after 
returned from reek yard, pt was watching lVand resting. \MIi oontinue to monitor. 
Hunger Strike: 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22!2018 
IM1en did the official hunger strike begin? 08/25/2018 
Date of last meal oonsumed: 08/22!2018 
Last meal oonsumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wants to be released from custody 
/!dequate supply of drinking water and other be1erages a,ailable: Yes 
Three meals deli'"'red per dayto patient Yes 
Lunch deli'"'red during current shift 0% oonsumed 
Pny unauthoriied food in room? No 
Ha'"' dailyorthostatic \alal signs been oompleted? Yes 
Has input and output been documented on the the M-IU Hunger Strike M::>nitoring Smart Form? Yes. 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/2212018 
IM1en did the official hunger strike begin? 08/25'2018 
Date of last meal oonsumed: 08/2212018 
Last meal oonsumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wcints to be released from custody 
/!dequate supply of drinking water and other be1erages a,ailable: Yes 
Three meals deli'"'red per day to detainee: Yes 
Lunch 0% oonsumed pt ate an apple 
Pny unauthoriied food in room? No 
Ha'"' dailyo~stat ic \<al signs been oompleted? Yes 
Has input and output been documented on the M-IU Hunger Strike M::>nitoring Smart Form? Yes 
Vit al Sign s 
Temp 
97.SF 10/0612018 09:53:46 /'M 
HR 
standing:88 10/0612018 09:53:46 /'M 
sitting:68 10/0612018 09:53:46 /'M 
supine:64 10/0612018 09:53:46 /'M 
BP 
standing:100/68 10/0612018 09:53:46 /'M 
sitting:95/60 10/0612018 09:53:46 /'M 
supine:108/65 10/0612018 09:53:46 /'M 
RR 
16/m in 10/0612018 09:53:46 /'M 
wt 
2019-ICLl-00051 3050 
(b )(6); RN (b)(?)(C) --
RN 
RN 
RN 
--
RN 
RN 
RN 
--
RN 
-

DHS-ICE-19-0196, 19-0197-N-000232
1452 lbs 
66.5 in 
23.08 Index 
Examination 
General Ei<amination: 
10/06/20181 1:56:16/>M 
H 
10/06/2018 09:53:46 PM 
BMI 
10/06/20181 1:56:16/>M 
GENERl'l /IPPE.ARANCE: in oo acute distress, well del.eloped , well nourished. 
HE.l>O: nonnocephalic. 
SKIN: normal, oo rashes, oo suspicious lesions. 
HEl>RT: oo murmurs, regular rate and rhythm, S 1, S2 oormal. 
LUNGS: normal, clear to auscultation bilaterally, oo Vvheezes, rales, rhonchi. 
CHEST: normal, oo gross rib detonnity, oormal shape and expansion. 
PBDOM:N: normal, txlwel sounds present, soft, nontender, oondistended. 
MJSCULOSKELETl'l: normal, oormal gait, 00 deformities, full range of motion, . 
(b)(6); 
(b)(7)(C) 
NEURQOGIC: alert and oriented, cooperati-a with exam, , gait normal, neck supple, oo rigidity, oo tremor. 
PSYCH: alert, oriented, cogniti-a function intact, cooperati-a with exam, good eye contact, judgement and insight 
~ 
-
iN"" 
-
-
~ 
good, mood/affect full range, oo auditory or \lsual hallucinations, speech clear, thought content without suicidal ideation, 
delusions, thought process logical, goal directed. 
Assessments 
/'I-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: 1. Continue with Othostatic 'vltal Signs e.eryday, Intake and Qnput M>nitoring e.erysh ift; Dailyweights; 2. P<l adequate 
supply of drinking water and other be.erages are available to patient at all times. 3. Three meals per day are deli.ered to the 
patient and deli.eryof meals is documented. 4. ~I food not authoriied byCD/Phy.;idan is remo.ed from patienfs room. 5. Patient 
is not allowed to purchase food from oommissary,ending machine while on hunger strike. 6. Patient will only be released from 
hunger strike treatment/monitoring by CD or phy.;idan order. 7. Patient oounseled regarding the medical risks of oontinuing the 
hunger strike. 8. Enoouraged to terminate the hunger strike and eat/drink as normal. Continue hunger strike protoool, enoourage 
po food/fluids, enoourage .erbali:zation of feelings. Enoourage to allow staff to monitor intake and output, I.ital signs, wt. Instructed 
to seek staff with any needs. Verbaliied understanding. Detainee offered three meals perdayand lea.e in room for20 to 30 
minutes. Enoourage dailyoral/phy.;ical h:,giene care. Change of dothing/bedding . Clfer BCX)ST and Pedil)le as ordered. Patient 
educated IO possible Side Effects of going for long period of time without food_ Patient -.erbalizes understanding of current Plan of 
Care. Patient -.erbalizes his option IO refuse food_ 
Appointment Providel(b)(5); L, '--· ""'- '"''-'-7"' \/.,_r-... ,~__.r'"' 
Bectronically signed b~ ... ~b...., )_(6_)_; _ __.fN on 10/0&'201815:13:45 (Pacific Daylight Time) 
Sign off status: Completed 
Northwest Detention Center 
1623 E. J STREEI" 
TACOMA, WA98421 
Tel: !/h\/R\· I 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 Prog,. .. Notel._~b_)_(6_); __ _.r" 10/06/2018 
/lkie generated byeOirica/Wcrlcs 8',R/PM s:,t,-e (w.w,eQinicEiWtxks.CCN"f1 
2019-ICLl-00051 3051 

DHS-ICE-19-0196, 19-0197-N-000233
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A:216269802 Su:llDt l h\/&:\· j 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunber~ 
1623 E J STREET, T~ 
Appoirimert Facility: Northwest Detertion Certer 
10 106/2018 
Curnont Medication s 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlral.el, see attached ser.ing mi>l!ure order 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"' I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Review of System s 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fewr denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbanoe denies. ~ ight gain denies. 
~ ight loss denies. 
Patient denied shortness of breath, abd or cihest pain, or reoent 
change in bowel or bladder. 
Reas on for Appointm ent 
1. Hunger Strike 
History of Pre se nt Illne ss 
Patient Identification: 
Patient Identification 
Appoin t ment P1'ovlde '1(b)(6 ): (b)(?)(C) !f'NP 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? __ 
Interpretation pro\aded? Yes, Interpreter Number 11464190 
Number Use notes ffeld 
Language Russian 
(8:15) This is a 39 }O male here in MiU due to a and adi'"' dedaration of hunger slrike. He mentions that he is with 4 out of 
10 disoomfort that is generali21!d. He states that he has had this disoomfortfortwoweeks. He denies the need for any 
medication for the disoomfort He has no additional problems at this time. 
Pain />ssessment 
Pain 
ke }OU currently in pain? Yes 
The pain is located Use Notes Section 
The se'"'rityof pain is rated at 4110 
The se'"'rityof the pain is mild 
The pain began 3-4 v.eeksago 
The character of the pain is aching 
The associated S)ffiptoms are none 
The pain is aggravated by any physical activity 
The pain is reliel.ed by rest 
Ex amination 
General Examination: 
GENERl>l !>PPE.ARPNCE: in no acute distress, well del.eloped, well nourished. 
SKIN: normal, no rashes, no suspicious lesions. 
HEPRT: no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, noWleeZes, rales, rhonchi. 
Assessme nt s 
1. lmbalanoed nutrition: Less than body requirements [00002] - ND00002 (Primary) 
2. Pain, unspecified - R52 
Tr e atm ent 
1. Imbalanced nutrnion: Less than bod; req..iremerts (00002] 
Notes: 
Notes: Patient '"'rba li,es understanding of regimen. Detainee knows to return if sxworsen or ad'"'rse reaction to current regimen 
is obserwd. M,ciication discussed along with teaching and administration. 
2. Pain, unspecified 
Notes: Notes: Patient '"'rba lizes understanding of regimen. Detainee knows to return if sxworsen or adl<!rse reaction to current 
regimen is obserwd. M,ciication discussed along with teaching and administration. 
Fo llow Up 
1D 
Appointment Provi de1'.-.b~)(=6)~; --~t ""' 
B ectro nicall y signed b (b)(6); /h\/ 7 \tr"\ 
Sign off status: Compl eted 
Ill' on 10/06/2018 13:25:52 (Pacific Dayli ght Time) 
Northwest Detention Center 
1623 E J STREET 
1: WA98421 
" /bl/6\: x: 
Patient: AMAR, II ERGENSANA DOB: 10/2 3/1978 Progre8S Notej~(b~)~(6~)~; __ __.IFNP 10/06/2018 
Ncte generated byeC/inica/Wcxi<s a.R/PM &Jt,,ere /"""'eC/inlca/Works.com) 
2019-ICLl-00051 3052 

DHS-ICE-19-0196, 19-0197-N-000234
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA A: 216269802 Su:llQ(b )(6); I 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll lunbe~ 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
10 106/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018 , KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Allergies 
NKDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. Weight loss denies. Dry M:>uth denies. 
Weakness admits. Cough denies. Shortness of breath at 
rest denies. Chest pain at rest denies. Palpitations denies. 
J>lxlominal Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \.l:>mitting denies. Painful urination denies. 
Decreased urine output denies. M.Jsde adhes denies. M.Jscie 
cramps denies. Skin breakdown denies. Difficultythinking denies. 
Reason for Appointment 
1. tvHU RN NIGHT ROUNDS/HUNGER STRIKE 
History of Present Illness 
Fiowsheets (tvHU): 
Hungerstrike M:>nitoring Form 
Day. 1005/2018 
Shift: Night 
Intake PO(in ml): 0 
QJtput Urine (in ml): 0 
Initials: LDM 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEOCEF/CER 
Wiat language do }OU speak? English 
Interpretation pro\aded? Pallant speaks English fluenUy 
Pain Assessment 
Pain 
ke }OU currently in pain? No 
Narrati'"': 
Appointment Provld e"l~(b-'-)"-(6""' ); __ __.P'" 
ENCOUNTERED PT DURING NIGHT ROUNDS. PT STATED HE FEELS GIENERl>llZEO \/\EPl<NESS BUT 011-iER~SIE 
OKAY. 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observation, and monitoring. 
Hunger Strike, 
Nursing Evaluation 
Date missed meals monitoring initiated: 081221.W18 
\M1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 081221.W18 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: 11\ants to be released from custody 
Pdequate supply of drinking water and other be1.erages available: Yes 
Three meals deli'"'red per day to detainee: Yes 
Other meal/nutritional supplement Qher DETA!Nff HA$ BEEN DRINK/NG PED/AL YTE, B(X)ST, ENSURE AND EA TING 
FRUITDAILY 
/lnyunauthori>edfood inroom? No 
Ha'"' dailyorlhostatic lia l signs been completed? Yes 
Has input and output been documented on the M-iU Hunger Strike M:>nitori ng Smart Form? Yes 
Ex amina tion 
General B<amination: 
GENERl>l !>PPE.ARMICE: in no acute distress, well OOl>eloped, well noorished. 
PSYCH: alert, oriented. 
Assessment s 
1. Imbalanced nutrition: Less than body requirements [00002] - ND00002 (Primary) 
Treatment 
1. Others 
Notes: 1. Continue with \Atal Signs e1.eryshift; Intake and Output M:>nitoring e1.eryshift; Dailyweights; Dailyorthostatic \ital signs. 
2. /In adequate supply of drinking water and other be1.erages are available to patient at all times. 
3. Three meals per day are deli1.ered to the patient and deli1.eryof meals is documented. 
4. ~ I food not authori>ed by CD,f>hyaician is remol.ed from patienrs room. 
5. Patient is not allowed to purchase food from commissa')llending machine while on hunger strike. 
6. Patient will only be released from hunger strike treatment/monitoring by CD or phyaician order. 
7. Patient counseled regarding the medical risks of continuing the hunger strike. 
8. Encouraged to terminate the hunger strike and eat/drink as normal. 
9. Pt 1.erbali>ed understanding of care plan. 
Disposition: /!dmitted to M-IU until medically evaluated 
Appoinbnent Provider¥._b_)(_6_); __ _.~ 
Electr onically signed b1M(6); (b)(7)(C) ~ 10/06/2018 06:29:54 (Pacific Daylight Time) 
Sign off status: Completed 
2019-ICLl-0005 1 3053 
Norttt.vest Detention Center 
1623 E J STREET 
T~WA98421 Te1foili3[ I 

DHS-ICE-19-0196, 19-0197-N-000235
P•tl-t: AMAR, MERGENSANA DOB: 10/23/1978 P,.,.... teotaj \~/\~/ic, IRN 10l08/2018 
Nd.e general.ed by eOinica/W<n<s EJvRIPM Sottw,re (""""eC/inica/WOrks .com) 
2019-ICLl-00051 3054 

DHS-ICE-19-0196, 19-0197-N-000236
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3055 
AMAR,MERGENSANA A:216269802 Su:lloj(b)( 6): ! 
Facility Code: CSONVWA Housing Area : M 
39 Y old Male, DOB: 10/23/1978 
Acc01.111 ~~~ I 1623 E J STREET, T 911421 

DHS-ICE-19-0196, 19-0197-N-000237
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA A: 216269802 Su:i1c:t:b )(6): 
Facility Code: CSONVWA Hous!h-=111=-ig7Ji"e"'a'"' : M...--' 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II l'unbe if b)(6) ; I 
10 /05/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Allergies 
NKDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. Weight loss denies. Dry M:>uth denies. 
Weakness admits. Cough denies. Shortness of breath at 
rest denies. Chest pain at rest denies. Palpitations denies. 
J>lxlominal Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \.l:>mitting denies. Painful urination denies. 
Decreased urine output denies. M.Jsde adhes denies. M.Jscie 
cramps denies. Skin breakdown denies. Difficultythinking denies. 
1623 E J STREET, T A£Xlfw'M, HA'564Z I 
Appoimnert Facility: Northwest Detertion Cert er 
Appointment Provlde~ (b)(6) ; (b)(7)(C) 
Reas on for Appointment 
1. PM SHIFT NOlE. Hunger Strike Nursing E1,0luation 
History of Pre se nt Illness 
Fiowsheets (MHU): 
Upon enoounter detainee was sitting up in bed watching a m01.ie. Detainee reported feeling "so-so" and no weakness. 
Detainee has his water cup a1,0ilable and has also been drinking Pedial)4e, Boost and Ensure. Detainee reported no pain and 
will recei'"' medications as needed/ordered. Detainee has chosen to miss his 134th meal this e'"'ning- dinner but did eat 1 
orange. Med 2 officer, Rich thought he noticed a couple tater tots missing from the dinner tray but was not 100% certain and 
detainee was notdirectiyobsen.ed picking off the tray. Detainee has gone back to watching his m01.ie quietly in his room. WII 
continue to monitor. 
Hungerstrike M:>nitoring Form 
Day: 1005/.2018 
Shift: PM 
Intake PO (in ml): 0 DETAINEE HAS BEEN DRINKNG UNKNCMN AM:XJNTS CF WATER, BOOST (8 OZ), PED/Al Y7E (1 
LITER) AND ENSURE (8 OZ). 
Intake rl/- Normal Saline (in ml): 0 
Intake rl/- LR (in ml): 0 
Intake NG(in ml): 0 
QJtput Urine (in ml): 0 
Comments: DETAINEE HAS BEEN DRINKNG WATER, BOOST (8 OZ), PED/Al Y7E (1 LITER) AND ENSURE (8 OZ). 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEO OFFICER 
\Mlat language do )OU speak? English 
Interpretation pro,..ded? Patient speaks English ffuenUy 
Pain 1'6sessment 
Pain 
Ne )OU currently in pain? No 
Narrati'"': 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
obseMtion , and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
\M1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: 11\ants to be released from custody 
/1<:!equate supply of drinking water and other be-erages a1,0ilable: Yes 
Three meals deli'"'red per day to detainee: Yes 
Other meal/nutritional supplement Qher DETAINEE HAS BEEN DRINK/NG PED/Al YTE, BOOST, ENSURE AND EA TING 
FRUITDAILY 
/lnyunauthori>edfood inroom? No 
Ha'"' dailyorthostatic " al signs been completed? Yes 
Has input and output been documented on the M-iU Hunger Strike M:>nitoring Smart Form? Yes 
Vital Signs 
98.0F 
standing:73 
sitting:60 
supine:56 
standing:95163 
sitting:93/59 
supine:93/57 
16 /min 
146.0 lbs 
66.5in 
2321 Index 
Examination 
General Examination: 
Temp 
10i05/201808:15:27 PM 
HR 
10i05/201808:15:27 PM 
10/05/201808:15:27 PM 
10/05/201807:57:02 PM 
BP 
10/05/201808:15:27 PM 
10/05/201808:15:27 PM 
10/05/201808:15:27 PM 
RR 
10i05/201807:57:02 PM 
wt 
10/05/201808:15:27 PM 
H 
10/05/201807:57:02 PM 
BMI 
10/05/201808:15:27 PM 
GENERJ>l PPPEAAPNCE: in no acute distress, well deleloped, well noorished. 
PSYCH: alert, oriented. 
Ass ess ment s 
/>I-Risk for imbalanced nutrition: Less than body requirements. 
Tr ea tm en t 
1. Others 
(b)(6) ; (b)(7)(C) 
Notes: 1. Continue with \Atal Signs e-eryshift; Intake and QJtput M:>nitoring e-eryshift; Dailyweights; Dailyorthostatic 1<tal signs. 
2019-ICLl-00051 3056 

DHS-ICE-19-0196, 19-0197-N-000238
2. />n adequate supply of drinking water and other be1.erages are available to patient at all times. 
3. Three meals per day are deli1.ered to the patient and deli1.eryof meals is dOaJmented. 
4. ~I food not authori2"d byCD/Phy.;ician is remo1.ed from patienfs room. 
5. Patient is not allowed to purchase food from commissar)l\,,nding machine while on hunger strike. 
6. Patient iMII only be released from hunger strike treatment/monitoring by CD or phy.;ician order. 
7. Patient counseled regarding the medical risks of continuing the hunger strike. 
8. Encouraged to terminate the hunger strike and eat/drink as normal. 
Appointment Provider: !(b)(6); (b)(7)(C) 
Electronically signed b* b)(6); (b)(7)(C) 
Sign off status: Completed 
~ on 10/05/2018 22:12:04 (Pacific Daylight Tim e) 
Northwest Detention Cente r 
1623 E J smEEr T~r.98421 Tel§% 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 P.....,.. ttoti (b)(6); (b)(7)(C) 
N(1e generaled by eOinica!Wcn<s E!vR'FM Soflv,e,-e (""""'eC/inica/Works.com) 
I RN 10/05/2018 
2019-ICLl-00051 3057 

DHS-ICE-19-0196, 19-0197-N-000239
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:llClfh \/R\· j 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB'g h\lR\· I 
AccOl.lll llunber: 1 00704789 
1623 E J STREET, TACOMA, WA-98421 
Appoimnert Facility: Northwest Detertion Certer 
10/05/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"' I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• 11/lldication List re'1ewed and reconciled with the patient 
Past Medlcal History 
No 11/lldical History. 
Allerglss 
NKDA 
Review of Systems 
General/Constitutional: 
Chills denies. Fatigue denies. Fe'"'r denies. 
Headache denies. Lightheadedness denies. Night 
sweats denies. ll\leight loss admits, is intentional. 
Aflpolntment Provlder:l (b)(6) ; (b)(?)(C) f PA 
Reason for Aflpolntment 
1.tvHU 
History of Present Illness 
Narrati'"': 
1230 hours: 39 yo male detainee in the M-iU for Hunger Strike medical monitoring. He states he is eating his daily apple, 
drinking, and able to ambulate and get around, no issues v,th bowel mo'"' ments and urination. No new complaints or 
worsening S}'llptoms since last medical '1sit Communicated adequately. 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? English 
Interpretation pro\aded? Pallant speaks English fluenUy 
Pain Assessment 
Pain 
ke }OU currently in pain? No 
Yitai Signs 
98 F 
60/min 
95163 mm Hg 
16/ min 
146 lbs 
66.Sin 
232 1 Index 
Examination 
General Examination: 
Temp 
10/05/201801:01:24 PM 
IR 
10/05/201801:01:24 PM 
EP 
10/05/201801:01:24 PM 
RR 
10/05/201801:01:24 PM 
Wt 
10/05/201801:01:24 PM 
H 
10/05/201801:01:24 PM 
BMI 
10/05/201801:01:24 PM 
GENER.Al PPPEAA!>NCE: in no acute distress, well de1€1oped, well nourished. 
HEPD: normocephalic. 
(b)(6); 
(b)(?)(C) 
ENT: EYES: normal, EARS: normal, NOSE: normal, SINUSES: sinuses non-tender to palpation, ORAL CAVITY: 
normal, 1HROAT: normal. 
HEl'RT: no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, no\Okleezes, rales, rhonchi. 
!>BDO!IIEN: normal, soft, nontender, nondistended. 
MJSCULOSKELET/>L: normal, normal gait, no deformities, full range cl motion, good strength and equal bilaterally. 
PSYCH: alerl, oriented . 
.Assessments 
1. lmbalanoed nutrition: Less than body requirements [00002] - ND00002 
Treatment 
1. Imbalanced nutr~ion: Less than bolt; requirernerts [00002] 
Notes: Patient educated the current treatment plan as directed, alert staff if new or worsening s)fllploms as needed, PRN. 
Patient to reoei'"' daily pro,.der checks while in the M-iU. 
Notes: Patient to remain in the M-iU unbl further notice 
Appoinbnent Provide b)(6); (b)(?)(C) PA 
b)(6); (b)(?)(C) 
Electronically signed (b)(6); (b)(?)(C) A on 10/05/201813 :02:50 (Pacific Daylight Time) 
Sign off status: Completed 
2019-ICLl-00051 3058 
NorthlYest Detention Center 
1623 E J STREET 
TACOMA, WA98421 
T,'.b)(6); l ax. 

DHS-ICE-19-0196, 19-0197-N-000240
Pati..,t: AMAR, MERGENSANA DOB: 10/23/1978 P ........ ......J (b)(6); (b)(?)(C) rA 10/05/2018 
11/d.e genera1.e<1 byeOinica/W<rts EJ.RIPM Sottoore (l'N.WeC/inica/ WcYks.coojl 
2019-ICLl-00051 3059 

DHS-ICE-19-0196, 19-0197-N-000241
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
.. A:216269802 Su:ll~b )(6); I 
Fac1lrtyCode:CSOINWA ng ,c;ea.lfi 
39 Y old Male, DOB: 10/23/1978 
AccOl.rll lunber~ 
1623 E J STREET, T~ 
Appoirimert Facility. Northwest Detertion Certer 
10 /0 5 /2018 
Curnont Medication s 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"' I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Allergie s 
NKDA 
Review of Syste ms 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness admits. 
Sleep Disturbanoe denies. Weightloss admits. Dry 
M::>uth denies. Weakness admits. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. Abdominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. 1,1:>mitting denies. Painful 
urination denies. Decreased urine output denies. MJsde 
aches denies. MJsde cramps denies. Skin breakdown denies. 
Difficulty thinking denies. 
Appointment Provld e,+::._b_,_)(.,_6-'-' );'-- _ __.! RN 
Reas on for Appointm ent 
1. RN day round/hunger strike 
History of Pre se nt Illne ss 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Time: 1530 
INPUT PO: 2900 
OUTPUTUrine 2500 
OUTPUTBM 0 
Net Gain: 500 
Initials: LM 
Hungerstrike M::>nitoring Form 
Day: 1005/.2018 
Shift: AM 
Intake PO (in ml): 2900 pt v.as observed to drink v.aterlrom pitch 
Intake rl/- Normal Saline (in ml): 0 
Intake rl/- LR (in ml): 0 
Intake NG(in ml): 0 
OJtput Urine (in ml): 2500 
Comments: HE HAS BEEN DRINKING PED/AL Y7E, boost, and drinking v.ater. Pt ate one apple 
Initials: LM 
Patient Identification: 
Patient Identification 
Patient propeMyidentified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEO OFFICER 
IM1at language do )OU speak? Russian 
Interpretation pro\<ded? Provider fluent in patient's native language 
Pain l'ssessmen t 
Pain 
Ne )OU currently in pain? Yes 
The pain is located .-back and legs 
The se'"'rityof pain is rated at 3110 
The se'"' rityof the pain is moderate 
The pain began 4-5 l\eeksago 
The character of the pain is aching 
The associated simptoms are v,eakness 
The pain is aggravated by other hunger $bike 
The pain is reliel<!d by other 
Describe: pt refused medication treatment 
Narrati'"': 
Patient is oonsidered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observation, and monitoring. 
Pl was in M-IU II/ED 2 Upon enoounter detainee was resting quietly in bed and reading book. Detainee reported weakness 
and pain on his legs and back, but refused any medical treatment He has been drinking Pedial)4e and Boost Right after 
enoounter pt went to recl<}erd, when he returned he took a shower. \MIi oontinue to monitor. 
Detainee has missed his 133 meal this lunch. Pl ate an apple from meal trail, but refused the lunch. M::>st of the day after 
returned from reek yard, pt was watching lVand resting. \MIi oontinue to monitor. 
Hunger Strike: 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/2212018 
'M1en did the official hunger strike begin? 08/25/2018 
Date of last meal oonsumed: 08/2212018 
Last meal oonsumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wants to be released from custody 
Mequate supply of drinking water and other be\erages a,ailable: Yes 
Three meals deli'"'red per dayto patient Yes 
Lunch deli'"'red during current shift 0% oonsumed 
Pny unauthoriied food in room? No 
Ha'"' dailyorthostatic \<tal signs been oompleted? Yes 
Has input and output been documented on the the M-IU Hunger Strike M::>nitoring Smart Form? Yes. 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/2212018 
'M1en did the official hunger strike begin? 08/25'2018 
Date of last meal oonsumed: 08/2212018 
Last meal oonsumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wcints to be released from custody 
Mequate supply of drinking water and other be\erages a,ailable: Yes 
Three meals deli'"'red per day to detainee: Yes 
Lunch 0% oonsumed pt ate an apple 
Pny unauthoriied food in room? No 
Ha'"' dailyoMh<>static lial signs been oompleted? Yes 
Has input and output been documented on the M-IU Hunger Strike M::>nitoring Smart Form? Yes 
Vit a l Signs 
Temp 
98.0F 10/05/2018 10:54:30 /WI 
HR 
standing:73 10/05/2018 10:54:30 /WI 
sitting:60 10/05/2018 10:54:30 /WI 
supine:56 10/05/2018 10:54:30 /WI 
BP 
standing:95/63 10/05/2018 10:54:30 /WI 
sitting:93159 10/05/2018 10:54:30 /WI 
supine:93157 10/05/2018 10:54:30 /WI 
RR 
16 /min 10/05/2018 10:54:30 /WI 
WI 
2019-ICLl-00051 3060 
(b)(6); ~ 
(b)(7)(C) ,-
,-
~N 
~N 
~ ,-
I-
~N 
~ 
~N 
-
~ I-

DHS-ICE-19-0196, 19-0197-N-000242
146 lbs 
66.Sin 
232 1 Index 
Ex a mination 
General Ei<amination: 
10/05/2018 10:54:30 PM 
H 
10/05/2018 10:54:30 PM 
BMI 
10/05/2018 10:54:30 PM 
GENERl'l /IPPE.AR.ANCE: in no acute distress, well del.eloped , well nourished. 
HE.l>O: nonnocephalic. 
SKIN: normal, no rashes, no suspicious lesions. 
HEl>RT: no murmurs, regular rate and rhythm, S 1, S2 nonnal. 
LUNGS: normal, clear to auscultation bilaterally, no Vvheezes, rales, rhonchi. 
CHEST: normal, no gross rib delonnity, nonnal shape and expansion. 
PBDOM:N: normal, txlwel sounds present, soft, nontender, oondistended. 
MJSCULOSKELETl'l: normal, nonnal gait, no deformities, full range o( motion, . 
(b)(6); 
(b)(7)(C) 
NEURQOGIC: alert and oriented, cooperati-a with exam, , gait normal, neck supple, no rigidity, no tremor. 
PSYCH: alert, oriented, cogniti-a function intact, cooperati-a with exam, good eye contact, judgement and insight 
~ 
-
iN"" 
-
-
~ 
-
good, mood/affect full range, no auditory or \lsual hallucinations, speech clear, thought content without suicidal ideation, 
delusions, thought process logical, goal directed. 
Asse ssm ent s 
/'I-Risk for imbalanced nutrition: Less than body requirements. 
Tr e atm e nt 
1. Others 
Notes: 1. Continue with Othostatic 'vltal Signs e-aryday, Intake and Qnput M>nitoring e;erysh ift; Dailyweights; 2. P<l adequate 
supply of drinking water and other be;erages are available to patient at all times. 3. Three meals per day are deli;ered to the 
patient and deli-aryof meals is documented. 4. ~ I food not authoriied byCD/Phy.;idan is remo\8d from patienfs room. 5. Patient 
is not allowed to purchase food from oommissa')O\ending machine while on hunger strike. 6. Patient will only be released from 
hunger strike treatment/monitoring by CD or phy.;idan order. 7. Patient oounseled regarding the medical risks of oontinuing the 
hunger strike. 8. Encouraged to terminate the hunger strike and eat/drink as normal. Continue hunger strike protoool, enoourage 
po food/fluids, encourage ;erbali,ation of feelings. Enoourage to allow staff to monitor intake and output, I.ital signs, wt. Instructed 
to seek staff with any needs. Verbaliied understanding. Detainee offered three meals perdayand lea,e in room for20 to 30 
minutes. Encourage dailyoral/phy.;ical h:,giene care. Change of dothing/bedding . Clfer BCX)ST and Pedil)le as ordered. Patient 
educated to possible Side Effects of going for long period of time without food_ Patient -.erbalizes understanding of current Plan of 
Care. Patient -.erbalizes his option to refuse food_ 
Appointment Provide b)(6); h\/ 7 \ff'\ 
RN 
Bectronically signed b b)(6); RN on 10/05,'201815:51:12 (Pacific Daylight Time) 
~"..., '~'7~'~'"~' -~ Sign off status: Completed 
Northwest Detention Center 
1623 E. J STREB" 
T~i~ro2n) 
Patient: AMAR, IIERGENSANA DOB: 10/2 3/19 78 Prog ,. .. Notej(b)(6); ~-
Ne-le generated by eOirica/Wcrlcs 8',R/PM s:,t,-e (w.w,eQinicEiWtxks.CCN"f1 
IRN 10/0 5/2018 
2019-ICLl-00051 3061 

DHS-ICE-19-0196, 19-0197-N-000243
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA . . A: 216269802 Su:ll,.J;6 )(6); _ 1 
Facility Code: CSOINWA liiQked . lfl 
39 Y kc0U11~beji}(5C old Male, i'~:: I 
10 /05/2018 
Cunont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"'I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Allergies 
NKDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbanoe denies. Weight loss denies. Dry M:>uth denies. 
Weakness admits. Cough denies. Shortness of breath at 
rest denies. Chest pain at rest denies. Palpitations denies. 
J>lxlominal Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \.l:>mitting denies. Painful urination denies. 
Decreased urine output denies. M.Jsde aches denies. M.Jscie 
a-amps denies. Skin breakdown denies. Difficultythinking denies. 
1623 E J STREET, TACO • 
Appoirimert Facility. Northwest Detertion Certer 
Reason for Appointment 
1. tvHU NIGHT RN ROUNDS/ HUNGER STRJKE 
History of Present Illness 
Fiowsheets (tvHU): 
Hungerstrike M:>nitoring Form 
Day. 1004/2018 
Shift: Night 
Intake PO(in ml): 0 
QJtput Urine (in ml): 0 
Initials: II!. V 
Patient Identification: 
Patient Identification 
Appointment Provlde1 (b)(6) ; (b)(7)(C) I RN 
Patient property identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEOCEF/CER 
Wiat language do }OU speak? English 
Interpretation pro\aded? Pallant speaks English fluenUy 
Pain Assessment 
Pain 
ke }OU currently in pain? No 
Narrati'"': 
Upon encounter patient was resting in bed and raised his head briefly to speak with nursing. He stated that he felt "so-so" 
and complained of generali2ed weakness. Pedial)4e gi'"'n to patient Patient offered no other medical or mental health concerns. 
/ldlised patient to notify nursing staff or Geo offioer of any needs. Refused breakfast (132nd meal). 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 081221.W18 
\Mien did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 081221.W18 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wcints to be released from custody 
/ldequate supply of drinking water and other be1.erages available: Yes 
Three meals deli1.ered per day to detainee: Yes 
CXher meal/nutritional supplement Qher DETA!Nff HAS BEEN DRINK/NG PED/AL YTE, B(X)ST, ENSURE AND EA TING 
FRUITDAILY 
/lny unauthori21!d food in room? No 
Ha1.e dailyorlhostatic lia l signs been completed? Yes 
Has input and output been documented on the M-IU Hunger Strike M:>nitori ng Smart Form? Yes 
Ex amination 
General B<amination: 
GENERAL !>PPE.ARMICE: in no acute distress, well del.eloped, well noorished. 
PSYCH: alert, oriented. 
Assessments 
1. lmbalanoed nutrition: Less than body requirements [00002] - ND00002 (Primary) 
Treatment 
1. Others 
Notes: 1. Continue with \Alai Signs e1.eryshift; Intake and QJtput M:>nitoring e1.eryshift; Dailyweights; Dailyorthostatic \ital signs. 
2. /In adequate supply of drinking water and other be1.erages are available to patient at all times. 
3. Three meals per day are deli1.ered to the patient and deli1.eryof meals is documented. 
4. ~ I food not authori21!d by CD/Phy.;ician is remo1.ed from patienrs room. 
5. Patient is not allowed to purchase food from oommissary\ending machine while on hunger strike. 
6. Patient will only be released from hunger strike lreatment/monitoring by CD or phy.;ician order. 
7. Patient counseled regarding the medical risks of continuing the hunger strike. 
8. Encouraged to terminate the hunger strike and eat/drink as normal. 
Disposition: /!dmitted to tvHU until medically evaluated 
Appoinbnent Provi4 (b)(6) ; (b)(7)(C) 
Electronically signed { b)(6); (b)(7)(C) fN on10/05/2018 06:39:51 (Pacific Dayligh t Time) 
Sign off status: Completed 
2019-ICLl-0005 1 3062 
Norttt.vest Detention Center 
1623 E J STREET 
T~~A98421 
Te1@iij I 

DHS-ICE-19-0196, 19-0197-N-000244
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 ProgNU No18l b)(6); (b)(? )(C) r 10/05/2018 
Nd.e generaf.ed by eOirica/Wcrks EJ..RIPM Sdtoore (www II Rta PPC¥RS.tt»t9 
2019-ICLl-00051 3063 

DHS-ICE-19-0196, 19-0197-N-000245
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U Nola: 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3064 
AMAR,MERGE~ 
A:216269802 Si.ti1 (b)(6) ; ~, Facility Code: CSCN/1/WA . 
39 Y old Male, DOB: 10/23/1978 
1623E~=~~ b)(~) ;_~ - I ' . 

DHS-ICE-19-0196, 19-0197-N-000246
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 21626980 2 su,d' h v R, I 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunber: ITTimi\:7 1623 E J STREET, T~ 
Appoirimert Facility: Northwest Detertion Certer 
10 104/2018 
Curnont Medication s 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"' I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Allergie s 
NKDA 
Review of Syste ms 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbanoe denies. Weight loss denies. Dry M:>uth denies. 
Weakness admits. Cough denies. Shortness of breath at 
rest denies. Chest pain at rest denies. Palpitations denies. 
J>lxlominal Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \.l:>mitting denies. Painful urination denies. 
Decreased urine output denies. M.Jsde adhes denies. M.Jscie 
cramps denies. Skin breakdown denies. Difficultythinking denies. 
Appoin t ment Provld e j(b)(6) ; (b)(7)(C) 
Reas on for Appointm ent 
1. PM SHIFT NOlE. Hunger Strike Nursing E1,0luation 
History of Pre se nt Illne ss 
Fiowsheets (MHU): 
Upon enoounter detainee was resting quietly in bed. Detainee reported feeling weakness but wanted no treatment for it 
Detai""7 has hi~ '"'.'ter cup a1,0ilable and has also been drinking Pedial)4e, Boost and Ensure. Detainee reported no pain and 
will reoe,'"' medications as needed/ordered. Detainee has chosen to miss his 131 st meal this e'"'ning- dinner but did eat 1 
apple. Detainee has gone back to watching his moi,e quietly in his room. WII continue to monitor. 
Hungerstrike M:>nitoring Form 
Day. 1004/2018 
Shift: PM 
Intake PO(in ml): 0 
Intake r.J- Normal Saline (in ml): 0 
Intake r.J- LR (in ml): 0 
Intake NG(in ml): 0 
QJtput Urine (in ml): 0 
Comments: DETAINEE HAS BEEN DRIN/<JI/G WAJ'ER, BOOST (8 OZ), PED/AL YTE (1 LIJ'ER) AND ENSURE (8 OZ). 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEOCEF/CER 
Wiat language do }OU speak? English 
Interpretation proi,ded? Pallant speaks English fluenUy 
Pain ffisessment 
Pain 
Ne }OU currently in pain? No 
Narrati'"': 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
\Mien did the official hunger strike begin? 08/25'2018 
Date of last meal oonsumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wclnts to be released from custody 
/ldequate supply of drinking water and other be\erages available: Yes 
Three meals deli'"'red per day to detainee: Yes 
CXher meal/nutritional supplement Qher DETA!NEE HAS BEEN DRINK/NG PED/AL YTE, BOOST, ENSURE AND EA TING 
FRUITDAILY 
/lnyunauthori>edfood inroom? No 
Ha'"' dailyorlhostatic lia l signs been completed? Yes 
Has input and output been documented on the M-iU Hunger Strike M:>nitori ng Smart Form? Yes 
Vit a l Sign s 
97.8F 
standing:92 
sitting:67 
supine:56 
standing:97/68 
sitting:95/65 
supine:98/61 
16/ min 
141.8 lbs 
66.5in 
22.54 Index 
Ex aminatio n 
General Examination: 
Temp 
10i04/201805:36:43 PM 
1-R 
10i04/201805:36:43 PM 
10i04/201805:36:43 PM 
10i04/201805:36:43 PM 
BP 
10i04/201805:36:43 PM 
10i04/201805:36:43 PM 
10i04/201805:36:43 PM 
RR 
10i04/201805:25:05 PM 
wt 
10i04/201805:36:43 PM 
H 
10i04/201805:25:05 PM 
BMI 
10i04/201805:36:43 PM 
GENERJ>l J>PPEAAPNCE: in no acute distress, well deleloped, well l'<lO.Jrished. 
PSYCH: alert, oriented. 
Assess ment s 
/>I-Risk for imbalanoed nutrition: Less than body requirements. 
Trea tm en t 
1. Others 
(b)(6); (b)(?)(C) 
Notes: 1. Continue 1Mth \Atal Signs e\erys hift; Intake and QJtput M:>nitoring e\erysh ift; Dailyweights; Dailyorthostatic i,tal signs. 
2. /In adequate supply of drinking water and other be\erages are a1,0ilable to patient at all times. 
3. Three meals per day are deli\ered to the patient and deli\eryof meals is documented. 
4. /11 food not authori>ed by CD~y., ician is remo\ed from patienrs room. 
2019-ICU-00051 3065 

DHS-ICE-19-0196, 19-0197-N-000247
5. Patient is not allowed to purchase food from commissar)l\,,nding machine while on hunger strike. 
6. Patient >MIi only be released from hunger strike treatment/monitoring by CD or physician order. 
7. Patient counseled regarding the medical risks of continuing the hunger strike. 
8. Encouraged to terminate the hunger strike and eat/drink as normal. 
Appointment Provider:l(b)(6); (b)(?)(C) 
Electronically signed bfb)(6); (b)(?)(C) 
Sign off status: Completed 
IRN on 10/04./2018 21:13:10 (Pacific Daylight Time) 
Northwest Detention Center 
1623 E J smEEr 
TACOMA, WA98421 
Tel: l<b \/6\ I 
Fax: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 P.....,.. Notj(b)(6); (b)(?)(C) ~ 10/04/201 8 
N(te generaled by eC/inica!Wt:n<s BvR'PM Soflvere /ww.l(eC//nica/Works.com) 
2019-ICLl-00051 3066 

DHS-ICE-19-0196, 19-0197-N-000248
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A:216269802 Su:llD:kb)(~l I 
Facility Code: CSONVWA Housing ea: M 
39 Y old Male, DOB: 10/23/1978 
Acc01.111 ~ (b)(6); 1623 E J STREET, T ~ VVA-9642 I 
Appoimnert Facility: Northwest Detertion Cert er 
10 104/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \AHC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"'I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• 11/lldication List re'1ewed and reconciled with the patient 
Past Medlc a l History 
No 11/lldical History. 
Allerglss 
NKDA 
Review of Systems 
General/Constitutional: 
Chills denies. Fatigue denies. Fe'"'r denies. 
Headache denies. Lightheadedness denies. Night 
sweats denies. 
Aflp oln tmen t Provlder:l (b)(6) ; (b)(7)(C) I PA 
Reas on for Aflpolntment 
1. Daily Rounds 
History of Pre se nt Illness 
Narrati'"': 
1415 hours: 39yo male detainee in the M-iU for Hunger Strike medical monitoring. He states he is eating, drinking, and able 
to ambulate and get around, no issues with bowel mo'"'ments and urination. No new complaints or worsening S)fllptoms since 
last medical lis it Communicated adequately 
He had 2 Pedial)4es, 2 Boos~ 2 cups of water, and an apple on todays shift. 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? Russian 
Interpretation prolided? 1:1:lUL/.WIJ. Kefer Name 
Name UsenotesfieldR (b)(6); 
Language Russian /h\/7\/ 
Pain Assessment 
Pain 
ke }OU currently in pain? No 
Yitai Signs 
97.8F 
67 /min 
95165 mm Hg 
16/ min 
141.8 lbs 
66.Sin 
22.54 Index 
Examination 
General Examination: 
Temo 
10i04/201803:42:46 PM 
HR 
10i04/201803:42:46 PM 
BP 
10i04/201803:42:46 PM 
RR 
10i04/201803:42:46 PM 
wt 
10i04/201803:42:46 PM 
H 
10i04/201803:42:46 PM 
BMI 
10i04/201803:42:46 PM 
GENERJ>l PPPEAAPNCE: in no acute distress, well de1€1oped, well rKllJrished. 
HEPD: norrnocephalic. 
(b)(6); 
(b)(?)(C) 
ENT: EYES: normal, EARS: normal, NOSE: normal, SINUSES: sinuses non-tender to palpation, ORAL CAVITY: 
normal, 1HROAT: normal. 
HEl'RT: no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, nowieezes, rales, rhonchi. 
!>8D0!\/EN: normal, soft, nontender, nondistended. 
MJSCULOSKELET/>L: normal, normal gait, no deformities, full range o( motion, good strength and equal bilaterally. 
PSYCH: alert, oriented . 
.Assessments 
1. Imbalanced nutrition: Less than body requirements [00002] - ND00002 
Tr eat ment 
1. Imbalanced nutr~ion: Less than body requiremerts (00002] 
Notes: Patient educated the current treatment plan as directed, alert staff if new or worsening s)fllptoms as needed, PRN. 
Patient to reoei'"' daily prolider checks while in the M-iU. 
Notes: Patient to remain in the M-iU until further notice 
Appointment Provide'l: b)(6) ; (b)(?)(C) rA 
b)(6); (b)(?)(C) 
Electronically signed b b)(6); (b)(?)(C) on 10/04/2018 15:43:58 (Pacific Daylight Time) 
Sign off status: Comple 
2019-ICLl-00051 3067 
NorthlYest Detention Center 
1623E.JSmEEr 

DHS-ICE-19-0196, 19-0197-N-000249
TACOMA, WA98421 
Telj(b )(6); _ I 
Pali-t: AMAR, IERGENSANA DOIi= 10/23/1978 P ....... A 10/CM/2018 
Ncl.e generated by e0inica/'Na1<s EJvR/PM Sottv.ere (,w,w 
2019-ICLl-00051 3068 

DHS-ICE-19-0196, 19-0197-N-000250
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:llOl/b )/6) ! 
Facility Code: CSONVWA Housing Area: M 
3
~c~~l~i: :: 
10 104/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Allergies 
NKDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness admits. 
Sleep Disturbance denies. Weightloss admits. Dry 
M::>uth denies. Weakness admits. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. Abdominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. 1,1:>mitting denies. Painful 
urination denies. Decreased urine output denies. MJsde 
aches denies. MJsde cramps denies. Skin breakdown denies. 
Difficulty thinking denies. 
1623 E J STREET, T v 
Appoimnert Facility: Northwest Detertion Cert er 
Appointment Provld (b)(6); (b)(?)(C) N 
Reas on for Appointm ent 
1. RN day round/hunger strike 
History of Pre se nt Illness 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Time: 1500 
INPUT PO: 2900 
OUTPUTUrine 2500 
OUTPUTBM 0 
Net Gain: 500 
Initials: LM 
Hungerstrike Mlnitoring Form 
Day: 1004/2018 
Shift: AM 
Intake PO (in ml): 2900 pt v.as observed to drink v.aterlrom pitch 
Intake rl/- Normal Saline (in ml): 0 
Intake rl/- LR (in ml): 0 
Intake NG(in ml): 0 
OJtput Urine (in ml): 2500 
Comments: HE HAS BEEN DRINKING PED/AL Y7E, boost, and drinking v.ater. Pt ate one apple 
Initials: LM 
Patient Identification: 
Patient Identification 
Patient propeMyidentified by2 sources induding: /0 Badge, Picture 
Chaperone Present? Yes GEO OFFICER 
IM1at language do )OU speak? Russian 
Interpretation pro\<ded? Provider fluent in patient's native language 
Pain l'ssessment 
Pain 
Ne )OU currently in pain? Yes 
The pain is located .-back and legs 
The se'"'rityof pain is rated at 3110 
The se'"'rityof the pain is moderate 
The pain began 4-5 l\eeksago 
The character of the pain is aching 
The associated simptoms are v,eakness 
The pain is aggravated by other hunger $bike 
The pain is reliel<!d by other 
Describe: pt refused medication treatment 
Narrati'"': 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observation, and monitoring. 
pt was in M-IU II/ED 2 Upon encounter detainee was resting quietly in bed and reading book Detainee reported weakness 
and pain on his legs and back, but refused any medical treatment He has been drinking Pedial)4e and Boost He stated that he 
would like to go to reck)0rd today: CXficerwas noted about this. WII continue to monitor. 
Detainee has missed his 130 meal this lunch. pt ate an apple from meal trail, but refused the lunch. Mlsto f the day pt was 
watching 1V and resting. W II continue to monitor. 
Hunger Strike: 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/2212018 
'M1en did the official hunger strike begin? 08/25/2018 
Date of last meal consumed: 08/2212018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wants to be released from custody 
Mequate supply of drinking water and other be1.erages a,ailable: Yes 
Three meals deli'"'red per dayto patient Yes 
Lunch deli'"'red during current shift 0% consumed 
Pny unauthoriied food in room? No 
Ha'"' dailyorthostatic \<tal signs been completed? Yes 
Has input and output been documented on the the M-iU Hunger Strike Mlnitoring Smart Form? Yes. 
Vital Sign s 
Temo 
97.8F 10/04/2018 08:56:21 /'M 
HR 
standing:92 10/0412018 08:56:21 /'M 
sitting:67 10/04/2018 08:56:21 /'M 
supine:56 10/0412018 08:56:21 /'M 
BP 
standing:97/68 10/04/2018 08:56:21 /'M 
sitting:95/65 10/0412018 08:56:21 /'M 
supine:98/61 10/0412018 08:56:21 /'M 
RR 
16/ min 10/0412018 08:56:21 /'M 
WI 
141.8 lbs 10/04/2018 08:56:21 /'M 
H 
66.5in 10/0412018 08:56:21 /'M 
BMI 
22.54 Index 10/0412018 08:56:21 /'M 
Ex amina tion 
General Examination: 
GENERJ>l.. />PPEAAPNCE: in no acute distress, well del.eloped, well 1UJrished. 
HEl'D: normocephalic. 
SKIN: nonnal, no rashes, no suspicious lesions. 
HEJ>RT: no murmurs, regular rate and rhythm, S 1, S2 normal. 
2019-ICLl-00051 3069 
b)(6); RN 
b)(?)(C) -
RN 
RN 
RN 
-
RN 
RN 
RN 
-
RN 
RN 
-
-
RN 
-
RN 
-

DHS-ICE-19-0196, 19-0197-N-000251
LUNGS: normal, clear to auscultation bilaterally, no wieezes, rales, rhonchi. 
CHEST: normal, no gross rib deformity, normal shape and expansion. 
/18D0\,EN: normal, bowel sounds present, soft, nontender, nondistended. 
MJSCULOSKELET.i>l: normal, normal gait, no deformities, full range ri motion, . 
NEUROLOGIC: alert and oriented, cooperati,e V>ith exam, , gait normal, neck supple, no rigidity, no tremor. 
PSYCH: alert, oriented, cogniti,e function intact, cooperati,e V>ith exam, good eye contact, judgement and insight 
good, mood/affect full range, no auditory or l.isual hallucinations, speech clear, thought content V>ithout suicidal ideation, 
delusions, thought process logical, goal directed. 
Assessment s 
/>!-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: 1. Continue with Othostatic \.ital Signs e1.eryday, Intake and Oitput Mmitoring e1.eryshifl; Dailyweights; 2. "'1 adequate 
supply of drinking water and other be1.erages are available to patient at all times. 3. Three meals per day are deli1.ered to the 
patient and deli1.eryof meals is documented. 4. ~ I food not authori2Bd by CD/Physician is remo\ed from patienfs room. 5. Patient 
is not allowed to purchase food from commissary,ending machine while on hunger strike. 6. Patient will only be released from 
hunger strike treatment/monitoring by CD or physician order. 7. Patient counseled regarding the medical risks of continuing the 
hunger strike. 8. Encouraged to terminate the hunger strike and eat/drink as normal. Continue hunger strike protocol, encourage 
po foodl!luids, encourage 1.erbalization a/feelings. Encourage to allow staff to monitor intake and output, '1tal signs, wt. Instructed 
to seek staff with any needs. Verbali21ld understanding. Detainee offered three meals perdayand lea1.e in room for20 to 30 
minutes. Encourage dailyoral/physical h19iene care. Change of clothing/bedding . a!er BCX)ST and Pedil)le as ordered. Patient 
educated to possible Side Effects of going for long period of time without food. Patient 1.erbali2es understanding of current Plan of 
Care. Patient 1.erbali2es his option to refuse food. 
Appointment Provi (b)(6); 
(b)(7)(C) RN 
Electronically signed ~"' (b"-')""(6"')._: __ ___.IN on 10/04/20181 5:00:06 (Pacific Daylig ht Time ) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J SmEEr 
T 21 
7)(C) 
Patient: AMAR, MERGENS.ANA DOB: 10/23/1978 Progrw .. Note b)(6); h \/ 7\/r'\ RN 10/04/2018 
N(te genertKed by eOinica!Wcn<s EM<IPM Sottve,-e (""""eC/inica/Wcn<s.com) 
2019-ICLl-0005 1 3070 

DHS-ICE-19-0196, 19-0197-N-000252
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:llol/b )/6) ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
1623 E J 
AccOl.lll 
STREET, 
lunber: 
T~ 
~ 
Appoimnert Facility: Northwest Detertion Certer 
10 104/2018 
Cunont Medication s 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Allergie s 
NKDA 
Review of Syste ms 
General/Constitutional: 
Chills denies. Fe'"'r denies. Sleep disturbance denies. 
Hunger Strike: 
1/'kakness admits, that is moderate, that is generalized. 
Reason for Appointment 
1. tvHU NIGHT RN ROUNDS 
History of Pre se nt Illne ss 
Patient Identification: 
Patient Identification 
Appointment Provlcle ~(b\(6): /b)(7)(C) 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: Geo ollicel/h\l R! 
Wiat language do }OU speak? English, Russian 
Interpretation pro\aded? No interpreter utilized 
Explain Use Notes Section speaks limited English 
Pain .1>6sessment 
Pain 
ke }OU currently in pain? Yes 
The pain is located : Generalized 
The se'"'rityof pain is rated at 4110 
The se'"'rityof the pain is mild 
The pain began 3-4 days ago 
The character of the pain other 
The associated simptoms are v.eakness 
The pain is aggravated by none 
The pain is reliel<!d by none Pa6ent refused medica6on for pain. 
Narrati'"': 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observation, and monitoring. 
Patient seen in tvHU for night nursing rounds. He was la)ing in bed during nursing assessment and complained of 4/10 
generali>ed pain. He also stated he was feeling weak. Patientdedined to take T)!enol for pain. Patient gi1.en l'MPedial)4e. 
/ldlised patient to notify nursing staff of any medical or mental health needs. \MIi continue to monitor. 
Refused breakfast (129th Mssed Maal). 
Fiowsheets (tvHU): 
lnput/C>Jtput Fiowsheet 
Time: 0500 
INPUTPO: 0 
OUTiPUT Urine O PaYent did not reporl any ou/pUt and >10s not observed using the restroom over night. 
Initials: Ill. V 
Hungerstrike tvbnitoring Form 
Day: 1004/2018 
Shift Night 
Intake PO(in ml): O 
C>Jtput Urine (in ml): 0 
Initials: 1/l.V 
Examination 
General Examination: 
GENERl>l !>PPE.AR!'NCE: in no acute distress, well del.e!oped, well nourished. 
CHEST: normal, no gross rib defoon~y. normal shape and expansion. 
PSYCH: alert, oriented. 
Assess ment s 
1. lmbalanoed nutrition: Less than body requirements [00002] - ND00002 (Primary) 
Tre atment 
1. Imbalanced nutr~ion: Less than body req.iremerts (00002] 
Notes: Detainee '"'rba li,ed understanding of plan of care and denies questions/concerns. Continue hunger strike protocol, 
encourage po food/fluids, encourage 1.erbalization offeelingst Refer to nursing care plan for on-going interwntions. Detainee 
offered three meals per day and lea1.e in room for at least 20 minutes. A:lequate supply of drinking water and other bel'alrages as 
oidered bypro,..der available. Encourage dailyoral/ph)Sical h19iene care. Detainee 1.erbali,ed an understanding of education 
and/or treatment. \.bioes no other concerns. 
Disposition: A:lmitted to tvHU until medicallye1,0luated 
Appointment Provide,fb )(6) ; (b)(7)(C) I RN 
Electronically signed (b)(6); (b)(7)(C) 
Sign off status: Comple 
on 10/04/2018 06:36:52 (Pacific Daylight Time) 
Northwest Detention Center 
1623 E J STREET 
T~~ ~' A 98421 ~KH-- I 
Patient: AMAR, MERGENS.ANA DOB: 10/23/19 78 Progrw .. No'"':l(b)(6); (b)(7)(C) r 10/04/2 018 
2019-ICLl-00051 3071 

DHS-ICE-19-0196, 19-0197-N-000253
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""1eC/inica'WGYks.coojl 
2019-ICLl-00051 3072 
AMAR,MERGENSANA A: 216269802 Su:llcj._, (h_\(_R_\ ·~..,......, 
Facility Code: CSONVWA Housing Area : M 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunber~ 
1623 EJ STREET, T~ 

DHS-ICE-19-0196, 19-0197-N-000254
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:llC/h \/R\· i 
Facility Code: CSONVWA Housing Area: M 
39Y old Male,~ ·1QOJ(1928 AccOllll l'un (b)(6): ! 
10 10 3 /2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Allergies 
NKDA 
Review of Syste ms 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. Weight loss denies. Dry Mouth denies. 
Weakness denies. Cough denies. Shortness of breath at 
rest denies. Chest pain at rest denies. Palpitations denies. 
J>lxlominal Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \.l:>mitting denies. Painful urination denies. 
Decreased urine output denies. M.Jsde adhes denies. M.Jscie 
cramps denies. Skin breakdown denies. Difficultythinking denies. 
1623 E J STREET, TACOMA, WA-98421 
Appoirimert Facility: Northwest Detertion Certer 
Appointment Provld e j(b)(6) ; (b)(?)(C) 
Reason for Appointment 
1. PM SHIFT NOlE. Hunger Strike Nursing E1,0luation 
History of Present Illness 
Fiowsheets (MHU): 
Upon enoounter detainee was resting quietlyin bed. Detainee reported feeling "so-so" and no weakness this shift. Detainee 
has his water cup a\eilable and has also been drinking Pedial)(e, Boost and Ensure. Detainee has chosen to miss his 128th 
meal this e'"'n ing-dinner but did eat 1 apple. Detainee has gone back to watching his mm.ie quietly in his rocm. WII continue to 
monitor. 
Hungerstrike Monitoring Form 
Day. 10031.2018 
Shift: PM 
Intake PO(in ml): 0 
Intake r.J- Normal Saline (in ml): 0 
Intake r.J- LR (in ml): 0 
Intake NG(in ml): 0 
QJtput Urine (in ml): 0 
Comments: DETAINEE REF'CR7S DRINKNG WAJ'ER FROM HIS w-1/l'E CUP AND HAS BEEN DRINKING BOOST. 
PED/AL YTE AND ENSURE ' 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEOCEF/CER 
Wiat language do }OU speak? English 
Interpretation pro\aded? Patient speaks English ffuenUy 
Pain f<;sessment 
Pain 
Ne }OU currently in pain? No 
Narrati'"': 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
IM1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wclnls to be released from custody 
/ldequate supply of drinking water and other be1.erages available: Yes 
Three meals deli'"'red per day to detainee: Yes 
CXher meal/nutritional supplement Qher DETA!NEE HAS BEEN DRINKING PED/AL YTE, BOOST, ENSURE AND EA TING 
FRUITDAILY 
/lnyunauthori>edfood inrocm? No 
Ha'"' dailyorthostatic lia l signs been completed? Yes 
Has input and output been documented on the M-iU Hunger Strike Monitoring Smart Fonn? Yes 
Vit al Signs 
982 F 
standing:77 
sitting:61 
supine:52 
standing:92/60 
sitting:95/60 
supine:90/55 
16 /min 
144.0 lbs 
66.5in 
22.89 Index 
Examination 
General Examination: 
Temo 
10/03/201806:06:16 PM 
1-R 
10/03/201806:06:16 PM 
10,03/201806:06:16 PM 
10/03/201806:06:16 PM 
BP 
10,03/201806:06:16 PM 
10/03/201806:06:16 PM 
10/03/201806:06:16 PM 
RR 
10/03/201805:51:52 PM 
WI 
10/03/201806:06:16 PM 
H 
10/03/201805:51:52 PM 
BMI 
10/03/201806:06:16 PM 
GENERJ>l /lPPEAAPNCE: in no acute distress, well del.eloped, well IXllJrished. 
PSYCH: alert, oriented. 
Assessments 
/>I-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
(b)(6); (b)(?)(C) 
Notes: 1. Continue 1Mth \Atal Signs e1.eryshift; Intake and QJtput Monitoring e1.eryshift; Dailyweights; Dailyorthostatic \ital signs. 
2. /In adequate supply of drinking water and other be1.erages are a1,0ilable to patient at all times. 
3. Three meals per day are deli1.ered to the patient and deli1.eryof meals is documented. 
2019-ICLl-0005 1 3073 

DHS-ICE-19-0196, 19-0197-N-000255
4. ~ I food notauthori2Bd byCD/Phy.;ician is remol.ed from patienfs room. 
5. Patient is not allowed to purchase food from commissar)l\,,nding machine while on hunger strike. 
6. Patient >MIi only be released from hunger strike treatment/monitoring by CD or phy.;ician order. 
7. Patient counseled regarding the medical risks of continuing the hunger strike. 
8. Encouraged to terminate the hunger strike and eat/drink as normal. 
Appointment Provider : l(b)(6); (b)(7)(C) 
Electronically signed ¥ )(6); (b)(7)(C) 
Sign off status: Comp1elea 
r on 10/03.1201818:11:52 (Pacific Daylight Time) 
Northwest Detention Center 
1623 E. J smEEr 
TACOMA, WA98421 
Tel:J(b)(6); I 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 P.....,.. ~ (b)(6); (b)(7)(C) r N(ie gener8led byeOinica!Wcxi<s ElvR'PM Softvere ( ... ------~--~ 
2019-ICLl-00051 3074 
10/03/201 8 

DHS-ICE-19-0196, 19-0197-N-000256
U.S. Immigration 
and Customs 
Enfor cement 
AMAR, MERGEN~ 
A:216269802 Si.ti1 (b)(6); 
Facility Code: CSCN/1/WA Housing ea: 
39 Y Acc01.111 ad ~:ar~:: ~ber: b)(6); 
1623 E J STREET, T ~~= I 
10 103/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"'I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
vlew of Systems 
~ : 
.Aroiietydenies. Jluditor)Nsual hallucinations denies. 
Delusions denies. Depressed mood denies. Difficulty 
sleeping denies. Eating disorder denies. Homicidal 
Thoughts denies. lnabilityto concentrate denies. Wental or 
Ph)<;ical abuse denies. Stressors admits; immigration 
legal/detention problems. Substance abuse denies. Suicidal 
thoughts denies. 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Provldef b)(6); (b)(7)(C) 
Reason for Appointment 
1. tvH Follow-up eval: Hunger Strike 
History of Present Illness 
Narrati'"': 
Wental Health Hunger Strike Evaluation 
Pt spoke: [] English; [] Spanish; [XI aher, Russian# Leonard 2963 
Pt identified by Ml, name, ID picture 
Session was obser.ed/chaperoned by GEO Wedi cal Staff member 
[] Initial El0mination; (] 14 Dayfollow-up; [XI 21 Dayfollow-up 
Yes [XI I No [] Reliewed Record 
Yes [] / No [XI Patient has history of mental illness 
Yes (] / No [XI Pt has acurrentDSM5 Diagnoses 
Yes [XI/ No [] Pt has confirmed shie has deciared a hunger strike. 
1. Wiat is (are) the reason(s) )OU ha'"' dedared a hunger strike? '1 want to be released from this facility' 
2. Wiatdo)OU hope to accomplish by going on a hunger strike? '1wantto ha'"' ICE release me" 
3. Wiat if an>tting would stop )OU from this hunger strike? I will only stop this hunger strike when I am released 
4. Our health care staff is conoemed about )OUr health, we want to ensure )OU know risks of a hunger strike. 
Yes [XI/ No[] Do )OU understand that )OU may die or ha'"' serious, lasting medical conditions if )Ou refuse food and/or fluid? 
Pt was sitting up in bed watching 1Vwhen this proliderentered Pt room for this encounter. Pt was oooperati'"' and shutoff 
the 1Vwhen I came in. Pt repeated what he has dedared before. He affirmed that he will continue his hunger strike until he is 
released. Pt denied an tvH symptoms. He denied anySt/1-1I or A\/1-t. 
Examination 
rv'ental Status: 
!>PPE.ARJlNCE: adequately-groomed, dressed in clean unifonn of the day. 
RELATEDNESS: cooperati-e . 
ATTITUDE: cooperati-e. 
SPEECH/l...ANGUl'G=: normal rate, rhythm, l.olume . . 
A"FECT: appropriate, full range. 
THOUGHT PROCESS: intact. 
THOUGHT CONTENT: unremali<able. 
PERCEPTU/IL DISORDERS: no perceptual disorder noted. 
PSYCHOM)TOR /\CTMTY: v.ithin normal range. 
KNCMlEDGE - INTELLECTU/IL FUNCTION: No oo.ious impairment . 
DEGREE OF AWAAENESS: v.ithin normal limits. 
ORIENTATION: person, place, time. 
CURRENT SUICID/IL POTENTI/IL: no to low acute Si risk. 
CURRENT HOMCID/IL POTENTI/IL: no to low acute risk. 
Assessment s 
1. Problems related to liling in residential institution -Z59.3 (Primary) 
-Pt's Hunger Strike appears to be motivated by: 
l] Yes l[XJ No: Wental Illness 
-ff }eS explain: 
[XI Yes/ ll No: Political Statement or Cause 
ff}es explain: \Mien asked todaywhyhe is on a hunger strike, Pl reported," because I want to be released". Pl affirmed that he 
understood that a hunger shrike could ha-e serious negati-e consequences for his health. 
Tre atm ent 
1. Others 
Notes: Treatment Prolided: 
-Educated on the dangers of not eating/ h)drating. 
-Educated on prosocial problem soll.ing and healthywas to address concerns. 
Preventive Medicine 
Due to the unpredictable nature of the immigration process induding length of detention stay, the purpose of ps)Cllological 
inten.ention will be the stabilization of presenting s)fllptoms, acute O'isis inten.ention, and brief supporti,e/solution-focused 
psy;hotherapy 
Discussed following Aan with ptto address Wental Health (M-i) issues. Pt 1.erbaliied agreement with Aan: 
Yes/ No 
[ XI/ [] Remain in tvHU; for Hunger Strike medical observation 
[ XI/ [ ] Fol low-up with medical pro~ders for ongoing medical observation 
I XI/ I] Follow-up with tvH Staff for.[ ] 14 day assessment [ I 21 day assessment 
[X] / I] Do not engage in any self-harm beha~or, Continue to focus on shor!Aong term goals, reasons for li~ng. resilient problem￾soiling skills - all to aid in reducing risk of harm to self ~a hunger strike and ultimately to achie-e pro-social, pro-indilidua l & 
familygoals. 
IX]/ I] ff atJ>NYtime pt has any thought intent or plan of suicide must alert custody officer for emergent aooess to medical for 
further evaluatioMx Pt agreed and denied communication and stigma barriers to alerting staff to Si. 
[ X] / [] l'lert Wedical/Custodyofficer if pt has an emergency for immediate aooess to Wedical,Oental/M-i ser.ioes 
IX]/ I] Begin/Continue daily routine with meaningful, purposeful acti~ty: regular elE!rcise, socialization, engagement in social 
support ne!IM::>rk , use of Jaill\/'ail Email sy.tem, engagement in religious customs/rituals, pleasurable actilities; pt to consider the 
work program locally-all to aid in coping and good mental health. 
[X] / [] Seek out attorney, ICE, Law Library, and Detainee Handbook to aid in proacti'"' problem-sol~ng - to aid in coping. 
[] No. [] Yes. Utili,e Jaill\/'ail sy.tem (or paper kite process) for further support engagement and to aooess facilitysupport, 
resouroes, and other ser.ioes to aid in prosocial beha~orand healthy problem sol~ng. 
[X] / [] Continue attention to h-,giene: shower, teeth, grooming to aid in coping 
[X] / [] Begin eatingh,)drating at each meal to aid in ph)<;ical health 
[ XI/ [] Chaplain Ser.ioes/Axess explained/encouraged for further support 
POST SESSION: Updated HAS, i>HSA CD, M-i Team on assessment/ plan. 
Appointment Providerf b)(6); (b)(7)(C) ~csw 
2019-ICLl-0005 1 3075 

DHS-ICE-19-0196, 19-0197-N-000257
Electronically slgned (b)(6); (b)( ?)(C) LCSW on 10/03/201815:02:17 (Pacific Daylight Time) 
Sign off status: Compie 
Patient: AMAR, IIERGENSANA DOB: 10/2 3/1978 
Northwest Detention Cente r 
1623 E J STREEr 
T~WA98421 
TeiJiill6f ! 
LCSW 10J0 3/2018 
Ncl.e general.ed by e0inica/Wa1<s aR/PM Safl,,ere ("""' 1r,c 
2019-ICLl-00051 3076 

DHS-ICE-19-0196, 19-0197-N-000258
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGEN~ANA 
A:216269802 Su:i10:7b)(6); I 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunbe ~"- " ~' -
10 10 3 /2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Allergies 
NKDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness admits 
Sleep Disturbance denies. Weightloss admits Dry 
M::>uth denies. Weakness admits Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. Abdominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. 1,1:>mitting denies. Painful 
urination denies. Decreased urine output denies. MJsde 
aches denies. MJsde cramps denies. Skin breakdown denies. 
Difficulty thinking denies. 
1623 E J STREET, TACOMA, WA-98421 
Appoirimert Facility: Northwest Detertion Cert er 
Reas on for Appointment 
1. RN day round/hunger strike 
History of Pre se nt Illness 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Time: 1505 
INPUT PO: 1850 
OUTPUT Urine 1500 
OUTPUTBM 0 
Net Gain: 350 
Initials: LM 
Hungerstrike M::>nitoring Form 
Day: 1003/.2018 
Shift: AM 
Intake PO (in ml): 1850 pt v.as observed lo drink v.ater from pitch 
Intake rl/- Normal Saline (in ml): 0 
Intake rl/- LR (in ml): 0 
Intake NG(in ml): 0 
OJtput Urine (in ml): 1500 
b)(6); 
Appointment Provide b)(?)(C) 
Comments: HE HAS BEEN DRINKING PED/AL Y7E, boost, and drinking v.ater. Pt ate one orange. 
Initials: LM 
Patient Identification: 
Patient Identification 
Patient propeMyidentified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEO OFFICER 
IM1at language do )OU speak? Russian 
Interpretation pro\<ded? Provider fluent in patient's native language 
Pain l'ssessmen t 
Pain 
Ne )OU currently in pain? Yes 
The pain is located _. back and legs 
The se'"' rityof pain is rated at 2110 
The se'"' rityof the pain is moderate 
The pain began 4-5 l\eeksago 
The character of the pain is aching 
The associated simptoms are v,eakness 
The pain is aggravated by other hunger $bike 
The pain is reliel<!d by other 
Describe: pt refused medication treatment 
Narrati'"': 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observation, and monitoring. 
RN 
Pl was in M-IU II/ED 2 Upon encounter detainee was resting quietly in bed and reading book Detainee reported weakness 
and pain on his legs and back, but refused any medical treatment He has been drinking Pedial)4e and Boost He stated that he 
would like to go to reck)0rd today: CXficerwas noted about this. WII continue to monitor. 
Detainee has missed his 127 meal this lunch. Pt ate an orange from meal trail, but refused the lunch. M::>st of the day pt was 
watching 1V and resting. W II continue to monitor. 
Hunger Strike: 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/2212018 
'M1en did the official hunger strike begin? 08/25/2018 
Date of last meal consumed: 08/2212018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wants to be released from custody 
Mequate supply of drinking water and other be1.erages a,ailable: Yes 
Three meals deli'"'red per dayto patient Yes 
Lunch deli'"'red during current shift 0% consumed 
Pny unauthoriied food in room? No 
Ha'"' dailyorthostatic \<tal signs been completed? Yes 
Has input and output been documented on the the M-iU Hunger Strike M::>nitoring Smart Form? Yes. 
Vital Sign s 
982F 
standing:77 
sitting:61 
supine:52 
standing:92/60 
sitting:95/60 
supine:90/55 
16 /min 
144.0 lbs 
66.5in 
22.89 Index 
Ex amination 
General Examination: 
Temo 
10/0312018 09:27:15 /'M 
HR 
10/0312018 09:27:15 /'M 
10/0312018 09:27:15 /'M 
10/0312018 09:27:15 /'M 
BP 
10/0312018 09:27:15 /'M 
10/0312018 09:27:15 /'M 
10/0312018 09:27:15 /'M 
RR 
10/0312018 09:27:15 /'M 
wt 
10/0312018 09:27:15 /'M 
H 
10/0312018 09:27:15 /'M 
BMI 
10/0312018 09:27:15 /'M 
GENERJ>I.. />PPEAAl>NCE: in no acute distress, well del,eloped, well nourished. 
HEPD: norrnocephalic. 
SKIN: normal, no rashes, no suspicious lesions. 
HE.ART: no murmurs, regular rate and rhythm, S 1, S2 normal. 
2019-ICLl-00051 3077 
(b
(b
)(
)(
6
7)
); 
(C) ~ I-
;-
~N 
RN 
-
-
~N 
RN 
~N 
-I￾RN 
I￾I￾RN 
I-
;-
--
RN 
I-

DHS-ICE-19-0196, 19-0197-N-000259
LUNGS: normal, clear to auscultation bilaterally, no wieezes, rales, rhonchi. 
CHEST: normal, no gross rib deformity, normal shape and expansion. 
/18D0\,EN: normal, bowel sounds present, soft, nontender, nondistended. 
MJSCULOSKELET.i>l: normal, normal gait, no deformities, full range ri motion, . 
NEUROLOGIC: alert and oriented, cooperati,e V>ith exam, , gait normal, neck supple, no rigidity, no tremor. 
PSYCH: alert, oriented, cogniti,e function intact, cooperati,e V>ith exam, good eye contact, judgement and insight 
good, mood/affect full range, no auditory or l.isual hallucinations, speech clear, thought content V>ithout suicidal ideation, 
delusions, thought process logical, goal directed. 
Assessment s 
/>!-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: 1. Continue with Othostatic \.ital Signs e1.eryday, Intake and Oitput Mmitoring e1.eryshifl; Dailyweights; 2. "'1 adequate 
supply of drinking water and other be1.erages are available to patient at all times. 3. Three meals per day are deli1.ered to the 
patient and deli1.eryof meals is documented. 4. ~ I food not authori2Bd by CD/Physician is remo\ed from patienfs room. 5. Patient 
is not allowed to purchase food from commissary,ending machine while on hunger strike. 6. Patient will only be released from 
hunger strike treatment/monitoring by CD or physician order. 7. Patient counseled regarding the medical risks of continuing the 
hunger strike. 8. Encouraged to terminate the hunger strike and eat/drink as normal. Continue hunger strike protocol, encourage 
po foodl!luids, encourage 1.erbalization a/feelings. Encourage to allow staff to monitor intake and output, '1tal signs, wt. Instructed 
to seek staff with any needs. Verbali21ld understanding. Detainee offered three meals perdayand lea1.e in room for20 to 30 
minutes. Encourage dailyoral/physical h19iene care. Change of clothing/bedding . a!er BCX)ST and Pedil)le as ordered. Patient 
educated to possible Side Effects of going for long period of time without food. Patient 1.erbali2es understanding of current Plan of 
Care. Patient 1.erbali2es his option to refuse food. 
Appointment Provider: (b)(6); 
/h\/7\/1.\ 
Electronically signed b \~/\~/:~, 
Sign off status: Completed 
Patient: AMAR, MERGENS.ANA DOB: 10/23/1978 
RN 
on 10/03/20181 5:05 :50 (Pacifi c Daylig ht Time ) 
Northwest Detention Center 
1623 E J SmEEr 
T~~ A98421 "~; I 
10/03/2018 
N(te genertKed by eOinica!Wcn<s EM<IPM Sottve,-e 1-.r ~- - ===-~ 
2019-ICLl-0005 1 3078 

DHS-ICE-19-0196, 19-0197-N-000260
10103/2018 
U.S. Immigration 
and Customs 
Enforcement 
Reason for Appointment 
1. RN nursing rounds/Hunger Strike 
Appointment Provide~b )(6); ! RN 
AMAR,MERGENSANA . . A: 216269802 Su:lltt'f )(6); 1 
Facility Code: CSOINNA II g A ea. n 
39 Y old Male, DOB: 10/23/1978 
AccOl.l'II ~ )<6) I 1623 E J STREET, T WA-911421 
Appoirimert Facility. Northwest Detertion Certer 
Appointment Provldel (b)(6) ; ~ -
Electronically signed b~(b)(6); -· ~ on 11/16/2018 at 07:28 MST 
Sign off status: Pending 
Northwest Detention Center 
1623 E J STREET 
T WA 8421 
Te (b)(6); 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progress Noto"-fb-"-)("-6""' ); __ ...,IRN 10/03/2018 
/lkxe generated by eC/inica/Wcrl.s a.RIPM Sottv.ere (""""eC/inica/Works.com) 
2019-ICLl-00051 3079 

DHS-ICE-19-0196, 19-0197-N-000261
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA A:21626980 2 Su:i1ol (b)(6); I 
Facility Code: CSONVWA Housing Area: M 39 Y old Male, DOB: 10/23/1978 
Acc01.111~ 11m- 1 
10 10 3 /2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15 , stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \AHC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e- Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fewr denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbance denies. ~ ight gain denies. 
~ ight loss denies. 
Patient denies shortness of breath, abd or cihest pain, or recent 
change in bowel or bladder. 
1623 E J STREET, T WA-98421 
Appoimnert Facility: Northwest Detertion Certer 
Reason for Appointment 
1. Daily Rounds 
History of Present Illness 
Patient Identification: 
Patient Identification 
Appointment P1'ovlde i (b) (6) ; (b)(7)(C) I FNP 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: l!filD<N 
Wiat language do }OU speak? English 
Interpretation pro\aded? Yes, Interpreter Name Lidia RN 
Name Use notes field 
Language Russian 
(9:45) This is a 39 }O Russian male here in M-iU due to his dedared hunger strike. He states that he is still with generali,ed 
musd e aches. He states that the acuity of the disccmfort is 4 out of 10. He denies any additional ccmplications at this time. 
Pain />ssessment 
Pain 
ke }OU currently in pain? Yes 
The pain is located Use Notes Section generalized 
The se'"' rityof pain is rated at 4110 
The se'"' rityof the pain is mild 
The pain began 3-4 v.eeksago 
The character of the pain is constant 
The associated S)ffiptoms are none The pain is aggravated by any physical activity 
The pain is reliel<!d by rest 
Ex amination 
General Examination: 
GENERl>l !>PPE.ARPNCE: in no acute distress , well del.eloped, well noorished. 
HE.ART: no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, nowieezes , rales, rhonchi. 
Assessment s 
1. Imbalanced nutrition: Less than body requirements [00002] - N000002 (Primary) 
Treatment 
1. Imbalanced nutr~ion: Less than bo<tj requiremerts (00002] 
Notes: Notes: Patient '"'rbali,es understanding of regimen. Detainee knows to return if sxworsen or adl<!rse reaction to current 
regimen is obseived. 11/edication discussed along with teaching and administration. 
Follow Up 
1D 
Appointment Provide,._. (b)(~6-); __ _.! FJIF 
Electronically signed b~(b)(6); ~-
Sign off status: Completed 
~ on 10/06/ 2018 14:15:03 (Pacific Daylight lime) 
Northwest Detention Center 
1623 E J STREET 
T 
Te (b)(6); /h \/ 7 \/r"\ 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 Progre8S No"f: b)(6 ); ~- IFNP 10/03/2018 
/1/cte generated by eOinica/Wai<s ElvRIPM &Jt,,ere (""""eC/inica/Works.com) 
2019-ICLl-00051 3080 

DHS-ICE-19-0196, 19-0197-N-000262
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
.. A:216269802 Su:ll~b )(6); ! 
Fac1lrtyCode:CSOINWA ng,c;ea .lfi 
39 Y old Male, DOB: 10/23/1978 
AccOl.rll lunbe~ 
1623 E J STREET, T~ 
Appoirimert Facility. Northwest Detertion Cert er 
10 10 3 /2018 
Cunont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \AHC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"'I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Allergies 
NKDA 
Review of Systems 
General/Constitutional: 
Chills denies. Fe'"'r denies. Sleep disturbanoe denies. 
Gastrointestinal: 
Constipation denies. Diarrhea denies. Nausea denies. 
MJsculoskeletal: 
MJScie aches denies. W9akness denies. 
Reason for Appointment 
1. tvHU NIGHT RN ROUNDS 
History of Present Illness 
Patient Identification: 
Patient Identification 
Appointment Provldet b)(6 ); (b)(7)(C) I RN 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: Geo ollice !<g;J (7j Wiat language do }OU speak? g 1 , Russian 
Interpretation pro\aded? No interpreter utilized 
Explain Use Notes Section speaks limited English 
Pain .1>6sessment 
Pain 
ke }OU currently in pain? No 
Narrati'"': 
Patient seen in tvHU for night RN rounds. Patient slept most of the nigh~ respirations e'"'n and unlabored. He denied pain 
and all other medical ooncems. Pedial)4e gi'"'n at 0500. Refused breakfast 
Fiowsheets (tvHU): 
lnput'OJtput Fiowsheet 
Time: 0500 
INPUTPO: 0 
OUTiPUT Urine O Pt oos up to toilet but did no/ report an accurate measurement for output. 
Initials: \I!. V 
Ex amina tion 
General B<amination: 
GENERl>l !>PPE.AR/lNCE: in no acute distress, well d8'eloped, well noorished. 
MJSCULOSKELETPL: noonal, noonal gait, no deformities, full range cl motion, good strength and equal bilaterally. 
Assessment s 
1. lmbalanoed nutrition: Less than body requirements [00002] - ND00002 (Primary) 
Treatment 
1. Imbalanced nutr~ior1: Less than body requirernerts [00002] 
Notes: Detainee '"'rba li>ed understanding of plan of care and denies questions/ooncems. Continue hunger strike protocol, 
enoourage po food/fluids, encourage '"'rbali,ation offeelingst Refer to nursing care plan for on-going inte""'n tions. Detainee 
offered three meals per day and lea'"' in room for at least 20 minutes. /ldequate supply of drinking water and other be'"'rages as 
ordered by pro,..der available. Enoourage dailyoral/ph)Sical h19iene care. Detainee '"'rbali>ed an understanding of education 
and/or treatment. \obioes no other ooncems. 
Disposition: /ldmitted to tvHU until medically evaluated 
Appointment Provide~ (b)(6); (b)(7)(C) !RN 
Electronically signed ~(b)(6); (b)(7)(C) FN on10/03/2018 05:55:28 (Pacific Daylight Time) 
Sign off status: Completed 
Patient: AMAR, MERGENSANA DOB: 10/2 311978 Progrw .. No~ (b)(6); (b)(?)(C) I RN 10/03/2018 
N(te generaled by eOinica/Worl<s BvR'PM Soflv.ere (""""'eOinica/Warks.com) 
2019-ICLl-00051 3081 

DHS-ICE-19-0196, 19-0197-N-000263
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3082 
AMAR,MERGENSANA 
A: 216269802 Si.tlll(b )(6): Facility Code: CSONVWA Hous----...111 .......... gPi~ea~, M..,.... 
39 Y old Male, DOB: 10/23/1978 
AccOllll lunberl ln \/ R\ · I 
1623 E J STREET, TACOMA, WA98421 

DHS-ICE-19-0196, 19-0197-N-000264
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
.. A:216269802 Su:ll~b)(6) ; _ J 
Facility Code: CSOINWA liiQked . I 
39 Y old Male, DOB: 10/23/1978 
AccOUll tunbe rf h \/RI I 
10 102/2018 
Cunont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounoes of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"'I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Allergies 
NKDA 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fe'"'r denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbanoe denies. Weight gain denies. 
Weight loss denies. 
Reason for Appointment 
1. tvHU E\.£ RN ROUNDS 
History of Present Illness 
Fiowsheets (tvHU): 
lnput/OJtput Fiowsheet 
Time: 2200 
INPUT PO: 240 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT Other. 0 
INPUT SUBTOT/11.. : 0 
OUTPUT Urine 0 
OUTPUTEmesis 0 
OUTPUTBM 0 
OUTPUT a. Wet Diaper Weight 0 
OUTPUT b. Dry Diaper Weight 0 
OUTPUT Total Diaper Weight output (calculate a-b) 0 
OUTPUTDrain: 0 
OUTPUT SUBTOT/11.. : 0 
NetGain: 0 
Initials: II!. V 
Patient Identification: 
1623 E J STREET, TACOMA, WA-98421 
Appoirimert Facility. Northwest Detertion Certer 
Appointment Provlder:l (b)(6) ; (b)(7)(C) I RN 
Patient seen in tvHU for e'"'ning RN rounds. Patient returned from rec and requested his e'"'ning Ensure. Patient was calm 
during encounter. RN will continue to monitor. 
Patient Identification 
Patient propeMyidentified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
\Mlat language do )OU speak? English, Russian 
Interpretation pro,..ded? Patient speaks English ffuenUy 
Pain /!ssessment 
Pain 
Ne )OU currently in pain? Yes 
The pain is located .-Back oflefl calf 
The se'"'rityof pain is rated at 2/10 
The se'"'rityof the pain is mild 
The pain began 1-2 days ago 
The character of the pain other 
The associated S)<llptoms are none 
The pain is aggravated by none 
The pain is reliel.ed by none Pt stated he did no/ oont to take anything for pain. 
Examina tion 
General Examination: 
GENER/II.. !>PPE.AR.ANCE : in no acute distress, well del.eloped, well nourished. 
NEURCX..OOC: alert and oriented, cooperati1.e with exam, motor strength normal upper and IOlll'ef extremities, normal 
exam, normal strength, tone and reflexes, sensory exam intact. 
Assessment s 
1. lneffecti'"' health maintenanoe - ND00099 (Primary) 
Treatment 
1. lneffectiw health maintenance 
Notes: Continue hunger strike protocol, encourage po food/tluids, encourage 1.erbaliiation offeelings. Encourage to allow staff to 
monitor intake and output, "tal signs, wt. Instructed to seek staff with any needs. Verbalized understanding. Detainee offered 
three meals per day and lea'"' in room for 20 to 30 minutes. A:lequate supply of drinking water and other be'"'rages as ordered 
by pro,..der available. Encourage dailyoral/phy.;ical h,giene care. Change of dothing,bedding . Oler BCX)ST and Pedil)4e as 
ordered. Do orthostatic "ta ls daily. Patient educated to possible Side Effects of going for long period of time without food. Patient 
'"'rba liies understanding of current Plan of Care. Patient '"'rbalizes his option to refuse food. 
Disposition: A:lmitted to tvHU until medically evaluated 
Appointment Provide{ b)(6) ; (b)(7)(C) FN 
Electronically signed bj(b)(6); (b)(7)(C) FN on 10/02/2018 23:11:15 (Pacific Daylight Time) 
Sign off status: Completed 
2019-ICLl-00051 3083 
Northwest Detention Center 
1623 E J STREET 
T~WA98421 
TeJ6Vm· I 
Fax: 

DHS-ICE-19-0196, 19-0197-N-000265
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 ProgNu Not,,fb)(6); (b)(7)(C) IRN 10/02/2018 
Nd.e general.ed by eOinica/W<n<s EJvRIPM Sottw,re (""""eC/inica/WOrks .com) 
2019-ICLl-00051 3084 

DHS-ICE-19-0196, 19-0197-N-000266
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3085 
AMAR,MERGENSANA A: 216269802 Si.tllq(b H6).i I 
Facility Code: CSONVWA Housing ea: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll ~be{(5'i/6):7 1623 EJ STREET, T~ 

DHS-ICE-19-0196, 19-0197-N-000267
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA A: 216269802 Su:llDtlh \In\ J 
Facility Code: CSONVWA Housing Area: 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunberfr5'ii6i:7 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
10 102/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"'I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Allergies 
NKDA 
vlew of Syste ms 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fe'"'r denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbanoe denies. Weight gain denies. 
Weight loss denies. 
Appointment Provld e 1 (b)(6) ; (b)(?)(C) I RN 
Reason for Appointment 
1. RN E\€NING SPLIT SHIFT: HUNGER SlRIKE 
History of Present Illness 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Time: 1400 
INPUT PO: 1480 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT Other. 0 
INPUT SUBTOT/11..: 0 
OUTiPUT Urine 0 
OUTiPUT Emesis 0 
OUTiPUTBM 0 
OUTiPUT a. Wet Diaper Weight 0 
OUTiPUT b. D,y Diaper Weight 0 
OUTiPUTTotal Diaper Weight output (calculate a-b) 0 
OUTiPUTDrain: 0 
OUTiPUT SUBTOT/11.. : 0 
NetGain: 0 
Net Loss: 16.6 
Initials: KM,! 
Patient Identification: 
Patient is 39 }ear old male from Russia, in M-IU for Hunger Slrike. It dinner patient refused most of meal 125. Patient ate 2 
apples that were on the tray. His weight this morning was 146.4 pounds. this shift patient has been up and alert and has also 
spent time sleeping in bed. Rise and fall of chest was l.isuali,edwhen sleeping. Went to see his laW)er. The only item refused 
this shift was lunch. 
Patient Identification 
Patient prope~yidentified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
\M1at language do )OU speak? &Jglish, Russian, __ 
Interpretation prol.ided? Patient speaks English ffuenUy 11230270 
Pain Assessment 
Pain 
Ne )OU currently in pain? No 
Vital Sign s 
16/min 
66.5in 
Ex amination 
General Examination: 
RR 
10/02/201805:43:28 PM 
H 
10/02/201805:43:28 PM 
GENER/II.. JIPPEPRANCE: in no acute distress, well del.eloped, well nourished. 
(b)(6); RN 
(b)(?)(C) -
-
RN 
NEURQOOC : alert and oriented. cooperati'"' with exam, motor strength normal upper and lc,.,,er ex1remities, normal 
exam, normal strength, tone and reflexes, sensory exam intact. 
Assessment s 
1. lneffecti'"' health maintenanoe - ND00099 (Primary) 
2. lneffecti'"' health management - ND00078 
Tre atm ent 
1. lneffectiYe health maintenance 
Notes: Continue hunger strike protocol, encourage po food/lluids, encourage -erbali:,ation offeelings. Encourage to allow staff to 
monitor intake and output, I.ital signs, wt. lnstruded to seek staff with any needs. Verbali,ed understanding. Detainee offered 
three meals per day and lea'"' in room for 20 to 30 minutes. A:lequate supply of drinking water and other be-erages as ordered 
byprol.ider available. Encourage dailyoral/phy.;ical h,giene care. Change of dothingfoedding . Ofer BOOST and Pedil)4e as 
ordered. Do orthostatic l.itals daily. Patient educated to possible Side Effects of going for long period of time without food. Patient 
'"'rba li,es understanding of current Plan of Care. Patient -erbali,es his option to refuse food. 
2. Others 
Notes: patient ate 2 apples off lunch tray, refuse all other food. Pccepted pedial)4e, and boost 
Appointment Provide1(b)(6); (b)(?)(C) IRN 
Bectronically signed b~,__ (b~)~(6=)~; ~---'~ , RN on 10/02/2018 17:59:27 (Pacific Daylight Time) 
Sign off status: Completed 
2019-ICLl-0005 1 3086 
Northwest Detention Center 
1623 E J STREET 
T WA 21 
Tel (b)(6); 

DHS-ICE-19-0196, 19-0197-N-000268
Patlent:AIIAR,IIERGENSANA DOB:10/23/1978 ProgrHsNot.tl (b)(6) ; (b)(?)(C) !RN 10/02/2018 
Ncl.e general.ed by eClinica/Wm<s BvRIPM Softvere (WNNeC/inica/WOrkS.C001 
2019-ICLl-00051 3087 

DHS-ICE-19-0196, 19-0197-N-000269
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:llQ(b )(6); J 
Facility Code: CSONVWA Housing Area: 
39 Y old Male, DOB: 10/23/1978 
Acc01.111 lunberlrbV6l· j 
10102/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"' I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• 11/lldication List re'1ewed and reconciled with the patient 
Past Medlc a l History 
No 11/lldical History. 
Allerglss 
NKDA 
Review of Systems 
General/Constitutional: 
Chills denies. Fatigue denies. Fe'"'r denies. 
Headache denies. Lightheadedness denies. Night 
sweats denies. ll\leight loss admits, is intentional. 
1623 E J STREET, TACOMA, WA-98421 
Appoimnert Facility: Northwest Detertion Certer 
Aflp oln tmen t Prov1c1e9(b)(6) ; (b)(7)(C) I PA 
Reas on for Aflpolntm ent 
1. Daily Rounds 
History of Pre se nt Illness 
Narrati'"': 
1530 hours: 39yo male detainee in the M-iU for Hunger Strike medical monitoring. He states he is drinking, and able to 
ambulate and get around, no issues with bowel mo'"'ments and urination. No new oomplaints or worsening S)fllptoms since 
last medical lisit Communicated adequately. 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? Russian 
Interpretation prolided? Yr lnterter Name 
Name Usenote~fieldRN b)(6); 
Language Russtan .. · ·- · · 
Pain />ssessment 
Pain 
ke }OU currently in pain? No 
Yitai Signs 
97.7F 
70/min 
103166mm Hg 
16/ min 
146.4 lbs 
66.5in 
2327 Index 
Examination 
General Examination: 
Temo 
10/02/201805:31:51 PM 
HR 
10/02/201805:31:51 PM 
BP 
10/02/201805:31:51 PM 
RR 
10/02/201805:31:51 PM 
wt 
10/02/201805:31:51 PM 
H 
10/02/201805:31:51 PM 
BMI 
10/02/201805:31:51 PM 
GENERPl PPPEAAPNCE: in no acute distress, well de1€1oped, well rKllJrished. 
HEl>D: nonnocephalic. 
(b )(6); 
(b)(7)(C) 
ENT: EYES: normal, EARS: normal, NOSE: normal, SINUSES: sinuses non-tender to palpation, ORAL CAVITY: 
normal, 1HROAT: normal. 
HEl'RT: no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, nowieezes, rales, rhonchi. 
!>8D0!\/EN: normal, soft, nontender, nondistended. 
MJSCULOSKELET/>L: normal, normal gait, no deformities, full range cl motion, good strength and equal bilaterally. 
PSYCH: alerl, oriented. 
Assessments 
1. Imbalanced nutrition: Less than body requirements [00002] - ND00002 
Treatme nt 
1. Imbalanced nutr~ion: Less than bo<ti requiremerts (00002] 
Notes: Patient educated the current treatment plan as directed, alert staff if new or worsening s)fllptoms as needed, PRN. 
Patient to reoei'"' daily prolider checks while in the M-iU. 
Notes: Patient to remain in the M-iU until further notice 
Appointment Provider. (b)(6); (b)(7)(C) PA 
(b)(6); (b)(7)(C) 
Electronically signed by (b)(6); A on 10/02/201817 :33:48 (Pacific Daylight Time) 
Sign off status: Comp le,tJiio1
hr\'-"17--'1
'-'- lr._.. 
1
'----' 
2019-ICLl-00051 3088 
NorthlYest Detention Center 
1623 E J STREET 
TACOMA, WA98421 

DHS-ICE-19-0196, 19-0197-N-000270
Te1J(b)(6); - · FaX. 
P•li-t: AMAR, IERGENSANA l>Olk 10/23/1978 p,...._.-~ b)(6); (b)(?)(C) IPA 10/02/2018 
Ncl.e general.ed by eC/inica/'Na1<s BvR'PM Sottv.ere (l'N.WeC/inica/W<Yks .coojl 
2019-ICLl-00051 3089 

DHS-ICE-19-0196, 19-0197-N-000271
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3090 
AMAR,MERGENSANA . . A: 21626980 2 Su:lltt1b )(6); I 
Fac1lrtyCode:CSOINWA ng ,c;ea.lfi 
39 Y old Male, DOB: 10/23/1978 
AccOl.rll l'unbe~(b)(6); I 1623 E J STREET, TACO ,IA, hA564Z I 

DHS-ICE-19-0196, 19-0197-N-000272
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3091 
AMAR,MERGENSANA A:216269802 Su:lloj(b)(?J: I 
Facility Code: CSONVWA Housing ea: M 
39 Y AccOUll ad ~'=f ~beb)(~= ~:: I 1623 E J STREET, T v 

DHS-ICE-19-0196, 19-0197-N-000273
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA A: 216269802 Su:lldlh \/R \ ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunber:~ 
1623 E J STREET, T~ 
Appoirimert Facility: Northwest Detertion Certer 
10102/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"'I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Allergies 
NKDA 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fe'"'r denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbanoe denies. Weight gain denies. 
Weight loss denies. 
Appointment Provlde~ (b)(6 ): (b)(?) (C) plN 
Reas on for Appointm ent 
1. RN DAYS: HUNGER STRIKE 
History of Pre se nt Illness 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Time: 1400 
INPUT PO: 1480 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT Other. 0 
INPUT SUBTOT/11.. : 0 
OUTiPUT Urine 0 
OUTiPUT Emesis 0 
OUTiPUTBM 0 
OUTiPUT a. Wet Diaper Weight 0 
OUTiPUT b. Dry Diaper Weight 0 
OUTiPUTTotal Diaper Weight output (calculate a-b) 0 
OUTiPUTDrain: 0 
OUTiPUT SUBTOT/11.. : 0 
NetGain: 0 
Net Loss: 16.6 
Initials: KM,! 
Patient Identification: 
Patient is 39 }ear old male from Russia, in M-IU for Hunger Slrike. It lunch patient refused most of meal 124. Patient ate 2 
apples that were on the tray. His weight this morning was 146.4 pounds. this shift patient has been up and alert and has also 
spent time sleeping in bed. Rise and fall of chest was l.isuali,edwhen sleeping. The only item refused this shift was lunch. 
Patient Identification 
Patient prope~yidentified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
\M1at language do )OU speak? English, Russian, __ 
Interpretation prol.ided? Patient speaks English ffuenUy 11230270 
Pain 1'6sessment 
Pain 
/l<e )OU currently in pain? No 
Vital Signs 
97.7F 
standing:67 
sitting:70 
standing:47 
standing:97165 
sitting:103166 
supine:100/61 
16/ min 
146.4 lbs 
66.Sin 
2327 Index 
Examination 
General El0mination: 
Temo 
10/02/2018 11:17:10/IM 
HR 
10/02/2018 11 :17:10 /IM 
10/02/2018 11 :17:10 /IM 
10/02/2018 11 :17:10 /IM 
BP 
10/02/2018 11 :17:10 /IM 
10/02/2018 11 :17:10 /IM 
10/02/2018 11 :17:10 /IM 
RR 
10/02/2018 11 :17:10 /IM 
WI 
10/02/2018 11 :17:10 /IM 
H 
10/02/2018 11 :17:10 /IM 
BMI 
10/02/2018 11 :17:10 /IM 
GENER/II.. l>PPEAAPNCE: in no acute distress, well del.elopec, well llOllrishec. 
(b)(6); 
(b)(7)(C) ~N 
,__ 
~N 
~N 
RN 
,__ 
,__ 
RN 
RN 
RN 
,__ 
,__ 
~N 
,--
I￾RN 
I￾I￾RN 
-I￾RN 
I￾NEUROLOOC: alert and oriented, cooperati'"' wth exam, motor strength normal upper and ICMer extremities, normal 
exam, normal strength, tone and reflexes, sensory exam intact. 
Assessments 
1. lneffect'"' health maintenanoe - ND00099 (Primary) 
2. lneffect'"' health management• ND00078 
Tr ea tm ent 
1. lneffectiYe health maintenance 
Notes: Continue hunger strike protocol, encourage po food/lluids, encourage '"'rbalization of feelings. Encourage to allow staff to monitor intake and output, llital signs. wt. Instructed to seek staff with any needs. lkrbali,ed understanding. Detainee offered 
three meals per day and lea'"' in room for 20 to 30 minutes. /ldequate supply of drinking water and other be'"'rages as ordered 
byprollider available. Encourage dailyoral/phy.;ical h)!liene care. Change of dothing,bedding. aler B<XJST and Pedil)4e as 
ordered. Do orthostatic l.itals daily. Patient educated to possible Side Effects of going for long period of time without food. Patient 
'"'rba li:,es understanding of current Plan of Care. Patient '"'rbali:,es his option to refuse food. 
2. Others 
Notes: patient ate 2 apples off lunch tray, refuse all other food. Pccepted pedial)4e. and boost 
Appo intment Provide1 (b )(6); (b )(7)(C) IRN 
2019-ICLl-00051 3092 

DHS-ICE-19-0196, 19-0197-N-000274
Electronically signed b1;,__b-'- )('-6"'"); _ ___.fN, RN on 10/02/201812:36:20 (Pacific Daylight Time) 
Sign off status: Completed 
Northwest Detention Center 
1623EJSTREI" 
l'. WA98421 
Tel /h\(R\· 
x: 
Patient: AIIIAR, IIERGENSANA DOB: 10/23/1978 Prog, .. s Notal(b)(6); (b)(?)(C) I RN 10/02/2018 
Nd.e general.ed by eOinica/W<n<s B>RIPM Sottw,re (""""eC/inica/works.CtJm) 
2019-ICLl-00051 3093 

DHS-ICE-19-0196, 19-0197-N-000275
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA . . A: 216269802 Su:lltt1b )(6); I 
Fac1lrtyCode:CSOINWA ng,c;ea .lfi 
39 Y old Male, DOB: 10/23/1978 
AccOl.rll lunber~ 
1623 E J STREET, T~ 
Appoirimert Facility. Northwest Detertion Cert er 
10 101/2018 
Cunont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"' I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Review of Systems 
General/Constitutional: 
Chills denies. Fel<!r denies. Sleep disturbanoe denies. 
Gastrointestinal: 
Constipation denies. Diarrhea denies. Nausea denies. 
MJsruloskeletal: 
M.lscie aches denies. ~ kness admits, that is 
generalized. 
Reason for Appointment 
1. Night nursing rounds 
History of Present Illness 
Narrati'"': 
Appointment Provlder:~ b)(6) ; (b)(7)(C) rN 
Ml le patient slept through the night IMlen asked if he had any pain he pointed to left leg and bilateral shoulder pain of 5/10/. 
Patient refused acetaminophen at this time. Refusal filled out patient refused to sign. Refused breakfast Did not keep apples (2) 
that were gi'"'n >Mth breakfast tray. Pedial)4e gi'"'n at 0500. 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: Geo o/licerf5i76] 
Wiat language do }OU speak? Fnglish, Russian 
Interpretation pro\aded? No interpreter utilized 
Explain Use Notes Section speaks limited English 
Pain />ssessment 
Pain 
ke }OU currently in pain? No 
11/edical Housing Unit 
Nursing Rounds 
Le'"' I of Care required: Madical Level 1 
11/edication orders: No 
Diagnostic Tests/Treatment orders: No 
Diet 0-ders: No 
/lcti,..ties or Restriction orders: activity as tolerated 
Ex amina tion 
General Examination: 
GENERl>l !>PPE.ARPNCE: in no acute distress. 
HE.ART:, regular rate and mythm, S1, S2 normal. 
LUNGS: normal, clear to auscultation bilat811lly, nowieezes , rales, rflonchi. 
MJSCULOSKELET/ll : normal, normal gait, no deformities, full range of motion, good strength and equal bilaterally. 
Assessment s 
1. lmbalanoed nutrition: Less than body requirements [00002] - ND00002 (Primary) 
Treatment 
1. Imbalanced nutrnion: Less than bod; req..iremerts (00002] 
Notes: Detainee '"'rba li>Bd understanding of plan of care and denies questions/concerns. Continue hunger strike protocol, 
encourage po food/fluids, encourage 1.erbali,ation offeelingst Refer to nursing care plan for on-going inte""'n tions. Detainee 
offered three meals per day and lea1.e in room for at least 20 minutes. A:lequate supply of drinking water and other be1.erages as 
ordered bypro,..der available. Encourage dailyoral/phy.,ical h)Qiene care. Detainee '"'rbali>Bd an understanding of education 
and/or treatment. \.bioes no other conoems. 
Disposition: A:lmitted to M-IU until medically evaluated 
Appointment Provider. (b)(6); / h \/7\trl 
Electronically signed b (b)(6); f l,,..\/ 7 \/r"\ 
Sign off status: Complete 
on 10/02/2018 06:17:26 (Pacific Daylight li me) 
Northviest Detention Center 
1623 E J STREET 
TACOMA, WA98421 
TelkbVGl · Fax: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Pn,g,.ss Notej(b)(6); (b)(7)(C) ~ 10/01/2018 
Ncte generated by eOinica!Wcxi<s ElvRIPM &itw!,J-e (l<MMleOinica/ Works.com) 
2019-ICLl-00051 3094 

DHS-ICE-19-0196, 19-0197-N-000276
U.S. Immi gration 
and Customs 
Enfor cement 
AMAR,MERGENSANA A: 216269802 Su:llollh \In\ 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunbe ~ 
1623 E J STREET, T~ 
Appoirimert Facility: Northwest Detertion Certe r 
10 101/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"'I 
• /lcetaminophen 500 t..G Tablet 1 tablets as needed OID PRN, 
stop date 12/.30/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
Allergies 
NKDA 
Review of Syste ms 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fe'"'r denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbanoe denies. Weight gain denies. 
Weight loss denies. 
Appointment P1'ov1c1e1 (b)(6 ); (b)(7)(C) ~ RN 
Reason for Appointment 
1. tvHU RN Rounds 
History of Pl'esent Illness 
Fiowsheets (tvHU): 
lnput/OJtput Fiowsheet 
Time: 2230 
INPUT PO: 1240 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT Other. 0 
INPUT SUBTOT/11.. : 0 
OUTiPUT Urine 0 
OUTiPUT Emesis 0 
OUTiPUTBM 0 
OUTiPUT a. Wet Diaper Weight 0 
OUTiPUT b. Dry Diaper Weight 0 
OUTiPUTTotal Diaper Weight output (calculate a-b) 0 
OUTiPUTDrain: 0 
OUTiPUT SUBTOT/11.. : 0 
NetGain: 0 
NetLoss: 0 
Initials: KM,! 
Patient Identification: 
Hunger Strike. f,/, dinner patient refused meal 120. Patient ate 2 apples that were on the lunch tray. His weight this morning 
was 141.8 pounds. Pl has been up and alert and has also spent time sleeping in bed. Rise and fall of chest was e1en and 
unlabored when sleeping. Dinner refused this shift. 
Patient Identification 
Patient prope~yidentified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
\Mat language do )OU speak? English, Russian 
Interpretation pro\aded? Patient speaks English ffuenUy 11230270 
Pain 1'6sessment 
Pain 
Ne )OU currently in pain? No 
Vit al Signs 
16 /min 
66.5in 
Examina tion 
General Examination: 
GENER/II.. JIPPEAA.ANCE: in no acute distress. 
NEURQOOC : alert and oriented. cooperati'"'. 
Assessment s 
1. lneffect'"' health maintenanoe - ND00099 (Primary) 
2. lneffect'"' health management - ND00078 
Treatment 
1. lneffecthle health maintenance 
RR 
10/01/201804:49:19 PM 
H 
10/01/201804:49:19 PM 
(b )(6); N 
(b)(7)(C) -
-
N 
-
Notes: Continue hunger strike protocol, encourage po food/lluids, encourage '"'rbali,ation offeelings. Encourage to allow staff to 
monitor intake and output, \atal signs, wt. lnstruded to seek staff with any needs. \/erbalized understanding. Detainee offered 
three meals per day and lea'"' in room for 20 to 30 minutes. /ldequate supply of drinking water and other be'"'rages as ordered 
bypro\ader available. Enoourage dailyoral/phy.,ical h,giene care. Change of dothing/bedding. Ofer 80:)ST and Pedil)4e as 
ordered. Do orthostatic \atals daily. Patient educated to possible Side Effects of going for long period of time without food. Patient 
'"'rba li,es understanding of current Plan of Care. Patient '"'rbalizes his option to refuse food. 
Pl ate 2 apples from lunch tray. 
Notes: tvHU until Medical determination 
Appointment Provide1(b)(6) ; (b)(7)(C) IRN 
Electronically signed b (b)(5); (b)(?)(C) on 10/01/2018 16:52:37 (Pacific Daylight Time) 
Sign off status: Completed 
2019-ICLl-0005 1 3095 
Northv,>esl Detention Center 
1623 E J STREET 
T~ AWA98421 
Te(b)(6l: I Fax: 

DHS-ICE-19-0196, 19-0197-N-000277
Pali-I: AMAR, -RGENSANA DOB: 10/23/1978 P ........ N 
Nd.e generated by eOinica/Wm<s EJvRIPM Sottv.ere {v.llW 
2019-ICLl-00051 3096 
RN 10/01/2018 

DHS-ICE-19-0196, 19-0197-N-000278
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3097 
AMAR,MERGENSANA .. A:216269802 Su:ll~ b)(6); I 
Fac1lrtyCode:CSOINWA ng,c;ea .lfi 
39 Y kc0U11 ad ~1~3f!t:: ~;;JE5C i 1623 E J STREET, T 

DHS-ICE-19-0196, 19-0197-N-000279
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3098 
AMAR,MERGENSANA 
A:21s2s9so2 su,d/bl/6): I 
Facility Code: CSONVWA Housing Area : M 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II ~be~ 
1623 EJ STREET, T~ 

DHS-ICE-19-0196, 19-0197-N-000280
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA A: 216269802 Su:ll~(b )(6); 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOI.D lffllbert J~~ 
10101/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el , see attached ser.ing mi>l!ure older 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"'I 
Allergies 
NKDA 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fe'"'r denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbanoe denies. Weight gain denies. 
Weight loss denies. 
1623 E J STREET, T />C.CA,304z 1 
Appoimnert Facility: Northwest Detertion Certer 
Reason for Appointment 
1. RN DAYS: HUNGER STRIKE 
History of Present Illness 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Time: 1400 
INPUT PO: 1240 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT Other. 0 
INPUT SUBTOT/11.. : 0 
OUTiPUT Urine 0 
OUTiPUT Emesis 0 
OUTiPUTBM 0 
OUTiPUT a. Wet Diaper Weight 0 
OUTiPUT b. D,y Diaper Weight 0 
OUTiPUTTotal Diaper Weight output (calculate a-b) 0 
OUTiPUTDrain: 0 
OUTiPUT SUBTOT/11.. : 0 
NetGain: 0 
NetLoss: 15 
Initials: KM,! 
Patient Identification: 
Appointment Provldei< b)(6) ; (b)(7)(C) 
Patient is 39 }ear old male from Russia, in M-IU for Hunger Slrike. It lunch patient refused most of meal 119. Patient ate 2 
apples that were on the tray. His weight this morning was 141.8 pounds. this shift patient has been up and alert and has also 
spent time sleeping in bed. Rise and fall of chest was l.isuali,edwhen sleeping. The only item refused this shift was lunch. 
Patient Identification 
Patient prope~yidentified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
\M1at language do )OU speak? English, Russian, __ 
Interpretation prol.ided? Patient speaks English ffuenUy 11230270 
Pain 1'6sessment 
Pain 
Ne )OU currently in pain? No 
Vital Signs 
97.9F 
standing:82 
sitting:66 
supine:56 
standing:94/64 
sitting:94/63 
supine:94/57 
16/ min 
141.8 lbs 
66.5in 
22.54 Index 
Examination 
General Examination: 
Temo 
10/01/201810:12:08 /WI 
HR 
10/01/201810:12:08 /WI 
10/01/2018 10:12:08 /WI 
10/01/2018 10:12:08 /WI 
BP 
10/01/2018 10:12:08 /WI 
10/01/2018 10:12:08 /WI 
10/01/201810:12:08 /WI 
RR 
10/01/2018 10:12:08 /WI 
WI 
10/01/201810:12:08 /WI 
H 
10/01/2018 10:12:08 /WI 
BMI 
10/01/2018 10:12:08 /WI 
GENER/II.. />PPEAAl>NCE: in no acute distress, well del,elopec, well r<)Urishec. 
(b)(6); RN 
(b)(7)(C) -,-
RN 
RN 
RN ,-
,-
RN 
RN 
RN ,-
,-
RN ....-
-
RN 
,-
,-
RN ,-
I￾RN I￾NEURCX..OOC: alert and oriented, cooperati'"' Vlith exam, motor strength normal upper and lc,,,,er extremities, normal 
exam, normal strength, tone and reflexes, sensory exam intact. 
Assessments 
1. lneffecti'"' health maintenanoe - ND00099 (Primary) 
2. lneffecti'"' health management - ND00078 
Treatm ent 
1. Ineffective health maintenance 
Notes: Continue hunger strike protocol, encourage po food/lluids. encourage '"'rbalization of feelings. Encourage to allow staff to monitor intake and output, I.ital signs, wt. lnstruded to seek staff with any needs. lkrbali,ed understanding. Detainee offered 
three meals per day and lea'"' in room for 20 to 30 minutes. A:lequate supply of drinking water and other be'"'rages as ordered 
by prO\<der available. Encourage dailyoral/phy.;ical h)9iene care. Change of dothing,bedding . ater BCOST and Pedil)4e as 
ordered. Do orthostatic l.itals daily. Patient educated to possible Side Effects of going for long period of time without food. Patient 
'"'rba li,es understanding of current Plan of Care. Patient '"'rbali,es his option to refuse food. 
Patient was gi'"'n T~enol 325 mg two tabs per prol.ider order for pain. GEO aticer Land,yobserl<!d patient remo'"' 1>1enol from 
mouth and try to plaoe under mattress. GEO Landryinstruded patient to swallow the pills or to gi'"' them up to be thrown away. 
Patient swallowed pills. 
11/edical placed and extra apple on patients lunch tray and patient ate 2 apples from lunch tray, he refused the rest of the food on 
tray. 
Appointment Providefb )(6) ; (b)(7)(C) F 
2019-ICLl-00051 3099 

DHS-ICE-19-0196, 19-0197-N-000281
Electronically signed b b )(6); RN , RN on 10/01/201813 :22:23 (Pacifi c Daylight Time) IL-.\1 "7 \fr,.\ 
Sign off status: Comple 
Addendum: 
100 1/20180 124 PM Martin RN, Karen M> Patient complained of general bodypa in4 /10today. PerPro'1derDa'1s patient 
stated he had been ha'1ng pain for 2 weeks. Wien gi\en T)leno l for lhe pain patient tried hiding T)leno l under his mattress. 
Northwest Detention Cente r 
1623 E J STREET 
l'."'-'1,- .................... :;i, 
P-nt: AMAR, IIERGENSANA DOB: 10/2311978 ProgNu No, (b)(6) ; (b)(7)(C) IRN 10/01/2018 
/1/cle generated by eC/inica/'Na1<s Bvr>IPM Softv.ere ("""'eC/inica'WGYks.COOjl 
2019-ICLl-00051 3100 

DHS-ICE-19-0196, 19-0197-N-000282
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:lld(h \/ R\· ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunbe f h\/r;\· 
10 101/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"' I 
Allergies 
NKDA 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fe'"'r denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbanoe denies. ~ ight gain denies. 
~ ight loss denies. 
Patient denies shortness of breath, abd or chest pain, or reoent 
change in bowel or bladder. 
1623 E J STREET, TACOMA,~;;.W;;.A-9 ~84=2~1-' 
Appoirimert Facility: Northwest Detertion Certer 
Appointment P1'ovlde i (b)(6) ; (b)(?)(C) jNP 
Reason for Appointment 
1. Daily Rounds 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? __ 
Interpretation pro\aded? Yes, Interpreter Number 11433730 
Number Use notes ffeld 
Language Russian 
(10:02) This is a 39 }O Russian male here in tvl-tU due to a Dedared Hunger strike. He states that he is in 6 out of 1 O musde 
pain that has a duration of 2 weeks. He states that the pain is constant and aggrav.,ted with phy.;ical adi\aly. 
Pain Assessment 
Pain 
ke }OU currently in pain? Yes 
The pain is located Use Notes Section 
The se'"' rityof pain is rated at 6110 
The se'"' rityof the pain is moderate 
The pain began 1-2v.eeksago 
The character of the pain is aching 
The associated simptoms are none 
The pain is aggra,ated by any physical activity 
Vital Signs 
97.9F 
66/min 
99/63 mm Hg 
16 /min 
66.5in 
Ex amination 
General Examination: 
Temp 
10/01/2018 10:12:15/lM 
HR 
10/01/201810: 12:15/lM 
BP 
10/01/201810: 12:15/lM 
RR 
10/01/2018 10:12:15/lM 
H 
10/01/201810:12:15/lM 
GENERN. JIPPEPRANCE: in no acute distress, well del.eloped, well nourished. 
(
(
b
b
)(
)(
6
7
); 
)(C) ~ 
,-
fN P ,-
,-
NP ,-
fN P 
,-
fN P 
MJSCULOSKELET/ll : noonal, noonal gait, no deformities, full range of motion, good strength anc equal bilaterally. 
Assessment s 
1. StaMJtion, subsequent encounter - T73.0JO<D (Primary) 
2. Pain, unspecified - R52 
Tr e atment 
1. Starvation, subsequent encOl.l"ller 
Notes: Notes: Patient '"'rba li;zes understanding of regimen. Detainee knows to return if sxworsen or adl<!rse readion to current 
regimen is obserued. rv'edication discussed along with teaching and administration. 
2. Pain, unspecified 
Start/lcetaminophen Tablet 500 M3, 1 tablets as needed, Oa lly, QID PRN, 90 day.;, 1, Refills 0, KCP: Yes, Drug Source: In 
House Pharmacy, Notes: Not required for tra'"'I 
Notes: Notes: Patient '"'rba li;zes understanding of regimen. Detainee knows to return if sxworsen or adl<!rse readion to current 
regimen is obserued. rv'edication discussed along with teaching and administration. 
Follow Up 
1D 
Appointment Provide1 b)(6) ; _. 
8 ctr . II . d (b) (B); e ornca y,agne (h\(7\ (C:\ 
Sign off status: Comp leted 
2019-ICLl-0005 1 
,.., on 10/01/201810 :36:27 (Pacific Daylight Time) 
3101 
Northwest Detention Center 
1623 E J STREET 
T~r. 98421 
Tel(b} (6[_. I u • 

DHS-ICE-19-0196, 19-0197-N-000283
Patient: AIIIAR, IIERGENSANA DOB: 10/23/1978 Prog,. u NotaFb)(6) ; (b)( ? )(C) tNP 10/01/2018 
Nd.e general.ed by eOinica/W<n<s EJvRIPM Sottw,re (""""eC/inica/WOrks .com) 
2019-ICLl-00051 3102 

DHS-ICE-19-0196, 19-0197-N-000284
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
.. A:216269802 Su:ll~b )(6); I 
Facility Code: CSCN/1/WA .. ,g A ca ."' 
39 Y old Male, DOB: 10/23/1978 
AccOl.rll lunber:~ 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
10 101/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"'I 
vlew of Systems 
General/Constitutional: 
Weight loss is intentional, is significant, [20 lbs°'"" a period 
of S""'leks ) . 
Reason for Appointment 
1. Noc shift. 
History of Present Illness 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Time: 0500 
INPUTPO: 240bottleofensure 
INPUT Other. 60 v.ater 
INPUT SUBTOT/11..: 300 estimaUon 
OUTPUT Urine 300 this is an estimaUon 
Initials: dlt 
Hungerstrike Mlnitoring Form 
Shift: Night 
Intake PO (in ml): 490 drinks v.ater, Pedialyte 
Intake rl/- Normal Saline (in ml): 0 
Intake rl/- LR (in ml): 0 
Intake NG(in ml): 0 
OJtput Urine (in ml): 400ptobservedvoiding 
Initials: dlt 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEOCEF/CER 
W1at language do )OU speak? Russian 
Interpretation pro\aded? No interpreter available during visit 
Pain Assessment 
Pain 
Ne )OU currently in pain? No 
Narrati'"': 
Appointment Provld e1(b)(6) ; ~-
Patient is on official hunger strike and isolated from other detainees for dose super.ision, obseMtion , and monitoring. 
Pl is in M-IU fvED 2. He makes e)e contact and has been awake, either lying on bed or sitting up. He has been drinking water 
and Ensure. 
Hunger Strike: 
Nursing Evaluation 
\M1en did the official hunger strike begin? 08t25'2018 
Drinking Fluids: Yes 
11/eals deli'"'red during shift: Breakfast, Oher meal/nutritional supplement 
Explain : Ensure 
Breakfast 0"/4 consumed 
Other meal/nutritional supplement 100%oonsumed 
lnput/OJtput Use Prooedures to enter hunger strike monitoring input/output 
Ex amination 
General Examination: 
GENER/II.. !>PPE.AR.ANCE : in no acute distress, well del.eloped, well nourished. 
HEAD: norrnocephalic. 
SKIN: mucous membranes moist, good turgor. 
LUNGS: good air mo\ement. 
MJSCULOSKELET/11.. : neulO\escular intact, good strength and equal bilaterally. 
NEUROLOOC: senscxy exam intact, ncxmal strength, tone and reflexes. 
PSYCH: alert, oriented, cogniti1.e function intact, cooperati1.e v.ith exam.. 
Assesamenta 
/II-Risk for imbalanced nutrition: Less than body requirements. 
Tre atm ent 
1. Others 
Notes: 1. Continue with Othostatic IAtal Signs e1.eryday, Intake and OJtput Mlnitoring e\Alryshift; Dailyweights; 2. /ln adequate 
supply of drinking water and other be\Alrages are a.ail able to patient at all times. 3. Three meals per day are deli\Alred to the 
patient and deli'"'ryof meals is documented. 4. /Ill food not authori,ed byCDiPhy.,ician is remo\Ald from patients room. 5. Patient 
is not allowed to purchase food from commissar)l'l.ending machine while on hunger strike. 6. Patient will only be released from 
hunger strike treatment/monitoring by CD or phy.,ician order. 7. Patient counseled regarding the medical risks of continuing the 
hunger strike. 8. Encouraged to tenninate the hunger strike and eat/drink as nonnal. Continue hunger strike protocol, encourage 
po fooclffluids, encourage '"'rbali,ation offeelings. Encourage to allow staff to monitor intake and output, \atal signs, wt Instructed 
to seek staff with any needs. Verbali,ed understanding. Detainee offered three meals per day and lea\Al in room for 20 to 30 
minutes. Encourage dailyoral/phy.,ical h½Jiene care. Change of dothing,bedding . Oler BCX)ST Ensure and Pedial)4e as 
ordered. Patient educated to possible Side Effects of going for long period of time without food. Patient \Alrbali,es understanding 
of current Plan of Care. Patient \Alrbali,es his option to refuse food. 
Appoinbnent Provide (b)(6); 
/h\/ 7\ /C:\ 
Bectronicall y signed ,_f'"' b'--' )'-' (6-");"--'---'L 10/01/2018 07:07:04 (Pacific Daylight Time) u~ h\/7\/f"\ r• 
Sign off status: Completed 
2019-ICLl-0005 1 3103 
Northwest Detention Center 
1623 E J STREET 

DHS-ICE-19-0196, 19-0197-N-000285
1: WA98421 
Tel b)(6); 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 Prog .. u No..j~(b_)(_6_); -~~ 10J01/2018 
Ncl.e generated by eC/inica/'Na1<s EJvR/PM Sottv.ere (,w,weC/inica/WGYks.COOjl 
2019-ICLl-00051 3104 

DHS-ICE-19-0196, 19-0197-N-000286
U.S. Immigration 
and Customs 
Enfor cement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U Nola: 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inic a'WGYks.coojl 
2019-ICLl-00051 3105 

DHS-ICE-19-0196, 19-0197-N-000287
U.S. Immigration 
and Customs 
Enfor cement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inic a'WGYks.coojl 
2019-ICLl-00051 3106 
AMAR, MERGEN _~ 
Facility~~~~~ 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunbe~ 
1623 EJ STREET, T~ 

DHS-ICE-19-0196, 19-0197-N-000288
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3107 
AMAR,MERGENSANA . . A: 216269802 Su:lltt1, b )(6); I 
Facility Code: CSCN/1/WA n ,g H ea . "' 
39 Y old Male, DOB: 10/23/1978 
1623 E ~~::=l~~~~ ~~L .c, I 

DHS-ICE-19-0196, 19-0197-N-000289
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA A: 216269802 Su:i1ollh \In\ I 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunber~ )· 
1623 E J STREET, T~ 
Appoirimert Facility: Northwest Detertion Certer 
09 13012018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"'I 
vlew of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fewr denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbanoe denies. Weight gain denies. 
Weight loss denies. 
Reason for Appointment 
1. RN DAYS: HUNGER STRIKE 
History of Present Illness 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Time: 1600 
INPUT PO: 240 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT Other. 0 
INPUT SUBTOT/11..: 0 
OUTiPUT Urine 0 
OUTiPUT Emesis 0 
OUTiPUTBM 0 
OUTiPUT a. Wet Diaper Weight 0 
OUTiPUT b. Dry Diaper Weight 0 
OUTiPUTTotal Diaper Weight output (calculate a-b) 0 
OUTiPUTDrain: 0 
OUTiPUT SUBTOT/11.. : 0 
NetGain: 0 
Net Loss: 19.6 
Initials: KM,! 
Patient Identification: 
Appointment Provid e (b)(6); (b)(?)(C) 
Patient is 39 }ear old male from Russia, in M-IU for Hunger Slrike. It dinner patient refused M)ST a= meal 119. Patient ate 
an apple. He stated this morning that Dr. Ml lakhova said that he could eat apple. No order for apple. His weight this morning 
was 143.4 pounds. this shift patient has been up and alert and has also spent time sleeping in bed. Rise and fall of chest was 
1o1suali2ed when sleeping. The only item refused this shift was lunch. 
Patient Identification 
Patient prope~yidentified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
\M1at language do )OU speak? Russian, __ 
Interpretation pro1o1ded? No interpreter available during visit 
Pain Assessment 
Pain 
Ne )OU currently in pain? No 
Vit al Sign s 
16/min 
66.5in 
Ex amination 
General Examination: 
RR 
H 
09/30/201805:07:09 PM 
09/30/201805:07:09 PM 
GENER/II.. JIPPEPRANCE: in no acute distress, well del.eloped, well nourished. 
(b)(6); N 
(b)(?)(C) -
-
N 
-
NEURQOOC : alert and oriented. cooperati'"' with exam, motor strength normal upper and lc,.,,er extremities, normal 
exam, normal strength, tone and reflexes, sensory exam intact. 
Assessments 
1. lneffecti'"' health maintenanoe - ND00099 (Primary) 
2. lneffecti'"' health management - ND00078 
Treatm ent 
1. Ineffective health maintenance 
Notes: Continue hunger strike protocol, encourage po food/lluids, encourage -erbali:,ation offeelings. Encourage to allow staff to monitor intake and output, 1o1tal signs, wt. Instructed to seek staff with any needs. Verbali,ed understanding. Detainee offered 
three meals per day and lea'"' in room for 20 to 30 minutes. A:lequate supply of drinking water and other be-erages as ordered 
bypro1o1der available. Enoourage dailyoral/phy.;ical h,giene care. Change of dothing/bedding . Ofer BOOST and Pedil)4e as 
ordered. Do orthostatic 1o1tals daily. Patient educated to possible Side Effects of going for long period of time without food. Patient 
'"'rba li;,es understanding of current Plan of Care. Patient -erbalizes his option to refuse food. 
2. Others 
Notes: It dinner patient refused M)ST a= meal 119. Patient ate an apple. Patient stated this morning that Dr. Ml lakhova said 
that he could eat apple. No order for apple. Patient still considered hunger strike until Dr. Mllakho,a remo-es patient from hunger 
strike. Report gi'"'n to onooming RN, Dr. Ml lakhova and A:lmin notified. 
Appointment Providerb)(6); (b)(?)(C) IRN 
Bectronically signed (b)(6); /h\/7\ff-..\ 
Sign off status: Comple 
2019-ICLl-0005 1 
RN, RN on 09130/2018 17:56:26 (Pacific Daylight Time) 
3108 
Northwest Detention Center 
1623 E J STREET 
TACOMA, WA98421 

DHS-ICE-19-0196, 19-0197-N-000290
TJb )(6); ~-
Fax: 
P-nt: AMAR, IIERGENSANA DOB: 10/23/1978 Prog,. .. Note{ b )(6): (b)(?)(C )! RN 09/30/2018 
/I/de general-ed by eC/inica/'Na1<s BvR'PM Sottv.ere (l'N.WeC/inica/W<Yks .coojl 
2019-ICLl-0005 1 3109 

DHS-ICE-19-0196, 19-0197-N-000291
U.S. Immigration 
and Customs 
Enfor cement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U Nola: 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inic a'WGYks.coojl 
2019-ICLl-00051 3110 

DHS-ICE-19-0196, 19-0197-N-000292
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U Nola: 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3111 
AMAR,MERGENSANA 
Facility~~~~~J( bl(~);_~, 
39 Y old Male, DOB: 10/23/1978 
1623 E ~~::=l~~(W~Lu .c J 

DHS-ICE-19-0196, 19-0197-N-000293
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3112 
AMAR,MERGENSANA A:216269802 Su:ll~(b)(6); I 
Facility Code: CSONVWA Housing Area : M 
39 Y old Male, DOB: 10/23/1978 
1623E~~::= l~~~ )_(~LOL. I 

DHS-ICE-19-0196, 19-0197-N-000294
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:lld lh \/R \ ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II ~ )<6) I 
09 /3 0/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for Ira'"' '· please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
Past Med lca l History 
No Maldical History. 
Allorglos 
NKDA 
Review of Systems 
Hunger Strike: 
Fatigue admits. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. lr'lleight loss admits. Dry 
M:>uth denies. lr'lleakness admits. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. l'odominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. \Qmitting admits. Painful 
urination denies. Decreased urine output denies. MJsde 
aches denies. M.lsde cramps denies. Skin breakdown denies. 
Difficulty thinking denies. 
1623 E J STREET,· VVA-98421 
Appoimnert Facility: Northwest Detertion Certer 
App oin tment Provlcle1 b)(6) ; (b)(7)(C) 'NP 
Reas on for Appointm ent 
1. DJ>JL YM-IU PRCMDER ROUNDS 
History of Pre se nt Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: Picture, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number 
Number : 11430042 
Language Russian 
Pain .1>6sessment 
Pain 
ke }OU currently in pain? No 
Narrati'"': 
39 yo male on day#36 of official hunger strike. He is drinking water, Pedial)4e, Boos~ and Ensure. He do weakness today. 
He states his last BM was 2da~ ago. He does not appear to be in distress. He went to rec)Brd today. He is la~ng on his bed 
reading a no'"'l,and is able to s~upwithoutanydifficulty. 
Hunger Strike: 
Maldical Eleluation 
Date missed meals monitoring initiated: 08/22/2018 
Wien did the official hunger strike begin? 08/25'2018 
Date of last meal oonsumed: 08/2212018 
Last meal oonsumed: Breakfast 
Drinking fluids: Yes 
# of da~ on hunger strike: 37 
Total \'\eight loss in pounds: 19.6 
Reason for hunger strike: 11\ants to be released from custody 
Housing/Isolation Location: M,dical Housing Unit 
Reason for Isolation F1acement For dose supervision, observation, and monitoring 
Re"ew of the Housing Placement Review housing every 24 hours 
Vit al Signs 
982F 
standing:64 
sitting:58 
supine:47 
standing:91/63 
sitti ng:96/64 
supine:98/61 
16/ min 
143.4 lbs 
66.5in 
22.80 Index 
HR: 4 7-58. This is pt's baseline. 
Ex amination 
General Examination: 
Temo 
HR 
BP 
RR 
WI 
H 
BMI 
GENERJ>l !>PPEPRl>NCE: in no acute distress, well del,eloped. 
HEl'D: normocephalic. 
ORl'l CA\ATY: normal, mucosa moist. 
SKIN: normal, no rashes, no suspicious lesions. 
HE.ART: no murmurs, regular rate and lhythm, S 1, S2 noonal. 
09/30/2018 09:53:36 PM 
09/30/2018 09:53:36 PM 
09/30/2018 09:53:36 PM 
09/30/2018 09:53:36 PM 
09/30/2018 09:53:36 PM 
09/30/2018 09:53:36 PM 
09/30/2018 09:53:36 PM 
09/30/2018 09:53:36 PM 
09/30/2018 09:53:36 PM 
09/30/2018 09:53:36 PM 
09/30/2018 09:53:36 PM 
LUNGS: normal, clear to auscultation bilaterally, nowieezes, rales, lhonchi. 
JIBDOM:N: normal, boNel sounds present, soft, nontender, nondistended. 
MJSCULOSKELET/IL: no deformities, full range of motion. 
NEURQ OOC: alert and oriented, cooperati'"' with exam. 
PSYCH: alert, oriented, cooperati'"' with exam, good eye contact, speech clear. 
Assessments 
1. StaMition, subsequent encounter - T73.0)00) (Primary) 
Trea tm en t 
1. Others 
Notes: HOUSING RESTRICTIO>J ORDERS: 
1. Patient is considered to be on hunger strike and will be isolated from other detainees for 
dose super.ision, obseMition, and monitoring. 
2. Patient will be placed in restricted housing, based on his or her medical condition, until 
medical personnel authori>e mo\Alment of the patient to a less restricti\Al en~ronment 
or the patient is transferred to a hospital. 
3. ~ • food not authoriied by CD/phy.,ician will be remo\Ald from the patienfs room 
4. Patient is not allowed to purchase food from commissal')ll.ending machine while on hunger strike. 
5. Re~ew of the housing placement will be documented e\Alry72 hours or less 
6. Patient will only be released from hunger strike treatment/monitoring by CD or ph~ician order 
NURSING ORDERS: 
1. Document the daily monitoring of patienfs: Intake, o.rtp~ ~ight and 01hostatic 
lillal Signs on the Hunger Strike M:>nitoring Smart Form 
2. Complete urinal~ is and olher labs if ordered 
(b)(6); 
(b)(7)(C) 
3. Ensure an adequate supply of drinking water, or other be\Alrages, and three meals per day are deli\Alred to the patient 
4. Documentdeli\Alryof meals 
PSYCHIATRIC EV/ILUATIO>J : 
1. BHP will evaluate patient to assess for possible ps)Chiatric causes for the hunger strike, 
2019-ICLl-0005 1 3113 
NP 
-,-
NP 
NP 
NP 
,-
-
NP 
NP 
NP 
,-
,-
NP 
,-
-
NP 
,-
,-
NP I￾I￾NP 
I-

DHS-ICE-19-0196, 19-0197-N-000295
and to prm,;de supportiw counseling lhat may help end lhe hunger strike. 
EDUCAllCN: 
1. Patient counseled regarding lhe medical risks of continuing lhe hunger strike and 
encouraged to terminate the hunger strike. 
Follow Up 
daily rounds, pm 
Appointment Provlde~(b)(6); (b)(7)(C) f 
Electronically signed bj~(b~}~(6~}~; -~tp on O!lt'30/201812:43:29 (Pacific Daylight Time ) 
Sign off status: Completed 
Northwest Detention Cente r 
1623 E J STREEr T~r:98421 
Fax: 
Pati-1: AMAR, MERGENSANA DOIi: 10/23/1978 p._... N<>ti ... b_)(_6_); __ ___.! NP 09/30/2018 
Ncie generaled byeOirica/Wcrlcs aR'PM /:1:J/tvqe (w.w,eO inicli Works.~ 
2019-ICLl-00051 3114 

DHS-ICE-19-0196, 19-0197-N-000296
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A:216269802 &tllD:!(b)~ ; I 
Facility Code: CSONVWA Housing ea: M 
39 Y old Male, DOB: 10/23/1978 
Acc01.111 ~ b)(6); 1623 E J STREET, T ;L.-. \/7\lr-, 
09 /30/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el , see attached ser.ing mi>l!ure older 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \AHC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"'I 
Allergies 
NKDA 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fe'"'r denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbanoe denies. Weight gain denies. 
Weight loss denies. 
Appoimnert Facility: Northwest Detertion Cert er 
Appointment Provlclei b)(6) ; (b)(?)(C) rN 
Reason for Appointment 
1. RN DAYS: HUNGER STRIKE 
History of Present Illness 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Time: 1400 
INPUT PO: 1240 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT Other. 0 
INPUT SUBTOT/11.. : 0 
OUTiPUT Urine 0 
OUTiPUT Emesis 0 
OUTiPUTBM 0 
OUTiPUT a. Wet Diaper Weight 0 
OUTiPUT b. D,y Diaper Weight 0 
OUTiPUTTotal Diaper Weight output (calculate a-b) 0 
OUTiPUTDrain: 0 
OUTiPUT SUBTOT/11.. : 0 
NetGain: 0 
NetLoss: 15 
Initials: KM,! 
Patient Identification: 
Patient is 39 }ear old male from Russia, in M-IU for Hunger Slrike. It lunch patient refused M'.)ST a= meal 118. V'vhen GEO 
went to retrie'"' tray the apple was missing from the tray. RN obtained interpreter and asked patient about apple. Patient stated 
Dr. Ml lakhova said he could eat apple. RN did not find a specific order for an apple. No sign of apple foound in room. Patient was 
asking for BOOST and Pedial)4e. His weight this morning was 143.4 pounds. this shift patient has been up and alert and has 
also spent time sleeping in bed. Rise and fall of chest was lisuali2Bd when sleeping. The only item refused this shift was lunch. 
Patient Identification 
Patient propeMyidentified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
\Mlat language do )OU speak? Russian, __ Interpretation prolided? Yes, Interpreter Number 11230270 
Number: 
Language Russian 
Pain 1'6sessment 
Pain 
Ne )OU currently in pain? No 
Vital Signs 
982F 
47 /min 
98/61 mm Hg 
16/min 
143.4 lbs 
66.5in 
22.80 Index 
Examination 
General Examination: 
Temo 
HR 
BP 
RR 
Wt 
H 
BMI 
09/30/2018 12:00:52 PM 
09/30/2018 12:00:52 PM 
09/30/2018 12:00:52 PM 
09/30/2018 12:00:52 PM 
09/30/2018 12:00:52 PM 
09/30/2018 12:00:52 PM 
09/30/2018 12:00:52 PM 
GENER/II.. PPPEAAPNCE: in no acute distress, well deleloped, well nourished. 
b )(6); N 
b)(?)(C) -
-
N 
-
-
N 
-
-
N 
-
-
N 
-
-N 
--N 
- NEUROLOGIC: alert and oriented, cooperatise Vl>ith exam, motor strength normal upper and ICM>er extremities, normal 
exam, normal strength, tone and reflexes, sensory exam intact. 
Assessments 
1. lneffecti'"' health maintenanoe - ND00099 (Primary) 
2. lneffecti'"' health management - ND00078 
Treatment 
1. lneffecti\11! health maintenance 
Notes: Continue hunger strike protocol, encourage po food/lluids, encourage serbalization of feelings. Encourage to allow staff to 
monitor intake and output, \i tal signs. wt. Instructed to seek staff with any needs. lkrbali2Bd understanding. Detainee offered 
three meals per day and leave in room for 20 to 30 minutes. /ldequate supply of drinking water and other beserages as ordered 
byprolider available. Encourage dailyoral/phy.;ical h)Qiene care. Change of dothing,bedding . CXfer B(X)ST and Pedil)4e as 
ordered. Do orthostatic lita ls daily. Patient educated to possible Side Effects of going for long period of time without food. Patient 
'"'rba liies understanding of current Plan of Care. Patient verbaliies his option to refuse food. 
2. Others 
Notes: It lunch patient refused M'.)ST a= meal 118. V'vhen GEOwent to retrieve traythe apple was missing from the tray. RN 
obtained interpreter and asked patient about apple. Patient stated Dr. Mllakho.a said he could eat apple. RN did not find a 
specific order for an apple. No sign of apple found in room. 
Appointment Providefb )(6); (b)(?)(C) IRN 
2019-ICLl-00051 3115 

DHS-ICE-19-0196, 19-0197-N-000297
Electronically signed by!(b)(6) ; ~ - ~, RN on 09/30/201812:33:39 (Pacific Daylight Time) 
Sign off status: Completed 
Northwest Detention Center 
1623EJSTREI' 
T=WA9a421 1'ffe6): ) Fax: 
Patient: AIWI, IIERGENSANA DOB: 10/2 3/19 78 Prog, .. s Nobt (b)(6) ; (b)(7)(C) 
Ncte generau,d byeOinica/WOO<s B>RIPM Sottw,re ("""' 'eertm:ll11>ffl=um,-~ 
09/30/2018 
2019-ICLl-00051 3116 

DHS-ICE-19-0196, 19-0197-N-000298
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:ll*b )(6); I 
Facility Code: CSONVWA Housing Area: M 
3
~c~~m: ::1 
09 /2912018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"'I 
Allergies 
NKDA 
Review of Systems 
General/Constitutional: 
1/\i<l ightloss is intentional, is significant, [17 lbs c,,er a period 
of 5 'Mleks J . 
1623 E J STREET, T 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Provld e f b)(6) ; ~ -
Reason for Appointment 
1. RN day round/hunger strike 
History of Present Illness 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Time: 2300 
INPUT PO: 237 bot/le of ensure 
INPUT Other. 200 this is an estimallon 
INPUT SUBTOT/ll: 437 
OUTiPUT Urine 300 this is an estimallon 
Initials: dlt 
Hungerstrike Mlnitoring Form 
Shift: Night 
Intake PO (in ml): 237 pt was ob served to drink water from pitch 
Intake rl/- Normal Saline (in ml): 0 
Intake rl/- LR (in ml): 0 
Intake NG(in ml): 0 
OJtput Urine (in ml): pt ob served voiding 
Initials: dlt 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEOCEFJCER 
W1at language do )OU speak? Russian 
Interpretation pro\aded? No interpreter available during visit 
Pain Assessment 
Pain 
Ne )OU currently in pain? No 
Narrati'"': 
Patient is on official hunger strike and isolated from other detainees for dose super.ision, obseMtion, and monitoring. 
Pl is in M-IU fvED 2 at time of first enoounter at 2100. He makes e)e oontact and has been awake, either l~ng on bed or 
sitting up. He has been drinking Pedial)4e and Boost/Ensure. A::cepted and drank 1,0nilla ensure at HS. Mist of the time pt was 
reading book, and resting. WII oontinue to monitor. 
Hunger Strike: 
Nursing E1,0luation 
\M1en did the official hunger strike begin? 08t25'2018 
Drinking Fluids: Yes 
l\i'eals deli'"'red during shift: Breakfast, Qher meallnutriflonal supplement 
Explain : Ensure 
Breakfast 0"/4 consumed 
Other meal/nutritional supplement 100"/oconsumed 
lnput/OJtput Use Prooedures to enter hunger strike monitoring input/output 
Vit a l Sign s 
._166 _ ._s i_n ______________ H __ 09129120 ___ 18_1_0:_22_:2_1_PM ___ -i!!l(b:,.1)(Q. 6:l!);l:.l..-l§ /h\/ 7 \/r\ 
Examination 
General Examination: 
GENER/II.. PPPEAAPNCE: in no acute distress, well de1€1oped, well l'KllJrished. 
HEPD: norrnocephalic. 
SKIN: normal, no rashes, no suspicious lesions. 
HEAAT: no murmurs, regular rate and rhythm, S 1, $2 normal. 
LUNGS: normal, clear to auscultation bilaterally, no wheezes, rales, rhonchi. 
CHEST: normal, no gross rib deformity, normal shape and expansion. 
!>8D0!\/EN: normal, l:x.>Mll sounds present, soft, nontencer, nondistended. 
MUSCULOSKELET/ll : normal, normal gait, no deformities, full range of motion, . 
NEURQOOC: alert and oriented, cooperati'"' with exam, , gait normal, neck supple, no rigidity, no tremor. 
PSYCH: alert, oriented, cogniti'"' function intact, cooperati'"' with exam, good eye contact, judgement and insight 
good, rroodlaflect full range, no auditory or 1,1sual hallucinations, speech clear, thought content without suicidal ideation, 
delusions, thought process logical, goal directed. 
Assessment s 
/>I-Risk for imbalanoed nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: 1. Continue with Orthostatic \Mal Signs e'"'ryday; Intake and ()Jfput M:mitoring e'"'ryshift; Dailyweights; 2. "'1 adequate 
supply of drinking water and other be'"'rages are a,ailable to patient at all times. 3. Three meals per day are deli'"'red to the 
patient and deli'"'ryof meals is documented. 4. />II food not authoriied byCDiPhysician is remol<!d from patients room. 5. Patient 
is not allowed to purchase food from oommissar)il,ending machine while on hunger strike. 6. Patient will only be released from 
hunger strike treatment/monitoring by CD or physician order. 7. Patient oounseled regarding the medical risks of oontinuing the 
hunger strike. 8. Enoouraged to terminate the hunger strike and eat/drink as normal. Continue hunger strike protocol, enoourage 
po foodffluids, enoourage '"'rbalization offeelings. Enoourage to allow staff to monitor intake and output, I.ital signs, v.t. Instructed 
to seek staff with any needs. Verbalized understanding. Detainee offered three meals per day and lea'"' in room for 20 to 30 
minutes. Enoourage dailyoral/physical h19iene care. Change of dothinglbedding . ()fer BCX)ST Ensure and Pedial)4e as 
ordered. Patient educated to possible Side Effects of going for long period of time without food. Patient '"'rbali,es understanding 
of current Plan of Care. Patient -erbali,es his option to refuse food. 
Appointment Provide1(b)(6); ~- r 
2019-ICLl-00051 3117 

DHS-ICE-19-0196, 19-0197-N-000299
Electronically signed b~(b)(6); 
Sign off status: Completed 
~ on 10/01/2018 05:12:34 (Pacific Daylight Time) 
Northwest Detention Center 
1623 E. J SffiEEI" 
1'.PO;,,JIIIA,-!OLII.IIB. 121, 
Patient: .AMAR, MERGENSANA DOB: 10/23/1978 ProgN u No m,,ii,i;;;i,...;,,,....... RN 09/2912018 
Ncl.e general.ed by eOirica/Wm<s a.RJPM Saftvere (WNNeCJi 
2019-ICLl-00051 3118 

DHS-ICE-19-0196, 19-0197-N-000300
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGV'ks.coojl 
2019-ICLl-00051 3119 
AMAR,MERGENSANA A:216269802 Su:i1ol(b)( 6 ): ! 
Facility Code: CSONVWA Housing Area : M 
39 Y ad ~le i' •~::::: 1623 E~=~$K~;~; ' ,,.~ I 

DHS-ICE-19-0196, 19-0197-N-000301
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A:216269802 Su:lloj(b)(6); I 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
1623E JSTREET, 
AccOl.lll lunber: 
T~ 
~ 
Appoimnert Facility: Northwest Detertion Cert er 
09 /2912018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
Allergies 
NKDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness 
admits. Sleep Disturbance denies. ~ ight loss admits. Dry 
M::>uth denies. ~kness admits. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. Abdominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. 1,1:>mitting denies. Painful 
urination denies. Decreased urine output denies. MJsde 
aches denies. MJsde cramps denies. Skin breakdown denies. 
Difficulty thinking denies. 
Appointment Provide (b)(6); 
/h\/ 7 \lr\ 
Reason for Appointment 
1. First 1/2 e'"'n ing RN round/Hungerstike 
History of Present Illness 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Time: 1900 
INPUT PO: 820 
OUTPUT Urine 300 
OUTPUTBM 0 
Net Gain: 500 Total lost since started hunger strike 17 lb at09:00 
Initials: LM 
Hungerstrike M::>nitoring Form 
Day. 09/29/2018 
Shift: PMfirst 112 evening shifl 
Intake PO (in ml): 820 pt was ob served to drink water from pitch 
Intake rl/- Normal Saline (in ml): 0 
Intake rl/- LR (in ml): 0 
Intake NG(in ml): 0 
OJtput Urine (in ml): 300 
Comments: HE HAS BEEN DRINKING PED/AL YTE and 2 boost, pt drank about 2 cups of water 
Initials: LM 
Patient Identification: 
Patient Identification 
Patient propeMyidentified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEO OFFICER 
IM1at language do )OU speak? Russian 
Interpretation pro\<ded? Provider fluent in patient's native language 
Pain l'ssessmen t 
Pain 
l'<e )OU currently in pain? Yes 
The pain is located : back and legs 
The se'"' rityof pain is rated at 5110 
The se'"' rityof the pain is moderate 
The pain began 4-5 l\eeksago 
The character of the pain is aching 
The associated simptoms are v,eakness 
The pain is aggravated by other hunger strike 
The pain is reliel<!d by other 
Desai be: pt refused medication treatment 
Narrati'"': 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observation, and monitoring. 
Pl is in M-IU fvED 2 This nurse encountered with pt about 1500. Upon encounter detainee was resting quietly in bed. 
Detainee reported weakness, lightheaded, and pain on his legs and back. but refused anymedical treatment He has been 
drinking Pedial~e and Boost Pt went to re~rd 16:59 and returned about 18:15. M::>st of the time pt was reading book, and 
resting. \M Ii continue to monitor. 
Hunger Strike: 
Nursing Evaluation 
Wien did the official hunger strike begin? 08/25'2018 
Drinking Fluids: Yes 
l\i'eals deli'"'red during shift: Lunch 
Lunch 0% consumed 
lnput/OJtput Entered below 
Vital Signs 
16/ min 
66.5in 
Examin ation 
General Examination: 
RR 
09/29/201805:03:59 PM 
H 
09/29/2018 05:03:59 PM 
GENERN. !>PPEAA.ANCE: in oo acute distress, well del.eloped, well nourished. 
HE.AO: norrnocephalic. 
SKIN: nomial, oo rashes, oo suspicious lesioos. 
HE.ART: oo murmurs, regular rate and rhythm, S 1, S2 nom,al. 
LUNGS: nomial, clear to auscultatioo bilaterally, oo v.tieezes, rales, rhonchi. 
CHEST: nomial, oo gross rib deformity, nom,al shape and expansioo. 
/l8D0\IEN : nomial, bowel sounds present, soft, nontender, nondistended. 
M.JSCULOSKELETl'l : nom,al, nom,al gait, 00 deformities, full range cl motioo, . 
(b)(6); 
(b)(7)(C) 
NEURCX.. OOC: alert and oriented, cooperati,e wth exam, . gait nomial, neck supple, oo rigidity, oo tremor. 
PSYCH: alert, oriented, cogniji,e functioo intact, cooperati,e v,ith exam, good eye cootact, judgement and insight 
~ 
-
-
Us 
-
good , mood/affect full range, oo auditory or \<sual hallucinatioos, speech clear, thought cootent wthout suicidal ideatioo, 
delusioos, thought process logical, goal directed. 
Assessments 
Ill-Risk for imbalanced nutrition: less than body requirements. 
Treatment 
1. Others 
N 
Notes: 1. Continue with 01hostatic liltal Signs e1eryday, Intake and QJ!put lvbnitoring e1eryshifl; Dailyweights; 2. "'1 adequate 
supply of drinking water and other be1erages are a1,0ilable to patient at all times. 3. Three meals per day are deli1ered to the 
patient and deli'"'ryof meals is documented. 4. /lll food not authori,ed byCD/Phy.,ician is rem01.ed from patients room. 5. Patient 
is not allowed to purchase food from commissary\end ing machine while on hunger strike. 6. Patient will only be released from 
hunger strike treatment/monitoring by CD or phy.,ician order. 7. Patient counseled regarding the medical risks of continuing the 
hunger strike. 8. Encouraged to terminate the hunger strike and eat/drink as normal. Continue hunger strike protocol, encourage 
po food/fluids, encourage '"'rbaliiation offeelings. Encourage to allow staff to monitor intake and output, I.ital signs, wt. Instructed 
to seek staff with any needs. Verbalized understanding. Detainee offered three meals per day and lea1e in room for 20 to 30 
minutes. Encourage dailyo ral/phy.,ical h)giene care. Change of dothinglbedding . Ofer BCOST and Pedil)4e as ordered. Patient 
educated to possible Side Effects of going for long period of time without food. Patient 1erbali:zes understanding of current Plan of 
Care. Patient '"'rba li:zes his option to refuse food. 
2019-ICLl-0005 1 3120 

DHS-ICE-19-0196, 19-0197-N-000302
Appointment Provide (b )(6); t h \f ? \tr'\ 
RN 
Electronically signed b~~(b~)~(6~)~; -~~ on 09/29/201819 :05:48 (Pacifi c Daytlght Time) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREEr 
T WA98421 
Tel (b)(6); 
Patient: AMAR, lll!RGl!NSANA DOB: 10/23/1978 ProgNss Notaj(b)(6);_ _ _ r 09/29/2018 
Nr:1.e general.eel by eC/irica/Wa1<s af</PM SofMere {IWMleC/itica'Waks.can) 
2019-ICLl-00051 3121 

DHS-ICE-19-0196, 19-0197-N-000303
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:llol lh \In\ ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II ~beib) (6); 1623E JSTREET, T~, .. o 
Appoirimert Facility: Northwest Detertion Certer 
09 /2912018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• Ensure High Protein-Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"'I 
Allergies 
NKDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness 
admits. Sleep Disturbanoe denies. ~ ight loss admits. Dry 
M::>uth denies. ~kness admits. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. Abdominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. 1,1:>mitting denies. Painful 
urination denies. Decreased urine output denies. MJsde 
aches denies. MJsde cramps denies. Skin breakdown denies. 
Difficulty thinking denies. 
Appointment Provide (b)(6); (b)(7)(C) N 
Reason for Appointment 
1. RN day round/hunger strike 
History of Present Illness 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Time: 1500 
INPUT PO: 2800 
OUTPUT Urine 1500 
OUTPUTBM 1 
Net Gain: 800 Total lost since started hunger strike 17 lb at09:00 
Initials: LM 
Hungerstrike M::>nitoring Form 
Day: 09/29/.2018 
Shift: AM 
Intake PO (in ml): 2800 pt v.as observed to drink v.aterfrom pitch 
Intake rl/- Normal Saline (in ml): 0 
Intake rl/- LR (in ml): 0 
Intake NG(in ml): 0 
OJtput Urine (in ml): 1500 
OJtput Bowel M::>'"'ments (in ml): OOE 81..fper pt it v.as loose 
Comments: HE HAS BEEN DRINKING PED/AL YTE and 2 boost, pt drank about 2 cups of v.ater 
Initials: LM 
Patient Identification: 
Patient Identification 
Patient prope~yidentified by2 sources induding: /0 Badge, Picture 
Chaperone Present? Yes GEO OFFICER 
\Mat language do )OU speak? Russian 
Interpretation pro\aded? Provider fluent in pa vent's native language 
Pain 1'6sessment 
Pain 
Ne )OU currently in pain? Yes 
The pain is located : back and legs 
The se'"'rityof pain is rated at 5110 
The se'"'rityof the pain is moderate 
The pain began 4-5 v.eeksago 
The character of the pain is aching 
The associated simptoms are v,eakness 
The pain is aggravated by other hunger strike 
The pain is reliel<!d by other 
Describe: pt refused medica#on treatment 
Narrati'"': 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observation, and monitoring. 
Pl is in M-IU fvED 2 This nurse encountered with pt together with pro"der. Upon encounter detainee was resting quietlyin 
bed. Detainee reported weakness. lightheaded, and pain on his legs and back, but refused any medical treatment He has been 
drinking Pedial)'e and Boost Pt stated that he has lose stool about 08:00. Pt requested to go to russian church at 1400 and 
reck)0rd. The request was translated to GEO officer, who let know about it to GEO offioer Wi ite. WII continue to monitor. Pt 
refused lunch. Detainee has missed his 115 meal this lunch. M::>st ofthe time pt was reading book, and resting. WII continue to 
monitor. 
Hunger Strike: 
Nursing Evaluation 
Vlnen did the official hunger strike begin? 08/25'2018 
Drinking Fluids: Yes 
l\i'eals deli'"'red during shift: Lunch 
Lunch 0% consumed 
lnput/OJtput: Entered below 
Vital Signs 
97.3F 
standing:79 
sitting:63 
supine:55 
standing:97/63 
sitting:88/59 
supine:100/60 
16/ min 
146.0 lbs 
66.5in 
2321 Index 
Examination 
General Examination. 
Temp 
09/29/2018 09:20:12 PM 
HR 
09/29/2018 09:20:12 /lM 
09/29/2018 09:20:12 /lM 
09/29/2018 09:20:12 /lM 
BP 
09/29/2018 09:20:12 /lM 
09/29/2018 09:20:12 /lM 
09/29/2018 09:20:12 /lM 
RR 
09/29/2018 09:20:12 /lM 
WI 
09/29/2018 09:20:12 /lM 
H 
09/29/2018 09:20:12 /lM 
BMI 
09/29/2018 09:20:12 /lM 
GENERJ>l !>PPEPRl>NCE: in no acute distress, well del.eloped, well r<JUrished. 
HEPD: norrnocephalic. 
SKIN: normal, no rashes, no suspicious lesicxis. 
HE.ART: no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNGS: normal, clear to auscullaticxi bilaterally, nowieezes , rales, rhonchi. 
CHEST: normal, no gross rib deformijy, normal shape and expansim 
JIBDOM:N: normal, boNel sounds present, soft, nontender, nondistended. 
MJSCULOSKELET/ll : normal, normal gait, no deformities, full range o( rnoticxi , . 
(b)(6); 
(b)(7)(C) 
NEURQ OOC: alert and oriented, cooperati'"' with exam, . gait normal, neck supple, no rigidity, no tremor. 
2019-ICLl-00051 3122 
N 
-
-
N 
~ 
~ 
-
-
~ 
~ 
N 
-
~ 
-
N 
-
-
N 
-
~ 

DHS-ICE-19-0196, 19-0197-N-000304
PSYCH: alert, Oliented, cogniti\El function intact, cooperati\El v.ith exam, good eye contact, judgement and insight 
good, mood/affect full range, no auditory or \isual hallucinations, speech clear, thought content v.ithout suicidal ideation, 
delusions, thought process logical, goal directed. 
Assessments 
Ill-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: 1. Continue with Othostatic 'vltal Signs e\Elryday, Intake and Qnput M>nitoring e1.eryshift; Dailyweights; 2. kl adequate 
supply of drinking water and other be1.erages are available to patient at all times. 3. Three meals per day are deli1.ered to the 
patient and deli\Elryof meals is documented. 4. ~I food not authoriied byCDiPhy.;iclan is remo\Eld from patienfs room. 5. Patient 
is not allowed to purchase food from commissary\ending machine while on hunger strike. 6. Patient will only be released from 
hunger strike treatment/monitoring by CD or phy.;iclan order. 7. Patient counseled regarding the medical risks of continuing the 
hunger strike. 8. Enoouraged to terminate the hunger strike and eat/drink as normal. Continue hunger strike protocol, encourage 
po food/fluids, enoourage 1.erbali:zation offeelings. Encourage to allow staff to monitor intake and output, lital signs, wt Instructed 
to seek staff with any needs. Verbaliied understanding. Detainee offered three meals perdayand lea1.e in room for20 to 30 
minutes. Enoourage dailyo ral/phy.;ical h:,giene care. Change of clothing/bedding . Offer BCX)ST and Pedil)le as ordered. Patient 
educated to possible Side Effeds of going for long period of time without food. Patient 1.erbaliies understanding of rurrent Plan of 
Care. Patient 1.erbali,es his option to refuse food. 
Appointment Provlde1(b)(6); ~- ! RN 
Electronically signed b (b)(6); on 09/29/201815:04:40 (Pacific Daylight Tlme) /h\/ 7 \/ r\ 
Sign off status: Complete 
Northwest Detention Center 
1623 E. J STREEr T®tr 98421 1 x: 
P.tlent: AMAR, IIERGENSANA DOB: 10/23/1978 Progr9as Notej(b)(6); _. I RN 09/29/2018 
Ncxe generated byeOirica/Wo-lcs EM>IPM ~e (w.w,eQiniceiWtxks.Cf:N11 
2019-ICLl-00051 3123 

DHS-ICE-19-0196, 19-0197-N-000305
U.S. Immi gration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
.. A:216269802 Su:ll~b )(6); I 
Fac1lrtyCode:CSOINWA ng ,c;ea.lfi 
39 Y old Male, DOB: 10/23/1978 
AccOl.rll lunbe~ 
1623 E J STREET, T~ 
Appoirimert Facility. Northwest Detertion Certer 
09 /2912018 
Cunont Medication s 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \AHC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Souroe: In House Pharmacy, Notes: 
Not required for tra'"'I 
Past Medlc al History 
No Maldical History. 
Allorglo s 
NKDA 
Review of Syste ms 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness admits. 
Sleep Disturbanoe denies. Vleight loss admits. Dry 
M:>uth denies. lr'lleakness admits, that is generalized. 
Cough denies. Shortness of breath at rest denies. Chest pain at 
rest denies. Palpitations denies. Pbdominal Pain denies. 
Constipation denies. Diarrhea denies. Nausea denies. 
I.omitting admits. Painful urination denies. Decreased urine 
output denies. M.Jsde aches denies. M.Jsde cramps denies. Skin 
breakdown denies. Difficultythinking denies. 
App ointment Provld e rf b)(6) ; (b)(7)(C) I NP 
Reas on for Appointm ent 
1. Hunger strike 
History of Pre se nt Illne ss 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: Picture, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Nam b)(6); Name : h\l?\tr'' 
Language Russian 
Pain .1>6sessment 
Pain 
ke }OU currently in pain? No 
Narrati'"': 
39 yo male on day#35 of official hunger strike. He is drinking water, PediaL)4e, and Boost He does complain of some mild 
diZ2iness this PM 
Hunger Strike: 
Maldical Eleluation 
Date missed meals monitoring initiated: 08/22/2018 
Wien did the official hunger strike begin? 08/2512018 
Date of last meal consumed: 08/2212018 
Last meal consumed: Breakfast 
Drinking fluids: Yes 
# of da)>S on hunger strike: 35 
Total \/\eight loss in pounds: 17 
Reason for hunger strike: Wcints to be released from custody 
Housing/Isolation Location: M,dical Housing Unit 
Reason for Isolation F1aoement For dose supervision, obse,vation, and monitoling 
Re-.;ew of the Housing Placement Review housing every 24 hours 
Vit al Sign s 
Temn 
97.3F 09/29/2018 09:25:57 /'M 
1-R 
55 /min 09/29/2018 09:25:57 /'M 
BP 
100160mm Hg 09/29/2018 09:25:57 /'M 
RR 
16/min 09/29/2018 09:25:57 /'M 
WI 
146.0 lbs 09/29/2018 09:25:57 /'M 
H 
66.5in 09/29/2018 09:25:57 /'M 
BMI 
2321 Index 09/29/2018 09:25:57 /'M 
Resting HR 55. As;mtpomatic. Clo mild diZ2iness when sitting up, standing up. 
Ex amination 
General Examination: 
GENERJ>l PPPEAAPNCE: ale<1, well hydrated, in no distress . 
ORPl. CAvlTY: nonnal, mucosa moist. 
SKIN: nonnal, no rashes, no suspicious lesions. 
HEl'RT: no murmurs, regular rate and rhythm, S 1, S2 nonnal. 
LUNGS: nonnal, clear to auscultation bilaterally, nowieezes, rales, rhonchi. 
!>BDOIVEN: nonnal, l:x.>Mll sounds present, soft, nontender, nondistended. 
MJSCULOSKELET/>L: no defum,ities, full range of motion, good strength and equal bilaterally. 
NEURQOOC : alert and oriented, cooperati'"' with exam 
PSYCH: alert, oriented, good eye contact, speech clear. 
Ass essm ents 
1. Starvation, subsequent encounter - T73.0X><D (Primary) 
Tr eatm ent 
1. Others 
Notes: HOJSING RESTRICTIO>J ~DERS : 
1. Patient is considered to be on hunger strike and will be isolated from other detainees for 
dose super.ision, observation, and monitoring. 
2. Patient will be placed in restricted housing, based on his or her medical condition, until 
medical personnel authorize mo'"'ment of the patient to a less restricli'"' en~ronment 
or the patient is transferred to a hospital. 
3. ~ I food not authorized by CD/phy.,ician will be remol<!d from the patienfs room 
4. Patient is not allowed to purchase food from commissary\ending machine while on hunger strike. 
5. Re-.;ew of the housing placement will be documented e'"'ry72 hours or less 
6. Patient will only be released from hunger strike treatment/monitoring byCD or phy.,ician order 
NURSING ~DERS : 
1. Document the daily monitoring of patienfs: Intake, OJlput, Vleighl and 01hostatic 
\/Ital Signs on the Hunger Strike M:lnitoring Smart Form 
2. Complete urinal)>Sis and other labs ifordered 
b)(6); 
b)(7)(C) 
3. Ensure an adequate supply of drinking water, or other be.erages, and three meals per day are deli'"'red to the patient 
4. Documentdeli'"'ryo f meals 
PSYCHIATRIC EV/>LUATIO>J: 
1. BHP will evaluate patient to assess for possible ps)dliatric causes for the hunger strike, 
and to pro,,,;de supporti'"' counseling that may help end the hunger strike. 
EDUCATIO>J: 
1. Patient counseled regarding the medical risks of continuing the hunger strike and 
encouraged to terminate the hunger strike. 
Follow Up 
2019-ICLl-00051 3124 
p 
-
-
p 
-
-
p 
-
-
p 
-
-
p 
-
-
p 
-
-
p 
-

DHS-ICE-19-0196, 19-0197-N-000306
Daily rounds, pm 
Appointment Provicle1..,~,. /'-' \~'-'- /;:.:.."'-'- '-----'' M' 
Electronically signed by Kb)(6); 
Sign off status: Completed 
IM' on O!lt'2912018 09:36:42 (Pacific Daylight Time ) 
Northwest Detention Center 
1623 E. J STREEr 
TACOMA, WA98421 
Telj(b)(6); ~- I 
P•tl-1: AMAR, MERGENSANA DOB: 10/23/1978 p ....... Note:l(b)(6); ~- INP 09/29/2018 
Ncxe generu.ed by eC/inica/lM'.rts 8'R/PM Sofn<ere (IW.WeC/inica/Works.com) 
2019-ICLl-00051 3125 

DHS-ICE-19-0196, 19-0197-N-000307
U.S. Immi gration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:llot(b )/6\ ! 
Facility Code: CSONVWA Housing Area: M 
39 Y Acc0Ull~beji}(5C old Male, i'~:: I 
09 /2912018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
Allergies 
NKDA 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fe'"'r denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbance denies. ~ ight gain denies. 
~ ight loss denies. 
1623 E J STREET, TACO • 
Appoimnert Facility: Northwest Detertion Certer 
Reason for Appointment 
1. tvHU RN NIGHT ROUNDS/HUNGER STRIKE 
History of Present Illness 
Fiowsheets (tvHU): 
lnput/OJtput Fiowsheet 
Time: 0700 
INPUT PO: 1240 
Initials: LDM 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEO OFFICER ON DUTY 
Wiat language do }OU speak? English, Russian 
Interpretation pro\aded? Pallant speaks English fluenUy 
Pain />ssessment 
Pain 
A-e }OU currently in pain? No 
Narrati'"': 
Appointment Pl'ovld e i (b )(6); __ 
PT IS ON OFACW. HUNGER STRIKE. TJ'l<ING PO PEDW. YT'E AT 0500, NCXl\l, PND BEDTIWE. SEE ffiD ER F~ M)<JNG 
BOOST. PT IS SEEN DRINKING WATER PT STA1EO HE SLEPT \/\ELL. 
Examination 
General Examination: 
GENERl>l !>PPE.ARPNCE: in no acute distress, well del.eloped, well nourished. 
NEURQOOC: alert and oriented, cooperati'"' with exam, motor strength normal upper and ICJlll'E!r extremities, normal 
exam, normal strength, tone and reflexes, sensory exam intact. 
Assessment s 
1. lneffecti'"' health maintenance - ND00099 (Primary) 
Treatment 
1. lneffectiw health maintenance 
Notes: Continue hunger strike protocol, encourage po food/tluids, encourage '"'rbaliiation offeelings. Encourage to allow staff to monitor intake and output, "tal signs, wt. Instructed to seek staff with any needs. Verbalized understanding. Detainee offered 
three meals per day and lea'"' in room for 20 to 30 minutes. A:lequate supply of drinking water and other be'"'rages as ordered 
by pro,..der available. Encourage dailyoral/phy.;ical h,giene care. Change of dothing,bedding .Oler BCX)ST and Pedil)4e as 
ordered. Do orthostatic "ta ls daily. Patient educated to possible Side Effects of going for long period of time without food. Patient 
'"'rbaliies understanding of current Plan of Care. Patient '"'rbaliies his option to refuse food. 
Disposition: A:lmitted to M-IU until medically evaluated 
Appointment Provide r.l(b) (6); ~- ~ 
Electronicall y signed b* b)(6) ; FN on 09/29/2018 06:28:17 (Pacific Daylight Time) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREET 
T~WA98421 
Tel}ii{ Rl· 
Fax: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 P.....,.. ~ 09/29/2018 
/lkte genertK8d by eClinica!Wcxi<s EM<IPM Sottve,-e (""'"'eClinica/Works.com) 
2019-ICLl-0005 1 3126 

DHS-ICE-19-0196, 19-0197-N-000308
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax : 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3127 
AMAR,MERGENSANA 
.. A:216269802 Su:ll~~/\~L. I 
Facility Code: CSCN/1/WA n ,g H ea . "' 
39 Y old Male, DOB: 10/23/1978 
AccOl.llt ~be ~,1.-. \le,. j 
1623 E J STREET, TACOMA, WA98421 

DHS-ICE-19-0196, 19-0197-N-000309
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A:216269802 &tllD:!(b)~ ; I 
Facility Code: CSONVWA Housing ea: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll lunber~ 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Cert er 
09 /2812018 
Curnont Medication s 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure older 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
• Pedial)4e-Solution 1 bottle three times a day TIO, stop date 
10/28/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
Allergies 
NKDA 
Review of Syst ems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. Weight loss admits. Dry 
M::>uth denies. Weakness admits. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. Abdominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. 1,1:>mitting denies. Painful 
urination denies. Decreased urine output denies. MJsde 
aches denies. MJsde cramps denies. Skin breakdown denies. 
Difficulty thinking denies. 
Appoin t ment Provld e r:f b)(6) ; (b)(7)(C) 
Rea son for Appointment 
1. PM SHIFT NOlE. Hunger Strike Nursing E1,0luation 
History of Pre se nt Illne ss 
Fiowsheets (MHU): 
Upon encounter detainee was resting quietlyin bed. Detainee reported weakness but refused any medical treatment 
Detainee water pitcher has been filled for him and he has been drinking Pedial)le and Boost and Ensure. Detainee has chosen 
to miss his 110th meal this e'"'ning-dinner. Detainee has gone back to resting quietly in his room. WII continue to monitor. 
Hungerstrike M::>nitoring Form 
Day: 09/28/.2018 
Shift: PM 
Intake PO(in ml): 0 
Intake rl/- Normal Saline (in ml): 0 
Intake rl/- LR (in ml): 0 
Intake NG(in ml): 0 
QJtput Urine (in ml): 0 
PED/£_'~~; c°r:Ztk~EE REPr:RTS DRINKNG WAl'ER FRa..tH1s vW-111E cup AND HAS BEEN DRINKING soosr, 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEOCEF/CER 
Wiat language do }OU speak? English 
Interpretation pro\aded? Pallant speaks English fluenUy 
Pain ffisessment 
Pain 
Ne }OU currently in pain? No 
Narrati'"': 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
\M1en did the official hunger strike begin? 08t25'2018 
Drinking Fluids: Yes 
Meals deli'"'red during shift: Dinner 
Dinner 0"/4 consumed 
lnpuVQJtput: Entered below 
Vit a l Sign s 
97.8F 
standing:92 
sitting:80 
supine:76 
standing:101/70 
sitting:100/66 
supine:105168 
16 /min 
146.2 lbs 
66.5in 
2324 Index 
Ex aminatio n 
General Examination: 
Temo 
09/28/201805:18:52 PM 
1-R 
09/28/201805:24:30 PM 
09/28/201805:24:30 PM 
09/28/201805:24:30 PM 
BP 
09/28/201805:24:30 PM 
09/28/201805:24:30 PM 
09/28/201805:24:30 PM 
RR 
09/28/201805:18:52 PM 
wt 
09/28/201805:24:30 PM 
H 
09/28/201805:18:52 PM 
BMI 
09/28/201805:24:30 PM 
GENERJ>l J>PPEAAPNCE: in no acute distress, well deleloped, well OOJrished. 
PSYCH: alert, oriented. 
Assess ment s 
/>I-Risk for imbalanced nutrition: Less than body requirements. 
Trea tm ent 
1. Others 
(b)(6); 
(b)(7)(C) 
Notes: 1. Continue 1Mth \Atal Signs e-.eryshift; Intake and QJtput M::>nitoring e-.eryshift; Dailyweights; Dailyorthostatic I.ital signs. 
2. kl adequate supply of drinking water and other be-.erages are a1,0ilable to patient at all times. 
3. Three meals per day are deli-.ered to the patient and deli-.eryof meals is documented. 
4. /11 food not authoriied by CD~y.,ician is remo-.ed from patienrs room. 
5. Patient is not allowed to purchase food from commissary\ending machine while on hunger strike. 
6. Patient will only be released from hunger strike treatment/monitoring byCD or phy.,ician order. 
7. Patient counseled regarding the medical risks of continuing the hunger strike. 
8. Encouraged to terminate the hunger strike and eat/drink as normal. 
2019-ICLl-00051 3128 

DHS-ICE-19-0196, 19-0197-N-000310
Appointment Provlder:l(b)(6); (b)(7)(C) 
Electronically signed byl(b)(6); (b)(7)(C) 
Sign off status: Completed 
IRN on 09/28/2018 18:23:40 (Pacific Daylig ht Time) 
Northwest Detention Cente r 
1623EJSTier 
1: WA98421 
Te (b)(6); 
Patient: AMAR, ME RGEN SANA DOB: 10/23/19 78 p,.,.._ j (b)(6); (b)(7)(C) 
NcJ.e genermed by eOinica/Wm<s a.RJPM S:fl"'8re ( . 
2019-ICLl-00051 3129 
09/28/20 18 

DHS-ICE-19-0196, 19-0197-N-000311
Cunent -dlcatlons 
Taking 
U.S. Immigration 
and Customs 
Enforcement 
Reason for Appointment 
1. renew PedialW, Rx 
• Calcium 500/0 500-200 M:;-UNITTablet 1 tablet with food Oice 
a day, KOP: Yes, Drug Source: Pharmacy Treatment 
1. Others 
AMAR,MERGENSANA A:21626980 2 Su:i1ol(b)(6); I 
Facility Code: CSONVWA Housing Area : M 39 Y old Male, DOB: 10/23/1978 
AccOl.lll lunber:~ 
1623 EJ STREET, T~ 
• Prenatal \Atamin Filed Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 M3Tablet 1 tablet as needed Four times a day, KOP: 
Start PedialW, Solution,-, 1 bottle three times a day, Crally, no, 30 day.;, 1, Refills 0, KOP: Yes, Drug Source: In House 
Pharmacy, Notes: Not required for trawl 
Yes, Drug Source: Pharmacy 
• Calcium 500/0 500-200 M:;-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tra;el 
• Fiber625 M3Tablet 1 tablet as needed BI0,stopdate 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for trawl 
• Cholecalciferol 2000 UNIT Tablet 1 tablet a-IS, stop date 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for trawl 
• Boost Glucose Control - Liquid 0.5 ser.ing mi-i no, stop date 
10/26/2018, KOP: No, Drug Source: In House Pharmacy, Notes: Not 
required for trawl, see attached ser.ing mildure order 
• Ensure High Protein - Liquid 1 ()-IS, stop date 10/11/2018, KOP: 
No, Drug Source: In House Pharmacy, Notes: Not required for tra;el 
• Boost \AHC - Liquid 0.5 ser.ing each mealtime no, stop date 
10/11/2018, KOP: No, Drug Source: In House Pharmacy, Notes: Not 
required for trawl, please mixwith 4 ounces of water 
......... 
NKDA 
Tel: 
Fax: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progress Note: 
/lkxe generated by e0irica/Wcx1<s EM<IPM Sotrv.ere (w,JN.eC/inica/Works .co«4 
2019-ICLl-00051 3130 

DHS-ICE-19-0196, 19-0197-N-000312
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
.. A:216269802 Su:lltt:1b}(6); I 
Fac1lrtyCode:CSOINWA ng ,c;ea.lfi 
39 Y old Male, DOB: 10/23/1978 
AccOUll tunbe ,f h \lR\· I 
09 /2812018 
Cunont Medication s 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"' I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounoes of water 
Allergie s 
NKDA 
Review of Syste ms 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbanoe denies. Weightloss admits. Dry 
M::>uth denies. Weakness admits. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. Abdominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. 1,1:>mitting denies. Painful 
urination denies. Decreased urine output denies. MJsde 
aches denies. MJsde cramps denies. Skin breakdown denies. 
Difficulty thinking denies. 
1623 E J STREET, TACOMA, WA-98421 
Appoirimert Facility. Northwest Detertion Cert er 
Appointment Provld e j(b}(6) ; ~· 
Rea son for Appointment 
1. RN day round/ Hunger Strike 
History of Pre se nt Illne ss 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Time: 1500 
INPUT PO: 1000 
OUTPUT Urine 800 
OUTPUTBM 1 
Net Gain: 200 
Initials: LM 
Hungerstrike M::>nitoring Form 
Day: 09/28/.2018 
Shift: AM 
Intake PO(in ml): 1000 ptv.asobserved to drink v.aterlrom pitch 
Intake rl/- Normal Saline (in ml): 0 
Intake rl/- LR (in ml): 0 
Intake NG(in ml): 0 
OJtput Urine (in ml): 800 
OJtput Bowel M::>'"'ments (in ml): OOE BM 
Comments: HE HAS BEEN DRINKING PED/AL YTE and 2 boost, pt drank about 2 cups of v.ater 
Initials: LM 
Patient Identification: 
Patient Identification 
Patient prope~yidentified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEO OFFICER 
\Mat language do )OU speak? Russian 
Interpretation pro1,1ded? Provider fluent in pa vent's native language 
Pain 1'6sessment 
Pain 
Ne )OU currently in pain? Yes 
The pain is located .-back and legs 
The se'"' rityof pain is rated at 4110 
The se'"' rityof the pain is moderate 
The pain began 4-5 v.eeksago 
The character of the pain is aching 
The associated simptoms are v,eakness 
The pain is aggravated by other hunger strike 
The pain is reliel<!d by other 
Describe: pt refused medica#on treatment 
Narrati'"': 
Patient is oonsidered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observation, and monitoring. 
In the morning pt took a shower about 07:30 am. 
pt is in M-IU fvED 2 Upon enoounter detainee was resting quietly in bed and watch lV. Detainee reported weakness and 
pain on his legs and back , but refused any medical treatment He has been drinking Pedial)te and Boost pt went to atomey\isit 
about 09:00 and returned to 11 :45, pt reasure medical and GEO staff that he feel ok and he can walk, and he stated that he 
doesn, need weelchair. W II continue to monitor. 
Upon returning pt denied anyadition medical ooncems, stated that he feel good and atomey\isit went well. pt refused lunch. 
Detainee has missed his 112 meal lhis lunch. M::>st ofthe time pt was watching lV, reading book, and resting. WII oontinue to 
monitor. 
Hunger Strike: 
Nursing Evaluation 
\Mien did the official hunger strike begin? 08/25'2018 
Drinking Fluids: Yes 
11/eals deli'"'red during shift: Lunch 
Lunch 0% oonsumed 
lnput/OJtput Entered below 
Vit al Sign s 
97.8F 
standing:92 
sitting:80 
supine:76 
standing:101f70 
sitting:100/66 
supine:105168 
18 /min 
146.2 lbs 
66.Sin 
2324 Index 
2019-ICLl-00051 3131 
Temo 
09128/2018 08:44:52 />M (b)(6); 
(b)(7)(C) 
HR 
09/28/2018 08:44:52 />M 
09128/2018 08:44:52 />M 
09/28/2018 08:44:52 />M 
BP 
09128/2018 08:44:52 />M 
09/28/2018 08:44:52 />M 
09/28/2018 08:44:52 />M 
RR 
09/28/2018 08:44:52 />M 
Wt 
09128/2018 08:44:52 />M 
H 
09/28/2018 08:44:52 />M 
BMI 
09/28/2018 08:44:52 />M 

DHS-ICE-19-0196, 19-0197-N-000313
Examination 
General Ei<amination: 
GENEFW. JIPPE.ARANCE: in oo acute distress, well del.e!oped , well oourished. 
HE.l>D: nonnocephalic. 
SKIN: normal, oo rashes, oo suspicious lesions. 
HEl>RT: oo murmurs, regular rate and rhythm, S 1, S2 oormal. 
LUNGS: normal, clear to auscultation bilaterally, oo Vvheezes, rales, rhonchi. 
CHEST: normal, oo gross rib delonnity, normal shape and expansion. 
PBDOM:N: normal, oo,;el sounds present, soft, nontender, oondistended. 
MJSCULOSKELETPl: normal, oormal gait, 00 deformities, full range rl. motion, . 
NEUROLOGIC: alert and oriented, cooperati-a with exam, , gait oormal, neck supple, oo rigidity, oo tremor. 
PSYCH: alert, Oliented, cogniti-a function intact, cooperati-a with exam, good eye contact, judgement and insight 
good, mood/affect full range, oo auditory or \isual hallucinations, speech clear, thought content without suicidal ideation, 
delusions, thought process logical, goal directed. 
Assessments 
/'I-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: 1. Ccntinue with Othostatic 'vltal Signs e.eryday, Intake and Qnput M>nitoring e.erysh ifl; Dailyweights; 2. kl adequate 
supply of drinking water and other be.erages are available to patient at all times. 3. Three meals per day are deli.ered to the 
patient and deli.eryof meals is documented. 4. ~ I food not authori2ed byCD/Phy.;idan is remo.ed from patienfs room. 5. Patient 
is not allowed to purchase food from commissary.ending machine while on hunger strike. 6. Patient will only be released from 
hunger strike treatment/monitoring by CD or phy.;idan order. 7. Patient counseled regarding the medical risks of continuing the 
hunger strike. 8. Encouraged to terminate the hunger strike and eat/drink as normal. Ccntinue hunger strike protocol, encourage 
po food/fluids, encourage .erbali,ation of feelings. Encourage to allow staff to monitor intake and output, lital signs, wt. Instructed 
to seek staff with any needs. Verbaliied understanding. Detainee offered three meals perdayand lea.e in room for20 to 30 
minutes. Encourage dailyoral/phy.;ical h:,giene care. Change of dothingibedding . Offer BCX)ST and Pedil)le as ordered. Patient 
educated to possible Side Effeds of going for long period of time without food. Patient .erbali2es understanding of current Plan of 
Care. Patient .erbali,es his option to refuse food. 
Appointment Provlde~L.;. (b-'-)(.;... 6-'-'- ); _ ___.IRN 
Bectronically signed ~\~/\~L, 
Sign off status: Completed 
Fon 09/28/201814:53:10 (Pacific Daylig ht Time ) 
Northwest Detention Cente r 
1623 E. J STREEr 
T=WA9842 1 Tei}bif 6l ] 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 Prog,. .. Note b)(6); 09/28/2018 (L-.\ f ? \fr-\ 
Ncxe generated byeOirica/Wo-lcs e.R/PM ~e (w.w,eQ,,.c 
2019-ICLl-00051 3132 

DHS-ICE-19-0196, 19-0197-N-000314
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA .. A:21626980 2 Su:ll~b)(6 ); ! 
Fac1lrtyCode:CSOINWA ng,c;ea .lfi 
39 Y old Male, DOB: 10/23/1978 
AccOl.rll lunber:~ 
1623 E J STREET, T~ 
Appoirimert Facility. Northwest Detertion Certer 
09 /2812018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el, see attached ser.ing mi>l!ure order 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/20 18, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
Allergies 
NKDA 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fe'"'r denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbance denies. Weight gain denies. 
Weight loss denies. 
Appointment P1'ovlderi'_b=)(_6-); __ ~I RN t h\/7\/f"'\ . 
Reason for Appointment 
1. tvHU RN NIGHT ROUNDS/HUNGER STRIKE 
History of Present Illness 
Fiowsheets (tvHU): 
lnput/OJtput Fiowsheet 
Time: 0700 
INPUT PO: 1240 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT Other. 0 
INPUT SUBTOT/11.. : 0 
Ot.JliPUT Urine 0 
Ot.JliPUT Emesis 0 
Ot.JliPUT BM 0 
Ot.JliPUT a. Wet Diaper Weight 0 
Ot.JliPUT b. Dry Diaper Weight 0 
Ot.JliPUTTotal Diaper Weight output (calculate a-b) 0 
Ot.JliPUT Drain: 0 
Ot.JliPUT SUBTOT/11.. : 0 
NetGain: 0 
NetLoss: 0 
Initials: LDM 
Patient Identification: 
Patient Identification 
Patient prope~yidentified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
\M1at language do )OU speak? &Jglish, Russian 
Interpretation pro\aded? Patient speaks English ffuenUy 
Pain Assessment 
Pain 
Ne )OU currently in pain? No 
Narrati'"': 
PT IS ON OFFICLAL HUNGER S1RIKE T/!KlNG PO PEDLAL YTE AT 0500, N~ . !'ND BEDTI'-'E SEE OODER FOO MXING 
BOOST. PT IS SEEN DRINKING WATER. STATED THE DIAARHEAIS NOT PS OFTEN. 
Ex amina tion 
General B<amination: 
GENER/II.. !>PPE.ARMICE: in no acute distress, well del.eloped, well nourished. 
NEUROLOGIC: alert and oriented, coope,ati'"' Vlith exam, motor strength noonal upper and lovver extremities, noonal 
exam, noonal strength, tone and reflexes, sensory exam intact. 
Assessment s 
1. lneffecti'"' health maintenance - ND00099 (Primary) 
Treatment 
1. lneffectiw health maintenance 
Notes: Continue hunger strike protocol, encourage po food/tluids, encourage '"'rbaliiation offeelings. Encourage to allow staff to monitor intake and output, \atal signs, wt. Instructed to seek staff with any needs. Verbali,ed understanding. Detainee offered 
three meals per day and lea'"' in room for 20 to 30 minutes. A:lequate supply of drinking water and other be'"'rages as ordered 
by pro\ader available. Encourage dailyoral/phy.;ical h,giene care. Change of dothing,bedding . Ofer BOOST and Pedil~ as 
ordered. Do orthostatic \atals daily. Patient educated to possible Side Effects of going for long period of time without food. Patient 
'"'rba liies understanding of current Plan of Care. Patient '"'rbaliies his option to refuse food. 
Disposition: A:lmitted to tvHU until medicallye1,0luated 
Appointment Providerf ... ~ .. i'"' i~-"i l"-r:'-' . \ _ __.r 
Electronically signed b* b)(6); 
Sign off status: Completed 
FN on 09/28/2018 06:01:47 (Pacific Daylight Time) 
Northwest Detention Center 
1623 E J STREET 
T~A98421 Te1foj{6y ! 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 P.....,.. ~ 09/28/201 8 
Ncte generated by eC/inica!Wcxi<s EM<IPM Soflvere (""""eC/inica/Warks.com) 
2019-ICLl-00051 3133 

DHS-ICE-19-0196, 19-0197-N-000315
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3134 
AMAR,MERGENSANA .. A:216269802 Su:ll~ b)(6); I 
Facility Code: CSCN/1/WA 1119,. ea . 1t1 
39 Y old Mal~,· 
AccOl.rll llunber b 6 · 1623 E J STREET, T , 

DHS-ICE-19-0196, 19-0197-N-000316
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
.. A:216269802 Su:lli-:J(b)(6); 
Fac1lrtyCode:CSOINWA ng,c;ea . lfi 
39 Y ad ~:31~~~:::: 
1623 E J~= ~~~Mc: 1 
09 127/2018 
Curnont Medications 
Taking 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KCP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KCP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lra\el 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for tra'"'I 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed TIO, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required forlra\el , see attached ser.ing mi>l!ure order 
• Ensure High Protein- Liquid 1 Q-15, stop date 10/11/2018, KCP: 
No, Drug Source: In House Pharmacy, Notes: Not required for lra\el 
• Boost \A-IC - Liquid 0.5 ser.ing each mealtime TIO, stop date 
10/11/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for tra'"'I, please mixwith 4 ounces of water 
Allergies 
NKDA 
Review of Systems 
Hunger Strike: Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. Weightloss admits. Dry 
M::>uth denies. Weakness admits. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. Abdominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. 1,1:>mitting denies. Painful 
urination denies. Decreased urine output denies. MJsde 
adhes denies. MJsde cramps denies. Skin breakdown denies. 
Difficulty thinking denies. 
Appoirimert Facility. ~est Det~on Cert er 
Appointment Provlder:f b)(6) ; (b)(7)(C) 
Reason for Appointment 
1. PM SHIFT NOTE. Hunger Strike Nursing Ev.iluation 
History of Present Illness 
Fiowsheets (M-tU): 
Upon encounter detainee was resting quietlyin bed. Detainee reported weakness but refused any medical treatment 
Detainee water pitcher has been filled for him and he has been drinking Pedial)le and Boost and Ensure. Detainee has chosen 
to miss his 110th meal this e'"'ning-dinner. Detainee has gone back to resting quietly in his room. W II continue to monitor. 
Hungerstrike M::>nitoring Form 
Day: 09/27/2018 
Shift: PM 
Intake PO(in ml): 0 
Intake rl/- Normal Saline (in ml): 0 
Intake rl/- LR (in ml): 0 
Intake NG(in ml): 0 
QJtput Urine (in ml): 0 
PED/£_'~~; E°riZtk~EE REPr:RTS DRINKNG WAl'ER FRa..tH1s vW-111E cup AND HAS BEEN DRINKING BOOST, 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEOCEF/CER 
Wiat language do }OU speak? English 
Interpretation pro\aded? Pallent speaks English fluenUy DETAINEE SPO<E AND UNDERSTrX)() ENGLISH TOOAY 
Pain ffisessment 
Pain 
Ne }OU currently in pain? No 
Narrati'"': 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observ.ition, and monitoring. 
Hunger Strike: 
Nursing Ev.iluation 
\M1en did the official hunger strike begin? 08t25'2018 
Drinking Fluids: Yes 
Vital Signs 
97.8F 
standing:50 
supine:56 
sitting:58 
sta ndi ng:93/59 
supine:96/59 
sitting:93/60 
16/ min 
147.0 lbs 
66.5in 
23.37 Index 
Examination 
General Examination: 
Temo 
09/27/201805:11:00 PM 
1-R 
09/27/201805:17:55 PM 
09/27/201805:17:55 PM 
09/27/201805:17:55 PM 
BP 
09/27/201805:17:55 PM 
09/27/201805:17:55 PM 
09/27/201805:17:55 PM 
RR 
09/27/201805:11:00 PM 
WI 
09/27/201805:17:55 PM 
H 
09/27/201805:11:00 PM 
BMI 
09/27/201805:17:55 PM 
GENERJ>l /PPEAAPNCE: in no acute distress, well deleloped, well OOJrished. 
PSYCH: alert, oriented. 
Assessments 
/!I-Risk for imbalanced nutrition: Less than body requirements. 
Tr ea tment 
1. Others 
b)(6) ; (b)(7) (C) 
Notes: 1. Continue 1Mth \Alai Signs e'"'rys hift; Intake and QJtput M::>nitoring e1.eryshift; Dailyweights; Dailyor1hostatic I.ital signs. 
2. l'n adequate supply of drinking water and other be1.erages are av.iii able to patient at all times. 
3. Three meals per day are deli1.ered to the patient and deli'"'ryo f meals is documented. 
4. I'l l food not authoriied by CD~y.,ician is remo1.ed from patienrs room. 
5. Patient is not allowed to purchase food from commissar)l'\ending machine while on hunger strike. 
6. Patient will only be released from hunger strike treatment/monitoring by CD or phy.,ician order. 
7. Patient counseled regarding the medical risks of continuing the hunger strike. 
8. Encouraged to terminate the hunger strike and eat/drink as normal. 
Appointment Providefb )(6 ); (b)(7)(C) 
2019-ICLl-00051 3135 

DHS-ICE-19-0196, 19-0197-N-000317
Electronically signed by ~b)(6); (b )(7)(C) 
Sign off status: Completed 
r on 09/27/2018 18:05:21 (Pacific Daylight Time) 
Northwest Detention Center 
1623EJSTREI" 
T~WA98421 
TelJbjr RI I 
Fax: 
P• tl-t: AMAR, MERGENSANA DOB: 10/23/1978 p..._. ~b )(6); (b)(7)(C) 
Nd.e general.ed by eOinica/W<n<s B>RIPM Sottw,re (""""eC/inica/works.CtJm) 
I RN 09/27/2018 
2019-ICLl-00051 3136 

DHS-ICE-19-0196, 19-0197-N-000318
U.S. Immi gration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:llollh \In\ ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOllll lunber: f h \/R I· I 
1623 E J STREET, TACOMA, WA98421 
Cunent -dlcatlons 
Taking 
• Boost Plus - Liquid 1 llD PRN, stop date 10/19/2018, KCF. No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl 
• Calcium 500/D 500-200 M:;-UNITTablet 1 tablet with food Oice 
a day, KCF. Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Filed Dose Tablet 1 , KCF. Yes, Drug Source: 
Pharmacy 
• Fiber625 M3Tablet 1 tablet as needed Four times a day, KCF. 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 M:;-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCF. Yes, Drug Source: In House Pharmacy, 
Notes: Not required for trawl 
• Fiber625 M3Tablet 1 tablet as needed BID,stopdate 
10/26/2018, KCF. Yes, Drug Source: In House Pharmacy, Notes: 
Not required for trawl 
• Cholecalciferol 2000 UNIT Tablet 1 tablet a-IS, stop date 
10/26/2018, KCF. Yes, Drug Source: In House Pharmacy, Notes: 
Not required for trawl 
• Boost Glucose Control - Liquid 0.5 ser.ing mi-i llD , stop date 
10/26/2018, KCF. No, Drug Source: In House Pharmacy, Notes: Not 
required for trawl, see attached ser.ing mildure order 
......... 
N.KDA 
Reason for Appointment 
1. Clarify boost orders 
Treatment 
1. Others 
Stop Boost Plus Liquid,-, 1, Orally, llD PRN, 30day.;, 1, KCF. No, Drug Source: In House Pharmacy, Notes: Not required for 
trawl 
Start Ensure High Protein Liquid, -, 1, Orally, Q-1S, 14 day.;, 1, KCF. No, Drug Source: In House Pharmacy, Notes: Not required for 
trawl 
Start Boost 'vHC Liquid,-, 0.5 ser.ing each mealtime, Orally, llD , 14 day.;, 1, KCF. No, Drug Source: In House Pharmacy, Notes: 
Not required for trawl, please mixwith 4 ounces of water 
Tel: 
Fax: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progress Note: 
Ncle generated by e0irica/Wcv1<s EM<IPM Sofrv,,ere (w.w,eQinica/Works.co«4 
2019-iCU-0005 1 3137 

DHS-ICE-19-0196, 19-0197-N-000319
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:ll l .. lh ... \a,IR ... ,,... · ___,,,.,..... 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.ri funbe dw/b"'-lw/G"'")i..· __ _. 
1623 E J STREET, TACOMA, WA-98421 
Appoirimert Facility: Northwest Detertion Certe r 
09 127/2018 
Curnont Medications 
Taking 
• Boost Plus - Liquid 1 11D PRN, stop date 10/19/2018, KCF. No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl 
• Calcium 500/D 500-200 M:,-UNITTablet 1 tablet with food Cnce 
a day, KCF. Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 , KCF. Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCF. 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 M:,-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KCF. Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tralel 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KCF. Yes, Drug Source: In House Pharmacy, Notes: 
Not required for traw l 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCF. Yes, Drug Source: In House Pharmacy, Notes: 
Not required for traw l 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed 11D, stop date 
10/26/2018, KCF. No, Drug Source: In House Pharmacy, Notes: Not 
required fortralel, see attached ser.ing mi>l!ure order 
Alle'9leS 
NKDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness admits. 
Sleep Disturbance denies. Weightloss admits. Dry 
M:>uth denies. Weakness admits. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. Abdominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. 1,1:>mitbng denies. Painful 
urination denies. Decreased urine output denies. MJsde 
aches denies. MJsde cramps denies. Skin breakdown denies. 
Difficulty thinking denies. 
Appointment Provlde'1'.""' b"'")(-' 6-");...._ _ __.plN 
Rea son for Appointment 
1. RN Rounds 
History of Present Illness 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Time: 1500 
INPUT PO: 1450 
OUTPUTUrine 1450 
OUTPUTBM 0 
NetGain: 0 
Initials: LM 
Hungerstrike M:>nitoring Form 
Day. 09/27/2018 
Shift: AM 
Intake PO (in ml): 1450 pt v.as observed to drink v.ater from pitch 
Intake rl/- Normal Saline (in ml): 0 
Intake rl/- LR (in ml): 0 
Intake NG(in ml): 0 
OJtput Urine (in ml): 1450 
Comments: HE HAS BEEN DRINKING PED/AL YTE and 2 boost, pt drank about 2 cups of v.ater 
Initials: LM 
Patient Identification: 
Patient Identification 
Patient propeMyidentified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEO OFFICER 
IM1at language do )OU speak? Russian 
Interpretation pro\<ded? Provider fluent in patient's native language 
Pain l'ssessment 
Pain 
Ne )OU currently in pain? Yes 
The pain is located : back and legs 
The se1erityof pain is rated at 5110 
The se1erityof the pain is moderate 
The pain began 4-5 l\eeksago 
The character of the pain is aching 
The associated simptoms are v,eakness 
The pain is aggravated by other hunger s/Jike 
The pain is relie\ed by other 
Desai be: pt refused medication treatment 
Narrati1e: 
Patient is oonsidered to be on official hunger strike and will be isolated from other detainees for dose super.is ion, 
observation, and monitoring. 
Pl was in M-IU II/ED 2 Upon encounter detainee was resting quietly in bed and watch lV. Detainee reported weakness and 
pain on his legs and back , but refused any medical treatment He has been drinking Pedial)le and Boost WII oontinue to 
monitor. 
Detainee has missed his 109 meal this lunch. M:>st of the day pt was watching lV , reading book. and resting. WII oontinue to 
monitor. 
Hunger Strike: 
Nursing Evaluation 
IM1en did the official hunger strike begin? 08/25'2018 
Drinking Fluids: Yes 
11/eals deli1ered during shift: Lunch 
Lunch 0% oonsumed 
lnput/OJtput Entered below 
Vit al Sign s 
97.8F 
standing :50 
supine:56 
sitting:58 
sta ndi ng:93/59 
sitbng:93/60 
supine:96159 
16/ min 
147 lbs 
66.Sin 
23.37 Index 
Ex amination 
General Examination: 
Temo 
09127/2018 09:05:55 />M 
HR 
09/27/2018 09:05:55 />M 
09127/2018 09:05:55 />M 
09/27/2018 09:05:55 />M 
BP 
09127/2018 09:05:55 />M 
09/27/2018 09:05:55 />M 
09/27/2018 09:05:55 />M 
RR 
09/27/2018 09:05:55 />M 
Wt 
09/27/201801:13:15 PM 
H 
09/27/2018 09:05:55 />M 
BMI 
09/27/201801:13:15 PM 
GENERJ>l PPPEAAPNCE: in no acute distress, well de\eloped, well nourished. 
2019-ICLl-0005 1 3138 
(b)(6); (b)(?)(C) 

DHS-ICE-19-0196, 19-0197-N-000320
HEl'D: nonnocephalic. 
SKIN: normal, no rashes, no suspicious lesions. 
HEPRT: no mumiurs, regular rate and rhythm, S 1, S2 nom,al. 
LUNGS: normal, clear to auscultation bilaterally, no wheezes, rales, rhonchi. 
CHEST: normal, no gross rib defonnity, normal shape and expansion. 
J>BDOM:N: normal, bowel sounds present, soft, nontender, nondistended. 
MJSCULOSKELET/ll: normal, normal gait, no deformities, full range cl motion, . 
NEURQOGIC: alert and oliented, cooperati-e Vllith exam, , gait normal, neck supple, no rigidity, no tremor. 
PSYCH: alert, oliented, cogniti-e function intact, cooperati-e Vllith exam, good eye contact, judgement and insight 
good , mood/affect full range, no auditory or l.isual hallucinations, speech clear, thought content Vllithout suicidal ideation, 
delusions, thought process logical, goal directed. 
Assessments 
/>I-Risk for imbalanced nutrition: Less than body requirements. 
Tr ea tment 
1. Others 
Notes: 1. Continue with Othostatic I.ital Signs e-eryday, Intake and Q.ifput Mmitoring e1<aryshift; Dailyweights; 2. "'1 adequate 
supply of drinking water and other be1<arages are av.iii able to patient at all times. 3. Three meals per day are deli1<ared tothe 
patient and deli1<aryof meals is documented. 4. /Ill food not authori,ed by CD/Physician is remol.ed from patienfs room. 5. Patient 
is not allowed to purchase food from commissa')(l,ending machine while on hunger strike. 6. Patient will only be released from 
hunger strike treatment/monitoring by CD or physician order. 7. Patient counseled regarding the medical risks of continuing the 
hunger strike. 8. Encouraged to temiinate the hunger strike and eat/drink as nomial. Continue hunger strike protocol, encourage 
po food/fluids, encourage 1<arbali2ation of feelings. Encourage to allow staff to monitor intake and output, 1.1tal signs, wt. Instructed 
to seek staff with any needs. Verbali,ed understanding. Detainee offered three meals perdayand lea1<a in room for20 to 30 
minutes. Encourage dailyoral/physical h)!liene care. Change of clothing/bedding . Ofer 8CXJST and Pedil)te as ordered. Patient 
educated to possible Side Effecis of going for long period of time without food. Patient 1<arbali2es understanding of current Plan of 
Care. Patient 1<arbali,es his option to refuse food. 
Appointment Provi4(b)(6); (b)(?)(C) r 
Bectronically signed b!.,_ (b...:}.,_(6_.)._; __ _.fN on 09/27/20181 5:03:11 (Pacific Daylight Time) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREEr 
TACOMA, WA98421 
TelJ(b ((!iJ_; ! 
Patient: AMAR, MERGENSANA DOB: 10/2 3/19 78 Progre .. No~~(b_)_(6_)_; --~IRN 09/27/2018 
Ncte generated byeOinica!Wai<s ElvRIPM &JtvHe (....weC/inicl!iWc.-ks.com) 
2019-ICLl-00051 3139 

DHS-ICE-19-0196, 19-0197-N-000321
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA A: 216269802 Su:lllfb )(6): ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll ~berftimii:7 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
09 127/2018 
Curnont Medication s 
Taking 
• Boost Plus - Liquid 1 11D PRN, stop date 10/19/2018 , KCF. No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl 
• Calcium 500/D 500-200 M:,-UNITTablet 1 tablet with food Cnce 
a day, KCF. Yes, Drug Source: Pharmacy 
• Prenatal \Alamin Flied Dose Tablet 1 , KCF. Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KCF. 
Yes, Drug Source: Pharmacy 
• Calcium 500/D 500-200 M:,-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018 , KCF. Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lralel 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018 , KCF. Yes, Drug Source: In House Pharmacy, Notes: 
Not required for trawl 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018 , KCF. Yes, Drug Source: In House Pharmacy, Notes: 
Not required for trawl 
• Boost Glucose Control - Liquid 0.5 ser.ing mi>ed 11D, stop date 
10/26/2018 , KCF. No, Drug Source: In House Pharmacy, Notes: Not 
required forlralel, see attached ser.ing mi>l!ure older 
Alla .... . 
NKDA 
Revie w of Syst ems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fewr denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbance denies. Weight gain denies. 
Weight loss denies. 
Reas on for Appointm ent 
1. tvHU RN NIGHT ROUNDS/HUNGER STRIKE 
History of Prese nt Illne ss 
Fiowsheets (tvHU): 
lnput/OJtput Fiowsheet 
Time: 0700 
INPUT PO: 1240 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT Other. 0 
INPUT SUBTOT/11.. : 0 
OUTiPUT Urine 0 
OUTiPUT Emesis 0 
OUTiPUTBM 0 
OUTiPUT a. Wet Diaper Weight 0 
OUTiPUT b. D,y Diaper Weight 0 
OUTiPUTTotal Diaper Weight output (calculate a-b) 0 
OUTiPUTDrain: 0 
OUTiPUT SUBTOT/11.. : 0 
NetGain: 0 
NetLoss: 0 
Initials: LDM 
Patient Identification: 
Patient Identification 
Patient prope~yidentified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
\M1at language do )OU speak? &Jglish, Russian 
Interpretation pro\aded? Patient speaks English ffuenUy 
Pain Assessment 
Pain 
/l<e )OU currently in pain? No 
Narratiw: 
Appointm e nt Provid er: Lou ise D May , RN 
PT IS ON OFFICLAL HUNGER S1RIKE T/!KlNG PO PEDLAL YTE AT 0500, N~ . !'ND BEDTI'-'E SEE OODER FOO MXING 
BOOST. PT IS SEEN DRINKING WATER. STATED THE DIAARHEAIS NOT PS OFTEN. 
Ex amina tion 
General B<amination: 
GENER/II.. !>PPE.ARMICE: in no acute distress, well del.eloped, well nourished. 
NEUROLOGIC: alert and oriented, coope,atiw Vlith exam, motor strength normal upper and lovver extremities, normal 
exam, normal strength, tone and reflexes, sensory exam intact. 
Assessme nt s 
1. lneffectiw health maintenance - ND00099 (Primary) 
Tre a tment 
1. lneffectiw health maintenance 
Notes: Continue hunger strike protocol, encourage po food/tluids, encourage wrbaliiation offeelings. Encourage to allow staff to 
monitor intake and output, \atal signs, wt Instructed to seek staff with any needs. Verbali,ed understanding. Detainee offered 
three meals per day and leaw in room for 20 to 30 minutes. A:lequate supply of drinking water and other bewrages as ordered 
by pro\ader available. Encourage dailyoral/phy.;ical h,giene care. Change of dothing,bedding . Ofer BOOST and Pedil~ as 
oidered. Do orthostatic \atals daily. Patient educated to possible Side Effects of going for long period of time without food. Patient 
wrba liies understanding of current Plan of Care. Patient wrbaliies his option to refuse food. 
Disposition: A:lmitted to tvHU until medicallye1,0luated 
Appo intment Provide!"- (b'-)('-6;.;.) ; ---'~ 
Electronically signed f b)(6); ~-
Sign off status: Completed 
IRN on 09/27/20 18 05:34:41 (Pacific Daylight Time) 
Northwest Detention Center 
1623 E J STREET 
TACOMA, WA98421 
Telkbl(6) : FaX. 
Patient: AMAR, MERGENSANA DOB: 10/2 3/1978 P.....,.. ~ 09/27 /20 18 
Ncte generated by eC/inica!Wcxi<s EM<IPM Soflvere (""""eC/inica/Warks.com) 
2019-ICLl-00051 3140 

DHS-ICE-19-0196, 19-0197-N-000322
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3141 
AMAR,MERGENSANA 
A: 216269802 Su:i1ot (b )(6): I 
Facility Code: CSONVWA Housing Ai'ea: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll llunber C .. ::-:::: --:::- ==::i 
1623 E J STREET, TACOMA, WA98421 

DHS-ICE-19-0196, 19-0197-N-000323
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 21626980 2 Su:llDt(h \In\ ! 
Facility Code: CSONVWA Housing Area: M 
39 Y Acca.nt ad ~:~r~ ~ J>(6)C :~ 1 
09 /2612018 
Curnont Medication s 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Boost Plus - Liquid 1 110 PRN, stop date 10/19/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl 
• Calcium 500/0 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KOP: Yes, Drug Source: Pharmacy 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes, Drug Source: 
Pharmacy 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes, Drug Source: Pharmacy 
• Calcium 500/0 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for lrale l 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for traw l 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KCP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for traw l 
• Boost Glucose Control - Liquid 0.5 senAng mi>ed 110, stop date 
10/26/2018, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for trawl, see attached senAng mildure order 
Allergie s 
NKDA 
Review of Syste ms 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. Weight loss admits. Dry 
M:>uth denies. Weakness admits. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. Abdominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. 1,1:>mitbng denies. Painful 
urination denies. Decreased urine output denies. MJsde 
aches denies. MJsde cramps denies. Skin breakdown denies. 
Difficulty thinking denies. 
1623 E J STREET, T v 
Appoimnert Facility: Northwest Detertion Certer 
Appoin t ment Provld e i b)(6) ; (b)(?)(C) 
Reas on for Appointm ent 
1. PM SHIFT NOlE. Hunger Strike Nursing E1,0luation 
History of Pre se nt Illne ss 
Flowsheets (MHU): 
Upon encounter detainee was resting quietly in bed. Detainee reported weakness but refused any medical treatment 
Detainee water pitcher has been filled for him and he has been drinking Pedial)le and Boost and Ensure. Detainee has chosen 
to miss his 107th meal this ewning-dinner. Detainee has gone back to resting quietly in his room. WII continue to monitor. 
Hungerstrike M:>nitoring Form 
Day. 09/26/2018 
Shift: PM 
Intake PO(in ml}: 0 
Intake rl/- Normal Saline (in ml}: 0 
Intake rl/- LR (in ml}: 0 
Intake NG(in ml): 0 
QJtput Urine (in ml): 0 
Comments: WATER PITCHER WAS FILLED FCR HI MAND HE HAS BEEN DRINKING PED/AL YTE 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEOCEF/CER 
Wiat language do }OU speak? English 
Interpretation pro\aded? Pallent speaks English fluenUy DETAINEE SPO<E AND UNDERSTCX)() ENGLISH TCOAY 
Pain />ssessment 
Pain 
/l<e }OU currently in pain? No 
Narratiw: 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose supenAsion, 
obseMtion , and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/220)18 
\M1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/220)18 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: 11\ants to be released from custody 
Pdequate supply of drinking water and other be-erages a1,0ilable: Yes 
Three meals deliwred per day to patient Yes 
/lnyunauthori>edfood inroom? No 
Haw dailyorlhostatic ,..131 signs been completed? Yes 
Has input and output been documented on the the M-IU Hunger Strike M:>nitoring Smart Form? Yes 
Vit a l Signs 
Temo 
97.SF 09/26/201805:35:42 PM 
HR 
standing:62 09/26/201805:35:42 PM 
sitting:48 09/26/2018 05:35:42 PM 
supine:45 09/26/201805:35:42 PM 
BP 
standing:89153 09/26/2018 05:35:42 PM 
sitting:94/59 09/26/201805:35:42 PM 
supine:93158 09/26/201805:35:42 PM 
RR 
16 /min 09/26/201805:31:21 PM 
WI 
1442 lbs 09/26/201805:35:42 PM 
H 
66.5in 09/26/201805:31:21 PM 
BMI 
22.92 Index 09/26/201805:35:42 PM 
Ex a min atl on 
General Examination: 
GENERJ>l /lPPEAAPNCE: in no acute distress, well del.eloped, well !Xlllrished. 
PSYCH: alert, oriented. 
Assess ments 
/>I-Risk for imbalanced nutrition: Less than body requirements. 
Tr ea tm ent 
1. Others 
(b)(6); (b)(?)(C) 
Notes: 1. Continue 1Mth \.ital Signs e-eryshift; Intake and QJtput M:>nitoring e-eryshift; Dailyweights; Dailyorlhostatic I.ital signs. 
2. /In adequate supply of drinking water and other be-erages are a1,0ilable to patient at all times. 
3. Three meals per day are deli sered to the patient and deli-eryof meals is documented. 
4. /11 food not authori>ed by CD~y., ician is remo-ed from patienrs room. 
5. Patient is not allowed to purchase food from commissar)ll.ending machine while on hunger strike. 
6. Patient will only be released from hunger strike treatment/monitoring by CD or phy.,ician order. 
7. Patient counseled regarding the medical risks of continuing the hunger strike. 
2019-ICLl-00051 3142 
I 

DHS-ICE-19-0196, 19-0197-N-000324
8. Enoouraged to terminate the hunger strike and eat/drink as normal. 
Appointment Provide1 (b)(6); (b)(7)(C) 
Electronically signed b~(b)(6); (b)(7)(C) 
Sign off status: Completed 
IRN on 09/26/2018 17:39:46 (Pacific Daylight Time) 
Northwest Detention Center 
1623 E. J STREEr 
T~r98421 Te½{~£- - i 
Pali-t: AMAR, IIERGENSANA DOB: 10/23/1978 P....,... itotj(b)(6); (b)(7)(C) r -1 • 
N(xe gener8led by eOinica!Wcxi<s EJvR'PM Softvere (-eC/inica/Wcn<s .com) 
2019-ICLl-00051 3143 

DHS-ICE-19-0196, 19-0197-N-000325
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:llct b )/6\ ! 
Facility Code: CSONVWA Housing Area: M 39 Y old Male, DOB: 10/23/1978 
AccOl.lll ~ )(6); 
09 /2612018 
Cunont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Boost Plus - Liquid 1 110 PRN, stop date 10/19/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl 
• Calcium 500/0 500-200 lliG-UNITTablet 1 tablet with food Cnce 
a day, KOP: Yes 
• Prenatal \Atamin Flied Dose Tablet 1 , KOP: Yes 
• Fiber625 t..GTablet 1 tablet as needed Four times a day, KOP: 
Yes 
Alla ..... 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness admits 
Sleep Disturbance denies. \Neight loss admits Dry 
M:>uth denies. \Neakness admits Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. Abdominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. 1,1:>mitbng denies. Painful 
urination denies. Decreased urine output denies. MJsde 
adhes denies. MJsde cramps denies. Skin breakdown denies. 
Difficulty thinking denies. 
1623 E J STREET, T VVM842 I 
Appoimnert Facility: Northwest Detertion Cert er 
Reas on for Appointment 
1. RN Day shift rounds/Hunger Strike 
History of Pre se nt Illness 
Flowsheets (M-tU): 
lnput/OJtput Flowsheet 
Time: 1505 
INPUT PO: 2000 
OUTPUT Urine 1000 
OUTPUTBM 0 
Net Gain: 1000 
Initials: LM 
Hungerstrike Mln itoring Form 
Day. 09/26/.2018 
Shift: AM 
Intake PO (in ml}: 2000 pt v.as observed to drink v.aterfrom pitch 
Intake rl/- Normal Saline (in ml}: 0 
Intake rl/- LR (in ml}: 0 
Intake NG(in ml): 0 
OJtput Urine (in ml): 1000 
Appointment Provlde~ (b)(6) ; ~-
Comments: HE HAS BEEN DRINKING PED/AL YTE and 2 boost, pt drank about 2 cups of v.ater 
Initials: LM 
Patient Identification: 
Patient Identification 
Patient propeMyidentified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEO OFFICER 
IM1at language do )OU speak? Russian 
Interpretation pro\<ded? Provider fluent in patient's native language 
Pain l'ssessment 
Pain 
l'<e )OU currently in pain? Yes 
The pain is located _. back and legs 
The se1erityof pain is rated at 5110 
The se1erityof the pain is moderate 
The pain began 4-5 l\eeksago 
The character of the pain is aching 
The associated symptoms are v,eakness 
The pain is aggravated by other hunger s/Jike 
The pain is relieled by other 
Describe: pt refused medication treatment 
Narratiw: 
Patient is oonsidered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Pl was in M-IU II/ED 2 Upon encounter detainee was resting quietly in bed and watch lV. Detainee reported weakness and 
pain on his legs and back , but refused any medical treatment He has been drinking Pedial)le and Boost Pt stated that he has 3 
lose stols, after each boost drink on past day. \MIi oontinue to monitor. 
Detainee has missed his 106 meal this lunch. Mist of the day pt was watchinglV and resting. Pt went to reek )0rd at 13:50 
and return at 14:59. IMII oontinue to monitor. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
\M1en did the official hunger strike begin? 08/25'2018 
Date oflast meal oonsumed: 08/22/2018 
Last meal oonsumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: W..nts to be released from custody 
/1<:!equate supply of drinking water and other be-erages available: Yes 
Three meals deli1ered per day to patient Yes 
Lunch deliwred during current shift 0% oonsumed 
/lnyunauthori>edfood inroom? No 
Hale dailyoMhostatic \<lal signs been oompleted? Yes 
Has input and output been documented on the the M-IU Hunger Strike Mlnitoring Smart Form? Yes 
Vital Signs 
97.8F 
standing:62 
sitting:48 
supine:45 
standing:89/53 
sitting:94/59 
supine:93/58 
16/ min 
1442 lbs 
66.5in 
22.92 Index 
Ex amination 
General Examination: 
Temp 
09/26/2018 10:51 :33 /'M 
HR 
09/26/2018 10:51 :33 /'M 
09/26/2018 10:51 :33 /'M 
09/26/201810:51:33 /'M 
BP 
09/26/2018 10:51 :33 /'M 
09/26/201810:51:33 /'M 
09/26/2018 10:51 :33 /'M 
RR 
09/26/201810:51:33 /'M 
1M 
09/26/2018 10:51 :33 /'M 
ti 
09/26/2018 10:51 :33 /'M 
BMI 
09/26/201810:51:33 /'M 
GENER/II. i>PPE.ARPNCE: in no acute distress , well del.eloped, well rKJUrished. 
HE.AD: norrnocephalic. 
SKIN: normal, no rashes, no suspicious lesions. 
HEPRT: no murmurs, regular rate and rhythm, S 1, S2 normal. 
2019-ICLl-00051 3144 
b)(6); ~ b)(7)(C) -
-
Us 
Us 
Us 
-
-
Us 
N 
Us 
-
-
Us 
-
~ 
-
-
N 
-
-
~ 

DHS-ICE-19-0196, 19-0197-N-000326
LUNGS: normal, clear to auscultation bilaterally, no wieezes, rales, rhonchi. 
CHEST: normal, no gross rib deformity, normal shape and expansion. 
/18D0\,EN: normal, bowel sounds present, soft, nontender, nondistended. 
MJSCULOSKELET.i>l: normal, normal gait, no deformities, full range ri motion, . 
NEUROLOGIC: alert and oriented, cooperati,e V>ith exam, , gait normal, neck supple, no rigidity, no tremor. 
PSYCH: alert, oriented, cogniti,e function intact, cooperati,e V>ith exam, good eye contact, judgement and insight 
good, mood/affect full range, no auditory or l.isual hallucinations, speech clear, thought content V>ithout suicidal ideation, 
delusions, thought process logical, goal directed. 
Assessment s 
/>!-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: 1. Continue with Othostatic \.ital Signs e1.eryday, Intake and Oitput Mmitoring e1.eryshifl; Dailyweights; 2. "'1 adequate 
supply of drinking water and other be1.erages are available to patient at all times. 3. Three meals per day are deli1.ered to the 
patient and deli1.eryof meals is documented. 4. ~ I food not authori2Bd by CD/Physician is remo\ed from patienfs room. 5. Patient 
is not allowed to purchase food from commissary,ending machine while on hunger strike. 6. Patient will only be released from 
hunger strike treatment/monitoring by CD or physician order. 7. Patient counseled regarding the medical risks of continuing the 
hunger strike. 8. Encouraged to terminate the hunger strike and eat/drink as normal. Continue hunger strike protocol, encourage 
po foodl!luids, encourage 1.erbalization a/feelings. Encourage to allow staff to monitor intake and output, '1tal signs, wt. Instructed 
to seek staff with any needs. Verbali21ld understanding. Detainee offered three meals perdayand lea1.e in room for20 to 30 
minutes. Encourage dailyoral/physical h19iene care. Change of clothing/bedding . a!er BCX)ST and Pedil)le as ordered. Patient 
educated to possible Side Effects of going for long period of time without food. Patient 1.erbali2es understanding of current Plan of 
Care. Patient 1.erbali2es his option to refuse food. 
Appointment Provide (b )(6); RN fh\f ? \tr'\ 
Electronically signed b (b)(6); •l.:ah .-\1_.7"'\ .. II'_ \.____. on 09/26/20181 5:05 :29 (Pacifi c Daylig ht Time ) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J SmEEr 
TACOMA. WA 98421 
TelJ(b )(6) I rax. 
Patient: AMAR, MERGENS.ANA DOB: 10/23/1 9 78 Progrw .. Note=~kb~)~(6~); __ ~~ 09/26/2018 
N(te genertKed by eOinica!Wcn<s EM<IPM Sottve,-e (""""eC/inica/Wcn<s.com) 
2019-ICLl-0005 1 3145 

DHS-ICE-19-0196, 19-0197-N-000327
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 21626980 2 51.tillkb )(6); I 
Facility Code: CSONVWA Housing Area: M 
Acc01.111 ~beb)I5C I 39 Y ad ~~ f!::: 
09 /2612018 
Curnont Medication s 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Boost Plus - Liquid 1 110 PRN, stop date 10/19/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl 
• Calcium 500/D 500-200 lliG-UNITTablet 1 tablet with food BID, 
stop date 10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for tralel 
• Fiber625 t..G Tablet 1 tablet as needed BID, stop date 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for traw l 
• Cholecalciferol 2000 UNIT Tablet 1 tablet Q-15, stop date 
10/26/2018, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for traw l 
• Boost Glucose Control - Liquid 1/5110, stop date 10/26/2018, 
KOP: No, Drug Source: In House Pharmacy, Notes: Not required for 
trawl; to be mi>ed equal parts, water, and boost \+IC 
Allergie s 
NKDA 
Review of Syste ms 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. Weightloss admits. Dry 
M:>uth denies. Weakness admits, but lessened. Slhortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. Abdominal Pain denies. Diarrhea denies. 
Nausea denies. \l:>mitting admits. Painful urination denies. 
MJsde aches impm.ed. Skin breakdown denies. Difficulty 
thinking denies. 
1623 E J STREET, T 
Appoimnert Facility: Northwest Detertion Cert er 
Aflpolntment Provld e rf b)(6) ; (b)(7)(C) I MD 
Re a son for Aflpolntment 
1. Hunger Strike 
History of Pre se nt Illne ss 
Flowsheets (M-tU): 
Pt has been drinking the new boost mi>dure that ccntains higher protein and less sugar with improwd response in his 
diarrhea. He is instructed to haw water mi>ed for dilution and for him to drink it slowly. He is doing well with improwd energy and 
strength. He has been walking to rec yard not requiring anywheelchair. He has been to the law library and has an upccming 
appointment1Mth an attorney scheduled. He is in improwd spirits. His prealbumen has also improwd from prei,ous. Ptwill stay 
on this schedule for the ne>I weeks as tolerated. 
Hungerstrike M:mitoring Form 
Day. 09/26/2018 
Shift: AM 
Intake PO(in ml}: 2500aboufr 2 literofelectro/yte solution, di/utedd boost mixture, and ensure 
Intake rl/- Normal Saline (in ml}: 0 
OJ!put Urine (in ml): 0 pt seen voiding, and UA obtained 
OJ!put Bowel M:>wments (in ml): 0 
Labs - Urine Ketones: Neg 
Labs - Sodium: 
Initials: SM 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
W1at language do )OU speak? Russian 
Interpretation pro\aded? Patient speaks English ffuenUy 
Pain Assessment 
Pain 
l'<e )OU currently in pain? No 
Narratiw: 
Hunger Strike: 
~ ical E~ luation 
Date missed meals monitoring initiated: 08/22/2018 
\M1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal ccnsumed: Breakfast 
Drinking fluids: Yes 
# of dai,s on hunger strike: 32 
Total Weight loss in pounds: 18 
Reason for hunger strike: Wcints to be released from custody 
Housingllsolation Location: M,dical Housing Unit 
Reason for Isolation Placement For dose supervision, observaflon, and monitoling 
Re\aew of the Housing Placement Review housing e11e,y 24 hours 
Vit a l Sign s 
Temo 
97.8F 09/28/201810:17:27 PM 
(b)(6); 
(b)(7)(C) 
1-R 
48/m in 09/28/201810:17:27 PM 
BP 
94/59 mm Hg 09/28/201810:17:27 PM 
RR 
16/ min 09/28/201810:17:27 PM 
wt 
144.2 lbs 09/28/201810:17:27 PM 
Pas tOrde n 
Lab:lSH - 004259 l():der Date - 0912112018) /Collection Date - 09/2112018} 
Result: \/\,NL 
TSH 0.977 
Lab:Prealbumin - 016931 (Qder Date - 0912112018) <Collection Date - 0912112018) 
Result: improled , \/\,NL 
0.450-4.500 - ufU/trL 
Prealbumin 24 14-35 - nw dL 
Notes: edinicalworks, support 09126/2018 06:09:00 : This order was created bythe Interface. 
Lab:\Atamin B12 -001503 /Qder Date - 09/2112018) /Collection Date - 09121/2018} 
Result: \/\,NL 
Vitani n 812 1294 H 232-1245. pg/mL 
Lab:CBC Wlh Differential/Platelet- 005009 !Qder Date - 0912112018} /Collection Date - 09/2112018} 
Result: \/\,NL 
bmnture Granulocytes 
lmmture Grans (Abs) 
Baso (Absolute) 
Neutrophils (Absolute) 
Hermglobin 
Morocytes(Absolute) 
RBC 
Eos (Absolute) 
Herrotocrit 
MCV 
2019-ICLl-00051 3146 
0 
0.0 
0.0 
2.4 
13.7 
0.3 
4.64 
0.2 
41.0 
88 
Not Estab. - % 
0.0-0.1 - xI0E3/uL 
0.0-0.2 - x!0E3/uL 
1.4-7.0 - x!0E3/uL 
13.0- 17.7- gldL 
0.1-0.9 - x!0E3/uL 
4.14-5.80 - x!0E6/uL 
0.0-0.4 - xI0E3/uL 
37.5-51.0 - % 
79-97 - 0... 

DHS-ICE-19-0196, 19-0197-N-000328
MCH 29.5 26.6-33.0 - pg 
MCHC 33.4 31.5-35.7 - gldL 
RDW 14.4 12.3-15.4- % 
Lyirphs (Absolute) 1.7 0.7-3. 1 - xl0E3/uL 
Neutrophils 52 Not Estab. - % 
Lyirphs 37 Not £stab. - % 
Morocytes 7 Not £stab. - % 
Eos 4 Not Estab. - % 
Basos 0 Not £stab. - % 
WBC 4.6 3.4- 10.8 - xI0E3/uL 
Platelets 187 150-379 - xI0E3/uL 
Lab:Comprehensi1.e rv'etabolic Panel (14) CM' - 322000 (Oder Date - 0912112018) (Collection Date - 0912112018) 
Result 1/1,NL 
eGFR If Afiicn Am 126 >59 - ml.Jmirvl . 73 
eGFR JfNonAJiicn Am I 09 >59 - ml.Jmirvl.73 
AIG Ratio 2.0 1.2-2.2 -
ALT (SGPT) 40 0-44 - IU/L 
AST (SG01) 33 0-40 - TU/L 
Bilirubin, Total 0.2 0.0- 1.2 - ajdL 
Globulin, Total 2.0 1.5-4.5 - gldL 
Albtmill 4.0 3.5-5.5 - gldL 
Protein, Total 6.0 6.0-8.5 - gldL 
Calcitm 9.0 8.7- 10.2 - tTlidL 
Chloride, Senm 103 96- 106 - mmVL 
Potassitnn 4.1 3.5-5.2 - mmVL 
Soditnn 143 134-144-mmVL 
BlJN/Creatinine Ratio 7 L 9-20 -
Creatinirc 0.86 0. 76-1.27 - ajdL 
BUN 6 6-20 - ajdL 
Glucose 102 H 65-99 - nwdL 
Carbon Dioxide, Total 28 20-29 - mmoVL 
Alkaline Phosphatase 52 39- I 17 - IU/L 
Lab:\Atamin D 25-H\droxy- 081950 CO'der Date - 0912112018) (Collection Date - 0912112018) 
Result: low 
Vitarrin D, 25-Hydroxy 26.8 L 30.0-100.0 - ng/mL 
Lab:Varicella-Zoster V /lb lgG- 096206 (Oder Date - 0912112018) /Collection Date - 0912112018) 
Result: immune 
Varice!la Zoster IgG 237 lmnine > I 65 - index 
Examinatio n 
General Examination: 
GENERJ>l /PPEAAPNCE: pt alert and oriented , , in no acute distress, looking -ery fatigued. 
ORPl. CAvlTY: mucosa moist, no lesions. 
SKIN: normal, no rashes, good turgor. 
HEl'RT: regular rate and rhythm. 
LUNGS: good air rr<)l.ement, no 'Aheezes, rales, rhonchi. 
MJSCULOSKELET/>L: muscles are atrophic but less lender and walks to his appointments. 
PSYCH: cogniti1.e function intact, cooperati1.e 1Mth exam, good eye contact, speech clear, thought content IMlhoot 
suicidal ideation, delusions, no auditory or IASual hallucinations. 
no problem IMlh " tals, no S)lllptoms from bradyeardia and BP impro.ed. 
Assessmen ts 
1. Stanetion, subsequent encounter - 173.0X><D (Primary) 
2. Imbalanced nutrition: Less than body requirements [00002]- ND00002 
Self-imposed Hunger strike. 
Trea tm ent 
1. Starvation, subsequent encotrter 
Stop Boost Glucose Control Liquid,-, 1/5, Oa lly, llD , 30 day;, 1, KCP No, Drug Source: In House Phannacy, Notes: Not required 
for tra1.el; to be mi>ed equal parts, water, and boost IA-IC 
Start Boost Glucose Control Liquid,-, 0.5 seNng mi>ed, Oa lly, llD , 30 day;, 1, KCP No, Drug Source: In House Phannacy, 
Notes: Not required for tra1.el, see attached seNng mildure order 
Notes: Nurses to gi1.e one Ensure high protein qhs daily for neld two weeks 
Nurses to mix1/2 seNing of Boost IA-IC, and 112 seNng of Glucose control Boost1Mth 4 ounces of water for total of 
appro~ mately 12 oz seN ng as llD. 
2. Imbalanced nutrition: Less than body req.iremerts (00002] 
Notes: \Alamin D and calcium IMlh fiber ha,e been ordered. He recei,es adequately,,.tamins from his boost and other 
supplements. 
Fo llow Up 
daily 
Notes: /lPP will be checking on this detainee. Pt is to let nurse know if diarrhea returns or new s)lllploms arise. He is educated 
on dangers of hunger strike. 
Appo intment Provicte,fb)(6); (b)(7)(C) IMD ,-
(b}(6); (b)(7)(C) 
Electronically signed b (b)(6); (b)(7)(C) Don 09/2812018 22:23:08 (Pacific Daylight Time) 
Sign off status: Comp le 
1 _________ _ 
--------------------~ 
2019-ICLl-00051 3147 

DHS-ICE-19-0196, 19-0197-N-000329
Northwest Detention Center 
1623 E J STREET 
1: WA98421 
Tel (b)/6) 
x: 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 ProgNu Nota /b )/6): (b \(7\(C\ ! 11D 09/28/2018 
Ncl.e general.ed by eOinicat'Mrks a.R/PM Sottv.ere (VM.WeC/inica/works.coojl 
2019-ICLl-00051 3148 

DHS-ICE-19-0196, 19-0197-N-000330
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A:216269802 Su:lloj/h\/R\· ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II l'unbe~ b ~ I 1623 E J STREET, Tm ...; ,41 042 1 
09 /2612018 
Curnont Medication s 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
traw l, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for traw l, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Boost Plus - Liquid 1 110 PRN, stop date 10/19/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl 
Alla .... . 
N.KDA 
Review of Syst ems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fewr denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbance denies. Weight gain denies. 
Weight loss denies. 
Reas on for Appointm ent 
1. tvHU RN NIGHT ROUNDS/HUNGER STRIKE 
History of Pre se nt Illne ss 
Flowsheets (tvHU): 
lnput/OJtput Flowsheet 
Time: 0700 
INPUT PO: 750 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT Other. 0 
INPUT SUBTOT/11.. : 0 
OUTiPUT Urine 0 
OUTiPUT Emesis 0 
OUTiPUTBM 0 
OUTiPUT a. Wet Diaper Weight 0 
OUTiPUT b. D,y Diaper Weight 0 
OUTiPUTTotal Diaper Weight output (calculate a-b} 0 
OUTiPUTDrain: 0 
OUTiPUT SUBTOT/11.. : 0 
Net Gain: 0 
NetLoss: 0 
Initials: LDM 
Patient Identification: 
Patient Identification 
Patient prope~yidentified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
\M1at language do )OU speak? &Jglish, Russian 
Interpretation pro\aded? Patient speaks English ffuenUy 
Pain Assessment 
Pain 
Ne )OU currently in pain? No 
Narratiw : 
Appoimne rt Facility: Northwest Detertion Cert er 
Appointment P1'ovlde,f b)(6): (b)(?)(C) ~N 
PT IS ON OFFICLAL HUNGER S1RIKE T/!KlNG PO PEDLAL YTE /IND B(X)ST AT 0500, N~ , /IND BEDTIM=. PT IS SEEN 
DRINKING WATER BUT DOES NOT /!OMT HOWMJCH. 
Exam ination 
General B<amination: 
GENER/II.. !>PPE.ARMICE: in no acute distress, well del.eloped, well nourished. 
NEURQ OGIC: alert and oriented, coope,atiw Vlith exam, motor strength nonmal upper and lovver extremities, nonmal 
exam, nonmal strength, tone and reflexes, sensory exam intact. 
Assess ment s 
1. lneffectiw health maintenance - ND00099 (Primary) 
Tre atment 
1. lneffectiw health maintenance 
Notes: Continue hunger strike protocol, encourage po food/tluids, encourage wrbaliiation offeelings. Encourage to allow staff to 
monitor intake and output, \atal signs, wt Instructed to seek staff with any needs. Verbali,ed understanding. Detainee offered 
three meals per day and leaw in room for 20 to 30 minutes. A:lequate supply of drinking water and other bewrages as ordered 
by pro\ader available. Encourage dailyoral/phy.;ical h,giene care. Change of dothing,bedding . Ofer B(X)ST and Pedil)le as 
ordered. Do orthostatic \atals daily. Patient educated to possible Side Effects of going for long period of time without food. Patient 
wrba liies understanding of current Plan of Care. Patient wrbaliies his option to refuse food. 
Disposition: A:lmitted to tvHU until medically evaluated 
Appointment Providef b)(6); ~-
Electronically signed bi{ b)(6); _ 
Sign off status: Completed 
FN on09/26/2018 05:48:20 (Pacific Daylight Time) 
Northwest Detention Cente r 
1623 E J STREET T~i~f oo12• 1 
Patient: AMAR, MERGENSANA DOB: 10/2 3/1978 P.....,.. Not.j,_(b_)_(6_); __ _.I RN 09/2e/201 8 
Ncte generated by eC/inica!Wcxi<s EM<IPM Soflvere (""""eC/inica/Warks.com) 
2019-ICLl-00051 3149 

DHS-ICE-19-0196, 19-0197-N-000331
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3150 
AMAR,MERGENSANA 
A: 216269802 &t,ll>j,o_ HM · 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, ~1JUr£J119ZB 
AccOl.l"II llunbe h · I 
1623 E J STREET, TACOMA, WA98421 

DHS-ICE-19-0196, 19-0197-N-000332
U.S. Immi gration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 51.till:f h \/R \ · I Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunbe ~ 
1623 E J STREET, T~ 
Appoirimert Facility: Northwes t Detertion Cert er 
09 12512018 
Cunont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Boost Plus - Liquid 1 110 PRN, stop date 10/19/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fewr denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbance denies. Weight gain denies. 
Weight loss denies. 
Reason for Appointment 
1. tvHU Ev£ RN ROUNDS SPLIT SHIFT 
History of Present Illness 
Flowsheets (tvHU): 
lnput/OJtput Flowsheet 
Time: 2100 
INPUT PO: 490 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT Other. 0 
INPUT SUBTOT/11.. : 490 
OUTiPUT Urine 0 
OUTiPUT Emesis 0 
OUTiPUTBM 0 
OUTiPUT a. Wet Diaper Weight 0 
OUTiPUT b. Dry Diaper Weight 0 
OUTiPUTTotal Diaper Weight output (calculate a-b} 0 
OUTiPUTDrain: 0 
OUTiPUT SUBTOT/11.. : 0 
NetGain: 0 
Netloss: 0 
Initials: \I!. V 
Patient Identification: 
Patient Identification 
Appointment Provlde1 (b)(6 ); (b)(7)(C) 
Patient property identified by2 sources induding: /0 Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEOCFFICER FIGUEROO. 
\Mlat language do )OU speak? Russian 
Interpretation prO\aded? No interpreter available during visit 
Pain /!ssessment 
Pain 
Ne )OU currently in pain? No 
Narratiw: 
Pl seen in tvHU for Ev£ RN rounds. Patient was resting in bed and was giwn Pedial)le and Boost No concerns ,oiced at 
this time. W II continue to monitor. 
Examination 
General B<amination: 
GENER/II.. !>PPE.ARMICE: in no acute distress, well del.eloped, well nourished. 
MJSCULOSKELET/11.. : normal gait no deformities full range of rnolion. 
PSYCH: alert, oriented. 
Asse ssm ent s 
1. lneffecl\Al health maintenance - ND00099 (Primary) 
Treatment 
1. lneffectiw health maintenance 
Notes: Continue hunger strike protocol, encourage po food/lluids, encourage wrbaliiation offeelings. Encourage to allow staff to 
monitor intake and output, \ital signs, wt Instructed to seek staff with any needs. Verbali,ed understanding. Detainee offered 
three meals per day and lea\Al in room for 20 to 30 minutes. /ldequate supply of drinking water and other bewrages as ordered 
by prolider available. Encourage dailyoral/phy.;ical h,giene care. Change of dothing,bedding . Oler BCX)ST and Pedil)le as 
ordered. Do orthostatic lita ls daily. Patient educated to possible Side Effects of going for long period of time without food. Patient 
\Alrbaliies understanding of current Plan of Care. 
Disposition: /ldmitted to tvHU until medically evaluated 
Appointment Providef b)(6) ; (b)(7)(C) IRN 
Electronically signed b (b)(6); f h.\/7\/r"\ 
Sign off status: Complete 
RN on 09126/2018 01:38:28 (Pacific Daylig ht Time ) 
Northwest Detention Center 
1623 E J STREET 
T WA98421 
Tel (b)(6); 
Patient: AMAR, MERGENS.ANA DOB: 10/23/1 978 Progrw .. No'"'!(b)(6); (b)(7)(C) IRN 09/25/2018 
Nr:te genertKe<J byeOinica!Wcxi<s EM<IPM Soflv,e,-e (w,,,weC/inica/Wcxi<s.com) 
2019-ICLl-0005 1 3151 

DHS-ICE-19-0196, 19-0197-N-000333
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 ProgN U Nola: 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3152 
AMAR, MERGEN~ 
A:216269802 Si.ti1 (b)(6); 
Facility Code: CSCN/1/WA Housing ea: 
Acc01.111 ~ber{ijx6)= I 39 Y ad ~l~!t::: 
1623 E J STREET, T 

DHS-ICE-19-0196, 19-0197-N-000334
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3153 
AMAR,MERGENSANA .. A:216269802 Su:ll~ b)(6); I 
Fac1lrtyCode:CSOINWA ng,c;ea .lfi 
39 Y old Male, DOB: 10/23/1978 
AccOl.rll lunberfr5ii6):7 1623 EJ STREET, T~ 

DHS-ICE-19-0196, 19-0197-N-000335
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:llQ(b )(6): ! 
Facility Code: CSONVWA Housi ng Area: M 39 Y old Male, DOB: 10/23/1978 
AccOl.lll lunber: ~ 
1623 E J STREET, T~ 
Appoimnert Facility: Northw est Detertion Cert er 
09 /25/2018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Boost Plus - Liquid 1 110 PRN, stop date 10/19/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fewr denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbance denies. Weight gain denies. 
Weight loss denies. 
Appointment Provld e1 (b)(6) ; (b)(?)(C) !RN 
Reason for Appointment 
1. RN E\€NING SPLIT SHIFT: HUNGER SlRIKE 
History of Present Illness 
Flowsheets (M-tU): 
lnput/OJtput Flowsheet 
Time: 1800 
INPUTPO: 0 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT Other. 0 
INPUT SUBTOT/11..: 0 
OUTiPUT Urine 0 
OUTiPUT Emesis 0 
OUTiPUTBM 0 
OUTiPUT a. Wet Diaper Weight 0 
OUTiPUT b. D,y Diaper Weight 0 
OUTiPUTTotal Diaper Weight output (calculate a-b} 0 
OUTiPUTDrain: 0 
OUTiPUT SUBTOT/11.. : 0 
NetGain: 0 
Netloss: 15 
Initials: KM,! 
Patient Identification: 
Patient is 39 }ear old male from Russia, in M-IU for Hunger Slrike. Al dinner he refused meal 104. His weight lhis morning 
was 1432 pounds. !his shift patient has been up and alert and has also spent time sleeping in bed. Rise and fall of chest was 
lisua li,ed when sleeping. The only item refused lhis shift was dinner. 
Patient Identification 
Patient prope~yidentified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
\Mat language do )OU speak? English, Russian, __ 
Interpretation prolided? Patient speaks English ffuenUy 
Pain 1'6sessment 
Pain 
Ne )OU currently in pain? No 
Vit a l Signs 
16/m in 
66.5in 
Ex amina tion 
General Examination: 
RR 
09/25/201806:15:15 PM 
H 
09/25/201806:15:15 PM 
GENER/II.. JIPPEPRANCE: in no acute distress, well del.eloped, well nourished. 
(b )(6) ; N 
(b)(?)(C) -
-
N 
-
NEURQOOC : alert and oriented, cooperatiw with exam, motor strength normal upper and lo,,er extremities, normal 
exam, normal strength, tone and reflexes, sensory exam intact. 
Assessment s 
1. lneffectiw heallh maintenance - ND00099 (Primary) 
2. lneffectiw heallh management - ND00078 
Treatment 
1. Ineffective health maintenance 
Notes: Continue hunger strike protocol, encourage po food/lluids, encourage .erbali:,ation offeelings. Encourage to allow staff to 
monitor intake and output, \ital signs, wt. lnslruded to seek staffwilh any needs. Verbali,ed understanding. Detainee offered 
lhree meals per day and leave in room for 20 to 30 minutes. Mequate supply of drinking water and olher be.erages as ordered 
byprolider available. Encourage dailyoral/ph)Sical h,giene care. Change of dolhingfoedding. CXfer BOo.ST and Pedil)le as 
ordered. Do orthostatic lita ls daily. Patient educated to possible Side Effects of going for long period of time wilhout food. Patient 
-erbali;,es understanding of current Plan of Care. Patient .erbalizes his option to refuse food_ 
Appointment Provide r:l(b)(6) ; (b)( ?)(C) fN 
Bectronically signed b~ (b)(6) ; _ _ !RN, RN on 09125"2018 18:15:24 (Pacifi c Daylight Ti me) 
Sign off statu s: Completed 
2019-ICLl-0005 1 3154 
Northwest Detention Center 
1623 E J STREET 
T=WA98421 TeJ6V n1 
Fax: 

DHS-ICE-19-0196, 19-0197-N-000336
Patient: AIIIAR, IIERGENSANA DOB: 10/23/1978 Prog,. u Nota: kb)(6); (b)(7)(C) It" 09/25/2018 
Nd.e general.ed by eOinica/W<n<s EJvRIPM Sottw,re (""""eC/inica/WOrks .com) 
2019-ICLl-00051 3155 

DHS-ICE-19-0196, 19-0197-N-000337
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA . . A: 216269802 Su:,1,-J& )(6); I 
Fac1lrtyCode:CSOINWA ng ,c;ea.lfi 
39 Y old Male, ~- 1Q{2J119ZB 
AccOUll l'unbe b )(6): I 
09 12512018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Boost Plus - Liquid 1 110 PRN, stop date 10/19/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl 
Alle'9leS 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue admits Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. \Neight loss admits Dry 
M)uth denies. \Neakness admits, . Shortness of breath at 
rest denies. Chest pain at rest denies. Palpitations denies. 
Podominal Pain denies. Diarrhea admits, that is intermittent. 
Nausea denies. Painful urination denies. MJsde aches impro,ed. 
Skin breakdown denies. Difficulty thinking denies. 
1623 E J STREET, TACOMA, WA-98421 
Appoirimert Facility. Northwest Detertion Certer 
Aflpolntment Provlder{ b)(6) ; (b)(7)(C) r'D 
Reason for Aflpolntment 
1. tvHU Rounds 
History of Present Illness 
Flowsheets (tvHU): 
Pt states he is not feeling too well. He has been getting diarrhea each time he drinks his boost He is offered food and states 
he will not go off his hunger strike until he is released from NVl,OC. Pt is wanting to go to the law library to fax some documents. 
He still wants to speak to a representatiw from ICE. 
Hungerslrike M:mitoring Form 
Day. 09/25/2018 
Shift: AM 
Intake PO (in ml}: 2500 2 literof electrolyte solution, boost and ooter 
Intake rl/- Normal Saline (in ml}: 0 
OJtput Urine (in ml): 0 pt seen voiding, and UA obtained 
OJtput Bowel fl.bwments (in ml): 0 
Labs - Urine Ke tones: Neg 
Labs - Sodium: 
Initials: SM 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources inducting: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Pallent speaks English fluenUy 
Pain ffisessment 
Pain 
l'<e }OU currently in pain? No 
Narratiw: 
Hunger Strike: 
Number of missed meals: 104. 
~ ical Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
IM1en did the official hunger strike begin? 08125l2018 
Date of last meal oonsumed: 08/22/2018 
Last meal oonsumed: Breakfast 
Drinking fluids: Yes 
# of day., on hunger strike: 31 
Total \Neigh! loss in pounds: 19.8 
Reason for hunger strike: 11\ants to be released from custody 
Housing/Isolation Location: M,dical Housing Unit 
Reason for Isolation Placement For dose supervision, observation, and monitoring 
Re"ew of the Housing Placement Review housing every 24 hours 
Vit al Sign s 
98F 
78/min 
88/51 mm Hg 
16/ min 
143 lbs 
Ex amlha tlon 
General Examination: 
Temp 
09/26/2018 11 :57:01 />M 
HR 
09/26/2018 11 :57:01 />M 
BP 
09/26/2018 11 :57:01 />M 
RR 
09/26/2018 11 :57:01 />M 
Wt 
09/26/2018 11 :57:01 />M 
GENER/ll !>PPEPRANCE: pl alert and oriented , , in no acute distress, looking ,ery fatigued. 
OR.AL CA\KIY: mucosa moist, no lesions. 
SKIN: nomial, no rashes, good turgor. 
HE.ART: regular rate and rhyttm 
LUNGS: good air rn<:J\ement , no v.tieezes, rales, rhonchi. 
MJSCULOSKELETJ>l: atrophic muscles, uses wheelchair for mobility to rec. yard. 
b)(6); 
b)(7)(C) 
PSYCH: cognitiw function intact, cooperatiw Vlith exam, good eye contact, speech clear, trough! content Vlithout 
suicidal ideation, delusions, no auditory r:K -.isual hallucinations. 
Assessments 
1. Starvation, subsequent encounter - T73.0JO<D (Pr mary) 
2. Imbalanced nutrition: Less than body requirements [00002]- ND00002 
Self-imposed Hunger strike. 
Trea tment 
1. Starvation, subsequent encOUller 
Notes: W II check with the dietician and pharmacy to see what calorie supplement would help stop this patients diarrhea. He will 
be instructed to drink the supplement more slowy. \Ne will oonsider to dilute it for slower oonsumption. 1'4so will offer fiber 
supplement 
2. Others 
Start Calcium 500/D Tablel 500-200 ~UN IT, 1 tablet with food, Oa lly, BID, 30 days, 60 Tablel KOP: Yes, Drug Source: In 
House Pharmacy, Notes: Not required for trawl 
Start FiberTablel 625 M3, 1 tablet as needed, Oal ly, BID, 30 days, 60 Tablel KOP: Yes, Drug Source: In House Pharmacy, 
Notes: Not required for trawl 
Stop Boost Plus Liquid,-, 1, Oa lly, 110 PRN, 30 days, 1, KOP: No, Drug Source: In House Pharmacy, Notes: Not required for 
trawl 
2019-ICLl-0005 1 3156 

DHS-ICE-19-0196, 19-0197-N-000338
Start Cholecalciferol Tablet, 2000 UNIT, 1 tablet, Oally, a-is, 30 day.;, 1, KCP. Yes, Drug Source: In House Pharmacy, Notes: Not 
required for traw l 
Start Boost Glucose Control Liquid, -, 1/5, Oally, TIO, 30 day.;, 1, KCP. No, Drug Source: In House Pharmacy, Notes: Not required 
for traw l; to be mi>ed equal parts, water, and boost \A-IC 
Fo llow Up 
daily 
Notes: Education prmided on Madi cation and Treatment, Patient acNsed to call the nurse if synptoms worsen. Pt ,erbali,ed 
understanding of all instructions 
Appointment Provider. (b)(6); (b)(?)(C) MD 
(b)(6); (b)(?)(C) 
Electronically signed byl(b)(6); (b)(?)(C) ro on 09/26/201812:02:48 (Pacific Daylight Time) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREEr 
T/:IIXAM, WA98421 
Tell(b)/6) 
FaX. 
Patient: AMAR, IIERGE NSANA DOB: 10/2 3119 78 Progreea Not-i(b)(6) ; (b)(7)(C) !MD 09/2 5/2018 
Ncte ger,,:,rtJ.ed by eClinicai\Mrls ElvRIPM &Jtv,ere ("""'eC/inica/Works .com) 
2019-ICLl-00051 3157 

DHS-ICE-19-0196, 19-0197-N-000339
U.S. Immi gration 
and Customs 
Enfor cement 
AMAR,MERGENSANA . . A: 216269802 Su:llCfb l(6l: Facility Code: CSOINWA HoJs"'ii'"IQ..,A"E"'d-. . lfl ....... 
39 Y old Male, DOB: 10/23/1978 
Acc01.r11 tuntiedTtiiim:-----i 
1623 E J STREET, T~ 
Appoirimert Facility. Northwest Detertion Certer 
09 /25/2018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy , Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Boost Plus - Liquid 1 110 PRN, stop date 10/19/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl 
Alla ..... 
N.KDA 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fewr denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbance denies. Weight gain denies. 
Weight loss denies. 
Appointment Provlcle1 b)(6 ); (b) (?)(C) rN 
Reas on for Appointm ent 
1. RN DAYS: HUNGER STRIKE 
History of Prese nt Illness 
Flowsheets (M-tU): 
lnput/OJtput Flowsheet 
Time: 1400 
INPUT PO: 1240 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT Other. 0 
INPUT SUBTOT/11.. : 0 
OUTiPUT Urine 0 
OUTiPUT Emesis 0 
OUTiPUTBM 0 
OUTiPUT a. Wet Diaper Weight 0 
OUTiPUT b. Dry Diaper Weight 0 
OUTiPUTTotal Diaper Weight output (calculate a-b} 0 
OUTiPUTDrain: 0 
OUTiPUT SUBTOT/11.. : 0 
NetGain: 0 
NetLoss: 15 
Initials: KM,! 
Patient Identification: 
Patient is 39 }ear old male from Russia, in M-IU for Hunger Slrike. It lunch he refused meal 103. His weight this morning 
was 1432 pounds. this shift patient has been up and alert and has also spent time sleeping in bed. Rise and fall of chest was 
lisua li,ed when sleeping. Patient drank his B(X)ST and pedial)le this shift. The only item refused this shift was lunch. 
Patient Identification 
Patient prope~yidentified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
\Mat language do )OU speak? English, Russian, __ 
Interpretation prolided? Patient speaks English ffuenUy 
Pain 1'6sessment 
Pain 
Ne )OU currently in pain? No 
Vit a l Signs 
Temp 
98F 
HR 
standing :102 
sitting:78 
supine:58 
BP 
slanding :77/48 
sitting:88151 
supine:91/53 
RR 
16 /min 
WI 
143.2 lbs 
H 
66.5in 
BMI 
22.76 Index 
Ex amination 
General E@mination: 
09/25/201812:34:19 PM 
09/25/201812:34:19 PM 
09/25/201812:34:19 PM 
09/25/201812:34:19 PM 
09/25/201812:34:19 PM 
09/25/201812:34:19 PM 
09/25/201812:34:19 PM 
09/25/201812:34:19 PM 
09/25/201812:34:19 PM 
09/25/201812:34:19 PM 
09/25/201812:34:19 PM 
GENER/II.. !>PPE.AR/lNCE: in no acute distress, well del.e!oped, well nourished. 
b )(6 ); RN 
b)(?)(C) -
-
RN 
RN 
RN 
-
-
RN 
RN 
RN 
-
-
RN 
-
-
RN 
-
-
RN 
-
-
RN 
-
NEURO..OOC: alert and oriented, coope,atiw Vlith exam, motor strength normal upper and lovver ex1remities, normal 
exam, normal strength, tone and reflexes, sensory exam intact. 
Assessments 
1. lneffectiw health maintenance - ND00099 (Primary) 
2. lneffectiw health management - ND00078 
Treatment 
1. lneffecti\le health maintenance 
Notes: Continue hunger strike protocol, encourage po food/lluids, encourage wrbaliiation offeelings. Encourage to allow staff to 
monitor intake and output, \ital signs, wt. Instructed to seek staff with any needs. Verbali,ed understanding. Detainee offered 
three meals per day and leaw in room for 20 to 30 minutes. /ldequate supply of drinking water and other bewrages as ordered 
by prolider available. Encourage dailyoral/phy.;ical h19iene care. Change of dothing,bedding . Ofer B(X)ST and Pedil)le as 
ordered. Do orthostatic lita ls daily. Patient educated to possible Side Effects of going for long period of time without food. Patient 
wrba liies understanding of current Plan of Care. Patient wrbaliies his option to refuse food. 
Appointment Provide 1(b) (6); (b) (?)(C) fN 
2019-ICLl-00051 3158 

DHS-ICE-19-0196, 19-0197-N-000340
Electronically signed b~(b)(6); ~- fN, RN on 09125,'201812:34:32 (Pacific Daylight Time) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREEr ,: WA98421 
Tel (b)(6); 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 ProgNu Nota: ~kb~)(~6~ ); __ __,! RN 09/25/2018 
/lk:l.e general.ed byeC/irica/Wa1<s af</PM Soft,.,.ere (\'MWeC/inica'INCYks .COO]I 
2019-ICLl-00051 3159 

DHS-ICE-19-0196, 19-0197-N-000341
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGEN~ A: 216269802 Si.ti1 (b)(6); ~· Facility Code: CSCN/1/WA Housing ea : 
Acc01.1111ffll beb)I6); 39 Y old Mal~,· •w~::: 
09 12512018 
Cunont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy , Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Boost Plus - Liquid 1 110 PRN, stop date 10/19/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. 11\eight loss admits. Dry 
M'.luth denies. 11\eakness denies. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. />lldominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. \bm itting admits. Painful 
urination denies. Decreased urine output denies. Mlsde 
aches admits. Mlsd e cramps denies. Skin breakdown denies. 
Difficultythinking denies. 
General/Constitutional: 
Chills denies. Fatigue denies. Fewr denies. 
Headache denies. 
1623 E J STREET, T 
Appoimnert Facility: Northwes t Detertion Cert er 
Reason for Appointment 
1. Night rounds 
History of Present Illness 
Narratiw: 
Appointment Provlde~ (b)( 6); (b)(7)(C) I RN 
Ml le patient here in M-IU on hunger strike. Mssed meal number 102 with breakfast this am. Patient did complain of some 
leg pain this am. pleasant and oooperatiw. 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? English, Russian, __ 
Interpretation pro\aded? No interpreter utilized 
~ lain Use Notes Section Pallent speaks some English. 
Pain Assessment 
Pain 
A-e }OU currently in pain? Yes 
The pain is located Use Noles Section legs 
The sew rityof pain is rated at 2110 
The sew rityof the pain is mild 
The pain began 1-2daysago 
The character of the pain is aching 
The associated symptoms are none 
The pain is aggravated by none 
The pain is relieled by none 
11/edical Housing Unit: 
Nursing Rounds 
Lew i of Care required: M,dical Level 1 
11/edication orders: No 
Diagnostic Tests/Treatment orders: No 
Diet 0-ders: No 
/lcti,..ties or Restriction orders: activity as tolerated 
Ex aminat ion 
General B<amination: 
GENERl>l !>PPE.AR.ANCE : normal, alert, in no acute distress, male. 
HE.ART: S 1, S2 normal. 
LUNGS:, clear to auscultation bilaterally, normal. 
PSYCH: alert, oriented. 
Assessment s 
1. Imbalanced nutrition: Less than body requirements [00002] - ND00002 (Primary) 
Treatment 
1. Imbalanced nutrnion: Less than bo<tj req..iremerts (00002] 
Notes: Detainee wrba liied understanding of plan of care and denies questions/concerns. Continue hunger strike protocol, 
encourage po food/fluids, encourage wrbalization of feelings. Encourage to allow staff to monitor intake and output, ,ital signs, 
wl Instructed to seek staff with any needs. Verbalized understanding .. Nursing Care Plan present Refer to nursing care plan for 
OrliJOing inter1entions. Detainee offered three meals per day and leaw in room for at least20 minutes. /ldequate supplyof 
drinking water and other bewrages as ordered bypro,ider available. Encourage daily oral/physical h19iene care. 
Disposition: /ldmitted to M-IU until medically evaluated 
Appointment Provide1 (b)(6) ; (b)(7)(C) fN 
Bectronically signed b~._b_)_(6_)_; __ _.!IN on 09/25/20 18 06:19:06 (Pacific Daylight li me) 
Sign off status: Completed 
Northwest Detention Cente r 
1623 E J STREET 
T~r98421 Te1Jix~f J 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Pn,g,.ss Notol(b)(6); (b)(7)(C) !tN 09/25/2018 
Ncte general.ad by eClinica!Wcxi<s ElvRIFM Soflv.ere (""'"'eC/inica/Wc.-ks.com) 
2019-ICLl-00051 3160 

DHS-ICE-19-0196, 19-0197-N-000342
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A:216269802 Su:lloj(b)( 6); I 
Facility Code: CSONVWA Housing Area: M 3~c~~E::1 
09 12512018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Boost Plus - Liquid 1 110 PRN, stop date 10/19/2018, KOP: No, 
Drug Source: In House Pharmacy , Notes: Not required for trawl 
Review of Systems 
General/Constitutional: 
Chills denies. Fewr denies. Night s1M3ats denies. 
Respiratory: 
Cough denies. Hemopl)<Sis denies. Sputum 
production denies. Wlee.zing denies. 
Gastrointestinal: 
Diarrhea denies. \b miting denies. 
1623 E J STREET, T 
Appoimnert Facility: Northwest Detertion Cert er 
Reason for Appointment 
1. Night rounds 
History of Present Illness 
Narratiw: 
Appointment Provlder:l (b)(6) ; (b)(7)(C) I RN 
Ml le patient slept through the night denies anys/s of Tb. pleasant and cooperatiw with assessment /'le 85% of breakfast 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? English, Spanish, __ 
Interpretation pro\aded? Pallent speaks English fluenUy 
Pain .1>6sessment 
Pain 
/>,e }OU currently in pain? No 
11/edical Housing Unit 
Nursing Rounds 
Lew i of Care required: Madical Level 1 
11/edication orders: No 
Diagnostic Tests/Treatment orders: No 
Diet Cxders: No 
/lcti\aties or Restriction orders: activity as tolerated 
Examination 
General Examination: 
SKIN: normal, no rashes, no suspicious lesions. 
HE.ART: no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, nowieezes , rales, rhonchi. 
PSYCH: alert, oriented. 
spo2 99%. heart rate 68. 
Assessments 
1. Risk for Infection [spread/reactivation] [00004] - ND00004 (Primary) 
Treatment 
1. Risk for Infection [spread'reactivation] [00004] 
Notes: Instructed on the results of his Cl<R and need for Respiratory Isolation, labs and sputums oollections. Instructed on 1B 
disease processes, treatment with RIPE, how many days of isolation (5 days of medication or longer depending on sputum 
results}. ¼rba li,ed understanding of lB protoool. 
Disposition: /ldmitted to M-IU until medically evaluated 
Appointment Provider.k~b~)(~6)~; --~!RN 
Electronically signed b{~b~)~(6~)~: --~!RN on 09/25/2018 05:53:16 (Pacific Daylight li me) 
Sign off status: Completed 
Addendum : 
09/25/2018 06:07 4 (b )(6); (b )(7)(C) I Cancel appt Documentation written on wrong patient 
Northwest Detention Center 
1623 E J STREET 
T=~A 98421 Te(b)(6t I 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progre .. Note!\~!\ ~/;,~ , r" 09/25/2018 
NcJ.e generated oye0irica/Wcv1<s 8'R/PM So/Iv.ere (w.w,eQinica/Wcx-ks.C0/"1'4 
2019-ICLl-00051 3161 

DHS-ICE-19-0196, 19-0197-N-000343
U.S. Immi gration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:ll~ (b )(6) I Facility Code: CSCN/1/WA Ht- s ' 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunbe ~ 
1623 E J STREET, T~ 
Appoirimert Facility: Northwes t Detertion Cert er 
09 12412018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Boost Plus - Liquid 1 110 PRN, stop date 10/19/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl 
Alla ..... 
N.KDA 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fewr denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbance denies. Weight gain denies. 
Weight loss denies. 
Appointment Pl'ovld e r:!( b)/6): /b)/7)/C ) )RN 
Reason for Appointment 
1. tvHU RN Rounds 
History of Pl'esent Illness 
Flowsheets (tvHU): 
lnput/OJtput Flowsheet 
Time: 0700 
INPUT PO: 1240 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT Other. 0 
INPUTSUBTOT/11.. : 1240 
OUTPUT Urine 0 
OUTPUTEmesis 0 
OUTPUTBM 0 
OUTPUT a. Wet Diaper Weight 0 
OUTPUT b. Dry Diaper Weight 0 
OUTPUT Total Diaper Weight output (calculate a-b} 0 
OUTPUTDrain: 0 
OUTPUT SUBTOT/11.. : 0 
NetGain: 0 
NetLoss: 0 
Initials: LDM 
Patient Identification: 
Patient Identification 
Patient property identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
\M1at language do )OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number 
Number: 
Language Russian 
Pain l'ssessment 
Pain 
Ne )OU currently in pain? No 
Narratiw: 
PT GM'N PEDl/ll YfE AND B(X)ST AT BEDlltvE. 
Vital Sign s 
16/min 
66.5in 
Ex amination 
General Examination: 
RR 
09/24/201807:10:45 PM 
H 
09/24/201807:10:45 PM 
GENER/II.. JIPPEPRANCE: in no acute distress, well del.eloped, well nourished. 
HEAD: norrnocephalic. 
E'l'ES: pu~l s equal, round, reactiw to light and accomroodation. 
NOSE: nares patent. 
CHEST: normal, no gross rib deformity, normal shape and expansion. 
b)(6); ~N 
b)(7)(C) -
-
~N 
MUSCULOSKELET/11.. : normal, normal gait, no deformities, full range o( motion, good strergth and equal bilaterally. 
NEUROLOGIC: alert and oriented, cooperatiw with exam, motor strergth normal upper and lc,,,,er extremities, normal 
exam, normal strength, tone and reflexes, sensory exam intact. 
PSYCH: alert, oriented. 
Ass e ssment s 
1. lneffectiw health maintenance - ND00099 (Primary) 
2. lneffectiw health management - ND00078 
Treatment 
1. lneffecti\11! health maintenance 
Notes: Continue hunger strike protocol, encourage po food/lluids, encourage wrbalization of feelings. Encourage to allow staff to 
monitor intake and output, \atal signs, wt. lnslruded to seek staff with any needs. lkrbali,ed understanding. Detainee offered 
three meals per day and leave in room for 20 to 30 minutes. /ldequate supply of drinking water and olher beverages as ordered 
bypro\ader a\0ilable. Encourage dailyoral/phy.;ical h)9iene care. Change of dothing,bedding. CXfer B(X)STand Pedil)le as 
ordered. Do orthostatic \atals daily. Patient educated to possible Side Effects of going for long period of time without food. Patient 
verbali:,es understanding of current Plan of Care. Patient verbali:,es his option to refuse food. 
Notes: tvHU until Medical Determination 
Appointment Providei b)(6); (b)(7)(C) r 
Electronically signed byl(b)(6); __ I RN on 09/241201819:16:42 (Pacific Daylight Time) 
Sign off status: Completed 
2019-ICLl-00051 3162 

DHS-ICE-19-0196, 19-0197-N-000344
Northwest Detention Center 
1623 E J STREET 
T~~~r Tel:Jii{o/, A98421 
Pali-I: AMAR,-RGENSANA DOB: 10/23/1978 P ........ N-k b)(6); (b)(?)(C)!RN 09/2A/2018 
NCl.e general.ed byeC/inica/'Na1<s EM>/PM Sottv.ere (,w,weC/inica/WGYks .coojl 
2019-ICLl-00051 3163 

DHS-ICE-19-0196, 19-0197-N-000345
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A:216269802 Su:llD:!lh\/R) ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunbe ~ 
1623 E J STREET, T~ 
Appoirimert Facility: Northwest Detertion Cert er 
09 12412018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Boost Plus - Liquid 1 110 PRN, stop date 10/19/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl 
Review of Systems 
General/Constitutional: 
Headache denies. Lightheadedness denies. 'M! ight 
loss denies. 
Hunger Strike: 
Fatigue admits Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. Dry MJuth denies. 'M!akness admits, 
. Shortness of breath at rest denies. Chest pain at rest denies. 
Palpitations denies. />bdominal Pain denies. Nausea denies. 
Painful urination denies. Mlsde aches impro,.ed. Skin 
breakdown denies. Difficultythinking denies. 
Aflpolntment Provld erf b)(6) ; (b)(7)(C) IMD 
Reas on for Aflpolntment 
1. Hunger Strike 
History of Pre se nt Illness 
Flowsheets (M-tU): 
Pt is sitting up and looking strong. He states he feels weak but has less chest pain. He goes to rec yard in the wheel chair. 
He is still determined to stay on hunger strike but he does drink the boost ordered and the pedial)led and water. He is gaining 
some weight back. He has not spoken with ICE for about three weeks. He has just missed his 100th meal. 
Hungerstrike MJnitoring Form 
Day. 09/24/2018 
Shift: AM 
Intake PO (in ml}: 2500 2 literof electrolyte solution, boost and ooter 
Intake rl/- Normal Saline (in ml}: 0 
OJtput Urine (in ml): 0 pt seen voiding, and UA obtained 
OJtput Bowel MJwments (in ml): 0 
Labs - Urine Ke tones: Neg 
Labs - Sodium: 
Initials: SM 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Pallent speaks English fluenUy 
Pain ffisessment 
Pain 
l'<e }OU currently in pain? No 
Narratiw: 
Hunger Strike: 
Number of missed meals: 100. 
~ ical Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
IM1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking fluids: Yes 
# of day., on hunger strike: 30 
Total 'M! ight loss in pounds: 15.2 
Reason for hunger strike: 11\ants to be released from custody 
Housing/Isolation Location: M,dical Housing Unit 
Reason for Isolation Placement For dose supervision, observation, and monitoring 
Re"ew of the Housing Placement Review housing every 24 hours 
Vital Sign s 
97.8F 
53/ min 
94/61 mm Hg 
16/ min 
147.8 lbs 
66.5in 
23.50 Index 
Examination 
General Examination: 
Temp 
09/24/201810:11:32 PM 
HR 
09/24/201810:11:32 PM 
BP 
09/24/201810:11:32 PM 
RR 
09/24/201810:11:32 PM 
Wt 
09/24/201810:11:32 PM 
H 
09/24/201810:11:32 PM 
BMI 
09/24/2018 10:11 :32 PM 
GENERJ>l J>PPEAAPNCE: pt alert and oriented ' more energetic and talkatiw . 
ORM. CAvfTY: mucosa moist, no lesions. 
NECK/lH'VROID: normal, neck supple, full range or motion. 
SKIN: normal, no rashes, good turgor. 
HEAAT: no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, nowieezes , rales, rhonchi. 
MUSCULOSKELET!>I.. : normal gait, full range or motion, tender to palpation, neurovascular intact. 
PSYCH: alert, oriented. 
Assessments 
1. Starvation, subsequent encounter- T73.0X><D (Prmary) 
2. Imbalanced nutrition: Less than body requirements [00002] - ND00002 
Self-imposed Hunger strike. 
Treatmen t 
1. Starvation, subsequent encOl.l"ller 
Notes: will continue current plan. Pt has no sxwith low BP or HR. 
Fo llow Up 
2019-ICLl-00051 3164 
b)(6); 
b)(7)(C) 

DHS-ICE-19-0196, 19-0197-N-000346
daily 
Notes: Education plOIAded on Madication and Treatment recommendations. Patient acNsed lo return lo call the nurse if 
simploms 1M>rsen prior lo evaluation. Patient \erbali2ed understanding of all instructions 
Appointment Provider:l (b)(6); (b)(7)(C) I MD 
~(b)(6); (b)(7)(C) 
Electronically slgned b* b)(6); (b)(7)(C) ~ Don 09/2512018 07:52:53 (Pacific Daytlght Time) 
Sign off status: Completed 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 
Northwest Detention Center 
1623 E J STREB" 
T~rr.A98421 
T~~- I 
MD 09/24/2018 
Ncte generated byeOirica/Wcrks El>R'PM s:itl<ere ("""'•ln ,;,,;,,,:;:;c ==-=;;r- ~ 
2019-ICLl-00051 3165 

DHS-ICE-19-0196, 19-0197-N-000347
U.S. Immi gration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:llol l h \In\ ! Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
1623 E J 
Acc
STREET, 
Ol.l"II llunber: 
T~ 
~ 
Appoirimert Facility: Northwest Detertion Certe r 
09 12412018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Boost Plus - Liquid 1 110 PRN, stop date 10/19/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl 
Alla ..... 
N.KDA 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fewr denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbance denies. Weight gain denies. 
Weight loss denies. 
patient states feeling weak today. 
Appointment Provld e 1 (b)(6) ; (b)(7)(C) !RN 
Rea son for Appointment 
1. RN DAYS: SUICIDE WATCH 
History of Present Illness 
Flowsheets (M-tU): 
lnput/OJtput Flowsheet 
Time: 1730 
INPUT PO: 1240 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT Other. 0 
INPUT SUBTOT/11.. : 0 
OUTiPUT Urine 0 
OUTiPUT Emesis 0 
OUTiPUTBM 0 
OUTiPUT a. Wet Diaper Weight 0 
OUTiPUT b. Dry Diaper Weight 0 
OUTiPUTTotal Diaper Weight output (calculate a-b} 0 
OUTiPUTDrain: 0 
OUTiPUT SUBTOT/11.. : 0 
NetGain: 0 
NetLoss: 15 
Initials: KM,! 
Patient Identification: 
Patient is 39 }ear old male from Russia, in M-IU for Hunger Slrike. It lunch he refused meal 100. His weight this morning 
was 147.8 pounds. this shift patient has been up and alert and has also spent time sleeping in bed. Rise and fall of chest was 
lisua li,ed when sleeping. Patient drank ~E B(X)STthis shift. /!od RN remol.ed two emptypedial)le containers from cell. The 
only item refused this shift was lunch. 
Patient Identification 
Patient prope~yidentified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
\M1at language do )OU speak? &Jglish, - -
Interpretation prolided? Patient speaks English ffuenUy 
Pain Assessment 
Pain 
Ne )OU currently in pain? No 
Vit al Sign s 
97.8F 
standing:71 
sitting:53 
supine:51 
standing:106/70 
sitting:94/61 
supine:99/65 
16 /min 
147.8 lbs 
66.Sin 
23.50 Index 
Ex amination 
General Examination: 
Temp 
09/24/201801:21:56 PM 
HR 
09/24/201801:21:56 PM 
09/24/201801:21:56 PM 
09/24/201801:21:56 PM 
BP 
09/24/201801:21:56 PM 
09/24/201801:21:56 PM 
09/24/201801:21:56 PM 
RR 
09/24/201801:21:56 PM 
WI 
09/24/201801:21:56 PM 
H 
09/24/201801:21:56 PM 
BMI 
09/24/201801:21:56 PM 
GENER/II.. !>PPEPRl>NCE: in no acute distress, well del,eloped, well nourished. 
(b)(6); RN 
(b)(?)(C) ,-
,-
RN 
RN 
RN 
-,-
RN 
RN 
RN ,-
-
RN 
-,-
RN ,-
,-
RN ,-
-
RN 
-
NEURQOGtC: alert and oriented, cooperatiw Vl>ith exam, motor strength nonmal upper and lc,,,,er extremities, nonmal 
exam, nonmal strength, tone and reflexes, sensory exam intact. 
Assessment s 
1. lneffectw health maintenance - ND00099 (Primary) 
2. lneffectw health management - ND00078 
Treatm ent 
1. Ineffective health maintenance 
Notes: Continue hunger strike protocol, encourage po food/lluids. encourage wrbalization offeelings. Encourage to allow staff to 
monitor intake and output, \ital signs, wt lnslrucled to seek staff with any needs. lkrbali,ed understanding. Detainee offered 
three meals per day and leaw in room for 20 to 30 minutes. A:lequate supply of drinking water and other bewrages as ordered 
by prolider available. Encourage dailyoral/phy.;ical h)Qiene care. Change of dothing,bedding . ate r B(X)ST and Pedil)le as 
ordered. Do orthostatic lita ls daily. Patient educated to possible Side Effects of going for long period of time without food. Patient 
wrba liies understanding of current Plan of Care. Patient wrbali:,es his option to refuse food. 
Appointment Provide (b)(6); (b)(?)(C) 
2019-ICLl-0005 1 3166 

DHS-ICE-19-0196, 19-0197-N-000348
Electronically signed b b)(6); 
Sign off status: Complet h\/ 7 \/1"'.\ 
, RN on 091241201813:23:47 (Pacific Daylight Time) 
Northwest Detention Center 
1623 E J STRE£T 
l'. WA98421 
Tel /h\lR\ · 
x: 
P-nt: AMAR, IIERGENSANA DOB: 10/2311978 Prog,_ u No )( ; (b)(7)(C) !RN 09/24/2018 
/\k:le ger,era,.ed by eC/inica/'Na1<s Bvr>IPM Softv.ere (1<11WeC/inica'WGYks .COOjl 
2019-ICLl-00051 3167 

DHS-ICE-19-0196, 19-0197-N-000349
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA .. A:21626980 2 Su:ll~b)(6); ! 
Fac1lrtyCode:CSOINWA ng,c;ea .lfi 
39 Y old Male, DOB: 10/23/1978 
Acc01.r11~ r61 I 
09 12412018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy , Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy , Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Boost Plus - Liquid 1 110 PRN, stop date 10/19/2018, KOP: No, 
Drug Source: In House Pharmacy , Notes: Not required for trawl 
Alla ..... 
N.KDA 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fewr denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbance denies. Weight gain denies. 
Weight loss denies. 
1623 E J STREET, T WA-98421 
Appoirimert Facility. Northwest Detertion Certer 
Reason for Appointment 
1. tvHU RN NIGHT ROUNDS/HUNGER STRIKE 
History of Present Illness 
Flowsheets (tvHU): 
lnput/OJtput Flowsheet 
Time: 0700 
INPUT PO: 1240 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT Other. 0 
INPUTSUBTOT/11.. : 1240 
OUTiPUT Urine 0 
OUTiPUT Emesis 0 
OUTiPUTBM 0 
OUTiPUT a. Wet Diaper Weight 0 
OUTiPUT b. Dry Diaper Weight 0 
OUTiPUTTotal Diaper Weight output (calculate a-b} 0 
OUTiPUTDrain: 0 
OUTiPUT SUBTOT/11.. : 0 
NetGain: 0 
NetLoss: 0 
Initials: LDM 
Patient Identification: 
Patient Identification 
Patient prope~yidentified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
\M1at language do )OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number 
Number: 
Language Russian 
Pain l'ssessment 
Pain 
Ne )OU currently in pain? No 
Narratiw: 
PT GM'N PEDl/ll YfE AND B(X)ST AT BEDlltvE. 
Ex amination 
General B<amination: 
Appointment Provide (b)(6); 
/h\/ 7 \lr.\ 
RN 
GENER/II.. !>PPE.ARANCE: in no acute distress, well del.eloped, well nourished. 
NEURO..OGIC: alert and oriented, coope,atiw Vlith exam, motor strength nonmal upper and lower extremities, nonmal 
exam, nonmal strength, tone and reflexes, sensory exam intact. 
Assessments 
1. lneffectiw health maintenance - ND00099 (Primary) 
2. lneffectiw health management - ND00078 
Treatment 
1. lneffectiw health maintenance 
Notes: Continue hunger strike protocol, encourage po food/tluids, encourage wrbaliiation offeelings. Encourage to allow staff to 
monitor intake and output, \atal signs, wt. Instructed to seek staff with any needs. Verbalized understanding. Detainee offered 
three meals per day and leaw in room for 20 to 30 minutes. A:lequate supply of drinking water and other bewrages as ordered 
by pro\ader available. Encourage dailyoral/phy.;ical h,giene care. Change of dothing,bedding . Oler B(X)ST and Pedil)le as 
ordered. Do orthostatic \atals daily. Patient educated to possible Side Effects of going for long period of time without food. Patient 
wrbaliies understanding of current Plan of Care. Patient wrbalizes his option to refuse food. 
Appointment Proviclej..__ (b~)(=6)~; ~___,I RN 
Bectronically signed ~(b)(6); _. 
Sign off status: Completed 
fN on 09/2412018 06:05:52 (Pacific Daylight lime) 
Northwest Detention Center 
1623 E J STREET 
TACOMA, WA98421 
iel(b)/6) I ,ax . 
Patient: AMAR, IIIERGENSANA DOB: 10/23/1978 p,__ ~ 09/24/2018 
Ncte generated by eOirica/Wcrks EM<IPM Sotr,.ere (w.w,eQinica/Works.CCJrr4 
2019-ICLl-00051 3168 

DHS-ICE-19-0196, 19-0197-N-000350
U.S. Immi gration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:llol/b )/6) I 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll lunber~ 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
09 /2 3 12018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Boost Plus - Liquid 1 110 PRN, stop date 10/19/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl 
Alla ..... 
N.KDA 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fewr denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbance denies. Weight gain denies. 
Weight loss denies. 
Rea son for Appointment 
1. tvHU RN SPLrT E\iE SHIFT NOTE/HUNGER SlRIKE 
History of Present Illness 
Flowsheets (tvHU): 
lnput/OJtput Flowsheet 
Time: 1730 
INPUT PO: 1240 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT Other. 0 
INPUT SUBTOT/11.. : 0 
OUTPUT Urine 0 
OUTPUTEmesis 0 
OUTPUTBM 0 
OUTPUT a. Wet Diaper Weight 0 
OUTPUT b. D,y Diaper Weight 0 
OUTPUT Total Diaper Weight output (calculate a-b} 0 
OUTPUTDrain: 0 
OUTPUT SUBTOT/11.. : 0 
NetGain: 0 
Netloss: 15 
Initials: KM,! 
Patient Identification: 
Patient Identification 
Patient prope~yidentified by2 sources induding: /0 Badge, Verbally 
Chaperone Present? No 
\M1at language do )OU speak? Russian, __ Interpretation prO\aded? Yes, Interpreter Number 11395360 
Number: 
Language Russian 
Pain l'ssessmen t 
Pain 
Ne )OU currently in pain? No 
Narratiw: 
PT GM'N PEDl/ll YfE AND B(X)ST AT BEDlltvE. 
Ex amination 
General B<amination: 
Appointment Provid e (b)(6); 
/h\/7\/C:\ 
RN 
GENER/II.. !>PPE.ARANCE: in no acute distress, well del.eloped, well nourished. 
NEURO..OGIC: alert and oriented, coope,atiw Vlith exam, motor strength nonmal upper and lower extremities, nonmal 
exam, nonmal strength, tone and reflexes, sensory exam intact. 
Assessments 
1. lneffectiw health maintenance - ND00099 (Primary) 
2. lneffectiw health management - ND00078 
Treatment 
1. lneffectiw health maintenance 
Notes: Continue hunger strike protocol, encourage po food/tluids, encourage wrbaliiation offeelings. Encourage to allow staff to 
monitor intake and output, \ital signs, wt. Instructed to seek staff with any needs. Verbalized understanding. Detainee offered 
three meals per day and leaw in room for 20 to 30 minutes. A:lequate supply of drinking water and other bewrages as ordered 
by prolider available. Encourage dailyoral/phy.;ical h,giene care. Change of dothing,bedding . Oler B(X)ST and Pedil)le as 
ordered. Do orthostatic lita ls daily. Patient educated to possible Side Effects of going for long period of time without food. Patient 
wrba liies understanding of current Plan of Care. Patient wrbalizes his option to refuse food. 
Disposition: A:lmitted to tvHU until medically evaluated 
(b)(6); 
Appointment Provide (b)(?)(C) 
Electronically signed b~(b)(6); 
Sign off status: Completed 
Addendum : 
RN 
!RN on 09/23/20 18 21:49:44 (Pacific Daylight Time) 
09/24/2018 01 :07 (b )(6); (b )(7 )( C) OORECll~ : INlll/llS UNDER 1&0 DOCUIYENTAll~ SH CUD REPO LDM 
09/24/2018 01 :12 OORECll~ TO 1&0 FLOMSHEET: 111,£ 2300; INPUT PO 500M.. 
2019-ICLl-0005 1 3169 
Northwest Detention Center 
1623 E J STREET 
T~WA98421 
Te1Jiill6[ ] 

DHS-ICE-19-0196, 19-0197-N-000351
Patl-t: AMAR, IIERGENSANA DOB: 10/23/1978 P ........ ~ RN 09/23/2018 
Nd.e generated by eC/inica/Wm<s EJvRIPM Sottv.ere {v.11WeC/inica/WGYks.COOJI 
2019-ICLl-00051 3170 

DHS-ICE-19-0196, 19-0197-N-000352
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3171 
AMAR,MERGENSANA 
A:216269802 Su:l1D: !(b)(6); I 
Facility Code: CSONVWA Housing Area : M 
39 Y old Male, DOB: 10/23/1978 
Acc01.111 tunberfh \/RI I 
1623 E J STREET, TACOMA, WA98421 

DHS-ICE-19-0196, 19-0197-N-000353
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3172 
AMAR,MERGENSANA A:216269802 Su:i1ol(b)(6); J 
Facility Code: CSONVWA Housing Area : 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll lunbe~ 
1623 EJ STREET, T~ 

DHS-ICE-19-0196, 19-0197-N-000354
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U Nola: 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3173 
AMAR,MERGE~ A:216269802 Si.ti1 (b)(6); ~· Facility Code: CSCN/1/WA . 
39 Y old Male, DOB: 10/23/1978 
AccOl.rll lunbe~ 
1623 E J STREET, T~ 

DHS-ICE-19-0196, 19-0197-N-000355
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:lloj(b )(~; 
Facility Code: CSONVWA Housing ea: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunbe ~/h\/R\ I 
09 /2 3 12018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Boost Plus - Liquid 1 110 PRN, stop date 10/19/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl 
Alla ..... 
N.KDA 
vlaw of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fewr denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbance denies. Weight gain denies. 
Weight loss denies. 
1623 E J STREET, TACOMA, WA-98421 
Appoimnert Facility: Northwest Detertion Certe r 
Appointment Provld e r:l(b)( 6 ); (b)(7)(C) I RN 
Rea son for Appointment 
1. RN E\€NING SPLIT SHIFT: HUNGER SlRIKE 
History of Present Illness 
Flowsheets (M-tU): 
lnput/OJtput Flowsheet 
Time: 1730 
INPUT PO: 1240 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT Other. 0 
INPUT SUBTOT/11.. : 0 
OUTiPUT Urine 0 
OUTiPUT Emesis 0 
OUTiPUTBM 0 
OUTiPUT a. Wet Diaper Weight 0 
OUTiPUT b. D,y Diaper Weight 0 
OUTiPUTTotal Diaper Weight output (calculate a-b} 0 
OUTiPUTDrain: 0 
OUTiPUT SUBTOT/11.. : 0 
NetGain: 0 
Netloss: 15 
Initials: KM,! 
Patient Identification: 
Patientis 39 }ear old male from Russia, in M-IU for Hunger Slrike. Al lunch he refused meal 97. His weight this morning was 
147 2 pounds, that is up one pound from )eSterday. this shift patient has been up and alert and has also spent time sleeping in 
bed. Rise and fall of chest was lisuali>ed when sleeping. Patient drank two BOOSTS this shift. /Ind RN remowd two empty 
pedialy!e containers from cell. The only item refused this shift was lunch. 
Patient Identification 
Patient property identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
\M1at language do )OU speak? Russian, _ _ Interpretation prO\aded? Yes, Interpreter Number 11395360 
Number: 
Language Russian 
Pain l'ssessmen t 
Pain 
Ne )OU currently in pain? No 
Vit al Sign s 
16/m in 
66.5in 
Ex amination 
General Examination: 
RR 
H 
09/23/201804:36:48 PM 
09/23/201804:36:48 PM 
GENER/II.. !>PPEPRANCE: in oo acute distress, well del.e!oped, well oourished. 
(b)(6); RN 
(b)(7)(C) -
-
RN 
NEURQOOC : alert and oriented, cooperatiw with exam, motor strength oonmal upper and lc,.,,er extremities, oonmal 
exam, oonmal strength, tone and reflexes, sensory exam intact. 
Assessment s 
1. lneffectiw health maintenance - ND00099 (Primary) 
2. lneffectiw health management - ND00078 
Tre a tment 
1. Ineffective health maintenance 
Notes: Continue hunger strike protocol, encourage po food/lluids, encourage -erbaliiation offeelings. Encourage to allow staff to 
monitor intake and output, \ital signs, wt. Instructed to seek staff with any needs. Verbali,ed understanding. Detainee offered 
three meals per day and leaw in room for 20 to 30 minutes. A:lequate supply of drinking water and other be-erages as ordered 
byprolider available. Encourage dailyoral/ph)Sical h,giene care. Change of dothingfoedding . Ofer B(X).ST and Pedil)le as 
ordered. Do orthostatic lita ls daily. Patient educated to possible Side Effects of going for long period of time without food. Patient 
wrba li,es understanding of current Plan of Care. Patient -erbaliies his option to refuse food. 
(b)(6); Appointment Provide /h \/?\/(:\ 
Electronically signed b (b)(6); 
Sign off statu s: Comp1eW1...' n, 1
,,...' 
2019-ICLl-0005 1 
RN 
, RN on 09123/2018 16:36:57 (Pacifi c Daylight Time) 
3174 
Northwest Detention Center 
1623 E J STREET 
TACOMA, WA9 8421 
Tel: 253-TT~9 
Fax: 

DHS-ICE-19-0196, 19-0197-N-000356
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 ProgN U Nota: ~tb_)(_6_); __ ~1 RN 09/23/2018 
Nd.e general.ed by eClinical.Worl<s a.RJPM Softvere (,w,weC/inica/Works.com) 
2019-ICLl-00051 3175 

DHS-ICE-19-0196, 19-0197-N-000357
U.S. Immigration 
and Customs 
Enfor cement 
AMAR, MERGEN W A:216269802 Si.tll (b)(6); 
Facility Code: CSCN/1/WA Housing ea: 
AccOlrt ~be(b)(6L 1 39 Y ad ~~ wt::~ 
09 /2 312018 
Curnont Medication s 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy , Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Boost Plus - Liquid 1 110 PRN, stop date 10/19/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl 
Alla .... . 
N.KDA 
vlaw of Syst ems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fewr denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbance denies. Weight gain denies. 
Weight loss denies. 
1623 E J STREET, T 
Appoimnert Facility: Northwest Detertion Cert er 
Appointm ent Provld e 1 (b)(6) ; (b)(?)(C) I RN 
Reas on for Appo intm ent 
1. RN DAYS: HUNGER STRIKE 
History of Prese nt Illness 
Flowsheets (M-tU): 
lnput/OJtput Flowsheet 
Time: 1400 
INPUT PO: 2500 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT SUBTOT/ll: 0 
OUTPUT Urine 0 
OUTPUTEmesis 0 
OUTPUTBM 0 
OUTPUT a. Wet Diaper Weight 0 
OUTPUT b. D,y Diaper Weight 0 
OUTPUT Total Diaper Weight output (calculate a-b} 0 
OUTPUTDrain: 0 
OUTPUT SUBTOT/ll: 0 
NetGain: 0 
NetLoss: 15 
Initials: KM,! 
Patient Identification: 
Patientis 39 iear old male from Russia, in M-IU for Hunger Slrike. It lunch he refused meal 97. His weight this morning was 
147 2 pounds, that is up one pound from )eSterday. this shift patient has been up and alert and has also spent time sleeping in 
bed. Rise and fall of chest was ~suali,ed when sleeping. Patient drank two B(X)SlS this shift. /Ind RN remowd two empty 
pedialyle containers from cell. The only item refused this shift was lunch. 
Patient Identification 
Patient property identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
\Mat language do )OU speak? Russian, __ Interpretation prO\aded? Yes, Interpreter Number 11395360 
Number: 
Language Russian 
Pain /!ssessment 
Pain 
Ne )OU currently in pain? No 
Vita l Signs 
98.0F 
51 /min 
92/53 mm Hg 
16 /min 
1472 lbs 
66.5in 
23.40 Index 
Ex aminatio n 
General El0mination: 
Temp 
HR 
BP 
RR 
wt 
H 
BMI 
09/23/201801:49:58 PM 
09/23/201801:51:31 PM 
09/23/201801:51:31 PM 
09/23/201801:51:31 PM 
09/23/201801:51:31 PM 
09/23/201801:49:58 PM 
09/23/201801:51:31 PM 
GENER/IL PPPEAAPNCE: in no acute distress, well deleloped, well nourished. 
(b)(6); ~N 
(b)(7)(C) -
-
~N 
-
-
~N 
-
-
~N 
-
-
~N 
-
~ 
-
-
~N 
-
NEUROLOGIC: alert and oriented, cooperatiw wth exam, motor strength nonmal upper and ICMer extremities, nonmal 
exam, nonmal strength, tone and reflexes, sensory exam intact. 
Assess ment s 
1. lneffectiw health maintenance - ND00099 (Prima,yj 
2. lneffectiw health management - ND00078 
Tr ea tm ent 
1. lneffecti\11! health maintenance 
Notes: Continue hunger strike protocol, encourage po food/lluids, encourage wrbali,ation of feelings. Encourage to allow staff to 
monitor intake and output, ~tal signs. wt lnslrucled to seek staff with any needs. lkrbali,ed understanding. Detainee offered 
three meals per day and leave in room for 20 to 30 minutes. /ldequate supply of drinking water and other bewrages as ordered 
bypro~der available. Encourage dailyoral/phy.;ical h)!liene care. Change of dothing,bedding. ater B(X)ST and Pedil)le as 
ordered. Do orthostatic ~tals daily. Patient educated to possible Side Effects of going for long period of time without food. Patient 
wrba li,es understanding of current Plan of Care. Patient 1.erbali,es his option to refuse food. 
Appo intment Provide1 (b)(6) ; (b)(?)(C) fN 
B ectro nically signed b* b)(6); ~- r, RN on 09/23/2018 14 :08:30 (Pacific Dayli ght Time) 
2019-ICLl-00051 3176 

DHS-ICE-19-0196, 19-0197-N-000358
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREEr 
l'. WA98421 
Tel b)(6) : 
x: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Prog, .. . Note: t b )(6); (b )(7)(C) IRN 09/23/2018 
Nd.e genertl.ed by eOinicaf'Mrts a.R'PM Sottoore (,w.weC/inica/Works.com) 
2019-ICLl-00051 3177 

DHS-ICE-19-0196, 19-0197-N-000359
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:llct b)/6): ! Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunbe ~ 
1623 E J STREET, T~ 
Appoirimert Facility: Northw est Detertion Certe r 
09 /2312018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy , Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy , Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Boost Plus - Liquid 1 110 PRN, stop date 10/19/2018, KOP: No, 
Drug Source: In House Pharmacy , Notes: Not required for trawl 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. 11\eight loss denies. Dry M>uth denies. 
11\eakness denies. Cough denies. Shortness of breath at 
rest denies. Chest pain at rest denies. Palpitations denies. 
J>l>dominal Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \bm itting denies. Painful urination denies. 
Decreased urine output denies. Mlsde aches denies. Mlsde 
cramps denies. Skin breakdown denies. Difficultythinking denies. 
Appointment P1'ovlderj (b)( 6); __ 
Rea son for Appointment 
1. Daily Rounds 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: Picture, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number 
Number : 11395360 
Language Russian 
Pain .1>6sessment 
Pain 
/>,e }OU currently in pain? No 
Narratiw: 
(0811) Patient still does not wish to resume eating meals. has been drinking boost and pedial)le. Denies pain. Denies 
weakness. Denies GI problems. 
Hunger Strike: 
Madical Eleluation 
Date missed meals monitoring initiated: 08/22/2018 
Wien did the official hunger strike begin? 08/2512018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking fluids: Yes 
# of da)>S on hunger strike: 30 
Total \/\eight loss in pounds: 15.8 
Reason for hunger strike: Wcints to be released from custody 
Housing/Isolation Location: M,dical Housing Unit 
Reason for Isolation Placement For dose supervision, obse,vation, and monitoling 
Re"ew of the Housing Placement Review housing every 24 hours 
Vit al Sign s 
98.0F 
standing:76 
sitting:50 
supine:51 
standing:96/63 
sitli ng:96/64 
supine:92/53 
16/ min 
147.2 lbs 
66.5in 
23.40 Index 
Ex amina tion 
General E><amination: 
Temo 
09/2312018 10:44:35 Ml 
HR 
09/2312018 10:44:35 Ml 
09/2312018 10:44:35 Ml 
09/2312018 10:44:35 Ml 
BP 
09/2312018 10:44:35 Ml 
09/2312018 10:44:35 Ml 
09/2312018 10:44:35 Ml 
RR 
09/2312018 10:44:35 Ml 
WI 
09/2312018 10:44:35 Ml 
H 
09/2312018 10:44:35 Ml 
BMI 
09/2312018 10:44:35 Ml 
GENER/II.. /IPPEIIRl'NCE: in no acute distress, well del.eloped, well nourished. 
OR/ll_ CA\ATY: mucosa moist, no lesions. 
SKIN: good turgor, no rashes, no suspicioos lesions. 
HE.ART: no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, nowieezes , rales, rhonchi. 
/18DOIVEN: normal, boNel soonds present, soft, nontender, nondistended. 
b)(6) ; 
b)(7)(C) 
MJSCULOSKELET/ll : normal, normal gait, no deformities, full range of motion, good strength and equal bilaterally. 
NEURQOOC : alert and oriented, cooperatiw with exam, gait normal, no tremor. 
PSYCH: alert, oriented, cooperatiw with exam, good eye contact, speech clear, thought process goal directed. 
Assessment s 
1. StaMition, subsequent encounter - T73.0JO<D (Primary) 
Treatment 
1. Starvation, subsequent encOl.l"ller 
~p 
-
~ 
~p 
~p 
-
-
~p 
~p 
~p 
-
~p 
-
~p 
-
-
~p 
-
~p 
Notes: Patient has been drinking boos~ but still does not want to resume eating meals. WII continue to offer and encourage to 
resume eating. Patient stable at this time. WII continue to monitor condition. Patient 1.0iced understanding and agreementwilh 
plan. 
Follow Up 
ina m 
Appointment Pro; (b)( 6); (b)( 7)(C) I t.f> 
(b)(6) ; (b)( 7)(C) 
2019-ICLl-0005 1 3178 

DHS-ICE-19-0196, 19-0197-N-000360
Electronically signed b~"-(b...;. )--(6--), __ · __ _.!" on 09/23/201810 :49:37 (Pacific Daylight Time) 
Sign off status: Comp leted 
Northwest Detention Center 
1623 E J STREEr 
,: b)( 6 ); Ti la...\ ( "'7\lr>\ 
Patient: AMAR, lll!RGl!NSANA DOB: 10/23/1978 ProgN - No~.._ (b __ ) __ (6 __ ),_ · __ _.rp 09/2312018 
/lk:l.e general.ed byeC/irica/Wa1<s E/>.f<IPM Soft,,,.ere (\'MWeC/inica'li\lcYks.COO]I 
2019-ICLl-00051 3179 

DHS-ICE-19-0196, 19-0197-N-000361
U.S. Immigration 
and Customs 
Enfor cement 
09 12212018 
Cunont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy , Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Boost Plus - Liquid 1 110 PRN, stop date 10/19/2018, KOP: No, 
Drug Source: In House Pharmacy , Notes: Not required for trawl 
Review of Systems 
Patient did not hale any medical complaits at this time. 
Reason for Appointment 
1. Nursing rounds 
History of Present Illness 
Flowsheets (M-tU): 
lnput/OJtput Flowsheet 
Time: 0630 
INPUTPO: 42 
Initials: sac Narratiw: 
Appointment Provlder:k b)/6): (b)(7)(C) ! RN 
Ml le patient asleep when I arriled on shift. Patient giwn pedial)le and boost at 2030, Patient woke up and drank some 
pediali!e when I left his cell. />wake at 0355 reading in bed. Pedial)le and boost giwn at 0500. 
Examination 
General Examination: 
GENER/IL l>PPEl'RPNCE: in no acute distress, male. 
SKIN: noonal, no rashes, no suspicious lesions. 
LUNGS: noonal, clear to auscultation bilaterally, no wieezes, rales, rhonchi. 
Assessments 
1. Imbalanced nutrition: Less than body requirements [00002]- ND00002 (Primary) 
Treatment 
1. Imbalanced nutr~ion: Less than body req..iremerts (00002] 
Notes: Detainee wrba li,ed understanding of plan of care and denies questions/concerns. Continue hunger strike protocol, 
encourage po food/fluids, encourage wrbalization offeelings. Encourage to allow staff to monitor intake and output, ,ital signs, 
wt. Instructed to seek staff with any needs. \lerbaliied understanding. Call bell within reach, bed in lowest position with siderails 
up x2, brakes on. Nursing Care Plan present Refer to nursing care plan for on-going inteMntions. Detainee offered three meals 
per day and leaw in room for at least 20 minutes. /ldequate supply of drinking water and other bewrages as ordered bypro,ider 
available. Encourage dailyoral/ph)Sical h,giene care. 
Disposition: /ldmitted to M-IU until medicallye1,0luated 
Appointment Provide{b )(6); ~-
Electronically signed (b )(6); 
(b)(7)(C) Sign off status: Compla,,..,...---~ 
RN on 09/23/2018 06:29:53 (Pacific Daylight Time) 
Northwest Detention Center 
1623 E J SmEEr 
TACOMA, WA98421 
"'Vh\/n\ Fax: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Pn,greM Now: .,,! (b__,)..,(6 __, ).._; __ __.ft" 09/22/2018 
Ncte generaled by eC/inica!Wt:n<s EM<IPM Soflvere (""""eC/inica/Works.com) 
2019-ICLl-00051 3180 

DHS-ICE-19-0196, 19-0197-N-000362
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA .. A:21626980 2 Su:ll~b )(6); I 
Facility Code: CSCN/1/WA 1119,. ea. 1t1 
AccOUll ~be Jbl<6L ! 39Y ad ~=E:: 
09 12212018 
Cunont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Boost Plus - Liquid 1 110 PRN, stop date 10/19/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. 11\eight loss admits. Dry 
M'.luth denies. 11\eakness admits. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. />lldominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. \bm itting denies. Painful 
urination denies. Decreased urine output denies. Mlsde 
aches denies. Mlsde aamps denies. Skin breakdown denies. 
Difficultythinking denies. 
1623 E J STREET, T 
Appoimnert Facility: Northwest Detertion Certer 
Reason for Appointment 
1. First 1/2ewn ing RN round/Hunger strike 
History of Present Illness 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Time: 1910 
INPUT PO: 200 
OUTPUTBM 0 
Net Gain: 200 
Initials: LM 
Hungerstrike M'.lnitoring Form 
Day. 09/22/2018 
Shift: PM 
Intake PO (in ml): 200 pt was ob served to drink water from pitch 
Intake rl/- Normal Saline (in ml}: 0 
Intake rl/- LR (in ml}: 0 
Intake NG(in ml): 0 
OJtput Urine (in ml): 00 
Comments: HE HAS BEEN DRINKING water 
Initials: LM 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEO OFFICER 
\Mlat language do )OU speak? Russian 
Interpretation pro,..ded? Provider fluent in pa vent's native language 
Pain 1'6sessment 
Pain 
l'<e )OU currently in pain? Yes 
The pain is located _. back and legs 
The se1erityof pain is rated at 6110 
The se1erityof the pain is moderate 
The pain began 4-5 v.eeksago 
The character of the pain is aching 
The associated S)<llptoms are ooakness 
The pain is aggravated by other hunger strike 
The pain is relieled by other 
Describe: pt refused medication treatment 
Narrati1e: 
Appointment Provlde1 (b)(6) ; ~-
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Pl was in M-IU II/ED 2 at 1515 Upon encounter detainee was resting quietly in bed. Detainee reported weakness and pain on 
his legs and back , but refused any medical treatment He has been drinking Pedial)le and Boost Detainee has missed his 95 
meal this dinner M'.lstofthedayptwas resting. \MIi continue to monitor. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
Vlnen did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: !Mlnts to be released from custody 
/1<:!equate supply of drinking water and other be-erages available: Yes 
Three meals deli1ered per day to patient Yes 
Lunch deli-ered during current shift 0% consumed 
Dinner deli-ered during current shift 0% consumed 
/lnyunauthori>edfoodinroom? No 
Hale dailyorthostatic "tal signs been completed? Yes 
Has input and output been documented on the the M-IU Hunger Strike M'.lnitoring Smart Form? Yes 
Ex amina tion 
General B<amination: 
GENER/II. !>PPE.ARANCE: in no acute distress, well del.e!oped, well noorished. 
HEJlD: normocephalic. 
SKIN: normal, no rashes, no suspicious lesions. 
HEPRT: no murmurs, regular rate and ohythm, S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, no Vvheezes, rales, ohonchi. 
CHEST: normal, no gross rib deformity, normal shape and expansion. 
PBDOM:N: normal, bowel sounds present, soft, nontender, nondistended. 
MJSCULOSKELETJ>l: normal, normal gait, no deformities, full range o( motion, . 
NEUROLOOC: alert and oriented, cooperati-e with exam, , gait normal, neck supple, no rigidity, no tremor. 
PSYCH: alert, oriented, cogniti-e function intact, cooperati-e with exam, good eye contact, judgement and insight 
good , mood/affect full range, no auditory or IASUal hallucinations, speech clear, thought content without suicidal ideation, 
delusions, thought process logical, goal directed. 
Assess ment s 
/II-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: 1. Continue with \Alai Signs e-eryshifl; Intake and OJtput lvbnitoring e-eryshifl; Dailyweights: Dailyorthostatic " tal signs. 
2. /In adequate supply of drinking water and other be-erages are available to patient at all times. 
3. Three meals per day are deli sered to the patient and deli-eryof meals is documented. 
4. /Ill food not authori>ed by CD/Phy.;ician is remo-ed from patienrs room. 
5. Patient is not allowed to purchase food from commissari,\ending machine while on hunger strike. 
6. Patient will only be released from hunger strike treatment/monitoring by CD or phy.;ician order. 
7. Patient counseled regarding the medical risks of continuing the hunger strike. 
8. Encouraged to terminate the hunger strike and eat/drink as normal. 
Appointment Provide1 b)(6); ~-
2019-ICLl-0005 1 3181 

DHS-ICE-19-0196, 19-0197-N-000363
Electronically signed by (b)(6); /h\/7\/r\ 
Sign off status: Complete 
on 09/22/201819 :14:22 (Pacific Daylight Time) 
Northwest Detention Center 
1623EJSTREI" 
TACOMA, WA98421 
Telj(b )(6) I rax. 
Patient: AMAR, IIERGENSANA DOB: 10/2 3/1978 ProgN u Notl~(b~)~(6~),~· --~!RN 09/22/2018 
Nd.e general.ed by eOinica/W<n<s B>RIPM Sottw,re (""""eC/inica/works.CtJm) 
2019-ICLl-00051 3182 

DHS-ICE-19-0196, 19-0197-N-000364
U.S. Immigration 
and Customs 
Enforcement 
AMAR, MERGEN~ 
A: 216269802 Si.ti1 (b )(6); 
Facility Code: CSCN/1/WA Housing ea : 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll~ )(f,I· 
09 12212018 
Cunont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Boost Plus - Liquid 1 110 PRN, stop date 10/19/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl 
1623 E J STREET, T VVM842 I 
Appoimnert Facility: Northwest Detertion Certer 
Rea son for Appointment 
1. SEGREG\llON ROUNDS/ t,,E/ll lvOJITCRING 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? No 
Wiat language do }OU speak? English 
Interpretation pro\aded? Pallent speaks English fluenUy 
Segregation: 
Segregation Rounds 
ke }OU currentlythinking about killing or harming }Ourself? No 
Do}Ou haw any medical complainls orconcems at this time? No 
Appointment Provld e,fb )(6 ); (b)(7)(C) I RN 
Was referral made to din ical sen.1ces (lvOIM.P, Dental, M-t, Sidk Call}? No 
Examination 
Segregation: 
Segregation Evaluation: Patient has spontaneous speech and ansWE!fS questions appropriately, in no acute distress, 
well de\eloped , well nourished, Patient appears to be v.ithin normal limits of beha"or, affect, and cogniti1.e functioning, 
Patient does not appear to ha,e any acute or unresol\ed medical conditions that may worsen in segregation, Patient does 
not appear to ha\e acti,e psychosis, mania, suicidal idealions or l'Klmicidal ideations. 
Assessments 
Health M!intenance Related to Segregation Placement 
Preventive Medicine 
Patient educated on how to access medical / mental health/ dental care while in Segregation. 
Notes: Per D-3 Segregation GEO officer, detainee refused his breakfast this morning (Saturday, 09/22/2018), which would be 
meal #93. 
Appointment Provide'fb )(6); __ 
(b)(6); (b)(7)(C) 
~b)(6); (b)(7)(C) I 
Electronically signed!'._ _____ _,~ on 09/22/201813:26:53 (Pacific Daylight Time) 
Sign off status: Completed 
Northviest Detention Center 
1623 E J STREET 
T=WA98421 
Tejbj[6 ) ! Fax: 
Patient: AMAR, MERGENSANA DOIi: 10/23/1 978 P--i (b)(6); (b)(7)(C) 
Ncte genersled by eClinica!Worl<s E!vR1'M Softw!Jre {l<MWeC/ inica/Worl<s.com) 
IRN 09/22/2018 
2019-ICLl-00051 3183 

DHS-ICE-19-0196, 19-0197-N-000365
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:ll1b )(6); 
Facility Code· CSCN/1/WA Hoo .. .. _ .. - • 
39 Y old Male, DOB: 13/23/1978 
AccOl.l'II lunber:~ 
1623 E J STREET, T~ 
Appoirimert Facility. Northwest Detertion Certer 
09 12212018 
Cunont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Boost Plus - Liquid 1 110 PRN, stop date 10/19/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl 
Alla ..... 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. \Neight loss admits. Dry 
Mluth denies. \Neakness admits. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. l'lxlom inal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. ½m illing denies. Painful 
urination denies. Decreased urine output denies. MJsde 
aches denies. MJsde cramps denies. Skin breakdown denies. 
Difficulty thinking denies. 
Reas on for Appointm ent 
1. RN Day rounds/Hunger Strike 
History of Prese nt Illness 
Flowsheets (M-tU): 
lnput/OJtput Flowsheet 
Time: 1520 
INPUTPO: 1500 
OUTPUT BM 500 
NetGain: 1000 
Initials: LM 
Hungerstrike Mln itoring Form 
Day. 09/22/2018 
Shift: AM 
Intake PO(in ml}: 1500 ptv.asobserved to drink v.aterfrom pitch 
Intake rl/- Normal Saline (in ml}: 0 
Intake rl/- LR (in ml}: 0 
Intake NG(in ml): 0 
OJtput Urine (in ml): 500 
Comments: HE HAS BEEN DRINKING PED/AL YTE 
Initials: LM 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEO OFFICER 
\Mlat language do )OU speak? Russian 
Interpretation pro,..ded? Provider fluent in pa vent's native language 
Pain 1'6sessment 
Pain 
Ne )OU currently in pain? Yes 
The pain is located _. back and legs 
The se1erityof pain is rated at 6110 
The se1erityof the pain is moderate 
The pain began 4-5 v.eeksago 
The character of the pain is aching 
The associated S}'llptoms are ooakness 
The pain is aggravated by other hunger strike 
The pain is relieled by other 
Describe: pt refused medication treatment 
Narrati1e: 
Appointment Provlde9 (b)(6) ; ~ -
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Pl was in Seg due M-IU 01erflow, and moled back to M-IU M:D 2 at 09:26 Upon encounter detainee was resting quietlyin 
bed. Detainee reported weakness and pain on his legs and back, but refused anymedical treatment He has been drinking 
Pedialjle and Boost. Detainee has missed his 94 meal this lunch. Mist of the day pt was reading and resting. \MIi continue to 
monitor. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
Wien did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wcints to be released from custody 
/ldequate supply of drinking water and other be1erages available: Yes 
Three meals deli1ered per day to patient Yes 
Lunch deliwred during current shift 0% consumed 
/lnyunauthori>edfood inroom? No 
Hale dailyorthostatic "ta l signs been completed? Yes 
Has input and output been documented on the the M-IU Hunger Strike Mlnitoring Smart Form? Yes 
Vital Signs 
97.7F 
sitting:61 
sitting:50 
supine:46 
standing:97 /59 
sitting:96/65 
supine:100/62 
16 /min 
146.2 lbs 
66.5in 
2324 Index 
Ex amination 
General Examination: 
Temp 
09/22/201812:06:30 PM 
HR 
09/22/2018 12:06:30 PM 
09/22/201812:06:30 PM 
09/22/2018 12:06:30 PM 
BP 
09/22/201812:06:30 PM 
09/22/2018 12:06:30 PM 
09/22/2018 12:06:30 PM 
RR 
09/22/2018 12:06:30 PM 
WI 
09/22/201812:06:30 PM 
H 
09/22/2018 12:06:30 PM 
BMI 
09/22/2018 12:06:30 PM 
GENER/II.. !>PPEJ>Rl'NCE: in no acute distress, well del,eloped, well nourished. 
HEJ>D: normocephalic. 
SKIN: normal, no rashes, no suspicious lesions. 
HEART: no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilateially, nowieezes, rales, rhonchi. 
CHEST: normal, no gross rib deformity, normal shape and expansion. 
2019-ICLl-00051 3184 
b)(6); N 
b)(7)(C) -
-
N 
N 
N 
-
-
N 
N 
N 
-
-
N 
-
-
N 
-
-
N 
-
-
N 
-

DHS-ICE-19-0196, 19-0197-N-000366
/18D0\iEN: normal, bowel sounds present, soft, nontender, oondistended. 
MJSCULOSKELETl>l: normal, normal gait, no defom1ities, full range ri motion, . 
NEUROLOOC: alert and oriented, cooperati1.e with exam, , gait normal, neck supple, no rigidity, no tremor. 
PSYCH: alert, oriented, cogniti1.e function intact, cooperati1.e with exam, good eye contact, judgement and insight 
good, mood/affect full range, no auditOI)' or llsual hallucinations, speech clear, thought content without suicidal ideation, 
delusions, thought process logical, goal directed. 
Assessments 
!(-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: 1. Continue with \Alai Signs e1.eryshift; Intake and CUtput Mlnitoring e1.eryshift; Dailyweights; Dailyor1hostatic \ital signs. 
2. /ln adequate supply of drinking water and other be1.erages are available to patient at all times. 
3. Three meals per day are deli1.ered to the patient and deli1.eryof meals is documented. 
4. ~I food notauthori2"d by CD/Physician is remo1.ed from patienfs room. 
5. Patient is not allowed to purchase food from commissar)l\ending machine while on hunger strike. 
6. Patient will only be released from hunger strike treatment/monitoring by CD or physician order. 
7. Patient counseled regarding the medical risks of continuing the hunger strike. 
8. Encouraged to terminate the hunger strike and eat/drink as normal. 
Appointment Provi (b)(6); 
(b)(7)(C) RN 
Electronically signed ~~(b_)_(6_),_· -~' RN on 09/22/201815 :27:15 (Pacifi c Daylight Time) 
Sign off status: Completed 
Northwest Detention Center 
1623E. JS mEEr 
T~WA98421 Tei{b)(6); t-ax: 
Patient: AMAR, IIERGENSANA DOB: 10/2 3/1978 Progre .. No~ (b)(6); ~- ~ 09/22/2018 
N(te generated byeOirica/Worl<s EJvRIFM So/tvere (""""eC/inica/Works.com) 
2019-ICLl-00051 3185 

DHS-ICE-19-0196, 19-0197-N-000367
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:i1ol(b)( 6) : ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, ~ -1QOJ(1928 AccOllll lunber: (b)( 6) : 
1623 E J STREET, TACOMA, WA-98421 
Appoirimert Facility: Northwest Detertion Cert er 
09 12212018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Boost Plus - Liquid 1 110 PRN, stop date 10/19/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue admits. 
Fewr denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbance denies. ~ ight gain denies. 
~ ight loss denies. 
Gastrointestinal: 
Blood in stool denies. Constipation denies. Nausea denies. 
Mlsculoskeletal: 
Mlsde aches denies. ~kness admits. 
Reason for Appointment 
1. Daily Rounds 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? Russian 
lnterpre ·b)(6). · ? Yes, Interpreter Name Name: , N Lang h \t 7 \tf'\ 
Pain .1>6sessment 
Pain 
/>,e }OU currently in pain? No 
Narratiw: 
(1345) Patient still does not wish to resume eating meals. has been drinking boost and pedial)le. Denies pain. 
Current status: Stable 
Mssed meals monitoring initiated: 081221'2018 
Official hunger strike date: 08125/2018 
Date last meal consumed: 81221'2018 
Last meal consumed: Breakfast 
Reason for Hunger Strike: Wants release from custody 
Drinking fluids: Yes. Boost and Pedial)le 
# of da}'> missed meal monitoring: 32 
# of da}'> on hunger strike: 29 
# of missed meals (Total}: 94 (as of 09/221'2018: Lunch} 
Initial weight at missed meal monitoring: 163.0 LBS 
Date of initial weight 08/221'2018 
Date of current weight 9/21/2018 
Currentweightin pounds: 146.2 LBS 
Total weight loss: 16.8 LBS 
Patient refused: food only. 
Vital Sign s 
97.7F 
standing:61 
sitting:50 
supine:46 
standing:97/59 
sitting:96156 
supine:100/62 
16/ min 
146.2 lbs 
66.Sin 
23.24 Index 
Ex amination 
General E><amination: 
Temp 
09/22/201802:01:11 PM 
HR 
09/22/201802:01:11 PM 
09/22/201802:01:11 PM 
09/22/201802:01:11 PM 
BP 
09/22/201802:01:11 PM 
09/22/201802:01:11 PM 
09/22/201802:01:11 PM 
RR 
09/22/201802:01:11 PM 
1M 
09/22/201802:01:11 PM 
H 
09/22/201802:01:11 PM 
BMI 
09/22/201802:01:11 PM 
GENER/IL /IPPEJIRIINCE: in no acute distress , well del.e!oped, well nourished. 
ClRJll CA\A'TY: mucosa moist, no lesions. 
SKIN: good turgor. 
HE.I.\RT: no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, nowieezes, rales, rhonchi. 
J>BDCM:N: normal, boNel sounds present, soft, nontender, nondistended. 
b)(6); 
b)(7)(C) 
MUSCULOSKELET/ll : normal, normal gait, no deformities, full range of motion, good strength and equal bilaterally. 
Assessment s 
1. StaMJtion, subsequent encounter - T73.0JO<D (Primary) 
Treatment 
1. Starvation, subsequent encOlllle r 
p 
-
-
p 
p 
p 
-
-
p 
p 
p 
-'"" p 
-
-
p 
-
-
p 
'"" 
'"" p 
-
Notes: Patient is stable. Continue to offer and encourage resuming eating regular meals. Patient at this time states he does not 
want to resume meals. W II continue to monitor his condition. Patient 1.0iced understanding. 
Follow Up 
pm 
Appointment Provider. (b )(6); 
(b)(7)(C) 
N> 
(b)(6); (b)(7)(C) 
2019-ICLl-00051 3186 

DHS-ICE-19-0196, 19-0197-N-000368
Electronically slgned b¥b)(6); NP on 09/22/201814:03:48 (Pacific Daylight Time) ! h\/ 7 \/ f' \ ~-
Sign off status: Completed 
Addendum: 
09/22/201802, (b)(6); (b)(7)(C) t f/u in am 
Northwest Detention Center 
1623 E J STREEr 
T=WA98421 ifu{Bi: I 
Fax: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progra .. Notaj,__ (b~)~(6~),~·-~ _ _.INP 09/22/2018 
Ncxe general.ed byeC/inica/W<rts EJ.RIPM Soft"8re (l'N.WeC/inical WcYks.COOJI 
2019-ICLl-00051 3187 

DHS-ICE-19-0196, 19-0197-N-000369
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A:216269802 Su:lloj(b)(6); ! 
Facility Code: CSONVWA Housing Area : M 
39 Y old Male, DOB: 10/23/1978 
Acc01.111 tunbe ,f hl/RI· I 
09 12212018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Boost Plus - Liquid 1 110 PRN, stop date 10/19/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl 
Alie ..... 
N.KDA 
Reason for Appointment 
1. SEG CLE/IRl>NCE 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEO OFFICER ON DUTY 
Wiat language do }OU speak? English, Russian 
Interpretation pro\aded? Pallent speaks English fluenUy 
Pain l>ssessment 
Pain 
/>,e }OU currently in pain? No 
Segregation: 
Segregation Clearance 
Evaluated for Segregation Placement on: 09/22/2018 
ke }OU currentlythinking about killing or harming }Ourself? No 
1623 E J STREET, TACOMA, WA-98421 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Provld e1 (b)( 6); ~-
Do}Ou haw any medical complainls prior to going into segregation? No 
ChartRe\aew 
History of mental illness or haw any mental health encounters at current facility? No 
Unresolled or acute medical problems that contraindicate Segregation housing? No 
/lctionsTaken 
/l!>pointment created or telephone encounter assigned to t;O/M.P, Dental, M-1, or SC? No 
Ex amina tion 
Segregation: 
Segregation Evaluation: Patient has spontaneous speech and answers questioos appropriately, in no acute distress, 
well de\eloped , well nourished, Patient appears to be v.ithin normal lim~s of 1Jeha1,1or, affect, and cogn~i1.e functiooing, 
Patient does not appear to ha1.e any acute or unresohed medical conditioos that may VIA'.l!Sen in segregatioo, Patient does 
not appear to ha\e actiw psychosis, mania, suicidal ideatioos or homicidal ideatioos. 
Time at which re\<ew for segregation was completed: 0100. 
Assess ment s 
Health M!intenance Related to Segregation Placement 
Pre vent ive Medic ine 
Patient educated on how to aocess medical I mental health I dental care while in Segregation. 
Disposition: rv'edicallydea red for custody 
Appointment Provide~(b)(6); btJ ·1-. ----·· 
Electronically signed (b )(6); on 09/22/2018 01:11:50 (Pacific Daylight Time) / h\ / 7 \fr'\ 
Sign off status: Comple 
North\Nest Detention Center 
1623 E J STREET 
A98421 
Patient: AMAR, MERGENSANA DOIi; 10/23/1978 p,_... ~ 09/22/2018 
Ncte generated by eOinica!Wai<s ElvRIPM &itV8e (l<MMleOinica/Works.com) 
2019-ICLl-00051 3188 

DHS-ICE-19-0196, 19-0197-N-000370
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A:216269802 Su:llDll h\//;\· I 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunber~ 
1623 E J STREET, T~ 
Appoirimert Facility: Northwest Detertion Certer 
09 12212018 
Curnont Medication s 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy , Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Boost Plus - Liquid 1 110 PRN, stop date 10/19/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl 
Review of System s 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. 11\eight loss admits. Dry 
M'.luth denies. 11\eakness admits. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. />lldominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. \bm itting denies. Painful 
urination denies. Decreased urine output denies. Mlsde 
aches denies. Mlsde aamps denies. Skin breakdown denies. 
Difficultythinking denies. 
Reas on for Appointm ent 
1. tvHU RN NIGHT ROUNDS/HUNGER STRIKE 
History of Pre se nt Illne ss 
Flowsheets (tvHU): 
Hungerstrike M'.lnitoring Form 
Day. 09/19/2018 
Shift: Night 
Intake PO(in ml}: 0 
Intake r.J- Normal Saline (in ml}: 0 
Intake r.J- LR (in ml}: 0 
Intake NG(in ml): 0 
QJtput Urine (in ml): 0 
Comments: HE HAS BEEN DRINKING PED/AL YTE AND BCX>ST 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes 
Chaperone Name: GEOCFF/CER ON DUTY 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number 
Number: 
Language Russian 
Pain />ssessment 
Pain 
Ne }OU currently in pain? No 
Narratiw: 
Appointment Provid er: (b)(6); 
(b)(7)(C ) 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/220)18 
\M1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/220)18 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: 11\ants to be released from custody 
/1<:!equate supply of drinking water and other be-erages available: Yes 
Three meals deliwred per day to patient Yes 
/lnyunauthori>edfood inroom? No 
Haw dailyorthostatic \ital signs been completed? Yes 
Has input and output been documented on the the M-IU Hunger Strike M'.lnitoring Smart Form? Yes 
Ex amination 
General Examination: 
GENERl>l !>PPE.AR.ANCE : in no acute distress, well del.e!oped, well nourished. 
PSYCH: alert, oriented. 
Assessme nt s 
/>I-Risk for imbalanced nutrition: Less than body requirements. 
Tre atment 
1. Others 
RN 
Notes: 1. Continue with \Alai Signs e-eryshift; Intake and QJtput M:mitoring e-eryshift; Dailyweights; Dailyorthostatic \ital signs. 
2. /In adequate supply of drinking water and other be-erages are available to patient at all times. 
3. Three meals per day are deliwred to the patient and deliwryo f meals is documented. 
4. ~ I food not authori>ed by CD/Phy.,ician is remo-ed from patienfs room. 
5. Patient is not allowed to purchase food from commissar)ll.ending machine while on hunger strike. 
6. Patient will only be released from hunger strike lreatmentlmonitoring byCD or phy.,ician order. 
7. Patient counseled regarding the medical risks of continuing the hunger strike. 
8. Encouraged to terminate the hunger strike and eat/drink as normal. 
9. Patientwrbali>ed understanding of care plan. 
Disposition: Pdmitted to tvHU until medically evaluated 
Appoinbnent Provide1(b )(6); _ _ I RN 
Electronically signed b1~!\~f;~, r on 09/22/2018 05:42:37 (Pacific Daylight Time) 
Sign off status: Completed 
Add endum : 
09/22/2018 05:48 Ml(b )(6); ~ INTERPRET ~K # 324640 RUSSI/IN 
2019-ICLl-00051 3189 
Northwest Detention Center 
1623 E J STREET 

DHS-ICE-19-0196, 19-0197-N-000371
P•ll-t: AMAR, IERGENSANA DOB: 10/23/1978 ......... Nohj-\b_)_(6_); __ -IRN 09/22/2018 
Ncl.e generated by eC/inica/'Na1<s EJvR/PM Sottv.ere (,w,weC/inica/WGYks.COOjl 
2019-ICLl-00051 3190 

DHS-ICE-19-0196, 19-0197-N-000372
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3191 
AMAR,MERGENSANA 
.. A:216269802 Su:llUl(b)(6); I 
Facility Code: CSONVWA Ho.J:LJ._ ...,s.,....._ ....,_ 
39 Y old Male,~•~::: 
1623 E~~::=1~~; 1 

DHS-ICE-19-0196, 19-0197-N-000373
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
.. A: 216269802 Su:ll~b)(6 ); I 
Facility Code: CSCN/1/WA 119,. ea. 1t1 
39 Y old Male, DOB: 10/23/1978 
1623 E J 
Acc
STREET, 
Ol.rll lunber: 
T~ 
~ 
Appoimnert Facility: Northwest Detertion Cert er 
09 12112018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Boost Plus - Liquid 1 110 PRN, stop date 10/19/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl 
Alla ..... 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. \Neight loss admits. Dry 
M)uth denies. \Neakness admits. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. l'lxlo minal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. ½m illing denies. Painful 
urination denies. Decreased urine output denies. MJsde 
aches denies. MJsde cramps denies. Skin breakdown denies. 
Difficulty thinking denies. 
Appointment Provld e 1 (b)(6) ; (b)(7)(C) 
Reason for Appointment 
1. PM SHIFT NOlE. Hunger Strike Nursing E1,0luation 
History of Present Illness 
Flowsheets (MHU): 
Upon encounter detainee was resting quietlyin bed. Detainee reported weakness but refused any medical treatment 
Detainee water pitcher has been filled for him and he has been drinking Pedial)le and Boost Detainee has missed his 92nd 
meal this ewn ing-dinner. Detainee has gone back to resting quietlyin his room. \MIi continue to monitor. 
Hungerstrike fl.bnitoring Form 
Day. 09/21/2018 
Shift: PM 
Intake PO(in ml}: 0 
Intake rl/- Normal Saline (in ml}: 0 
Intake rl/- LR (in ml}: 0 
Intake NG(in ml): 0 
QJtput Urine (in ml): 0 
Comments: WATER PITCHER WAS FILLED FCR HI MAND HE HAS BEEN DRINKING PED/AL YTE 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEOCEFICER 
Wiat language do }OU speak? English 
Interpretation pro\aded? Pallent speaks English fluenUy DETAINEE SPO<E AND UNDERSTCX)() ENGLISH TCOAY 
Pain />ssessment 
Pain 
Ne }OU currently in pain? No 
Narratiw: 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/220)18 
\M1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/220)18 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: 11\ants to be released from custody 
/1<:!equate supply of drinking water and other be-erages a1,0ilable: Yes 
Three meals deliwred per day to patient Yes 
/lnyunauthori>edfoodinroom? No 
Haw dailyorthoslatic "la l signs been completed? Yes 
Has input and output been documented on the the M-IU Hunger Strike M)nitoring Smart Form? Yes 
Vital Signs 
Temp 
98.0F 09/21/201806:57:58 PM 
1-R 
46/m in 09/21/201806:57:58 PM 
BP 
standing:97/63 09/21/201806:57:58 PM 
sitting:108/70 09/21/201806:57:58 PM 
RR 
16/m in 09/21/201806:03:40 PM 
WI 
144.4 lbs 09/21/201806:57:58 PM 
H 
66.5in 09/21/201806:03:40 PM 
BMI 
22.96 Index 09/21/201806:57:58 PM 
Ex amination 
General Examination. 
GENER/II.. !>PPEAAl'NCE: in no acute distress, well del.eloped, well nourished. 
PSYCH: alert, oriented. 
Assessment s 
Ill-Risk for imbalanced nutrition: Less than body requirements. 
Treatm ent 
1. Others 
(b)(6); (b)(7)(C) 
I" 
Notes: 1. Continue with \Alai Signs e-eryshift; Intake and QJtput Mlnitoring e-eryshift; Dailyweights: Dailyor1hoslatic \ital signs. 
2. /In adequate supply of drinking water and other be-erages are a1,0ilable to patient at all times. 
3. Three meals per day are deliwred to the patient and deliwryof meals is documented. 
4. ~ I food not authori>ed by CD/Phy.;ician is remo-ed from patienrs room. 
5. Patient is not allowed to purchase food from commissar)llending machine while on hunger strike. 
6. Patient will only be released from hunger strike treatment/monitoring byCD or phy.;ician order. 
7. Patient counseled regarding the medical risks of continuing the hunger strike. 
8. Encouraged to terminate the hunger strike and eat/drink as normal. 
Appointment Provide~ (b)(6) ; (b)(7)(C) 
2019-ICLl-0005 1 3192 

DHS-ICE-19-0196, 19-0197-N-000374
Electronically signed by!(b)(6); (b)(7)(C) 
Sign off status: Completed 
~ on 09/21/201819 :03:34 (Pacific Daylight Time) 
Northwest Detention Center 
1623 E J STieT 
T~r98421 TeJ§i(~f I 
Pali-I: AMAR, MERGENSANA DOB: 10/23/1978 P ....... ._, (b)(6); (b)(7)(C ) 
/\k:le ge,,e,-ated by eC/inica/Wo1<s Bvf<IPM Softv.ere (l'MWeC/inica'WGYks .COOjl 
I RN 09/21/2018 
2019-ICLl-00051 3193 

DHS-ICE-19-0196, 19-0197-N-000375
U.S. Immigration 
and Customs 
Enforcement 
AMAR, MERGENiANA 
A: 216269802 Su:,1Ji)(6); I 
Facility Code: CSONVWA Housing Area: M 
39 Y AccOl.l"II old Mala lfflli;;.:(b)(6); ,· '~!t::: ! 
09 12112018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Boost Plus - Liquid 1 110 PRN, stop date 10/19/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl 
Alie ..... 
N.KDA 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue admits, 
that is constant. Fewr denies. Headache denies. 
Lightheadedness admits, s8\.eral limes. Night sweats denies. 
Sleep disturbance denies. Weight gain denies. Weight 
loss denies. 
Respiratory: 
Change in breathing pattem denies. Chest pain denies. 
Shortness of breath at rest denies. 
Cardi0\0Scular. 
Chestpainatrestdenies. Di22iness admits, frequently, with 
changing position. Irregular heartbeat denies. 
Palpitations denies. Shortness of breath denies. 
~ kness admits, that is 5eloele , that is generalized. 
Gastrointestinal: 
Podominal pain denies. Change in bowel habits Denies BM. 
Nausea denies. \l:>miting denies. 
Genitourinary. 
Podominal pain/swelling denies. Blood in urine denies. 
Difficulty urinating denies. Frequent urination denies. Pain in lower 
back denies. Painful urination denies. 
MJsculoskeletal: 
Leg cramps are felt in both legs, admits, that occur 
occasionally, at rest, with acti\ity. MJsde aches admits legs 
thighs and calves. Painful joints denies. ~ kness admits, 
that is generalized, that is 5e\oele. 
~ : 
.Aroiietydenies. Jluditor)Nsual hallucinations denies. 
Depressed mood denies. Homicidal Thoughts denies. Suicidal 
thoughts denies. 
1623 E J STREET, T Y¾jriVV 
Appoirimert Facility: Northwest Detertion Certer 
Appointment P1'ovldef b)(6) ; (b)(?)(C) I RN 
History of Pl'esent Illness 
Flowsheets (M-!U\: 
lnpuVQ.rtput Flowsheet 
Time: 1300 
INPUT PO: 1250 refuses to keep track of fluids. Drank Boost, Pedialyte 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT IV Fluids: 0 
INPUTOher. 0 
INPUT SUBTOT/ll: 0 
OUTPUT Urine O Unknow, - refuses to measure 
OUTPUTEmesis 0 
OUTPUTBM 0 
OUTPUT a. Wet Diaper Weight 0 
OUTPUT b. Dry Diaper Weight 0 
OUTPUT Total DiaperWeightoutput(calculate a-b) 0 
OUTPUTDrain: 0 
OUTPUT SUBTOT/ll: 0 
NetGain: 0 
NetLoss: 0 
Initials: JS 
Patient klentification: 
Patient klentification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wlat language do ',OU speak? English, Russian 
Interpretation pro\aded? No interpreter utilized 
Urgent or emergent care: 
Elq:)lain Use Notes Section Patient denied needing interpreter v.hen offered and v.i/1 ask for one if he needs. Russian 
inte,preter 110s offered and refused 
Pain Assessment 
Pain 
ke ',OU currently in pain? Yes 
The pain is located Use Notes Section leg muscles thighs, calfs, lov,erback and pain v.ith urination 
The sewrityof pain is rated at 3110 
The sewrityof the pain is moderate 
The pain began 2-3 days ago 
The character of the pain is aching 
The associated symptoms are light headednes.s 
The pain is aggravated by any physical activity 
The pain is relieled by lying dO'MI 
Narratiw: 
M-!U M::D ISO 11 HUNGER STRIKE\ 0730 Sleeping on bed, respirations ewn no distress noted. 
0920 VS and assessment done. Patient laying in bed and able to rise quickly and steadily to sitting position. Patient offered 
Russian phone interpreter and stated "no I do not need" He was able to answer questions in English and respond appropriately 
with ;es or no responses. Encouraged patient to ask for Russian interpreter at anytime he wants one. He nodded '\es" that he 
understood. Patient states he is feeling 'weak and din,/' Denies pain or any other medical concerns at this time. Encouraged 
patient to change positions slowly and carefuly. Patient states he will not eat today, agrees to drink Boost and Pedial)le. (per Dr. 
11/al khova urine dip no longer needed daily). Pain with urination. 
1145 Refused lunch. 
1430 Q.iiet afternoon. 
Vlt•ISlgns 
98F 
46/min 
97/60 mm Hg 
16/ min 
144.4 lbs 
66.5in 
22.96 Index 
Exam ina tion 
General Examination: 
Temo 
09/21/201801:09:33 PM 
~ 
09/21/201801:09:33 PM 
BP 
09/21/201801:09:33 PM 
RR 
09/21/201801:09:33 PM 
1M 
09/21/201801:09:33 PM 
H 
09/21/201801:09:33 PM 
BMI 
09/21/201801:09:33 PM 
GENER/IL !>PPEAAl'NCE: in no acute distress, well del.e!oped, well nourished. 
HEPD: normocephalic. 
OR.Al CA\A'TY: normal, mucosa moist. 
NECK/THYROID: normal, neck supple, full range of motion. 
SKIN: normal, no rashes, no suspicious lesions. 
HEPRT: no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, no Vvheezes, rales, rhonchi. 
CHEST: normal, no gross rib defoonity, normal shape and expansion. 
PBDOl'vEN: bowel sounds diminished, soft, nontender, nondistended. 
(b)(6); 
(b)(?)(C) 
MJSCULOSKELET/ll : nonnal, normal gait, no defonnities, full range of motion, good strergth and equal bilaterally. 
NEUROLOGIC: alert and oriented, cooperatiw vi.1th exam. 
PSYCH: alert, oriented, cognitiw function intact, good eye contact. 
Assessments 
1. lneffectiw Coping [00069]- ND00069 (Prmary) 
2. lneffectiw community coping - ND00077 
3. Risk for Deficient Fluid \l:>lume [00028] - ND00028 
Hunger Strike. 
Treatment 
2019-ICLl-00051 3194 
N 
-
-
N 
-
-
N 
-
N 
-
-
N 
-
-
N 
-
N 
-

DHS-ICE-19-0196, 19-0197-N-000376
1. lneffectiw Coping [00069] 
Notes: Detainee wrba li2Bd understanding of plan of care and denies questions/concerns. Continue hunger strike protocol, 
encourage po food/fluids, encourage wrbali,ation of feelings. Encourage to allow staff to monitor intake and ou1put, \ital signs, 
wt. Instructed to seek staffiMth any needs. \lerbali2Bd understanding. Nursing Care Plan present Refer to nursing care plan for 
on-going inteM!ntions. Detainee offered three meals per day and leaw in room for atleast20 minutes. Pdequate supplyof 
drinking water and other bewrages as ordered byprolider available. Encourage dailyoral/phy.;ical h>9iene care. Detainee 
w rbali2Bd an understanding of education and/or treatment Voices no other concerns. 
Notes: M-iU until medical determination 
Appointment Prov1<1efb)(6) ; (b)(7)(C ) ~ 
Electronically signed b~fM(6); ~-
Sign off status: Completed 
~ on 09/21/201813:11:51 (Pacific Daylight Time) 
Northwest Detention Center 
1623EJSffiEEI" 
T ACJ::M.A, WA 98421 
Tel: (b)(6); (b)(7)(C) 
Pati-t: AMAR, MERGENSANA DOIi: 10/23/1978 p._... Nowi._(b_)_(6_); __ _.! RN 09/21/2018 
/lk:te generated byeOirica/Wcrks aR'PM Softl<ere (w,N1.eC/ inica/Works.co«4 
2019-ICLl-00051 3195 

DHS-ICE-19-0196, 19-0197-N-000377
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:llD: !(b )(6); 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.ri tunbe rk~"~'~""~'~· -~ 
09 12112018 
Current Medications 
Taking 
• Pedial~ - Solution 1 bottle Daily AA\ stop date 09/26/2018, KCP 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
tra\Ac! I, please gi"" to patient at 0500 near breakfast time 
• Pedial~ - Solution I bottle Twice A Day, stop date 09/26/2018, 
KCP Yes, Drug Source: In House Pharmacy, Notes: Not required 
for tra\Ac! I, pt may ha"" at bedside, please gi"" 1 bottle to patient at 
1200 and 2000 (hs) 
• Boost Plus - Liquid 1 110 PRN, stop date 10/19/2018, KCP No, 
Drug Source: In House Pharmacy, Notes: Not required for tra\Ac! I 
Review of Systems 
Ps\Chiatric: 
Prucietydenies. /luditor)ll,sual hallucinations denies. 
Delusions denies. Depressed mood denies. Difficulty 
sleeping denies. Reports c,,erall gocxl sleep. States he has had 
a few odd dreams and people calling/talking to him in his 
dreams but not kr1<M'ing 1M10 they are. Pt states dreams do not 
bother him, do not cause him distress. Reports upon waking, "I 
just ignore it." . Eating disorder denies. Homicidal 
Thoughts denies. lnabilityto concentrate denies. Mmtal or 
Ph',6ical abuse denies. Stressors admits; immigration 
legal/detention problems. Substance abuse denies. Suicidal 
thoughts denies. 
1623 E J STREET, TACOMA, WA-98421 
Appoimnert Facility: Northwest Detertion Cert er 
Aflpolntment Provider: (b)(6); (b)(7)(C) 
Supervising Prov 
Reason for Aflpolntment 
1. Hunger Strike E\laluation 
History of Present Illness 
Narrati"": 
Mmtal Health Hunger Strike Evaluation 
-Pt spoke: [x] Some English (often answering most questions in Englilsh before Russian Int asks them. "6ks questions in 
English}; [] Spanish; [x] Other. Russian Interpreter# 11389210 
-Pt identified by/'# , name, ID picture 
-Session was obserwdlchaperoned byGEO l\i'edical Staff member 
-[x] follow-up hunger strike evaluation 
Yes [x] / No [] Reliewed Record 
Yes []/No [x] Patient has historyofmental illness 
Yes [] /No [x] Pt has acurrentDSM5 Diagnoses 
Yes [x]/ No[] Pt has confirmed he has dedared a hunger strike. 
1. Wiat is (are) the reason(s) )OU ha"" dedared a hunger strike? 
-Pt stated he is protesting immigration detention and wants to be released to the US. 
2. Wiatdo)Ou hope to accomplish by going on a hunger strike? 
-Pt reports, "I want to be released to the outside." 
3. Wiat if an;1hing =u ld stop )OU from this hunger strike? 
-Being released from immigration detention to the US population. 
4. Our health care staff is concerned about )OUr health, we want to ensure )OU know risks of a hunger strike. 
Yes [x]/ No[] Do )OU understand that )OU may die or ha"" serious, lasting medical conditions if )Ou refuse food and/or fluid? 
-Pt reports he continues to be educated on the risks of not eating/drinking. Pt reports he finds medical staff \Ac!ryattenti"" to 
him, assessing him for his needs and encouraging him. 
-Pt asks for nail dippers and shows \Ac!rydeanails. Pccepts education on how to make this request lia his RN in the M-iU. 
Ex amination 
11/ental Status: 
JIPPE/IRANCE: adequately-groomed, dressed in clean unifoon of the day. 
RELATEDNESS: cooperati\Ac! . 
ATTITUDE: cooperati\Ac!. 
SPEECt-lll.PNGUPGE: normal rate. mythm, \Olume . . 
A"FECT: appropriate, full range. 
THOUGHT PROCESS: intact. 
THOUGHT CONTENT: unremarl<able. 
PERCEPTU/ll DISORDERS: no perceptual disorder noted. 
PSYCHOM)TQR l'CTMTY: v.ithin normal range. 
KNOM.EDGE - INTELLECTU/ll RJNCTION: No obl.ious impairment . 
DEGREE CF AWARENESS: v.ithin normal limijs. 
ORIENTAllON: person, place, time. 
CURRENT SUICID/ll POTENll/ll : no to low acute Si risk. 
CURRENT HOMCID/ll POTENll/ll : no to low acute risk. 
Assessment s 
1. Problems related to lili ng in residential institution -Z59.3 (Primary) 
-Pt's Hunger Strike appears to be motivated by: 
[] Yes/[ x] No: 11/ental Illness 
[x] Yes/ [] No: Political Statement or Cause 
- ~ies e~ lain: Pt demands to be released from Immigration and allowed to be in the US. 
Treatment 
1. Others 
Notes: Treatment Prolided: 
-Educated on importance of following medical adlice to promote his health; reiterated that medical staff cares about his health 
and wellness. 
-Educated on prosocial problem soiling and healthywas to address concerns. 
Preventive Medicine 
Due to the unpredictable nature of the immigration process induding length of detention stay, the purpose of ps)Cliological 
inter1.ention will be the stabili,ation of presenting S)!llptoms. acute crisis inter1.ention. and brief supportil.e/solution-focused 
ps)dlotherapy 
Discussed following Plan with ptto address Mantal Health (M-i) issues. Pt -.erbali,ed agreement with Plan: 
Yes/ No 
[lg/ [] Remain in M-iU; for Hunger Strike medical observation 
[ lg/ [] Fol low-up with medical pro~ders for ongoing medical observation 
[lg/ [] Follow-up with M-t Staff in 2 weeks for M-i follow-up eval during hunger strike 
[X] / [] Do not engage in any self-harm behalior, Continue to focus on sho~ong term goals, reasons for li~ng, resilient problem￾soiling skills - all to aid in reducing risk of harm to self lia hunger strike and ultimatelyto achie-.e pro-social, pro-indilidual & 
familygoals. 
[ X] / [] ~ atJ>NYtime pt has any thought intent or plan of suicide must alert custody officer for emergent access to medical for 
further evaluationltx Pt agreed and denied communication and stigma barriers to alerting staff to Si. 
[ X] / [] ~ert Mldical/Custody officer if pt has an emergency for immediate access to Wedical/DentaliM-1 serlices 
[ X] / []Continue daily routine with meaningful, purposeful acti~ty: regular exercise. sociali,ation. engagement in social support 
network, use of Jail Mail Email sy.;tem. engagement in religious customs/rituals, pleasurable actilities; pt to consider the work 
program locally-all to aid in coping and good mental health. 
[X] / [] Seek out attorney, ICE, Law Library, and Detainee Handbook to aid in proacti\Ac! problem-soiling - to aid in coping. 
[]No .[ ] Yes. Lltili,eJa ilMail S',6tem (or paper kite process) for further support engagement and to access facilitysupport, 
resources, and other serlices to aid in prosocial behaliorand healthy problem soiling. 
[X] / [] Continue attention to h>9iene: shower. teeth, grooming to aid in coping 
[X] / [] Begin eating/h)drating at each meal to aid in ph)6ical health- PT agrees to h)dration and Boost but DOES NOT /!GREE 
\MTH EATING sol id foods. 
[ x] I [ J Chaplain Serlices/Pccess e~ lainedlencouraged for further support 
POST SESSION: Updated HAS. /ll-lSA, CD, M-i Team on assessment/ plan. 
2019-ICLl-00051 3196 

DHS-ICE-19-0196, 19-0197-N-000378
Appointment Providej(b)(6); (b)(7)(C) ~csw 
Confirmatory sign off: 
.... f b_)(6_);_(b_)(_7)_(C_) __ _.p12s1201s 12:14:39 AM 
fh \/R\ 
Electronica ll y signed tfh \(R\· (h \(7\(C:\ ~CSW on 09/21/201812:00:55 (Pacific Daylight Time ) 
Electronically co-signed by!(h \/R\· !MO on 09/25/2018 at 12:14 PM MDT 
Sign off status: Completed 
Northwest Detention Cente r 
1623EJSffiEEI" 
T~WA98421 Teljill~/:~, I 
Patient: AMAR, MERGENSANA DOB: 10/2 3/19 78 Progre .. Not9:l(b)(6); (b)(7)(C) fSW 09/21/2018 
/lk:te generated byeOirica/Wcrks EM<IPM S?ttv.ere (w,N1.eC/inica/Works .co«4 
2019-ICLl-00051 3197 

DHS-ICE-19-0196, 19-0197-N-000379
09 12112018 
U.S. Immigration 
and Customs 
Enforcement 
Reas on for Aflpolntment 
1. tvHU /'M RN ROUNDS\ HUNGER STRIKE 
AMAR,MERGENSANA A: 216269802 Su:llOl/h \In \ ! 
Facility Code : CSONVWA Housing Area: A 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunber:fti'i(6i:7 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
Aflp oln tmen t Provlder:~ b)(6) ; (b)(7)(C) I RN 
Appointment Provider. ~tb .. )('-'-6-" );........_ _ ___.I RN !'.t,,11,w , . 
Electronically signed b~(b)(6); (b)(7)(C) r, RN on 11/16/2018 at 07:29 MST 
Sign off status: Pending 
Northwest Detention Center 
1623 E J STREET T~/i r:~0121 Te{b)(~\ I 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 Progre .. N- : f b)(6); ~- I RN 09/21/2018 
/lkxe generated by eC/inica/Wcrl.s a.RIPM Sottv.ere ("""'eC/inica/Works .com) 
2019-ICLl-00051 3198 

DHS-ICE-19-0196, 19-0197-N-000380
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A:216269802 Su:llD:kb)(~l I 
Facility Code: CSONVWA Housing ea: M 
39Y old Mal~,· AccOllll l'unbe b )(6); 
09 12112018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy , Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Boost Plus - Liquid 1 110 PRN, stop date 10/19/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. 11\eight loss admits. Dry 
M'.luth denies. 11\eakness admits. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. />lldominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. \bm itting denies. Painful 
urination denies. Decreased urine output denies. Mlsde 
aches denies. Mlsde aamps denies. Skin breakdown denies. 
Difficultythinking denies. 
1623 E J STREET, T 
Appoimnert Facility: Northwest Detertion Certer 
Reason for Appointment 
1. tvHU RN NIGHT ROUNDS/HUNGER STRIKE 
History of Present Illness 
Flowsheets (tvHU): 
Hungerstrike M'.lnitoring Form 
Day. 09/19/2018 
Shift: Night 
Intake PO(in ml}: 0 
Intake r.J- Normal Saline (in ml}: 0 
Intake r.J- LR (in ml}: 0 
Intake NG(in ml): 0 
QJtput Urine (in ml): 0 
Appointment Pl'ovlde'l""(b--')-'-(6-'-)'-; __ _.I RN 
Comments: WATER PITCHER WAS FILLED FCR HI MAND HE HAS BEEN DRINKING PED/AL YTE 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes 
Chaperone Name: GEOCFF/CER ON DUTY 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number 
Number: 
Language Russian 
Pain />ssessment 
Pain 
/ll'e }OU currently in pain? No 
Narratiw: 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/220)18 
\M1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/220)18 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: 11\ants to be released from custody 
/1<:!equate supply of drinking water and other be-erages available: Yes 
Three meals deliwred per day to patient Yes 
/lnyunauthori>edfood inroom? No 
Haw dailyorthostatic \ital signs been completed? Yes 
Has input and output been documented on the the M-IU Hunger Strike M'.lnitoring Smart Form? Yes 
Examination 
General Examination: 
GENERl>l !>PPE.AR.ANCE: in no acute distress, well del.e!oped, well nourished. 
PSYCH: alert, oriented. 
Assessment s 
/>I-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: 1. Continue with \Alai Signs e-eryshift; Intake and QJtput M:mitoring e-eryshift; Dailyweights; Dailyorthostatic \ital signs. 
2. /In adequate supply of drinking water and other be-erages are available to patient at all times. 
3. Three meals per day are deliwred to the patient and deliwryof meals is documented. 
4. ~ I food not authori>ed by CD/Ph1>5ician is remo-ed from patienfs room. 
5. Patient is not allowed to purchase food from commissar)llending machine while on hunger strike. 
6. Patient will only be released from hunger strike lreatmentlmonitoring byCD or ph1>5ician order. 
7. Patient counseled regarding the medical risks of continuing the hunger strike. 
8. Encouraged to terminate the hunger strike and eat/drink as normal. 
9. Patientwrbali>ed understanding of care plan. 
Disposition: Pdmitted to tvHU until medically evaluated 
Appoinbnent Provider.!(b)(6) ; fN 
Electronically signed by Kb)(6); ~- I on 09/21/2018 06:12:11 (Pacific Daylight Time) 
Sign off status: Completed 
2019-ICLl-0005 1 3199 
NorthlYest Detention Center 
1623 E J STREET 
TACOMA, WA98421 
Tell(b)/6) I Pai . 

DHS-ICE-19-0196, 19-0197-N-000381
Patl-t: AMAR, IIERGENSANA DOB: 10/23/1978 P ........ ttot.j \~ /\ ~ /; c, IRN 09/21/2018 
Nd.e generated by eC/inica/Wm<s EJvRIPM Sottv.ere {v.11WeC/inica/WGYks.COOJI 
2019-ICLl-00051 3200 

DHS-ICE-19-0196, 19-0197-N-000382
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3201 
AMAR,MERGENSANA A:21626980 2 Su:llD: !{b)~) ; I 
Facility Code: CSONVWA Housing ea: M 
39 Y old Male, (b)(B)· AccOl.lll llunber , 1623 EJ STREET, T /1,-,.\/?\ff'' 

DHS-ICE-19-0196, 19-0197-N-000383
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:llot(b )/6\ ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll lunberli5ii6i:7 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
09 /2012018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Boost Plus - Liquid 1 110 PRN, stop date 10/19/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl 
Alla ..... 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. \Neight loss admits. Dry 
M)uth denies. \Neakness admits. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. l'lxlom inal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. ½m illing denies. Painful 
urination denies. Decreased urine output denies. MJsde 
aches denies. MJsde cramps denies. Skin breakdown denies. 
Difficulty thinking denies. 
Appointment Provld e 1 b)(6) ; (b)(7)(C) 
Reason for Appointment 
1. PM SHIFT NOlE. Hunger Strike Nursing E1,0luation 
History of Present Illness 
Flowsheets (MHU): 
Upon encounter detainee was resting quietlyin bed. Detainee reported weakness but refused any medical treatment 
Detainee water pitcher has been filled for him and he has been drinking Pedial)le and Boost Detainee has gone back to resting 
quietly in his room. W II continue to monitor. 
Hungerstrike fl.bnitoring Form 
Day. 09i20/.2018 
Shift: PM 
Intake PO(in ml}: 0 
Intake rl/- Normal Saline (in ml}: 0 
Intake rl/- LR (in ml}: 0 
Intake NG(in ml): 0 
QJtput Urine (in ml): 0 
Comments: WATER PITCHER WAS FILLED FCR HI MAND HE HAS BEEN DRINKING PED/AL YTE 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEOCEFICER & DR. I.MLAKHOVA 
Wiat language do }OU speak? English 
Interpretation pro\aded? Pallent speaks English fluenUy DETAINEE SPO<E AND UNDERSTCX)() ENGLISH TCOAY 
Pain />ssessment 
Pain 
Ne }OU currently in pain? No 
Narratiw: 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/220)18 
\M1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/220)18 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: 11\ants to be released from custody 
/1<:!equate supply of drinking water and other be-erages a1,0ilable: Yes 
Three meals deliwred per day to patient Yes 
/lnyunauthori>edfood inroom? No 
Haw dailyorthostatic "ta l signs been completed? Yes 
Has input and output been documented on the the M-IU Hunger Strike M:lnitoring Smart Form? Yes 
Vital Signs 
98.0F 
46/m in 
97161 mm Hg 
16/m in 
144.2 lbs 
66.5in 
22.92 Index 
Examination 
General Examination: 
Temp 
09/20/201807:46:09 PM 
1-R 
09/20/201807:46:09 PM 
BP 
09/20/201807:46:09 PM 
RR 
09/20/201807:43:00 PM 
Wt 
09/20/201807:46:09 PM 
H 
09/20/201807:43:00 PM 
BMI 
09/20/201807:46:09 PM 
GENER.Al PPPEAAPNCE: in no acute distress, well del.eloped, well rKJO.Jrished. 
PSYCH: alert, orented. 
Assessments 
/!I-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
b)(6); (b)(7)(C) 
Notes: 1. Continue with vltal Signs e-eryshift; Intake and QJtput M:lnitoring e-eryshift; Dailyweights; Dailyorlhostatic 1<tal signs. 
2. /In adequale supply of drinking water and other be-erages are a1,0ilable to patient at all times. 
3. Three meals per day are deli sered to the patient and deli-eryof meals is documented. 
4. /11 food not authori>ed by CD~y.,ician is remo-ed from patienrs room. 
5. Patient is not allowed to purchase food from commissar)l\ending machine while on hunger strike. 
6. Patient will only be released from hunger strike treatment/monitoring by CD or phy.,ician order. 
7. Patient counseled regarding the medical risks of continuing the hunger strike. 
8. Encouraged to terminate the hunger strike and eat/drink as normal. 
Appointment Provide~(b)(6) ; (b)(7)(C) 
2019-ICLl-00051 3202 
I 

DHS-ICE-19-0196, 19-0197-N-000384
Electronically signed by l(b)(6); (b)(?)(C) 
Sign off status: Completed 
Addendum : 
09/20/2018 10:29 * b)/6): /b)/7)/C) 
r on 09/20'2018 19:46:33 (Pacific Daylight Time) 
i> INPUT- 1 LITER PEOIPl YTE, 8 OZ BCOST, OJTPUT UNKNOll'uN 
Northwest Detention Center 
1623 E J STRE£T 
T~WA98421 Te(b){6r ] 
Pali-I: AMAR, MERGENSANA DOB: 10/23/1978 p,.,.... :j (b)(6); (b)(?)(C) 
~e generated byeOil1cafVm1<s ENRIPM &>ft\\are WWWeUtnl'CaWdkS.cdfV 
r 09/2Q.l2018 
2019-ICLl-00051 3203 

DHS-ICE-19-0196, 19-0197-N-000385
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:llol(b \/6\ ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, rq:t· 1QOJ(1928 
AccOl.l"II tunberU~-h~\=ffi~\· __ ~ 
1623 E J STREET, TACOMA, WA-98421 
Appoirimert Facility: Northwest Detertion Cert er 
09 /2012018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
Review of Systems 
General/Constitutional: 
Headache denies. Lightheadedness denies. 'M!ight 
loss denies. 
Hunger Strike: 
Fatigue admits. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. Dry MJuth denies. 'M!akness admits, 
. Shortness of breath at rest denies. Chest pain at rest denies. 
Palpitations denies. />bdominal Pain denies. Nausea denies. 
Painful urination denies. Mlsde aches impro,.ed. Skin 
breakdown denies. Difficultythinking denies. 
Aflpolntment Provlde1 (b)(6) ; (b)(7)(C) I MD 
History of Present Illness 
Flowsheets (M-!U\: 
Pt is looking better. He is cooperatiw and talkatiw. He is drinking the boost He still refuses to eat 
Hungerstrike MJnitoring Form 
Day. 09/1912f)18 
Shift: AM 
Intake PO (in ml}: 2500 2 literof electrolyte solution, boost and v.ater 
Intake r./- Normal Saline (in ml): 0 
OJtput Urine (in ml): 0 pt seen voiding, and UA obtained 
OJtput Bowel Mllements (in ml): 0 
Labs - Urine Ketones: Neg 
Labs - Sodium: 
Initials: SM 
Patient k:lentification: 
Patient k:lentifcation 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
IMlat language do )OU speak? Russian 
Interpretation prmided? Patient speaks English fluenUy 
Pain Assessment 
Pain 
/Ira )OU currently in pain? No 
Narratiw: 
Pt looks better than he is sajing. He walks around the room with steady gait He has gained a small amount of weight Since 
he refuses to eat will order labs. 
Hunger Strike: 
Number of missed meals: 88. 
tv'edical Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
\Mien did the official hunger strike begin? 08!25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking fluids: Yes 
# of dais on hunger strike: 26 
Total 'M!ight loss in pounds: 18.8 
Reason for hunger strike: Wcmls to be released from custody 
Housing/Isolation Location: M;dical Housing Unit 
Reason for Isolation Placement For dose supervision, observation, and monitoring 
Re-..ew of the Housing Placement Review housing eve,y 24 hours 
Yit ai Signs 
98F 
46/ min 
97/61 mm Hg 
16/m in 
144 lbs 
Examination 
General Examination: 
Temp 
09/23/201807:40:57 PM 
~ 
09/23/201807:40:57 PM 
BP 
09/23/201807:40:57 PM 
RR 
09/23/201807:40:57 PM 
WI 
09/23/201807:40:57 PM 
GENER.Al PPPEAAPNCE: pt alert and oriented ' more energetic and talkati,e. 
ORM. CA\ATY: mucosa moist, no lesions. 
SKIN: good turgor, normal. 
LUNGS: good air mo,ement, . 
(b)(6) ; (b)(7)(C) 
MUSCULOSKELETPl : normal gait, full range of motion, tender to palpation, neurovascular intact. 
PSYCH: alert, oriented. 
Assessment s 
1. Starvation, subsequent encounter - T73.0X><D (Primary) 
2. Imbalanced nutrition: Less than body requirements [00002] - ND00002 
Self-imposed Hunger strike. 
Treat ment 
1. Starvation, subsequent encOl.l"ller 
u>a: TSH - 004259 (Q:dered for 09121!2018) 
u>a: Comprehensive Wetabolic Panel 114} CM'-322000 IQ:dered for09!21!2018) 
u>a: CBC Wth Diflerentialn=>iatelet - 005009 IQ:dered for 09!21!2018) 
u>a: \Alamin B12 - 001503 IQ:dered for 09121!2018) 
u>B: \Alamin D 25-H)droxy-081950 IQ:dered for 09!21!2018) 
u>B: \faric.ella-Zoster V Pb lgG- 096206 (Q:dered for 09!21!2018) 
Notes: if patient is drinking his pedial)le and boost he does not need a dailyurine oror1hostatics. Continue dailyweight Labs to 
be drawn. Encourage rec. ia rd and e>ercse. IAtals on a q day basis and pm. 
Labs 
Lab: TSH-004259 IQ:dered for09121f2018) V\,NL 
TSH 0.977 
Lab: Comprehensive Wetabolic Panel 114} CM' - 322000 IQ:dered for 09121!2018} 
eGFR ff M ien J>m 126 
eGFRffNon/ltricnJ>m 109 
A'GRatio 2.0 
2019-ICLl-0005 1 3204 
0.450-4.500 - ulU/mL 
V\,NL 
>59- mUmin/1.73 
>59- mUmin/1.73 
1.2-2.2-
I 

DHS-ICE-19-0196, 19-0197-N-000386
l'lT(SGPl) 40 
/fil (SGOT) 33 
Bilirubin, Total 0.2 
Globulin, Total 2.0 
~bum in 4.0 
Protein, Total 6.0 
Calcium 9.0 
Chloride, Serum 103 
Potassium 4.1 
Sodium 143 
EllHCreatinine Ratio 7 
Creatinine 0.86 
BUN 6 
Gucose 102 
Carbon Dio>ide, Total 28 
~ka line Phosphatase 52 
Lab: CBC Wth Differential/Platelet - 005009 (Cxdered for 09/21/2018) 
Immature Granul<X¥es 0 
Immature Grans (l'bs) 0.0 
Baso (l'bso lute) 0.0 
Neutrophils (l'bso lute) 2.4 
Hemoglobin 13.7 
11/o~(/lbso lute) 0.3 
RBC 4.64 
Eos (l'bso lute) 0.2 
Hematocrit 41.0 
WCI/ 88 
l\iCH 29.5 
l\iCHC 33.4 
ROW 14.4 
Liffiphs (l'bso lute) 1.7 
Neutrophils 52 
~~ ~ 
IVonCX¥es 7 Eos 4 
Basos 0 
WBC 4.6 
Platelets 187 
Lab: vitamin B12 - 001503 (Qdered for 09/21/2018) \l\,I\IL 
Vitamin B12 1294 
Lab: vitamin D 25-H)droxy- 081950 (Qdered for 09/21/2018) low 
Vitamin D, 25-l-¥!roxy 26.8 
Procedure Code s 
T1013 Sign Lang/0-al Interpreter 
81002 URINE-NO MCRO 
Fol low Up 
daily 
Appointment Provide1(b)(6); (b)(?)(C) f'-10 
b)(6); (b)(?)(C) 
L 
H 
H 
L 
0-44 - IUIL 
0-40 - IUIL 
0.0-1.2 - mg/dL 
1.5-4.5 - g/dL 
3.5-5.5 - g/dL 
6.0-8.5 - g/dL 
8.7-10.2 - mg/dL 
96-106 - mmol/L 
3.5-5.2 - mmol/L 
134-144 - mmol/L 
9-20 • 
0. 76-1.27 - mg/dL 
6-20 - mg/dL 
65-99 • mg<L 20-29 - mmol/L 
39-117 - IUIL 
Not Estab. - % 
0.0-0.1 - x10E3/uL 
0.0-0.2 - x1 OE3/uL 
1.4-7.0 - x10E3/uL 
13.0-17.7 - g/dL 
0.1-0.9 - x10E3/uL 
4.14-5.80 - x10E6/uL 
0.0-0.4 - x1 OE3/uL 
37.5-51.0 - % 
79-97 -ft. 
26.6-33.0 - pg 
31.5-35. 7 - g/dL 
12.3-15.4 - % 
0.7-3.1 - x10E3/uL 
Not Estab. - % 
Not Estab. - % 
Not Estab. - % 
Not Estab. - % 
Not Estab. - % 
3.4-10.8 - x1 OE3/uL 
150-379 - x1 OE3/uL 
232-1245 · pgml 
30.0-100.0 · ng'ml 
Bectronically signed b (b)(6); (b)(?)(C) Don 09/23/201819 :49:37 (Pacific Daylight Time) 
Sign off status: Comple 
Northwest Detention Center 
1623 E J SIBEEr 
T¥2£~)1f/!/ )~C) 1 
Fax: 
Patient: AMAR, MERGENSANA DOB: 10/2 3/19 78 Progre .. No, (b)(6); (b)(?)(C) f MD 09/20/2018 
/lk:te generated byeOinica/Wcrks a.R'PM Soft"8re {IWNleOinica/Works.com) 
2019-ICLl-00051 3205 

DHS-ICE-19-0196, 19-0197-N-000387
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3206 
AMAR,MERGENSANA .. A:216269802 Su:ll~(b )(6); I 
Fac1lrtyCode:CSOINWA ng,c;ea .lfi 
39 Y old Male, DOB: 10/23/1978 
AccOl.rll lunberlibii6i:7 
1623 EJ STREET, T~ 

DHS-ICE-19-0196, 19-0197-N-000388
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A:216269802 &ti1ot(b)(6): ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll llunber: ~ )(6) 1623E JSTREET, T~ 
Appoimnert Facility: Northwest Detertion Cert er 
09 /2012018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Boost Plus - Liquid 1 110 PRN, stop date 10/19/2018, KOP: No, 
Drug Source: In House Pharmacy , Notes: Not required for trawl 
Alie ..... 
N.KDA 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue admits, 
that is constant. Fewr denies. Headache denies. 
Lightheadedness admits, s8\.eral limes. Night sweats denies. 
Sleep disturbance denies. Weight gain denies. Weight 
loss denies. 
Respiratory: 
Change in breathing pattem denies. Chest pain denies. 
Shortness of breath at rest denies. 
Cardi0\0Scular. 
Chestpainatrestdenies. Di22iness admits, frequently, with 
changing position. Irregular heartbeat denies. 
Palpitations denies. Shortness of breath denies. 
~ kness admits, that is 5eloele , that is generalized. 
Gastrointestinal: 
Podominal pain denies. Change in bowel habits Denies BM. 
Nausea denies. \l:>miting denies. 
Genitourinary. 
Podominal pain/swelling denies. Blood in urine denies. 
Difficulty urinating denies. Frequent urination denies. Pain in lower 
back denies. Painful urination denies. 
MJsculoskeletal: 
Leg cramps are felt in both legs, admits, that occur 
occasionally, at rest, with acti\ity. MJsde aches admits legs 
thighs and calves. Painful joints denies. ~ kness admits, 
that is generalized, that is 5e\oele. 
~ : 
.Aroiietydenies. Jluditor)Nsual hallucinations denies. 
Depressed mood denies. Homicidal Thoughts denies. Suicidal 
thoughts denies. 
Aflp oln tmen t Prov1c1ej(b)(6 ); (b)(7)(C) ~ RN 
Reas on for Aflpolntment 
1. tvHU /'M RN ROUNDS\ HUNGER STRIKE 
History of Pre se nt Illness 
Flowsheets (tvHU): 
lnput/OJtput Flowsheet 
Time: 1400 
INPUT PO: 1250 refuses to keep track of fluids. Drank Boost, Pedialyte 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT Other. 0 
INPUT SUBTOT/11.. : 0 
OUTPUTUrine Orefusestomeasure 
OUTPUTEmesis 0 
OUTPUTBM 0 
OUTPUT a. Wet Diaper Weight 0 
OUTPUT b. D,y Diaper Weight 0 
OUTPUT Total Diaper Weight output (calculate a-b} 0 
OUTPUTDrain: 0 
OUTPUT SUBTOT/11.. : 0 
NetGain: 0 
NetLoss: 0 
Initials: JS 
Patient Identification: 
Patient Identification 
Patient prope~yidentified by2 sources induding: /0 Badge, Verbally 
Chaperone Present? No 
\M1at language do )OU speak? &Jglish, Russian 
Interpretation pro\aded? No interpreter utilized 
Urgent or emergent care: 
E>q:, lain Use Notes Sedion Patient denied needing interpreter 1111en offered and viii/ ask for one if he needs. Russian 
interpreter ..as offered and refused 
Pain 1'6sessment 
Pain 
l'<e )OU currently in pain? Yes 
The pain is located Use Notes Section leg muscles thighs and calfs 
The sew rityof pain is rated at 6110 
The sew rityof the pain is moderate 
The pain began 1-2 days ago 
The character of the pain is aching 
The associated simptoms are light headedness 
The pain is aggravated by any physical adivily 
The pain is relieled by lying dOWJ 
Narratiw: 
tvHU M:D ISO 11 HUNGER STRIKE\ 0730 Sleeping on bed, respirations ew n no distress noted. 
0920 \JS and assessment done. Patient la:,ing in bed and able to rise quickly and steadily to sitting position. Patient offered 
Russian phone interpreter and stated "no I do not need" He was able to answer questions in English and respond appropriately 
v,lh )8S or no responses. Encouraged patient to ask for Russian interpreter at anytime he wants one. He nodded '')es" that he 
understood. Patient states he is feeling "weak and dizzy' Denies pain or any other medical concerns at this time. Encouraged 
patient to change positions slowly and carefully. Patient states he will not eat today, agrees to drink Boost and Pedial)le. (per Dr. 
11/al khova urine dip no longer needed daily) 
1145 Refiused lunch. 
1430 Q.iiet afternoon. 
Vital Signs 
98F 
46/ min 
97161 mm Hg 
16 /min 
66.5in 
Temp 
09/20/2018 10:30:56 />M 
HR 
09/20/2018 10:30:56 />M 
BP 
09/20/2018 10:30:56 />M 
RR 
09/20/2018 10:30:56 />M 
H 
09/20/2018 10:30:56 />M 
0x-nsat % 
99% 
ORTIHOSTATIC 0 LAY97/61 P--46991/o 
SIT 91/55 P= 82 97% 
ST/lND 86/53 P= 85 96%. 
Ex amina tion 
General EJ<amination: 
09/20/2018 10:30:56 />M 
GENER/II.. !>PPEJ>R/lNCE: in no acute distress, well del.eloped, well nourished. 
HE.AD: nonnocephalic. 
OR.Al CA\ATY: normal, mucooa moist. 
NECK/THYROID: normal, neck supple, full range or motion. 
SKIN: normal, no rashes, no suspicious lesions. 
HEPRT: no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, no vileezes, rales, rhonchi. 
CHEST: normal, no gross rib defoonity, normal shape and expansion. 
J>BDOI\/EN: t>c:M,ei sounds diminished, soft, nontender, nondistended. 
(b)(6); 
(b)(7)(C) 
MJSCULOSKELET/11.. : normal, normal gait, no deformities, full range or motion, good strergth and equal bilaterally. 
2019-ICLl-00051 3207 

DHS-ICE-19-0196, 19-0197-N-000389
NEUROLOGIC: alert and oriented, cooperati\e with exam. 
PSYCH: alert, oliented, cognili\e function intact, good eye contact. 
Assassments 
1. lneffecti\e Coping [00069]- ND00069 (Primary) 
2. lneffecti1.e community coping - ND00077 
3. Risk for Deficient Fluid Volume [00028]- ND00028 
Hunger Strike. 
Treatment 
1. Ineffective Coping (00069] 
Notes: Detainee 1.erbaliied understanding of plan of care and denies questions/concerns. Continue hunger strike protocol, 
encourage po food/fluids, encourage \erbaliiation of feelings. Encourage to allow staff to monitor intake and output, -.ital signs, 
wt. Instructed to seek staffiMth any needs. Verbali2Bd understanding. Nursing Care Plan present Refer to nursing care plan for 
on-going inter1.entions. Detainee offered three meals per day and lea\e in room for at least20 minutes. /ldequate supplyof 
drinking water and other be1.erages as ordered bypro-.ider a1,0ilable. Encourage daily oral/physical h>9iene care. Detainee 
1.erbaliied an understanding of education and/or treatment Voices no other concerns. 
Disposition: /ldmitted to M-IU until medicallye1,0luated 
Appointment Provlde1 (b)(6) ; (b)(?)(C) IRN 
Bectronlcally signed b b)(6) ; (b)( ?)(C) 
Sign off status: Comple 
, RN on 09/20'201814 :11:09 (Pacific Daylight nme) 
Addend11m: 
09/20/201802:41 P~(b)(6) ; (b)(?)(C) ~wr = 144.2 
Northviest Detention Cente r 
1623 E J SmEEr 
T~WAQM21 
Te@( 6): ! 
Fax: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progresa N-: f b)(6); (b)( ?)(C) IRN 09/20/2018 
Neta generated by eOinica/Wai<s ElvRIPM &llwiJre ("""'eC/inicalWorks.com) 
2019-ICLl-00051 3208 

DHS-ICE-19-0196, 19-0197-N-000390
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
.. A:216269802 Su:ll~b )(6); I 
Fac1lrtyCode:CSOINWA ng ,c;ea.lfi 
39 Y old Male, DOB: 10/23/1978 
AccOllll lunber irh\/R\· I 
1623 E J STREET, TACOMA, WA-98421 
Appoirimert Facility. Northwest Detertion Certer 
09 /2012018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy , Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Boost Plus - Liquid 1 110 PRN, stop date 10/19/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl 
Alla ..... 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. \Neight loss admits. Dry 
M)uth denies. \Neakness admits. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. l'lxlom inal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. ½m illing denies. Painful 
urination denies. Decreased urine output denies. MJsde 
aches denies. MJsde cramps denies. Skin breakdown denies. 
Difficulty thinking denies. 
Reason for Appointment 
1. tvHU RN NIGHT ROUNDS/HUNGER STRIKE 
History of Present Illness 
Flowsheets (tvHU): 
Hungerstrike Mln itoring Form 
Day. 09/19/2018 
Shift: Night 
Intake PO(in ml}: 0 
Intake r.J- Normal Saline (in ml}: 0 
Intake r.J- LR (in ml}: 0 
Intake NG(in ml): 0 
QJtput Urine (in ml): 0 
Appointment P1'ovlde '1~(b~)~(6~)~: --~I RN 
Comments: WATER PITCHER WAS FILLED FCR HI MAND HE HAS BEEN DRINKING PED/AL YTE: 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes 
Chaperone Name: GEOCFF/CER ON DUTY 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number 
Number: 
Language Russian 
Pain />ssessment 
Pain 
Ne }OU currently in pain? No 
Narratiw: 
Patient is oonsidered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/220)18 
\M1en did the official hunger strike begin? 08/25'2018 
Date of last meal oonsumed: 08/220)18 
Last meal oonsumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: 11\ants to be re/eased from custody 
/1<:!equate supply of drinking water and other be-erages available: Yes 
Three meals deliwred per day to patient Yes 
/lnyunauthori>edfood inroom? No 
Haw dailyorthoslatic \ital signs been oompleted? Yes 
Has input and output been documented on the the M-IU Hunger Strike Mlnitoring Smart Form? Yes 
Ex amination 
General Examination: 
GENERl>l !>PPE.AR.ANCE: in no acute distress , well del.e!oped, well nourished. 
PSYCH: alert, oriented. 
Assessment s 
/>I-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: 1. Continue with \Alai Signs e-eryshift; Intake and QJtput M:mitoring e-eryshift; Dailyweighls; Dailyorthoslatic \ital signs. 
2. /In adequate supply of drinking water and other be-erages are available to patient at all times. 
3. Three meals per day are deliwred to the patient and deliwryof meals is documented. 
4. ~ I food not authori>ed by CD/Phy.,ician is remo-ed from patienfs room. 
5. Patient is not allowed to purchase food from oommissary\ending machine while on hunger strike. 
6. Patient will only be released from hunger strike treatment/monitoring byCD or phy.,ician order. 
7. Patientoounseled regarding the medical risks ofoontinuing the hunger strike. 
8. Enoouraged to terminate the hunger strike and eat/drink as normal. 
9. Patientwrbali>ed understanding of care plan. 
Disposition: Pdmitted to tvHU until medically evaluated 
Appoinbnent Providef b)(6) ; IRN 
Electr onically signed b~ ~/\~/;c, ~ on 09/20/2018 06:45:57 (Pacific Daylight Time) 
Sign off status: Completed 
2019-iCU-0005 1 3209 
NorthlYest Detention Center 
1623 E J STREET T~~r98421 Tolbi11 I

DHS-ICE-19-0196, 19-0197-N-000391
P•tl-t: AMAR, IIERGENSANA DOB: 10/23/1978 ......... Not.l~/h~\=/n~\-__ ~I RN 09/20/2018 
Nd.e generated by eC/inica/Wm<s EJvRIPM Sottv.ere {v.11WeC/inica/WGYks.COOJI 
2019-ICLl-00051 3210 

DHS-ICE-19-0196, 19-0197-N-000392
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3211 
AMAR,MERGENSANA 
A: 216269802 Su:llWh \(R\ I 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOllll lunbellh \/R\ I 
1623 E J STREET, TACOMA, WA98421 

DHS-ICE-19-0196, 19-0197-N-000393
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENS~: A: 216269802 Su:ll®!5C: _ Facility Code: CSCN/1/WA Housing ea: 
39 Y ad ~le , 3!'~!t::: 
1623E J~~ = 1~8~CI 
09 /1912018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Boost Plus - Liquid 1 110 PRN, stop date 10/19/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl 
Alla ..... 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. \Neight loss admits. Dry 
M)uth denies. \Neakness admits. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. l'lxlomina l Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. ½m illing denies. Painful 
urination denies. Decreased urine output denies. MJsde 
aches denies. MJsde cramps denies. Skin breakdown denies. 
Difficulty thinking denies. 
Appoimnert Facility: Northwest Detertion Cert er 
Appointment Provlde1 b)(6) ; (b)(7)(C) 
Reason for Appointment 
1. PM SHIFT NOlE. Hunger Strike Nursing E1,0luation 
History of Present Illness 
Flowsheets (M-tU): 
Upon encounter detainee was resting quietlyin bed. Detainee reported weakness but refused any medical treatment 
Detainee water pitcher has been filled for him and he has been drinking Pedial)le and Boost Detainee has gone back to resting 
quietly in his room. W II continue to monitor. 
Hungerstrike M:mitoring Form 
Day. 09/19/2018 
Shift: PM 
Intake PO(in ml}: 0 
Intake rl/- Normal Saline (in ml}: 0 
Intake rl/- LR (in ml}: 0 
Intake NG(in ml): 0 
QJtput Urine (in ml): 0 
Comments: WATER PITCHER WAS FILLED FCR HI MAND HE HAS BEEN DRINKING PED/AL YTE 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEOCEFICER 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number Llc»J BRIDGE-# 1349 
Number Use notes ffeld 
Language Russian 
Pain f<;sessment 
Pain 
Ne }OU currently in pain? No 
Narratiw: 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals moniloring initiated: 08/22/2018 
IM1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wclnts to be released from custody 
/ldequate supply of drinking water and other be-erages available: Yes 
Three meals deliwred per day to patient Yes 
/lnyunauthori>edfood inroom? No 
Haw dailyorthoslatic \ital signs been completed? Yes 
Has input and output been documented on the the M-IU Hunger Strike M:miloring Smart Form? Yes 
Vital Signs 
97.3F 
40 /min 
91/58 mm Hg 
16/ min 
145.8 lbs 
66.5in 
23.18 Index 
Examination 
General Examination: 
Temp 
09/19/201807:07:28 PM 
1-R 
09/19/201807:07:28 PM 
BP 
09/19/201807:07:28 PM 
RR 
09/19/201807:04:49 PM 
wt 
09/19/201807:07:28 PM 
H 
09/19/201807:04:49 PM 
BMI 
09/19/201807:07:28 PM 
GENER.Al J>PPEAAPNCE: in no acute distress, well del.eloped, well r<JO.Jrished. 
PSYCH: alert, oriented. 
Assessments 
/!I-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
(b)(6); (b)(7)(C) 
Notes: 1. Continue with \Alai Signs e-eryshift; Intake and QJtput M:lniloring e-eryshift; Dailyweights; Dailyor1hoslatic \ital signs. 
2. /In adequate supply of drinking water and other be-erages are available lo patient at all times. 
3. Three meals per day are deli sered lo the patient and deli-eryof meals is documented. 
4. /11 food not authori>ed by CD~y., ician is remo-ed from patienrs room. 
5. Patient is not allowed to purchase food from commissar)l\ending machine while on hunger strike. 
6. Patient will only be released from hunger strike lreatrnentlmoniloring byCD or phy.,ician order. 
7. Patient counseled regarding the medical risks of continuing the hunger strike. 
8. Encouraged lo terminate the hunger strike and eat/drink as normal. 
Appointment Provider. f b)(6); (b)(7)(C) 
2019-ICLl-00051 3212 

DHS-ICE-19-0196, 19-0197-N-000394
Electronically signed b~(b)(6); (b)(7)(C) 
Sign off status: Completed 
Addendum: 
09/19/2018 10:32 P'fb )/6\ (b\(7\(C\ 
~ on 09/19/2018 19:08:08 (Pacific Daylight Time) 
pNPUT-1 Ll1ER PEOll'l YTE, 8 OZ BOOST PLUS, a.JTPUT UNKNOJI.N 
Northwest Detention Center 
1623 E J STREEr 
,: b)(6); 
" h \17\//"'.\ 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 p,.,.._ ::1 (b)(6); (b)(7)(C) 
Nr:1.e general.eel by e0 inica/Wa1<s af</PM So/Mere wwweCJ1n,cal Mv-ks.cooi) 
r 09/19/2018 
2019-ICLl-00051 3213 

DHS-ICE-19-0196, 19-0197-N-000395
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA A:21s2s9so 2 su,d lh\fR\· I 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
1623 E J 
AccOllll 
STREET, 
llunber: 
T~ 
~ 
Appoirimert Facility: Northwest Detertion Certer 
09 /1912018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
Alle'9leS 
N.KDA 
Review of Systems 
General/Constitutional: 
Headache denies. Lightheadedness denies. 'Neigh! 
loss denies. 
Hunger Strike: 
Fatigue admits. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. Dry M:>uth denies. 'Neakness admits, 
. Shortness of breath at rest denies. Chest pain at rest denies. 
Palpitations denies. l'lxlom inal Pain denies. Nausea denies. 
Painful urination denies. Mlsde aches impro,.ed. Skin 
breakdown denies. Difficultythinking denies. 
Aflpolntment Provlclei b)(6) ; (b)(7)(C) r-D 
Rea son for Aflpolntment 
1. tvHU Rounds 
History of Present Illness 
Flowsheets (tvHU): 
Pt is looking better. He is cooperatiw and talkatiw. He is drinking the boost He still refuses to eat 
Hungerstrike M:>nitoring Form 
Day. 09/19/2018 
Shift AM 
Intake PO (in ml}: 2500 2 literof electrolyte solution, boost and ooter 
Intake rl/- Normal Saline (in ml}: 0 
OJtput Urine (in ml): 0 pt seen voiding, and UA obtained 
OJtput Bowel M:>wments (in ml): 0 
Labs - Urine Ketones: Neg 
Labs - Sodium: 
Initials: SM 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Pallent speaks English fluenUy 
Pain Assessment 
Pain 
l'<e }OU currently in pain? No 
Narratiw : 
Pt looks better than he is sa~ng. He walks around the room with steady gait He has gained a small amount of weight Since 
he refuses to eat will order labs. 
Hunger Strike: 
Number of missed meals: 85. 
~ ical E~ luation 
Date missed meals monitoring initiated: 08/22/2018 
\Mien did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking fluids: Yes 
# of da)', on hunger strike: 25 
Total 'Neigh! loss in pounds: 17.5 
Reason for hunger strike: W.,nts to be released from custody 
Housing/Isolation Location: M,dical Housing Unit 
Reason for Isolation Placement For dose supervision, obse,vation, and monitoling 
Re"ew of the Housing Placement Review housing every 24 hours 
Vital Signs 
Temp I 
97.3F 09/21/2018 07:22:32 />M (b)(6); (b)(7)(C) 
42 /min 
91/58 mm Hg 
16/m in 
145 lbs 
as',fTlptomatic with brad;card1a. 
Ex amina tion 
General Examination: 
HR 
09/21/2018 07:22:32 />M 
BP 
09/21/2018 07:22:32 />M 
RR 
09/21/2018 07:22:32 />M 
wt 
09/21/2018 07:22:32 />M 
GENER/ll !>PPEPRANCE: pt alert and oriented , more energetic and talkatiw . 
OR.AL CA\ATY: mucosa moist, no lesions. 
SKIN: good turgor, normal. 
LUNGS: good air rt10\ement, . 
MJSCULOSKELETM.: normal gait, full range of motion, tender to palpation, neuro-.ascular intact 
PSYCH: alert, oriented. 
Assess ment s 
1. Starvation, subsequent encounter - T73.0)0cl) (Primary) 
2. Imbalanced nutrition: Less than body requirements [00002] - ND00002 
Self-imposed Hunger strike. 
Trea tment 
1. Starvation, subsequent encOllller 
l..J>B: Urinah.sis Dipstick 
Notes: no other changes for today. Pt encouraged to go to rec. 19rd. 
2. Others 
Start Boost Plus Liquid,-, 1, Oa lly, 110 PtRN, 30 da)S, 1, KCP: No, Drug Source: In House Pharmacy, Notes: Not required for 
trawl 
Procedure Code s 
T1013 Sign Lang/0-al Interpreter 
81002 URINE-NO MCRO 
Fo llow Up 
daily 
2019-ICLl-0005 1 3214 

DHS-ICE-19-0196, 19-0197-N-000396
Notes: Education pro1Aded on treatment recommendations, Hunbger strike risks, altemati\A3s discussed 
Appointment Provider.l(b)(6); (b)(7)(C) ~D 
(b)(6); (b)(7)(C) 
Electronically signed b* b)/6): (b)/7)/C) ~Don 09/21/2018 07:28:27 (Pacific Daytlght Time) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREEr 
TACOMA, WA98421 
Tel: !lh \/R\ I 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 ProgN ss No4 b)(6); (b)(7)(C) 1110 09/19/2018 
/lk:l.e general.ed byeC/irica/Wa1<s af</PM Soft,.,.ere (\'MWeC/inica'WcYks.CO'!jl 
2019-ICLl-00051 3215 

DHS-ICE-19-0196, 19-0197-N-000397
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA A:21626980 2 Si.tll(b)(6): ! 
Facility Code: CSONVWA Housing Area: M 
39 Y Acc01.111 ad ~~ ~be(b)(6EL :: I 
09 /1912018 
Curnont Medication s 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
Alie .... . 
N.KDA 
vlew of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue admits, 
that is constant. Fewr denies. Headache denies. 
Lightheadedness admits, s8\.eral times. Night sweats denies. 
Sleep disturbance denies. Weight gain denies. Weight 
loss denies. 
Respiratory: 
Change in breathing pattem denies. Chest pain denies. 
Shortness of breath at rest denies. 
Cardi0\0Scular. 
Chestpainatrestdenies. Di22iness admits, frequently, with 
changing position. Irregular heartbeat denies. 
Palpitations denies. Shortness of breath denies. 
~ kness admits, that is se1e1e , that is generalized. 
Gastrointestinal: 
Podominal pain denies. Change in bowel habits Denies BM. 
Nausea denies. \l:>miting denies. 
Genitourinary. 
Podominal pain/swelling denies. Blood in urine denies. 
Difficulty urinating denies. Frequent urination denies. Pain in lower 
back denies. Painful urination denies. 
MJsculoskeletal: 
Musde aches denies. Painful joints denies. 
~ kness admits, that is generalized, that is se1e1e. 
~: 
l'ruiietydenies. Jluditor)Nsual hallucinations denies. 
Depressed mood denies. Homicidal Thoughts denies. Suicidal 
thoughts denies. 
1623 E J STREET, T 
Appoimnert Facility: Northwest Detertion Cert er 
Aflp o lntmen t Provlcle1 (b)(6) ; (b)(7)(C) r" Reas on for Aflpolntm ent 
1. tvHU /'M RN ROUNDS/ HUNGER STRIKE 
History of Pre se nt Illne ss 
Flowsheets (tvHU): 
lnput/OJtput Flowsheet 
Time: 1400 
INPUT PO: 1250 refuses to keep track of fluids. Drank Boost, Pedialyte 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT Other. 0 
INPUT SUBTOT/11.. : 0 
OUTPUTUrine Orefusestomeasure 
OUTPUTEmesis 0 
OUTPUTBM 0 
OUTPUT a. Wet Diaper Weight 0 
OUTPUT b. D,y Diaper Weight 0 
OUTPUT Total Diaper Weight output (calculate a-b} 0 
OUTPUTDrain: 0 
OUTPUT SUBTOT/11.. : 0 
NetGain: 0 
NetLoss: 0 
Initials: JS 
Patient Identification: 
Patient Identification 
Patient prope~yidentified by2 sources induding: /0 Badge, Verbally 
Chaperone Present? No 
\M1at language do )OU speak? &Jglish, Russian 
Interpretation pro\aded? Yes, Interpreter Name 
Name Use notes field LICN BRIGDE 11376711 
Language Russian 
Pain l'ssessment 
Pain 
Ne )OU currently in pain? No 
Narratiw: 
tvHU M:D ISO 11 HUNGER STRIKB V-3 and assessment done. Patient states he is feeling ''Weak and dizzy' Denies pain or 
anyother medical concerns at this time. Encouraged patient to change positions slowly and carefully. He said he is doing so and 
hangs on to things in tlhe room if needed. Patient states he will not eat today, agrees to collect urine for dip analy.,is and to drink 
Boost and Pedialjle. 
11:45 Refused lunch. fh \/R\ · ~ kewith patient 
12:00 Drank Boost. 
1430 Has been sitting up in bed, ambulating steady on feet 
Vit al Sign s 
Temo 
97.3F 09/19/2018 10:06:31 />M 
HR 
40 /min 09/19/2018 10:06:31 />M 
BP 
91/58 mm Hg 09/19/2018 10:06:31 />M 
RR 
16/ min 09/19/2018 10:06:31 />M 
wt 
145.8 lbs 09/19/2018 10:06:31 />M 
H 
66.5in 09/19/2018 10:06:31 />M 
BMI 
23.18 Index 09/19/2018 10:06:31 />M 
On,n:a,n sat % 
99% 
ORTHOSTATIC 
LAY91/58 P--40 99% 
SIT94/68 P--46100% 
ST/IND 82/46 P= of 100%. 
Ex amina tion 
General Examination: 
09/19/2018 10:06:31 />M 
GENER/II.. !>PPEAA/INCE: in oo acute distress, well del.eloped, well nourished. 
HEAD: normocephalic. 
NECK/THYROID: normal, neck supple, full range of motion. 
CHEST: normal, no gross rib deformity, normal shape and expansion. 
(b)(6); (b)(7)(C) 
MJSCULOSKELET/11.. : normal, normal gait, oo defonnities, full range of motion, good strergth and equal bilaterally. 
NEUROLOGIC: alert and oriented, cooperatiw with exam. 
PSYCH: alert, oriented, cognitiw function intact, good eye contact. 
Assess ment s 
1. lneffectiw Coping [00069] - ND00069 (Primary) 
2. lneffectiw community coping - ND00077 
3. Risk for Deficient Fluid \l:>lume [00028] - ND00028 
Hunger Strike. 
2019-ICLl-00051 3216 

DHS-ICE-19-0196, 19-0197-N-000398
Treatment 
1. Ineffective Coping [00069] 
Notes: Detainee wrba li,ed understanding of plan of care and denies questions/concerns. Continue hunger strike protocol, 
encourage po food/fluids, encourage 1<arbali2ation of feelings. Encourage to allow staff to monitor intake and output, -.ital signs, 
wt. Instructed to seek staff>Mth any needs. verbali,ed understanding. Nursing Care Plan present Refer to nursing care plan for 
on-going interventions. Detainee offered three meals per day and lea1<a in room for at least 20 minutes. /ldequate supply of 
drinking water and other bewrages as ordered bypro-.ider a1,0ilable. Encourage daily oral/physical h>9iene care. Detainee 
wrba li,ed an understanding of education and/or treatment Voices no other concerns. 
Procedure Code s 
T1013 Sign Lang/Oaf Interpreter 
Disposition: /ldmitted to M-IU until medicallye1,0luated 
Appointment Provlde,(b)(6); (b)(?)(C) !"" 
Electronically signed b (b)(6); (b)(7)(C) 
Sign off status: Comple,t,,,.------' 
, RN on 09/1!112018 15:07:59 (Pacific Daylight Time) 
Northwest Detention Center 
1623 E J STREET 
TACOMA, WA98421 
'ef b)/6) ! FaX. 
Patient: AMAR, IIERGENSANA DOB: 10/23/ 19 78 Progre .. N-: f b)(6); (b)(7)(C) r" 09/19/2018 
Ncte generated byeOirica/Wcrks EM<IPM Softl<ere (w.w,e0inica/Works.COf1"4 
2019-ICLl-00051 3217 

DHS-ICE-19-0196, 19-0197-N-000399
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Si.tllq(b )(6): Facility Code: CSONVWA Holis...,.111.......,gPi..-e-a- :-M.,..... 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunber~ 
1623 E J STREET, T~ 
Appoirimert Facility: Northwest Detertion Certer 
09 /1912018 
Cunont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy , Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
Review of Systems 
Patient denies any pain at this time. Pleasant 
Reason for Appointment 
1. Night rounds 
History of Present Illness 
Narratiw: 
Appointment Prov1c1erfb)(6): (b)(7)(C) 
PATIENT ASLEEP IM-IEN I PRRJ\/ED Fffi SHIFT. SLEPTTl-lROUGH Tl-IE NIGHT. Patient giwn pedial)!l at 0510. Patient 
refused breakfast, 84th meal. 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? English, Russian, __ 
Interpretation pro\aded? No interpreter utilized 
~ lain : limited English 
Pain Assessment 
Pain 
ke }OU currently in pain? No 
Hunger Strike: 
Nursing Eleluation 
Date missed meals monitoring initiated: 08/22/2018 
Wien did the official hunger strike begin? 08/2512018 
Date of last meal consumed: 08/2412018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: 11\ants to be released from custody 
/1<:!equate supply of drinking water and other bewrages a.ail able: Yes 
Three meals deliwred per day to patient Yes 
Breakfast deliwred during current shift 0% consumed 
/lnyunauthori>edfood inroom? No 
Haw dailyorthostatic \ital signs been completed? No; WI/ complete before the end of the current shifl WI/ be done on day 
shifl 
Has input and output been documented on the the M-IU Hunger Strike M:lnitoring Smart Form? No; WI/ complete before 
the end of the current shifl 
Ex amination 
General B<amination: 
GENERl>l !>PPE.ARMICE: in no acute distress, well del.e!oped, pleasant. 
Input and output for night shift is 0ml. 
Assessment s 
1. Imbalanced nutrition: Less than body requirements [00002] - ND00002 (Primary) 
/II-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: Continue hunger strike protocol, encourage po foodllluids, encourage -erbali:zation of feelings. Encourage to allow staff to 
monitor intake and output, \ital signs, wt lnslrUcted lo seek staff with any needs. 1/erbali>ed understanding. Detainee offered 
three meals per day and leave in room .. Pdequate supply of drinking water and other be-erages as ordered byprolider a.ail able. 
Encourage dailyoral/phy.;ical h)!liene care. 
1. Intake and OJtput M::mitoring e-eryshift; Dailyweights; Dailyorthostatic \ital signs. 
2. /In adequate supply of drinking water and other be-erages are a.ail able lo patient at all times. 
3. Three meals per day are deli-ered to the patient and delivery of meals is documented. 
4. ~ I food not authori>ed by CDn'hy.;ician is remo-ed from patienrs room. 
5. Patient is not allowed to purchase food from commissar)l'vending machine while on hunger strike. 
6. Patient will only be released from hunger strike lrealmentlmoniloring byCD or phy.;ician order. 
7. Patient counseled regarding the medical risks of continuing the hunger strike. 
8. Encouraged to terminate the hunger strike and eat/drink as normal. 
Disposition: Pdmitted to M-iU until medicallye.aluated 
Appointment Provider.l \~/\~/ b 
Bectronically signed (b)(6); (b)(7)(C) on 09/19/2018 06:06:40 (Pacific Daylight Time) 
Sign off status: Comple,.______ ..... 
Northwest Detention Center 
1623 E J STREET 
\N.e:ql: ~(bH)(6~);'""""'W., 
/h\/7\11.\ 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progrees Notej~{b_)_(6_); __ ~1RN 09/19/2018 
Ncte generaled byeOinica/Wcrks a.R'PM Soft"8re {1WNteOinica/Works .com) 
2019-ICLl-0005 1 3218 

DHS-ICE-19-0196, 19-0197-N-000400
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:i1ot(b )(6); I 
Facility Code: CSONVWA Housing Ai'ea: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.ri tunbe rk~"~'~""~'~· -~ 
09 /1812018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Thiamine HCI 100 M3 Tablet 1 tablet BID, stop date 09/18/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl 
• Boost Plus - Liquid 1 BID PRN, stop date 09/18/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl, 
please giw this with the thiamine 
Alla'9leS 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. \Neight loss denies. Dry M>uth denies. 
\Neakness admits. Cough denies. Shortness of breath at 
rest denies. Chest pain at rest denies. Palpitations denies. 
J>bdominal Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \l:>mitting denies. Painful urination denies. 
Decreased urine output denies. MJsde aches denies. MJsde 
cramps denies. Skin breakdown denies. Difficultythinking denies. 
1623 E J STREET, TACOMA, WA-98421 
Appoimnert Facility: Northwest Detertion Cert er 
Aflpolntment Provlcle1 (b)(6) ; (b)(7)(C) I RN 
Reason for Aflpolntment 
1. tvHU E\.£ NSG RDS 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEOO'li"cejl~)(6) ! 
Wiat language do }OU speak? Russi 
Interpretation prO\aded? Yes, Interpreter Number 11378467 
Number Use notes ffeld 
Language Russian 
Pain .1>6sessment 
Pain 
/>,e }OU currently in pain? No 
Flowsheets (tvHU): 
lnput/OJtput Flowsheet 
Time: 1500 (SH/FT9/18/20181500- 9/18/2018 2300) 
INPUT PO: 1500 DETAINEE REPORTS HE HAD "A LlffiEBIT"CEWATER DURING SHIFT, STATESAPPROXHAlFCE 
THE GREEN PITCHER 'M-1/CH /SABCXJT500M., BESIDES HIS PED/AL YTE DURING SH/FT. DETAINEE DRANK 1L 
PED/AL YTE AT2000. 
INPUTSUBTOT/11.. : 1500 
OUTPUTUrine 0DETAINEEREPORTSHEHASN'TVOIDEDDURINGSH/FT. 
OUTPUT SUBTOT/11.. : 0 
Initials: RK 
Hungerstrike M:mitoring Form 
Day: 09/18/2018 
Shi~ PM(SHIFT9118/20181500- 9/18/2018 2300) 
Intake PO(in ml}: 1500DETA/Nff REPORTSHEHAD "A LlffiEBIT"CEWATERDURINGSHIFT, STATES APPROX 
HALF CE THE GREEN PITCHER 11\HICH ISABCXJT500M., BESIDES HIS PED/AL YTE DURING SHIFT. DETAINEE DRANK 1L 
PED/AL YTE AT 2000. 
OJtput Urine (in ml}: 0 
Initials: RK 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
\M1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes ordered Pedialyte and viater 
Reason for hunger strike: 11\ants to be released from custody 
l'<:!equate supply of drinking water and other be-erages available: Yes 
Three meals deliwred per day to patient Yes 
/lnyunauthori>edfood inroom? No 
Haw dailyorthostatic \ital signs been completed? Yes 
Has input and output been documented on the the M-IU Hunger Strike M:lnitoring Smart Form? Yes 
~ : Detainee was noted sleeping, la~ng in bed during initial rounds, does not appear to be in anydislress and noted normal rise 
and fall of chesl flt 1700, detainee was noted. awake and watching lVwhi le la~ng in bed. Detainee denied any issues or 
concerns, reports he has 'weakness" when asked how he's doing. Detainee refused he needed an)lhing from the nurse at the 
time of assessment. W II continue to monitor. Unable to li suali:re if detainee drank water during observation but detainee reports 
he's drank water about halfof the green pitcher, whicih is 500ml. WII continue to monitor. Detainee refused dinner, meal number 
83. 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Ex amination 
General B<amination: 
GENER/II.. /IPPE.ARANCE: in no acute distress, well del.eloped, well noorished. 
PSYCH: alert, oriented. 
Assessments 
flt-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: Nursing to assess h)dration slatus: skin turgor, mucous membranes, blood pressure, heart rate, inlake & output WII 
continue to encourage delainee to eat all meals deli sered to him and to drink fluids. Detainee has access to drinking water 
inside of cell. Detainee educated on possible risks to health if he continues to miss meals. Detainee educated on risks of not 
drinking adequate amount of fluids. Delainee educated to drink at least 8-10 cups of liquids per day.Detainee educated on 
possible medical risks of continuing to refuse meals. Delainee instructed to inform nursing slaff/officers if s,mptoms discussed 
begins, or if haling continues or becomes worse. Detainee also instructed to let officer know if he wants a tray to consume. 
Detainee wrba li>ed understanding of all instructions and did not ha-e anyadditional questions. Delainee to remain in M-IU/seg 
until will only released from hunger strike treatment/monitoring byphy.;ician. Delainee 1.erbali>ed underslanding of all 
instructions. 
Procedure Codes 
T1013 Sign Lang/0-al Interpreter 
Notes: Detainee to remain in M-IUA-lunger Strike 
Appoinbnent Provide r:l(b)(6); (b)( 7)(C) IRN 
2019-ICLl-0005 1 3219 

DHS-ICE-19-0196, 19-0197-N-000401
Electronically slgned by~l<b_)(_6_); --~r on 09/1812018 22:24:49 (Pacific Daytight Time) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREEr 
\el b)(6); (b)(7)(C) 
Patient: AMAR, IIERGENSANA DOB: 10/2 3/1978 ProgN ss No ) RN 09/18/2018 
Ncl.e general.ed by eC/inica/Wa1<s aR/PM Safl,,ere (WMI/ ,,.c 
2019-ICLl-00051 3220 

DHS-ICE-19-0196, 19-0197-N-000402
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:llol/b )/6) ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II l'unbe~b),6~ I 1623 E J STREET, TM:aM,tAao4Z 1 
09 /1812018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Thiamine HCI 100 M3 Tablet 1 tablet BID, stop date 09/18/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl 
• Boost Plus - Liquid 1 BID PRN, stop date 09/18/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl, 
please giw this with the thiamine 
Alla ..... 
N.KDA 
vlew of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue admits, 
that is constant. Fewr denies. Headache denies. 
Lightheadedness admits, s8\.eral limes. Night sweats denies. 
Sleep disturbance denies. Weight gain denies. Weight 
loss denies. 
~ : 
/lruiietydenies. Jluditor)Nsual hallucinations denies. 
Depressed mood denies. Homicidal Thoughts denies. Suicidal 
thoughts denies. 
Appoimnert Facility: Northwest Detertion Certer 
Reas on for Aflpolntm ent 
1. tvHU ~D ISO 1\HUNGER STRIKE 
History of Pre se nt Illness 
Flowsheets (tvHU): 
lnput/OJtput Flowsheet 
Time: 1400 
Aflp oln tmen t Provldefo )/6) /b )/l )/C) 
INPUT PO: 1000 refuses to keep track of fluids. Drank Boost, Pedialyte 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT Other. 0 
INPUT SUBTOT/11.. : 0 
OUTiPUTUrine Orefusestomeasure 
OUTiPUT Emesis 0 
OUTiPUTBM 0 
OUTiPUT a. Wet Diaper Weight 0 
OUTiPUT b. D,y Diaper Weight 0 
OUTiPUTTotal Diaper Weight output (calculate a-b} 0 
OUTiPUTDrain: 0 
OUTiPUT SUBTOT/11.. : 0 
NetGain: 0 
NetLoss: 0 
Initials: JS 
Patient Identification: 
Patient Identification 
Patient property identified by2 sources induding: /0 Badge, Verbally 
Chaperone Present? No 
\M1at language do )OU speak? &Jglish, Russian 
Interpretation pro\aded? Yes, Interpreter Name 
Name Use notes field LICN BRIGDE 11369667 
Language Russian 
Pain l'ssessmen t 
Pain 
Ne )OU currently in pain? No 
Narratiw: 
tvHU ~D ISO 11 HUNGER STRIKB V-3 and assessment done. Sitting up in bed alert orienld steady. Cooperatiw with IA, 
and assessment. Watching lV. Refused phy.,ical exam and to e~• food 
10:00 urine for dip analy.,is prol.ided and results shown to D1(b )(6) ; 
11:30 Refused lunch. Watching lVs illing up on bed. 
Vital Signs 
Temp 
t'" 
97.8F 09/18/201811:51:441¥,,1 b)(6); (b) (7)(C) 
44 /min 
106/63mm Hg 
16 /min 
143.4 lbs 
66.5in 
22.80 Index 
99% 
ORTHOSTATIC 
LA'l1NG 102/63 P--44 
SITTINQJ7/60 P=56 
ST/INDING 96/60 P= 75. 
Examination 
General Examination: 
HR 
09/18/201811:51:44!¥,,I 
BP 
09/18/2018 11 :51 :441¥,,1 
RR 
09/18/2018 11 :51 :441¥,,1 
wt 
09/18/201811:51:44!¥,,I 
H 
09/18/2018 11 :51 :441¥,,1 
BMI 
09/18/2018 11 :51 :441¥,,1 
oxvaensat% 
09/18/201811:51:44!¥,,I 
GENER/II.. JIPPEAA.ANCE: in oo acute distress, well del.eloped, well nourished. 
HEAD: norrnocephalic. 
NECK/THYROID: normal, neck supple, full rarge of motion. 
CHEST: normal, no gross rib deformity, normal shape and expansion. 
MJSCULOSKELET/11.. : normal, normal gait, no deformities, full rarge of motion, good strergth and equal bilaterally. 
NEUROLOOC: alert and oriented, motor strergth normal upper and lc,.,,,er extremities, normal exam, normal strergth, 
tone and reflexes, senso,y exam intact. 
PSYCH: alert, oriented, cognitiw function intact, good eye contact. 
Assessments 
1. lneffectiw Coping [00069]- ND00069 (Primary) 
2. lneffectiw community coping - ND00077 
3. Risk for Deficient Fluid \b lume [00028] - ND00028 
Hunger Strike. 
Trea tm en t 
1. lneffect;..., Coping [00069) 
2019-ICLl-00051 3221 

DHS-ICE-19-0196, 19-0197-N-000403
Notes: Detainee wrba li2Bd understanding of plan of care and denies questions/concerns. Continue hunger strike protocol, 
encourage po food/fluids, encourage wrbalization of feelings. Encourage to allow staff to monitor intake and ou1put, \ital signs, 
wt. Instructed to seek staffiMth any needs. \lerbali2Bd understanding. Nursing Care Plan present Refer to nursing care plan for 
on-going inteM!ntions. Detainee offered three meals per day and lea\e in room for at least20 minutes. Pdequate supplyof 
drinking water and other be\erages as ordered byprolider available. Encourage daily oral/physical h>9iene care. Detainee 
\erbali2Bd an understanding of education and/or treatment Voices no other concerns. 
Procedure Codes 
T1013 Sign Lang/0-al Interpreter 
Disposition: Pdmitted to M-IU until medically evaluated 
Appointment Provider.""l (b-'-)("-6)-'-; __ .... I RN 
8 ctr ' II ' db (b)(B); e ornca y sagne y lh \/ 7\ff'. \ 
Sign off status: Completed 
, RN on 09/18/201815 :04:50 (Pacific Daylight Time ) 
Northwest Detention Center 
1623 E J STREEr 
T WA98421 
Tel: (b )(6): 
Patient: AMAR, IIERGENSANA DOB: 10/23/1 9 78 Progre ea N (b)(6); (b)(7)(C) RN 09/18/2018 
Ncte generated by eOinica/lM:xi<s ElvRIPM &Jt,,ere 1- ·bmrom,,i=m::mr--' 
2019-ICLl-00051 3222 

DHS-ICE-19-0196, 19-0197-N-000404
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A:216269802 Su:llD:f b)/6): ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, ~~lf 1
~gf119za AccOl.lll llunber b \ · I 
09 /1812018 
Curnont Medication s 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Thiamine HCI 100 M3 Tablet 1 tablet BID, stop date 09/18/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl 
• Boost Plus - Liquid 1 BID PRN, stop date 09/18/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl, 
please giw this with the thiamine 
Alla .... . 
N.KDA 
Review of Syst ems 
Hunger Strike: 
Fatigue admits Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. \Neight loss denies. Dry M>uth denies. 
\Neakness that is moderate, admits, that is generalized. 
Cough denies. Shortness of breath at rest denies. Chest pain at 
rest denies. Palpitations denies . .Abdominal Pain denies. 
Constipation denies. Diarrhea denies. Nausea denies. 
\.t>mitling denies. Painful urination denies. Decreased urine 
output denies. M.Jsde adnes denies. M.Jsde cramps denies. Skin 
breakdown denies. Difficultythinking denies. 
Reas on for Appointm ent 
1. tvHU RN NIGHT ROUNDS/HUNGER STRIKE 
History of Pre se nt Illne ss 
Flowsheets (tvHU): 
Hungerstrike M>nitoring Form 
Day. 09/1 7/2018 
Shift: Night 
Intake PO(in ml}: 0 
1623 E J STREET, TACOMA, WA-98421 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Provld e ,Kb )(6); __ . 
OJtput Urine (in ml): detainee did not measure in urinal but was ob served urinallng in the toilet three llmes throughout the 
nightshifl. 
Initials: LDM 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEO OFFICER ON DUTY 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number 
Number: 
Language Russian 
Pain Assessment 
Pain 
ke }OU currently in pain? No 
~ : Patient is considered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
IM1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wcints to be released from custody 
/ldequate supply of drinking water and other be-erages available: Yes 
Three meals deliwred per day to patient Yes 
Breakfast deli-ered during current shift 0% consumed 
/lnyunauthori>edfood inroom? No 
Haw dailyorlhostatic "ta l signs been completed? Yes 
Has input and output been documented on the the M-IU Hunger Strike M:>nitoring Smart Form? Yes 
Ex amina tion 
General B<amination: 
GENERl>l !>PPE.ARMICE: in no acute distress, well del.eloped, well nourished. 
OR.Al CA\AlY: normal. mucosa moist. 
SKIN: normal, no rashes, no suspicious lesions. 
HEAAT: no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, no vileezes, rales, rhonchi. 
PBDOM:N: normal, bowel sounds present, soft, nontender, nondistended. 
MJSCULOSKELETJIL: normal, normal gait, no deformities, full range of motion, good strength and equal bilaterally. 
NEUROLOOC: alert and oriented, cooperatiw with exam, motor strength normal upper and ICMer extremities, normal 
exam, normal strength, tone and reflexes, sensory exam intact. 
PSYCH: alert, oriented. 
Detainee was awake and sitting on his bed prior to nursing staff entering room with GEO officer chapperone. Detainee 
allowed staff to take "ta l signs, do nursing assessment and measure weight Wien staff left room, detainee continued to sleep 
comfortably in his bed with his chest rising and falling e-enlyand unlabored at 16 breaths per minute. He woke up various times 
at nighl sat up on the side of his bed and was obsen.ed urinating in the toilet three times. Detainee refused breakfast per GEO 
officer Riley, detainee ate 0% of breakfast 
Assess ment s 
/!I-Risk for imbalanced nutrition: Less than body requirements. 
Tre a tment 
1. Others 
Notes: 1. Continue with \Atal Signs e-eryshift; Intake and OJtput M:>nitoring e-eryshift; Dailyweights; Dailyorthostatic 1<tal signs. 
2. /In adequate supply of drinking water and other be-erages are available to patient at all times. 
3. Three meals per day are deli sered to the patient and deli-eryof meals is documented. 
4. I'l l food not authori>ed by CD/Phy.,ician is remo-ed from patienrs room. 
5. Patient is not allowed to purchase food from commissar)l\ending machine while on hunger strike. 
6. Patient will only be released from hunger strike trealmentlmonitoring by CD or phy.,ician order. 
7. Patient counseled regarding the medical risks of continuing the hunger strike. 
8. Encouraged to terminate the hunger strike and eat/drink as normal. 
Nursing to assess h}dration status: skin turgor, mucous membranes, blood pressure, heart rate, intake & oulput \MIi continue to 
encourage detainee to eat all meals deli-ered to him and to drink fluids. Detainee has access to drinking water inside of cell. 
Detainee educated on possible risks to health if he continues to miss meals. Detainee educated on risks of not drinking 
adequate amount offluids. Detainee educated to drink at least 8-1 O cups of liquids per day. Detainee educated on possible 
medical risks of continuing to refuse meals. Detainee instructed to inform nursing staft'officers if symptoms discussed begins, 
or if ha"ng continues or becomes worse. Detainee also instructed to let officer know if he wants a tray to consume. Detainee did 
not ha-e any additional questions. Detainee to remain in M-IU until released from hunger strike trealmentlmonitoring by 
phy.,ician. Detainee 1.erbaliied understanding of all instructions. 
Proc edu re Cod es 
T1013 Sign Lang/0-al Interpreter 
Disposition: Jldmitted to tvHU until medically evaluated 
Appointment Provider: ""! (b'-'-)(.c.6.:... ): _ __.! RN 
2019-ICLl-00051 3223 

DHS-ICE-19-0196, 19-0197-N-000405
Electronically signed by._! (b_)_(6_); _ __.~ on 09/18/2018 07:39:28 (Pacific Daylight Time) 
Sign off status: Completed 
Northwest Detention Center 
1623EJSTREI" 
T=WA984'1 1'Jb)(6 ) 
Fax: 
P•ll-t: AMAR, MERGENSANA DOB: 10/23/1978 ......... -~l <b~)~/6~)~-~ltN 09/18/2018 
Nd.e general.ed by eOinica/W<n<s B>RIPM Sottw,re (""""eC/inica/works.CtJm) 
2019-ICLl-00051 3224 

DHS-ICE-19-0196, 19-0197-N-000406
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U Nola: 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""1eC/inica'WGV'ks.coojl 
2019-ICLl-00051 3225 
AMAR, MERGENJANA 
A:21s2s9so2 Si.tll fa l<6); I 
Facility Code: CSONVWA Housing Area : M 
39 Y old Male,~- 1Q/2J119ZB 
AccOUll l'unbe (bl/6): I 
1623 E J STREET, TACOMA, WA98421 

DHS-ICE-19-0196, 19-0197-N-000407
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:llofh \In\ I 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOUll lunberVh""'· I 
09 117/2018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Thiamine HCI 100 M3 Tablet 1 tablet BID, stop date 09/18/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl 
• Boost Plus - Liquid 1 BID PRN, stop date 09/18/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl, 
please giw this with the thiamine 
Alla'9leS 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. \Neight loss denies. Dry M>uth denies. 
\Neakness admits. Cough denies. Shortness of breath at 
rest denies. Chest pain at rest denies. Palpitations denies. 
J>bdominal Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \l:>mitting denies. Painful urination denies. 
Decreased urine output denies. MJsde aches denies. MJsde 
cramps denies. Skin breakdown denies. Difficultythinking denies. 
1623 E J STREET, TACOMA, WA-98421 
Appoirimert Facility: Northwest Detertion Certer 
Aflpolntment Prov1c1e9(b)(6) ; (b)(7)(C) I RN 
Rea son for Aflpolntment 
1. tvHU E\.£ NSG RDS 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sourcelb)( 6 .
1 
,y. ID Badge, Picture 
Chaperone Present? Yes GEOCXficer 
Wiat language do }OU speak? Russia · 
Interpretation prO\aded? Yes, Interpreter Number 11367642 
Number Use notes ffeld 
Language Russian 
Pain .1>6sessment 
Pain 
/>,e }OU currently in pain? No 
Flowsheets (tvHU): 
lnput/OJtput Flowsheet 
Time: 1500 (SH/FT9/17/20181500- 9/17/2018 2300) 
INPUT PO: 1237 DETAINEE REPORTS HE HAS NOT BEEN DRINKING ANY R.UIDS BESIDES HIS PED/AL YTE DURING 
SHIFT. DETAINEE DRANK 1L PED/AL YTE AT2000, BCXJSTPLUS 237M... 
INPUTSUBTOT/11.. : 1237 
OUTPUT Urine O DETAINEE REPORTS HE'S VOIDED 2X DURING SHIFT 
OUTPUT SUBTOT/11..: 0 
Initials: RK 
Hungerstrike M'.lnitoring Form 
Day: 09/17/2018 
Shift PM(SHIFT9117/20181500-9/1712018 2300) 
Intake PO(in ml}: 1237 DETAINEE REPORTS HE HAS NOT BEEN DRINKING ANY R.U/DSBES/DES HIS PED/AL YTE 
DURING SHIFT. DETAINEE DRANK 1L PED/AL YTEAT2000, BCXJSTPLUS 237M... 
OJ!put Urine (in ml}: 0 
Initials: RK 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
IM1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes ordered Pedialyte and boost plus 
Reason for hunger strike: Wcints to be released from custody 
/ldequate supply of drinking water and other be-erages available: Yes 
Three meals deliwred per day to patient Yes 
/lnyunauthori>edfood inroom? No 
Haw dailyorthostatic \ital signs been completed? Yes 
Has input and output been documented on the the M-IU Hunger Strike M'.lnitoring Smart Form? Yes 
Narrati-e: 
Detainee was noted sleeping, la~ng in bed during initial rounds, does not appear to be in anydislress and noted normal rise 
and fall of chesl /ll 1700, detainee was noted, awake and watching lVwhi le la~ng in bed. Detainee denied any issues or 
concerns, reports he has 'weakness" when asked how he's doing. Detainee refused he needed an)lhing from the nurse at the 
time of assessmenl W II continue to monitor. Detainee compliant with his prescribed Thiamine and boost plus gi-en as 
prescribed. Detainee was noted doing his nighUyh>9iene practice by the sink, brushing his teeth and washing his face. Unable 
to lisua li,e if detainee drank water during observation. WII continue to monitor. Detainee refused dinner, meal number 80. 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Ex amlinatlon 
General B<amination: 
GENER/II.. /IPPE.AR/I/IICE: in no acute distress , well del.e!oped, well noorished. 
PSYCH: alert, oriented. 
Assessments 
/ll-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: Nursing to assess h)<lration status: skin turgor, mucous membranes, blood pressure, heart rate, intake & output WII 
continue to encourage detainee to eat all meals deli-ered to him and to drink fluids. Detainee has access to drinking water 
inside of cell. Detainee educated on possible risks to health if he continues to miss meals. Detainee educated on risks of not 
drinking adequate amount of fluids. Detainee educated to drink at least 8-10 cups of liquids per day.Detainee educated on 
possible medical risks of continuing to refuse meals. Detainee instructed to inform nursing staff/officers if s,mptoms discussed 
begins, or if haling continues or becomes worse. Detainee also instructed to let officer know if he wants a tray to consume. 
Detainee wrba li>ed understanding of all instructions and did not ha,e anyadditional questions. Detainee to remain in M-iU/seg 
until will only released from hunger strike lrealrnentlmonitoring byphy.;ician. Detainee -erbali>ed understanding of all 
instructions. 
Procedure Code s 
T1013 Sign Lang/0-al Interpreter 
Notes: Detainee to remain in M-lU.1-iunger Strike 
Appointment Provi4 (b)(6) ; (b)( 7)(C) IRN 
Electronically signed by Kb)(6) ; -· FN on 09/17/2018 22:13:36 (Pacific Dayl ight Time) 
Sign off status: Completed 
2019-ICLl-0005 1 3226 

DHS-ICE-19-0196, 19-0197-N-000408
Northwest Detention Center 
1623EJ~ 
l'. WA98421 
Tel (b)(6); 
Patie nt: AMAR, MERGENSANA DOB: 10/23/1978 Prog,. u Nni (b)(6); (b)(7)(C) r" 09117/2018 
Nd.e general.ed by eClinica/Wm<s BvRIPM Saftvere (1W.WeClinica/WOrks.Ctlm) 
2019-ICLl-00051 3227 

DHS-ICE-19-0196, 19-0197-N-000409
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:lloj(b )(6); 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll lunber:~ 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
09 117/2018 
Curnont Medication s 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy , Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Thiamine HCI 100 M3 Tablet 1 tablet BID, stop date 09/18/2018, 
KOP: Yes, Drug Source: In House Pharmacy , Notes: Not required 
for trawl 
• Boost Plus - Liquid 1 BID PRN, stop date 09/18/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl, 
please giw this with the thiamine 
Review of System s 
General/Constitutional: 
Headache denies. Lightheadedness admits W! ight 
loss admits 
Hunger Strike: 
Fatigue admits Sleep Disturbance denies. Dry M:>uth denies. 
W!akness admits, . Shortness of breath at rest denies. Chest 
pain at rest admits Palpitations denies. /lt>dominal Pain denies. 
Nausea denies. Mlsde aches admits extremities and back. 
Skin breakdown denies. Difficulty thinking denies. 
Aflpolntment Provlcle i b)(6) ; (b)(7)(C) rD 
Reas on for Aflpolnlm ent 
1. Hunger strike ew l. 
History of Pre se nt Illne ss 
Flowsheets (M-tU): 
Pt has been seen drinking a boost His UAis \IIA\IL today. He states he is weak and dizzy but mows around easily. He is 
talkatiw and not asking for the trans later. He is not wanting to end his hunger strike. 
Hungerstrike M:mitoring Form 
Day. 09/17/2018 
Shift AM 
Intake PO(in ml}: 2000 2 literof electro/yte solution for day shifl 
Intake rl/- Normal Saline (in ml}: 0 
OJtput Urine (in ml): 0 pt seen voiding, and UA obtained 
OJtput Bowel 11/owments (in ml): 0 
Labs - Urine Ke tones: Neg 
Labs - Sodium: 
Initials: SM 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Pallent speaks English fluenUy 
Pain />ssessment 
Pain 
l'<e }OU currently in pain? Yes 
The pain is located : 
The sewrityof pain is rated at 3110 
The sewrityof the pain is mild lo moderate 
The pain began 3-4 days ago 
The character of the pain is aching 
The associated S)<llptoms are dizziness 
The pain is aggrawted by physical activity 
The pain is relieled by none 
Narratiw: 
Hunger Strike: 
~ ical Ewluation 
Date missed meals monitoring initiated: 08/220)18 
\M1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/220)18 
Last meal consumed: Breakfast 
Drinking fluids: Yes 
# of da),S on hunger strike: 24 
Total Wl ight loss in pounds: 20 
Reason for hunger strike: Wcints to be released from custody 
Housingllsolation Location: M,dicaf Housing Unit 
Reason for Isolation Placement For dose supervision, observaflon, and monitoling 
Relie,,v of the Housing Placement Review housing e11e,y 24 hours 
Vit al Sign s 
97F 
57 /min 
88/57 mm Hg 
16/ min 
143.4 lbs 
66.5in 
22.80 Index 
Ex aminatio n 
General Examination: 
Temn 
09/17/201810:42:28 PM 
1-R 
09/17/201810:42:28 PM 
BP 
09/17/201810:42:28 PM 
RR 
09/17/201810:42:28 PM 
wt 
09/17/201810:42:28 PM 
H 
09/17/201810:42:28 PM 
BMI 
09/17/201810:42:28 PM 
GENERJ>l PPPEAAPNCE: pt alert and oriented ' more energetic and talkatiw . 
ORPl. CAvfTY: mucosa moist, no lesions. 
SKIN: good turgor, normal. 
LUNGS: good air mo,ement, . 
MUSCULOSKELET!>I.. : normal gait, full range of motion, tender to palpation, neuro1.ascular intact. 
PSYCH: alert, oriented. 
Assess ment s 
1. Starvation, subsequent encounter - T73.0X><D (Primary) 
2. Imbalanced nutrition: Less than body requirements [00002] - ND00002 
3. Risk for Deficient Fluid \b lume [00028] - ND00028 
/II-Risk for imbalanced nutrition: Less than bodyrequiremenls 
Self-imposed Hunger strike. 
2019-ICLl-00051 3228 
(b)(6); (b)(7)(C) 

DHS-ICE-19-0196, 19-0197-N-000410
Tr ea tm ent 
1. Starvatioo, subsequent encOtriler 
Notes: Pt wi lling to oontinue pedial)le and he wi ll take occasional boost to boost his energy. Pt is stable and refusing to eat 
Pro ce du re Cod es 
T1013 Sign Lang/Q-al Interpreter 
Fo llo w Up 
daily 
Notes: Education prmi ded on risks of hunger slrike and reoommended treatment 
Appointment Provide1(b)(6); (b)(?)(C) I MD 
(b)(6); (b)(?)(C) 
Electronically signed !(b)(6); (b)(?)(C) ~ Don 09/17/2018 22:47:54 (Pacific Daylight Time ) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREET 
TACOMA, WA98421 
T1(b)(6); I 
,ax. 
Patie nt: AMAR, MERGENSANA DOB: 10/23/19 78 Progre ea N"'{ b)(6); (b)(?)(C) l•D 09/17/2018 
Ncte generated byeOinica!Wai<s ElvRIPM &JtVHe (....weC/inicl"iWorks.com) 
2019-ICLl-00051 3229 

DHS-ICE-19-0196, 19-0197-N-000411
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:llol (b )(6): 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II ~be~ 
1623 E J STREET, T~ 
Appoirimert Facility: Northwest Detertion Certer 
09 117/2018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Thiamine HCI 100 M3 Tablet 1 tablet BID, stop date 09/18/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl 
• Boost Plus - Liquid 1 BID PRN, stop date 09/18/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl, 
please giw this with the thiamine 
Alla ..... 
N.KDA 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue admits, 
that is constant. Fewr denies. Headache denies. 
Lightheadedness admits, s8\.eral limes. Night sweats denies. 
Sleep disturbance denies. Weight gain denies. Weight 
loss denies. 
Aflpolntment Provlclef b)(6) ; (b)(7)(C) f RN 
Reason for Aflpolntment 
1. tvHU /'M RN ROUNDS/ HUNGER STRIKE 
History of Present Illness 
Flowsheets (tvHU): 
lnput/OJtput Flowsheet 
Time: 1400 
INPUT PO: 1250 refuses to keep track of fluids. Drank Boost, Pedialyte 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT Other. 0 
INPUT SUBTOT/11.. : 0 
OUTPUTUrine Orefusestomeasure 
OUTPUTEmesis 0 
OUTPUTBM 0 
OUTPUT a. Wet Diaper Weight 0 
OUTPUT b. Dry Diaper Weight 0 
OUTPUT Total Diaper Weight output (calculate a-b} 0 
OUTPUTDrain: 0 
OUTPUT SUBTOT/11.. : 0 
NetGain: 0 
NetLoss: 0 
Initials: JS 
Patient Identification: 
Patient Identification 
Patient property identified by2 sources induding: /0 Badge, Verbally 
Chaperone Present? No 
\M1at language do )OU speak? &Jglish, Russian, __ 
Interpretation pro\aded? Patient speaks English fluenUy 
Pain Assessment 
Pain 
l'<e )OU currently in pain? No 
Narratiw: 
tvHU M:D ISO 11 HUNGER STRIKB lf-3 and assessment done. Sitting up in bed alert orienld steady. Cooperatiw with IA, 
and >MUii collect urine for dip ne>ltime he 1,0ids. Drank Boost Watching lV Refused phy.,ical e,ram and to eat food. 
11 :30 Refused lunch. Has not pro\ided urine sample :,e~ encouraged again to do so .. Watching lVsitting up on bed. 
Vital Sign s 
Temp 
97.1 F 09/17/2018 11 :36:54 /IM 
HR 
57 /min 09/17/2018 11 :36:54 /IM 
BP 
88/57 mm Hg 09/17/2018 11 :36:54 /IM 
RR 
16/m in 09/17/2018 11 :36:54 /IM 
H 
66.Sin 09/17/2018 11 :36:54 /IM 
Orthostatic BP 0900 09/17/2018 Supine 91/58 p =43, sitting 91/60/ p=46, standing 75143 P=57. 
Ex amination 
General E>ramination: 
GENER/II.. !>PPE/IRANCE: in oo acute distress, well deleloped, well oourished. 
HEAD: oorroocephalic. 
NECK/THYROID: normal, neck supple, full range of motion. 
CHEST: normal, oo gross rib deformity, normal shape and expansion. 
(b)(6); (b)(7)(C) 
MJSCULOSKELET/11.. : normal, normal gait, oo deformities, full range of motion, good strergth and equal bilaterally. 
NEUROLOOC: alert and oriented, motor strergth normal upper and lc,.,,,er extremities, normal exam, nomial strergth, 
tone and reflexes, sensory exam intact. 
PSYCH: alert, oriented, cognitiw function intact, good eye contact. 
Assessments 
1. lneffectiw Coping [00069]- ND00069 (Primary) 
2. lneffectiw community coping - ND00077 
3. Risk for Deficient Fluid Volume [00028]- ND00028 
Hunger Strike. 
Trea tment 
1. lneffecthle Coping [00069) 
I 
Notes: Strike Detainee wrbali,ed understanding of plan of care and denies questions/concerns. Continue hunger strike protocol, 
encourage po food/fluids, encourage wrbalization offeelings. Encourage to allow staff to monitor intake and output, \ital signs, 
wt. Instructed to seek staff>Mth any needs. \/erbali,ed understanding. Nursing Care Plan present Refer to nursing care plan for 
on-going inter,entions. Detainee offered three meals per day and leaw in room for at least20 minutes. /ldequate supplyof 
drinking water and other bewrages as ordered bypro\ider available. Encourage dailyoral/phy.,ical h19iene care. Detainee 
wrbali,ed an understanding of education and/or treatment Voices no other concerns. 
Disposition: /ldmitted to M-IU until medicaly evaluated 
Appointment Provide* b)(6 ); (b)(7)(C) !RN 
2019-ICLl-0005 1 3230 

DHS-ICE-19-0196, 19-0197-N-000412
Electronically signed b~(b)/ 6): (b)( 7)(C) ~, RN on 09/17/201814 :49:08 (Pacific Daylight Time) 
Sign off status: Completed 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 
Northwest Detention Cente r 
1623EJSTREI" 
TACOMA, WA98421 
TeljrhlfR\· 
Fax: 
RN 09117/2018 
Nd.e general.ed by eOinica/W<n<s B>RIPM Sottw,re ("""' 1n1c 
2019-ICLl-00051 3231 

DHS-ICE-19-0196, 19-0197-N-000413
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3232 
AMAR,MERGENSANA 
A:216269802 Su:lloj(b)(6); I 
Facility Code: CSONVWA Housing Area : M 
Acc0Ull ~beb){6)C ! 39 Y ad ~l~i::: 
1623 E J STREET, T 

DHS-ICE-19-0196, 19-0197-N-000414
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3233 
AMAR,MERGENSANA 
.. A:216269802 Su:ll~ b)(6); I 
Fac1lrtyCode:CSOINWA ng,c;ea .lfi 
kcOUll ~ y)(6t ! 39 Y ad ~I~!::: 
1623 E J STREET, T 

DHS-ICE-19-0196, 19-0197-N-000415
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 21626980 2 Su:ll~b )(61, J 
Facility Code: CSCN/1/WA Housing ea: 
AccOlrt ~0)@C I 39 Y ad~~ 1::: 
09 117/2018 
Curnont Medication s 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Thiamine HCI 100 M3 Tablet 1 tablet BID, stop date 09/18/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl 
• Boost Plus - Liquid 1 BID PRN, stop date 09/18/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl, 
please giw this with the thiamine 
ll '9laS 
N.KDA 
vlaw of Syst ems 
Hunger Strike: 
Fatigue admits Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. \Neight loss denies. Dry M>uth denies. 
\Neakness that is moderate, admits, that is generalized. 
Cough denies. Shortness of breath at rest denies. Chest pain at 
rest denies. Palpitations denies . .Abdominal Pain denies. 
Constipation denies. Diarrhea denies. Nausea denies. 
\.t>mitling denies. Painful urination denies. Decreased urine 
output denies. M.Jsde adnes denies. M.Jsde cramps denies. Skin 
breakdown denies. Difficultythinking denies. 
1623 E J STREET, T 
Appoimnert Facility: Northwest Detertion Certer 
Reas on for Appointm ent 
1. Nocturnal M-IU Nursing Assessment 
History of Prese nt Illne ss 
Flowsheets (M-!U): 
Hungerstrike M>nitoring Form 
Day. 09/16/2018 
Shift: Night 
Appointm ent Provld e 1 (b) (6 ); (b)(7)(C) 
Intake PO (in ml): 2000 pedialyte from the latter part of the evening shifl and night shift 
OJtput Urine (in ml): detainee did not measure in urinal but was ob served urinallng in the toilet three llmes throughout the 
night shift. 
Initials: ~(b i(6 ! 
Patient ldenti ca on: 
Patient Identification 
Patient property identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEOoffl~ second half of evening shift and GEOolliaj(b )(6); I nocturnal shift. 
Wiat language do }OU speak?~ -
lnterpretation pro\aded? Yes, Interpreter Number 
Number : lnterpretalk #324637 
Language Russian 
Pain Assessment 
Pain 
ke }OU currently in pain? No 
~ : Patient is oonsidered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Detainee stated that he plans to oontinue his hunger strike and states that he has no plan to start eating again. He stated that 
he is on a hunger strike because ''this is my protest" He states that he is drinking fluids and stated that he will pro~de a urine 
sample later in the morning. He stated that nursing staff is allowed to take his orthostatic ~tal signs, weight and do a nursing 
assessment 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
IM1en did the official hunger strike begin? 08/25'2018 
Date of last meal oonsumed: 08/22/2018 
Last meal oonsumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wcints to be released from custody 
/ldequate supply of drinking water and other be1.erages available: Yes 
Three meals deliwred per day to patient Yes 
Breakfast deli1.ered during current shift 0% consumed 
/lnyunauthori>edfood inroom? No 
Haw dailyorthostatic ~tal signs been oompleted? Yes 
Has input and output been documented on the the M-IU Hunger Strike M:>nitoring Smart Form? Yes 
Vit al Sign s 
Temp I 
97.8F 09/17/2018 12:48:45 />lvl (b}(6); (b}(7)(C) 
HR 
standing:84 09/171201812:48:45/>lvl 
sitling:62 09/17/2018 12:48:45 />lvl 
supine:46 09/17/2018 12:48:45 i>lvl 
BP 
standing: 7 4150 09/17/2018 12:48:45 />lvl 
sitting:82/53 09/17/2018 12:48:45 />lvl 
supine: 78/50 09/17/2018 12:48:45 />lvl 
RR 
16 /min 09/17/2018 12:48:45 />lvl 
wt 
143.4 lbs 09/171201812:48:45/>lvl 
H 
66.5in 09/17/2018 12:48:45 />lvl 
BMI 
22.80 Index 09/17/2018 12:48:45 />lvl 
O'lhostatic 1<tal signs re;;hecked after detainee drank 1000ml of ped1al)le and 240ml of Boost Supine: BP 83/49, Pulse: 49. 
Stting: BP: 85/55, Pulse: 65. Standing: BP: 91/57, Pulse: 84. 
Ex aminatio n 
General Examination: 
GENERJ>l /PPEAAPNCE: in no acute distress, well del.eloped, well r<lllrished. 
ORPl. CAvlTY: nonnal, mucosa moist. 
SKIN: nonnal, no rashes, no suspicious lesions. 
HEPRT: no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNGS: nonnal, clear to auscultation bilaterally, nowieezes, rales, rhonchi. 
!>BDOIVEN: nonnal, bcmel sounds present, soft, nontender, nordistended. 
MJSCULOSKELET/>L: nonnal, nonnal gait, no deformities, full range cl motion, good strength and equal bilaterally. 
NEURQOOC : alert and oriented, cooperatiw with exam, motor strength nonnal upper and lower extremities, normal 
exam, nonnal strength, tone and reflexes, senscxy exam intact. 
2019-ICLl-00051 3234 

DHS-ICE-19-0196, 19-0197-N-000416
PSYCH: alert, Oliented. 
Detainee was awake and sitting on his bed prior to nursing staff entering room with GEO officer chapperone. Detainee 
allowed staff to take -,1a1 signs, do nursing assessment and measure weight Wien staff left room, detainee continued to sleep 
comfortably in his bed with his chest rising and falling e""n lyand unlabored at 16 breaths per minute. He woke up various times 
at night, sat up on the side of his bed and was obse=d urinating in the toilet three times. Detainee refused breakfas~ per GEO 
officer Riley, detainee ate 0% of breakfast 
Assessments 
/>I-Risk for imbalanced nutrition: Less than body requirements. 
Treatm e nt 
1. Others 
Notes: 1. Continue with \Alai Signs e""ryshi fl; Intake and Output M,nitoring e""rysh ifl; Dailyweights; Dailyorthostatic 1Atal signs. 
2. "'1 adequate supply of drinking water and other be""rages are available to patient at all times. 
3. Three meals per day are deli""red to the patient and deli,.,ryof meals is documented. 
4. ~ I food notauthori,ed byCD~ys ician is remo~ from patienrs room. 
5. Patient is not allowed to purchase food from commissaril""nding machine while on hunger strike. 
6. Patient will only be released from hunger strike treatment/monitoring by CD or physician order. 
7. Patient counseled regarding the medical risks of continuing the hunger strike. 
8. Encouraged to terminate the hunger strike and eat/drink as normal. 
Consulted with orK:all pro\<der Oa1As, NP regarding orthostatic 1Atal signs. Per telephone order per pro1Ader Oa1As, "Okayto re￾check orthostatic -,tal signs after drinking fluids. Orthostatic ,,;1a1 signs impro~ after re-checking. Continue to encourage 
detainee to eat food and drink fluids." Order read back and "" rified. 
Pro ce dur e Code s 
T1013 Sign Lang/Oral Interpreter 
Notes: Continue M-IU pro-,der orders. 
Appointment Providerf b)(6); (b)(7)(C) 
Bectronically signed ~(b)(6); (b)(?)(C) 
Sign off status: Comp leted 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 
~ on 09/17/2018 06 :59 :49 (Pacific Daylight Time ) 
Northwest Detention Center 
1623 E J STREEr 
T~WA98421 
Teljl(6) ; ~- I 
09/17/2018 
Ncie generated byeOinica/W<rls EhiRIFM So/fw3re <-~=====:r--~ 
2019-ICLl-00051 3235 

DHS-ICE-19-0196, 19-0197-N-000417
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3236 
AMAR,MERGENSANA . . A: 216269802 Su:lltt1b )(6); I 
Fac1lrtyCode:CSOINWA ng,c;ea .lfi 
39 Y old Male, DOB: 10/23/1978 
AccOl.rll lunber1Ttiii6\:7 1623 EJ STREET, T~ 

DHS-ICE-19-0196, 19-0197-N-000418
U.S. Immi gration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:llol(b \/6\ ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunbe ~ 
1623 E J STREET, T~ 
Appoirimert Facility: Northwest Detertion Certer 
09 /1612018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Thiamine HCI 100 M3 Tablet 1 tablet BID, stop date 09/18/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl 
• Boost Plus - Liquid 1 BID PRN, stop date 09/18/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl, 
please giw this with the thiamine 
Alla ..... 
N.KDA 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fewr denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbance denies. Weight gain denies. 
Weight loss denies. 
Appointment Provlcle 1 (b)(6) ; (b)(7)(C) rN 
Reason for Appointment 
1. RN E\€NING SPLIT SHIFT: HUNGER SlRIKE 
History of Present Illness 
Flowsheets (M-tU): 
lnput/OJtput Flowsheet 
Time: 1400 
INPUTPO: 0 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT Other. 0 
INPUT SUBTOT/11.. : 0 
OUTiPUT Urine 0 
OUTiPUT Emesis 0 
OUTiPUTBM 0 
OUTiPUT a. Wet Diaper Weight 0 
OUTiPUT b. Dry Diaper Weight 0 
OUTiPUTotal Diaper Weight output (calculate a-b} 0 
OUTiPUTDrain: 0 
OUTiPUT SUBTOT/11.. : 0 
NetGain: 0 
Netloss: 0 
Initials: KM,! 
Patient Identification: 
Patient is 39 yo russian male on Hunger Slrike. He is awake and alert when RN enters room. he is co-operatiw with all 
e>«:ept taking meals. He refuses lunch, this is meal 77 missed. Patient states no complaint at this time. 
Patient Identification 
Patient propeMyidentified by2 sources inducting: ID Badge, Verbally 
Chaperone Present? No 
IM1at language do )OU speak? English, Russian, __ 
Interpretation pro\<ded? Patient speaks English ffuenUy 
Pain l'ssessment 
Pain 
Ne )OU currently in pain? No 
Vital Sign s 
16 /min 
66.5in 
Ex amination 
General Examination: 
RR 
09/16/201804:08:14 PM 
H 
09/16/201804:08:14 PM 
GENER/II.. !>PPEPRANCE: in no acute distress, well del.e!oped, well nourished. 
HE.ART: no murmurs, regular rate and rhythm. S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, no Vvheezes. rales. rhonchi. 
b)(6) ; 
b)(7) (C) 
N 
-
-
N 
NEUROLOOC: alert and oriented. cooperatiw with exam. motor strength normal upper and lc,,,,er extremities. normal 
exam, normal strength, tone and reflexes. sensory exam intact. 
Assassmants 
1. lneffecliw Coping [00069] - ND00069 (Prmary) 
2. lneffecliw community coping - ND00077 
3. Risk for Deficient Fluid \t>lume [00028] - ND00028 
Hunger Strike. 
Treatment 
1. Ineffective Coping [00069) 
Notes: Continue hunger strike protocol. encourage po food/lluids. encourage wrbali,ation offeelings. Encourage to allow staff to 
monitor intake and output, \<tal signs. wt. Instructed to seek staff with any needs. Verbali2ed understanding. Detainee offered 
three meals per day and leaw in room 20 minutes before taking away. A:lequate supply of drinking water and other bewrages 
as ordered by pro\<der available. Encourage dailyoral/ph15ical h)!liene care. Change of dothing/bedding. Continue to offer 
\<lals, weights, food, labs. meds. Patient wrbali,es understanding of Plan of Care. and he wrbali,es his right to refuse. 
Appointment Provi, (b)(6 ); (b)(7)(C) r 
Bectronically signed bJ!(b)(6) ; ~-
Sign off status: Completed 
2019-ICLl-0005 1 
~ , RN on 09/1&'201817 :57:04 (Pacific Daylight Time) 
3237 
Northwest Detention Center 
1623 E J STREET 
TACOMA, WA98421 
lel/h)/n) I FaX. 

DHS-ICE-19-0196, 19-0197-N-000419
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 ProgNu No~(b)(6); (b)(7)(C) IRN 09/111/2018 
Ncle gene,a,.ed by eC/inicall'lcr1<s Bf</PM Softw3re (w.w,eC/inicfiWorks.COff9 
2019-ICLl-00051 3238 

DHS-ICE-19-0196, 19-0197-N-000420
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3239 
AMAR,MERGENSANA A:216269802 Su:i10:fb)(6); I 
Facility Code: CSONVWA Housing Area : M 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll lunbe~ 
1623 EJ STREET, T~ 

DHS-ICE-19-0196, 19-0197-N-000421
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:llol l h \In\ ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II ~berfti'ii6i:7 
1623 E J STREET, T~ 
Appoirimert Facility: Northwest Detertion Certer 
09 /1612018 
Curnont Medication s 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Thiamine HCI 100 M3 Tablet 1 tablet BID, stop date 09/18/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl 
• Boost Plus - Liquid 1 BID PRN, stop date 09/18/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl, 
please giw this with the thiamine 
• fl/edication List re\iewed and reconciled with the patient 
Past Medlc a l History 
No fl/edical History. 
........ s 
N.KDA 
Review of Sys tems 
General/Constitutional: 
Chills denies. Fatigue admits. Fewrden ies. 
Headache denies. Lightheadedness denies. Night 
sweats denies. ll\leight loss admits, is intentional. 
Aflp o lntmen t Provlcler:~ b)(6) ; (b)(7)(C) rA 
Reas on for Aflpolntm ent 
1. DJ>JL YM-IU PRCMDER ROUNDS 
History of Prese nt Illne ss 
Narratiw: 
0745 hcurs: 39yo male detainee in the M-IU for Hunger Strike medical mcnitoring. He states he is drinking, and able to 
ambulate and get around, no issues with urination. No new complaints or worsening S)fllptoms since last medical \i sit 
Patient Identification: 
Patient Identification 
Patient property identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? Russian 
Interpretation pro\ided? Yes, Interpreter Number 
Number Use notes ffeld 11359957 
Language Russian 
Pain />ssessment 
Pain 
/>,e }OU currently in pain? No 
Yitai Sign s 
97.1 F 
57 /min 
95161 mm Hg 
16/ min 
145.2 lbs 
66.Sin 
23.08 Index 
Ex aminat ion 
General Examination: 
Temo 
09/16/201810:13:11 PM 
1-R 
09/16/2018 10:13:11 PM 
BP 
09/16/201810:13:11 PM 
RR 
09/16/201810:13:11 PM 
Wt 
09/16/2018 10:13:11 PM 
H 
09/16/201810:13:11 PM 
BMI 
09/16/201810:13:11 PM 
GENER/IL /IPPEl'Ri'NCE: in no acute distress, well deleloped, well nourished. 
HEPD: nonnocephalic. 
(b)(6); 
(b)(7)(C) 
ENT: EYES: normal, EARS: normal, NOSE: normal, SINUSES: sinuses non-tender to palpation, ORAL CAVITY: 
normal, 1HROAT: normal. 
HEl'RT: no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, nowieezes, rales, rhonchi. 
/IBDO!I/EN: normal, soft, nontender, nondistended. 
MJSCULOSKELET/ll : normal, normal gait, no deformities, full range cl motion, good strength and equal bilaterally. 
PSYCH: alerl, oriented . 
.Asse ssm ents 
1. Star1>ation, subsequent encounter - T73.0X><D 
Tr e atm ent 
1. Starvation, subsequent encOl.l"ller 
Notes: Patient educated the current treatment plan as directed, alert staff if new or worsening s)fllploms as needed, PRN. 
Patient to receiw daily pro\ider checks while in the M-IU. 
Notes: Patient to remain in the M-IU until further notice 
Appo intment Provide (b)(6); (b)(7)(C) PA 
(b)(6); (b)(7)(C) 
Electronically signed b~1,; ~b...;)...;. (6..;.).;.. ; __ ...Jf A on 09/16/2018 10:14:31 (Pacific Daylight Time) 
Sign off status: Completed 
2019-ICLl-00051 3240 
NorthlYest Detention Center 
1623 E J STREET 
T~WA98421 
Tel faJ<6); I 

DHS-ICE-19-0196, 19-0197-N-000422
Fax: 
Pali-t: AMAR, IERGENSANA D01k 10/23/1978 p,..._. _, i(b)(6); (b)(7)(C) rA 09/16/2018 
Ncl.e general.ed byeC/inica/'Na1<s EM>/PM Sottv.ere (,w,weC/inica/WGYks .COOjl 
2019-ICLl-00051 3241 

DHS-ICE-19-0196, 19-0197-N-000423
U.S. Immi gration 
and Customs 
Enfor cement 
AMAR, MERGEN~ 
A:216269802 Si.ti1 (b)(6); 
Facility Code: CSCN/1/WA Housing ea: 
39 Y old Male, DOB: 10/23/1978 
1623 E J 
AccOl.lll 
STREET, 
lunber: 
T~ 
~ 
Appoimnert Facility: Northwest Detertion Certer 
09 /1612018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Thiamine HCI 100 M3 Tablet 1 tablet BID, stop date 09/18/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl 
• Boost Plus - Liquid 1 BID PRN, stop date 09/18/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl, 
please giw this with the thiamine 
Alla ..... 
N.KDA 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fewr denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbance denies. Weight gain denies. 
Weight loss denies. 
Reason for Appointment 
1. RN DAYS: HUNGER STRIKE 
History of Present Illness 
Flowsheets (M-tU): 
lnput/OJtput Flowsheet 
Time: 1400 
INPUT PO: 2240 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT Other. 0 
INPUT SUBTOT/11.. : 0 
OUTiPUT Urine 0 
OUTiPUT Emesis 0 
OUTiPUTBM 0 
OUTiPUT a. Wet Diaper Weight 0 
OUTiPUT b. D,y Diaper Weight 0 
OUTiPUTTotal Diaper Weight output (calculate a-b} 0 
OUTiPUTDrain: 0 
OUTiPUT SUBTOT/11.. : 0 
NetGain: 0 
NetLoss: 0 
Initials: KM,! 
Patient Identification: 
Appointment Provld efb)(6) ; (b)(7)(C ) 
Patient is 39 yo russian male on Hunger Slrike. He is awake and lertwhen RN enters room. he is co-operati1.e with all e>eept 
taking meals. He rfuses lunch, this is meal 76 missed. He is co-perati1.e with urine sample for urine dipstick. Patient states no 
complaint at this time. 
Patient Identification 
Patient prope~yidentified by2 sources inducting: ID Badge, Verbally 
Chaperone Present? No 
\Mat language do )OU speak? English, Russian, __ 
Interpretation pro\aded? Patient speaks English ffuenUy 
Pain 1'6sessment 
Pain 
Ne )OU currently in pain? No 
Vit a l Signs 
16 /min 
66.5in 
Ex aminat ion 
General Examination: 
RR 
09/16/201803:55:35 PM (b)(6); (b)(7)(C) 
H 
09/16/201803:55:35 PM 
GENER/II.. JIPPEPRANCE: in no acute distress, well del.eloped, well nourished. 
HE.ART: no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, no Vvheezes, rales, rhonchi. 
NEUROLOOC: alert and oriented, cooperatiw with exam, motor strength normal upper and lc,,,,er extremities, normal 
exam, normal strength, tone and reflexes, sensory exam intact. 
Assass mant s 
1. lneffectiw Coping [00069]- ND00069 (Primary) 
2. lneffectiw community coping - ND00077 
3. Risk for Deficient Fluid \t>lume [00028] - ND00028 
Hunger Strike. 
Treatment 
1. Ineffective Coping [00069) 
Notes: Continue hunger strike protocol, encourage po food/lluids, encourage 1.erbalization offeelings. Encourage to allow staff to 
monitor intake and output, \atal signs, wt. lnslructed to seek staff with any needs. Verbali2ed understanding. Detainee offered 
three meals per day and leaw in room 20 minutes before taking away. J>dequate supply of drinking water and other be1.erages 
as ordered by pro\ader available. Encourage dailyoral/phy.;ical h)!liene care. Change of dothing/bedding. Continue to offer 
,Hals, weights, food, labs, meds. Patient 1.erbali2es understanding of Plan of Care, and he 1.erbali2es his right to refuse. 
Appointment Providet b)(6) ; (b)(7)(C) r 
Bectronically signed b{b)(6); ~-
Sign off status: Completed 
2019-ICLl-0005 1 
!RN, RN on 09/1&'201816:01:11 (Pacific Daylight Time) 
3242 
Northwest Detention Center 
1623 E J STREET 
TACOMA, WA98421 
,el(b)/6): I ,ax . 

DHS-ICE-19-0196, 19-0197-N-000424
Patient: .AMAR, IIERGENSANA DOB: 10/23/1978 ProgN u Notaj(b)(6); (b)(?)(C) r" 09/18/2018 
Nd.e general.ed by eClinical.Worl<s a.RJPM Softvere (,w,weC/inica/Works.com) 
2019-ICLl-00051 3243 

DHS-ICE-19-0196, 19-0197-N-000425
U.S. Immigration 
and Customs 
Enfor cement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 Prog N U Nola : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inic a'WGYks.coojl 
2019-ICLl-00051 3244 
AMAR, MERGEN _~ 
Facility~~~~~ 39 YkcOUll ad ~I~!: ~IJebi@C :: ! 
1623 E J STREET, T 

DHS-ICE-19-0196, 19-0197-N-000426
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:i1D:kb)(6): 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll ~berfb )(6) 
09 /1612018 
Curnont Medication s 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Thiamine HCI 100 M3 Tablet 1 tablet BID, stop date 09/18/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl 
• Boost Plus - Liquid 1 BID PRN, stop date 09/18/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl, 
please giw this with the thiamine 
ll '9laS 
N.KDA 
vlaw of Systems 
Hunger Strike: 
Fatigue admits Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. \Neight loss denies. Dry M>uth denies. 
\Neakness that is moderate, admits, that is generalized. 
Cough denies. Shortness of breath at rest denies. Chest pain at 
rest denies. Palpitations denies . .Abdominal Pain denies. 
Constipation denies. Diarrhea denies. Nausea denies. 
\.t>mitling denies. Painful urination denies. Decreased urine 
output denies. M.Jsde adnes denies. M.Jsde cramps denies. Skin 
breakdown denies. Difficultythinking denies. 
1623 E J STREET, TAl:ClfJ.:i,r,; ,..,,.,.,., .;.;~..,.,,..,..._. 
Appoimnert Facility: Northwest Detertion Cert er 
Appointm ent Provld e i(b)(6) ; (b)(7)(C) 
Rea son for Appointment 
1. Nocturnal Nursing Assessment 
History of Pre se nt Illne ss 
Flowsheets (M-tU): 
Hungerstrike M>nitoring Form 
Day. 09/16/2018 
Shift: Night 
Intake PO (in ml): 2000 pedialyte from the latter part of the evening shifl and night shift 
OJtput Urine (in ml): detainee did not measure in urinal but was ob served urinallng in the toilet three llmes throughout the 
nightshifl. 
lnitialsf ~~~ J Patient Iden . 
Patient Identification 
Patient property identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes .,,..,.,.,.,---. lihlffil 
Chaperone Name: GEOoflicet b )(6); jr second half of evening shift and GEOoffl~ nocturnal shift. 
Wiat language do }OU speak? \'·,aw.,., ,-, · Interpretation pro\aded? Yes, Interpreter Number 
Number : Uonbridge #11359444 at 2126 hours on 9115118 and #11359560 for nocturnal shift. 
Language Russian 
Pain Assessment 
Pain 
ke }OU currently in pain? No 
~ : Patient is oonsidered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Detainee slated that he plans to oontinue his hunger strike and slates that he has no plan to start eating again. He slated that 
he is on a hunger strike because ''this is my protest" He slates that he is drinking fluids and slated that he will pro~de a urine 
sample later in the morning. He slated that nursing staff is allowed to lake his orthoslatic ~lal signs, weight and do a nursing 
assessment He also slated that he is fine with nursing staff laking a urine sample later today. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
IM1en did the official hunger strike begin? 08/25'2018 
Date of last meal oonsumed: 08/22/2018 
Last meal oonsumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wcints to be released from custody 
/ldequate supply of drinking water and other be1.erages available: Yes 
Three meals deliwred per day to patient Yes 
Breakfast deli1.ered during current shift 0% consumed 
/lnyunauthori>edfoodinroom? No 
Haw dailyorthoslatic ~lal signs been oompleted? Yes 
Has input and output been documented on the the M-IU Hunger Strike M:>nitoring Smart Form? Yes 
Vit al Sign s 
97.1 F 
standing:79 
sitting:57 
supine:50 
standing:90/64 
sitling:95/61 
supine:96150 
16 /min 
145.2 lbs 
66.Sin 
23.081ndex 
Ex aminatio n 
General Examination: 
Temp 
09/16/2018 03:32:38 />M 
HR 
09/1612018 03:32:38 />M 
09/16/2018 03:32:38 />M 
09/16/2018 03:32:38 />M 
BP 
09/16/2018 03:32:38 />M 
09/16/2018 03:32:38 />M 
09/16/2018 03:32:38 />M 
RR 
09/16/2018 03:32:38 />M 
wt 
09/16/2018 03:32:38 />M 
H 
09/16/2018 03:32:38 />M 
BMI 
09/16/2018 03:32:38 />M 
GENERJ>l J>PPEAAPNCE: in no acute distress, well del.eloped, well l'<llJrished. 
ORPl. CAvfTY: nonnal, mucosa moist. 
SKIN: nonnal, no rashes, no suspicious lesions. 
HEPRT: no murmurs, regular rate and rhythm, S 1, S2 nonnal. 
LUNGS: nonnal, clear to auscultation bilaterally, nowieezes , rales, rhonchi. 
!>BDOIVEN: nonnal, bowel sounds present, soft. nontender, nor-distended. 
(b)(6); 
(b)(7)(C) 
MJSCULOSKELET/>L: nonnal, nonnal gait, no deformities, full range cl motion, good strength and equal bilaterally. 
NEURQOOC : alert and oriented, cooperatiw with exam, motor strength nonnal upper and lower extremities, nonnal 
exam, nonnal strength, tone and reflexes, senscxy exam intact. 
PSYCH: alert, oriented. 
2019-ICLl-00051 3245 

DHS-ICE-19-0196, 19-0197-N-000427
Detainee was sleeping oomfortablyin his bed prior to nursing staff entering room with GEO officer chapperone. Detainee 
allowed staff to take ,.;ta1 signs, do nursing assessment and measure weight He easilywoke up on staff entering room. Wien 
staff left room, detainee oontinued to sleep oomfortablyin his bed with his chest rising and falling e1.enlyand unlabored at 16 
breaths per minute. He woke up various times at night sat up on the side of his bed and was obsen.ed urinating in the toilet 
three times. He receil.ed his breakfast tray from GEO, looked at it and then lied down on his right side in his bed, 001.ered himself 
up with his blanket and then rested oomfortably. Detainee refused break/as~ per GEO officer Joliff, detainee ate 0% of breakfast 
Assessments 
/>I-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: 1. Continue with \Atal Signs e1.eryshift; Intake and o.rtput Mmitoring e1.eryshift; Dailyweights; Dailyorthostatic l>ital signs. 
2. kl adequate supply of drinking water and other be1.erages are available to patient at all times. 
3. Three meals per day are deli1.ered to the patient and deli1.eryof meals is documented. 
4. ~ I food not authorized byCD~ ysician is remo1.ed from patienrs room. 
5. Patient is not allowed to purchase food from oommissa')l\ending machine while on hunger strike. 
6. Patient will only be released from hunger strike treatment/monitoring by CD or physician order. 
7. Patientoounseled regarding the medical risks of oontinuing the hunger strike. 
8. Enoouraged to terminate the hunger strike and eat/drink as normal. 
Consulted with prol>ider Robinson, PA regarding orthostatic l>ital signs. Per on-site 1.erbal order per Robinson, PA "Continue to 
enoourage detainee to eat food and drink fluids." Order read back and 1.erified. 
Procedure Codes 
T1013 Sign Lang/Oral Interpreter 
Notes: Continue tvHU Hunger Suike protoool per prol>ider orders. 
Appointment Provlde1(b)(6); (b)(7)(C) 
Bectronically signed b~(b)(6); (b)(7)(C) 
Sign off status: Completed 
~ on 09/16/2018 06:32:09 (Pacific Daylight Time) 
Northwest Detention Center 
1623 E. J STier 
T--;======.. 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Prog'9ss Note:l(b)(6); (b)(7)(C) f" 09M8/2018 
Ncie generaled by eOirica/Wcrlcs EM<IPM S:Jttvqe (""""eOinica/Works .com) 
2019-ICLl-00051 3246 

DHS-ICE-19-0196, 19-0197-N-000428
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Si.tllq(b )(6): ! Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
Acc01.111 l'unbe~ (6); 1623 E J STREET, T PCJ:P VVA-9642 I 
Appoimnert Facility: Northwest Detertion Cert er 
09 11512018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Thiamine HCI 100 M3 Tablet 1 tablet BID, stop date 09/18/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl 
• Boost Plus - Liquid 1 BID PRN, stop date 09/18/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl, 
please giw this with the thiamine 
Alla ..... 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness admits. 
Sleep Disturbance denies. \Neight loss admits. Dry 
M,uth denies. \Neakness admits, . Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. Abdominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. 1,1:>mitting denies. Painful 
urination denies. Decreased urine output denies. MJsde 
aches denies. MJsde cramps denies. Skin breakdown denies. 
Difficulty thinking denies. 
Reason for Appointment 
1. First 1/2 ewn ing shift m round 
History of Present Illness 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Time: 1500-1900 
INPUTPO: 0 
INPUT SUBTOT/11..: 0 
OUTiPUT Urine 200 
OUTiPUTBM 0 
NetGain: 0 
Net Loss: 200 
Initials: LM 
Hungerstrike Mln itoring Form 
Day. 09/15/2018 
Shift: PM 
Intake PO(in ml}: 0 
Intake rl/- Normal Saline (in ml}: 0 
Intake rl/- LR (in ml}: 0 
Intake NG(in ml): 0 
OJtput Urine (in ml): 200 
Labs - Urine Ketones: See labs 
Initials: LM 
Patient Identification: 
Patient Identification 
Patient prope~yidentified by2 sources induding: /0 Badge, Picture 
Chaperone Present? Yes GEO OFFICER on duty 
\M1at language do )OU speak? &Jglish, Russian 
Interpretation pro\aded? Provider fluent in patient's native language 
Pain Assessment 
Pain 
Ne )OU currently in pain? Yes 
The pain is located : legs and back 
The se1erityof pain is rated at 5110 
The se1erityof the pain is mild to moderate 
The pain began 2-3v.eeksago 
The character of the pain is aching 
The associated symptoms are v.eakness 
The pain is aggravated by other 
Describe: not eaYng 
The pain is relie\ed by rest Pt stated that he >Iii/ not take pain meds 
Narrati1e: 
Appointment Provlde1 (b)( 6) ; ~-
Pl in M-IU Wed 2, due to hungerslrike, Upon encounter at 1507 detainee was la~ng in the bed, resting. Pt stated that he feel 
normal, admitted pain. Stated to feel week and lightheaded. Pt reported his l'Mintake and output \MIi continue to monitor. 
Encountered with pt se1eral times during the shift, and encouraged pt to drink and eat Pt refused to eat dinner. As dinner it is 
Mssed meal #74. IMII continue to monitor. 
Encountered with pt about 1830 pt stated that he didn't drink an)lhing since 1500, and just one time he urinated. Pt stated that 
he feel ok, stated that he feel to rest during this afternoon. \MIi continue to monitor. 
Patient is considered to be on official hunger slrike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/220)18 
When did the official hunger slrike begin? 08125l2018 
Date of last meal consumed: 08/220)18 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wcints to be released from custody 
/ldequate supply of drinking water and other be1erages available: Yes 
Three meals deli1ered per day to patient Yes 
Lunch deli1ered during current shift 0% consumed 
Dinner deli1ered during current shift 0% consumed 
/lnyunauthori>edfood inroom? No 
Ha\e dailyo~tatic \atal signs been completed? Yes 
Has input and output been documented on the the M-IU Hunger Strike Mlnitoring Smart Form? Yes 
Vit al Signs 
97.?F 
52 /min 
83/50 mm Hg 
16/ min 
66.5in 
Examination 
General Examination: 
Temp 
09/15/201804:01:35 PM 
HR 
09/15/201804:01:35 PM 
BP 
09/15/201804:01:35 PM 
RR 
09/15/201804:01:35 PM 
H 
09/15/201804:01:35 PM 
GENER/II.. JIPPE.ARANCE: in no acute distress, well del.eloped, well nourished. 
HE.AD: normocephalic. 
SKIN: noonal, no rashes, no suspicious lesions. 
HEAAT: no murmurs, regular rate and rhythm, S 1, S2 noonal. 
LUNGS: noonal, clear to auscultation bilaterally, no wheezes, rales, rhonchi. 
CHEST: noonal, no gross rib deformity, noonal shape and expansion. 
"8D0M:N : noonal, bowel sounds present, soft, nontencler, nondistencled. 
MJSCULOSKELET/11.. : noonal, noonal gait, no deformities, full range cl motion, . 
(b)(6); 
(b)(?)(C) 
NEURCX..OOC: alert and oriented, cooperati,e Vl>ith exam, , gait normal, neck supple, no rigidity, no tremor. 
PSYCH: alert, oriented, cogniji,e function intact, cooperatiw Vl>ith exam, good eye contact, mood/affect full range, 
mood/affect full range, speech clear, thought process logical, goal directed. 
2019-ICLl-0005 1 3247 
N 
--N 
-
-
N 
--
N 
--N 
-

DHS-ICE-19-0196, 19-0197-N-000429
Assessments 
1>1-Risk for imbalanced nutrition: Less than body requirements. 
Tr ea tm ent 
1. Others 
Notes: 1. Continue with \Atal Signs ewrys hift; Intake and OJtput Mm itoring ewrysh ift; Oailyweights ; Oailyortho static ;ital signs. 
2. M adequate supp ly of drinking water and other bewrages are available to patient at all times. 3. Three mea ls per day are 
de liw red to the patient and de liw ryof mea ls is documented. 4. ~I food not authori,ed by CO/Physician is remowd from patient's 
room. 5. Patient is not allowed to purchase food from commissar)l'l.<!nding machine whi le on hunger strike. 6. Patient wi ll only be 
released from hunge r strike treatment/monitoring by CO or physician order. 7. Patient counseled regarding the med ical risks of 
continu ing the hunge r strike. 8. Encouraged to terminate the hunger strike and eat/drink as normal. Pro;ide care per pro;ider 
orde r and nurse care plan. Pt was educated to drink at leas t 2 L of water, stayactiw , do exercise as tolerated , pt was instructed to 
inform imm ediately if there any changes in menta l, health, or dental status. Receil.<!d wrbali,ation of understanding to all 
educations and instructions. 
Electronically signed ~ b )(6); __ 
Sign off status: Completed 
~ on 09/151201818:32:53 (Pacific Daytight Time) 
Northwest Detention Center 
1623 E J SIBE£r 
TACOMA, WA98421 
Telj(b)(6); (b)(7)(C) ! 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progre .. Noe.j(b)(6); __ ~ 09/15/2018 
/lkte generated by eC/inica/Worl<s a.R/PM &ltv.ere (w.w,eC/inicl!iWorks.~ 
2019-ICLl-00051 3248 

DHS-ICE-19-0196, 19-0197-N-000430
U.S. Immi gration 
and Customs 
Enfor cement 
AMAR,MERGENSANA . . A: 216269802 Su:lloj(b )(~; J 
Facility Code: CSCN/1/WA Housing ea: 
39 Y old Male, DOB: 10/23/1978 
AccOl.rll lunber ~ 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Cert er 
09 11512018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy , Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Thiamine HCI 100 M3 Tablet 1 tablet BID, stop date 09/18/2018, 
KOP: Yes, Drug Source: In House Pharmacy , Notes: Not required 
for trawl 
• Boost Plus - Liquid 1 BID PRN, stop date 09/18/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl, 
please giw this with the thiamine 
Alle'9leS 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness admits. 
Sleep Disturbance denies. \Neight loss admits. Dry 
M,uth denies. \Neakness admits, . Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. Abdominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. 1,1:>mitting denies. Painful 
urination denies. Decreased urine output denies. MJsde 
aches denies. MJsde cramps denies. Skin breakdown denies. 
Difficulty thinking denies. 
Appointment Provlde'1"-(b_,_),_(6.) .... ; __ _.! RN 
Reason for Appointment 
1. RN day round/hunger strike 
History of Present Illness 
Flowsheets (M-tU): 
lnput/OJtput Flowsheet 
Ti me: 0700-1500 
INPUTPO: 1200 
INPUTSUBTOT/11..: 1200 
OUTiPUT Urine 1000 
OUTiPUTBM 0 
Net Gain: 200 
Initials: LM 
Hungerstrike Mln itoring Form 
Day. 09/15/2018 
Shift: AM 
Intake PO(in ml}: 1200 
Intake r.J- Normal Saline (in ml}: 0 
Intake r.J- LR (in ml}: 0 
Intake NG(in ml): 0 
OJtput Urine (in ml): 1000 
Labs - Urine Ketones: See labs 
Initials: LM 
Patient Identification: 
Patient Identification 
Patient prope~yidentified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEO OFFICER on duty 
\Mat language do )OU speak? English, Russian 
Interpretation pro\aded? Provider fluent in pa vent's native language 
Pain 1'6sessment 
Pain 
Ne )OU currently in pain? Yes 
The pain is located : legs and back 
The se1erityof pain is rated at 5110 
The se1erityof the pain is mild to moderate 
The pain began 2-3v.eeksago 
The charader of the pain is aching 
The associated symptoms are v.eakness 
The pain is aggravated by other 
Describe: not eavng 
The pain is relieled by rest 
Narratiw: 
pt in M-IU fv'ed 2, due to hungerslrike, Upon encounter at 0845 detainee was sitting and talking on phone, he stop to talk on 
phone and talk to this nurse. pt stated that he feel normal, admited pain. Stated to feel week and lightheaded. Detainee agreed to 
take medication, but refused medication for pain. O:,ser1ed pt to drink 1o0ter fom water fontain, and ambulated around the room, 
pt took a shower at 10:30.1'6ked for lVwh ich was gi1.en to him. No other concerns '°iced at this time. WII continue to monitor. 
Encountered with pt sewra l times during the shift, and encouraged pt to drink and eat pt refused to eat lunch. l'6 lunch will 
be Mssed meal #73. W II continue to monitor. 
Patient is considered to be on official hunger slrike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
Wien did the official hunger slrike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wclnls to be released from custody 
/ldequate supply of drinking water and other be1.erages a1o0i lable: Yes 
Three meals deli1ered per day to patient Yes 
Lunch deliwred during current shift 0% consumed 
/lnyunauthori>edfood inroom? No 
Hale dailyo~static \atal signs been completed? Yes 
Has input and output been documented on the the M-IU Hunger Strike Mln itoring Smart Form? Yes 
Vit al Signs 
97.8F 
68/min 
110/73mm Hg 
16 /min 
66.5in 
Ex amina tion 
General Examination: 
Temp 
09/15/2018 10:38:06 /'M 
HR 
09/15/2018 10:38:06 /'M 
BP 
09/15/2018 10:38:06 /'M 
RR 
09/15/2018 10:38:06 /'M 
H 
09/15/2018 10:38:06 /'M 
GENER/II.. Jlf'PEPRANCE: in oo acute distress, well del.eloped, well nourished. 
HEAD: norrnocephalic. 
SKIN: normal, oo rashes, oo suspicious lesions. 
HE.ART: oo murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, oo wieezes, rales, rhonchi. 
CHEST: normal, oo gross rib deformity, normal shape and expansion. 
J>BDO\,EN: normal, bowel sounds present, soft, nontender, nondistended. 
MJSCULOSKELET/11.. : normal, normal gait, 00 deformities, full range cl motion, . 
(b)(6); 
(b)(7)(C) 
NEUROLOGIC: alert and oriented, cooperati,e wth exam, . gait normal, neck supple, oo rigidity, oo tremor. 
PSYCH: alert, oriented, cogniji,e function intact, cooperati,e w th exam, good eye contact, mood/affect full range, 
mood/affect full range, speech clear, thought process logical, goal directed. 
Assessments 
2019-ICLl-0005 1 3249 
N 
--
N 
-
>-
N 
>-
-
N 
--
N 
>-

DHS-ICE-19-0196, 19-0197-N-000431
/'I-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: 1. Continue with \Atal Signs e-.eryshift; Intake and OJtput Monitoring e-.eryshift; Dailyweights; Dailyorthostatic lital signs. 
2. />n adequate supply of drinking water and other be-.erages are available to patient at all times. 3. Three meals per day are 
deli\e red to the patient and deli-.eryof meals is documented. 4. ~ I food not authori2ed byCDn>hy.;ician is remo-.ed from patient's 
room. 5. Patient is not allowed to purchase food from oommissaf)'\ending machine while on hunger strike. 6. Patient will onlybe 
released from hunger strike treatment/monitoring by CD or phy.;ician order. 7. Patient oounseled regarding the medical risks of 
oontinuing the hunger strike. 8. Enoouraged to terminate the hunger strike and eat/drink as normal. Prolide care per prolider 
order and nurse care plan. Pt was educated to drink at least 2 L of water, stayacti-.e, do e,ercise as tolerated, pt was instructed to 
inform immediately if there any changes in mental, health, or dental status. Recei-.ed -.erbalization of understanding to all 
educations and instructions. 
Appointment Provlde1(b)(6); ~-
Electronically signed b~._b_)(_6_); _ ___.fN on 09/15/201815:26:52 (Pacific Daylight Time) 
Sign off status: Completed 
Northwest Detention Center 
1623 E. J STRBa￾T WA98421 
Tel /h\/R\· 
x: 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 Progr9aa Notef~(b~ )~(6~);~-~!RN 09/15/2018 
Ncie generaled byeOirica/Wcrlcs EM<IPM /:icftvqe {WNNe0inica/Works.<X;XJ1 
2019-ICLl-0005 1 3250 

DHS-ICE-19-0196, 19-0197-N-000432
U.S. Immi gration 
and Customs 
Enfor cement 
AMAR, MERGEN _~ 
Facility~ ~~~~ 
39 Y old Male, DOB: 10/23/1978 
1623 E J 
Acc
STREET, 
Ol.l"II llunber: 
T~ 
~ 
Appoirimert Facility. Northw est Detertion Certe r 
09 /15/2018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Thiamine HCI 100 M3 Tablet 1 tablet BID, stop date 09/18/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl 
• Boost Plus - Liquid 1 BID PRN, stop date 09/18/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl, 
please giw this with the thiamine 
• fl/edication List re\iewed and reconciled with the patient 
Past Medlcal History 
No fl/edical History. 
........ s 
N.KDA 
Review of Systems 
General/Constitutional: 
Chills denies. Fatigue admits. Fewrdenies. 
Headache denies. Lightheadedness denies. Night 
sweats denies. ll\leight loss admits, is intentional. 
Aflpolntment Provlder:i (b)(6) ; (b)(?)(C) IPA 
Rea son for Aflpolntment 
1.tvHU 
History of Present Illness 
Narratiw: 
0645 hcurs: 39 yo male detainee in the M-iU for Hunger Strike medical mcnitoring. He missed 72 meals, he states he is 
drinking, and able to ambulate and get around, he is able to pro\ide urination. No new oomplaints or worsening S)ITiptoms since 
last medical \is it Communicated adequately. 
Patient Identification: 
Patient Identification 
Patient property identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? Russian 
Interpretation pro\ided? Yes, Interpreter Number 
Number Use notes ffeld 11358063 
Language Russian 
Pain />ssessment 
Pain 
/>,e }OU currently in pain? No 
Yitai Signs 
97.SF 
63/min 
100/64mm Hg 
16 /min 
146.4 lbs 
66.5in 
2327 Index 
Ex amination 
General Examination: 
Temo 
09/15/2018 07:01 :03 PM 
1-R 
09/15/2018 07:01:03 PM 
BP 
09/15/2018 07:01:03 PM 
RR 
09/15/2018 07:01:03 PM 
wt 
09/15/2018 07:01:03 PM 
H 
09/15/2018 07:01:03 PM 
BMI 
09/15/2018 07:01:03 PM 
GENER/IL /IPPEl'Ri'NCE: in no acute distress, well de1€1oped, well nourished. 
HEl>D: nonnocephalic. 
(b)(6); (b)(?)(C) 
ENT: EYES: normal, EARS: normal, NOSE: normal, SINUSES: sinuses non-tender to palpation, ORAL CAVITY: 
normal, 1HROAT: normal. 
HEl'RT: no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, nowieezes, rales, rhonchi. 
/IBDO!I/EN: soft, nontender, nondistended. 
MJSCULOSKELET/IL: normal, normal gait, no deformities, full range cl motion, good strength and equal bilaterally. 
PSYCH: alerl, oriented. 
Assessment s 
1. Stanetion, subsequent encounter - T73.0X><D 
Treatment 
1. Starvation, subseque nt encOl.l"ller 
Notes: Patient educated the current treatment plan as directed, alert staff if new or worsening s)ITiptoms as needed, PRN. 
Patient to receiw daily pro\ider checks while in the M-iU. 
Notes: Patient to remain in the M-iU until further notice 
Appointment Provide (b)(6); (b)(7)(C) PA 
(b)(6); (b)(?)(C) 
Electronicall y signed b~"(b....; ).;.. (6...;. );.. __ __,IA on 09/1512018 08:09:07 (Pacific Daylight Time) 
Sign off status: Completed 
2019-ICLl-0005 1 3251 
NorthlYest Detention Center 
1623 E J STREET 
TACOMA, WA98421 

DHS-ICE-19-0196, 19-0197-N-000433
Pali-t: AMAR, IERGENSANA DOIi= 10/23/1978 P ....... (b)(6); (b)(7)(C) A 09/15/2018 
Ncl.e general.ed by e0inica/'Na1<s BvR'PM Sottv.ere (,w,w·et:mrm:rm::n""1:!7fTV""-----' 
2019-ICLl-00051 3252 

DHS-ICE-19-0196, 19-0197-N-000434
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3253 
AMAR,MERGENSANA . . A: 216269802 Su:ll,.J,6 )(6); I 
Fac1lrtyCode:CSOINWA ng,c;ea .lfi 
39 Y old Male, DOB: 10/23/1978 
1623 E ~~::=l~~~)_(~L .c, I 

DHS-ICE-19-0196, 19-0197-N-000435
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3254 
AMAR,MERGENSANA 
A:216269802 Su:l1D: !(b)(6): ! 
Facility Code: CSONVWA Housing Area : M 
39 Y old Male, DOB: 10/23/1978 
AccOllll lunbe llh \/R\· I 
1623 E J STREET, TACOMA, WA98421 

DHS-ICE-19-0196, 19-0197-N-000436
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:llQ/b l/6) ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
Acc01.111 tunberf b)(6)· 
09 11512018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Thiamine HCI 100 M3 Tablet 1 tablet BID, stop date 09/18/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl 
• Boost Plus - Liquid 1 BID PRN, stop date 09/18/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl, 
please giw this with the thiamine 
All '9laS 
N.KDA 
vlaw of Systems 
Hunger Strike: 
Fatigue admits Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. \Neight loss denies. Dry M>uth denies. 
\Neakness that is moderate, admits, that is generalized. 
Cough denies. Shortness of breath at rest denies. Chest pain at 
rest denies. Palpitations denies . .Abdominal Pain denies. 
Constipation denies. Diarrhea denies. Nausea denies. 
\.t>mitling denies. Painful urination denies. Decreased urine 
output denies. M.Jsde adnes denies. M.Jsde cramps denies. Skin 
breakdown denies. Difficultythinking denies. 
1623 E J STREET, TACOr,C ,.-.,--'--~ Appoimnert Facility: Northwest Detertion Certer 
Appointment Provlde1 (b)(6) ; (b)(7)(C) 
Reason for Appointment 
1. tvHU Nocturnal Nursing Assessment 
History of Present Illness 
Flowsheets (tvHU): 
Hungerstrike M>nitoring Form 
Day. 09/15/2018 
Shift: Night 
Intake PO (in ml}: 1000 pedialyte 
OJtput Urine (in ml): detainee did not measure in urinal 
Initials: KRF 
Patient Identification: 
Patient Identification 
Patient property identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEO officer /<J:Jfoed 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number 
Number : 11357727 
Language Russian 
Pain Assessment 
Pain 
/>,e }OU currently in pain? No 
Narratiw: 
Patient is oonsidered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Detainee stated that he plans to oontinue his hunger strike and states that he has no plan to start eating again. He stated that 
he is on a hunger strike because ''this is my protest" He states that he is drinking fluids and stated that he will pro~de a urine 
sample later in the morning. He stated that nursing staff is allowed to take his orthostatic ~tal signs, weight and do a nursing 
assessment He also stated that he is fine with nursing staff taking a urine sample later today. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
\Mien did the official hunger strike begin? 08125l2018 
Date of last meal oonsumed: 08/22/2018 
Last meal oonsumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wcints to be released from custody 
/ldequate supply of drinking water and other be1.erages available: Yes 
Three meals deliwred per day to patient Yes 
Breakfast deli1.ered during current shift 0% consumed 
/lnyunauthori>edfood inroom? No 
Haw dailyorthostatic ~tal signs been oompleted? Yes 
Has input and output been documented on the the M-IU Hunger Strike M:>nitoring Smart Form? Yes 
Vit al Signs 
97.5F 
standing:72 
sitling:63 
supine:53 
standing:93/61 
sitling:100/64 
supine:96/60 
16 /min 
146.4 lbs 
66.5in 
2327 Index 
97% 
RA 
Ex amlinatlon 
General Examination: 
Temp 
09/15/2018 01 :55:04 />M 
HR 
09/15/2018 01 :55:04 />M 
09/15/2018 01 :55:04 />M 
09/15/2018 01 :55:04 />M 
BP 
09/15/2018 01 :55:04 />M 
09/15/2018 01 :55:04 />M 
09/15/2018 01 :55:04 />M 
RR 
09/15/2018 01 :55:04 />M 
wt 
09/15/2018 01 :55:04 />M 
H 
09/15/2018 01 :55:04 />M 
BMI 
09/15/2018 01 :55:04 />M 
°"-'non sat ¾ 
09/15/2018 01 :55:04 />M 
RA/ #Uters 02 Ilia: 
09/15/2018 01 :55:04 />M 
GENER/ll /IPPE.ARPNCE: in no acute distress , well del.e!oped, well rKJUrished. 
OR/ll CA\ATY: normal, mucosa moist. 
SKIN: normal, no rashes, no suspicious lesions. 
HE/IRT: no murmurs, regular rate and rhythm, S 1, S2 normal. 
2019-ICLl-0005 1 3255 
(b)(6); 
(b)(7)(C) 

DHS-ICE-19-0196, 19-0197-N-000437
LUNGS: normal, clear to auscultation bilaterally, no wieezes, rales, rhonchi. 
PBDOVEN: normal, bc1.Yel sounds present, soft, nontender, nondistended. 
MJSCULOSKELET./ll: normal, normal gait, no defom1ilies, full range ri motion, good strength and equal bilaterally. 
NEUROLOGIC: alert and oriented, cooperali-.e with exam, motor strength normal upper and lc,,,,,er extremities, normal 
exam, normal strength, tone and reflexes, sensory exam intact. 
PSYCH: alert, oriented. 
Detainee was sleeping comfor1ablyin his bed prior to nursing staff entering room with GEO officer chapperone. Detainee 
allowed staff to take \Otal signs, do nursing assessment and measure weight He easilywoke up on staff entering room. \i\ihen 
staff left room, detainee continued to sleep comfor1ablyin his b~ ,chest rising and falling e1.enlyand unlabored at 16 
breaths per minute. Detainee refused breakfast per GEO offi~etainee ate 0% of breakfast 
Assessments 
!(-Risk for imbalanced nutrition: Less than body requirements. 
Tr ea tm ent 
1. Others 
Notes: 1. Continue with \Atal Signs e1.eryshift; Intake and Output Mmitoring e1.eryshift; Dailyweights; Dailyorthostatic \ital signs. 
2. /ln adequate supply of drinking water and other be1.erages are available to patient at all times. 
3. Three meals per day are deli1.ered to the patient and deli1.eryof meals is documented. 
4. ~ I food notauthoriied byCD/Ph)Bician is remo1.ed from patienfs room. 
5. Patient is not allowed to purchase food from commissar)l\ending machine while on hunger strike. 
6. Patient will only be released from hunger strike treatment/monitoring by CD or ph)Bician order. 
7. Patient counseled regarding the medical risks of continuing the hunger strike. 
8. Enoouraged to terminate the hun er strike and eat/drink as normal. 
Consulted with pr01Ader (b )/6\: ,A.regarding orthostatic \ital signs. Per on-site 1.erbal order r, (b )(6) ; ~A "Continue to 
enoourage detainee to ea an drink fluids." Order read back and 1.erified. 
Pro ce dure Code s 
T1013 Sign Lang/0-al Interpreter 
Notes: Continue monitoring per orders in M-iU. 
Appointment Provider :l(b)(6) ; (b)(7)(C) 
Bectronically signed b* b)(6) ; (b)( 7)(C) 
Sign off status: Completed 
IRN on 09/1512018 06:27:00 (Pacific Daylight lime) 
Northwest Detention Center 
1623E JSmEEr 
TACOMA, WA98421 
lel/b\/6) I FaX. 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Prog,. .. Note:l (b)(6) ; (b)(7)(C) IRN 09/15/2018 
Ncte generated by eOinica!Wcxi<s EJvR'PM ~e /"""'eC/inica/Wc.-ks.com) 
2019-ICLl-00051 3256 

DHS-ICE-19-0196, 19-0197-N-000438
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A:216269802 Su:i1ol (b)(6): ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, ~,fij%'.)3119za AccOl.lll llunbe h · I 
09 11412018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Thiamine HCI 100 M3 Tablet 1 tablet BID, stop date 09/18/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl 
• Boost Plus - Liquid 1 BID PRN, stop date 09/18/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl, 
please giw this with the thiamine 
Alla ..... 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. \Neight loss admits. Dry 
M)uth denies. \Neakness admits. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. Abdominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. 1,1:>mitting denies. Painful 
urination denies. Decreased urine output denies. MJsde 
aches denies. MJsde cramps denies. Skin breakdown denies. 
Difficulty thinking denies. 
1623 E J STREET, TACOMA, WA-98421 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Provld e 1 (b)( 6 ); (b)(7)(C) 
Reason for Appointment 
1. PM SHIFT NOlE. Hunger Strike Nursing E1,0luation 
History of Present Illness 
Flowsheets (MHU): 
Upon encounter detainee was resting quietlyin bed. Detainee reported weakness but refused any medical treatment 
Detainee water pitcher has been filled for him and he has been drinking Pedial)le and Boost Detainee has gone back to resting 
quietly in his room. W II continue to monitor. 
Hungerstrike fl.bnitoring Form 
Day. 09/14/2018 
Shift: PM 
Intake PO(in ml}: 0 
Intake rl/- Normal Saline (in ml}: 0 
Intake rl/- LR (in ml}: 0 
Intake NG(in ml): 0 
QJtput Urine (in ml): 0 
Comments: WATER PITCHER WAS FILLED FCR HI MAND HE HAS BEEN DRINKING PED/AL YTE 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEOCEFICER 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number Llc»J BRIDGE-# 2963 
Number Use notes ffeld 
Language Russian 
Pain f<;sessment 
Pain 
l'<e }OU currently in pain? No 
Narratiw : 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
IM1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wclnts to be released from custody 
/ldequate supply of drinking water and other be-erages available: Yes 
Three meals deliwred per day to patient Yes 
/lnyunauthori>edfoodinroom? No 
Haw dailyorthostatic \ital signs been completed? Yes 
Has input and output been documented on the the M-IU Hunger Strike M)nitoring Smart Form? Yes 
Vit al Signs 
96.2 F 
standing:88 
sitting:74 
supine:48 
sta ndi ng:99157 
sitting:82/52 
supine:96/64 
16/ min 
143.2 lbs 
66.5in 
22.76 Index 
Examination 
General Examination: 
Temp 
09/14/2018 06:38:57 PM 
HR 
09/14/201806:38:57 PM 
09/14/2018 06:38:57 PM 
09/14/2018 06:38:57 PM 
BP 
09/14/2018 06:38:57 PM 
09/14/2018 06:38:57 PM 
09/14/201806:38:57 PM 
RR 
09/14/201806:25:03 PM 
wt 
09/14/201806:38:57 PM 
H 
09/14/201806:25:03 PM 
BMI 
09/14/201806:38:57 PM 
GENERJ>l PPPEAAPNCE: in no acute distress, well del.eloped, well noorished. 
PSYCH: alert, oriented. 
Assessments 
/>I-Risk for imbalanced nutrition: Less than body requirements. 
Tr ea tment 
1. Others 
b)(6); (b)(7)(C) 
Notes: 1. Continue 1Mth \Atal Signs e-eryshift; Intake and QJtput lvbnitoring e-eryshift; Dailyweights; Dailyorthostatic \ital signs. 
2. /In adequate supply of drinking water and other be-erages are a1,0ilable to patient at all times. 
3. Three meals per day are deli sered to the patient and deli-eryof meals is documented. 
4. /11 food not authori>ed by CD/Phy.,ician is remo-ed from patienrs room. 
5. Patient is not allowed to purchase food from commissar)l'l.ending machine while on hunger strike. 
2019-ICLl-0005 1 3257 
I 

DHS-ICE-19-0196, 19-0197-N-000439
6. Patient iMII only be released from hunger strike treatment/monitoring by CD or physician order. 
7. Patient counseled regarding the medical risks of continuing the hunger strike. 
8. Encouraged to terminate the hunger strike and eat/drink as normal. 
Appointment Provide'fb)(6); (b)(?)(C) 
Electronically signed b~(b)(6): (b)(?)(C) 
Sign off status: Completed 
~ on 09/14.12018 18:39:41 (Pacific Daylight Time) 
Northwest Detention Center 
1623 E J smEEr 
TACOMA, WA98421 
Tej(b)(6); 
,ax. 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 P.....,.. ...., (b)(6); (b)(?)(C) lltN N(te generaled byeOinica!Wcn<s EJvR'FM &ill<arJ,., ..------...,...---'· 
2019-ICLl-00051 3258 
09/14/2018 

DHS-ICE-19-0196, 19-0197-N-000440
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: A11AR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3259 
AMAR,MERGENSANA A: 216269802 Su:llOl/h \In \ ! 
Facility Code: CSONVWA Housing Area : M 39 Y old Male, DOB: 10/23/1978 
AccOl.l"II llunber : lltii/6i:7 1623 EJ STREET, T~ 

DHS-ICE-19-0196, 19-0197-N-000441
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA . . A: 216269802 Su:ll~ )(6); I 
Fac1lrtyCode:CSOINWA ng ,c;ea.lfi 
39 Y old Male, DOB: 10/23/1978 
AccOUll l'unbe ~/h\fn\ I 
09 11412018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy , Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
Review of Systems 
Hunger Strike: 
Fatigue admits Headache denies. Sleep 
Disrurbance denies. Dry M>uth denies. 11\eakness admits, . 
Cough denies. Shortness of breath at rest denies. i>lldominal 
Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \obmitting denies. Painful urination denies. 
Decreased urine output admits Mlsde aches admits 
extremities and back. Mlsde cramps admits Skin 
breakdown denies. Difficultythinking denies. 
Cardi0\0Scular. 
Chest pain at rest admits, occurred frequently. 
C)anosis denies. Difficulty laying flat denies. Fluid accumulation in 
the legs denies. Irregular heartbeat denies. Palpitations denies. 
11\eakness admits 
feels heart is pounding. 
1623 E J STREET, TACOMA, WA-98421 
Appoirimert Facility. Northwest Detertion Certer 
Aflpolntment Provld~ (b)(6) ; (b)(7)(C) 
Reason for Aflpolntment 
1. Daily Rounds 
History of Present Illness 
Flowsheets (M-tU): 
Pt did drink one boost and has taken his thiamine but his morning boost he poured down the sink. He states his chest pain 
is improled. He is also drinking the pedial)le, and has been seen drinking water but will not admit it He continues to sayhe is 
wry weak. He does not want to talk through the interpreter. 
Hungerstrike M:mitoring Form 
Day. 09/14/2018 
Shift: AM 
Intake PO(in ml}: 2000 2 literof e/ectro/yte solution for day shifl 
Intake rl/- Normal Saline (in ml}: 0 
OJtput Urine (in ml): 0 pt seen voiding, and UA obtained 
OJtput Bowel M>wments (in ml): 0 
Labs - Urine Ke tones: Pos 
Labs - Sodium: 
Initials: SM 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number 
Number : Uonbridge 11356597 
Language Russian 
Pain Assessment 
Pain 
Ne }OU currently in pain? Yes 
The pain is located : 
The sew rityof pain is rated at 4110 
The sew rityof the pain is mild lo moderate 
The pain began 3-4 days ago 
The character of the pain is aching 
The associated symptoms are v,eakness 
The pain is aggravated by physical activity 
The pain is relieled by none 
Narratiw: 
Hunger Strike: 
~ ical Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
\M1en did the official hunger strike begin? 08/25'20 18 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking fluids: Yes 
# of days on hunger strike: 18 
Total Wl ight loss in pounds: 20 
Reason for hunger strike: Wcints to be released from custody 
Housing/Isolation Location: M,dical Housing Unit 
Reason for Isolation Placement For dose supervision, observaflon, and monitoling 
Re"ew of the Housing Placement Review housing e,-e,y 24 hours 
Vit al Signs 
Temo 
96.2 F 09/16/201810:19:53 PM 
HR 
77 /min 09/16/201810:19:53 PM 
BP 
82/52 mm Hg 09/16/201810:19:53 PM 
RR 
16/ min 09/16/201810:19:53 PM 
Wt 
143 lbs 09/16/201810:19:53 PM 
Pa st Orders 
Lab:Urinal),SiS Dipstick /Oder Date - 0911412018) /Collection Date - 09/1412018) 
Leukocytes NEG 
Nitrate NEG 
Urobilimgen 0.2 
Protein NEG 
pH 6.0 
Blood NEG 
Specific Gravity 1.005 
Ketones NEG 
Billin.ibin NEG 
Glucose NEG 
Color YELLOW 
Chrify CLEAR 
(b)(6); (b)(7)(C) 
Lab:Comprehensiw Metabolic Panel (14) CIYP -322000 /Oder Date - 09/12/2018) /Collection Date - 09112/2018) 
Result: J>bnorrnal 
2019-ICLl-0005 1 3260 

DHS-ICE-19-0196, 19-0197-N-000442
eGFR If AJiicn Am 
eGFR lfNonAJiicn Am 
NGRafo 
ALT(SGPT) 
AST(SC.01) 
Bilirubin, Total 
Globulin, Total 
Albtrnin 
Protein, Total 
Calcium 
Chloride, Senm 
Potassium 
Sodium 
BUN/Creatinine Ratio 
Crcatinirc 
BUN 
Glucose 
Camon Dioxide, Total 
Alkalirn Phosphatase 
Ex amina tion 
General El<lmination: 
110 
96 
1.7 
13 
16 
0.3 
2.1 
3.5 
5.6 
8.7 
105 
3.9 
145 
4 
0.99 
4 
I03 
JI 
41 
>59 - 1111/mirvl. 73 
>59 - ml.Jrnirvl.73 
1.2-2.2 -
0-44- TU/L 
0-40- fU/L 
0.0-1.2 - J1lidL 
1.5-4.5 - gldL 
3.5-5.5 - gldL 
L 6.0-8.5 - gldL 
8.7-10.2 - tllifdL 
96-106 - 1111110VL 
3.5-5.2 - 1111110 VL 
H 134-144 - IIIIDIIL 
L 9-20 -
0. 76-1.27 - 11lifdL 
L 6-20 - mgldL 
H 65-99 - mgldL 
H 20-29 - n•ml/L 
39-117 - TU/L 
GENERJ>l l>Pf'El>Rl>NCE: pt alert and oriented , sullen, looks slightly distressed. 
ORl'l CAl,f!Y: mucosa moist. no lesions. 
SKIN: good turgor, normal. 
HE.ART: no munnurs, regular rate and rhythm, S 1, S2 nonnal. 
LUNGS: good air mmement, . 
EXTREMTIES: full range of motion, no edema, good capillary refill in nail beds, no clubbing, cyanosis, or edema 
PSYCH: alert, oriented, cognili-e function intact, poor eye contact, speech diminished output, ldume, . 
Assess ment s 
1. Starvation, subsequent encounter• T73.0)()(I) (Primary) 
2. Imbalanced nutrition: Less than body requirements [00002]- ND00002 
3. Risk for Deficient Fluid \b lume [00028]- ND00028 
.Al-Risk for imbalanced nutrition: Less than body requirements 
Self-imposed Hunger strike. 
Treatment 
1. Starvation, subsequent encourt er 
Notes: Pt will oontinue to hale ,itals taken. Hhe refuses to talk or gets weak we will need to ha1e another mental health 
assessment and oonsider forced feeding. 
Procedure Codas 
T1013 Sign Lang/0-al Interpreter 
Fo llow Up 
daily 
Notes: Education prolided on ~dication and Treatment Patient ad\Ased to call for the nurse if s)fllptoms worsen prior to nel4 
appointment Patient 1erbalized understanding of all instructions 
Appo intment Provider:l(b)(6) ; (b)(7 )(C) IMO ~ 
(b)(6); (b)(7)(C) 
Bectronically signed b b}(6 }; (b)(7)(C) Don 09/16/2018 22:21:06 (Pacific Daylight Time) 
Sign off status: Comple,t.-,,------' 
Northwest Detention Center 
1623 E J STREEr T®~t°oen) x: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progre.., No1a¥b)(6) ; (b)(7)(C) !•o 09/1412018 
/lkxe generated by e0irica/Wc,1<s e.R/PM Sotrv.ere (WM'leOinica/Wcrks.com/ 
2019-ICLl-00051 3261 

DHS-ICE-19-0196, 19-0197-N-000443
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:,10: !/b)/6): ! 
Facility Code: CSONVWA Housing Area: M 
39 Y ad ~=1~:~ AccOUll ~y,e§}(5C ! 
09 11412018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy , Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Thiamine HCI 100 M3 Tablet 1 tablet BID, stop date 09/18/2018, 
KOP: Yes, Drug Source: In House Pharmacy , Notes: Not required 
for trawl 
• Boost Plus - Liquid 1 BID PRN, stop date 09/18/2018, KOP: No, 
Drug Source: In House Pharmacy , Notes: Not required for trawl, 
please giw this with the thiamine 
Alla'9leS 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. \Neight loss denies. Dry M>uth denies. 
\Neakness admits. Cough denies. Shortness of breath at 
rest denies. Chest pain at rest denies. Palpitations denies. 
J>bdominal Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \Qmitting denies. Painful urination denies. 
Decreased urine output denies. M.Jsde aches denies. M.Jsde 
cramps denies. Skin breakdown denies. Difficultythinking denies. 
1623 E J STREET, T v 
Appoimnert Facility: Northwest Detertion Cert er 
Reason for Aflpolntment 
1. tvHU/'MNSGRDS 
History of Present Illness 
Patient Identification: 
Patient Identification 
Aflpolntment Provldef b)(6 ); (b)(7)(C) I RN 
Patient properly identified by2 sources in Badge, Picture 
Chaperone Present? Yes GEOCEF/C 
Wiatlanguage do }OU speak? Russian h\17\tr 
Interpretation pro\aded? Yes, Interpreter Number 11356597 
Number Use notes ffeld 
Language Russian 
Pain .1>6sessment 
Pain 
/>,e }OU currently in pain? No 
Flowsheets (tvHU): 
lnput/OJtput Flowsheet 
Time: 0700 (SHIFT9/14l20180700- 9/14/20181500) 
INPUT PO: 2000 DETA/Nff CESER\IED TOBE DRINKING WA'IER FRCMTHE CELL FOJNTAJNAND VOD/NGX 3. 
DETAINEE REPORTS HE HAS NOT BEEN DRINKING ANY FLUIDS BESIDES HIS PED/AL Y'IE. DETA!Nff DRANK 1L 
PED/AL Y'IEAT0SOO, 1L PED/AL Y'IEFRCM1200. DETA!NffALSOCESER\IED TOBETHROMNGH/SAMORDERED 
BOOST OVER THE SINK 
INPUT SUBTOT/11.. : 2000 
OUTPUT Urine 0DETA/NffCESER\IED TOBEVOD/NGX3DURINGSH/FT. 
OUTPUT SUBTOT/11.. : 0 
Initials: RK 
Hungerstrike M:mitoring Form 
Day: 09/14/2018 
Shi~ AM(SHIFT9114/20180700-9/14120181500) 
Intake PO(in ml}: 2000DETA1Nff CESERVED TOBE DRINKING WA'IERFRCMTHECELL FOJNTAJNAND VODINGX 
3. DETAINEE REPORTS HE HAS NOT BEEN DRINKING ANY FLUIDS BESIDES HIS PED/AL Y'IE. DETA!NEE DRANK 1L 
PED/AL Y7E AT0SOO, 1L PED/AL Y'IEFRCM1200. DETA!NEE ALSOCESERVED TOBE THROMNGHISAMORDERED 
BOOST OVER THE SINK. 
OJtput Urine (in ml): 0 
Initials: RK 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
\Mien did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes ordered Pedialyte and tap v.ater 
Reason for hunger strike: Wcints to be released from custody 
/ldequate supply of drinking water and other be-erages available: Yes 
Three meals deliwred per day to patient Yes 
/lnyunauthori>edfood inroom? No 
Haw dailyorthostatic \ital signs been completed? Yes 
Has input and output been documented on the the M-IU Hunger Strike M:mitoring Smart Form? Yes 
~ : Detainee was noted awake, watching lV in his room during initial rounds. Does not appear to be in anydistress, normal rise 
and fall of chesl Detainee compliant with his prescribed Thiamine but was obserled to be throwing the Boost o-er the sink_ 
Detainee prolided urine sample as ordered, urinaly.;is dipstick results placed under lab. Sent Tcon to dinical director for e10I. 
Detainee went to an attorney Ii sit on wheelchair, escorted by GEO. Detainee was assessed how he's doing, still reporting 
generali>ed weakness, states he has not drank anywater during shill Detainee was obsen.ed by this RN and LPN assigned to 
be drinking water from his green cup and o-er the fountain. \MIi continue to monitor. 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Ex amination 
General B<amination: 
GENER/II.. /IPPE.AR.ANCE: in no acute distress, well del.e!oped, well noorished. 
PSYCH: alert, oriented. 
Assessments 
/II-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: Nursing to assess h)<lration status: skin turgor, mucous membranes, blood pressure, heart rate, intake & output. \MIi 
continue to encourage detainee to eat all meals deli-ered to him and to drink fluids. Detainee has access to drinking water 
inside of cell. Detainee educated on possible risks to health if he continues to miss meals. Detainee educated on risks of not 
drinking adequate amount of fluids. Detainee educated to drink at least 8-10 cups of liquids per day.Detainee educated on 
possible medical risks of continuing to refuse meals. Detainee instructed to inform nursing staff/officers if s,mptoms discussed 
begins, or if ha"ng continues or becomes worse. Detainee also instructed to let officer know if he wants a tray to consume. 
Detainee wrba li>ed understanding of all instructions and did not ha-e anyadditional questions. Detainee to remain in M-IU/seg 
until will only released from hunger strike treatment/monitoring byphy.;ician. Detainee -erbali>ed understanding of all 
instructions. 
Procedure Codes 
T1013 Sign Lang/0-al Interpreter 
Notes: Detainee to remain in M-IU.1--i unger Strike 
Appointment Provide1(b)(6); (b)(7)(C) FN 
2019-ICLl-0005 1 3262 

DHS-ICE-19-0196, 19-0197-N-000444
Electronically signed by!(b)(6); ~-
Sign off status: Comp leted 
I RN on 09/14./2018 14:55:54 (Pacific Daylight nme) 
Northwest Detention Center 
1623EJSffiEEI' 
l'. WA98421 
Te /h )/ R)· 
x: 
Patient: AMAR, MERGENSANA DOB: 10/2 3/1978 Progre u NotaFb)(6); (b)(7)(C) I RN 09114/2018 
Nd.e general.ed by eClinica/Wm<s 8"R'PM Sattv.ere (IW.WeCiinica/Works.com) 
2019-ICLl-00051 3263 

DHS-ICE-19-0196, 19-0197-N-000445
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Si.tllq(b )(6): ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll lunbe~ 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
09 11412018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy , Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Thiamine HCI 100 M3 Tablet 1 tablet BID, stop date 09/18/2018, 
KOP: Yes, Drug Source: In House Pharmacy , Notes: Not required 
for trawl 
• Boost Plus - Liquid 1 BID PRN, stop date 09/18/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl, 
please giw this with the thiamine 
Review of Systems 
General/Constitutional: 
Chills denies. Fewr denies. Headache denies. Night 
sweats denies. V\eight loss admits due to hunger strike .. 
Respiratory 
Cough denies. Pain with inspiration denies. Shortness of 
breath at rest denies. 
CardiQ\0SCUla~ 
Dizziness admits, with changing position, with acti1,1ty_ 
Shortness of breath denies. V\eakness admits. 
MJsculoskeletal: 
Mlsde aches admits. V\eakness admits, that is 
generalized. 
Reason for Appointment 
1. Night rounds 
History of Present Illness 
Flowsheets (M-tU): 
Hungerstrike Mln itoring Form 
Day. 09/14/2018 
Shift: Night 
Intake PO(in ml}: 8 
Appointment Provld e , (b)(6) ; (b)(7)(C) ~N 
Comments: Urine output unknow, v.ittnesed 3 #mes going to restromm during the night. 
Initials: sac Narratiw: 
Ml le patient on hunger strike was asleep when I arriled for shift. Up 2-3 times to use restroom and drink water. Patient 
reading in bed for part of the night Pedial)le giwn at 0500 as ordered. Patient has oomplaints of musde aches in legs 5/10 did 
not want anything for it Patient get diz,ywhen he gets up to mow . Refused breakfast 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? Russian, __ 
Interpretation pro1,1ded? No interpreter u#lized 
~ lain Use Notes Section speaks limited English 
Pain Assessment 
Pain 
l'<e }OU currently in pain? No 
Ex amination 
General B<amination: 
GENERl>l !>PPE.AR/lNCE: in no acute distress, well del.e!oped,. male. 
SKIN: normal, no rashes, no suspicious lesions. 
HEPRT: S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, no wieezes, rales, rhonchi. 
Assessments 
1. Imbalanced nutrition: Less than body requirements [00002] - ND00002 (Primary) 
Treatment 
1. Imbalanced nutr~ion: Less than bolt; req..iremerts (00002] 
Notes: Detainee wrba liied understanding of plan of care and denies questions/oonoems. Continue hunger strike protoool, 
enoourage po food/fluids, encourage wrbalization offeelings. Enoourage to allow staff to monitor intake and output, ,ital signs, 
wt. Instructed to seek staff with any needs. \/erbaliied understanding . . Nursing Care Plan present Refer to nursing care plan for 
on-going inter1entions. Detainee offered three meals per day and leaw in room for at least20 minutes. /ldequate supplyof 
drinking water and other bewrages as ordered bypro,ider available. Enoourage daily oral/physical h19iene care. ½ices no other 
oonoems. 
Disposition: /!dmitted to M-IU until medically evaluated 
Appointment Providef b)(6 ); (b)(7)(C ) ~ 
Electronically signed by!(b)(6); __ 
Sign off status: Completed 
fN on 09/18/20 18 06:20:23 (Pacific Daylight lime) 
Northviest Detention Center 
1623 E J STREET 
T~WA9 8421 
Te1JiVm I 
Fax: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Prog,. ss No1 b)(6); (b)(7)(C) r" 
Ncte generated byeClinica!Wcxi<s ElvRIPM &itw!,J-e (l<MMleClinica/ Works.com) 
09/14/2018 
2019-ICLl-0005 1 3264 

DHS-ICE-19-0196, 19-0197-N-000446
U.S. Immigration 
and Customs 
Enforcement 
AMAR, MERGEN~ 
A: 216269802 Si.ti1 b )(6); 
Facility Code: CSCN/1/WA Housing ea: 
Acc01.111 ~ber(bR6); 39 Y ad~~ E:: 
09 /13 12018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
• Thiamine HCI 100 M3 Tablet 1 tablet BID, stop date 09/18/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl 
• Boost Plus - Liquid 1 BID PRN, stop date 09/18/2018, KOP: No, 
Drug Source: In House Pharmacy, Notes: Not required for trawl, 
please giw this with the thiamine 
Alla ..... 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. \Neight loss admits. Dry 
M)uth denies. \Neakness admits. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. Abdominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. 1,1:>mitting denies. Painful 
urination denies. Decreased urine output denies. MJsde 
aches denies. MJsde cramps denies. Skin breakdown denies. 
Difficulty thinking denies. 
1623 E J STREET, T 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Provld e l(b)(6) ; (b)(?)(C) 
Reason for Appointment 
1. PM SHIFT NOlE. Hunger Strike Nursing E1,0luation 
History of Present Illness 
Flowsheets (MHU): 
Upon encounter detainee was resting quietlyin bed. Detainee reported weakness but refused any medical treatment 
Detainee water pitcher has been filled for him and he has been drinking Pedial)le. Detainee has gone back to resting quietly in 
his room. W II continue to monitor. 
Hungerstrike fl.bnitoring Form 
Day. 09/13/2018 
Shift: PM 
Intake PO(in ml}: 0 
Intake rl/- Normal Saline (in ml}: 0 
Intake rl/- LR (in ml}: 0 
Intake NG(in ml): 0 
QJtput Urine (in ml): 0 
Comments: WATER PITCHER WAS FILLED FCR HI MAND HE HAS BEEN DRINKING PED/AL YTE 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEOCEFICER 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number Llc»J BRIDGE-# 9242 
Number Use notes ffeld 
Language Russian 
Pain f<;sessment 
Pain 
l'<e }OU currently in pain? No 
Narratiw: 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
IM1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wclnts to be released from custody 
/ldequate supply of drinking water and other be-erages available: Yes 
Three meals deliwred per day to patient Yes 
/lnyunauthori>edfood inroom? No 
Haw dailyorihostatic \ital signs been completed? Yes 
Has input and output been documented on the the M-IU Hunger Strike M)nitoring Smart Form? Yes 
Vit al Signs 
97.4F 
46/m in 
91/53 mm Hg 
16/m in 
143.0 lbs 
66.5in 
22.73 Index 
PRCMDER AWAAE OF\1TPlS. 
Ex amination 
General Examination: 
Temp 
09/13/201808:15:58 PM 
HR 
09/13/201808:15:58 PM 
BP 
09/13/201808:15:58 PM 
RR 
09/13/201808:10:50 PM 
wt 
09/13/201808:15:58 PM 
H 
09/13/201808:10:50 PM 
BMI 
09/13/201808:15:58 PM 
GENERPl J>PPEAAPNCE: in no acute distress, well de1€1oped, well r<lllrished. 
PSYCH: alert, oriented. 
Assess ment s 
/!I-Risk for imbalanced nutrition: Less than body requirements. 
Tre a tme nt 
1. Others 
b)(6); (b)(?)(C) 
Notes: 1. Continue with vltal Signs e-eryshift; Intake and QJtput M:lnitoring e-eryshift; Dailyweights; Dailyor1hostatic \ital signs. 
2. /In adequate supply of drinking water and other be-erages are available to patient at all times. 
3. Three meals per day are deli sered to the patient and deli-eryof meals is documented. 
4. ~ I food not authori>ed by CD~y.;ician is remo-ed from patenrs room. 
5. Patient is not allowed to purchase food from commissar)l\ending machine while on hunger strike. 
6. Patient will only be released from hunger strike treatment/monitoring byCD or phy.;ician order. 
7. Patient counseled regarding the medical risks of continuing the hunger strike. 
8. Encouraged to terminate the hunger strike and eat/drink as normal. 
Appointment Provide1(b)(6) ; (b)(?)(C) 
2019-ICLl-0005 1 3265 
I 

DHS-ICE-19-0196, 19-0197-N-000447
Electronically signed b* b)(6); (b)(7)(C) 
Sign off status: Completed 
t RN on 09/13.12018 20:16:58 (Pacific Daylight Time) 
Addendum : 
09/13/201810:40 P (b)(6); (b)(7)(C) INPUT 1 L11ER, a.JTPUT- CBSERl,EO 1X 
09/13/201810:48 P INPUT 1 Ll1ER PEOll'l YTE, 8 OZ BOOST, t.EDICATIOJ CCM'lll'NT 
1/\ffil lH WVINE 1uv..- ~-----~ 
Northwest Detention Center 
1623 E J STREEI' T~r9S421 Te(b}~\ 
Pati-t: AMAlt, MERGENSANA DOB: 10/23/1978 p..._.. '"14 (b)(6); (b)(7)(C) 
/lk:te generated byeOinica/Wcrks EJ.RIPM &ltl<ere {1WNteOinica/Works.com) 
2019-ICLl-00051 3266 
re 09/13/2018 

DHS-ICE-19-0196, 19-0197-N-000448
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Si.tllq(b )(6): ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll lunber: ITti\i6i:7 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
09 /1312018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
Alle'9leS 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue admits Headache denies. Sleep 
Disturbance denies. Dry M>uth denies. \11/eakness admits, . 
Cough denies. Shortness of breath at rest denies. l'odominal 
Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \bm itling denies. Painful urination denies. 
Decreased urine output admits MJsde aches admits 
extremities and back. MJsde cramps admits Skin 
breakdown denies. Difficultythinking denies. 
CardiQ\0SCUla~ 
Chest pain at rest admits, occurred frequently. 
C)enosis denies. Difficulty la),ing flat denies. Fluid accumulation in 
the legs denies. Irregular heartbeat denies. Palpitations denies. 
\11/eakness admits 
feels heart is pounding. 
Aflpolntment Provlde1 (b)(6) ; (b)(7)(C) I MD 
Reason for Aflpolntment 
1. Hunger strike 
History of Present Illness 
Flowsheets (M-tU): 
Pt is ooncemed about his ''hearf' pain. He has been lying in bed not wanting to go to rec. )0rd. Pt is oom.inced to start 
thiamine since he oontinues to refuse to eat His labs haw been W>JL. His HR is slow but ECG is W>JL. He is drinking the 
pediali!e. He agrees to try one or two sen.ings of boost for added 1,1tamin benefit This will not fulfill the requirement of eating. He 
is oompliant>Mth his oourtorderof monitoring but will most likely need oourtorderfeeding since he is dedining either from plain 
weakness or from depression. 
Hungerstrike M:mitoring Form 
Day. 09/13/2018 
Shift: AM 
Intake PO(in ml}: 2000 2 literof e/ectro/yte solution for day shifl 
Intake rl/- Normal Saline (in ml}: 0 
OJtput Urine (in ml): 0 pt seen voiding, and UA obtained 
OJtput Bowel M>wments (in ml): 0 
Labs - Urine Ketones: Pos 
Labs - Sodium: 
Initials: SM 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
W1at language do )OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number 
Number : Uonbrldge 11351254 
Language Russian 
Pain l'ssessment 
Pain 
Ne )OU currently in pain? Yes 
The pain is located : 
The sew rityof pain is rated at 4110 
The sew rityof the pain is mild to moderate 
The pain began 3-4 days ago 
The character of the pain is aching 
The associated symptoms are v,eakness 
The pain is aggravated by physical activity 
The pain is relieled by none 
Narratiw: 
Hunger Strike: 
~ ical Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
Wien did the official hunger strike begin? 08/25'2018 
Date of last meal oonsumed: 08/22/2018 
Last meal oonsumed: Breakfast 
Drinking fluids: Yes 
# of days on hunger strike: 16 18 
Total \/\eight loss in pounds: 20 
Reason for hunger strike: W.,nts to be released from custody 
Housing/Isolation Location: M,dical Housing Unit 
Reason for Isolation F1acement For dose supervision, obse,vation, and monitoling 
Re\aew of the Housing Placement Review housing every 24 hours 
13% ded ine in W. with BM down to 22. 
Vit al Signs 
Temc 
97.4F 09/15/2018 11 :41 :03 />M 
HR 
46/m in 09/15/2018 11 :41 :03 />M 
BP 
91/53 mm Hg 09/15/2018 11 :41 :03 />M 
RR 
16/m in 09/15/2018 11 :41 :03 />M 
wt 
143 lbs 09/15/2018 11 :41 :03 />M 
Ex amination 
General Examination. 
GENER/ll JIPPEPR.ANCE: pt alert and oriented . sullen, looks slightly distressed. 
HEAD: normocephalic. 
E'l'ES: pupils equal, round, reactiw to light and accommodation. 
ORl>L CA\ATY: mucosa moist, no lesions. 
SKIN: good turgor, normal. 
HEAAT: regular rate and rhyttrn. 
LUNGS: good air rrmement, no Ykleezes, rales, rhonchi. 
(b )(6); 
(b)(7)(C) 
EXIREMTIES: full range <:I motion, no edema, good capillary refill in nail beds, no clubbing, cyanosis, or edema. 
PSYCH: alert, oriented, cogniti,e function intact, poor eye contact, speech diminished output, l.olume, . 
Assessments 
1. Starvation, subsequent encounter - T73.0JO<D (Primary) 
2. Imbalanced nutrition: Less than body requirements [00002] - ND00002 
3. Risk for Deficient Fluid \b lume [00028] - ND00028 
/>I-Risk for imbalanced nutrition: Less than body requirements 
Self-imposed Hunger strike. 
2019-ICLl-0005 1 3267 

DHS-ICE-19-0196, 19-0197-N-000449
Treatment 
1. Starvation, subsequent enccxrt er 
Start Thiamine HCI Tablet 100 M3, 1 tablet Oal ly, BID, 5 day.;, 10 Tablet KCP Yes, Drug Source: In House Phannacy, Notes: 
Not required for trm.el 
Start Boost Plus Liquid,-, 1, Oa lly, BID PRN, 5 day.;, 1, KCP No, Drug Source: In House Phannacy, Notes: Not required for tra1.el, 
please gi1.e this with the thiamine 
l.J>B: Urinalysis Dipstick 
Labs 
Lab: Urinalysis Dipstick IMJL 
Leuk~ 
Nitrate 
Urobilinogen 
Protein 
pH 
Blood 
Specific Qa"ty 
Ketones 
Billirubin 
Glucose 
Color 
Clarity 
Procedure Codes 
T1013 Sign Lang/Oal Interpreter 
Follow Up 
daily 
Neg 
Neg 
0.2 
Neg 
7.5 
Neg 
1.015 
Tr 
Neg 
Neg 
Yellow 
Clear 
Notes: Discussed medication use and side effects with patient Education pro\Oded on Madication and Treatment Patient 
acMsed to call for the nurse if S)fllptoms worsen prior to neld \OSit Patient1.erbali:zed understanding of all instructions 
Appolnbnent Provi~ (b)(5); (b)(?)(C) ~ D 
(b)(6); (b)(7)(C) 
Electronically signed b (b)(6); (b)(7)(C) Don 09/151201812:04:14 (Pacific Dayligh t Time) 
Sign off status: Comple 
Northwest Detention Center 
1623 E J SIBE£r 
T WA9842 1 
Tel b)(6); (b)(7)(C) 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progress Notei(b)(6); (b)(7)(C) I MD 09/13/2018 
/lkte generated by eC/inica/Worl<s a.R/PM &ltv.ere (w.w,eC/inicl!iWorks.COff4 
2019-ICLl-00051 3268 

DHS-ICE-19-0196, 19-0197-N-000450
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
.. A:216269802 Su:lli-:lb )(6); I 
Facility Code: CSONVWA .. ,g A ca ."' 
3~c~~SE ::: 
09 /13 12018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
Alla ..... 
N.KDA 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fewr denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbance denies. 
pjlerg:Jlmmunology: 
Congestion denies. Cough denies. Hi,es denies. 
Itching denies. Rash denies. Sneeiing denies. 
Respiratory: 
Change in breathing pattern nomnal breathing pattern. Chest 
pain denies. Shortness of breath at rest denies. Shortness of 
breath with eiertion denies. 
Patient denies shortness of breath, abd or chest pain, or recent 
change in bowel or bladder. 
1623 E J STREET, T 
Appoimnert Facility: Northwest Detertion Cert er 
Appointment Provld e 1 (b)(6) ; (b)( 7)(C) ~N 
Reas on for Appointm ent 
1. tvHU RN Day I Hunger Strike 
History of Pre se nt Illness 
Flowsheets (tvHU): 
lnput/OJtput Flowsheet 
Time: 1415 
INPUT PO: 2000 
Initials: JCL 
Patient Identification: 
Pt able to drink water from tap freely, and drank 2 liter of Pedial)le. (induding the litre from 0500 and 1200 ) 
Cooperatiw with assessments and V.S- UAcompleted 
obser.ed 1,0iding -. 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: Geo 0/fi /bl/6): 
Wiat language do }OU speak? gll 
Interpretation pro\aded? Yes, Interpreter Number Detainee cooperallve v.ith VS'Assessments- able to make his needs 
knoWJ in English 
Number : 11350595 
Language Russian 
Pain Assessment 
Pain 
Ne }OU currently in pain? No 
Vital Signs 
97.4F 
46 /min 
91/53 mm Hg 
16/min 
143.0 lbs 
66.5in 
22.73 Index 
Pro\<der aware of brad)card,a and H)POtens,on. 
Examination 
General El0mination: 
Temp 
09/13/201801:42:23 PM 
HR 
09/13/201801:42:23 PM 
BP 
09/13/2018 01 :42:23 PM 
RR 
09/13/201801:42:23 PM 
wt 
09/13/201801:42:23 PM 
H 
09/13/201801:42:23 PM 
BMI 
09/13/201801:42:23 PM 
GENERJ>l PPPEAAPNCE: in no acute distress, well deleloped, well noorished. 
QRl>I.. CAvfTY: nomnal, mucosa moist. 
SKIN: nomnal, no rashes, no suspicious lesions. 
HEJ>RT: no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNG.5: nomnal, clear to auscultation bilaterally, nowieezes, rales, rhonchi. 
CHEST: normal, no gross rib defoonity, normal shape and expansion. 
!>llDOIVEN: nomnal, bowel sounds present, soft, nontender, nondistended. 
b)(6) ; 
b)(7)(C) 
MUSCULOSKELET/ll : normal, normal gait, no deformities, full range o( motion, good strength and equal bilaterally. 
PSYCH: alert, oriented. 
Assessmen ts 
1. Imbalanced nutrition: Less than body requirements [00002] - ND00002 (Primary) 
Treatment 
1. Imbalanced nutrnion: Less than bolt; req..iremerts (00002] 
N 
--N 
--N 
-
-N 
--N 
--N 
-
-N 
Notes: Detainee wrbalized understanding of plan of care and denies questions/concerns. Continue hunger strike protocol, 
encourage po food/fluids, encourage wrbalization of feelings. Staff to monitor intake and output, \ital signs, wt. Instructed to seek 
staff wilh any needs. Verbalized understanding. Nursing Care Plan present Detainee wrbalized an understanding of education 
and/or treatment. \.bices no other concerns. 
Clinical Notes: Pedial~e administered per wrbal order of Dl(b )(6) ; ~, ~n her schedule of 1 lilre each at 0500, 1230, and 2000. 
Appo intment Providerltb )(6); bN .,,_~--~r· 
Bectronically signed bj~(b~)~(6~)~; --~~ on 09/13/2018 14:55:26 (Pacific Daylight lime) 
Sign off status: Completed 
Northwest Detention Center 
2019-ICLl-00051 3269 

DHS-ICE-19-0196, 19-0197-N-000451
1623 E J STREET 
T~~.6.98421 Te1:ijl(5f I r-a. 
P•tl-t: AMAR, IIIERGENSANA DOB: 10/23/1978 p ......... -K b)(6); - · ~ 09/13/2018 
NCl.e generated by eC/inica/Wm<s Bvr>IPM Sottv.ere (,w,weC/inica/WGV'ks .COOjl 
2019-ICLl-00051 3270 

DHS-ICE-19-0196, 19-0197-N-000452
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA .. A:21s2s9so2 Su:i10:fo)(6); 1 
Fac1lrtyCode:CSOINWA t-k'.AS'ug,c;ea .lfi 
39 Y old Male, DOB: 10/23/1978 
AccOl.rll lunbe ~/h\/R\· 
09 /1312018 
Cunont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy , Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
Allo'9loS 
N.KDA 
Review of Systems 
General/Constitutional: 
Chills denies. Fewr denies. Headache denies. Night 
sweats denies. \flieight loss admits due to hunger strike .. 
Respiratory 
Cough denies. Pain with inspiration denies. Shortness of 
breath at rest denies. 
Cardi0\0Scula~ 
Dizziness admits, with changing position, with actil.ity. 
Shortness of breath denies. \flieakness admits. 
MJsruloskeletal: 
M.Jsde aches admits in both legs. \flieakness admits, that 
is generalized. 
1623 E J STREET, TACOMA,\f+-'¥e'W"'A-9:..,,..,,.84=2~1--' 
Appoirimert Facility. Northwest Detertion Cert er 
Appointment Provlde1 (b)(6) ; (b)(7)(C) rN 
Reason for Appointment 
1. Nursing rounds night 
History of Present Illness 
Narratiw: 
Ml le patient on hunger strike was asleep when I arriwd for shift. Up 2-3 times to use restroom and drink water. Slept through 
the night Pedial)le giwn at 0500 as ordered. Patient has complaints of musde aches in legs and diziiness when he gets up to 
mow. Patient was asked if he would like meto see ifh e has any pain meds ordered which he dedines. Refused breakfast 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? Russian, __ 
Interpretation pro\aded? No interpreter utilized 
~ lain Use Notes Section speaks limited English 
Pain />ssessment 
Pain 
/>,e }OU currently in pain? Yes 
The pain is located Use Notes Section legs 
The sew rityof pain is rated at 11101-2 
The sew rityof the pain is mild 
The pain began 1-2daysago 
The character of the pain is aching 
The associated symptoms are dizziness 
The pain is aggravated by none 
The pain is relieled by none 
Vital Signs 
97.9F 
59 /min 
96161 mm Hg 
16/min 
143.0 lbs 
66.Sin 
22.73 Index 
Temo 
1-R 
BP 
RR 
wt 
H 
BMI 
01ho supine 99/59 p 47, sitting 96/61 p 59, standing 115/77 p-68. 
Examination 
General Examination: 
09/1312018 04:48:47 /'M 
09/1312018 04:48:47 /'M 
09/1312018 04:48:47 /'M 
09/1312018 04:48:47 /'M 
09/1312018 04:48:47 /'M 
09/1312018 04:48:47 /'M 
09/1312018 04:48:47 /'M 
GENER/IL /lPPEAA/INCE: in no acute distress, well de"31oped., male. 
SKIN: noonal, no rashes, no suspicious lesions. 
HEl'RT: S1, S2 noonal. 
LUNGS: noonal, clear to auscultation bilaterally, no wieezes, rales, rhonchi. 
Assessments 
1. Imbalanced nutrition: Less than body requirements [00002] - ND00002 (Primary) 
Treatm ent 
1. Imbalanced nutrition: Less than body requiremerts (00002] 
b)(6); ,_ 
b)(7)(C) RN 
,_ 
,_ 
RN ,_ 
,_ 
RN ,_ 
RN 
,_ 
f<N ,_ 
,_ 
i<N ,_ 
RN 
Notes: Detainee wrba li>ed understanding of plan of care and denies questions/concerns. Continue hunger slrike protocol, 
encourage po food/fluids, encourage .erbalization offeelings. Encourage to allow staff to monitor intake and output, IAtal signs, 
wt Instructed to seek staff>Mlh any needs. \krba liied understanding .. Nursing Care Plan present Refer to nursing care plan for 
OrliJ(ling inter1entions. Detainee offered three meals per day and lea,e in room for at least 20 minutes. J>dequate supplyof 
drinking water and other bewrages as ordered byprolAder available. Encourage dailyoral/phy.;ical h19iene care. l.bioes no other 
concerns. 
Disposition: J>dmitted to M-IU until medically evaluated 
Appointment Provide~(b)(6); (b)(7)(C) FN 
Bectronically signed l(b)(6); (b)(7)(C) ~ on 09/13/2018 05:28:19 (Pacific Daylight Time) 
Sign off status: Completed 
2019-ICLl-00051 3271 
Northwest Detention Center 
1623 E J STREET 
TACOMA, WA98421 

DHS-ICE-19-0196, 19-0197-N-000453
Telj(b)(6) : FdX. 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 Progreu Note{ b)(6) ; (b)(7)(C) jiN 09113/2018 
Ncl.e general.ed by eC/inica/'Na1<s BvR'PM Sottv.ere (l'N.WeC/inica/W<Yks .coojl 
2019-ICLl-00051 3272 

DHS-ICE-19-0196, 19-0197-N-000454
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 &ti1ot (b )(6): 
Facility Code: CSONVWA Housing Area: M 
Acc01.111 ~be(bR6C I 39 Y ad~~ 1£:: 
09 11212018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
Alla ..... 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. li ghtheadedness denies. 
Sleep Disturbance denies. \Neight loss admits. Dry 
M:>uth denies. \Neakness admits. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. l'lxlom inal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. ½m illing denies. Painful 
urination denies. Decreased urine output denies. Mlsde 
aches denies. Mlsde cramps denies. Skin breakdown denies. 
Difficulty thinking denies. 
1623 E J STREET, T 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Provid e r: j(b)(6) ; (b)(7)(C) 
Reason for Appointment 
1. PM SHIFT NOlE. Hunger Strike Nursing E1,0luation 
History of Present Illness 
Flowsheets (MHU): 
Upon encounter detainee was resting quietlyin bed. Detainee reported weakness but refused any medical treatment 
Detainee water pitcher has been filled for him and he has been drinking Pedial)le. Detainee has gone back to resting quietly in 
his room. W II continue to monitor. 
Hungerstrike M:>nitoring Form 
Day. 09/12/2018 
Shift: PM 
Intake PO(in ml}: 0 
Intake rl/- Normal Saline (in ml}: 0 
Intake rl/- LR (in ml}: 0 
Intake NG(in ml): 0 
QJtput Urine (in ml): 0 
Comments: WATER PITCHER WAS FILLED FCR HI MAND HE HAS BEEN DRINKING PED/AL YTE 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEOCEFICER 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number Llc»J BRIDGE-# 9171 
Number Use notes ffeld 
Language Russian 
Pain f<;sessment 
Pain 
l'<e }OU currently in pain? No 
Narratiw: 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
IM1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wclnts to be released from custody 
/ldequate supply of drinking water and other be-erages available: Yes 
Three meals deliwred per day to patient Yes 
/lnyunauthori>edfood inroom? No 
Haw dailyorthoslatic "la l signs been completed? Yes 
Has input and output been documented on the the M-IU Hunger Strike M:mitoring Smart Form? Yes 
Vit a l Signs 
96.8F 
50/m in 
98161 mm Hg 
16/m in 
143.8 lbs 
66.5in 
22.86 Index 
Examination 
General Examination: 
Temp 
09/12/2018 06:02:03 PM 
1-R 
09/12/201806:02:03 PM 
BP 
09/12/201806:02:03 PM 
RR 
09/12/2018 05:56:39 PM 
wt 
09/12/201806:02:03 PM 
H 
09/12/201805:56:39 PM 
BMI 
09/12/2018 06:02:03 PM 
GENER.Al J>PPEAAPNCE: in no acute distress, well de\€1oped, well r<JO.Jrished. 
PSYCH: alert, oriented. 
Assessments 
/!I-Risk for imbalanced nutrition: Less than body requirements. 
Tre a tment 
1. Others 
(b)(6) ; (b)(7)(C) 
Notes: 1. Continue with \Alai Signs e-eryshift; Intake and QJtput M:lnitoring e-eryshift; Dailyweights; Dailyorlhoslatic ,,;1a1 signs. 
2. /In adequate supply of drinking water and other be-erages are available to patient at all times. 
3. Three meals per day are deli sered to the patient and deli-eryof meals is documented. 
4. /11 food not authori>ed by CD~y.,ician is remo-ed from patienrs room. 
5. Patient is not allowed to purchase food from commissar)l\ending machine while on hunger strike. 
6. Patient will only be released from hunger strike treatment/monitoring byCD or phy.,ician order. 
7. Patient counseled regarding the medical risks of continuing the hunger strike. 
8. Encouraged to terminate the hunger strike and eat/drink as normal. 
Appointment Provider.l(b)(6); (b)(7)(C) 
2019-ICLl-0005 1 3273 
I 

DHS-ICE-19-0196, 19-0197-N-000455
Electron ica lly signed b* b)(6); (b)(7)(C) 
Sign off status: Completed 
Add endum : 
09/12/2018 11 :05 P~b )(6); (b)(7)(C) 
fN on 09/12/2018 18:03:28 (Pacific Daylight Time) 
~ INPUT-1 Ll1ER PEOll'l YTE, OJTPUT-\0O 1X 
Northwest Detention Center 
1623 E J STREEr 
TACOMA, WA98421 
Tel:!(b)(6) ; I ,ax. 
Patien t: AMAR, MERGENSANA DOB: 10/23/1 978 p,.,.._ ...., (b)( 6); (b)(7)(C) 
Nr:1.e general.eel by e0inica/Wa1<s af</PM So/Mere (\WM/eC/inica'WCYks.coo,) 
r 09/12/2018 
2019-ICLl-00051 327 4 

DHS-ICE-19-0196, 19-0197-N-000456
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3275 
AMAR,MERGENSANA A:216269802 Su:i1ol(b)(6); I 
Facility Code: CSONVWA Housing Area : M 39 Y old Male, DOB: 10/23/1978 
Acc01.111 ~~ 'WA 1623 E J STREET, T 911421 

DHS-ICE-19-0196, 19-0197-N-000457
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3276 
AMAR,MERGENSANA .. A:216269802 Su:lli-:J(b)( 6): ! 
Fac1lrtyCode:CSOINWA ng,c;ea .lfi 
39Y old Mal~,· AccOllll lunbe b )(6): 
1623 E J STREET, T 

DHS-ICE-19-0196, 19-0197-N-000458
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:llot(b )/6\ ! 
Facility Code: CSONVWA Housing Area: M 
39Y old Mal~,· 
AccOl.lll llunbe b 6 · 
09 11212018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Daily M1, stop date 09/26/2018, KOP: 
Yes, Drug Source: In House Pharmacy, Notes: Not required for 
trawl, please giw to patient at 0500 near breakfast time 
• Pedial)le - Solution I bottle Twice A Day, stop date 09/26/2018, 
KOP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, pt may haw at bedside, please giw 1 bottle to patient at 
1200 and 2000 (hs) 
Alla ..... 
N.KDA 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fewr denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbance denies. 
pjlerg:Jlmmunology: 
Congestion denies. Cough denies. Hi,es denies. 
Itching denies. Rash denies. Sneeiing denies. 
Respiratory: 
Change in breathing pattern nomnal breathing pattern. Chest 
pain denies. Shortness of breath at rest denies. Shortness of 
breath with eiertion denies. 
Patient denies shortness of breath, abd or chest pain, or recent 
change in bowel or bladder. 
1623 E J STREET, T , 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Provlde1 (b)(6) ; ~-
Reas on for Appointment 
1. tvHU RN Day I Hunger Strike 
History of Pre se nt Illness 
Flowsheets (tvHU): 
lnput/OJtput Flowsheet 
Time: 1415 
INPUT PO: 2000 
Initials: JCL 
Patient Identification: 
Pt able to drink water from tap freely, and drank 2 liter of Pedial)le. (induding the litre from 0500 and 1200 ) 
Cooperatiw with assessments, UAand \iS 
obser.ed 1,0iding -. 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: Geo ali'cet~~ ,I Wiat language do }OU speak? 
Interpretation pro\aded? No interpreter available during visit Detainee coopera#ve v.ith VS'Assessments - able to make his 
needs know, in English 
Pain />6sessment 
Pain 
ke }OU currently in pain? No 
Vital Signs 
96.8F 
50/m in 
98161 mm Hg 
16/ min 
143.8 lbs 
66.5in 
22.86 Index 
TE Sent to Robinson PA Detainee Is as)fllptomatic. 
Examination 
General Examination: 
Temo 
09/12/201810: 13:561¥,,1 
HR 
09/12/2018 10:13:561¥,,1 
BP 
09/12/2018 10:13:561¥,,1 
RR 
09/12/201810:13:561¥,,1 
wt 
09/12/2018 10:13:561¥,,1 
H 
09/12/2018 10:13:561¥,,1 
BMI 
09/12/2018 10:13:561¥,,1 
GENERJ>l JIPPEAAPNCE: in no acute distress, well deleloped, well r<JO.Jrished. 
ORPl CAvlTY: nomnal, mucosa moist. 
SKIN: nomnal, no rashes, no suspicious lesions. 
HEAAT: no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNGS: nomnal, clear to auscultation bilaterally, no wheezes, rales, rhonchi. 
CHEST: nomnal, no gross rib deformity, normal shape and expansion. 
!>BDOIVEN: nomnal, bowel sounds present, soft, nontender, roridistended. 
b)(6); (b}(7)(C) 
MJSCULOSKELET/>L: normal, normal gait, no deformities, full range cl motion, good strength and equal bilaterally. 
PSYCH: alert, oriented. 
Assessments 
1. Imbalanced nutrition: Less than body requirements [00002] - ND00002 (Primary) 
Tr eat ment 
1. Imbalanced nutr~ion: Less than bo<ti requiremerts (00002] 
I 
Notes: Detainee wrba li>ed understanding of plan of care and denies questions/concerns. Continue hunger strike protocol, 
encourage po food/fluids, encourage l<:lrbalization offeelings. Staff to monitor intake and output, 1.1tal signs, wt. lnstrucled to seek 
staff with any needs. Verbaliied understanding. Nursing Care Plan present Detainee l<:lrbali>ed an understanding of education 
and/or treatment. \.bioes no other concerns. 
Clinical Notes: Pedial~e administered per l<:lrbal order of Dr n her schedule of 1 litre each at 0500, 1230, and 2000. 
Appointnnent Provide1 (b)(6) ; ! RN 
Bectronically signed bJ!(b}( 6); ~- Fon 09/12/201814:19:57 (Pacific Daylight Time) 
Sign off status: Completed 
2019-ICLl-00051 3277 

DHS-ICE-19-0196, 19-0197-N-000459
Northwest Detention Center 
1623 E J STREEr 
T~A9S421 Te(b}(K, 1 
Patient: AMAR, MERGENSANA IIOlk 10/23/1978 P ......... ~ 09/12/2018 
Ncl.e general.eel by eC/irica/Wa1<s af</PM SofMere ("""' eC/inica'\NcYks.C001) 
2019-ICLl-00051 3278 

DHS-ICE-19-0196, 19-0197-N-000460
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA .. A:21626980 2 Su:lltt:1b}(6); I 
Fac1lrtyCode:CSOINWA ng,c;ea .lfi 
kcOUll ~ 7½@C I 39Y ad ~~c:: 
09 11212018 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. Waight loss admits. Dry 
M>uth denies. Waakness denies. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. />bdominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. l.bmitting admits. Painful 
urination denies. Decreased urine output denies. Mlsde 
aches denies. Mlsde cramps denies. Skin breakdown denies. 
Difficulty thinking denies. 
1623 E J STREET, T 
Appoirimert Facility. Northwest Detertion Cert er 
Appointment Provld e'1 (b)(6) ; (b)(7)(C) I RN 
Reas on for Appointment 
1. Nights hift 
History of Pre se nt Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? English, Russian, __ 
Interpretation pro\aded? Pallent speaks English fluenUy 
Pain Assessment 
Pain 
/>,e }OU currently in pain? No 
Narrati"': 
Ml le patient slept most of the night I did witness him urinating and drinking water twice through the night Patient was gi"'n 
packets from tray to mix'Mth water until pedial)le can be reordered bypro\aded if to continue. Patient has no complaints of pain or 
questions at this time. 
Patient is considered to be on official hunger strike and ,,,;11 be isolated from other detainees for dose supen.ision, 
obser\0tion, and monitoring. 
Hunger Strike: 
Nursing Eleluation 
Date missed meals monitoring initiated: 09/22/2018 
Wien did the official hunger strike begin? 09/25'2018 
Date of last meal consumed: 09/25'2018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wcints to be released from custody 
/ldequate supply of drinking water and other be"'rages a.ail able: Yes 
Three meals deli,,.,red per day to patient Yes 
Breakfast deli,,.,red during current shift 0% consumed 
/lnyunauthori>edfood inroom? No 
Ha"' dailyorthostatic \ital signs been completed? Yes 
Has input and output been documented on the the M-IU Hunger Strike M>nitoring Smart Fonn? No; WI/ complete before 
the end of the current shifl 
Vit al Signs 
Tern 
97.7F 09/12/2018 06: 15:08 Ml 
HR 
63/min 09/12/2018 06:15:08 Ml 
BP 
90/60 mm Hg 09/12/2018 06: 15:08 Ml 
RR 
16/ min 09/12/2018 06: 15:08 Ml 
Wt 
143.8 lbs 09/12/2018 06:15:08 Ml 
H 
66.5in 09/12/2018 06: 15:08 Ml 
BMI 
22.86 Index 09/12/2018 06: 15:08 Ml 
01hostatic "ta ls supine 101/64 p-46, sitting 90/60 p-63, standing 83-57 p-81. 
Examination 
General Examination: 
GENER/IL /IPPEAAl>NCE: in no acute distress, well de1€1oped. 
OR/IL CAvfTY: normal, mucosa moist. 
SKIN: normal, no rashes, no suspicious lesions. 
HEAAT: regular rate and rhythm, S1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, no wheezes, rales, rhonchi. 
/IBDOM:N: soft, nontender, nondistended. 
MJSCULOSKELET/ll : normal, normal gait, no deformities. 
NEURQOOC : alert and oriented, cooperati-e Vlith exam. 
PSYCH: alert, oriented. 
Assessments 
/II-Risk for imbalanced nutrition: Less than body requirements. 
Tr eat ment 
1 . Others 
b)(6) ; (b)(7) (C) 
Notes: 1. Continue 1Mth \Alai Signs e-eryshift; Intake and O.,tput M:mitoring e-eryshift; Dailyweights; Dailyorthostatic \ital signs. 
2. /In adequate supply of drinking water and other be-erages are a.ail able to patient at all times. 
3. Three meals per day are deli-ered to the patient and deli-eryof meals is documented. 
4. ~ I food not authori>ed by CD/Phy,;ician is remol.ed from patienfs room. 
5. Patient is not allowed to purchase food from commissa')llend ing machine while on hunger strike. 
6. Patient will only be released from hunger strike lreatmentlmonitoring by CD or phy,;ician order. 
7. Patient counseled regarding the medical risks of continuing the hunger strike. 
8. Encouraged to tenninate the hunger strike and eat/drink as nonnal. 
Disposition: /ldmitted to M-IU until medicallye.aluated 
Appointment Provi<lej(b)(6 ); (b)(7)(C) fN 
2019-ICLl-00051 3279 

DHS-ICE-19-0196, 19-0197-N-000461
Electronically signed t:fb )(6) ; ~-
Sign off status: Completed 
~ on 09/12/2018 06:18:01 (Pacific Daylight Time) 
Northwest Detention Center 
1623 E J STREEr 
T~WA984 21 reffii@f I 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 ProgN u Notal=(b~)~(6~)~: --~"'" 09/12/2018 
/I/de generu.ed by eC/inica/W<rts EM<IPM Sottoore (""""'eC/irica/Works.com) 
2019-ICLl-00051 3280 

DHS-ICE-19-0196, 19-0197-N-000462
U.S. Immigration 
and Customs 
Enforcement 
Cunent -dlcatlons Rea son for Appointment 
Taking 1. ~ ired Pediali!e order 
• Pedial>4e- Solution 1 bottle Three limes A Day, stop date 
09/11/2018, Ka>: No, Drug Source: In House Pharmacy, Notes: Not 
required for traw l, this is to be giwn if patient not taking adequate 
po or IVh)dration 
Tel: 
Fax: 
Patlettt: AMAR, IIERGENSANA DOB: 10/23/1978 ProgNss Note: 
Ncl.e generated by eC/inica/lM:n<s 8'R/PM Sottv.ere (w.w,eC/inica/Works.~ 
2019-ICLl-00051 3281 
AMAR,MERGENSANA A:21626980 2 Su:i1c:(b)(6); 
Facility Code: CSONVWA Hous'"',"'"ng..,Ai i"'e--a-,: M,,..... 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll lunber~ 
1623 EJ STREET, T~ 

DHS-ICE-19-0196, 19-0197-N-000463
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3282 
AMAR,MERGENSANA A:216269802 Su:i10:fb)(6); I 
Facility Code: CSONVWA Housing Area : M 
39 Y ad ~1~3f ~:: 1623 E ~~::=,~be Ji.@C I 

DHS-ICE-19-0196, 19-0197-N-000464
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A:216269802 Su:lloj(b)(6); I 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll lunber~ 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
09 11112018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Three limes A Day, stop date 
09/11/2018, K<F. No, Drug Source: In House Pharmacy, Notes: Not 
required for tra\el, this is to be giwn if patient not taking adequate 
po or IVh)dration 
Past Medlcal History 
No t,/edical History. 
........ s 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. Waight loss denies. Dry M>uth denies. 
Waakness admits. Cough denies. Shortness of breath at 
rest denies. Chest pain at rest denies. Palpitations denies. 
J>bdominal Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \om itting denies. Painful urination denies. 
Decreased urine output denies. MJsde aches denies. MJsde 
cramps denies. Skin breakdown denies. Difficultythinking denies. 
Reason for Aflpolntment 
1. tvHU RN E\E RDS 
History of Present Illness 
Patient Identification: 
Patient Identification 
Aflpolntment Prov1c1ert'.b)(6) ; (b)(7)(C) ~N 
Patient properly identified by2 sources i 
6
· · dge, Picture 
Chaperone Present? Yes GEOa=FIC (b)( ); 
Wiatlanguage do }OU speak? Russian lh ' 17 " r' 
Interpretation pro\aded? Yes, Interpreter Number 11340349, 11340513 
Number Use notes ffeld 
Language Russian 
Pain .1>6sessment 
Pain 
ke }OU currently in pain? No 
Flowsheets (tvHU): 
lnput/OJtput Flowsheet 
li me: 1500 (SHIFT9/11/20181500- 9/11/2018 2300) 
INPUT PO: 1000 DETAINff CESER\IED TOBE DRINKING WA'IER FRCMTHE CELL FOJNTAJNAND VODINGX 2, AT 
2000and 2215. UNABLE TOREPORTAMYJNTCEWA'IER INTAKE. 
INPUT SUBTOT/11.. : 1000 
OUTPUTUrine 0DETAINffCESER\IEDTOBEVODINGX2,AT2000and2215 
OUTPUT SUBTOT/11..: 0 
Initials: RK 
Hungerstrike M>nitoring Form 
Day: 09/11/2018 
Shift PM(SHIFT9/11/20181500- 9/11/2018 2300) 
Intake PO(in ml): 1000DETA1Nff DRANKHIS 1Ll'IERCEPEDIAL Y'IEGIVENAT1400. CESERVED TOBE DRINKING 
WA'IER FROM THE CELL FOJNTAJN AND VODINGX 2, AT2000 and 2215. UNABLE TOM=ASUREAMYJNTCE WA'IER. 
OJtput Urine (in ml): 0 
Initials: RK 
Hunger Strike: 
Nursing Evaluation 
Date missed meals moniloring initiated: 08/22/2018 
IM1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes ordered Pedialyte 
Reason for hunger strike: Wcints to be released from custody 
/ldequate supply of drinking water and other be-erages available: Yes 
Three meals deliwred per day to patient Yes 
/lnyunauthori>edfood inroom? No 
Haw dailyorthostatic \ital signs been completed? Yes 
Has input and output been documented on the the M-IU Hunger Strike M>nitoring Smart Form? Yes 
Narratiw: 
Detainee was noted awake. watching lV in his room during initial rounds. Does not appear to be in anydistress, normal rise 
and fall of chesl detainee refused his dinner, missed meal #62. Detainee prolided urine sample for daily urine dip, processed 
and tcon sent to ordering prolider for evaluation (see labs). Detainee was offered juice packet in replacement of e~ ired 
Pedialjte order, detainee wrba li>ed he will lryit but detainee has not !ouched the juice during whole shift. Detainee was 
obserl.ed lo be drinking fluids from water fountain and l,(liding with no issues during shift. \MIi continue to monilor. Tcon sent to 
prolider for e~ ired Pedialjte order. 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Ex amination 
General B<amination: 
GENER/II.. !>PPE.ARANCE: in no acute distress, well del.eloped, well noorished. 
PSYCH: alert, oriented. 
Assessments 
/>I-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: Nursing to assess h)<lration status: skin turgor, mucous membranes, blood pressure, heart rate, intake & output. \MIi 
continue to encourage detainee to eat all meals deli-ered lo him and lo drink fluids. Detainee has access to drinking water 
inside of cell. Detainee educated on possible risks to health if he continues to miss meals. Detainee educated on risks of not 
drinking adequate amount of fluids. Detainee educated to drink at least 8-10 cups of liquids per day.Detainee educated on 
possible medical risks of continuing to refuse meals. Detainee instructed lo inform nursing staff/officers if s,mptoms discussed 
begins, or if ha"ng continues or becomes worse. Detainee also instructed to let officer know if he wants a tray lo consume. 
Detainee wrba li>ed understanding of all instructions and did not ha-e anyadditional questions. Detainee to remain in rvtiU/seg 
until will only released from hunger strike treatment/monitoring byphy.;ician. Detainee 1.erbali>ed understanding of all 
instructions. 
Procedure Code s 
T1013 Sign Lang/0-al Interpreter 
Notes: Detainee to remain in tMU.1-iunger Strike 
Appointment Provide (b)(6); (b)(7)(C) RN 
Electronically signed J"'(b"")"-- (6""")""; --'----'L, on 09/11/2018 22:42:55 (Pacific Daylight Time) ~h \/7\/f'\ r 
Sign off status: Completed 
2019-ICLl-0005 1 3283 

DHS-ICE-19-0196, 19-0197-N-000465
Patie nt: AMAR, MERGENSANA DOB: 10/23/1978 Prog,. u N 
Northwest Detention Center 
1623EJ~ 
l'. WA98421 
Te l (b)(6); 
09111/2018 
Nd.e general.ed by eClinica/Wm<s BvRIPM Saftvere (1w.W·.hc 1111 iwc,;;:n;i,=;,;;;;;r- ~ 
2019-ICLl-00051 3284 

DHS-ICE-19-0196, 19-0197-N-000466
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Si.tllq(b )(6): ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
Acc01.111 ~ 1r61 I 
09 /11/2018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Three limes A Day, stop date 
09/11/2018, K<F. No, Drug Source: In House Pharmacy, Notes: Not 
required for lra\el, this is to be giwn if patient not taking adequate 
po or IVh)dration 
Alie ...... 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue admits Headache denies. Sleep 
Disturbance denies. \l\leight loss denies. DryM:>uth denies. 
\l\leakness admits, that is mild. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. l'lxlo minal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. ½m illing denies. Painful 
urination denies. Decreased urine output admits MJsde 
aches admits extremities and back. MJsde cramps denies. 
Skin breakdown denies. Diflicultythinking denies. 
1623 E J STREET, T WA-98421 
Appoimnert Facility: Northwest Detertion Cert er 
Aflpolntment Provld e rf b)(6) ; (b)(7)(C) ~D 
Reas on for Aflpolntm ent 
1. Daily Rounds 
History of Pre se nt Illness 
Flowsheets (M-tU): 
Pt is wry sullen today not wanting to talk. He did ccmplyfor examination of his abdomen, heart and lungs. He states he does 
not want to go out to the Rec yard today. He refuses to say if he is haling pain but he does notlookccmfortablewith a small 
musde squee>B to this quadriceps. 
Hungerstrike M:mitoring Form 
Day. 09/11/2018 
Shift: AM 
Intake PO(in ml): 2000 2 literof e/ectro/yte solution for day shifl 
Intake IV- Normal Saline (in ml): 0 
QJtput Urine (in ml): 0 pt seen voiding, and UA obtained 
QJtput Bowel M:>wments (in ml): 0 
Labs - Urine Ke tones: Pos 
Labs - Sodium: 
Initials: SM 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources inducting: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number 
Number : Uonbridge 11339831 
Language Russian 
Pain Assessment 
Pain 
Ne }OU currently in pain? No 
Narratiw: 
Hunger Strike: 
~ ical E16Iuation 
Date missed meals monitoring initiated: 08/22/2018 
\M1en did the official hunger strike begin? 08/25'2018 
Date of last meal oonsumed: 08/22/2018 
Last meal ccnsumed: Breakfast 
Drinking fluids: Yes 
# of days on hunger slri ke: 16 
Total \l\leight loss in pounds: 20 
Reason for hunger strike: Wcints to be released from custody 
Housing/Isolation Location: M,dical Housing Unit 
Reason for Isolation Placement For dose supervision, observaflon, and monitoling 
Re"ew of the Housing Placement Review housing e,-e,y 24 hours 
13% ded ine in W. with BM down to 22. 
Vit al Signs 
Temp 
97.8F 09/12/201810:55:15 PM 
HR 
76/min 09/12/201810:55:15 PM 
BP 
83/53 mm Hg 09/12/201810:55:15 PM 
RR 
16/ min 09/12/201810:55:15 PM 
Wt 
143 lbs 09/12/201810:55:15 PM 
p t abetoa I m buIaebut t i s no t stro g,a d o n n n t r fo dsta i n ces 
Past Orde rs 
Lab:Urinal),SiS Dipstick /Oder Date - 0911112018) /Collection Date - 09/1112018) 
Leukocytes NEG 
Nitrate NEG 
Urobilinogen 1.0 
Protein NEG 
pH 8.0 
Blood NEG 
Speci.6c Gravity 1.0 I 5 
Ketones TRACE 
Billinbin NEG 
Glucose NEG 
Color YELLOW 
Chrify CLEAR 
Ex amination 
General Examination: 
(b)(6); (b)(7)(C) 
GENERl>l />PPE.ARPNCE: pt alert and oriented in no distress , saying few \O,QllJs but cooperating. 
OR.Al CA\ATY: mucosa moist, no lesions. 
NECK/THYROID: normal, neck supple, full range of motim 
SKIN: good turgor, normal. 
HEPRT: regular rate and rhyttm 
LUNGS: good air mowment, no v.tieezes, rales, rhonchi. 
2019-ICLl-0005 1 3285 
I 

DHS-ICE-19-0196, 19-0197-N-000467
/IBDOM:N: scaphoid, , no hepatosplenomegaly, soft, nontender, nondistended. 
MJSCULOSKELETl>l: atrophic muscles, tender to palpation. 
NEUROLOOC: no tremor, cranial neMS 2-12 grossly intact, equal n-o-.ement of all extremities, able to reposition 
himself in bed. 
PSYCH: alert, oriented, cognitiw function intact, poor eye contact, speech diminished output, -.olume, . 
Assessments 
1. Starvation, subsequent encounter - T73.0lO<D (Primary) 
2. Imbalanced nutrition: Less than body requirements [00002) - ND00002 
3. Risk for Deficient Fluid \b lume [00028)- ND00028 
,<II-Risk for imbalanced nutrition: Less than body requirements 
Self-imposed Hunger strike. 
Tr eat ment 
1. Starvation, s ubseque nt enc otrt er 
Stop Pedialjte Solution,-, 1 boltle, Crally, Three limes ADay,4 days, 1, KCP: No, Drug Source: In House Pharmacy, Notes: Not 
required for trawl, this is to be gi,en if patient not taking adequate po or IVh,dration 
Start Pedialjte Solution,-, 1 boltle, Crally, Daily JIM 14 days, 1, KCP: Yes, Drug Source: In House Pharmacy, Notes: Not required 
for trawl, please gi,e to patient at 0500 near breakfast time 
Start Pedialjte Solution,-, I boltle, Crally, Twice A Day, 14 days, 1, KCP: Yes, Drug Source: In House Pharmacy, Notes: Not 
required for trawl, pt may haw at bedside, please gi,e 1 boltle to patient at 1200 and 2000 (hs) 
l~NG: Electrocardiogram (EKG) (Odered for 09/13/2018) 
Procedure Code s 
T1013 Sign Lang/Cral Interpreter 
Fo llow Up 
daily 
Notes: Education prmi ded on labs and Treatment reoommendation, Patient acNsed to notify the nurse f S)fllptoms ooour. Patient 
,erbalized understanding of instructions.Pt told of normal ECG. 
Appolnbnent Provider:fb)(6); (b)(?)(C) ~ D 
(b)(6); (b)(?)(C) 
Electronically signed b (b)(6); (b)(?)(C) Don 09/13/2018 09:29:44 (Pacific Daylight Time ) 
Sign off status: Comple 
Northwes t Detention Center 
1623 E J SIBE£r 
T WA984 21 
Tel bl(6): x : 
Patie nt: AMAR, MERGENSANA DOB: 10/23/1978 Progre .. Note (b)(6); (b)(?)(C) MD 09/11/2018 
/lkte generated by eC/inica/Worl<s a.R/PM &ltv.ere r-· eorm:tmi,:nr.=mr-' 
2019-ICLl-00051 3286 

DHS-ICE-19-0196, 19-0197-N-000468
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A:216269802 Su:lloj(b)(6); I 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.ri funbdwlbc..lw/Go.;).,_· __ _. 
1623 E J STREET, TACOMA, WA-98421 
Appoimnert Facility: Northwest Detertion Certer 
09 11112018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Three limes A Day, stop date 
09/11/2018, K<F. No, Drug Source: In House Pharmacy, Notes: Not 
required for tra\el, this is to be giwn if patient not taking adequate 
po or IVh)dration 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fewr denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbance denies. 
pjlerg)l')mmunolocw 
Congestion denies. Cough denies. Hiws denies. 
Itching denies. Rash denies. Snee.2ing denies. 
Respiratory. 
Change in breathing pattern normal breathing pattern. Chest 
pain denies. Shortness of breath at rest denies. Shortness of 
breath with e,ertion denies. 
Patient denies shortness of breath, abd or chest pain, or recent 
change in bowel or bladder. 
Appointment Prov1c1e1(b)(6) ; (b)(7)(C) rN 
Reas on for Appointm ent 
1. tvHU RN Day I Hunger Strike 
History of Prese nt Illness 
Flowsheets (tvHU): 
lnput/OJtput Flowsheet 
li me: 1450 
INPUT PO: 1000 
Initials: JCL 
Patient Identification: 
Pt able to drink water from tap freely, and drank 2 liter of Pedial)le. 
Cooperatiw with assessments, UAand IIS. 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: Geo alice ,fh \/RI I 
Wiat language do }OU speak? English, Russian, __ 
Interpretation pro\aded? No interpreter available during visit 
Pain Assessment 
Pain 
ke }OU currently in pain? No 
Yitai Signs 
97.SF 
76/min 
83153 mm Hg 
16/min 
143 lbs 
66.Sin 
22.73 Index 
Examination 
General El0mination: 
Temp 
HR 
BP 
RR 
wt 
H 
BMI 
09/11/2018 10:27:27 /lM 
09/11/2018 10:27:27 /lM 
09/11/2018 10:27:27 /lM 
09/1112018 10:27:27 /lM 
09/11/2018 10:27:27 /lM 
09/11/2018 10:27:27 /lM 
09/1112018 10:27:27 /lM 
GENERJ>l /PPEPRPNCE: in no acute distress, well deleloped, well r<JO.Jrished. 
ORPl. CAvlTY: normal, mucosa moist. 
SKIN: normal, no rashes, no suspicious lesions. 
H~T : no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, no\Okleezes, rales, rhonchi. 
CHEST: normal, no gross rib deformity, nonmal shape and expansion. 
!>BDOIVEN: nonmal, b<:>M!I sounds present, soft, nontender, nordistended. 
(b)(6); 
(b)(7)(C) 
MJSCULOSKELET/>l: nonmal, nonmal gait, no deformities, full range cl motion, good strength and equal bilaterally. 
PSYCH: alert, oriented. 
Assessmen ts 
1. Imbalanced nutrition: Less than body requirements [00002] - ND00002 (Primary) 
Treatment 
1. Imbalanced nutr~ion: Less than bo<tj req.iremerts (00002] 
~ -
-
'l.N 
-
~ 
-
-
'l.N 
-
~ 
-
-
'l.N 
-
-
'l.N 
-
Notes: Detainee wrba liied understanding of plan of care and denies questionslooncems. Continue hunger strike protoool, 
enoourage po food/fluids, encourage 1<,rbali,ation offeelings. Staff to monitor intake and output, \ital signs, wt. Instructed to seek 
staff with any needs. Verbaliied understanding. Nursing Care Plan present Detainee 1<,rbal i,ed an understanding of education 
and/or treatment. \.bioes no other ooncems. 
Appointment Providefb )(6); ~· 
Bectronically signed b~~( b~)~(6~);_~~ on 09/11/2018 at 14:50 MST 
Sign off status: Completed 
2019-ICLl-00051 3287 
Northwest Detention Center 
1623 E J STREET 
1: WA 8421 
Tel (b)(6); 

DHS-ICE-19-0196, 19-0197-N-000469
P•tl-t: AMAR, IIERGENSANA DOB: 10/2311978 p ........ -K b)(6); _. ~ 09/11/2018 
Nd.e generated by eC/inica/Wm<s EJvRIPM Sottv.ere {v.11WeC/i nica/WGYks.COOJI 
2019-ICLl-00051 3288 

DHS-ICE-19-0196, 19-0197-N-000470
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:i1ot(b )(~; I 
Facility Code: CSONVWA Housing ea: M 
AccOUll ~ fa@= ! 39Yad~:ic : : 
09 111 12018 
Curnont Medication s 
Taking 
• Pedial)le - Solution 1 bottle Three limes A Day, stop date 
09/11/2018, K<F. No, Drug Source: In House Pharmacy, Notes: Not 
required for tra\el, this is to be giwn if patient not taking adequate 
po or IVh)dration 
Review of Syst ems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. 11\eight loss denies. Dry M>uth denies. 
11\eakness denies. Cough denies. Shortness of breath at 
rest denies. Chest pain at rest denies. Palpitations denies. 
J>l>dominal Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \bm itting admits. Painful urination denies. 
Decreased urine output denies. Mlsde aches denies. Mlsde 
cramps denies. Skin breakdown denies. Difficultythinking denies. 
1623 E J STREET, T 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Provlcle ~ (b)(6) ; (b)(7)(C) rN 
Reas on for Appointm ent 
1. Night rounds 
History of Prese nt Illne ss 
Flowsheets (M-tU): 
lnput/OJtput Flowsheet 
lime: 0530 
INPUTPO: 33 
Initials: sac Narratiw: 
Ml le Patient slept most of night No complaints at this time. Patient is considered to be on official hunger strike and will be 
isolated from other detainees for dose supen.1sion, observation, and monitoring. Denies any pain or discomfort at this time. 
refused breakfast meal #60. Patient has drank 1 liter of pedial)'e since last ewning, unable to measure output butwittnesed 
urinating. 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
VIM! language do }OU speak? English, Russian, __ 
Interpretation pro\aded? No interpreter utilized 
~ lain : Patient stated speaks and understands some English 
Pain Assessment 
Pain 
ke }OU currently in pain? No 
Hunger Strike: 
Nursing E118Iuation 
Date missed meals monitoring initiated: 081221.W18 
\M1en did the official hunger strike begin? 08/25'2018 
Date of last meal oonsumed: 081221.W18 
Last meal oonsumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wcints to be released from custody 
/1<:!equate supply of drinking water and other bewrages a1,0ilable: Yes 
Three meals deliwred per day to patient Yes 
Breakfast deliwred during current shift 0% consumed 
/lnyunauthori>edfood inroom? No 
Haw dailyorthostatic \ital signs been oompleted? Yes 
Has input and output been documented on the the M-IU Hunger Strike M:lnitoring Smart Form? Yes 
Vit al Signs 
Temp 
97.4F 09/11/2018 06:30:26 /'M 
HR 
51 /min 09/11/2018 06:30:26 /'M 
BP 
93/60 mm Hg 09/11/2018 06:30:26 /'M 
RR 
16/min 09/11/2018 06:30:26 /'M 
wt 
142.8 lbs 09/11/2018 06:30:26 /'M 
H 
66.Sin 09/11/2018 06:30:26 /'M 
BMI 
22.70 Index 09/11/2018 06:30:26 /'M 
orthostatic bp done. l)'ng 94/58 p-46, sitting 93/60 p-51, standing 79/49 p-80. 
Ex aminatio n 
General El<>mination: 
GENERJ>l /PPEAAPNCE: ale<1, in no acute distress. 
ORPl. CAvlTY: normal. 
SKIN: no rashes, warm and dry. 
HEl'RT: , bradycardia. 
LUNGS: no wieezes , rales, monchi, clear anteriorly and posteriorly. 
!>BDOIVEN: soft, nontender, nondistended. 
MJSCULOSKELET/>L: normal gait, normal. 
NEURQOOC : alert and oriented, cooperatiw with exam. 
PSYCH: alert, oriented. 
Assessme nt s 
/>I-Risk for imbalanced nutrition: Less than body requirements. 
Tre atment 
1. Others 
(b)(6); N 
(b)(7)(C) -
-
N 
-
-
<N 
-
-
N 
-
-
N 
-
-
<N 
-
-
N 
-
Notes: 1. Continue with \Atal Signs ewryshift; Intake and OJtput M:lnitoring ewrysh itl; Dailyweights; Dailyorthostatic \ital signs. 
2. /In adequate supply of drinking water and other bewrages are a1,0ilable to patient at all times. 
3. Three meals per day are deliwred to the patient and deliwryof meals is documented. 
4. ~ I food not authori>ed by CD/Phy,;ician is remowd from patienfs room. 
5. Patient is not allowed to purchase food from commissary\ending machine while on hunger strike. 
6. Patient will only be released from hunger strike treatment/monitoring by CD or phy,;ician order. 
7. Patientoounseled regarding the medical risks of continuing the hunger strike. 
8. Enoouraged to terminate the hunger strike and eat/drink as normal. 
Disposition: /!dmitted to M-IU until medicallye1,0luated 
Notes: Contacted pro1Ade1rh \/R\· r,garding heartrate (ekg). 
Appointment Providerb)(6); (b)(7)(C) r 
2019-ICLl-00051 3289 

DHS-ICE-19-0196, 19-0197-N-000471
Electronically signed f b)(6); ~ -
Sign off status: Completed 
Fon 09/11/2018 06:36:14 (Pacific Daylight Tlme) 
Northwest Detention Center 
1623EJSTREI" 
T~WA98421 
Teifa{R l I 
Fax: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 ProgN u No18j(b)(6); (b)(7)(C) r" 09/11/2018 
Nd.e general.ed by eOinica/W<n<s B>RIPM Sottw,re (""""eC/inica/works.CtJm) 
2019-ICLl-00051 3290 

DHS-ICE-19-0196, 19-0197-N-000472
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3291 
AMAR,MERGENSANA A:216269802 Su:ll1.J1ih\lf;\- I 
Facility Code: CSONVWA Housing Area : M 39 Y old Male, DOB: 10/23/1978 
Acc01.111 lunber:ftii/6i:7 
1623 EJ STREET, T~ 

DHS-ICE-19-0196, 19-0197-N-000473
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA A:21626980 2 Su:i1ctb)(6): ! 
Facility Code: CSONVWA Housing Area : M 
AccOUll lffllber(b K6); 39Y ad ~:aE:: 
09 /1012018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Three limes A Day, stop date 
09/11/2018, K<F. No, Drug Source: In House Pharmacy, Notes: Not 
required for lra\el, this is to be giwn if patient not taking adequate 
po or IVh)dration 
Alle'9leS 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. li ghtheadedness denies. 
Sleep Disturbance denies. \Neigh! loss denies. Dry M>uth denies. 
\Neakness denies. Cough denies. Shortness of breath at 
rest denies. Chest pain at rest denies. Palpitations denies. 
Podominal Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \bm illing denies. Painful urination denies. 
Decreased urine output denies. MJsde adhes denies. MJsde 
cramps denies. Skin breakdown denies. Difficultythinking denies. 
1623 E J STREET, T 
Appoimnert Facility: Northwest Detertion Cert er 
Reason for Aflpolntment 
1. tvHU RN E\E ROUNDS 
History of Present Illness 
Patient Identification: 
Patient Identification 
Aflpolntment Prov1c1e9(b)(6) ; (b)(7) (C ) I RN 
Patient properly identified by2 sources indqding· IQ rdge, Picture 
Chaperone Present? Yes GEOCff/C ~( b )(6) ; _ Wiatlanguage do }OU speak? Russia~ ·· · · · · -
Interpretation pro\aded? Yes, Interpreter Number 11334513 
Number Use notes ffeld 
Language Russian 
Pain .1>6sessment 
Pain 
/>,e }OU currently in pain? No 
Flowsheets (tvHU): 
lnput/OJtput Flowsheet 
li me: 1500 (SHIFT9/10/20181500- 9/10/2018 2300) 
INPUTPO: 1000DETA/Nff DRANKHIS 1LITEROFPED/Al YTEAT2030. a3SER\IED TOBE DRINKING WATER FROM 
THE CELL FOUNTAIN AND VOD/NGX 1 AT1930. UNABLE TOI.IEASURE AMXJNTOF WATER. 
INPUT SUBTOT/11.. : 1000 
OUTPUTUrine 0OBSERVEDTOHA\IEVO/DEDAT1930/NTHETOLET 
OUTPUT SUBTOT/11..: 0 
Initials: RK 
Hungerstrike M'.lnitoring Form 
Day: 09/10/2018 
Shift PM(SHIFT9110/20181500-9/10/2018 2300) 
Intake PO(in ml): 1000DETAINEEDRANKHIS 1LITEROFPEDIAL YTEAT2030. a3SERVED TOBE DRINKING WATER 
FROM THE CELL FOUNTAIN AND VODINGX 1 AT1930. UNABLE TOI.IEASUREAMXJNTOF WATER. 
OJtput Urine (in ml): 0 
Initials: RK 
Hunger Strike: 
Nursing Evaluation 
Date missed meals moniloring initiated: 08/22/2018 
IM1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes ordered Pedialyte 
Reason for hunger strike: Wcints to be released from custody 
/ldequate supply of drinking water and other be-erages available: Yes 
Three meals deliwred per day to patient Yes 
/lnyunauthori>edfood inroom? No 
Haw dailyorthostatic \ital signs been completed? Yes 
Has input and output been documented on the the M-IU Hunger Strike M'.lnitoring Smart Form? Yes 
Narratiw: 
Detainee was noted awake, watching lV in his room during initial rounds. Does not appear to be in anydistress, normal rise 
and fall of chesl \MIi continue lo monitor. Detainee refused his dinner, missed meal #59. Detainee's EKG was completed as 
ordered. Detainee was assessed, compliant with his ordered Pedial)le and consumed 1 Liter at 2030. Detainee was obsen.ed 
to be drinking fluids and 1,1'.) iding with no issues during shift. Vli\11 continue to monitor. 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Ex amlinatlon 
General B<amination: 
GENER/II.. /IPPE/IR.ANCE: in no acute distress, well del.eloped, well noorished. 
PSYCH: alert, oriented. 
Assessments 
/II-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: Nursing to assess h)dration status: skin turgor, mucous membranes, blood pressure, heart rate, intake & output Vli\11 
continue to encourage detainee to eat all meals deli sered lo him and lo drink fluids. Detainee has access to drinking water 
inside of cell. Detainee educated on possible risks to health if he continues to miss meals. Detainee educated on risks of not 
drinking adequate amount of fluids. Detainee educated to drink at least 8-10 cups of liquids per day.Detainee educated on 
possible medical risks of continuing to refuse meals. Detainee instructed lo inform nursing staff/officers if s,mptoms discussed 
begins, or if ha"ng continues or becomes wcrse. Detainee also instructed to let officer know if he wants a tray lo consume. 
Detainee wrba li>ed understanding of all instructions and did not ha,e anyadditional questions. Detainee to remain in M-IU/seg 
until will only released from hunger strike treatment/monitoring byphy.;ician. Detainee 1.erbali>ed understanding of all 
instructions. 
Proc edure Code s 
T1013 Sign Lang/0-al Interpreter 
Notes: Detainee to remain in M-IUA-lunger Strike 
Appoinbnent Provide1 (b)(6) ; (b)( 7)(C) IRN 
Bectronically signed b b)(6) ; on 09/10/2018 23:55:07 (Pacific Dayl ight lime) 
Sign off status: Comple,tfr'rhr"""7
---""-r'-''---' 
2019-ICLl-0005 1 3292 

DHS-ICE-19-0196, 19-0197-N-000474
Northwest Detention Center 
1623E.JSffiEEI" 
TACOMA, WA984 21 
lel/b)/ 6) l Fai. 
Patle nt:AIIAR,IIERGENSANA DOB:10/2311978 Progre u Nota :kb)(6 ); (b)(7)(C) jRN 09110/2018 
Nd.e generated by eC/inica/Wm<s BvfilFM Softvere (,w,weC/inica/WOrks.~ 
2019-ICLl-00051 3293 

DHS-ICE-19-0196, 19-0197-N-000475
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A:216269802 Su:llD:fh \/R\ ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, 
AccOUll l'unber: (b)(6); 
09 /1012018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Three limes A Day, stop date 
09/11/2018, K<F. No, Drug Source: In House Pharmacy, Notes: Not 
required for tra\el, this is to be giwn if patient not taking adequate 
po or IVh)dration 
Alla ..... 
N.KDA 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fewr denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbance denies. 
pjlerg:Jlmmunology: 
Congestion denies. Cough denies. Hiws denies. 
Itching denies. Rash denies. Sneeiing denies. 
Respiratory: 
Change in breathing pattern normal breathing pattern. Chest 
pain denies. Shortness of breath at rest denies. Shortness of 
breath with eiertion denies. 
Patient denies shortness of breath, abd or chest pain, or recent 
change in bo'Nel or bladder. 
1623 E J STREET, T '"'"7\tf", 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Provider: f b)(6); ~-
Reason for Appointment 
1. tvHU RN Day I Hunger Strike 
History of Present Illness 
Flowsheets (tvHU): 
lnput/OJtput Flowsheet 
li me: 1400 
INPUT PO: 2000 
Initials: JCL 
Patient Identification: 
Pt able to drink water from tap freely, and drank 2 liter of Pedial)le. 
Cooperatiw with assessments, UAand IIS. 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: Geo GV1ice ~~/J7Ji h Wiat language do }OU speak? , ussian, __ 
Interpretation pro\aded? No interpreter available during visit 
Pain Assessment 
Pain 
ke }OU currently in pain? No 
Yitai Signs 
97.9F 
58 /min 
121169 mm Hg 
16/min 
146.6 lbs 
66.Sin 
23.30 Index 
Temp 
HR 
BP 
RR 
wt 
H 
BMI 
09/10/201812:49:55 PM 
09/10/201812:49:55 PM 
09/10/2018 12:49:55 PM 
09/10/201812:49:55 PM 
09/10/201812:49:55 PM 
09/10/2018 12:49:55 PM 
09/10/201812:49:55 PM 
oxvaensat% 
99% 
RA 
Sit9994163 
Stand 120 79/52. 
Exam ina tion 
General E@mination: 
09/10/201812:49:55 PM 
RA/ #Uters 02 Ilia: 
09/10/201812:49:55 PM 
GENERl'l !>PPE.ARPNCE: in no acute distress, well del.e!oped, well nourished. 
OR.Al CA\KIY: normal, mucosa moist. 
SKIN: normal, no rashes, no suspicious lesions. 
HEPRT: no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, no wieezes, rales, rhonchi. 
CHEST: normal, no gross rib deformity, normal shape and expansion. 
JIBDOM:N: normal, bc>Nel sounds present, soft, nontender, nondistended. 
b)(6); 
b)(7)(C) 
MUSCULOSKELETJIL: normal, normal gait, no deformities, full range of motion, good strength and equal bilaterally. 
PS'YCH: alert, oriented. 
Assessments 
1. Imbalanced nutrition: Less than body requirements [00002]- ND00002 (Primary) 
Treatment 
1. Imbalanced nutrition: Less than body req.iremerts (00002] 
N 
-
-
N 
-
-
N 
-
-
N 
-
-
N 
-
-
N 
-
-
N 
-
-
N 
-
-
N 
-
Notes: Detainee l<lrbali>ed understanding of plan of care and denies questions/concerns. Continue hunger strike protocol, 
encourage po food/fluids, encourage \Alrbali,ation offeelings. Staff to monitor intake and output, 1.1tal signs, wt Instructed to seek 
staff with any needs. \Alrbali:,ed understanding. Nursing Care Plan present Detainee IAlrbali>ed an understanding of education 
and/or treatment \tl ices no other concerns. 
Appointment Provide~~(b_)(_6_); _~I RN 
Bectronically signed b~ b)(6); 
Sign off status: Completed 
2019-ICLl-00051 
~ on 09/10/201814:28:45 (Pacific Daylight Time) 
3294 

DHS-ICE-19-0196, 19-0197-N-000476
Northwest Detention Center 
1623 E J STREET 
T~~ ~!A 98421 Tol(b~~J,; ~- I 
Patl-t: AMAR, IERGENSANA DOB: 10/23/1978 P ........ ~ RN 09/10/2018 
NCl.e general.ed byeC/inica/'Na1<s EM>/PM Sottv.ere (,w,weC/1~ 
2019-ICLl-00051 3295 

DHS-ICE-19-0196, 19-0197-N-000477
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A:21626980 2 Su:lloj(b)(6); I 
Facility Code: CSONVWA Housing Area: M 
39 Y ad ~:3· 1~~t:::: 1623 EJ~=~~~iwc:1 
09 /1012018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Three limes A Day, stop date 
09/11/2018, K<F. No, Drug Source: In House Pharmacy, Notes: Not 
required for tra\el, this is to be giwn if patient not taking adequate 
po or IVh)dration 
Review of Systems 
Ps\Chiatric: 
Pru<ietydenies . .l>uditor)t'IAsual hallucinations denies. 
Delusions denies. Depressed mood denies. Difficulty 
sleeping denies. Eating disorder denies. Homicidal 
Thoughts denies. lnabilityto concentrate denies. Mmtal or 
Ph)Sical abuse denies. Stressors admits; immigration 
legal/detention problems. Substance abuse denies. Suicidal 
thoughts denies. 
' c;. 
Appoimnert Facility: Northwest Detertion Cert er 
Reason for Appointment 
1. tvH hunger strike assessment 
History of Present Illness 
Narratiw: 
Appointment Provlde9 (b)(6) ; (b)(7)(C) 
Due to facility power outage, charting was completed on a SF 600 form. Please see scanned SF 600 form. 
Examination 
11/ental Status: 
PPPEPRPNCE: adequately-groomed, dressed in clean uniform of the day. 
RELATEDNESS: cooperati..e . 
ATTmJDE: cooperati..e. 
SPEECH/l.JINGU/>GE: noimal rate, mythm, \Olume . . 
J>FFECT: appropriate, full range. 
lHOUGHT PROCESS: intact. 
lHOUGHT CONTENT: unremarkable. 
PERCEPlU/ll DISORDERS: no perceptual disorder noted. 
PSYCHO'liOTOR /IClMTY: 'Aithin normal range. 
KNCW\lEDGE - INTELLECTIJ/ll RJNClla-J: No oo.ious impairment . 
DEGREE CF AWAAENESS: 'Aithin normal limits. 
ORIENTAllON: person, place, time. 
CURRENT SUICID/ll POTENll/ll: no to low acute Si risk. 
CURRENT HO\IICID/ll POTENll/ll: no to low acute risk. 
Assessment s 
1. Problems related to liling in residential institution -Z59.3 (Primary) 
-Pt's Hunger Strike appears to be moti1o0ted by: 
l] Yes 1M No: 11/ental Illness 
-ff }eS e~ lai n: 
(XI Yes/ l] No: Political Statement or Cause 
- ff}es e~ lain: pt hopes to gain release if he continues the Hunger Strike. 
Treatment 
1. Others 
Notes: Treatment Prolided: 
-Educated on the dangers of not eating/ h)drating. 
-Educated on prosocial problem soll.ing and healthywas to address concerns. 
Preventive Medicine 
Due to the unpredictable nature of the immigration prooess including length of detention stay, the purpose of ps\ctlological 
inten.ention will be the stabilization of presenting s)fllptoms, acute crisis inten.ention, and brief supportileisolution-focused 
ps\ctlatherapy 
Discussed followng Plan with ptto address IVental Health (M-i) issues. pt wrbaliied agreement with Plan: 
Yes/No 
(XI/ (] Remain in tvHU; for Hunger Strike medical obser1.0tion 
(XI/ [ ] Fol low-up with medical proliders for ongoing medical obser1.0tion 
( Xj/ [] Follow-up with tvH Staff for.[ ] 14 day assessment [Xl 21 day assessment 
[X] / [] Do not engage in any self-harm behalior, Continue to focus on shcrtAong term goals, reasons for Ii ling, resilient problem￾soiling skills - all to aid in reducing risk of harm to self lia hunger strike and ultimatelyto achiew pro-social, pro-indilidual & 
familygoals. 
( X] / (] ff at/lNYtime pt has any though~ intent or plan of suicide must alert custodyoffioer for emergent aooess to medical for 
further e1,0luationlbt pt agreed and denied rommunication and stigma barriers to alerting staff to Si. 
( X] / (] Pieri 11/edical/Custody offioer if pt has an emergency for immediate aooess to IVedicaliOental/M-i ser,,ioes 
( X] / (] Begin/Continue daily routine with meaningful, purposeful aclili ty. regular exercise, socialization, engagement in social 
support nel\M:>rk, use of Jaill\/'ail Email s)Stem, engagement in religious customs/rituals, pleasurable aclilities; pt to ronsider the 
work program locally-all to aid in roping and good mental health. 
[X] / (] Seek out attorney, ICE, Law Library, and Detainee Handbook to aid in proacliw problem-soiling - to aid in roping. 
(]No .( ] Yes. Utilize Jaill\/'ail s)Stem (or paper kite prooess) for further support engagement and to aooess facilitysupport, 
resouroes, and other ser,,ioes to aid in prosocial behaliorand healthy problem soiling. 
[X] / [] Continue attention to h½)iene: shower, teeth, grooming to aid in coping 
[X] / [] Begin eatinglh)drating at each meal to aid in ph)Sical health 
(XI/ [] Chaplain Seruoes/J>coess e~la ined/encouraged for further support 
POST SESSIO>J: Updated HAS, i>HSA, CD, M-i Team on assessment/ plan. 
Appointment Providej(b)( 6); (b)(7)(C) ILCSW 
Bectronically signed b~(b)(6); (b)(7)(C) 1csw on 09/11/2018 08:11:40 (Pacific Daylight lime) 
Sign off status: Completed 
2019-ICLl-0005 1 3296 
Northwest Detention Center 
1623 E J STREET 
TACOMA, WA98421 
TelJ(b )(6); _ I 

DHS-ICE-19-0196, 19-0197-N-000478
P-nt: A11AR, IIERGENSANA DOB: 10/23/1978 Prog,. u No"'i (b )(6); (b )(7)(C) ~CSW 09/10/2018 
Nd.e generated by eC/inica/Wm<s EJvRIPM Sottv.ere {v.11WeC/i nica/WGYks.COOJI 
2019-ICLl-00051 3297 

DHS-ICE-19-0196, 19-0197-N-000479
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA A:21626980 2 Su:llD:kh\/R\ I 
Facility Code: CSONVWA Housing Area: M 
39Y old Mal~,· AccOl.l"II llunbe b 6 · 
09 /1012018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Three limes A Day, stop date 
09/11/2018, K<F. No, Drug Source: In House Pharmacy, Notes: Not 
required for tra\el, this is to be giwn if patient not taking adequate 
po or IVh)dration 
Review of Systems 
General/Constitutional: 
Fffi.er denies. Headache denies. Lightheadedness denies. 
\/\eight loss admits. 
Hunger Strike: 
Fatigue admits. that is constant. Headache denies. Sleep 
Disturbance denies. \/\eight loss denies. DryM:>uth denies. 
11\eakness admits. that is mild. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. />bdominal Pain denies. Diarrhea denies. 
Nausea denies. \bm itting denies. Painful urination denies. 
Decreased urine output admits. Mlsde aches admits 
extremities and back. Mlsde cramps improl,ed. Skin 
breakdown denies. Difficultythinking denies. 
1623 E J STREET, T , 
Appoirimert Facility: Northwest Detertion Certer 
Aflpolntment Provlcler:f b)(6) ; (b)(?)(C) rD 
Reason for Aflpolnlment 
1. Daily Rounds 
History of Present Illness 
Flowsheets (M-tU): 
Pt is doing much better since drinking the pedial)le regularlyowrthe week-end and today. He has more energyand has 
been seen up and around his room. He has been oooperating with urine testing and 1,1tal signs. He still refuses food. He is 
ha1,1ng less complaints about pain. 
Hungerstrike M:mitoring Form 
Day. 09/10/2018 
Shift: AM 
Intake PO(in ml): 2000 2 literof e/ectro/yte solution for day shifl 
Intake IV- Normal Saline (in ml): 0 
QJtputUrine(inm l): 0300cc 
QJtput Bowel M:>wments (in ml): 0 about a i<eek 
Labs - Urine Ke tones: Pos 
Labs - Sodium: prea/bumen 11\NL 
Initials: SM 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? Russian 
Interpretation pro1,1ded? Yes, Interpreter Number 
Number : Uonblidge 1132 
Language Russian 
Pain Assessment 
Pain 
/ll'e }OU currently in pain? No 
Narratiw: 
Hunger Strike: 
~ ical E16Iuation 
Dale missed meals monitoring initiated: 08/22/2018 
\M1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking fluids: Yes 
# of day., on hunger strike: 16 
Total Wl ight loss in pounds: 18.8 
Reason for hunger strike: Wcints to be released from custody 
Housing/Isolation Location: M,dical Housing Unit 
Reason for Isolation Placement For dose supervision, observaflon, and monitoling 
Relie\V of the Housing Placement Review housing e,-e,y 24 hours 
Vit al Signs 
Temp I 
97.9F 09/12/2018 11 :40:32 />M (b)(6); (b)(?)(C) 
HR 
58/ min 09/12/2018 11 :40:32 />M 
BP 
121169mm Hg 09/12/2018 11 :40:32 />M 
RR 
16/ min 09/12/2018 11 :40:32 />M 
Wt 
146.6 lbs 09/12/2018 11 :40:32 />M 
H 
66.5in 09/12/2018 11 :40:32 />M 
BMI 
23.30 Index 09/12/2018 11 :40:32 />M 
Pa et Orders 
Lab:Phosphorus Serum -001024 (Oder Date - 09/07/2018) /Collection Date - 09/07/2018) 
Result:V',NL 
Phosphonis 2.8 2.5-4.5 - rrgldL 
Lab:Creatine Kinase Total Serum - 001362 /Oder Date - 09/07/2018} /Collection Date - 09/07/2018} 
Result: 1/',NL 
Creatire Kinase,Total 98 24-204 - U/L 
Lab:Mlgnesium Serum - 001537 /Oder Date - 09/07/2018) /Collection Date - 09/07/2018) 
Result: V',NL 
Magresitm 1.8 1.6-2.3 - n~dL 
Lab:Prealbumin - 016931 (Oder Date - 09/07/2018) /Collection Date - 09/07/2018) 
Result: V',NL 
Prealbumin 18 14-35 - tl"§"dL 
Lab:Urinal)'l iS Dipstick 10-der Date - 09/07/2018) /Collection Date - 09/07/2018) 
Result: Pbnorrnal 
Leukoc)tes 
Nitrate 
Urob ilinogen 
Protein 
2019-ICU-0005 1 3298 
Neg 
Neg 
0.2 
Neg 

DHS-ICE-19-0196, 19-0197-N-000480
pH 6.5 
Blood Neg 
Specific Gravity 1.010 
Ketorxc:s 80 
Billirubin S1mll 
Gh.tcose Neg 
Color Otl~r 
Ctrity C~M 
Notes: Ml lakho\0 rvD,Sheri W09/12/2018 11 :59:55 > late entry 
Examination 
General Ei<amination: 
GENERl'l JIPPE.ARANCE: pt alert and oriented in oo distress, saying few IMJl'ds but cooperating. 
NECK/THYROID: nom,al, neck supple, full range of motion. 
SKIN: nom,al, oo rashes, oo suspicious lesions. 
HEl>RT: oo murmurs, regular rate and rhythm, S 1, S2 oorrnal. 
LUNGS: nom,al, clear to auscultation bilaterally, oo Vvheezes, rales, rhonchi. 
/>BDOVEN: scaphoid, • no guarding or rigidity, oo ascites, oo hepatosplenornegaly, salt, nontender, oondistended. 
MJSCULOSKELETPl : nom,al gait, oo deformities, full range of motion, able to sit up readily by self. 
PSYCH: alert, oriented, cogniti-e function intact, poor eye contact, speech diminished output, -.otume, oo auditory or 1.1sual hallucinations, thought content v.ithout suicidal ideation, delusions. 
Assessments 
1. S!aMtion, subsequent encounter - T73.0X)(I) (Primary) 
2. Imbalanced nutrition: Less than body requirements [00002]- ND00002 
3. Risk for Deficient Fluid \b lume [00028]- ND00028 
/II-Risk for imbalanced nutrition: Less than body requirements 
Self-imposed Hunger strike. 
Treatment 
1. Starvation, subsequent encotrter 
L/>8: Urinal)ISis Dipstick (Order Cancelled) 
!/b\(6): !)9/06/201812:07:31 > Refused 
L/>8: Comprehensi"' llletabolic Panel (14) ClvP- 322000 (Ordered for 09/12/2018) 
1.,.1>8 : CBC Wlh Differential/Platelet - 005009 (Odered for 09/12/2018) 
Notes: rwe can not add on the missing labs we will ha"' to schedule a re-<lraw. We will continue to monitor for his nutritional 
and h)<lration status. 
Procedure Code s 
T1013 Sign Lang/0-al Interpreter 
81002 URINE-NO MCRO 
Follow Up 
dailywilh nurses 
Notes: E<lucation proli ded on Lab resulls and Treatment recommendations. Patient adlised to return to notify nurses I if 
symptoms v.orsen prior to next nurse lisi~ Patient "'rbali:zed understanding of all instructions 
Appoin1ment Provide (b)(6); (b)(7)(C) D 
~b)(6); (b)(7)(C) 
I 
Bectronically signed b (b)(6); (b)(7)(C) Don 09/12/201812 :08:12 (Pacific Daylight Time) 
Sign off status: Comple 
Northwest Detention Center 
1623 E J SIBEEr 
T WA98421 
Tel (b)(6); 
Patient: AMAR, MERGENSANA DOB: 10/23/ 19 78 Progre ss Notei (b )(6); (b )(7)(C) ~D 09/10/2018 
N<:xe generated by eOinica/Wcrks EM<IPM Soft"8re /VNN<eOinica/Wcrks.corrv 
2019-ICLl-00051 3299 

DHS-ICE-19-0196, 19-0197-N-000481
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""1eC/inica'WGYks.coojl 
2019-ICLl-00051 3300 
AMAR,MERGENSANA A: 216269802 Su:lld(b )(6): ! 
Facility Code: CSONVWA Housing Area : M 
39Y old Mal~,· AccOl.l"II llunber b 6 · 1623 E J STREET, T , 

DHS-ICE-19-0196, 19-0197-N-000482
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3301 
AMAR,MERGENSANA A: 216269802 Su:lldlh \/R \ ! 
Facility Code: CSONVWA Housing Area : M 
39 Y Acc01.111 ad Malal!t::: ~i;;,y){6t 1623 E J STREET, T v 

DHS-ICE-19-0196, 19-0197-N-000483
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:,10: !/b)/6): ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II l'unbe1 b)(6) I 1623 E J STREET TMD,a · · · '· -
09 /09/2018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Three li mes A Day, stop date 
09/11/2018, K<F. No, Drug Source: In House Pharmacy, Notes: Not 
required for lra\el, this is to be giwn if patient not taking adequate 
po or IVh)dration 
Alla ..... 
N.KDA 
1 CJ ii C I 
Appoimne rt Facility: Northwest Detertion Cert er 
Appointment Provlde"l"'/b"")~/6"")'--: _ ___.! RN 
Reas on for Appointment 
1. Noc shift 
History of Pre se nt Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? Russian, __ 
Interpretation pro\aded? Yes, Interpreter Name 
Name : 1179325 
Language Russian 
Pain .1>6sessment 
Pain 
ke }OU currently in pain? Yes 
The pain is located : 
The sewrityof pain is rated at 0/10 repeated, no ansv,er given 
The sewrityof the pain is moderate 
The pain began other has had a previous episode in M-IU 
The character of the pain otherbuming 
The associated symptoms are other 
Desai be: constipation 
The pain is aggrawted by other 
Describe: not eating 
The pain is reliel.ed by one pilloww;dge - t.e. to Provider for order 
Narratiw : 
Shook head no when asked about radiating pain from center of upper epigastric area. '11 bums", he says. Unable to ele1,0te 
HOB due to old bed. Ga1.e wedhe pilllow to aocomplish this. Pro1.1der T.E. sent for wedge and to report normal urine dip. 
Vital Signs 
98.0F 
44 /min 
101/61 mm Hg 
12/min 
1442 lbs 
66.Sin 
22.92 Index 
98 % 
RA 
Examination 
General E@mination: 
Temp 
09/09/201811:32:40 PM 
1-R 
09/09/2018 11 :32:40 PM 
BP 
09/09/2018 11 :32:40 PM 
RR 
09/09/201811:32:40 PM 
Wt 
09/09/2018 11 :32:40 PM 
H 
09/09/2018 11 :32:40 PM 
BMI 
09/09/201811:32:40 PM 
°"-'non sat ¾ 
09/09/2018 11 :32:40 PM 
RA/ #Uters 02 Ilia: 
09/09/2018 11 :32:40 PM 
GENER/II. !>PPEPRPNCE: chaperone present in room, in no acute distress, withdra111,11. 
HE.AD: atraumatic. 
E'i'ES: BOTH EYES, normal. 
OR.Al CA\ATY: normal. 
SKIN: good turgor, no rashes, warm and dry. 
HE.ART: regular rate and rhyttm , S1, S2 normal, ~ 44. 
LUNGS: clear anteriorly and posteriorly, clear to auscultation bilaterally. 
CHEST: normal shape and expansion. 
(b)(6) ; 
(b)( 7)(C) 
J>BDOI\IEN: bowel sounds present, no guarding or rigidity, no rebound tenderness, bowel sounds diminished. 
MUSCULOSKELETJ>l: no deformities, full range of motion, neurc>leScular intact. 
NEUROLOGIC: alert and oriented, motor strength normal upper and lc,.,,,er extremities, cerebelar function normal. 
PSYCH: poor eye contact, speech diminished output, loo/ume, affect flat.. 
gained weight{ 2 lbs} in past 2 -3 dais. 
Assessments 
1. Constipation - ND00011 (Primary) 
2. Deficient knowledge [00126] - ND00126 
3. lmpairedcomfort- ND00214 
Tr ea tm en t 
1. Constipation 
~ 
-
RN 
-
RN 
-
-
RN 
-
-
RN 
-
RN 
-
-
RN 
-
-
RN 
-
RN 
Notes: Detainee1.erbaliied understanding of plan of care and denies questions/concerns. Continue hunger strike protocol, 
encourage po food/fluids, encourage 1.erbali,ation offeelings. Staff to monitor intake and output, 1.1tal signs, wt. Instructed to seek 
staff>Mth any needs. Verbali,ed understanding. Nursing Care Plan present Detainee 1.erbaliied an understanding of education 
and/or treatment. \o ices no other concerns. Urine Dip results added to lab section. T.O. to Pro1.1derfor dip results and request for 
bedge wedge due to HOB ele1,0tion mechanism OCR on bed on Wed 2. 
Disposition:---
Appointnnent Provide~[b~)(=6)~; ~~IRN 
2019-ICLl-00051 3302 

DHS-ICE-19-0196, 19-0197-N-000484
Electronically signed b.J/h\/ 6\ · 
Sign off status: Completed 
RN on 09/1(112018 00:07:50 (Pacific Daylight Time) 
Northwest Detention Center 
1623EJSTREI" 
T~~WA9842i Tel:(b]V, ; 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 Prog,.u Nota (b (6 ; -~IRN 09/09/2018 
Nd.e general.ed by eOinica/W<n<s B>RIPM Sottw,re (""""eC/inica/works.CtJm) 
2019-ICLl-00051 3303 

DHS-ICE-19-0196, 19-0197-N-000485
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:llq/h \/R\ ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
Acc01.1"11~ <61 I 
09 /09/2018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Three limes A Day, stop date 
09/11/2018, K<F. No, Drug Source: In House Pharmacy, Notes: Not 
required for tra\el, this is to be giwn if patient not taking adequate 
po or IVh)dration 
Alla ..... 
N.KDA 
vlaw of Systems 
Patient refuses to ans,..,, assessment questions. Refusal form 
submitted to 11/edical Records. 
1623 E J STREET, T WA-98421 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Provld e i (b)(6) ; (b)(7)(C) I RN 
Rea son for Appointment 
1. RN E\€NING SPLIT SHIFT: HUNGER STRIKE 
History of Present Illness 
Flowsheets (M-tU): 
lnput/OJtput Flowsheet 
li me : 1400 
INPUTPO: 0 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT IV Fluids: 0 
INPUT Other. 0 
INPUT SUBTOT/11.. : 0 
OUTPUT Urine 0 
OUTPUTEmesis 0 
OUTPUTBM 0 
OUTPUT a. Wet Diaper Weight 0 
OUTPUT b. D,y Diaper Weight 0 
OUTPUT Total Diaper Weight output (calculate a-b) 0 
OUTPUTDrain: 0 
OUTPUT SUBTOT/11.. : 0 
NetGain: 0 
Netloss: 0 
Initials: KM,! 
Patient Identification: 
Patient is 39 yo russian male on Hunger Strike. He is easilyarroused when RN enters room and agrees to orthostatic blood 
pressures and weight He refuses only food loday. But tells RN he forgot to urinate in cup pro,ided for urine dip. Drank a half litre 
of Pedial),!e this shift.wrbali,es his right to refuse. 
Patient Identification 
Patient prope~yidentified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
\Mat language do )OU speak? English, Russian, __ 
Interpretation pro\aded? Patient speaks English ffuenUy 
Pain 1'6sessment 
Pain 
l'<e )OU currently in pain? No 
Vital Signs 
16 /min 
66.5in 
Examination 
General Examination: 
RR 
09/09/201806:45:09 PM 
H 
09/09/201806:45:09 PM 
GENER/II.. JIPPEAA.ANCE: in no acute distress, well del.eloped, well nourished. 
Assessments 
1. lneffectiw Coping [00069]- ND00069 (Primary) 
2. lneffectiw community coping - ND00077 
3. Risk for Deficient Fluid \o lume [00028] - ND00028 
Hunger Strike. 
Tr ea tment 
1. lneffecti\11! Coping [00069] 
(b)(6); 
(b)(7)(C) ~ 
-
~ 
Notes: Continue hunger strike protocol, encourage po food/lluids, encourage wrbalization of feelings. Encourage to allow staff to monitor intake and output, ,i tal signs, wt lnslruded to seek staff with any needs. lkrbali>ed understanding. Detainee offered 
three meals per day and leave in room 20 minutes before taking away. /ldequate supply of drinking water and other beverages 
as ordered by prol,jder available. Encourage dailyoral/phy.,ical h)lliene care. Change of dothinglbedding. Continue to offer 
1o1tals, weights, food, labs, meds. Patient verbali,es understanding of Plan of Care, and he verbali,es his right to refuse. 
Appointment Provide (b)(6); (b)(7)(C) RN 
Electronically signed b b)(6); 
Sign off status: Comple•tl';';i "r"~
7
~" ~,-.~' -~ 
, RN on 09/09/201818:45:17 (Pacific Daylight lime) 
Northviest Detention Center 
1623 E J STREET 
T 21 
2019-ICLl-00051 3304 

DHS-ICE-19-0196, 19-0197-N-000486
Patient: AIIIAR, IIERGENSANA DOB: 10/23/1978 Prog,.u Nota:"'!(b"')""(6"")'-- : __ __,!RN 09/09/2018 
Nd.e general.ed by eOinica/W<n<s EJvRIPM Sottw,re ("""" eC/inica/WOrks.com) 
2019-ICLl-00051 3305 

DHS-ICE-19-0196, 19-0197-N-000487
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A:216269802 Su:i1D:kb)(6): J 
Facility Code: CSONVWA Housing Area: 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll lunber: ITti\i6i:7 1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Cert er 
09 /09/2018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Three limes A Day, stop date 
09/11/2018, K<F. No, Drug Source: In House Pharmacy, Notes: Not 
required for lra\el, this is to be giwn if patient not taking adequate 
po or IVh)dration 
Alla ..... 
N.KDA 
vlaw of Systems 
Patient refuses to ans,..,, assessment questions. Refusal form 
submitted to 11/edical Records. 
Appointment Provld e 1 (b) (6) ; (b)(7)(C) I RN 
Reas on for Appointm ent 
1. RN DAYS: HUNGER STRIKE 
History of Pre se nt Illness 
Flowsheets (M-tU): 
lnput/OJtput Flowsheet 
li me: 1400 
INPUT PO: 500 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT IV Fluids: 0 
INPUT Other. 0 
INPUT SUBTOT/11..: 0 
OUTPUT Urine 0 
OUTPUTEmesis 0 
OUTPUTBM 0 
OUTPUT a. Wet Diaper Weight 0 
OUTPUT b. D,y Diaper Weight 0 
OUTPUT Total Diaper Weight output (calculate a-b) 0 
OUTPUTDrain: 0 
OUTPUT SUBTOT/11.. : 0 
NetGain: 0 
NetLoss: 0 
Initials: KM,! 
Patient Identification: 
Patient is 39 yo russian male on Hunger Strike. He is easilyarroused when RN enters room and agrees to orthostatic blood 
pressures and weight He refuses only food loday. But tells RN he forgot to urinate in cup pro,ided for urine dip. Drank a half litre 
of Pedial),!e this shift. Patient sleeps most of shift. Patient wrbali:,es understanding of Plan of Care; and he wrbali:,es his right to 
r efuse. 
Patient Identification 
Patient prope~yidentified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
\M1at language do )OU speak? &Jglish, Russian, __ 
Interpretation pro\aded? Patient speaks English ffuenUy 
Pain Assessment 
Pain 
l'<e )OU currently in pain? No 
Vital Sign s 
Tern 
98F 
46 /min 
91/55 mm Hg 
16/ min 
144.2 lbs 
66.5in 
22.92 Index 
ORTHOSTATIC v!T/11..S 
LYING BP 91 /55 HR 46 
SITTING 91/55 51 
STANDING 88/57 68. 
Examination 
General El0mination: 
1-R 
BP 
RR 
WI 
H 
BMI 
09/09/201806:41:18 PM 
09/09/201806:41:18 PM 
09/09/201806:41:18 PM 
09/09/201806:41:18 PM 
09/09/201806:41:18 PM 
09/09/201806:41:18 PM 
09/09/201806:41:18 PM 
GENER/II.. PPPEAAANCE: in no acute distress, well del.eloped, well nourished. 
Assessments 
1 . lneffectiw Coping [00069]- ND00069 (Primary) 
2. lneffectiw community coping - ND00077 
3. Risk for Deficient Fluid \b lume [00028] - ND00028 
Hunger Strike. 
Trea tment 
1 . lneffecthle Coping [00069) 
b)(6); N 
b)(?)(C) 
Notes: Continue hunger strike protocol, encourage po food/lluids, encourage wrbali,ation offeelings. Encourage to allow staff to 
monitor intake and output, ,ital signs, wt. Instructed to seek staff with any needs. \ierbali:,ed understanding. Detainee offered 
three meals per day and leaw in room 20 minutes before taking w,ay. Pdequate supply of drinking water and other bewrages 
as ordered by pro\ader available. Encourage dailyoral/ph)Sical h)!Jiene care. Change of dothing,bedding. Continue to offer 
1<tals, weights, food, labs, meds. Patient wrbali:,es understanding of Plan of Care, and he wrbali:,es his right to refuse. 
Appointment Provide (b)(6); RN / h\ / 7\ /r\ 
2019-ICLl-0005 1 3306 

DHS-ICE-19-0196, 19-0197-N-000488
Electronica ll y signed b (b)(6); /h\/ 7 \/1"'\ 
Sign off status: Complete 
, RN on 09/09/201818 :42:20 (Pacific Daylight Tlme) 
Northwest Detention Center 
1623 E J STREEr 
TACOMA, WA98421 
Te1Kb)(6); 
Patient: AMAR, IIERGENSANA DOB: 10/2 3/1978 ProgNu Nota (b)(6); (b)(?){C) RN 09J09/2018 
NcJ.e general.ed by eC/inica/Wm<s EM?./PM &1ft..ere (WNNeC/inlca/Works.COff9 
2019-ICLl-00051 3307 

DHS-ICE-19-0196, 19-0197-N-000489
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA .. A:21626980 2 Su:i1~) (6); _ I 
Facility Code: CSOINWA liiQked . lfl 
39Y old Mal~,· AccOl.rll llunbe b 6 · 
09 /09/2018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Three limes A Day, stop date 
09/11/2018, K<F. No, Drug Source: In House Pharmacy, Notes: Not 
required for lra\el, this is to be giwn if patient not taking adequate 
po or IVh)dration 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue admits. 
Fewr denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbance denies. ~ ight gain denies. 
~ ight loss denies. 
Gastrointestinal: 
Pbdominal pain denies. Blood in stool denies. Change in 
bowel habits denies. Constipation denies. Decreased 
appetite denies. Diarrhea denies. Difficulty swallowing denies. 
~ure to hepatitis denies. Heartburn denies. 
Hematemesis denies. Nausea denies. Rectal bleeding denies. 
\bm iting denies. ~ ight loss denies. 
Neurologic: 
Balance difficulty denies. Coordination admits. Difficulty 
speaking denies. Dizziness denies. Fainting denies. Gait 
abnormalitydenies. Headache denies. lrritabilitydenies. Loss of 
strength denies. Loss of use of e>dremitydenies. Low back 
pain denies. IVernory loss denies. Pain denies. Sei,ures denies. 
lies denies. Tingling/Numbness denies. Transient loss of 
lis ion denies. Tremor denies. 
1623 E J STREET, T , 
Appoirimert Facility. Northwest Detertion Certer 
Appointm en t Provld e f b)(6) ; (b)(7)(C) rp 
Reas on for Appointment 
1. DJ>JL YM-IU PRCMDER ROUNDS 
History of Pre se nt Illness 
Patient Identification: 
(0851) daily M-IU rounds for a 39 i,o male on hunger strike; he continues to not eat food; now on 52+ missed meals. He is 
drinking water and Pediali!e regularly and his His UAdip )<lSterdaywas normal and reassuring but he does haw some 
h~tens ion still; he remains in bed most of the dayand is retioentto speak with me as he was )<lSterdaytoo. He sa)'S he feels 
weak' but doen not elaborate anyfuther. He has no acute pain n/1/d/f/c. His diastolic BPs are less than 60 mmHg also. Today he 
is allowing me to assess his P80 and listen to his heart sounds. k, before he is withdrawn and does not engage in 
conwrsation; he lies on his bed and pulls his cowrs owrhis head. reoentlabs are normal too. 
Patient Identification 
Patient properly identified by2 sources induding: /0 Badge, Verbally 
Chaperone Present? Yes geo officer 
Wiat language do i,ou speak? Russian 
Interpretation pro\aded? Yes, Interpreter Name 
Name Use notes field 
Language Russian call # 11327 444 
Pain k.sessment 
Pain 
ke i,ou currently in pain? No 
Yitai Signs 
98F 
46 /min 
91/55 mm Hg 
16/ min 
148.3 lbs 
66.5in 
23.58 Index 
orthostatic V.S: l:i,ng 91/55, HR Is 46 bpm 
sitting 91/55, HR is 51 bpm 
standing 88157, HR is 68 bpm. 
Examination 
General El0mination: 
Temp 
09/09/201810:37:12 /'M 
HR 
09/09/2018 10:37:12 /'M 
BP 
09/09/2018 10:37:12 /'M 
RR 
09/09/2018 10:37:12 /'M 
wt 
09/09/2018 10:37:12 /'M 
H 
09/09/201810:37:12 /'M 
BMI 
09/09/2018 10:37:12 /'M 
GENERJ>l PPPEAAPNCE: in no acute distress, well deleloped, well noorished. 
SKIN: nomial, no rashes, no suspicious lesions. 
(b)(6); NP 
(b)(7)(C) -
-
NP 
-
-
NP 
-
-
NP 
-
-
NP 
-
-
NP 
-
-
NP 
-
HEl'RT: S 1, S2 nomial, no murmurs, rubs, gallops. the LT racial pulse feels weaker than yesterday; it is about 50 bpm 
and regular. his skin is midly pale as before; his back is pink, moist, no skin breakde>Ml . . 
!>8O0!\/EN: his ABO appears slightly less concaw than yesterday. it is non tender, no guarding or rigidity. his ABO is 
soft, non distended. 
pt is offering a limited e><i!m. 
Assessment s 
1. Sta~tion , subsequent encounter - T73.0X><D (Primary) 
2. Other malaise and fatigue - 780.79 
Tr eat ment 
1. Starvation , subsequent encOl.rller 
Notes: pt's BP is still low but he is not orthostatic. he is drinking water and pedial)le with a normal labs on the 7th. RN staff to 
continue to obtain orthostatic V.S daily. food encouraged. no acute skin breakdown noted. consider l\iF as needed. 
2. Other malaise and fatigue 
Notes: food and regular water intake encouraged. continue pedial)<l and h;dration to help with diastolic BP: to help increase this 
li a electroliles and fluid. reassess as needed for worsening weakness. 
Follow Up 
pm, dailywhile in the M-IU 
Notes: Education prolided on IVedication and Treatment Ma!dication and Treatment Plan Re"ewed, IVedication risks, benefits, 
alternatiws discussed, Nutrition counseling completed, Patient ad"sed to return to sick call if S)Olptoms worsen prior to nM 
appointment Patient wrba liied understanding of all instructions. Sta)ing Healthy brochure was gi,en to detainee on intake. 
Appointment Provider: (b)(5); (b)(?)(C) 
b)(6); (b)(7)(C) 
-C 
Electronically signed b*~b_)_(6_); __ ~f'P on 09/09/201810:43:31 (Pacific Daylight Time) 
Sign off slatus: Completed 
2019-ICLl-00051 3308 

DHS-ICE-19-0196, 19-0197-N-000490
Northwest Detention Center 
1623 E. J SffiEEI" 
T~WA98421 TelzjJ_; I 
Patient: AMAR, IIERGENS.ANA DOB: 10/23/1978 Pn,g ,.u No ta:~b)(6) ; rp 09/09/2018 
Nd.e general.ed by eOinica/Wm<s B>RIPM Softvere (IW.WeC/inica/Works.com) 
2019-ICLl-00051 3309 

DHS-ICE-19-0196, 19-0197-N-000491
09 10912018 
Curnont Medications 
Taking 
U.S. Immigration 
and Customs 
Enforcement 
Rea son for Appointment 
1. Noc rounds 
AMAR,MERGENSANA 
A:216269802 Su:lloj(b)(6): ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
Acc01.111 lunber:fti}(6);7 
1623 E J STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
• Pedial)le - Solution 1 bottle Three limes A Day, stop date 
09/11/2018, K<F. No, Drug Source: In House Pharmacy, Notes: Not 
required for lra\el, this is to be giwn if patient not taking adequate 
po or IVh)dration 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No Alla ..... 
N.KDA Wiat language do }OU speak? Russian, __ 
Interpretation pro\aded? No interpreter available during visit 
Pain Assessment 
Pain 
/>,e }OU currently in pain? No 
Narratiw: 
Pt awake watching mo\aes on ew shift. Drank a total of 1 liter Pedial)le. !'a:epted a fresh bottle this am. 
Examination 
General Examination: 
GENER/IL PPPEPRPNCE: comfortable. 
HE/ID: nonnocephalic, atraumatic. 
ENT: EYES: nonm l, EARS: normal, NOSE: noonal, ORAL CAVITY: normal, Tl-ROAT: normal. 
SKIN: good turgor, no rashes, no suspicious lesioos, warn, and dry. 
HE.i>RT: regular rate and rhyttvn. 
LUNGS: no wheezes, rales, rhoochi. 
/>BDO\,EN: nom,al. 
MJSCULOSKELETM.: good strength and equal bilaterally. 
EXTREMTIES: full range of motioo. 
NEUROLOGIC: neck supple, no rigidity, no trem:,r, noonal strength, tooe and reflexes, sensory exam intact. 
PSYCH: cognitiw functioo intact. 
Assessments 
1. Defensiw coping - ND00071 (Primary) 
2. Deficient knowledge [00126] - ND00126 
Treatmen t 
1. Defensive coping 
Notes: Detaineewrba li>Bd understanding of plan of care and denies questions/concerns. Continue hunger strike protocol, 
encourage po food/fluids, encourage 1.erbali,ation offeelings. Encourage to allow staff to monitor intake and ou1put, 1,1tal signs, 
wt. Instructed to seek staff'Mth any needs. 'lkrbaliied understanding. Call bell within reach, bed in lowest position with siderails 
up x2, brakes on. Nursing Care Plan present Refer to nursing care plan for on-going inten.entions. Detainee offered three meals 
per day and leaw in room for at least 20 minutes. /ldequate supply of drinking water and other be1.erages as ordered bypro1,1der 
a\0ilable. Encourage dailyoral/phy.;ical h19iene care. Change of dothinglbedding offered M[]-W[] - F []. Detainee 1.erbali>Bd an 
understanding of education and/or lreabnenl Voices no other concerns. 
Appointment ProvideHb)(6); RN -~~- --~r-· 
Electronically signed b~_b_)(_6_);_~~ on 09/09/2018 07:05:10 (Pacific Daylight lime) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREET 
TACOMA, WA98421 
re!(b)(6) ; I ax. 
Patient: AMAR, MERGENSANA DOB: 10/2 3/19 78 ProgrwM N~ 09/09/2018 
Ncte gener8/ed byeC/inica!Wcxi<s EM<IPM Soflvere (""""'eC/inica/Works.com) 
2019-ICLl-00051 3310 

DHS-ICE-19-0196, 19-0197-N-000492
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:llDt(h \In\ ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOUll lunber: lrh\m \- I 
1623 E J STREET, TACOMA, WA-98421 
Appoimnert Facility: Northwest Detertion Certer 
09 10812018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Three limes A Day, stop date 
09/11/2018, K<F. No, Drug Source: In House Pharmacy, Notes: Not 
required for lra\el, this is to be giwn if patient not taking adequate 
po or IVh)dration 
Alla ..... 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache admits. 
Lightheadedness admits, when stand up very quickly from 
bed . Sleep Disrurbance admits. ll'ieight loss admits. Dry 
M:>uth denies. ll'ieakness admits. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. l'lxlo minal Pain denies. Constipation denies. 
Diarrhea denies,. Nausea denies. \bm illing denies. Painful 
urination denies. Decreased urine output denies. Mlsde 
aches denies. Mlsde cramps denies. Skin breakdown denies. 
Difficultythinking denies. 
Reason for Appointment 
1. RN ewning round firs1/2 shift 
History of Present Illness 
Flowsheets (M-tU): 
lnput/OJtput Flowsheet 
1i me: 1500 From 15:00 to 19:00 
INPUT PO: 300 drinking fluids, 
INPUT SUBTOT/11..: 300 
Appointment Provlde1 (b)(6) ; ~-
OUTPUT Urine 200 + voiding stated that he voided as much he drinking 
OUTPUT SUBTOT/11.. : 200 
Net Gain: 100 
NetLoss: 0 
Initials: LM 
Hungerstrike M:>nitoring Form 
Day. 09/08/.2018 
Shift: PM 
Intake PO (in ml): 300 per pt didnT measure 
OJtput Urine (in ml): 200 voiding, didnT measure, pt stated that he urinated aproximative the same amount as he drink 
Comments: See under lab the u/A dipstick results 
Initials: LM 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEOCFFICER 
IM1at language do )OU speak? Russian 
Interpretation pro\<ded? Provider fluent in patient's native language 
Pain l'ssessment 
Pain 
l'<e )OU currently in pain? Yes 
The pain is located : multiple sites:back, headache 
The sewrityof pain is rated at 6110 
The sewrityof the pain is moderate 
The pain began 1-2 days ago 
The character of the pain is aching 
The associated simptoms are v,eakness 
The pain is aggravated by other 
Describe: hunger strike 
The pain is reliewd by none Pt stated that he '1,/1/ no/ take meds, ""1en this nurse offered him pain killer 
Narratiw: 
pt in M-IU M=D2 for hunger strike: States he is feeling so-so, he feel weakness, admitted pain. This nurse offered pain 
meds, but pt stated that he v,;11 not lake them. Encouraged to eat and drink_ Educated on self care. pt cooperati1.e 1Mth medical 
staff. pt drank electorl)les. W II continue to monilor. 
pt stated that he is drinking eleclol)les and he is urinating, but he not measured how much, He refused lo eat dinner. l's 
dinner it is meal# 53 missed. W II continue to monitor. pt 1.erbali:iation understanding lo all inslrudions and educations. pt asked 
for N, which was giwn to him. W II continue to monilor. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals moniloring initiated: 08/22/2018 
IM1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: Wcints to be released from custody "Release me to US"-" 
/ldequate supply of drinking water and other be1.erages available: Yes 
Three meals deliwred per day to patient Yes 
Lunch deliwred during current shift 0% consumed 
Dinner deli1.ered during current shift 0% consumed 
/lnyunauthori>edfoodinroom? No 
Haw dailyorthoslatic \<tal signs been completed? Yes 
Has input and output been documented on the the M-IU Hunger Strike M:>niloring Smart Form? Yes 
Ex amina tion 
General Examination: 
GENEAA. !>PPE.ARANCE: in no acute distress, well del.eloped, well nourished. 
HEJlD: normocephalic. 
OR.Al CA\ATY: norrnal, mucosa moist. 
SKIN: norrnal, no rashes, no suspicious lesions. 
HE.ART: no murmurs, regular rate and rhythm, S 1, S2 norrnal. 
LUNGS: norrnal, clear to auscultation bilaterally, no Vvheezes, rales, rhonchi. 
PBDOl'vEN: norrnal, bowel sounds present, soft, nontender, nondistended. 
MJSCULOSKELET/11.. : norrnal, norrnal gait, no defonnities, full range o( motion, good strergth and equal bilaterally. 
EXrREMTIES: no edema, full range of motion, no clubbing, cyanosis, or edema. 
NEUROLOGIC: alert and oriented, cooperati1.e with exam, . 
PSYCH: alert, oriented, cogniti1.e function intact, cooperati1.e with exam, good eye contact, judgement and insight 
good , mood/affect full range, speech clear, thought process logical, goal directed. 
Assessments 
/II-Risk for imbalanced nutrition: Less than body requirements. 
Trea tment 
1. Others 
Notes: Detainee wrbali>ed understanding of plan of care and denies questions/concerns. Continue hunger strike prolocol, 
encourage po food/fluids, encourage 1.erbali:iation offeelings. Encourage lo allow staff lo monitor intake and output, ,.;1a1 signs, 
wt. Instructed to seek slafflMth any needs. \krba li,ed understanding. Nursing Care Plan present Refer lo nursing care plan for 
on-going inteiventions. Detainee offered three meals per day and lea1.e in room for at least 20 minutes. A'.lequate supplyof 
drinking water and other bewrages as ordered bypro1Ader available. Encourage dailyoral/phy.;ical h19iene care. Detainee 
wrbali>ed an understanding of education and/or treatment Voices no other concerns. 
Procedure Codes 
T1013 Sign Lang/0-al Interpreter 
2019-ICLl-0005 1 3311 

DHS-ICE-19-0196, 19-0197-N-000493
Electronically signed D*b )/6): f<N on 09/08/201819:52 :06 (Pacific Daytight Time) 
Sign off status: Completed 
Patient: AMAR, Ml!RGl!NSANA DOB: 10/23/1978 ProgN- Note 
Northwest Detention Center 
1623EJSTier 
T~WA98421 Te1Jili6f ! 
RN 09J08/2018 
NcJ.e genermed by eC/inica/Wm<s a.RJPM S:fl"'8re (w.w.,ea, m,,;;,,;,,;;,;,.-;.,.,. r' 
2019-ICLl-00051 3312 

DHS-ICE-19-0196, 19-0197-N-000494
U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgN U No la : 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3313 
AMAR,MERGENSANA .. A:216269802 Su:ll~(b )(6); I 
Fac1lrtyCode:CSOINWA ng,c;ea .lfi 
39 Y old Male, DOB: 10/23/1978 
Acc01.r11 lffl1~ 1
~ I 1623 E J STREET, T 911421 

DHS-ICE-19-0196, 19-0197-N-000495
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA .. A:216269802 Su:ll~b )(6); I 
Fac1lrtyCode:CSOINWA ng,c;ea .lfi 
kcOU11 ~bebX5C ! 39 Y ad ~~ f!::: 
09 /08/2018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Three limes A Day, stop date 
09/11/2018, K<F. No, Drug Source: In House Pharmacy, Notes: Not 
required for lra\el, this is to be giwn if patient not taking adequate 
po or IVh)dration 
Alla ..... 
N.KDA 
vlaw of Systems 
Refuse to giw information related to health, but admited to haw 
-..kness and lightheadedness, and pain. 
1623 E J STREET, T 
Appoirimert Facility. Northwest Detertion Cert er 
Appointment Provlde,t"~b.:..: )..., (6-')'-'- ; -'--'---'~N !'._h\/7\/r.\ ! 
Reason for Appointment 
1. RN day round/hunger strike 
History of Present Illness 
Flowsheets (M-tU): 
lnput/OJtput Flowsheet 
1i me: 0700 From 07:00 to 15:00 
INPUT PO: 1700 
INPUTSUBTOT/11..: 1700 
OUTPUTUrine 700 
OUTPUTBM 0 
OUTPUT SUBTOT/11..: 700 
Net Gain: 1000 
Initials: LM 
Hungerstrike Mln itoring Form 
Day. 09/08/.2018 
Shift: AM 
Intake PO(in ml): 1700 
OJtput Urine (in ml): 700 
OJtput Bowel Mlwments (in ml): 0 PER PT CAN NOT RECALL LAST BM 
Comments: See UIA dip stick under/abs 
Initials: LM 
Patient Identification: 
Patient Identification 
Patient propeMyidentified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEOCf'FICERon duty 
\Mat language do )OU speak? Russian 
Interpretation pro\aded? Provider fluent in pa vent's native language 
Pain 1'6sessment 
Pain 
Ne )OU currently in pain? No 
Narrati\e: 
pt in M-IU med 2 for hunger strike. Encounter with plat 0835 during RN dayround. La~ng on bed appears to be asleep. 
respirations e\en, no distress noted. Wien this nurse called pt name he open his eyes and talk with the nurse, when this nurse 
asked how he is feeling pt stated" so so", pt allowed\$ , Wt, nurse assessment pt is calm and oooperatiw. This nurse strongly 
encouraged pt to drink water and educated about hydration. This nurse instructed pt to inform immediately nurse or officer about 
any changes, or if he need anything, this nurse asked if he has any question for her, pt denied to ha1.e question. \MIi continue to 
monitor. 
Ctlser.ed pt to walking and using toilel pt pro\ided urine for U/Adip stick Mer using toilel pt was it 1.erymiticulosly. 
Encountered with pt multiple times, all the time pt was la~ng in the bed , about 1500 encountered again with pt his head was 
cow redwilh towel, when this nurse called him, he rise the towel from his eyes and talk to this nurse. pt continue to refuse meal. 
pt miss meal # 52 with lunch. \MIi continue to monitor. 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
Wien did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes 
Reason for hunger strike: IMlnts to be released from custody "relase to USI\" 
/1<:!equate supply of drinking water and other be1.erages available: Yes 
Three meals deli\ered per day to patient Yes 
Lunch deliwred during current shift 0% consumed 
Dinner deli1.ered during current shift 0% consumed 
/lnyunauthori>edfood inroom? No 
Ha\e dailyorthostatic \ital signs been completed? Yes 
Has input and output been documented on the the M-IU Hunger Strike Mlnitoring Smart Form? Yes 
Vital Signs 
982F 
standing:77 
sitting:58 
supine:50 
standing :85/56 
sitting:94/59 
supine:92/52 
16/ min 
143.8 lbs 
66.5in 
22.86 Index 
Examlinatlon 
General Examination: 
Temp 
09/08f201811:04:08JIM 
1-R 
09/08/2018 11 :04:08 JIM 
09/08/2018 11 :04:08 JIM 
09/08f201811:04:08JIM 
BP 
09/08/2018 02:51 :09 PM 
09/08/2018 11 :04:08 JIM 
09/08/2018 11 :04:08 JIM 
RR 
09/08f201811:04:08JIM 
WI 
09/08/2018 11 :04:08 JIM 
H 
09/08/2018 11 :04:08 JIM 
BMI 
09/08f201811:04:08JIM 
GENER/II.. />PPE.ARPNCE: in no acute distress , well del.e!oped, well r<JUrished. 
HE.AD: normocephalic. 
OR.Al CA\AlY: normal, mucosa moist. 
NECK/THYROID: normal, neck supple, full range of motion. 
SKIN: normal, no rashes, no suspicious lesions. 
HE.ART: no murmurs, regular rate and rhythm, S 1, S2 normal. 
2019-ICLl-00051 3314 
(b)(6); 
(b)(?)(C) 
(b)(6); 
(b)(?)(C) 
~ 
-
~N 
~N 
~ 
-
~ 
~N 
~N 
-
~ 
-
-
~ 
N 
-
-
N 

DHS-ICE-19-0196, 19-0197-N-000496
LUNGS: normal, clear to auscultation bilaterally, no wieezes, rales, rhonchi. 
CHEST: normal, no gross rib deformity, normal shape and expansion. 
/18D0\,EN: normal, bowel sounds present, soft, nontender, nondistended. 
MJSCULOSKELET.i>l: normal gait, full range of motion. 
NEUROLOGIC: alert and oriented,. 
PSYCH: alert, oriented, cognili1oe function intact,, good eye contact, speech clear, thought process logical, goal 
directed. 
Assessments 
/II-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: Detainee 1oerbali2ed understanding of plan of care and denies questions/concerns. Continue hunger strike protocol, 
encourage po food/fluids, encourage ;erbaliiation of feelings. Encourage to allow staff to monitor intake and output, \ital signs, 
wt. Instructed to seek staff with any needs. \lerbali,ed understanding. Nursing Care Plan present Refer to nursing care plan for 
on-going interwntions. Detainee offered three meals per day and lea,e in room for atleast20 minutes. Pdequate supplyof 
drinking water and other be;erages as ordered byprolider available. Encourage daily oral/physical h>9iene care. Detainee 
;erbali2ed an understanding of education and/or treatment Voices no other concerns. 
Procedure Codes 
T1013 Sign Lang/0-al Interpreter 
Appointment Provider: (b)(6); /h \/ 7\ tr"\ 
Electronically signed ~(b)(6); ~-
Sign off status: Completed 
RN 
~ on 09/08/201816 :33:05 (Pacific Daylight Time) 
Northwest Detention Center 
1623 E. J STRfE 
T~=A98421 !@61~ I 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 Progr9as Notej(b)(6); ~- "" 09/08/2018 
/lkie generated by eOirica/Wo-lcs aR'PM s:,t,-e (w.w,eC/iniceiWorks.lXJl11 
2019-ICLl-00051 3315 

DHS-ICE-19-0196, 19-0197-N-000497
U.S. Immigration 
and Customs 
Enfor cement 
AMAR,MERGENSANA 
A: 216269802 Su:lltfb )(6 ): J 
Facility Code: CSONVWA Housing Area : 
39 Y old Male, DOB: 10/23/1978 
Acc01.111 ~ )(6); I 
09 10812018 
Curnont Medications 
Taking 
• Pedial)le - Solution 1 bottle Three limes A Day, stop date 
09/11/2018, K<F. No, Drug Source: In House Pharmacy, Notes: Not 
required for lra\el, this is to be giwn if patient not taking adequate 
po or IVh)dration 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue admits. 
Fewr denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbance denies. ~ ight gain denies. 
~ ight loss denies. 
Gastrointestinal: 
Pbdominal pain denies. Blood in stool denies. Change in 
bowel habits denies. Constipation denies. Decreased 
appetite denies. Diarrhea denies. Difficulty swallowing denies. 
~ure to hepatitis denies. Heartburn denies. 
Hematemesis denies. Nausea denies. Rectal bleeding denies. 
\bm iting denies. ~ ight loss denies. 
Neurologic: 
Balance difficulty denies. Coordination admits. Difficulty 
speaking denies. Dizziness denies. Fainting denies. Gait 
abnormalitydenies. Headache denies. lrritabilitydenies. Loss of 
strength denies. Loss of use of e>dremitydenies. Low back 
pain denies. IVernory loss denies. Pain denies. Sei,ures denies. 
lies denies. Tingling/Numbness denies. Transient loss of 
lis ion denies. Tremor denies. 
1623 E J STREET,·, VVM842 I 
Appoimnert Facility: Northwest Detertion Cert er 
Appointm en t Prov1c1e ,t;b)(6) ; (b) (?)(C) !NP 
Reas on for Appointm ent 
1. tvhu lis it hunger strike 
History of Prese nt Illness 
Patient Identification: 
(1254) dailyM-IU rounds for a 39 i,o male on hunger strike; he continues to not eat food; now on 50+ missed meals. He is 
drinking water and Pediali!e. His UAdip today is reassuring but he does haw some hwatension still; he remains in bed most of 
the day and is reticent to speak with me; he says he knows his name, DC8andwhere he is but he does not actually say his 
name, DC8 or where he is. he says he has generali2Bd weakness but does not want any medication or inten.ention. he is 
allowing me to assess his skin, pulse and P80 today but otherwise is wrywi thdrawn and does not engage in conwrsation; he 
lies on his bed and pulls his cowrs owr his head. recent labs are normal. 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes geo olli<'.j,~) (6)! 
Wiat language do i,ou speak? Ru 
Interpretation pro\aded? Yes, Interpreter Name 
Name Use notes field 
Language Russian INT# 7163, call# 112602 (interpreter does not knowthe lull call# and i could not hearit ooen itoos 
given in#ally) 
Pain />ssessment 
Pain 
ke i,ou currently in pain? No 
Yitai Signs 
982F 
50 /min 
92/52 mm Hg 
16/min 
143.8 lbs 
66.5in 
22.86 Index 
Pa st Ord ers 
Temp 
09/08/2018 01 :29:46 PM 
HR 
09/08/201801:29:46 PM 
BP 
09/08/201801:29:46 PM 
RR 
09/08/201801:29:46 PM 
wt 
09/08/201801:29:46 PM 
H 
09/08/201801:29:46 PM 
BMI 
09/08/201801:29:46 PM 
Lab:Urinall§ is Dipstick IQ:der Date - 09/08/2018) /Collection Date - 09/08/2018) 
Result:wn l 
Leukocytes 
Nitrate 
Urobilirogen 
Protein 
pH 
Blood 
Specific Gravity 
Ketores 
Billirubin 
Glucose 
Colo r 
Clarity 
Examination 
General Elo!mination: 
NEG 
NEG 
0.2 
NEG 
7.0 
NEG 
1.010 
15 
NEG 
NEG 
YELLOW 
CLEAR 
GENER/IL N'PEPRMICE: in no acute distress, well de1€1oped, well nourished. 
SKIN: normal, no rashes, no suspicious lesions. 
b)(6) ; 
b)(?) (C ) 
HEAAT: LT radial pulse is bounding and regular. his skin is midly pale; his back is pink, moist, no skin breakdcMn. 
ASDO\IEN: his ABD appears slightly concaw . it is non tender, no guarding or rigidity . 
pt is offering a limited e><am. 
Assessments 
1. Starvation, subsequent encounter - T73.0JO<I) 
2. Other malaise and fatigue - 780.79 
Treatmen t 
1. Starvation, subsequent encOl.lller 
Notes: pt's BP is low but his urine dip is normal. he is drinking water and pedial)le with a normal labs on the 7th. RN staff to 
oontinue to obtain orthostatic vS daily, he is not orhotstatic now. consider ivF as needed. 
2. Other malaise and fatigue 
Notes: food and regular water intake encouraged. reassess as needed. 
Follow Up 
pm 
p 
-
-
p 
-
-
,p 
-
-
p 
-
-
JP 
-
-
p 
-
-
p 
Notes: Education proli ded on IVedication and Treatrnenl IVedication and Treatment Plan Re~ewed, IVedication risks, benefits, 
altematiws discussed, Nutrition counseling completed, Patient ad~sed to return to sick call if S',fllptoms worsen prior to neld 
appointrnenl Patient wrba li,ed understanding of all instructions. Sta)ing Healthy brochure was gi,en to detainee on intake. 
Appointment Provide (b)(6) ; 
/h\/ 7 \/r.\ 
2019-ICLl-00051 3316 

Office of Information Governance and Privacy 
 U.S. Department of Homeland Security 
500 12th St., SW
Washington, D.C. 20536 
www.ice.gov 
November 30, 2020 
Erica Lai 
Cohen & Gresser LLP 
2001 Pennsylvania Ave. NW 
Suite 300 
Washington, DC 20006 
RE: American Oversight v ICE,. 19-cv-01817-RCL
ICE FOIA Case Number 2019-ICLI-00051 
Fourteenth Interim Release 
Dear Ms. Lai, 
This is the fourteenth interim response to your client’s Freedom of Information Act (FOIA) 
requests to U.S. Immigration and Customs Enforcement (ICE), dated June 21, 2018, given the 
tracking number 2019-ICLI-00051. Your clients are seeking the following: 
x A copy of ICE’s initial report on the May 2018 death of ICE detainee Roxana Hernandez 
(also listed in DHS records as Jeffry Hernandez), which ICE was required to publish by 
June 24, 2018. 
x A copy of ICE’s final report on the May 2018 death of ICE detainee Roxana Hernandez 
(also listed in DHS records as Jeffry Hernandez), which ICE was required to publish by 
July 24, 2018. 
x Responsive records include, but are not limited to, records related to the care, treatment, 
discipline, and abuse of Ms. Hernandez, as well as reports or reviews of Ms. Hernandez’s 
death. The records containing the factual information relied upon for ICE’s public 
statements regarding Ms. Hernandez’s death and detention are also responsive. 
x A copy of ICE’s initial report on the November 2018 death of ICE detainee Mergensana 
Amar.
x A copy of ICE’s final report on the November 2018 death of ICE detainee Mergensana 
Amar.
x Responsive records include, but are not limited to, records related to the care, treatment, 
discipline, forced-feeding, and involuntary hydration of Mr. Amar, as well as reports or 
reviews of Mr. Amar’s death. The records containing the factual information relied upon 
for ICE’s public statements regarding Mr. Amar’s death and detention are also 
responsive. Please provide all responsive records from March 1, 2018, through the date of 
the search. 
U.S. Immigration 
and Customs 
Enforcement 

Page 2 of 3
ICE has considered this request under the FOIA, 5 U.S.C. § 552, and processed 501 pages of 
potentially responsive records. ICE has determined that 6 pages were deemed non-responsive. 
ICE has further determined that 30 pages will be released in full and portions of 465 pages will 
be withheld pursuant to Exemptions 6, 7(C), and 7(E) of the FOIA, 5 U.S.C. § 552 as described 
below. 
 
ICE has applied FOIA Exemptions 6 and 7(C) to protect from disclosure the names, e-mail 
addresses, and phone numbers of ICE and DHS employees contained within the documents, as 
well as the names, and other personally identifiable information of other individuals contained 
within the records. 
FOIA Exemption 6 exempts from disclosure personnel or medical files and similar files the 
release of which would cause a clearly unwarranted invasion of personal privacy. This requires a 
balancing of the public’s right to disclosure against the individual’s right to privacy. The privacy 
interests of the individuals in the records you have requested outweigh any minimal public 
interest in disclosure of the information. Any private interest you may have in that information 
does not factor into the aforementioned balancing test. 
FOIA Exemption 7(C) protects records or information compiled for law enforcement purposes 
that could reasonably be expected to constitute an unwarranted invasion of personal privacy. 
This exemption takes particular note of the strong interests of individuals, whether they are 
suspects, witnesses, or investigators, in not being unwarrantably associated with alleged criminal 
activity. That interest extends to persons who are not only the subjects of the investigation, but 
those who may have their privacy invaded by having their identities and information about them 
revealed in connection with an investigation. Based upon the traditional recognition of strong 
privacy interest in law enforcement records, categorical withholding of information that 
identifies third parties in law enforcement records is ordinarily appropriate. As such, I have 
determined that the privacy interest in the identities of individuals in the records you have 
requested clearly outweigh any minimal public interest in disclosure of the information. Please 
note that any private interest you may have in that information does not factor into this 
determination. 
The ICE FOIA Office applied FOIA Exemption (b)(7)(E) to protect from disclosure an internal 
law enforcement sensitive investigative technique. The release of this information would 
disclose investigative techniques and procedures, and could be reasonably expected to risk 
circumvention of the law. 
FOIA Exemption 7(E) protects records compiled for law enforcement purposes, the release of 
which would disclose techniques and/or procedures for law enforcement investigations or 
prosecutions, or would disclose guidelines for law enforcement investigations or prosecutions if 
such disclosure could reasonably be expected to risk circumvention of the law. I have determined 
that disclosure of certain law enforcement sensitive information contained within the responsive 
records could reasonably be expected to risk circumvention of the law. Additionally, the 
techniques and procedures at issue are not well known to the public. 

Page 3 of 3
If you have any questions about this letter, please contact Assistant U.S. Attorney Benton 
Peterson at Benton.Peterson@usdoj.gov or 202-252-2534. 
Sincerely, 
 
 Fernando Pineiro Jr. 
(A)FOIA Officer 
Enclosure: 495 pages 
FERNANDO 
PINEIRO JR
Digitally signed by FERNANDO 
PINEIRO JR 
Date: 2020.11.30 16:25:07 -05'00'

b)(6); (b)(?)(C) 
Electronically signed b (b)(6); 
Sign off status: Comple (b )(?)(C) 
on 09/08/201813:58:22 (Pacific Daylight Time) 
Northwest Detention Center 
1623EJSTREI" 
T~WA98421 "JM1x. I 
Patient: AMAR, IIERGENS.ANA DOB: 10/23/1978 Prog,_u Nohlj~(b_)(_6_); __ ~!NP 09/08/2018 
Nd.e general.ed by eOinica/W<n<s B>RIPM Sottw,re (""""eC/inica/works.CtJm) 
2019-ICLl-00051 3317 
DHS-ICE-19-0196, 19-0197-O-000001

U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:llctb )/6\ ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOllll lunbedlh \/R\· I 
0910812018 
Curnont Medications 
Taking 
• Pedial)le- Solution 1 bottle Three limes A Day, stop date 
09/11/2018, K<F. No, Drug Source: In House Pharmacy, Notes: Not 
required for tra\el, this is to be giwn if patient not taking adequate 
po or IVh)dration 
Alla ..... 
N.KDA 
Review of Systems 
PT REFUSES TO />NSVvER />NY QUESTIONS. 
1623 E J STREET, TACOMA, WA-98421 
Appoimnert Facility: Northwest Detertion Certer 
Reason for Appointment 
1. tvHU RN NIGHT ROUNDS/HUNGER STRIKE 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEOa=F/CERfililil 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number 
Number: 
Language Russian 
Pain Assessment 
Pain 
/>,e }OU currently in pain? No 
Flowsheets (tvHU): 
lnput/OJtput Flowsheet 
lime: 2300 (SH/FT9/712018 2300-9/!ll.2018 0700) 
Appointment Provide (b)(6); 
(b)(7)(C) 
INPUT PO: 0 PT DRINKING WA TE'R AND PED/AL YTE' DURING THE NIGHT. 
INPUT SUBTOT/11..: 0 
OUTPUTUrine 0PTVO/DEDINTOLETONCEDURINGSH/FT 
OUTPUT SUBTOT/11..: 0 
Initials: LDM 
Hungerstrike M'.lnitoring Form 
Day: 09/07 !2018 (SHIFT 9/7/2018 2300 - 9/!ll.2018 0700) 
Shift Night 
lntakePO(inml): 0PTSEENDRINKINGFRCMFAUCETONCEDURINGSHIFT. 
OJtput u~ ml): 0 PTVCWED IN TaLETONCE DURING SHIFT 
lnitials:[Q1!§.J 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
\Mien did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: Yes PT DENIED DRINKING BUT WAS SEEN DRINKING FRCMFAUCET 
Reason for hunger strike: Wcints to be released from custody 
/ldequate supply of drinking water and other be-erages available: Yes 
Three meals deliwred per day to patient Yes 
Breakfast deli-ered during current shift 0% consumed 
/lnyunauthori>edfoodinroom? No 
Haw dailyorthostatic \ital signs been completed? __ DAY SHIFT 
Has input and output been documented on the the M-IU Hunger Strike M'.lnitoring Smart Form? Yes 
Narratiw: 
2300 pt was noted l}'ng in his bed, sleeping with normal rise and fall of chest Detainee does not appear to be in any 
distress. WII continue to monitor. 
0600 pt was assessed after refusing breakfast (missed meal #51 ). pt allowed assessment WII continue to monitor. 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Examination 
General Examination: 
GENER/II.. /IPPE.AR.ANCE: in no acute distress, appears weak and lethargic .. 
PSYCH: alert, oriented. 
Assessments 
1. Risk for electrol}'e imbalance - ND00195 (Primary) 
Treatment 
1. Others 
Notes: 1. Continue with \Atal Signs e-eryshift; Intake and OJtput M'.lnitoring e-eryshift; Dailyweighls; Dailyorthostatic \ital signs. 
2. /In adequate supply of drinking water and other be-erages are available to patient at all times. 
3. Three meals per day are deli-ered to the patient and deli-eryof meals is documented. 
4. ~I food not authori>ed by CD/Phy.,ician is remo-ed from patienfs room. 
5. Patient is not allowed to purchase food from oommissary\ending machine while on hunger strike. 
6. Patient will only be released from hunger strike treatment/monitoring byCD or phy.,ician order. 
7. Patient counseled regarding the medical risks of continuing the hunger strike. 
8. Encouraged to terminate the hunger strike and eat/drink as normal. 
9. pt 1.erbali>ed understanding of care plan. 
Disposition: /ldmitted to tvHU until medically evaluated 
Appointment Providel(b)(6); RN ~-~--~r-· 
Electronically signed b ,~/\~!;~, 
Sign off status: Completed 
2019-ICLl-00051 
on 09/08/2018 04:14:05 (Pacific Daylight Time) 
3318 
N 
DHS-ICE-19-0196, 19-0197-O-000002

Northwest Detention Center 
1623 E J STREET T~FF)~r onto◄ I 
Pati-t: AMAR, IERGENSANA DOB: 10/23/1978 P ........ Not.111.JCbc.l.,..C6>-1l"-· __ ....,jlDI 09/08/2018 
NCl.e general.ed by eC/inica/'Na1<s EM>/PM Sottv.ere (,w,weC/inica/WGYks.COOjl 
2019-ICLl-00051 3319 
DHS-ICE-19-0196, 19-0197-O-000003

U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 ProgNU Nola: 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3320 
AMAR,MERGENSANA A:216269802 Su:lloj(b)(6); I 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll lunber:~ 
1623 EJ STREET, T~ 
DHS-ICE-19-0196, 19-0197-O-000004

U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
.. A:216269802 Su:i1Dl(b)(6); 
Facility Code: CSOINWA t-kxA;inn•,Y"'A'""Ed'" .... lfl.... 
P<:cOlrt ~be(b)(6L I 39 Y old Mal~,·•~~::: 
0910712018 
Curnont Medications 
Taking 
• Pedial)le- Solution 1 bottle Three limes A Day, stop date 
09/11/2018, K<F. No, Drug Source: In House Pharmacy, Notes: Not 
required for tra\el, this is to be giwn if patient not taking adequate 
po or IVh)dration 
Alla ..... 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. lightheadedness denies. 
Sleep Disturbance denies. \Neigh! loss admits. Dry 
Mouth denies. \Neakness admits. Cough denies. Shortness of 
breath at rest denies. Chest pain at rest denies. 
Palpitations denies. l'lxlominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. ½milling denies. Painful 
urination denies. Decreased urine output denies. Mlsde 
aches denies. Mlsde cramps denies. Skin breakdown denies. 
Difficultythinking denies. 
1623 E J STREET, T 
Appoirimert Facility. Northwest Detertion Certer 
Appointment Provlde,(b)(6); (b)(7)(C) 
Reason for Appointment 
1. PM SHIFT NOlE. Hunger Strike Nursing E1,0luation 
History of Present Illness 
Flowsheets (MHU): 
Upon encounter detainee was resting quietlyin bed. Initially, detainee ignored nursing staff but ewntuallydid speak when 
reminded of how he was cooperatiw earlier in the day. Detainee reported weakness in his stomach, legs and back but refused 
any medical treatment Detainee has showered, has been drinking Pedial)le and was obseM!d urinating 1 xthis shift. Detainee 
is now resting quietly in his room. \MIi continue to monitor. 
Hungerstrike Monitoring Form 
Day. 09KJ7 l2018 
Shift: PM 
Intake PO(in ml): 0 
Intake IV- Normal Saline (in ml): 0 
Intake IV- LR (in ml): 0 
Intake NG(in ml): 0 
QJtput Urine (in ml): 0 
Comments: REFUSES TO USE GIVEN WA7ER PITCHER. HAS BEEN DRINKING PED/AL YTE AND WAS SEEN 
URINAnNG 1X 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEOCEF/CER 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number LION BRIDGE-# 9242 
Number Use notes field 
Language Russian 
Pain 1'6sessment 
Pain 
Ne }OU currently in pain? No 
Narratiw: 
Patient is oonsidered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
\M1en did the official hunger strike begin? 08/25'2018 
Date of last meal oonsumed: 08/22/2018 
Last meal oonsumed: Breakfast 
Drinking Fluids: No REFUSES TO USE GIVEN WA7ER PITCHER. 
Reason for hunger strike: 11\ants to be released from custody 
/1<:!equate supply of drinking water and other be-erages a1,0ilable: Yes 
Three meals deliwred per day to patient Yes 
/lnyunauthori>edfoodinroom? No 
Haw dailyorthoslatic \alal signs been completed? Yes 
Has input and output been documented on the the M-IU Hunger Strike Monitoring Smart Form? Yes 
Vital Signs 
Temp 
98F 09,07/201808:45:57 PM 
1-R 
supine:50 09,07/201808:45:57 PM 
standing: 111 09,07/201808:45:57 PM 
sitting:67 09,07/201808:45:57 PM 
BP 
standing:88,161 09,07/201808:45:57 PM 
sitting:102/67 09,07/201808:45:57 PM 
RR 
16/min 09,07/201808:41:02 PM 
H 
66.5in 09,07/201808:41:02 PM 
Examlinatlon 
General B<amination: 
GENER.Al !>PPE.ARANCE: in no acute distress, well del.e!oped, well noorished. 
PSYCH: alert, oriented. 
Assessments 
/>I-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
(b)(6); (b)(7)(C) 
Notes: 1. Continue with \Alai Signs e-eryshift; Intake and QJtput l>lonitoring e-eryshift; Dailyweights; Dailyorthoslatic l>ilal signs. 
2. /In adequate supply of drinking water and other be-erages are a1,0ilable to patient at all times. 
3. Three meals per day are deli-ered to the patient and deli-eryof meals is documented. 
4. ~I food not authori>ed by CD/Phy.;ician is remo-ed from patienrs room. 
5. Patient is not allowed to purchase food from commissary\ending machine while on hunger strike. 
6. Patient will only be released from hunger strike treatment/monitoring by CD or phy.;ician order. 
7. Patientoounseled regarding the medical risks of continuing the hunger strike. 
8. Encouraged to terminate the hunger strike and eat/drink as normal. 
Appointment Providel(b)(6); (b)(7)(C) 
2019-ICLl-00051 3321 
DHS-ICE-19-0196, 19-0197-O-000005

Electronically signed J(b)( 5); (b)(?)(C) r on 09/07/2018 20:49:30 (Pacific Daytight Time) 
Sign off status: ComplJe.re..-uu-------~ 
Addendum: 
OMJ7/201809:50P~bl(6l (bl(?l(Cl ~ 1 LITER a= PEDll'l YTE Ca-JSUM:D ll-ilS E'vENING 
Northwest Detention Center 
1623 E J STREEr 
T=WAg&421 
1'Jb)(6l 
Fax: 
Patl..,t: AMAR, MERGENSANA DOB: 10/23/1978 P ........ (b)(6); (b)(?)(C) 09/07/2018 
2019-ICLl-00051 3322 
DHS-ICE-19-0196, 19-0197-O-000006

09/07/2018 
Allorglos 
N.KDA 
Review of Systems 
U.S. Immigration 
and Customs 
Enforcement 
Reason for Appointment 
1. RN day round/Hunger strike 
AMAR,MERGENSANA 
A: 216269802 Su:llollh \/R\ I 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II lll.mber•fZ,C::• ;:;.,:;;:-::::, =::::J 
1623 E J STREET, TACOMA, WA-98421 
Appoirimert Facility: Northwest Detertion Certer 
Appointment Provide (b)(6); 
(b)(7)(C) 
N 
Refuse to giw infonnation related to health, but admited to ha\A3 
weakness and lightheadedness, and pain during RN />M round. 
History of Present Illness 
Flowsheets (M-tU): 
lnput/OJtput Flowsheet 
Ti me: 0700 From 07:00 to 15:00 
INPUT PO: 1000 
INPUT SUBTOT/11..: 1000 
OUTPUT Urine 300 
OUTPUTBM 0 
OUTPUT SUBTOT/11..: 300 
NetGa~ 
lnitialsi'.l:illfi.l 
Hungerstrike Mlnitoring Fonn 
Day. 09/06>2018 
Shift: AM 
Intake PO(in ml): 1000 
OJtput Urine (in ml): 300 
OJtput Bowel Mlwments (in ml): 0 
Labs - Urine Ke tones: pt provided urine for dip stick ula see lab 
Initials: Vhii7 
Patient ldentifii:iitiu/,: 
Patient Identification 
Patient property identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEOCf'FICERon duty 
\Mat language do )OU speak? Russian 
Interpretation pro\aded? Provider fluent in pa vent's native language 
Pain 1'6sessment 
Pain 
Ne )OU currently in pain? Yes 
The pain is located : pt stated that everything is painful: abd, back, legs, hearl, head 
The sewrityof pain is rated at 9110 
The sewrityof the pain is severe 
The pain began 1-2v.eeksago 
The character of the pain is aching 
The associated symptoms are v.eakness 
The pain is aggravated by none 
The pain is reliewd by other 
Describe: pt refused any treatment 
Narratiw: 
Pl in M-IU med 2 for hunger slrike. Encounter with ptat 07:35 with M:llh \/R\· l>clorlried to com.incept to coopetate, but 
he stated bring me the order. Encountered during RN dayround at 08:00. La~ng on bea appears to be asleep. respirations ewn, 
no distress noted. 'M1en this nurse called pt name he open his e\eS and talk with the nurse, when this nurse asked how he is 
feeling pt stated" ploho" he refused VS, refused assessment he refused any treatments, but he admitted to haw weakness, 
lightheadedness, when this nurse asked if he has any pain he stated that ewr')thing is in pain, this nurse offered lo bring pain 
medication, or any treatment but he stated that he will not lake any medications. This nurse strongly encouraged ptlo drink water 
and educated pt about kidneys damage, and body damage if he continue do not drink water, but pt adamantly refused an'.,lhing. 
Pl refused to sign refusal fonn. This nurse instructed pt lo infonn immediately nurse or officer about any changes, or if he need 
an'.,lhing, this nurse asked if he has any question for her, pt denied lo haw question. \MIi continue lo monilor. 
fl/, 08:50"_\ll~~II.L\ICE went inside and spoke with pt 
0905 (b )(6); e>q:>lained lo pt ewr')thing 
0920 pt re s s 19n refusal fonn 
0921 reeling court order lo pt l.ia translalor 
0936 giwn to pt paper to read 
0940 spec al force team present ne>I lo door, theydidnt enter in the room 
0945 M)~lk to pt again 
09:46L~VS 
0957-1000 draw blood for lab 
1008 ~sessed pt 
10:13 pt drink a little of electrol)!e solution 
Enoounteredwith pt during shift multiple times, and encouraged lo drink, pt follow the instruction. Mlstof the shift he was 
la}'ng in the bed and resting, he urinate, and giw urine for dip stick. \MIi continue lo monilor. 
Pl miss meal # 49 with lunch, he continue lo refused meal. Encouraged lo drink_ This nurse didn't obserwd pt lo drink water. 
\MIi oontinue to monilor. 
Patient is oonsidered lo be on official hunger slrike and will be isolated from other detainees for dose superl.ision, 
observation, and moniloring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals moniloring initiated: 08/22/2018 
'M1en did the official hunger slrike begin? 08/25'2018 
Date of last meal oonsumed: 08/22/2018 
Last meal oonsumed: Breakfast 
Drinking Fluids: Yes pt starled to drink fluids a/le 10:30 wien oourl orderv.as read to him 
Reason for hunger strike: W.,nts to be released from custody "relase to US<\" 
/1<:!equate supply of drinking water and other bewrages available: Yes He states he refuses to drink v.ateror any fluids. 
Three meals deliwred per day lo patient Yes 
Lunch deliwred during current shift 0% consumed 
Dinner deliwred during current shift 0% consumed 
/lny unautihori,ed food in room? No 
Haw dailyorthoslalic I.ital signs been oompleted? Patient refused, see oompleted refusal form Refused to sign refusal 
form. 
Has input and output been documented on the the M-IU Hunger Strike Mlniloring Smart Fonn? Yes 
Vital Signs 
Temp b)(6); 
98F 09/07/201804:23:51 PM b)(7)(C) 
HR 
standing:111 09/07/201804:23:51 PM 
silting:67 09/07/201804:23:51 PM 
supine:50 09/07/201804:23:51 PM 
BP 
2019-ICU-00051 3323 
~ 
-
-
~ 
~ 
~ 
- DHS-ICE-19-0196, 19-0197-O-000007

standing:88/61 
sitting:102167 
supine:106/63 
16/min 
142.4 lbs 
66.Sin 
22.64 Index 
'vS taken at 09:46 after oourt order was read to pt 
Examination 
General Examination: 
09/07/201804:23:51 PM 
09/07/201804:23:51 PM 
09/07/201804:23:51 PM 
RR 
09/07/201804:23:51 PM 
Wt. 
09/07/201804:23:51 PM 
H 
09/07/201804:23:51 PM 
BMI 
09/07/201804:23:51 PM 
GENERl>I.. J>PPE.ARl'NCE: in oo acute distress, well del.eloped, well rourished. 
HE.AD: nonnocephalic. 
ORPl CA'v!TY: REFUSED TO OPEN MOUTH, SOME LIGHT DRYNESS OF n-E LIPS NOTED . 
NECK/TH'\'ROID: nonral, neck supple, full range of motion. 
SKIN: refuse exam. 
HEPRT: REFUSED EX<I.M. 
LUNGS: REFUSED EX<I.M. 
/>BDOM:N: REFUSED EXAM. 
MJSCULOSKELETl'l: not obsE!f\ed. did shoMlr. 
NEUROLOGIC: alert and oriented,, . 
(b)(6); 
(b)(7)(C) 
PSYCH: alert, Oliented, cogniti\e function intact,, good eye contact, speech clear, ttKlught process logical, goal 
directed. 
Assassments 
/>I-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
RN 
RN 
RN 
-,-
RN 
,-
,-
RN 
,-
I￾RN 
-,-
RN 
,-
Notes: Detainee "i>rbaliied understanding of plan of care and denies questions/oonoems. Continue hunger strike protocol, 
enoourage po food/fluids, encourage 1.erbalization of feelings. Enoourage to allow staff to monitor intake and output, \ital signs, 
wt Instructed to seek staff with any needs. Verbali,ed understanding. Nursing Care Plan present Refer to nursing care plan for 
on-going inter1.entions. Detainee offered three meals per day and lea1.e in room for at least20 minutes. /ldequate supplyof 
drinking water and other be"i>rages as ordered byprolider available. Enoourage daily oral/physical h19iene care. Detainee 
"i>rbaliied an understanding of education and/or lrealment Voioes no other oonoems. 
Procedure Codes 
T1013 Sign Lang/Q-al Interpreter 
Appointment Provide (b)(6); 
(b)(7)(C) 
Bectronically signed bj(b)(6); ~-
Sign off status: Completed 
~ on 09/07/201816:25:27 (Pacific Daylight Time) 
Northwest Detention Center 
1623 E J STRE£r 
TACOMA, WA98421 
Tefb)/6) i 
Fax: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progress No,(b)(6); (b)(7)(C) r 09/07/2018 
Ncte generated byeC/inica/Wcrl.s a.R/PM Sottv.ere ("""'eC/inica/Works.com) 
2019-ICLl-00051 3324 
DHS-ICE-19-0196, 19-0197-O-000008

U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:lll\'b )/6) ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll lunber~ 
1623 EJ STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
09/07/2018 
Allergles 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue admits, that is constant, that is 'Mll'Sening. 
Headache denies. Lightheadedness admits, SEMlllll times. 
Sleep Disturbance denies. W.ight loss denies. Dry M:>uth denies. 
W!akness admits, his legs 'Mlf'll hold him. Cough denies. 
Shortness of breath at rest denies. Chest pain at rest denies. 
Palpitations denies. />bdominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. \bmitting denies. Painful 
urination denies. Decreased urine output admits. Mlsde 
aches admits extremities and back. Mlsde cramps denies. 
Skin breakdown denies. Difficultythinking denies. 
Aflpolntment Provlcle1(b)(6); (b)(7)(C) IMD 
Reason for Aflpolntment 
1. Hunger Strike 
History of Present Illness 
Flowsheets (M-tU): 
Pt has refused all assessments and food and fluids. The judge agreed with the dedaration and granted court ordered lab 
monitoring as well as forced ,;tals and IVh)<lration as needed. The GEO team came with ICE to inform the patient of his court 
order to ensure medical is able to carryout the court orders. Russian telephone interpreter was used to read the court order and 
e~lain the process. In the end the patient agreed to the ,;tals monitoring, lab draw and urine testing without being forced. He 
also agreed to drink oral electrol)(e solution rather than be forced to ha1.e IV placed. Pt was found to ha1.e marked orthostatic 
changes as well as significant weight loss. The labs were sent out at stat 
Hungerstrike Mlnitoring Form 
Day. 08/29/2018 
Shift: AM 
Intake PO(in ml): 0 1 literofelectro/yte solution for day shift 
OutputUrine(inml): 0300cc 
Output Bowel Ml-vements (in ml): 0 about a i<eek 
Labs - Urine Ketones: Pos 
Labs - Sodium: see attached 
lnitials:lffiii] 
Patient ldenti!Fai'!ron: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
W1at language do )OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number 
Number _. Uonbrldge 11321717 
Language Russian 
Pain l'ssessment 
Pain 
Ne )OU currently in pain? Yes 
The pain is located Use Notes Section all over l0i<er body 
The se-verityof pain is rated at 6110 
The se-verityof the pain is moderate 
The pain began 1-2i<eeksago 
The character of the pain is aching, is constant 
The associated symptoms are none 
The pain is aggravated by olherv.ith orwthout movement 
The pain is relieved by none refused offer of medication 
Narrative: 
Hunger Strike: 
~ical Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
Wien did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking fluids: Yes denies drinking but has been seen to drink a small amount 
# of da)', on hunger strike: 13 
Total W.ight loss in pounds: 21 
Reason for hunger strike: W.,nts to be released from custody 
Housing/Isolation Location: M,dical Housing Unit 
Reason for Isolation Placement For dose supervision, obse,vation, and monitoring 
Re\aew of the Housing Placement Review housing every 24 hours 
13% dedine in W. with BM down to 22. 
Vital Signs 
98F 
111 /min 
88/61 mm Hg 
16/min 
142.4 lbs 
66.5in 
22.64 Index 
Examination 
General Examination: 
Temp 
09/09/201808:40:02 PM 
HR 
09/09/201808:40:02 PM 
BP 
09/09/201808:40:02 PM 
RR 
09/09/201808:40:02 PM 
wt 
09/09/201808:40:02 PM 
H 
09/09/201808:40:02 PM 
BMI 
09/09/201808:40:02 PM 
GENERJ>l J>PPEAAPNCE: pt alert and oriented in no distress, saying few words but cooperating. 
EYES: pupils equal, round, reacti1e to light and accommodation. 
ORPl CA\/ITY: dry MM but no lesions. 
NECKfTHYROID: normal, neck supple, full range or motion. 
SKIN: normal, no rashes, no suspicious lesions. 
HE.ART: no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNG.5: normal, clear to auscultation bilaterally, nowieezes, rales, rhonchi. 
CHEST: normal, no gross rib defoonity, normal shape and expansion. 
(b)(6); (b)(7)(C) 
/lllDOIVEN: scaphoid, , no guarding or rigidity, no ascites, no hepatosplenornegaly, soft, nontender, nondistended. 
2019-ICLl-00051 3325 
DHS-ICE-19-0196, 19-0197-O-000009

MJSCULOSKELETl'l: atrophic muscles, tender to palpation. 
PSYCH: alert, oliented, cognitilA'l function intact, poor eye contact, speech diminished output, ',Olume, no auditory or 
1.1sual hallucinations, thought content v.ithout suicidal ideation, delusions. 
Assessments 
1. Starvation, subsequent encounter - 173.0X)Q) (Primary) 
2. Imbalanced nutrition: Less than body requirements [00002]-ND00002 
3. Risk for Deficient Fluid \blume [00028]-ND00028 
/II-Risk for imbalanced nutrition: Less than body requirements 
Self-imposed Hunger strike. 
Treatment 
1. Starvation, subsequent encotrter 
L/18: Phosphorus Serum -001024 /Cxdered for09/0712018) 
L/18: Creatine Kinase Total Serum - 001362 (Cxdered for 09/0712018) 
L/18: tyagnesium Serum - 001537 (Cxdered for 09/0712018) 
L/18: Prealbumin -016931 (Cxdered for 09/0712018) 
Notes: We halA'! recei\A'ld a oourtorderfor lab testing, ,Hals and IVh)dration. tthe refuses oral h)dration he will need an IVof 
05NS tra 250cc/hr x2 liters. 
2. Others 
Start Pedialjte Solution,-, 1 bottle, Oally, Three limes A Day, 4 days, 1, Ka>: No, Drug Source: In House Pharmacy, Notes: Not 
required for trawl, this is to be gi1.en if patient not taking adequate po or IVh)dration 
Labs 
Lab: Phosphorus Serum - 001024 (Cxdered for 09/0712018) \/\NL 
Phosphorus 2.8 
Lab: Creatine Kinase Total Serum -001362 /Cxdered for09/0712018) 
Creatine Kinase.Total 98 
Lab: tyagnesium Serum - 001537 /Cxdered for 09/0712018) 
11/agnesium 1.8 
Lab: Prealbumin-016931 /Cxdered for 09/0712018) 
Prealbumin 18 
Procedure Codes 
T1013 Sign Lang/0-al Interpreter 
Follow Up 
daily 
2.5-4.5 - mg/dL 
24-204-UA. 
1.6-2.3 - mg/dL 
14-35 - mg/dL 
Notes: Education prolAded on M:ldication and Treatmenl M:ldication and Treatment Plan RelAewed, Patient 1.erbali>ed 
understanding of all instructions 
Appointment Provide b)(6); (b){?)(C) 
~b)(6); (b)(?)(C) 
Electronically signed b )(6); (b )(?)(C) 
Sign off status: Comp! 
D 
Don 0910912018 21 :56:11 (Pacific Daylight Time) 
Northwest Detention Center 
1623 E J STREEr 
TACOMA. WA98421 
Telvh\/R\· 
Fax: 
Patient: AMAR, MERGENSANA DOB: 10/2311978 ProgrwM N (b)(6); (b)(7)(C) D 09/07/2018 
N(xe gene,aled by eOinica/Worl<s BvR'FM Soflvere (IWM:i'!!Clrmll:!l"Vl!7'1!1rm~~ 
2019-ICLl-00051 3326 
DHS-ICE-19-0196, 19-0197-O-000010

09/07/2018 
Allergles 
N.KDA 
Review of Systems 
U.S. Immigration 
and Customs 
Enforcement 
Reason for Appointment 
1. tvHU RN NIGHT ROUNDS/HUNGER STRIKE 
History of Present Illness 
AMAR,MERGEN~ 
A:216269802 Si.ti1 (b)(6); 
Facility Code: CSCN/1/WA Housing ea: 
39 Y old Male, DOB: 10/23/1978 
Acc01.111~)(6) 
1623 E J STREET, TWA-911421 
Appoimnert Facility: Northwest Detertion Certer 
Appointment P1'ovldefb)(6); ~-
PT REFUSES TO/>Nsv.ER />NY QUESTIONS. Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEOa=F/CER(b}fl 
Wiat language do }OU speak? Ruf!iirirr 
Interpretation pro\aded? Provider fluent in pallenrs nallve language 
Pain l>ssessment 
Pain 
/>,e }OU currently in pain? No 
Flowsheets (tvHU): 
lnput/OJtput Flowsheet 
Time: 2300 (SH/FT9/612018 2300-9/7/2018 0700) 
INPUT PO: 0 PT DENIED DRINKING WA7ER DURING THE NIGHT BUT HE WAS SEEN DR/NIK/NG FROM THE FAUCET 
71MCE. 
INPUT SUBTOT/ll: 0 
OUTiPUTUrine 0PTVO/DEDINTOLETONCEDURINGSH/FT 
OUTiPM/ll, o Initials: (b )(6) 
Hungers itoring Form 
Day 09t!J6l2018 (SHIFT9/6/2018 2300-9/7/2018 0700) 
Shi~ Night 
lntakePO(inml): 0PTSEENDRINKINGFROMFAUCET71MCEDURINGSHIFT 
OJtput rne 'T ml): 0PTVCWEDIN TaLETONCEDURINGSHIFT 
Initials: b )(6 
Hunger Strik . 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/220)18 
\M1en did the official hunger strike begin? 08/25'2018 
Date of last meal oonsumed: 08/220)18 
Last meal oonsumed: Breakfast 
Drinking Fluids: Yes PT DENIED DRINKING BUT WAS SEEN DRINKING FROM FAUCET 
Reason for hunger strike: 11\ants to be released from custody 
l'<:!equate supply of drinking water and olher be-erages available: Yes 
Three meals deli-ered per day to patient Yes 
Breakfast deli-ered during current shift 0% consumed 
/lnyunauthori>edfoodinroom? No 
Hase dailyorthostatic \ital signs been oompleted? __ DAY SHIFT 
Has input and output been documented on lhe lhe M-IU Hunger Strike M:lnitoring Smart Form? Yes 
Narratiw: 
2300 pt was noted l}'ng in his bed, sleeping wilh normal rise and fall of chest Detainee does not appear to be in any 
distress. WII oontinue to monitor. 
0110 pt up to brush teeth, drink water, and urinate. 
0530 Watched pt lia lideo twice grab mashed potatoes in hand and slide arm under blanket pulled 01.er head. Pre 3% 
breakfast 
0600 pt was assessed after refusing breakfast (missed meal #48). pt refused to speak wilh nurse. pt refused to cooperate 
during RN assessment Refused IS or to prolide a urine sample or weight assessment WII continue to monitor. 
Patient is considered to be on official hunger strike and will be isolated from olher detainees for dose supen.ision, 
observation, and monitoring. 
Examination 
General B<amination: 
GENER/ll /IPPE/IR.ANCE: in no acute distress, appears weak and lethargic .. 
PSYCH: alert, oriented. 
Assessments 
1. Risk for electrol}'e imbalance - ND00195 (Primary) 
Treatment 
1. Others 
Notes: 1. Continue with \,Ital Signs e-eryshift; Intake and Output M:lnitoring e-eryshift; Dailyweights; Dailyorthostatic \ital signs. 
2. /In adequate supply of drinking water and olher be-erages are available to patient at all times. 
3. Three meals per day are deli-ered to lhe patient and deli-eryof meals is documented. 
4. ~I food not authori>ed by CD/Phy.;ician is remo-ed from patienfs room. 
5. Patient is not allowed to purchase food from commissar)llending machine while on hunger strike. 
6. Patient will only be released from hunger strike treatment/monitoring byCD or phy.;ician order. 
7. Patient counseled regarding lhe medical risks of continuing lhe hunger strike. 
8. Enoouraged to terminate the hunger strike and eat/drink as normal. 
9. pt 1.erbali>ed understanding of care plan. 
Disposition: /ldmitted to M-IU until medically evaluated 
Appointment Provide!~(b_)(_6_); -~I RN 
Electronically signed b)(6); (b)(7)(C) 09/07/2018 06:18:28 (Pacific Daylight Time) 
Sign off status: Comp!-------~ 
2019-ICLl-00051 3327 
DHS-ICE-19-0196, 19-0197-O-000011

Northwest Detention Center 
1623 E. J STREEr 
T~~.6.98421 Tel}x6\_, I 
P•tl-t: AMAR, MERGENSANA DC>lk 10/23/1978 ....... -~kb_)(_6_); __ ~1tN 09/07/2018 
/I/de generau,<1 by eOinica/W<rts EJ.RIPM Soft"8re {1W.WeC/inica/WcYks.coojl 
2019-ICLl-00051 3328 
DHS-ICE-19-0196, 19-0197-O-000012

U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgNU Nola: 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3329 
AMAR,MERGENSANA 
Facility~~~~~~~~;ea: lf1 
39 Y old Male, cx.· 10O3'1918 
AccOl.l"II l'unber:[(b)(6); 
1623 E J STREET, TACOMA,i,:-,;.W;.,.A.;,:,984~21,........, 
DHS-ICE-19-0196, 19-0197-O-000013

U.S. Immigration 
and Customs 
Enforcement 
0910612018 
Allergles 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. 11\eight loss denies. Dry M>uth denies. 
11\eakness admits Cough denies. Shortness of breath at 
rest denies. Chest pain at rest denies. Palpitations denies. 
J>l>dominal Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \bmitting denies. Painful urination denies. 
Decreased urine output denies. Mlsde aches denies. Mlsde 
cramps denies. Skin breakdown denies. Difficultythinking denies. 
Appointment Prov1c1e9(b)(6); (b)(7)(C) 
Reason for Appointment 
1. PM SHIFT NOlE. Hunger Strike Nursing E1,0luation 
History of Present Illness 
Flowsheets (MHU): 
Upon encounter detainee was resting quietlyin bed. \/\Ith the translator on the phone, detainee said "no", turned his head 
awayfrom this nurse and covered his head. Detainee refused further oonversation. Detainee is now resting quietly in his room. 
\MIi continue to monitor. 
Hungerstrike M>nitoring Form 
Day. 09i06/.2018 
Shift: PM 
Intake PO(in ml): 0 
Intake rl/- Normal Saline (in ml): 0 
Intake rl/- LR (in ml): 0 
Intake NG(in ml): 0 
QJtput Urine (in ml): 0 
Comments: REFUSES TO USE GIVEN WA7ER PITCHER AND REFUSES TOSI\Y IF HE HAS BEEN DRINKING CR NOT. 
REFUSES TO REPORT OUTPUT. 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEOCEFICER WARD 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number L/00 BRIDGE-# 2963 
Number Use notes field 
Language Russian 
Pain Assessment 
Pain 
/l<e }OU currently in pain? No 
Narrative: 
Patient is oonsidered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Hunger Strike: 
Nursing E11aluation 
Date missed meals monitoring initiated: 08/22/2018 
\M1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: No REFUSES TO USE GIVEN WA7ER PITCHER AND REFUSES TOSI\YIFHE HAS BEEN DRINKING 
ORNOT 
Reason for hunger strike: 11\ants to be released from custody 
/1<:!equate supply of drinking water and other beverages a.ail able: Yes 
Three meals delivered per day to patient Yes 
/lnyunauthori>edfoodinroom? No 
Have dailyorthostatic "tal signs been oompleted? Yes 
Has input and output been documented on the the M-IU Hunger Strike M>nitoring Smart Form? Yes 
VllalSlgns 
16/min 
66.5in 
REFUSES \ATJ>lS A'ID VIEIGHTS. 
Examination 
General Examination: 
RR 
09i06/2018 06:23:04 PM 
H 
09i06/201806:23:04 PM 
GENERJ>l JIPPEJ>RANCE: in no acute distress, well del.eloped, well nourished. 
PSYCH: alert, oriented. 
Assessments 
Ill-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
(b)(6); (b)(7)(C) 
Notes: 1. Continue with \1tal Signs everyshift; Intake and QJtput M>nitoring every shift; Dailyweights; Dailyorthostatic ,ital signs. 
2. /In adequate supply of drinking water and other beverages are a.ail able to patient at all times. 
3. Three meals per day are delivered to the patient and delivery of meals is documented. 
4. /lll food not authori,ed by CDn=>h)Sician is removed from patienrs room. 
5. Patient is not allowed to purchase food from oommissar)l'vending machine while on hunger strike. 
6. Patient will only be released from hunger strike lreatmentlmonitoring byCD or ph)Sician order. 
7. Patient counseled regarding the medical risks ofoontinuing the hunger strike. 
8. Encouraged to terminate the hunger strike and eaVdrink as normal. 
Appointment Providel(b)( 6); (b)(?)(C) 
Electronically signed b¥~(b-)-(6_)_; (-b-)(_7-)(_C_) __ _,r on 09/06/2018 18:24:03 (Pacific Daylight Time) 
Sign off status: Complela · 
2019-ICLl-00051 3330 
DHS-ICE-19-0196, 19-0197-O-000014

Northwest Detention Center 
1623 E. J SffiEEI" 
l'. WA98421 
Tel: (b)/6) x: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progress ~b)(6); (b)(7)(C) ~ 09/08/2018 
Nd.e general.ed by eOinica/Wm<s B>RIPM Softvere (IW.WeC/inica/Works.com) 
2019-ICLl-00051 3331 
DHS-ICE-19-0196, 19-0197-O-000015

0910612018 
Allorglos 
N.KDA 
Review of Systems 
U.S. Immigration 
and Customs 
Enforcement 
Reason for Appointment 
1. RN day round/ Hunger Strike 
AMAR, ~2~!~2~£ I 
Facility Code: CSCN/1/WA . 39 YAcca.nt old Mala,·<!!::: ~ber(b86); 1623 E J STREET, T 
Appoirimert Facility: Northwest Detertion Certer 
Appointment Prov1c1efb)(6); (b)(?)(C) rN 
Refuse to giw infonnation related to health, but admited to ha\A3 
weakness and lightheadedness, and pain. 
History of Present Illness 
Flowsheets (M-tU): 
lnput/OJtput Flowsheet 
Ti me: 0700 From 07:00 to 15:00 
INPUTPO: 0 
INPUT SUBTOT/11..: 0 
OUTPUT Urine 0 
OUTPUTBM 0 
OUTPUJ;S!.IBTOT/11..: 0 
lnitials:l{Qlj 
Hungerstrike Mlnitoring Fonn 
Day. 09!06l.2018 
Shift: AM 
Intake PO (in ml): 0 refuses to measure intake states not drinking 
OJtput Urine (in ml): 0 REFUSED TOCQ.LECTURINE. 
OJtput Bowel Mlwments (in ml): 0 PER PT CAN NOT RECALL LAST BM 
Labs - Urine Ketones: REFUSED URINE DIP ANAL YS/S 
lnitials:Vh\/1 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEOCfflCERon duty 
IM1at language do )OU speak? Russian 
Interpretation pro\<ded? Provider fluent in patient's native language 
Pain l'ssessment 
Pain 
Ne )OU currently in pain? Yes 
The pain is located : pt stated that everything is painful 
The sewrityof pain is rated at 9110 
The sewrityof the pain is moderate 
The pain began 1-21\eeksago 
The character of the pain is aching 
The associated simptoms are l\eakness 
The pain is aggravated by none 
The pain is reliewd by other 
Descr be: Pf refused any treatment 
Narratiw: 
pt in M-IU med 2 for hunger strike. Encounter with ptat 0815 during RN dayround. La~ng on bed appears to be asleep. 
respirations ewn, no distress noted. Wlen this nurse called pt name he open his eyes and talk with the nurse, when this nurse 
asked how he is feeling pt stated" pl oho" which mean bed, he refused lf-3, refused assessmen~ he refused any treatments, but 
he admitted to haw weakness, lightheadedness, when this nurse asked if he has any pain he stated that ewr)lhing is in pain, 
this nurse offered to bring pain medication, or anytreatmen~ but he stated that he will not take any medications. This nurse 
stronglyenoouraged pt to drink water and educated pt about kidney., damage, and body damage if he continue do not drink 
water, but pt adamantly refused anything. Pt refused to sign refusal fonn. This nurse instructed pt to infonn immediately nurse or 
offioer about any changes, or if he need anything, this nurse asked if he has any question for her, pt denied to haw question. VIAii 
continue to monitor. 
Enoounteredwilh pt multiple times, all the time pt was la~ng in the bed, about 1400 encountered again with pt his head was 
cowredwith towel, when this nurse called him, he rise the towel from his eyes and stated that he doesn't want to talk, the nurse 
then stated it is ok but he need some education regarding mo"ng, and this nurse educated pt about how important ii is to mow 
his body, and do some light exercise with anns and legs. Pt miss meal #46 with lunch, he continue to refuse water, and meal. 
Enoouraged to drink, but he whement refused. This nurse didn't obserwd pt to drink water, nor to urinate during the /!Mshifl. VIAii 
continue to monitor. 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose supeNsion, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
Wlen did the official hunger strike begin? 08/25'2018 
Date of last meal oonsumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: No 
Reason for hunger strike: Wcints to be released from custody "relase to USI\" 
/ldequate supply of drinking water and other bewrages available: Yes He states he refuses to drink ooteror any fluids. 
Three meals deliwred per day to patient Yes 
Lunch deliwred during current shift 0% consumed 
Dinner deliwred during current shift 0% consumed 
/lnyunauthori2edfoodinroom? No 
Haw dailyorlhostatic \<lal signs been completed? Patient refused, see completed refusal fom1 Refused to sign refusal 
form 
Has input and output been documented on the the M-IU Hunger Strike Mlnitoring Smart Fonn? Yes 
Vital Signs 
16/min 
66.5in 
pt refused lf-3. 
Examination 
General Examination: 
RR 
09/06/2018 09:37:14 /!M 
H 
09/06/2018 09:37:14 /!M 
GENER/II.. !>PPEPRANCE: inoo acute distress, well del.eloped, well nourished. 
HEAD: normocephalic. 
CJRAL CAvfTY: REFUSED TO OPEN MOUTH, SOME LIGHT DRYNESS OF n-E LIPS NOTED . 
NECK/THYROID: normal, neck supple, full range of motion. 
SKIN: refuse exam. 
HEAAT: REFUSED EXA.M. 
LUNGS: REFUSED EXl'.M. 
J>BDO\,EN: REFUSED EXAM. 
MJSCULOSKELET/11..: not obserwd. did shcMer. 
NEURQOGIC: alert and oriented., . 
2019-ICLl-00051 3332 
b)(6); 
b)(?)(C) 
DHS-ICE-19-0196, 19-0197-O-000016

PSYCH: alert, Oliented, cogniti\El function intact,, good eye contact, speech clear, tl'Klught process logical, goal 
directed. 
Assassments 
Ill-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: Detainee \Elrbali:zed understanding of plan of care and denies questions/concerns. Continue hunger strike protocol, 
encourage po food/fluids, encourage 1.erbali2ation of feelings. Encourage to allow staff to monitor intake and output, ,.;taI signs, 
wt Instructed to seek staff with any needs. \krbaliied understanding. Nursing Care Plan present Refer to nursing care plan for 
Orl-9(ling inter1.entions. Detainee offered three meals per day and lea1.e in room for atleast20 minutes. Pdequate supplyof 
drinking water and other be1.erages as ordered bypro,.;der available. Encourage dailyoral/phy.,ical h19iene care. Detainee 
1.erbali:zed an understanding of education and/or treatment Voices no other concerns. 
Procedure Codes 
T1013 Sign Lang/Oral Interpreter 
Appolnbnent Provide~b)(6); N 
& .. _'-"-''-''"'="'-"-''---'' 
Electronically signed ~b)(6); ~-
Sign off status: Completed 
Addendum: 
09/06/201802:07 p1b)(6); ~-
Patient: AMAR, MERGENSANA DOB: 10/23/1978 
2019-ICLl-00051 
~ on 09/06/201814:05:23 (Pacific Daytight Time) 
(b)(6); 
/h\/7\/C:\ PN she obser1.ed pt to drink water about 12:00 
3333 
Northwest Detention Center 
1623 E J STREEr 
r.,..,....C>...11==""-'-~ 
DHS-ICE-19-0196, 19-0197-O-000017

09/06/2018 
U.S. Immigration 
and Customs 
Enforcement 
Reason for Appointment 
1. DJ>JL YROUNDS 
Appointment Provide b )(6); RN 
._.h.,_,1:....:17_.\l"-r--'. \ _ _. 
AMAR, MERGEN~ 
A:216269802 Si.ti1 (b)(6); 
Facility Code: CSONVWA Hciis1ng ea: 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll llunbl,..lh'-"\"-'lf'..,_,\_· __ _. 
1623 E J STREET, TACOMA, WA-98421 
Appoimnert Facility: Northwest Detertion Certer 
Appointment P1'ovlde!(b)(6); (b)(7)(C) ~N 
Electronically signed b (b)(6); 
/h\/7\/r'\ 
on 11/16/2018 at 07:30 MST 
Sign off status: Pendl 
Northwest Detention Center 
1623 E J STREET 
T WA98421 
Tel b)(6); 
Patl-t: AMAR, MERGENSANA DOIi: 10/23/1978 p,_.... NotJ""(b'-").;..;(6;.:.);_; __ _.!,RN 09/06/2018 
/lkxe generated by eC/inica/Wcrl.s a.RIPM Sottv.ere ("""'eC/inica/Works.com) 
2019-ICLl-00051 3334 
DHS-ICE-19-0196, 19-0197-O-000018

09/06/2018 
Allergles 
N.KDA 
Review of Systems 
U.S. Immigration 
and Customs 
Enforcement 
Reason for Appointment 
1. tvHU RN NIGHT ROUNDS/HUNGER STRIKE 
History of Present Illness 
AMAR,MERGE~ 
A:216269802 Si.ti1 (b)(6); ~· Facility Code: CSCN/1/WA . 
39 Y old Male, DOB: 10/23/1978 
AccOl.rll ~beilibl16l:7 
1623 EJ STREET, T~ 
Appoirimert Facility. Northwest Detertion Certer 
Appointment Provlde1b)(6); (b)(7)(C) ~N 
PT REFUSES TO/>Nsv.ER />NY QUESTIONS. Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes ..f5iiRl)(B Chaperone Name: GEOa=F/CE't:.'..::] 
Wiat language do }OU speak? Russ,an 
Interpretation pro\aded? Provider fluent in pallenrs nallve language 
Pain l>ssessment 
Pain 
/>,e }OU currently in pain? No 
Flowsheets (tvHU): 
lnput/OJtput Flowsheet 
Time: 2300 (SH/FT9/512018 2300-9.l6'2018 0700) 
INPUT PO: 0 PT DENIED DRINKING WA7ER DURING THE NIGHT BUT HE WAS SEEN DR/NIK/NG FROM THE FAUCET 
71MCE. 
INPUT SUBTOT/ll: 0 
OUTiPUTUrine 0PTVO/DEDINTOLETONCEDURINGSH/FT 
OUTiPUT SUBTOT/ll: 0 
lnitials:j(R \la)! Hungerstri e nitoring Form 
Day 09/05/2018 (SHIFT9/5/2018 2300-9.l6'2018 0700) 
Shi~ Night 
lntakePO(inml): 0PTSEENDRINKINGFROMFAUCET71MCEDURINGSHIFT 
OJtput Upne /ij ml): 0PTVCWEDIN TaLETONCEDURINGSHIFT 
Initials: h "" 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/220)18 
\M1en did the official hunger strike begin? 08/25'2018 
Date of last meal oonsumed: 08/220)18 
Last meal oonsumed: Breakfast 
Drinking Fluids: Yes PT DENIED DRINKING BUT WAS SEEN DRINKING FROM FAUCET 
Reason for hunger strike: 11\ants to be released from custody 
/ldequate supply of drinking water and olher be-erages available: Yes 
Three meals deli-ered per day to patient Yes 
Breakfast deli-ered during current shift 0% oonsumed 
/lnyunauthori>edfoodinroom? No 
Hase dailyorthostatic \ital signs been oompleted? __ DAY SHIFT 
Has input and output been documented on lhe lhe M-IU Hunger Strike M:lnitoring Smart Form? Yes 
Narratiw: 
2300 pt was noted l}'ng in his bed, sleeping wilh normal rise and fall of chest Detainee does not appear to be in any 
distress. WII oontinue to monitor. 
0118 pt up to brush teeth, drink water, and urinate. 
0320 pt up reading for 10 minutes 
0600 pt was assessed after refusing breakfast (missed meal #42). pt refused to speak wilh nurse. pt refused to cooperate 
during RN assessment Refused IS or to prolide a urine sample or weight assessment WII oontinue to monitor. 
Patient is oonsidered to be on official hunger strike and will be isolated from olher detainees for dose supen.ision, 
observation, and monitoring. 
Examination 
General B<amination: 
GENER/ll /IPPE/IR/INCE: in no acute distress, appears weak and lethargic .. 
PSYCH: alert, oriented. 
Assessments 
1. Risk for electrol}'e imbalance - ND00195 (Primary) 
Treatment 
1. Others 
Notes: 1. Continue with \,Ital Signs e-eryshifl; Intake and Output M:lnitoring e-eryshifl; Dailyweights; Dailyorthostatic \ital signs. 
2. /In adequate supply of drinking water and olher be-erages are available to patient at all times. 
3. Three meals per day are deli-ered to lhe patient and deli-eryof meals is documented. 
4. ~I food not authori>ed by CD,fi,yaician is remol.ed from patienfs room. 
5. Patient is not allowed to purchase food from oommissar)ll.ending machine while on hunger strike. 
6. Patient will only be released from hunger strike treatment/monitoring byCD or phyaician order. 
7. Patientoounseled regarding lhe medical risks ofoontinuing lhe hunger strike. 
8. Enoouraged to terminate the hunger strike and eat/drink as normal. 
9. pt 1.erbali>ed understanding of care plan. 
Disposition: /ldmitted to M-IU until medically evaluated 
Ap ·ntment P "de b}(B); RN po, rovi h \/ 7\/1. 1 
Electronically signed (b )(6); on 09/06/2018 05:52:07 (Pacific Daylight Time) /h \/7\ff'\ 
Sign off status: Comple 
2019-ICLl-00051 3335 
DHS-ICE-19-0196, 19-0197-O-000019

Northwest Detention Center 
1623EJ~ 
T~~,.,6 98421 Te(b)(61, I 
P•ll-t: AMAR, MERGENSANA DOIi: 10/23/1978 P ........ ~ 09l06/2018 
Nd.e general.ed by eClinica/Wm<s 8"R'PM Softvere (1W.WeClinica/WOrks.Ctlm) 
2019-ICLl-00051 3336 
DHS-ICE-19-0196, 19-0197-O-000020

U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgNU Nola: 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3337 
DHS-ICE-19-0196, 19-0197-O-000021

U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
.. A:216269802 Su:ll~)(6); 
Facility Code: CSCN/1/WA 1119,. ea. 1t1 
39 Y old Male, DOB: 10/23/1978 
1623 E J STREET, T~tdaso4Z 1 AccOUll~b),6~ 
09/05/2018 
Allergles 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue admits. Headache denies. 
Lightheadedness admits. Sleep Disturbance denies. W!ight 
loss admits. Dry MJuth admits. W!akness admits. 
Cough denies. Shortness of breath at rest denies. Chest pain at 
rest denies. Palpitations denies. Pbdominal Pain denies. 
Constipation denies. Diarrhea denies. Nausea denies. 
\.bmitting denies. Painful urination denies. Decreased urine 
output denies. Mlsde aches admits. Mlsde cramps denies. 
Skin breakdown denies. Difficultythinking denies. 
Appoimnert Facility: Northwest Detertion Certer 
Reason for Appointment 
1. tvHU Ewning Nursing Rounds 
History of Present Illness 
Flowsheets (tvHU): 
Hungerstrike MJnitoring Form 
Day. 09/05/.2018 
Shift: PM 
Intake PO(in ml): 0 
Intake r.J-Normal Saline (in ml): 0 
Intake r.J-LR (in ml): 0 
Intake NG(in ml): 0 
QJtput Urine (in ml): 0 
QJtput Bowel MJwments (in ml): 0 
Appointment Provlde,tb)(6): 
Commrts: ]t refused to use urinal. did not take shooorthis evening. No po fluid intake observed 
Initials: /h )In 
Patient ldenti cation: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEO"'h~\~/R~\-- -, 
Wiat language do }OU speak? Russian some english 
Interpretation pro\aded? Yes, Interpreter Number 
Number Use notes ffeld 11313352 
Language Russian 
Pain f<;sessment 
Pain 
Ne }OU currently in pain? No pt declined to ansv,er 
Narratiw: 
"Go ~ay, don, want an)Ahing "First enccunter@ 161 0; do weakness, silting up side bed. J't. firs~ engaged ccnwrsation 
(greeting) howewr soon as requesting urine/blood workMtal sign for his health status pt staled as abow la)ing down on bed 
toward wall cowr his face with blanket 
Patient is ccnsidered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
\Mien did lhe official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal ccnsumed: Breakfast 
Drinking Fluids: No not ansv,eling. 
Reason for hunger strike: Other not ansv,ering 
/ldequate supply of drinking water and other be-erages available: Yes 
Three meals deliwred per day to patient Yes 
Breakfast deli-ered during current shift 0% ccnsumed previous shift 
Lunch deli-ered during current shift 0% ccnsumed previous shift 
Dinner deli-ered during current shift 0% ccnsumed 
Other meal/nutrtional supplement deli sered during current shift, see notes 0% ccnsumed 
/lnyunauthori>edfoodinroom? No 
Haw dailyorthostatic \ital signs been ccmpleted? Yes duling day shift 
Has input and output been documented on the the M-IU Hunger Strike MJnitoring Smart Form? No; WI/ ccmplete before 
the end of the current shift 
Vital Signs 
18/min 
66.5in 
Examination 
General Examination: 
RR 
09/05/201806:42:32 PM 
H 
09/05/201806:42:32 PM 
GENER/ll JIPPEAA.ANCE: chaperone present in room, alert, well hydrated, in no distress . 
OR.AL CAvflY: declined . 
SKIN:~ no suspicious lesions. 
HEART: declined. 
LUNGS:-- declined. 
ASDO\,E~ declined. 
MUSCULOSKELET/>l: refused to sit up or ambulated; obseMd to ambulating to toilet himself. 
(b)(6); - (b)(?)(C) N 
-
-
N 
-
PSYCH:~ alert, oriented, good eye contact, rooodlaffect full range, no auditory or loisual hallucinations, speech 
clear, thought content without suicidal ideation, delusions. 
Assessments 
1. lneffectiw health management - ND00078 (Primary) 
/>I-Risk for imbalanced nutrtion: Less than body requirements. 
Treatment 
1. Others 
Notes: 1. Continue with orthostatic vltal Signs daily(see am shift note); Intake and QJtput M:mitoring e-eryshift; Dailyweights; 
see refusal form 
2. /In adequate supply of drinking water and other be-erages are available to patient at all times. 
3. Three meals per day are deli>ered to the patient and deli-eryof meals is documented. 
4. />II food not authori>ed by CDn:>hy.,ician is remol.ed from patienrs room. 
5. Patient is not allowed to purchase food from ccmmissar)/1.ending machine while on hunger strike. 
6. Patient will only be released from hunger strike lreatmentlmonitoring byCD or phy.,ician order. 
7. Patientccunseled regarding the medical risks ofccntinuing the hunger strike. 
8. Enccuraged to terminate the hunger strike and eat/drink as normal. 
Procedure Codes 
T1013 Sign Lang/Q-al Interpreter 
Disposition:---
2019-ICLl-00051 3338 
DHS-ICE-19-0196, 19-0197-O-000022

Appointment Provider: \~!\~/;,._, 
b)(6); (b)(7)(C) 
Electronically signed ':ti.:..b..:..)(:....6:..:.); _ ___.~ on 09/05{2018 22:31:12 (Pacific Daytlght Time) 
Sign off status: Completed 
Northwest Detention Center 
1623EJSTier 
1: WA98421 
Tel b)(6); 
ti-1: AMAR, IIIIERGENSANA DOB: 10/23/1978 P ........ N°'1.._/b .... )(___ 6 ___ ) _ _.fN 09/05/2018 
NcJ.e genermed by eC/inica/Wm<s a.RJPM S:fl"'8re (w.w.1eC/inica/Works.caT9 
2019-ICLl-00051 3339 
DHS-ICE-19-0196, 19-0197-O-000023

09/05/2018 
Review of Systems 
U.S. Immigration 
and Customs 
Enforcement 
Appointment Provldei(b)(6); (b)(7)(C) !RN 
Patient refuses to ansv.er assessment questions. Refusal form 
submitted to l\lladical Records. 
Reason for Appointment 
1. Day Shift RN Nursing Rounds 
History of Present Illness 
Flowsheets (M-tU): 
lnput/OJtput Flowsheet 
Time: 1400 
INPUTPO: 0 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT SUBTOT/ll: 0 
OUTPUT Urine 0 
OUTPUTEmesis 0 
OUTPUTBM 0 
OUTPUT a. Wet Diaper Weight 0 
OUTPUT b. Dry Diaper Weight 0 
OUTPUT Total Diaper Weight output (calculate a-b) 0 
OUTPUTDrain: 0 
OUTPUT SUBTOT/ll: 0 
NetGain: 0 
Initials: b )(~); Nell~ 
Patient Iden . 
Patient is 39 yo russian male on Hunger Strike. He is easilyarroused when RN enters room and refuses orthostatic blood 
pressures and v.eight. He refuses all else, refuses Prol.ider and nursing assessment refuses lunch. Patient will not stale if he 
has drank water or urinated. Refusal forms are completed and submitted lo IVedical Records. Patient sleeps most of shift. 
Patient 1erbali2es understanding of Plan of Care; and he 1erbali2es his right lo refuse. 
Patient Identification 
Patient prope~yidentified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
\Mal language do )OU speak? English, Russian, __ 
Interpretation prol.ided? Patient speaks English ffuenUy 
Pain 1'6sessment 
Pain 
l'<e )OU currently in pain? No 
Vital Signs 
Refused. 
Examination 
General E><amination: 
GENER/IL !>PPEJ>Rl'NCE: in no acute distress, well del.eloped, well nourished. 
Assessments 
1. lneffecti1e Coping [00069]- ND00069 (Primary) 
2. lneffecti1e community coping - ND00077 
3. Risk for Deficient Fluid \blume [00028]- ND00028 
Hunger Strike. 
Treatment 
1. lneffecthle Coping [00069] 
Notes: Continue hunger strike protocol, encourage po foodllluids, encourage 1erbali,ation of feelings. Encourage lo allow staff lo 
monitor intake and output I.ital signs, wt. lnstruded lo seek staff with any needs. Verbali,ed understanding. Detainee offered 
three meals per day and lea1e in room 20 minutes before taking away. /ldequate supply of drinking water and other be1erages 
as ordered by pro,,der available. Encourage dailyoral/physical h)9iene care. Change of dothing/bedding. Continue lo offer 
l.itals, v,,eights, food, labs, meds. Patient 1erbali,es understanding of Plan of Care, and he 1erbali,es his right lo refuse. 
Appoinbnent Provide b)(6); (b)(7)(C) 
Bectronically signed b )(6); , RN on 09{0&201815:03:25 (Pacific Daylight Time) 
Sign off status: Compl,l'nihi,"-- 7
--"--r ... , _ _. 
Northwest Detention Center 
1623 E. J STREB" 
T WA98421 
Te /bl/6): x: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progrwss No (b)(6); (b)(7)(C) jt.. 09/05/2018 
Ncie generated byeC/inica/Wcrks EM<IPM $oltv.ere (""""eC/inica/Works.com) 
2019-ICLl-00051 3340 
DHS-ICE-19-0196, 19-0197-O-000024

U.S. Immigration 
and Customs 
Enforcement 
AMAR, MERGEN~ 
A:216269802 Si.ti1 (b)(6); ~· Facility Code: CSCN/1/WA Housing ea: 
39 Y old Male, DOB: 10/23/1978 
AccOllll l'unbe1b)(6); 1623 E J STREET TMD,a · · · · -
09/05/2018 
Allergles 
N.KDA 
Review of Systems 
Hunger Strike: 
Headache admits. Dry M'.luth denies. W!akness denies. 
Cough denies. Shortness of breath at rest denies. Chest pain at 
rest denies. Palpitations denies. Pbdominal Pain admits. 
Constipation denies. Diarrhea denies. Nausea denies. 
\bmitting denies. Painful urination denies. Decreased urine 
output admits. Mlsde aches admits. Mlsde cramps denies. 
Skin breakdown denies. Difficultythinking denies. 
1 CJ ii C 
Appoimnert Facility: Northwest Detertion Certer 
Reason for Appointment 
1. tvHU RN NIGHT ROUNDS/HUNGER STRIKE 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEOa=F/CERfilii[J 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number 
Number : 11301432 
Language Russian 
Pain Assessment 
Pain 
ke }OU currently in pain? Yes PT REFUSED PAIN A/ED/CATION 
The pain is located : HEAD, BACK, STCMI\CH, AND LEGS PAIN 
The sewrityof pain is rated at 5110 
The sewrityof the pain is mild to moderate 
The pain began 1-2daysago 
The character of the pain is aching, is constant 
The associated S)ffiptoms are none 
The pain is aggrawted by none 
The pain is relie\ed by none 
Rowsheets (tvHU}: 
lnpuVOJtput Rowsheet 
Time: 2300 (SHIFT91412018 2300-9M018 0700) 
Appointment Provlde1(b)(6); ~-
INPUT PO: 0 PT DENIED DRINK/NG WA1ER DURING 1HE NIGHT BUT HE WAS SEEN DRINIK1NGFRCM1HE FAUCET 
ONCE 
INPUT SUBTOT.AJ..: 0 PT SEEN DRINK/NG FRCMFAUCETONCE DURING SHIFT 
OUTiPUTUrine 0PTSffNDRINKINGFRCMFAUCETONCEDURINGSHIFT 
OUTiPlll,.Sl.llilPT.AJ..: 0 PT DENIED VOIDING DURING SHIFT 
lnitials:l'.!:illfil.l 
Hungerstrike M'.lnitoring Form 
Day 09t04l2018 (SHIFT9/4/2018 2300-9M018 0700) 
Shi~ Night 
lntakePO(inml): 0PTSffNDRINKINGFRCMFAUCETONCEDURINGSHIFT 
OJtput~· ml): 0PTDENIEDVOIDINGDURINGSHIFT 
Initials: (b )(6 
Hunger Strik . 
Nursing Ewluation 
Date missed meals monitoring initiated: 08/22/2018 
\Mien did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: No DETAINEE DENIED DRINKING FLUIDS 7HIS SHIFT 
Reason for hunger strike: Wcints to be released from custody 
/ldequate supply of drinking water and other bewrages awilable: Yes 
Three meals deliwred per day to patient Yes 
Breakfast deliwred during current shift 0% consumed 
/lnyunauthoriiedfoodinroom? No 
Haw dailyorlhostatic \ital signs been completed? __ DAY SHIFT 
Has input and output been documented on the the M-IU Hunger Strike M'.lnitoring Smart Form? Yes 
~: 2300 pt was noted l}'ng in his bed, sleeping with normal rise and fall of chest Detainee does not appear to be in any 
distress. WII continue to monitor. 
0118 pt up to brush teeth, drink water, and urinate. 
0320 pt up reading for 10 minutes 
0600 pt was assessed after refusing breakfast (missed meal #42). pt refused to speak with nurse. pt refused to cooperate 
during RN assessment Refused IS or to prolide a urine sample or weight assessment WII continue to monitor. 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Examination 
General Examination: 
GENER.AJ.. !>PPE.ARANCE: in no acute distress, appears weak and lethargic .. 
PSYCH: alert, oriented. 
Assessments 
1. Risk for electrol}'e imbalance - ND00195 (Primary) 
Treatment 
1. Others 
Notes: 1. Continue with \Alai Signs ewryshift; Intake and OJtput M'.lnitoring ewryshift; Dailyweights; Dailyorthostatic \ital signs. 
2. /In adequate supply of drinking water and other bewrages are available to patient at all times. 
3. Three meals per day are deliwred to the patient and deliwryof meals is documented. 
4. ~I food not authoriied by CD/Phy,;ician is remowd from patienfs room. 
5. Patient is not allowed to purchase food from commissary\ending machine while on hunger strike. 
6. Patient will only be released from hunger strike treatment/monitoring byCD or phy,;ician order. 
7. Patient counseled regarding the medical risks of continuing the hunger strike. 
8. Encouraged to terminate the hunger strike and eat/drink as normal. 
9. pt wrbaliied understanding of care plan. 
Procedure Codes 
T1013 Sign Lang/0-al Interpreter 
Disposition: !'dmitted to tvHU until medicallyewluated 
Appointment Provide (b)(6); 
(b)(7)(C) 
2019-ICLl-00051 3341 
DHS-ICE-19-0196, 19-0197-O-000025

Electronically signed f~b,..)"'(6 __ );---'--'b.., on 09/05/2018 06:33:57 (Pacific Daylight Time) 12.h \/7\lr'\ r-• 
Sign off status: Completed 
Northwest Detention Center 
1623EJSTREI" 
P•ll-t: AMAR, MERGENSANA DOB: 10/23/1978 P ........ -
Nd.e general.ed by eOinica/W<n<s B>RIPM Sottw,re (WNNeC/i 
2019-ICLl-00051 3342 
T~~A98421 r½[~: I 
RN 09IOS/2018 
DHS-ICE-19-0196, 19-0197-O-000026

U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgNU Nola: 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3343 
AMAR, MERGEN_~ 
Facility~~~~~ 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunbe~ 
1623 EJ STREET, T~ 
DHS-ICE-19-0196, 19-0197-O-000027

09/04/2018 
Allergles 
N.KDA 
Review of Systems 
U.S. Immigration 
and Customs 
Enforcement 
Reason for Appointment 
1. tvHU RN Rounds 
AMAR,MERGENSANA 
.. A:216269802 Su:llttib)(6); I 
Fac1lrtyCode:CSOINWA ng,c;ea.lfi 
39 Y old Male, DOB: 10/23/1978 
AccOUll tunbe,fh\lR\· I 
1623 E J STREET, TACOMA, WA-98421 
Appoirimert Facility. Northwest Detertion Certer 
Appointment P1'ovlder:kb)(6); (b)(7)(C) f RN 
Patient refuses to answer assessment questions. Refusal form 
submitted to 11/edical Rerords. 
History of Pl'esent Illness 
Flowsheets (tvHU): 
lnput/OJtput Flowsheet 
Time: 2130 
INPUT PO: 0 unknow, but did shoo,,er for a lengthy #me v.ith curtain pulled 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT SUBTOT/ll: 0 
OUTPUTUrine Ounknow, 
OUTPUTEmesis 0 
OUTPUTBM 0 
OUTPUT a. Wet Diaper Weight 0 
OUTPUT b. Dry Diaper Weight 0 
OUTPUT Total Diaper Weight output (calculate a-b) 0 
OUTPUTDrain: 0 
OUTPUT SUBTOT/ll: 0 
NetGain: 0 
NetLoss: 0 
lnitial~~~l(f ): ! 
Patient Iden ca on: 
Hunger Strike. He is easilyarroused. Refuses all care & pro'1der assessment Patient will not stale if he has drank waler or 
urinated. Refusal forms are completed and submitted lo 1\/edical Reoords. Patient sleeps most of shill Patient verbali,es 
understanding of Plan of Care, but refuses care. 
Patient Identification 
Patient propeMyidentified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
IM1at language do )OU speak? English, Russian 
Interpretation pro'1ded? Patient speaks English ffuenUy 
Pain l'ssessment 
Pain 
Ne )OU currently in pain? No 
Vital Signs 
16/min 
66.5in 
Examination 
General Examination: 
RR 
09/04/201810:07:27 PM 
H 
09/04/201810:07:27 PM 
GENER/IL !>PPEPRANCE: in no acute distress, well del.e!opec, well nourished. 
Assessments 
1. Ineffective Coping [00069]- ND00069 (Primary) 
2. Ineffective oommunityooping - ND00077 
Hunger Strike. 
Treatment 
1. lneffecti\11! Coping [00069] 
(b )(6); -
N (b)(7)(C) -
-
N 
Notes: Continue hunger strike protocol, enoourage po food/lluids, enoourage verbalization of feelings. Enoourage lo allow staff lo 
monitor intake and output, '1tal signs. wt Instructed lo seek staff with any needs. ½rbali,ed understanding. Detainee offered 
three meals per day and leave in room 20 minutes before taking away. Pdequale supply of drinking waler and other beverages 
as ordered by pro'1der awilable. Enoourage dailyoral/phy.,ical h)lliene care. Change of dothinglbedding. Continue lo offer 
litals, weights, food, labs, meds. Patient verbali,es understanding of Plan of Care, oontinues lo refuse. 
Disposition: Pdmitted to tvHU until medicallyewluated 
Notes: tvHU until medical determination 
Appointment Providerb)(6); (b)(7)(C)I, RN 
Electronically signed bfb)(6); __ 
Sign off status: Completed 
2019-ICLl-00051 
pl on 09/04/2018 22:08:51 (Pacific Daylight Time) 
3344 
Northwest Detention Center 
1623 E J STREET 
T'."'l~~=""°i 
DHS-ICE-19-0196, 19-0197-O-000028

P•ll-1: AMAR, IIERGENSANA DOB: 10/23/1978 p,__. b)(6); (b)(?)(C) RN 09/CM/2018 
Nd.e general.ed by eOinica/W<n<s EJvRIPM Sottw,re ("""' 11>0 
2019-ICLl-00051 3345 
DHS-ICE-19-0196, 19-0197-O-000029

09/04/2018 
Allergles 
NKDA 
Review of Systems 
U.S. Immigration 
and Customs 
Enforcement 
Reason for Appointment 
1. RN E\€NING SPLIT SHIFT: HUNGER STRIKE 
History of Present Illness 
AMAR,MERGE 
A: 216269802 Si.tll FacilityCode:CSONVWA -""i""-'r-"-....,,... 
39 Y old Male, 
AccOllll l'unber: i(b )(6); ! 1623 E J STREET, TACOMA, 
Appoirimert Facility: Northwest Detertion Certer 
Appointment Provlcler:t'h\/R\· /h\/7\IC\ I RN 
Patient refuses to answer assessment questions. Refusal form 
submitted to 11/edical Rerords. 
Flowsheets (M-tU): 
lnput/OJtput Flowsheet 
Time: 1400 
INPUTPO: 0 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT SUBTOT/ll: 0 
OUTPUT Urine 0 
OUTPUTEmesis 0 
OUTPUTBM 0 
OUTPUT a. Wet Diaper Weight 0 
OUTPUT b. Dry Diaper Weight 0 
OUTPUT Total Diaper Weight output (calculate a-b) 0 
OUTPUTDrain: 0 
OUTPUT SUBTOT/ll: 0 
NetGain: 0 
Netloss: 0 
Initials: l§JJ~)! Patient ldentifi . 
Patient is 39 yo russian male on Hunger Strike. He is easilyarroused when RN enters room and refuses orthostatic blood 
pressures and weight. He refuses all else, refuses Prolider and nursing assessment refuses dinner. Patient will not state if he 
has drank water or urinated. Refusal forms are completed and submitted lo 1\/edical Records. Patient sleeps most of shift. 
Patient 1erbali2es understanding of Plan of Care; and he 1erbali2es his right lo refuse. Patient id on missed meal #41 as of 
dinner. ICE spoke >Mth detainee today. 
Patient Identification 
Patient prope~yidentified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
\M1at language do )OU speak? &Jglish, Russian, __ 
Interpretation pro\aded? Patient speaks English ffuenUy 
Pain Assessment 
Pain 
Ne )OU currently in pain? No 
Vital Signs 
16/min 
66.5in 
Examination 
General Examination: 
RR 
09/04/201806:40:42 PM 
H 
09/04/201806:40:42 PM 
GENER/IL JIPPEPRANCE: in no acute distress, well del.eloped, well nourished. 
Assessments 
1. lneffecti,e Coping [00069]- ND00069 (Primary) 
2. lneffecti,e community coping - ND00077 
3. Risk for Deficient Fluid \olume [00028]- ND00028 
Hunger Strike. 
Treatment 
1. lneffecti\11! Coping [00069] 
(b)(6); N 
(b)(7)(C) -
-
N 
-
Notes: Continue hunger strike protocol, encourage po foodllluids, encourage 1erbalization of feelings. Encourage lo allow staff lo 
monitor intake and output \atal signs, wt lnslrucled lo seek staff>Mth any needs. lkrbali>ed understanding. Detainee offered 
three meals per day and lea1e in room 20 minutes before taking away. Pdequate supply of drinking water and other be1erages 
as ordered by pro\ader awilable. Encourage dailyoral/phy.,ical h)lliene care. Change of dothinglbedding. Continue lo offer 
\atals, weights, food, labs, meds. Patient 1erbali2es understanding of Plan of Care, and he 1erbali2es his right lo refuse. 
Appointment Provide,fb)(6); (b)(7)(C)!RN 
Electronically signed b (b)(6); 
/h\/7\/f:\ 
Sign off status: Comple 
2019-ICLl-00051 
, RN on 09/04/201818:43:56 (Pacific Daylight lime) 
3346 
Northviest Detention Center 
1623 E J STREET 
T WA98421 
Tel: (b)(6): 
DHS-ICE-19-0196, 19-0197-O-000030

P-nt: AIIAR, IIERGENSANA DOB: 10/23/1978 Prog,.u Noj(b )(6); (b)(7)(C) I RN 09/04/2018 
Nd.e generated by eC/inica/Wm<s EJvRIPM Sottv.ere {v.11WeC/inica/WGYks.COOJI 
2019-ICLl-00051 3347 
DHS-ICE-19-0196, 19-0197-O-000031

U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:ll*b )/6) ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll ~)/6) 
0910412018 
Review of Systems 
Hunger Strike: 
Fatigue admits, that is constant, that is 'M'.ll'Sel'ling. 
Headache denies. Lightheadedness admits, se-.eral times. 
Sleep Disturbance denies. 'lleight loss denies. Dry M>uth denies. 
'lleakness admits, his legs v.onl hold him. Cough denies. 
Shortness of breath at rest denies. Chest pain at rest denies. 
Palpitations denies. /lbdominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. l.bmitting denies Painful 
urination denies. Decreased urine output admits Mlsde 
aches admits extremities and back_ Misde cramps denies. 
Skin breakdown denies. Difficultythinking denies. 
1623 E J STREET, T WA-911421 
Appoimnert Facility: Northwest Detertion Certer 
Reason for Aflpolntment 
1. Hunger Strike 
History of Present Illness 
Flowsheets (M-tU): 
Aflpolntment Provlder:fb)(6); (b)(7)(C) !MD 
Pt continues to refuse all medical evaluation. This indudes -.itals, VO, weights and laboratorytesting induding UA Pt denies 
taking a showerfor4 day.;. He has been seen getting out of bed as night to take drinks of water. Hev.ill nottalkor answer 
questions. He is refusing to go to rec yard. He stay.; in bed most of the time. Pt is dear minded and goal oriented. He states his 
body hurts all mer especially his back but continues to refuse pain medication. 
Hungerstrike M:mitoring Form 
Day. 08/2912018 
Shift: AM 
Intake PO (in ml): 0 refuses to measure intake states not drinking 
QJtput Urine (in ml): 0 REFUSED TOCO..LECTURINE. 
QJtput Bowel M>wments (in ml): 0 PER PT CAN NOT RECALL LAST BM 
Labs - ~tones: REFUSED URINE DIP ANAL YS/S 
Initials: Kl21L.J 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do you speak? Russian 
Interpretation pro-.ided? Yes, Interpreter Number 
Number : Uonbridge 11294042 
Language Russian 
Pain f<;sessment 
Pain 
/l<e you currently in pain? Yes 
The pain is located Use Notes Section all over lov.er body 
The sewrityof pain is rated at 6110 
The sewrityof the pain is moderate 
The pain began 1-2v.eeksago 
The character of the pain is aching, is constant 
The associated symptoms are none 
The pain is aggravated by any physical adivily, bending 
The pain is relie\ed by none refused offer of medication 
Narratiw: 
Patient is on official hunger strike and is being housed in M-IU for dose supen.ision, observation, and monitoring. He is 
offered meals three times a day and -.itals q shift. 
Hunger Strike: 
~ical Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
\M1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal oonsumed: Breakfast 
Drinking fluids: Yes denies drinking but has been seen to drink a small amount 
#ofday.;onhungerstrike: 10 
Total Wlightloss in pounds: 0 unknow,, palientis refusing 
Reason for hunger strike: Wcints to be released from custody 
Housing/Isolation Location: M,dical Housing Unit 
Reason for Isolation Placement For dose supervision, observation, and monitoling 
Re-.;e\V of the Housing Placement Review housing eve,y 24 hours 
Vital Signs 
refuses, last ,,,;tais were prior to hunger strike v.ith BM at 25. 
Examination 
General E><amination: 
GENERl'l />PPEJ>Rl'NCE: ill-appearing, thin, withdr.M>11, alert and oriented lying beneath a blanket refusing to get up. 
EYES: dry eyes. 
OR.Al CA\KIY: refused exam. 
SKIN: normal, no rashes, no suspicious lesions. 
HEPRT: refused exam. 
MJSCULOSKELET/ll: refused exam -.ery thin. 
PSYCH: alert, oriented, cognitiw function intact, poor eye contact, speech diminished output, ldume, no auditcxy or 
-.isual hallucinations, thought content without suicidal ideation, delusions. 
Assessments 
1. Starvation, subsequent encounter - 173.0JO<D (Primary) 
Ill-Risk for imbalanced nutrition: Less than body requirements 
Self-imposed Hunger strike. 
Treatment 
1. Starvation, subsequent encOl.lller 
Notes: Pl with symptoms of deh)<lration. Vie are unable to tell his full oondition due to no labs, ~tals, e>0m or weight Vie v.ill 
request forced monitoring, feeding and/or IVh)<lration from the oourl ICE has agreed to talkv.ith this detainee later today. 
Procedure Codes 
T1013 Sign Lang/0-al Interpreter 
Follow Up 
daily 
Notes: Education pro,,,;ded on reoommended lreatrnent and plan of care but patient refusing all. Pt ad~sed to call for the nurse if 
his symptoms worsen. 
Appointment Provide1b)(6); (b)(7)(C) IMD 
2019-ICLl-00051 3348 
DHS-ICE-19-0196, 19-0197-O-000032

(b)(6); (b)(?)(C) 
Electronically signed byl(b)(6); (b)(?)(C) ~Don 09/0512018 00:05:29 (Pacific Daylight Tlme) 
Sign off status: Completed 
Northwest Detention Center 
1623EJSTREI" 
l'. WA98421 
Tel b)(6): 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 ProgNu N4(b)(6); (b)(7)(C) ~D 09/04/2018 
Nd.e general.ed by eOinica/W<n<s B>RIPM Sottw,re (""""eC/inica/works.CtJm) 
2019-ICLl-00051 3349 
DHS-ICE-19-0196, 19-0197-O-000033

09/04/2018 
Review of Systems 
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:i1ctb )(6): Facility Code: CSONVWA Hous .. , .... ng ....... Pi""e-a-: M,....... 
39 Y old Male,~•~~::: 
1623 E J~~=l~~t:: 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Prov1c1efb)(6); (b)(7)(C) rN 
Patient refuses to ansv.er assessment questions. Refusal form 
submitted to IVedical Records. 
Reason for Appointment 
1. RN DAYS: HUNGER STRIKE 
History of Present Illness 
Flowsheets (M-tU): 
lnput/OJtput Flowsheet 
Time: 1400 
INPUTPO: 0 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT SUBTOT/ll: 0 
OUTPUT Urine 0 
OUTPUTEmesis 0 
OUTPUTBM 0 
OUTPUT a. Wet Diaper Weight 0 
OUTPUT b. D,y Diaper Weight 0 
OUTPUT Total Diaper Weight output (calculate a-b) 0 
OUTPUTDrain: 0 
OUTPUT SUBTOT/ll: 0 
NetGain: 0 
NetLoss: 0 
Initials: ~(b i(6) I 
Patient ldenti ca on: 
Patient is 39 yo russian male on Hunger Strike. He is easilyarroused when RN enters room and refuses orthostatic blood 
pressures and v,,eight. He refuses all else, refuses Prolider and nursing assessment refuses lunch. Patient will not state if he 
has drank water or urinated. Refusal forms are completed and submitted lo IVedical Records. Patient sleeps most of shift. 
Patient 1erbali2es understanding of Plan of Care; and he 1erbali2es his right lo refuse. 
Patient Identification 
Patient prope~yidentified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
\M1at language do )OU speak? English, Russian, __ 
Interpretation prolided? Patient speaks English ffuenUy 
Pain 1'6sessment 
Pain 
l'<e )OU currently in pain? No 
Examination 
General B<amination: 
GENER/IL !>PPE.ARMICE: in no acute distress, well del.e!oped, well noorished. 
Assessments 
1. lneffecti1e Coping [00069]-ND00069 (Primary) 
2. lneffecti,e community coping - ND00077 
3. Risk for Deficient Fluid \.blume [00028]-ND00028 
Hunger Strike. 
Treatment 
1. lneffectille Coping (00069] 
Notes: Continue hunger strike protocol, encourage po foodllluids, encourage 1erbali:zation of feelings. Encourage to allow staff lo 
monitor intake and output lital signs, wt. lnslrUcted lo seek staffwilh any needs. Verbali,ed understanding. Detainee offered 
lhree meals per day and lea1e in room 20 minutes before taking away. Pdequate supply of drinking water and olher be1erages 
as ordered by pro\Oder available. Encourage dailyoral/phy.;ical h>9iene care. Change of dolhinglbedding. Continue lo offer 
litals, weights, food, labs, meds. Patient 1erbali2es understanding of Plan of Care, and he 1erbali2es his right to refuse. 
Appointment Provi~(b)(6); (b)(7)(C) fN 
Bectronically signed ~~/\~/;c, 
Sign off status: Completed 
fN, RN on 09104/201812:54:36 (Pacific Daylight Time) 
Northwest Detention Center 
1623EJSmEEr T$l~F'" oem 1 
x: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progresa Notefb )(6); (b )(7)(C) pt 09/04/2018 
N(xe generated byeOinica/Worl<s BvR'PM S:Jtvere {ww.<leC/inica/Works.com) 
2019-ICLl-00051 3350 
DHS-ICE-19-0196, 19-0197-O-000034

09/04/2018 
U.S. Immigration 
and Customs 
Enforcement 
Reason for Appointment 
1. DJ>JL YROUNDS 
Appointment Provider. Tacoma Provider 
AMAR,MERGENSANA . . A: 216269802 Su:l1Jg)(6); 
Facility Code: CSOINNA II g A ea. n 
39 Y old Male, DOB: 10/23/1978 
AccOl.l'II ~be{(5'i/6):7 1623 EJ STREET, T~ 
Appoirimert Facility. Northwest Detertion Certer 
Appointment Provider: Tacoma Provider 
Electronically signed by Tacoma Provider on 11/16/2018 at 07:30 MST 
Sign off status: Pending 
Northwest Detention Center 
1623 E J STREET 
T~i~6r oe12•1 a . 
Patl-t: AMAR, MERGENSANA DOB: 10/23/1978 p,_... Note: T- Pnmcler 09/04/2018 
/lkxe generated by eC/inica/Wcrl.s a.RIPM Sottv.ere ("""'eC/inica/Works.com) 
2019-ICLl-00051 3351 
DHS-ICE-19-0196, 19-0197-O-000035

U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA . . A: 216269802 Su:ll,.J;6 )(6) _I 
Facility Code: CSOINWA liiQked. lfl 
39 Y AccOllll ad ~~'i::: l'unbe b)(6); 
Appoirimert 
1623 
Facility. 
E J STREET, 
Northwest 
T 
Detertion 
~~= Certer 
09/04/2018 
Allergles 
N.KDA 
Review of Systems 
Hunger Strike: 
Headache admits Dry M'.luth denies. W!akness denies. 
Cough denies. Shortness of breath at rest denies. Chest pain at 
rest denies. Palpitations denies. Pbdominal Pain admits 
Constipation denies. Diarrhea denies. Nausea denies. 
\bmitting denies. Painful urination denies. Decreased urine 
output admits Mlsde aches admits Mlsde cramps denies. 
Skin breakdown denies. Difficultythinking denies. 
Appointment Provlde.l"'(b-'-'}'-'(6"-);"--'---'!RN •k_h\/7\/r-\ . 
Reason for Appointment 
1. tvHU RN NIGHT ROUNDS/HUNGER STRIKE 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEOa=FICERfti}(l 
Wiat language do }OU speak? Rus'£irr 
Interpretation pro\aded? Yes, Interpreter Number 
Number : 11301432 
Language Russian 
Pain Assessment 
Pain 
ke }OU currently in pain? Yes PT REFUSED PAIN A/ED/CATION 
The pain is located : HEAD, BACK, STCMI\CH, AND LEGS PAIN 
The sewrityof pain is rated at 5110 
The sewrityof the pain is mild to moderate 
The pain began 1-2daysago 
The character of the pain is aching, is constant 
The associated simptoms are none 
The pain is aggrawted by none 
The pain is relie\ed by none 
Rowsheets (tvHU}: 
lnpuVOJtput Rowsheet 
Time: 2300 (SHIFT91312018 2300-91412018 0700) 
INPUT PO: 0 PT DENIED DRINK/NG WA1ER DURING 1HE NIGHT BUT HE WAS SEEN DRINIK1NGFRCM1HE FAUCET 
ONCE 
INPUT SUBTOT.AJ..: 0 PT SEEN DRINK/NG FRCMFAUCETONCE DURING SHIFT 
OUTiPUTUrine 0PTSffNDRINKINGFRCMFAUCETONCEDURINGSHIFT 
OUTiPUT UBTOT.AJ..: 0PTDENIED VOIDING DURING SHIFT 
Initials: /h \/R\ 
Hungerslrike tvbnitoring Form 
Day /)9tf)3/2018 (SHIFT9/3/2018 2300-914/2018 0700) 
Shi~ Night 
lntakePO(inml): 0PTSffNDRINKINGFRCMFAUCETONCEDURINGSHIFT 
OJtput~- ml): 0PTDENIEDVOIDINGDURINGSHIFT 
Initials: (b )(6 
Hunger Strik . 
Nursing Ewluation 
Date missed meals monitoring initiated: 08/22/2018 
\Mien did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: No DETAINEE REFUSED ALL RN ASSESSM=NTDURING SHIFT 
Reason for hunger strike: Wcints to be released from custody 
/ldequate supply of drinking water and other bewrages awilable: Yes 
Three meals deliwred per day to patient Yes 
Breakfast deliwred during current shift 0% consumed 
/lnyunauthoriiedfoodinroom? No 
Haw dailyorthostatic \ital signs been completed? __ Refused. Detainee refused to sign refusal form 
Has input and output been documented on the the M-IU Hunger Strike tvbnitoring Smart Form? Yes 
~: 2300 Detainee was noted l)ing in his bed, sleeping with normal rise and fall of chest Detainee does not appear to be in any 
distress. WII continue to monitor. 
0600 Detainee was assessed after refusing breakfast (missed meal# 39). Detainee refused to speak with nurse. Detainee 
refused to cooperate during RN assessment Refused 'vS, orthostatic, prolide a urine sample or weight assessment WII 
continue to monitor. 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
VllalSlgns 
16/min 
66.5in 
REFUSED \ilT.AJ.. SIGNS /IND Vl,EJGHT. 
Examlhatlon 
General Examination: 
RR 
09/04/2018 05:36:16 PM 
H 
09/04/2018 05:36:16 PM 
GENER.AJ.. />PPEPRANCE: in oo acute distress, appears weak and lethargic .. 
PSYCH: alert, oriented. 
Assessments 
1. Risk for electrol}'e imbalance - ND00195 (Primary) 
Treatment 
1. Others 
(b)(6); 
(b)(7)(C) 
N 
,-
,-
N 
Notes: 1. Continue with \Atal Signs ewryshift; Intake and OJtput M)nitoring ewryshift; Dailyweighls; Dailyorthostatic \ital signs. 
2. /In adequate supply of drinking water and other bewrages are available to patient at all times. 
3. Three meals per day are deliwred to the patient and deliwryof meals is documented. 
4. ~I food not authoriied by CDn:>hy.,ician isremo\ed from patienrs room. 
5. Patient is not allowed to purchase food from commissar)/1.ending machine while on hunger strike. 
6. Patient will only be released from hunger strike treatment/monitoring byCD or phy.,ician order. 
7. Patient counseled regarding the medical risks of continuing the hunger strike. 
8. Encouraged to terminate the hunger strike and eat/drink as normal. 
9. pt wrbaliied understanding of care plan. 
Procedure Codes 
T1013 Sign Lang/Q-al Interpreter 
Disposition: Pdmitted to tvHU until medicallyewluated 
2019-ICLl-00051 3352 
DHS-ICE-19-0196, 19-0197-O-000036

Appointment Provide (b)(6); RN lh\/7\tr\ 
Electronically signed bl(b)(6); ~ _ ~ on 09/04/2018 05:45:24 (Pacific Daylight Time) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J S1REEI' 
T~WAg&421 ,,Jb)(6): I tax: 
Patient: AMAR, MERGENSANA DOIi; 10/23/1978 P ....... Not.j~(b_)_(6_); __ ~1RN 09ICM/2018 
Nd.e genertl.ed by eOiricaWorks a.R/PM Sottoore (w.w.eC/iricaJWorks.~ 
2019-ICLl-00051 3353 
DHS-ICE-19-0196, 19-0197-O-000037

U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 ProgNU Nola: 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3354 
AMAR,MERGENSANA A:216269802 Su:i10:fb)(6); I 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll lunber~ 
1623 EJ STREET, T~ 
DHS-ICE-19-0196, 19-0197-O-000038

09/03/2018 
Allergles 
N.KDA 
Review of Systems 
U.S. Immigration 
and Customs 
Enforcement 
Reason for Appointment 
1. tvHU RN Rounds 
AMAR,MERGENSANA 
A: 216269802 Su:llQ/b l/6) I 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll llunber:~ 
1623 EJ STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
Appointment P1'ovldefb)(6); (b)(?)(C) IRN 
Patient refuses to answer assessment questions. Refusal form 
submitted to 11/edical Rerords. 
History of Pl'esent Illness 
Flowsheets (tvHU): 
lnput/OJtput Flowsheet 
Time: 2100 
INPUT PO: 0 unknow, but did shoo,,er for a lengthy #me v.ith curtain pulled 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT SUBTOT/ll: 0 
OUTPUTUrine Ounknow, 
OUTPUTEmesis 0 
OUTPUTBM 0 
OUTPUT a. Wet Diaper Weight 0 
OUTPUT b. D,y Diaper Weight 0 
OUTPUT Total Diaper Weight output (calculate a-b) 0 
OUTPUTDrain: 0 
OUTPUT SUBTOT/ll: 0 
NetGain: 0 
NetLoss: 0 
Initials: !th \In\! 
Patient Identification: 
Hunger Strike. He is easilyarroused. Pt stated he had HA LBP and stomach upset but Refuses all care & pro'1der 
assessment Patient will not state if he has drank water or urinated. Refusal forms are completed and submitted to fvt:ldical 
Rerords. Patient sleeps most of shift. Showered this shift Patient verbali:,es understanding of Plan of Care, but refuses care. 
Patient Identification 
Patient propeMyidentified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
IM1at language do )OU speak? English, Russian 
Interpretation pro'1ded? Patient speaks English ffuenUy 
Pain l'ssessment 
Pain 
Ne )OU currently in pain? No 
Vital Signs 
16/min 
66.5in 
Examination 
General Examination: 
RR 
09/03/201806:30:13 PM 
H 
09/03/201806:30:13 PM 
GENER/IL !>PPEPRANCE: in no acute distress, well del.e!opec, well nourished. 
Assessments 
1. Ineffective Coping [00069]- ND00069 (Primary) 
2. Ineffective oommunityooping - ND00077 
Hunger Strike. 
Treatment 
1. lneffecti\11! Coping [00069] 
b)(6); 
b)(?)(C) 
~N 
-
~ 
Notes: Continue hunger strike protoool, encourage po food/lluids, encourage verbalization of feelings. Encourage to allow staff to 
monitor intake and output, '1tal signs. wt Instructed to seek staff with any needs. ½rbali2Bd understanding. Detainee offered 
three meals per day and leave in room 20 minutes before taking away. Pdequate supply of drinking water and other beverages 
as ordered by pro'1der awilable. Encourage dailyoral/phy.,ical h)lliene care. Change of dothinglbedding. Continue to offer 
'1tals, weights, food, labs, meds. Patient verbali:,es understanding of Plan of Care, and he verbali:,es his right to refuse. 
Disposition: Pdmitted to tvHU until medicallyewluated 
Notes: tvHU until 11/edical Determination 
Appointment Provi (b)(6); (b)(7)(C) RN 
Electronically signed bi(b)(6); ~- Fon 09/03/201818:31:04 (Pacific Daylight Time) 
Sign off status: Completed 
2019-ICLl-00051 3355 
Northwest Detention Center 
1623 E J STREET T®~EA98421 re@~L- 1 
DHS-ICE-19-0196, 19-0197-O-000039

P•ll-1: AMAR, IIERGENSANA DOB: 10/23/1978 p,__. N-.l(b)(6); (b)(7)(C)jtN 09/03/2018 
Nd.e general.ed by eOinica/W<n<s EJvRIPM Sottw,re (""""eC/inica/WOrks.com) 
2019-ICLl-00051 3356 
DHS-ICE-19-0196, 19-0197-O-000040

09/03/2018 
Allergles 
N.KDA 
Review of Systems 
U.S. Immigration 
and Customs 
Enforcement 
Reason for Appointment 
1. RN DAYS: HUNGER STRIKE 
AMAR,MERGENSANA 
.. A:216269802 Su:llot{b)(6); I 
Facility Code: CSOINWA Hot.in g ,c; ea. lfi 
39 Y old Male,~- 1QOJ(1928 
AccOl.rll r-un1ie,[bl(6l: 
1623 E J STREET, TACOMA,-W.;..,A-9~84~21,_...... 
Appoirimert Facility. Northwest Detertion Certer 
Appointment Provlcle1(b)(6); (b)(?)(C) rN 
Patient refuses to answer assessment questions. Refusal form 
submitted to 11/edical Rerords. 
History of Present Illness 
Flowsheets (M-tU): 
lnput/OJtput Flowsheet 
Time: 1400 
INPUTPO: 0 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT SUBTOT/ll: 0 
OUTPUT Urine 0 
OUTPUTEmesis 0 
OUTPUTBM 0 
OUTPUT a. Wet Diaper Weight 0 
OUTPUT b. Dry Diaper Weight 0 
OUTPUT Total Diaper Weight output (calculate a-b) 0 
OUTPUTDrain: 0 
OUTPUT SUBTOT/ll: 0 
NetGain: 0 
NetLoss: 0 
lnitials:~h¥R I 
Patient ldenti ca on: 
Patient is 39 yo russian male on Hunger Strike. He is easilyarroused when RN enters room and refuses orthostatic blood 
pressures and weight. He refuses all else, refuses Prolider and nursing assessment refuses lunch. Patient will not stale if he 
has drank water or urinated. Refusal forms are completed and submitted lo 1\/edical Records. Patient sleeps most of shift. 
Patient 1erbali2es understanding of Plan of Care; and he 1erbali2es his right lo refuse. 
Patient Identification 
Patient prope~yidentified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
\Mat language do )OU speak? English, Russian, __ 
Interpretation prolided? Patient speaks English ffuenUy 
Pain 1'6sessment 
Pain 
Ne )OU currently in pain? No 
Vital Signs 
16/min 
66.5in 
RR 
H 
Patient refused 1Atals. Refusal form submitted lo medical records. 
Examination 
General Examination: 
09/03/201812:05:08 PM 
09/03/201812:05:08 PM 
GENER/IL JIPPEPRANCE: inno acute distress, well del.eloped, well nourished. 
Assessments 
1. lneffecti,e Coping [00069]-ND00069 (Primary) 
2. lneffecti,e community coping - ND00077 
Hunger Strike. 
Treatment 
1. lneffecti\11! Coping [00069] 
b)(6); N 
b)(?)(C) -
-N 
Notes: Continue hunger strike protocol, encourage po foodllluids, encourage -erbalization of feelings. Encourage lo allow staff lo 
monitor intake and output lital signs. wt lnslructed lo seek staffwilh any needs. lkrbali>ed understanding. Detainee offered 
lhree meals per day and lea1e in room 20 minutes before taking away. /ldequate supply of drinking water and olher be1erages 
as ordered by prolider available. Encourage dailyoral/phy.,ical h)lliene care. Change of dolhinglbedding. Continue lo offer 
litals, weights, food, labs, meds. Patient 1erbali2es understanding of Plan of Care, and he 1erbali2es his right lo refuse. 
Appointment Providerfb)(6); ~-
Electronically signed bJ=(ba,,):....(6:.:.),,.._· '-'-----'bN, RN on 09/03/201812:06:06 (Pacific Daylight lime) h.,17\ff"",\ ,-· 
Sign off status: Completed 
2019-ICLl-00051 3357 
Nort"""8st Detention Center 
1623 E J STREET 
T~WA98421 
Tel:JiR~; I 
DHS-ICE-19-0196, 19-0197-O-000041

Patient: A111AR, IIERGENSANA DOB: 10/23/1978 Prog,.u No~(b)(6); (b)(7)(C) "" 09/03/2018 
Nd.e general.ed by eOinica/W<n<s EJvRIPM Sottw,re (""""eC/inica/WOrks.com) 
2019-ICLl-00051 3358 
DHS-ICE-19-0196, 19-0197-O-000042

U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA .. A:216269802 Su:lljib/~~1'.~. I 
Facility Code: CSCN/1/WA n ,g H ea."' 
AccOUll ~beb@C I 39 Y ad ~:i !::: 
09/03/2018 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. Fe,.,, denies. Headache admits Lightheadedness denies. Night 
sweats denies. Sleep disturbance denies. W.ight gain denies. 
W.ight loss denies. 
Gastrointestinal: 
Pbdominal pain admits, ditluse. Blood in stool denies. 
Change in bowel habits denies. Constipation denies. Decreased 
appetite denies. Diarrhea denies. Diffirultyswallowing denies. 
~ure to hepatitis denies. Heartburn denies. 
Hematemesis denies. Nausea denies. Rectal bleeding denies. 
l.bmiting denies. W.ight loss denies. 
Neurologic: 
Balance diffirultydenies. Coordination admits Diffirulty 
speaking denies. Di22iness denies. Fainting denies. Gait 
abnormality denies. Headache admits Irritability denies. Loss of 
strength denies. Loss of use of e>dremitydenies. Low back 
pain denies. 11/emoryloss denies. Pain denies. Sei2Ures denies. 
lies denies. lingling/Numbness denies. Transient loss of 
lision denies. Tremor denies. 
1623 E J STREET, T 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Provider: .,_!(b'-')"-(6'-')-'-; __ __,!NP 
Reason for Appointment 
1. Daily Rounds 
History of Present Illness 
Patient Identification: 
(1248) dailyM-IU rounds for a 39 i,o male on hunger strike; he continues to not eat food and drink water in protest of his court 
case. he is refusing labs, urine tests, v.:;, medications and a physical exam. he says he has a mild headache and diffuse 
stomach pain; he motions in a circle with his hand under a blanket when asked to identify his location of stomach pain. despite 
this he does no elaborate anymore on the nature of his pain; he is refusing medications and an exam too. he seems equally 
disinterested in engaging in any kind of con,.,rstation; for example, when i asked if he knew his birth date he says, 'yes,' but does 
not actually tell me the date of his birth. 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes geo offl~ 
Wiat language do i,ou speak? Russian 
Interpretation prolided? Yes, Interpreter Name 
Name Use notes field 
Language Russian 1300579 
Pain Assessment 
Pain 
ke i,ou rurrentlyin pain? Yes 
The pain is located Use Noles Section 
The se,.,rityof pain is rated at 0/10ptdoes not ansv.er 
The se,.,rityof the pain is mild pt does not ansv.er 
The pain began other pt does not ansv.er 
The character of the pain other pt does not ansv.er 
The associated symptoms are other pt does not ansv.er 
The pain is aggravated by otherptdoesnotansv.er 
The pain is relie~ by otherptdoesnotansv.er 
Vital Signs 
16/min 
66.5in 
pt is refusing to ha"' his \f-, taken. FICES pain scale: 2. 
Examination 
General Examination: 
RR 
09/03/201801:10:36 PM 
H 
09/03/201801:10:36 PM 
GENER/ll !>PPEPRANCE: in no acute distress, well del.eloped, well nourished. 
SKIN: normal, no rashes, no suspicious lesions. 
pt is refusing an exam. 
Assessments 
1. Staovation, subsequent encounter - T73.0JO<D 
2. Headache - R51 
3. Generaliied abdominal pain - R10.84 
Treatment 
1. Starvation, subsequent encOUller 
(b)(6); 
(b)(?)(C) 
Notes: pt is a 39 i,o male on hunger strike that is symptomatic for a mild headache and diffuse stomach//ll30 discomfort but 
simultaneously refusing any care, exam, labs, medications, food or fluids. pt encouraged to e'1)ress his feelings; he does not 
appear to be interested in engaging in con,.,rsation to listen to any education on the risks that prolonged staovation and 
dehydration poses to his health. will continue to monitor. 
2. Headache 
Notes: pt is refusing exam, history and medications. he does not appear to be in anyarute distress. patient follow up as 
needed. 
3. Generalized abdominal pain 
Notes: pt is refusing exam, history and medications. he does not appear to be in anyarute distress. patient follow up as 
needed. 
Follow Up 
pm 
p 
,.... 
,.... 
p 
,.... 
Notes: Education prolided on 11/edication and Treatment 11/edication and Treatment Plan Reliewed, 11/edication risks, benefits, 
altemati"'s discussed, Nutrition counseling completed, Patient adlised to return to sick call if symptoms worsen prior to nel<I 
appointment Patient "'rbali,ed understanding of all instructions. Sta)ing Healthy brochure was gi"'n to detainee on intake. 
Appoinbnent Providefb)(6); ~-
(b)(6); (b)(?)(C) 
Bectronically signed ~(b)(6); ~-
Sign off status: Completed 
2019-ICLl-00051 
t,P on 09/03/201813:19:30 (Pacific Daylight Time) 
3359 
Northwest Detention Center 
1623 E J STREET 
DHS-ICE-19-0196, 19-0197-O-000043

1: WA98421 
" (b)(6); 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 Progreu Notej,.__(b~)=(6~);~ _ _,INP 09/03/2018 
Ncl.e generated by eC/inica/'Na1<s EJvR/PM Sottv.ere (,w,weC/inica/WGYks.COOjl 
2019-ICLl-00051 3360 
DHS-ICE-19-0196, 19-0197-O-000044

U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
.. A:216269802 Su:llctb}(6); I 
Facility Code: CSOINWA HoJsn g ,c; ea. lfi 
39Y old Mal~,· 
AccOl.rll llunber b 6 · 
0910312018 
Allergles 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue Refused to answer. Headache Refused to answer . 
Lightheadedness Refused to answer. Sleep 
Disturbance Refused to answer. 'Mlight loss Refused to answer 
. DryM>uth Refused to answer. 'Mlakness Refused to answer. 
Cough Refused to answer. Shortness of breath at rest Refused to 
answer. Chest pain at rest Refused to answer. 
Palpitations Refused to answer. J>bdominal Pain Refused to 
answer. Constipation Refused to answer. Diarrhea Refused to 
answer. Nausea Refused to answer. \bmitting Refused to 
answer. Painful urination Refused to answer. Decreased urine 
output Refused to answer. Mlsde aches Refused to answer. 
Mlsde cramps Refused to answer. Skin breakdown Refused to 
answer. Difficultythinking Refused to answer. 
1623 E J STREET, T , 
Appoirimert Facility. Northwest Detertion Certer 
Reason for Aflpolntment 
1. tvHU NOC NSG RDS 
History of Present Illness 
Patient Identification: 
Patient Identification 
Aflpolntment Provlcle~(b}(6); (b}(7)(C) IRN 
Patient properly identified by2 sources ~n~: ID Badge, Picture 
Chaperone Present? Yes GEOO"FIC~ 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number 
Number Use notes ffeld 11299522 
Language Russian 
Pain .1>6sessment 
Pain 
ke}Oucurrentlyin pain? No DETAINEE REFUSED ALL RNASSESS/IENT 
Flowsheets (tvHU): 
lnput/OJtput Flowsheet 
Time: 2300 (SHIFT9/2/2018 2300-9/3/2018 0700) 
INPUT PO: 0 DETAINEE REFUSED ALL RN ASSESS/IENTDURING SHIFT. CESERVED TOBE DRINKING WA7ER 
FROM 71-IE FOUNTAIN AROUND 2:40 
INPUT SUBTOT/11..: 0 DETAINEE REFUSED ALL RN ASSESSAIENTDURING SHIFT. OBSERVED TOBE DRINKING 
WA 7ER FROM71-IE FOUNTAIN AROOND 2:40 
OUTPUT Urine 0DETAINEEREFUSEDALL RNASSESSAIENTDURINGSHIFT 
OUTP~
6 
OT/11..: 0 DETAINEE REFUSED ALL RN ASSESS/IENTDURING SHIFT 
Initials:~ 
Hungerstrike M:mitoring Form 
Day: 09t02/2018 (SHIFT9/2/2018 2300-9/3/2018 0700) 
Shi~ Night 
Intake PO (in ml): 0 DETAINEE REFUSED ALL RN ASSESSIIENTDURING SHIFT. CESERVED TOBE DRINKING 
WA 7ER FROM71-IE FOUNTAIN AROOND 2:40 
OJ!put 49:'>!,(in ml): 0 DETAINEE REFUSED ALL RN ASSESSIIENTDURING SHIFT 
lnitials:IQ1] 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
\M1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: No DETAINEE REFUSED ALL RN ASSESSIIENTDURING SHIFT 
Reason for hunger strike: W.,nts to be released from custody 
/ldequate supply of drinking water and other be-erages available: Yes 
Three meals deli-ered per day to patient Yes 
Breakfast deli-ered during current shift 0% consumed 
/lnyunauthori>edfoodinroom? No 
Hase dailyorthostatic \ital signs been completed? __ Refilsed. Detainee refilsed to sign refilsal form 
Has input and output been documented on the the M-IU Hunger Strike M:mitoring Smart Form? Yes 
~: 23:00 Detainee was noted la:,ing in his bed, sleeping with normal rise and fall of cihest Detainee does not appear to be in 
anydistress. WII continue to monitor. 
02:40 Detainee was obsen.ed gelling up from his bed and drinking water from the fountain. 
05:55 Detainee was assessed after refusing breakfast (missed meal# 36). Detainee refused to speak with nurse. Detainee 
refused to oooperate during RN assessment Refused 'vS, orthostatic, prolide a urine sample or weight assessment WII 
continue to monitor. 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Examination 
General B<amination: 
GENER/II.. !>PPE.ARANCE: in no acute distress, appears weak and lethargic .. 
PSYCH: alert, oriented. 
Assessments 
/>I-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: Nursing to assess h)dration status: skin turgor, mucous membranes, blocd pressure, heart rate, intake & output WII 
continue to encourage detainee to eat all meals deli sered to him and to drink fluids. Detainee has aooess to drinking water 
inside of cell. Detainee educated on possible risks to health if he continues to miss meals. Detainee educated on risks of not 
drinking adequate amount of fluids. Detainee educated to drink at least 8-10 cups of liquids per day.Detainee educated on 
possible medical risks of continuing to refuse meals. Detainee instructed to inform nursing staff/officers if s,mptoms discussed 
begins, or if ha"ng continues or becomes worse. Detainee also instructed to let officer know if he wants a tray to consume. 
Detainee 1.erbali>ed understanding of all instructions and did not ha,e anyadditional questions. Detainee to remain in M-IU/seg 
until will only released from hunger strike treatment/monitoring byphy.;ician. Detainee refused to acknowledge patient education 
and instructions pro"ded by nurse. 
Procedure Codes 
T1013 Sign Lang/0-al Interpreter 
Notes: Detainee to remain in M-IUA-lunger Strike 
Appoinbnent Providel(b)(6); (b)(7)(C) !RN 
2019-ICLl-00051 3361 
DHS-ICE-19-0196, 19-0197-O-000045

Electronically slgned bfb)(6); ~-
Sign off status: Completed 
IN on 09/03/2018 05:28:30 (Pacific Daytight Time) 
Northwest Detention Center 
1623 E J STREEr 
T WA98421 
Tel b)(6); 
Patient: AMAR, IIERGl!NSANA DOB: 10/23/1978 ProgNss Notib)(6); (b)(7)(C) fN 09l03/2018 
Ncl.e general.ed by eC/inica/Wa1<s aR/PM Safl,,ere {WNNeC/inic;iWorks.COff9 
2019-ICLl-00051 3362 
DHS-ICE-19-0196, 19-0197-O-000046

U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:i1c:t:b )(~ I 
Facility Code: CSONVWA Housing ea: M 
39Y old Mal~,· 
AccOl.lll llunbe b 6 · 
09102/2018 
Allergles 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue Refused to answer. Headache Refused to answer . 
Lightheadedness Refused to answer. Sleep 
Disturbance Refused to answer. 'Mlight loss Refused to answer 
. DryM>uth Refused to answer. 'Mlakness Refused to answer. 
Cough Refused to answer. Shortness of breath at rest Refused to 
answer. Chest pain at rest Refused to answer. 
Palpitations Refused to answer. J>bdominal Pain Refused to 
answer. Constipation Refused to answer. Diarrhea Refused to 
answer. Nausea Refused to answer. \bmitting Refused to 
answer. Painful urination Refused to answer. Decreased urine 
output Refused to answer. Mlsde aches Refused to answer. 
Mlsde cramps Refused to answer. Skin breakdown Refused to 
answer. Difficultythinking Refused to answer. 
1623 E J STREET, T , 
Appoimnert Facility: Northwest Detertion Certer 
Reason for Aflpolntment 
1. 212 H/llF M-IU PM SHIFT 
History of Present Illness 
Patient Identification: 
Patient Identification 
Aflpolntment Provlde~(b)(6); (b)(7)(C) 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEOCfflC~(b)/6)· I 
Wiat language do }OU speak? Russian · 
Interpretation pro\aded? Yes, Interpreter Number 11299188 
Number Use notes ffeld 
Language Russian 
Pain .1>6sessment 
Pain 
ke}Oucurrentlyin pain? No DETAINEE REFUSED ALL RNASSESS/IENT 
Flowsheets (M-IU): 
lnput/OJtput Flowsheet 
Time: 1900 (SHIFT9/2/20181900-9/2/2018 2300) 
INPUT PO: 0 DETAINEE REFUSED ALL RN ASSESS/IENTDURING SHIFT BUT WAS NOTED WASHING HIS FACE AND 
BRUSHING HIS TEETH 
INPUT SUBTOT/11..: 0 DETAINEE REFUSED ALL RN ASSESSAIENTDURING SHIFT BUT WAS NOTED WASHING HIS 
FACE AND BRUSHING HIS TEETH 
OUTPUT Urine 0DETAINEEREFUSEDALL RNASSESSAIENTDURINGSHIFT, REFUSED TORl=F'CRTIFHE'S VOIDED 
DURING SHIFT 
OUTPUT SUBTOT/11..: 0 DETAINEE REFUSED ALL RN ASSESSAIENTDURING SHIFT, REFUSED TORl=F'CRT IF HE'S 
VOIDED DURING SHIFT 
Initials: IZ5I] 
Hungerstrike tvbnitoring Form 
Day: 09/02/2018 
Shift PM 
Intake PO(in ml): 0 DETAINEE REFUSED ALL RN ASSESSIIENTDURING SHIFT BUT WAS NOTED WASHING HIS 
FACE AND BRUSHING HIS TEETH 
OJ!put Urine (in ml): 0 DETAINEE REFUSED ALL RN ASSESSIIENTDURING SHIFT, REFUSED TOREPORTIF HE'S 
VOIDED SURING SHIFT 
lnitials:ffi[J 
Hunger Strike: 
Nursing Evaluation 
Date missed meals moniloring initiated: 08/22/2018 
\Mien did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: No DETAINEE REFUSED ALL RN ASSESSIIENTDURING SHIFT 
Reason for hunger strike: Wcints to be released from custody 
/ldequate supply of drinking water and other be-erages available: Yes 
Three meals deli-ered per day lo patient Yes 
/lnyunauthori>edfoodinroom? No 
Hase dailyorthostatic \ital signs been completed? __ Refused. Detainee refused to sign refusal form 
Has input and output been documented on the the M-IU Hunger Strike tvbniloring Smart Form? Yes 
~: 19:00 Detainee was noted awake, laying on his bed and watching a molie during initial rounds. Does not appear lo be in any 
distress. WII continue lo monilor. 
20:10 Detainee was awake, laying on his bed watching lV. Detainee acknowledged presence of RN and GEO upon entring 
cell. Detainee refused all RN assessmen~ states "I refuse all medical assessment" Detainee refused lo prclide information 
about his intake and output during shift, refused his litals, orthostatic, weight and prclide urine sample for testing. Detainee 
refused to sign a refusal form. WII continue lo monilor. 
22:30 Detainee noted brushing his teeth and washing his face. 
23:00 Detainee was noted laying in his bed, sleeping with normal rise and fall of chest Detainee does not appear lo be in 
anydistress. WII continue to monilor. 
Patient is considered lo be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and moniloring. 
Vital Signs 
REFUSED /Ill RN A5SESSMENT. 
Examination 
General E><amination: 
GENER/II.. !>PPE.ARl'NCE: in no acute distress, appears weak and lethargic .. 
PSYCH: alert, oriented. 
Assessments 
Ill-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: Nursing to assess h)<lration status: skin turgor, mucous membranes, blood pressure, heart rate, intake & output. WII 
continue to encourage detainee lo eat all meals deli sered lo him and lo drink fluids. Detainee has access lo drinking water 
inside of oell. Detainee educated on possible risks lo health if he continues lo miss meals. Detainee educated on risks of not 
drinking adequate amount of fluids. Detainee educated to drink at least 8-10 cups of liquids per day.Detainee educated on 
possible medical risks of continuing lo refuse meals. Detainee instructed lo inform nursing stafl/offioers if s)!'Tlploms discussed 
begins, or if haling continues or becomes worse. Detainee also instructed lo let offioer know if he wants a tray lo consume. 
Detainee 1.erbali>ed understanding of all instructions and did not ha,e anyadditional questions. Detainee lo remain in M-IU/seg 
until will only released from hunger strike treatmentlmoniloring byphy.;ician. Detainee refused lo acknowledge patient education 
and instructions prolided by nurse. 
Procedure Codes 
T1013 Sign Lang/0-al Interpreter 
Notes: Detainee to remain in M-IU/Hunger Strike 
Appointment Provi~(b)(6); (b)(7)(C) IRN 
2019-ICLl-00051 3363 
DHS-ICE-19-0196, 19-0197-O-000047

Electronically signed b1;,__b-'-)('-6""'); __ _.fN on 09/02/2018 23:00:56 (Pacific Daylight Time) 
Sign off status: Completed 
Northwest Detention Center 
1623EJSTREI" T~~r98421 ½§1~4. I 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 ProgNU Not8:~b )(6); (b )(?)(C) I RN 09/02/2018 
Nd.e general.ed by eOinica/W<n<s B>RIPM Sottw,re (""""eC/inica/works.CtJm) 
2019-ICLl-00051 3364 
DHS-ICE-19-0196, 19-0197-O-000048

09102/2018 
Review of Systems 
U.S. Immigration 
and Customs 
Enforcement 
Reason for Appointment 
AMAR,MERGEN-..a-..... --. A:216269802 Si.tll b)(6); 
Facility Code: CSONVWA h\/7\tr.\ 
39 Y old Male, DOB: 10/23/1978 
AccOllll l'unberJ(b )(6); I 
1623 E J STREET, T ACOf,...; HA'564Z I 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Prov1c1e,fb)(6); (b)(7)(C) IRN 
Patient refuses to ansv.er assessment questions. Refusal form 
submitted to l\lla<:lical Records. 
1. RN E\€NING SPLIT SHIFT: HUNGER STRIKE 
History of Present Illness 
Flowsheets (M-tU): 
lnput/OJtput Flowsheet 
Time: 1900 
INPUTPO: 0 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT Other. 0 
INPUT SUBTOT/11..: 0 
OUTPUT Urine 0 
OUTPUTEmesis 0 
OUTPUTBM 0 
OUTPUT a. Wet Diaper Weight 0 
OUTPUT b. D,y Diaper Weight 0 
OUTPUT Total Diaper Weight output (calculate a-b) 0 
OUTPUTDrain: 0 
OUTPUT SUBTOT/11..: 0 
NetGain: 0 
Netlos~ 
Initials: l!!ili§l 
Patient Identification: 
Patient is 39 yo Russian male on Hunger Strike. He has missed meal 35 as of dinner this evening.He is easilyarroused 
when RN enters room and allows orthostatic blood pressures and weight to be checked. He refuses all else, refuses Pro\ider 
and nursing assess men~ refuses dinner. Patient will not state if he has drank water or urinated. Refusal forms are completed 
and submitted to l\lla<:lical Records. Patient sleeps most of shift. Patient verbali:,es understanding of Plan of Care; and he 
verbali:,es his right to refuse. 
Patient Identification 
Patient propeMyidentified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
\Mlat language do )OU speak? English, Russian, __ 
Interpretation pro,..ded? Patient speaks English ffuenUy 
Pain /!ssessment 
Pain 
l'<e )OU currently in pain? No 
Vital Signs 
16/min 
66.5in 
Examination 
General Examination: 
RR 
09/02/201804:40:15 PM 
H 
09/02/201804:40:15 PM 
GENER/II.. !>PPEPRANCE: in no acute distress, well del.eloped, well nourished. 
Assessments 
1. Ineffective Coping [00069]- ND00069 (Primary) 
2. Ineffective community coping - ND00077 
Hunger Strike. 
Treatment 
1. lneffecti\11! Coping [00069] 
(b)(6); -
N 
(b)(?)(C) -
-
N 
-
Notes: Continue hunger strike protocol, encourage po food/lluids, encourage verbalization of feelings. Encourage to allow staff to 
monitor intake and outp~ "tal signs, wt. Instructed to seek staff with any needs. lkrbali>ed understanding. Detainee offered 
three meals per day and leave in room 20 minutes before taking away. Pdequate supply of drinking water and other beverages 
as ordered by pro,..der awilable. Encourage dailyoral/phy.,ical h)lliene care. Change of dothinglbedding. Continue to offer 
"tals, weights, food, labs, meds. Patient verbali:,es understanding of Plan of Care, and he verbali:,es his right to refuse. 
Appointment Provide1(b)(6); (b)(?)(C) r 
Electronically signed b~~(b_)_(6_),_· -~!RN, RN on 09/02/201818:33:33 (Pacific Daylight lime) 
Sign off status: Completed 
2019-ICLl-00051 3365 
Northviest Detention Center 
1623 E J STREET 
T~r98421 r4~ 
DHS-ICE-19-0196, 19-0197-O-000049

P-nt: AIIAR, IIERGENSANA DOB: 10/23/1978 Prog,.u Note: kb )(6); (b )(7)(C) ~ 09/02/2018 
Nd.e generated by eC/inica/Wm<s EJvRIPM Sottv.ere {v.11WeC/inica/WGYks.COOJI 
2019-ICLl-00051 3366 
DHS-ICE-19-0196, 19-0197-O-000050

09102/2018 
Allergles 
N.KDA 
Review of Systems 
U.S. Immigration 
and Customs 
Enforcement 
Reason for Appointment 
1. RN DAYS: HUNGER STRIKE 
AMAR,MERGENSANA 
.. A:216269802 Su:ll~(b)(6); ! 
Fac1lrtyCode:CSOINWA ng,c;ea.lfi 
39 Y old Male, DOB: 10/23/1978 
AccOl.rll lunbe~ 
1623 EJ STREET, T~ 
Appoirimert Facility. Northwest Detertion Certer 
Appointment Provlder:l(b)(6); (b)(7)(C) r" 
Patient refuses to answer assessment questions. Refusal form 
submitted to 11/edical Rerords. 
History of Present Illness 
Flowsheets (M-tU): 
lnput/OJtput Flowsheet 
Time: 1400 
INPUTPO: 0 
Breastfeeding (time in minutes): 0 
INPUTNG: 0 
INPUT II/Fluids: 0 
INPUT SUBTOT/ll: 0 
OUTPUT Urine 0 
OUTPUTEmesis 0 
OUTPUTBM 0 
OUTPUT a. Wet Diaper Weight 0 
OUTPUT b. Dry Diaper Weight 0 
OUTPUT Total Diaper Weight output (calculate a-b) 0 
OUTPUTDrain: 0 
OUTPUT SUBTOT/ll: 0 
NetGain: 0 
NetLoss: 0 
Initials: ~/htnl 
Patient ldenti ca on: 
Patient is 25 yo russian male on Hunger Strike. He is easilyarroused when RN enters room and allows orthostatic blood 
pressures and weight to be checked. He refuses all else, refuses Pro\ader and nursing assessmen~ refuses lunch. Patient will 
not state if he has drank water or urinated. Refusal forms are completed and submitted to Mldical Records. Patient sleeps most 
of shift. Patient \erbali,es understanding of Plan of Care; and he \erbali,es his right to refuse. 
Patient Identification 
Patient prope~yidentified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
\Mat language do )OU speak? Russian, __ Interpretation pro\aded? Yes, Interpreter Number 
Number : 11298339 
Language Russian 
Pain /!ssessment 
Pain 
Ne )OU currently in pain? No 
Vital Signs 
16/min 
66.5in 
Examination 
General Examination: 
RR 
09/02/201804:37:19 PM 
H 
09/02/201804:37:19 PM 
GENER/IL !>PPEPRANCE: in no acute distress, well del.eloped, well nourished. 
Assessments 
1. lneffecti\e Coping [00069]-ND00069 (Primary) 
2. lneffecti\e community coping - ND00077 
Hunger Strike. 
Treatment 
1. lneffecti\11! Coping [00069] 
b)(6); N 
b)(7)(C) -
-
N 
Notes: Continue hunger strike protocol, encourage po food/lluids, encourage \erbalization of feelings. Encourage to allow staff to monitor intake and outp~ \atal signs, wt. lnslrucled to seek staffwilh any needs. lkrbali>ed understanding. Detainee offered 
lhree meals per day and lea\e in room 20 minutes before taking away. Pdequate supply of drinking water and olher be\erages 
as ordered by pro\ader awilable. Encourage dailyoral/phy.,ical h)lliene care. Change of dolhinglbedding. Continue to offer 
\atals, weights, food, labs, meds. Patient \erbali,es understanding of Plan of Care, and he \erbali,es his right to refuse. 
Procedure C::odes 
T1013 Sign Lang/0-al Interpreter 
Appoinbnent Provide1(b)(6); (b)(7)(C) fN 
Electronically signed bi.._b"'-).>.-'(6_..);.__ _ _.~, RN on 09/02/201816:37:27 (Pacific Daylight Time) 
Sign off status: Completed 
Addendum: 
09/02/201806:19P (b)(6); (b)(7)(C) PA11ENTIS39YEPRSQD,NOT25 
09/02/2018 06:20 P PATIENT IS 39 YEPRS QD, NOT 25 
2019-ICLl-00051 3367 
DHS-ICE-19-0196, 19-0197-O-000051

Northwest Detention Center 
1623 E J STREET T~~r98421 0itJ;__ I 
P-nt: AMAR, IIERGENSANA DOB: 10/23/1978 Prog,. .. Not-!(b)(6): (b)/7)/Cl ,.. 09/02/2018 
NCl.e gene,>11.ed by eC/inica/'Na1<s BvR'PM Sottv.ere (l'N.WeC/inica/W<rks.coojl 
2019-ICLl-00051 3368 
DHS-ICE-19-0196, 19-0197-O-000052

09102/2018 
Review of Systems 
Refused to answer questions. 
U.S. Immigration 
and Customs 
Enforcement 
Reason for Appointment 
1. Daily Rounds 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: Picture, Verbally 
Chaperone Present? No 
Wiat language do you speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number 
Number : 11298339 
Language Russian 
Pain .1>6sessment 
Pain 
ke you currently in pain? No 
Narrati,,.,, 
AMAR,MERGE~ A:216269802 Si.ti1 b)(6); 
Facility Code: CSCN/1/WA . 
39 Y old Male, DOB: 10/23/1978 
AccOl.rll lunbe~ 
1623 EJ STREET, T~ 
Appoirimert Facility: Northwest Detertion Certer 
Appointment Provldefb)(6); (b)(?)(C) !NP 
(0840) Patient in M-tU for health monitoring while he is on hunger strike. Patient did not want to answer any questions today. 
Refused \atal signs. refused weight check. Refused exam. Refused to pro.ide urine sample for testing. 
Hunger Strike: 
Madical Eleluation 
Date missed meals monitoring initiated: 08/22/2018 
Wien did the official hunger strike begin? 08/2512018 
Date of last meal oonsumed: 08/22/2018 
Last meal oonsumed: Breakfast 
Drinking fluids: No Patient refused to ansvier if he is drinking fluids 
# of dai,s on hunger strike: 9 
Total \/\eight loss in pounds: 0 Patient is refusing v.eight checks 
Reason for hunger strike: Wclnls lo be released from custody 
Housing/Isolation Location: M,dical Housing Unit 
Reason for Isolation F1acement For dose supervision, obse,vation, and monitoring 
Re-.;ew of the Housing Placement Review housing every 24 hours 
Vital Signs 
Refused ,,,;ta1 signs check. 
Examination 
General E><amination: 
Refused exam. 
Assessments 
1. Starvation, subsequent encounter - T73.0X><D (Primary) 
Treatment 
1. Starvation, subsequent encOl.rller 
Notes: Patient told interpreter he did not want to allow anjlhing done this morning, and he would not prolide anyinfonnation in 
regards to any symptoms he may ha,,.,_ \MIi continue to monitor patient and round routinely. \MIi continue to offer food and water. 
Continue with current plan of care. Patient ,oiced understanding. 
Follow Up 
inam 
Appoinbnent Provide 
b)(6); (b)(?)(C) 
b}(6); 
b)(?)(C) "" 
Bectronically signed b)(6); (b)(?)(C) on 09/02/201812:54:29 (Pacific Daylight Time) 
Sign off status: Compll!n!.,,...----~ 
Northwest Detention Center 
1623 E J STREET 
T~~ ~'A 98421 r:i§{~/-- I 
Patient: AMAR, MERGENS.ANA DOB: 10/23/1978 Progress Note: l(b)(6); -· ~p 09/02/2018 
Ncxe generated byeOinica/Worl<s BvR'PM Solfv.ere (""""'eC/inic81Works.com) 
2019-ICLl-00051 3369 
DHS-ICE-19-0196, 19-0197-O-000053

U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A:216269802 Su:ll~b)(6); I 
Facility Code: CSCN/1/WA tb'' ,;---~• 39 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunbe~ 
1623 EJ STREET, T~ 
Appoirimert Facility: Northwest Detertion Certer 
09102/2018 
Allergles 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue Refused to answer. Headache Refused to answer . 
Lightheadedness Refused to answer. Sleep 
Disturbance Refused to answer. 'Mlight loss Refused to answer 
. DryM>uth Refused to answer. 'Mlakness Refused to answer. 
Cough Refused to answer. Shortness of breath at rest Refused to 
answer. Chest pain at rest Refused to answer. 
Palpitations Refused to answer. J>bdominal Pain Refused to 
answer. Constipation Refused to answer. Diarrhea Refused to 
answer. Nausea Refused to answer. \bmitting Refused to 
answer. Painful urination Refused to answer. Decreased urine 
output Refused to answer. Mlsde aches Refused to answer. 
Mlsde cramps Refused to answer. Skin breakdown Refused to 
answer. Difficultythinking Refused to answer. 
Reason for Aflpolntment 
1. tvHU NOC NSG RDS 
History of Present Illness 
Patient Identification: 
Patient Identification 
Aflpolntment Provlcle,(b)(6); (b)(7)(C) IRN 
Patient properly identified by2 sources indudin : ID Badge, Picture 
Chaperone Present? Yes GEOCEF/C hi/" 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number 11298134 
Number Use notes ffeld 
Language Russian 
Pain .1>6sessment 
Pain 
ke }OU currently in pain? No REFUSED ANY I.ED/CAL ASSESSNENT 
Flowsheets (tvHU): 
lnput/OJtput Flowsheet 
Time: 2300 (SH/FT9/112018 2300-9/2/2018 0700) 
INPUT PO: 0 DETAINEE REFUSED ANY l,IED/CAL ASSESSI.IENT 
INPUT SUBTOT/ll: 0 DETA!NEE REFUSED ANY l,IED/CAL ASSESSI.IENT 
OUTPUTUrine 0DETAINEEREFUSEDANYI.EDICALASSESSNENT 
OUTPl.Jl.S!,laIOT/ll: 0 DETA!NEE REFUSED ANY I.ED/CAL ASSESSNENT 
Initials:~ 
Hungerstrike M>nitoring Form 
Day 09/01/2018 (SHIFT9/1/2018 2300-9/2/2018 0700) 
Shi~ Night 
Intake PO(in ml): 0 DETA!NEE REFUSED 70REPORTIF HE'S DRANK ANY R.UIDS DURING SHIFT BUT WAS NOTED 
WASHING HIS FACE AND BRUSHING HIS TEETH 
OJ!put Urine (in ml): 0 DETA!NEE WAS OOSERVED 70HAVE USED 1HE TOILET TO PEE X 1 ARCXJND 8:00PM 
DETAINEE R~ 70PROVIDE URINE SAM'LE 
Initials:_~ 
Hunger Strike. 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
IM1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: No DETA!NEE REFUSED ANY I.ED/CAL ASSESSNENT 
Reason for hunger strike: Wcints to be released from custody 
/ldequate supply of drinking water and other be-erages available: Yes 
Three meals deli-ered per day to patient Yes 
Breakfast deli-ered during current shift 0% consumed 
/lnyunauthori>edfoodinroom? No 
Haw dailyorthostatic \ital signs been completed? __ Refilsed. Detainee refilsed to sign refilsal form 
Has input and output been documented on the the M-IU Hunger Strike M>nitoring Smart Form? Yes 
Narrati-e: 
23:00 Detainee was noted la:,ing in his bed, sleeping with normal rise and fall of chest Detainee does not appear to be in 
anydistress. \MIi continue to monitor. 
05:50 Detainee was assessed after refusing breakfast (missed meal# 33). Detainee refused to speak with nurse. Detainee 
refused to oooperate during RN assessment non-erbal at first but e-entuallynodded when asked if he's refusing any medical 
assessment Refused \JS, orthostatic, prolide a urine sample or weight assessment Pt refused to eat breakfast it is missed 
meal #33. \MIi continue to monitor. 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Vital Signs 
REFUSED TO HA\IE HIS \JS, ffiTHOSTAllC l'ND IM:IGHT BE TPl<EN. 
Examination 
General E><amination: 
GENER/IL !>PPEJ>Rl'NCE: inno acute distress, appears weak and lethargic .. 
PSYCH: alert, oriented. 
Assessments 
Ill-Risk for imbalanced nutrition: less than body requirements. 
Treatment 
1. Others 
Notes: Nursing to assess h)<lration status: skin turgor, mucous membranes, blood pressure, heart rate, intake & output \MIi 
continue to encourage detainee to eat all meals deli sered to him and to drink fluids. Detainee has access to drinking water 
inside of oell. Detainee educated on possible risks to health if he continues to miss meals. Detainee educated on risks of not 
drinking adequate amount of fluids. Detainee educated to drink at least 8-10 cups of liquids per day.Detainee educated on 
possible medical risks of continuing to refuse meals. Detainee instructed to inform nursing staff/offioers if s)fllptoms discussed 
begins, or if ha\<ng continues or beccmes worse. Detainee also instructed to let offioer know if he wants a tray to consume. 
Detainee 1.erbali>ed understanding of all instrudions and did not ha,e anyadditional questions. Detainee to remain in M-IU/seg 
until ,,,;11 only released from hunger strike treatment/monitoring byphy.;ician. Detainee refused to acknowledge patient education 
and instructions pro\<ded by nurse. 
Procedure Codes 
T1013 Sign Lang/0-al Interpreter 
Notes: Detainee to remain in M-IU~unger Strike 
Appointment Provider. (b)(6); (b)(7)(C) RN 
2019-ICLl-00051 3370 
DHS-ICE-19-0196, 19-0197-O-000054

Electronically signed by ... ~b_)_(6_); __ ....,IRN on 09/02/2018 06:17:47 (Pacific Daytight Time) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREEr 
TAIXMA, WA98421 
Tfb)/6) ! Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 Progress Notai(b )(6); (b )(7)(C) t'N 09/02/2018 
NcJ.e genermed by eC/inica/Wa1<s a.RJPM &:f/"'8re (w.w.1eC/inica/Works.caT9 
2019-ICLl-00051 3371 
DHS-ICE-19-0196, 19-0197-O-000055

U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:llol_/h~\=/R~\~· -~ 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunber:~ 
1623 EJ STREET, T~ 
Appoirimert Facility: Northwest Detertion Certer 
09101/2018 
Allergles 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue Refused to answer. Headache Refused to answer . 
Lightheadedness Refused to answer. Sleep 
Disturbance Refused to answer. 'Mlight loss Refused to answer 
. DryM>uth Refused to answer. 'Mlakness Refused to answer. 
Cough Refused to answer. Shortness of breath at rest Refused to 
answer. Chest pain at rest Refused to answer. 
Palpitations Refused to answer. J>bdominal Pain Refused to 
answer. Constipation Refused to answer. Diarrhea Refused to 
answer. Nausea Refused to answer. \bmitting Refused to 
answer. Painful urination Refused to answer. Decreased urine 
output Refused to answer. Mlsde aches Refused to answer. 
Mlsde cramps Refused to answer. Skin breakdown Refused to 
answer. Difficultythinking Refused to answer. 
Aflpolntment Provlde'f:b)(B); (b)(?)(C) 
Reason for Aflpolntment 
1. 212 H/llF a= PM SHIFT MHU NSG RDS 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEOCffl~EJifb)(6): ! 
Wiat language do }OU speak? Russ,an 
Interpretation pro\aded? Yes, Interpreter Number 112977 45 
Number Use notes ffeld 
Language Russian 
Pain .1>6sessment 
Pain 
/>,e }OU currently in pain? No 
Flowsheets (MHU): 
lnput/OJtput Flowsheet 
Time: 1900 (SHIFT9/1120181900-9/1/2018 2300) 
INPUTPO: 0DETAINEEREFUSED TOREPORTIFHE'SDRANKANYFLUIDSDURINGSH/FTBUTWASNOTED 
WASHING HIS FACE AND BRUSHING HIS TEETH 
INPUTSUBTOT/11..: 0DETA!NEEREFUSEDTOREPORTIFHE'SDRANKANYFLUIDSDURINGSH/FTBUTWASNOTED 
WASHING HIS FACE AND BRUSHING HIS TEETH 
OUTiPUTUrine 0DETAINEEWASa3SER\IED TO HAVE USED THETOILETTOPEEX1 ARCXJND8:00PM DETA!NEE 
REFUSED TO PROVIDE URINE SAAPLE 
OUTiPUT SUBTOT/11..: 0 DETAINEE WAS a3SERVED TO HAVE USED THE TOILETTOPEEX 1 ARCXJNDB:OOPM 
DETAINEE~ TO PROVIDE URINE SAAPLE 
Initials:~ 
Hungerstrike M:mitoring Form 
Day: 09/01/2018 
Shift PM 
Intake PO(in ml): 0 DETA!NEE REFUSED TOREPORTIF HE'S DRANK ANY FLUIDS DURING SHIFT BUT WAS NOTED 
WASHING HIS FACE AND BRUSHING HIS TEETH 
OJ!put Urine (in ml): 0 DETA!NEE WAS a3SERVED TO HAVE USED THE TOILET TO PEE X 1 ARCXJND 8:00PM 
DETAINEE ~ED TO PROVIDE URINE SAAPLE 
lnitials:K!:llLJ 
Hunger Strike: 
Nursing Evaluation 
Date missed meals moniloring initiated: 08/22/2018 
\Mien did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: No REFUSES TO USE GIVEN WATER Pt1CHERAND REFUSES TO SAY IF HE HAS BEEN DRINKING 
ORNOT 
Reason for hunger strike: W.,nts lo be released from custody 
l'<:!equate supply of drinking water and other be-erages available: Yes 
Three meals deli-ered per day lo patient Yes 
/lnyunauthoriiedfoodinroom? No 
Hase dailyorthostatic \ital signs been completed? __ Refused. Detainee refused to sign refusal form 
Has input and output been documented on the the M-IU Hunger Strike M:miloring Smart Form? Yes 
~: 19:00 Detainee was noted awake, la~ng on his bed and watching a molie during initial rounds. Does not appear lo be in any 
distress. WII continue lo monilor. 
20:10 Detainee was obsen.ed using the loilet lo pee, he was also noted brushing his teeth and washing his face. Unable lo 
properlyliew if he's drank water in the process. 
20:45 Detainee was sleeping on his bed, woke up upon RN and GEO entering his room. Detainee reports he's feeling "bad" 
but refused lo elaborate more on how he's feeling. Detainee states he showered this afternoon that made him feel better. 
Detainee was encouraged to prolide urine sample but refused as part of his hunger strike. Detainee refused lo prolide 
information if he's drank any fluids during the shift WII continue lo monilor. Detainee went back lo sleep. 
22:00 Detainee woke up and requested for a molie to watch. GEO aticer prolided mo,ie for detainee. 
23:00 Detainee was noted la~ng in his bed, sleeping with normal rise and fall of chest Detainee does not appear lo be in 
anydistress. WII continue to monilor. 
Patient is considered lo be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and moniloring. 
Vital Signs 
REFUSED HIS \t.5, ORTHOSTATIC /IND V\EJGHT TO BE A5SESSED/T/IKEN. 
Examination 
General E><amination: 
GENER/II.. /IPPEJIR/INCE: in no acute distress, appears weak and lethargic .. 
PSYCH: alert, oriented. 
Assessments 
/II-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: Nursing to assess hy:!ration status: skin turgor, mucous membranes, blood pressure, heart rate, intake & output. WII 
continue to encourage detainee lo eat all meals deli sered lo him and lo drink fluids. Detainee has aocess lo drinking water 
inside of cell. Detainee educated on possible risks lo health if he continues lo miss meals. Detainee educated on risks of not 
drinking adequate amount of fluids. Detainee educated to drink at least 8-10 cups of liquids per day.Detainee educated on 
possible medical risks of continuing lo refuse meals. Detainee instructed lo inform nursing staff/officers if s)fllploms discussed 
begins, or if haling continues or becomes worse. Detainee also instructed lo let officer know if he wants a tray lo consume. 
Detainee 1.erbaliied understanding of all instructions and did not ha-e anyadditional questions. Detainee lo remain in M-IU/seg 
until >MIi only released from hunger strike treatmentlmoniloring byphy.;ician. Detainee refused lo acknowledge patient education 
and instructions pro"ded by nurse. 
Procedure Codes 
T1013 Sign Lang/0-al Interpreter 
Notes: Detainee to remain in M-IU~unger Strike 
Appointment Provi~(b)(6); (b)(7)(C) F 
2019-ICLl-00051 3372 
DHS-ICE-19-0196, 19-0197-O-000056

Electronically signed ~b )(6); r on 09/01/2018 23:33:11 (Pacific Daylight Time) 
Sign off status: Comple"'ti.'"'"d'"',-,""'"""""-'-' _ _.. 
Northwest Detention Center 
1623EJSTREI" 
TACOMA, WA98421 
Telfl•,\f~\· 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 ProgNU Not8: l(b )(6); (b)(7)(C) I" 09/01/2018 
Nd.e general.ed by eOinica/W<n<s B>RIPM Sottw,re (""""eC/inica/works.CtJm) 
2019-ICLl-00051 3373 
DHS-ICE-19-0196, 19-0197-O-000057

09101/2018 
Allorglos 
N.KDA 
Review of Systems 
U.S. Immigration 
and Customs 
Enforcement 
Reason for Appointment 
1. First 1/2 ewning RN round. 
AMAR,MERGENSANA 
A:216269802 Su:llj(b)(6); I 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll lunbelth\/R\· 
1623 E J STREET, TACOMA,,;.;.:..W~A-9~84=2~1 __. 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Provide (b)(6); (b)(7)(C) N 
Refuse to giw infonnation related to health, but admited to ha\A3 
some weakness and lightheadeclness. 
History of Present Illness 
Fiowsheets (M-tU): 
lnput/OJtput Fiowsheet 
Ti me: 0700 From 15:00 to 1930 
INPUTPO: 0 
INPUT SUBTOT/11..: 0 
OUTPUT Urine 0 
OUTPUTBM 0 
OUTPUT SUBTOT/11..: 0 
Initials: !th\/ I 
Hungerstrike Mlnitoring Fonn 
Day. 09,,01/2018 
Shift: PM 
Intake PO (in ml): 0 refuses to measure intake states not drinking 
OJtput Urine (in ml): 0 REFUSED TOCQ.LECTURINE. 
OJtput Bowel Mlwments (in ml): 0 PER PT CAN NOT RECALL l.ASTBM 
Labs - Urine Ketones: REFUSED URINE DIP ANAL YS/S 
lnitials:Vh\/1 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEOCfflCERon duty 
IM1at language do )OU speak? Russian 
Interpretation pro\<ded? Provider fluent in patient's native language 
Pain l'ssessment 
Pain 
Ne )OU currently in pain? Yes 
The pain is located : multiple sites:headache, backpain and leg pain, 
The sewrityof pain is rated at 7110 
The sewrityof the pain is moderate 
The pain began 1-21\eeksago 
The character of the pain is aching 
The associated symptoms are l\eakness 
The pain is aggravated by none 
The pain is reliewd by other 
Describe: Pf refused any treatment 
Narratiw: 
pt in M-IU med 2 for hunger strike. Encounter with pt at 1604 during RN First 1/2 e-ening RN round. La~ng on bed, resting, 
this nurse asked how he is feeling, pt stated" pl oho" which mean bed, he refused 1,$, refused assessment he refused any 
treatments, he refused dipstick U/A, but he admitted there are no oheanges in his health status and admited to ha-eweakness, 
lightheadeclness, headache, and leg pain, this nurse offered to bring pain medication, or anytreatmenl but he stated that he will 
not lake any medications. This nurse strongly encouraged pt to drink water and educated pt about kidney., damage, and body 
damage if he continue do not drink water, but pt adamantly refused an)thing. pt refused to sign refusal fonn. This nurse 
instructed pt to infonn immediately nurse or officer about any changes. or if he need an)thing, this nurse asked if he has any 
question for her, pt denied to ha-e question, pt requested lVwhioh was gi-en to him. WII continue to monitor. /!bout 16:30 
obserwd pt to silting on toilel posible he urinated. 
pt refused to eat dinner, it is meal #32 missed. 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
Vlnen did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: No 
Reason for hunger strike: !Mlnts to be released from custody "relase to USI\" 
/1<:!equate supply of drinking water and other be-erages available: Yes He states he refuses to drink v.ateror any fluids. 
Three meals deli.ered per day to patient Yes 
Lunch deli.ered during current shift 0% consumed 
Dinner deli-ered during current shift 0% consumed 
/lnyunauthori2edfoodinroom? No 
Haw dailyorlhostatic \<lal signs been completed? Patient refused, see completed refusal tom, Refused to sign refusal 
form 
Has input and output been documented on the the M-IU Hunger Strike Mlnitoring Smart Fonn? Yes 
Vital Signs 
16/min 
66.5in 
Refused\,$. 
Examination 
General Examination: 
RR 
09/01/201804:46:37 PM 
H 
09/01/201804:46:37 PM 
GENER/II.. />PPEPRANCE: in oo acute distress, well del.eloped, well nourished. 
HEAD: normocephalic. 
ORAL CAvfTY: REFUSED TO OPEN MOUTH, SOME LIGHT DRYNESS OF TI-E LIPS NOTED . 
NECK/THYROID: nomnal, neck supple, full range of motion. 
SKIN: refuse exam. 
HEAAT: REFUSED EXA.M. 
LUNGS: REFUSED EXA.M. 
J>BDO\,EN: REFUSED EXAM. 
MJSCULOSKELET/11..: nomnal gait, full range of motion. 
NEURCX..OGIC: alert and oriented., . 
(b)(6); 
(b)(7)(C) 
PSYCH: alert, oriented, cogniji-e function intact,, good eye contact, speech clear, tt-<;,ught process logical, goal 
directed. 
Assessments 
/>I-Risk for imbalanced nutrition: less than body requirements. 
2019-ICLl-00051 3374 
DHS-ICE-19-0196, 19-0197-O-000058

Treatment 
1. Others 
Notes: Detainee verbaliaad understanding of plan of care and denies questions/concerns. Continue hunger strike protocol, 
encourage po food/fluids, encourage i,erbaliiation of feelings. Encourage to allow staff to monitor intake and output, ,ital signs, 
wt. Instructed to seek staff with any needs. lkrbaliaad understanding. Nursing Care Plan present Refer to nursing care plan for 
Orl-90ing interventions. Detainee offered three meals per day and leai,e in room for at least 20 minutes. Pdequate supply of 
drinking water and other beverages as ordered bypro,ider a,ailable. Encourage daily oral/physical h)!liene care. Detainee 
verbaliaad an understanding of education and/or treatment Voices no other concerns. 
Procedure Codes 
T1013 Sign Lang/Oral Interpreter 
Appointment ProvideK.__b~)(=6)~;· ~--'~ 
Electronically signed ~b)(6); ~-
Sign off status: Completed 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 
2019-ICLl-00051 
r on 09/01/201817:51:49 (Pacific Daylight Time) 
3375 
Northwest Detention Center 
1623 E J STREEr 
TACOMA, WA98421 
Telkh)(fl) I 
Fax: 
RN 09/01/2018 
DHS-ICE-19-0196, 19-0197-O-000059

U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgNU Nola: 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGV'ks.coojl 
2019-ICLl-00051 3376 
AMAR,MERGENSANA A:216269802 Su:llD:!lh\/R) I 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, tq;i:.· .1111_:1311.!IZII'""' AccOl.l"II l'unber (b )(6); 
1623 EJ STREET, T t1t-..\/7\/r-, 
DHS-ICE-19-0196, 19-0197-O-000060

09101/2018 
Allorglos 
N.KDA 
Review of Systems 
U.S. Immigration 
and Customs 
Enforcement 
Reason for Appointment 
1. RN day round/hunger strike 
AMAR,MERGENSANA 
.. A:216269802 Su:ll~b)(6); _ I 
Facility Code: CSOINWA 11\J k ea. lfi 
39 Y old Male, DOB: 10/23/1978 
AccOllll lunbedlh \/R\· I 
1623 E J STREET, TACOMA, WA-98421 
Appoirimert Facility. Northwest Detertion Certer 
Appointment Provide{~ /\~L, 
Refuse to giw information related to health, but admited to ha\A3 
some weakness and lightheadeclness. 
History of Present Illness 
Flowsheets (M-tU): 
lnput/OJtput Flowsheet 
Ti me: 0700 From 07:00 to 15:00 
INPUTPO: 0 
INPUT SUBTOT/11..: 0 
OUTiPUT Urine 0 
OUTiPUTBM 0 
OUTiPl,II..SUSTOT/11..: 0 
lnitialsfililifill 
Hungerstrike Mlnitoring Form 
Day. 09,,01/2018 
Shift: AM 
Intake PO (in ml): 0 refuses to measure intake states not drinking 
OJtput Urine (in ml): 0 REFUSED TOCQ.LECTURINE. 
OJtput Bowel Mlwments (in ml): 0 PER PT CAN NOT RECALL LAST BM 
Labs - Urine Ketones: REFUSED URINE DIP ANAL YS/S 
Initials: fh \/RI 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEOCfflCERon duty 
IM1at language do )OU speak? Russian 
Interpretation pro\<ded? Provider fluent in patient's native language 
Pain l'ssessment 
Pain 
Ne )OU currently in pain? Yes 
The pain is located : multiple sites:headache, backpain and leg pain, 
The sewrityof pain is rated at 7110 
The sewrityof the pain is moderate 
The pain began 1-21\eeksago 
The character of the pain is aching 
The associated simptoms are l\eakness 
The pain is aggravated by none 
The pain is reliewd by other 
Describe: Pf refused any treatment 
Narratiw: 
pt in M-IU med iso4 for hungerslrike. Encounterwilh ptat0810 during RN day round. Laying on bed appears to be asleep. 
respirations ewn, no distress noted. Wlen lhis nurse called pt name he open his eyes and talk wilh lhe nurse, when lhis nurse 
asked how he is feeling pt stated" pl oho" which mean bed, he refused lf-3, refused assessmen~ he refused any treatments, but 
he admitted to haw weakness, lighlheadedness, headache, and leg pain, lhis nurse offered to bring pain medication, or any 
treatrnen~ but he stated Iha! he will not take any medications. This nurse strongly encouraged pl to drink water and educated pl 
about kidnei,s damage, and body damage if he continue do not drink water, but pl adamantly refused anything. pt refused to sign 
refusal form. This nurse instruded pt to inform immediately nurse or officer about any changes, or if he need anything, lhis nurse 
asked if he has anyquestion for her, pl denied to haw question,. \l\illl continue to monitor. 
Jll>out 1000 enoountered wilh pl togelherwilh pro\ider, and pt again refused any assessment and treatments. 
Enoountered wilh pt multiple times and ewrytime encouraged to drink, pl requested to go to church, per GEO officer 
superusor told Iha! he cannot attend lhe church. Plso, pt was informed Iha! he will be mow to another room. 
Enoounter wilh pt about 1420, also, at lhis time pt was mow to rvED2, pl stated Iha! he liked lhe pre\iouslyroom more. pt 
miss meal #31 >Mlh lunch, he continue to refuse water, and slated Iha! he didnturinated. This nurse strongly recommended and 
educated pl to drink water to a1.0id kidney.; damage, but pl slated Iha! he wants to be set free. Plso, pl asked for Russian books, 
lhis nurse informed officer about pl request Encouraged to drink, but he whement refused. \l\illl continue to monitor. 
Patient is oonsidered to be on official hunger slrike and will be isolated from other detainees for dose superusion, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
Wlen did the official hunger slrike begin? 08/25'2018 
Date of last meal oonsumed: 08/22/2018 
Last meal oonsumed: Breakfast 
Drinking Fluids: No 
Reason for hunger strike: Wcints to be released from custody "relase to USI\" 
/ldequate supply of drinking water and other bewrages available: Yes He states he refuses to drink ooteror any fluids. 
Three meals deliwred per day to patient Yes 
Lunch deliwred during current shift 0% oonsumed 
Dinner deliwred during current shift 0% oonsumed 
/lnyunauthori2edfoodinroom? No 
Haw dailyorlhostatic \<!al signs been oompleted? Patient refused, see completed refusal fonn Refused to sign refusal 
form. 
Has input and output been documented on lhe lhe M-IU Hunger Slrike Mlnitoring Smart Form? Yes 
Vital Signs 
16/min 
66.5in 
Pt refused lf-3. 
Examination 
General Examination: 
RR 
09/01/201811:10:38MI 
H 
09/01/2018 11 :10:38 Ml 
GENER/II.. !>PPEPRANCE: in oo acute distress, well del.eloped, well nourished. 
HEAD: normocephalic. 
CJRAL CAvfTY: REFUSED TO OPEN MOUTH, SOME LIGHT DRYNESS OF n-E LIPS NOTED . 
NECK/THYROID: noonal, neck supple, full range of motion. 
SKIN: refuse exam. 
HEAAT: REFUSED EXA.M. 
LUNGS: REFUSED EXl'.M. 
J>BDO\,EN: REFUSED EXAM. 
MJSCULOSKELET/11..: not obserwd. did shcMer. 
NEURQOGIC: alert and oriented ... 
2019-ICLl-00051 3377 
(b)(6); 
(b)(?)(C) ~ 
-
-
~ 
DHS-ICE-19-0196, 19-0197-O-000061

PSYCH: alert, Oliented, cogniti\El function intact,, good eye contact, speech clear, tl'Klught process logical, goal 
directed. 
Assassments 
Ill-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: Detainee \Elrbali:zed understanding of plan of care and denies questions/concerns. Continue hunger strike protocol, 
encourage po food/fluids, encourage 1.erbali2ation of feelings. Encourage to allow staff to monitor intake and output, ,.;ta1 signs, 
wt Instructed to seek staff with any needs. \krbaliied understanding. Nursing Care Plan present Refer to nursing care plan for 
Orl-9(ling inter1.entions. Detainee offered three meals per day and lea1.e in room for atleast20 minutes. Pdequate supplyof 
drinking water and other be1.erages as ordered bypro,.;der available. Encourage dailyoral/phy.,ical h19iene care. Detainee 
1.erbali:zed an understanding of education and/or treatment Voices no other concerns. 
Procedure Codes 
T1013 Sign Lang/Oral Interpreter 
Appolnbnent Providefb)(6); ~-
Electronically signed b,_l(b_)_(6_); __ _.~ on 09/01/201815:45:43 (Pacific Daytight Time) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STRE£r T~~r98421 ™fai~f_ I 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progre .. No"'!.._(b __) __ (6__ ) __ :__ _.!RN 09/01/2018 
/I/de generated byeC/inica/Wcrl.s a.R/PM &itware ("""'eC/inicl'iWorks.com) 
2019-ICLl-00051 3378 
DHS-ICE-19-0196, 19-0197-O-000062

09101/2018 
Review of Systems 
Mlsculoskeletal: 
Mlsde aches admits. 
U.S. Immigration 
and Customs 
Enforcement 
Reason for Appointment 
1. tvHU DJ>JL YROJNDS 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? Russian ~"::et~~rud~~ Yes, Interpreter Name 
Language usstan 
Pain .1>6sessment 
Pain 
/>,e }OU currently in pain? No 
Narrati,,.,, 
AMAR,MERGENW A:216269802 Su:llD: b)(6); 
Facility Code: CSCN/1/WA Housing ea: 
39 Y old Male, DOB: 10/23/1978 
Acc01.rHunbe~~)(6Ji I 1623 E J STREET, TPCac nde.D4z 1 
Appoimnert Facility: Northwest Detertion Certer 
(1020) Patient in tvHU for hunger strike. He refused ,,;1a1 signs. Refused to pro,,;de urine sample for testing. Refused exam. 
Stated he was ha,,;ng some body aches but when asked if he would take an oral analgesic he refused as well. 
Yitai Signs 
Refused ,,;1a1 signs. 
Examination 
General E>amination: 
Refused exam. 
Assessments 
1. Star.etion, subsequent encounter - T73.0X><D (Pr mary) 
Treatment 
1. Starvation, subsequent enc01.11ter 
Notes: Patient also refused weight check. \MIi continue to monitor and do rounds routinely. Continue with current plan of care. 
patient 10ioed underslandi ng. 
Follow Up 
inam 
Ap ·ntment P ·de{b)( 6); po, rovih\/ 7 \/C:\ 
(b)(6); (b)(7)(C) 
Electronically signed b)(6); (b)(7)(C) on 09/01/201812:46:23 (Pacific Daylight Time) 
Sign off status: Comp e 
Northwest Detention Center 
1623 E J STREET 
T 21 
Patient: AMAR, MERGENS.ANA DOB: 10/23/1978 Progre .. Notel(b)(6); ~- I NP 09/01/2018 
N(te generaled byeOirica/Worl<s EM>/PM &:ifvere {IWMleClinica/Works.com) 
2019-ICLl-00051 3379 
DHS-ICE-19-0196, 19-0197-O-000063

U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA . . A: 216269802 Su:ll~ )(6); 
Facility Code: CSONVWAn og,. ea. 1t1 
39 Y old Male, DOB: 10/23/1978 
Acc0Ull~b)(6); I 
08131/2018 
Allergles 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue Refused to answer. Headache Refused to answer . 
Lightheadedness Refused to answer. Sleep 
Disturbance Refused to answer. 'Mlight loss Refused to answer 
. DoyM>uth Refused to answer. 'Mlakness Refused to answer. 
Cough Refused to answer. Shortness of breath at rest Refused to 
answer. Chest pain at rest Refused to answer. 
Palpitations Refused to answer. J>bdominal Pain Refused to 
answer. Constipation Refused to answer. Diarrhea Refused to 
answer. Nausea Refused to answer. \bmitting Refused to 
answer. Painful urination Refused to answer. Decreased urine 
output Refused to answer. Mlsde aches Refused to answer. 
Mlsde cramps Refused to answer. Skin breakdown Refused to 
answer. Difficultythinking Refused to answer. 
1623 E J STREET, T, , .. o , 
Appoimnert Facility: Northwest Detertion Certer 
Reason for Aflpolntment 
1. tvHU E\.£ NSG RDS 
History of Present Illness 
Patient Identification: 
Patient Identification 
Aflpolntment Provlael(b)( 6); (b)(?)(C) 
Patient properly identified by2 sources i~qdipg- ID {3adge, Picture 
Chaperone Present? Yes GEOa=F/CS Jl)(6); ! 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number 
Number Use notes ffeld 
Language Russian 
Pain .1>6sessment 
Pain 
/>,e }OU currently in pain? No 
Flowsheets (tvHU): 
lnput/OJtput Flowsheet 
Time: 2300 (SHIFTB/3112018 2300-9/1/20180700) 
INPUTPO: 0 
INPUT SUBTOT/ll: 0 
OUTPUTUrine 0PAnENTREFUSEDTOPRO\/IDEURINES4M'LE 
OUTPUT SUBTOT/ll: 0 
lnitials:!lh \/R I 
Hungerstrike M>nitoring Form 
Day 08/31/2018 
Shi~ Night 
Intake PO(in ml): 0 
OJtput Urine (in ml): 0 
I" 
Comments: REFUSES TO USE GIVEN WA1ER PITCHER AND REFUSES 70$<\Y IF HE HAS BEEN DRINKJNGOR NOT 
REFUSES ~TOOTPUT 
Initials: l'.b.llli.l 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
IM1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: No REFUSES 70USE GIVEN WA1ER Pl1CHERAND REFUSES 70$<\YIFHE HAS BEEN DRINKING 
ORNOT 
Reason for hunger strike: W.,nts to be released from custody 
/ldequate supply of drinking water and other be-erages available: Yes 
Three meals deli-ered per day to patient Yes 
/lnyunauthori>edfoodinroom? No 
Hase dailyorthostatic \ital signs been completed? __ Refilsed. Detainee refilsed to sign refilsal form 
Has input and output been documented on the the M-IU Hunger Strike M>nitoring Smart Form? Yes 
Narrati-e: 
23:00 Detainee was noted la:,ing on his bed, sleeping with normal rise and fall of chest Detainee does not appear to be in 
acute distress. WII continue to monitor. 
05:30 Detainee was assessed after refusing breakfast (missed meal# 30). Detainee reports he feels "bad". Detainee 
refused to prolide urine sample or ha-e his 1,$ be taken. Detainee reports he has not drank anyfluids or used the bathroom to 
pee during shift. WII continue to monitor. 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Examination 
General B<amination: 
GENER/ll /IPPE.AR.ANCE: in no acute distress. appears weak and lethargic .. 
PSYCH: alert, oriented. 
Assessments 
/II-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: Nursing to assess h)<lration status: skin turgor, mucous membranes, blood pressure, heart rate, intake & output WII 
continue to encourage detainee to eat all meals deli-ered to him and to drink fluids. Detainee has access to drinking water 
inside of cell. Detainee educated on possible risks to health if he continues to miss meals. Detainee educated on risks of not 
drinking adequate amount of fluids. Detainee educated to drink at least 8-10 cups of liquids per day.Detainee educated on 
possible medical risks of continuing to refuse meals. Detainee instructed to inform nursing staff/officers if s,mptoms discussed 
begins, or if ha"ng continues or becomes worse. Detainee also instructed to let officer know if he wants a tray to consume. 
Detainee 1.erbali>ed understanding of all instructions and did not ha,e anyadditional questions. Detainee to remain in M-IU/seg 
until will only released from hunger strike treatment/monitoring byphy.;ician. Detainee refused to acknowledge patient education 
and instructions pro"ded by nurse. 
Procedure Codes 
T1013 Sign Lang/0-al Interpreter 
Notes: Detainee to remain in M-IU.1-iunger Strike 
Appointment Provide1b)(6); (b)(7)(C) I RN 
Electronically signed (b)(6); on 09/01/2018 06:51:28 (Pacific Daylight Time) fh\/7\lr\ 
Sign off status: Comple 
2019-ICLl-00051 3380 
DHS-ICE-19-0196, 19-0197-O-000064

Northwest Detention Center 
1623EJ~ 
TACOMA, WA98421 
Tel'kb/~?_); 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Prog,.u Nota b)(6); (b)(7)(C) 
Nd.e general.ed byeClinica/Wm<s BvRIPM Saftvere (1w.W·etrnm:irvvm=m,-~ 
08/31/2018 
2019-ICLl-00051 3381 
DHS-ICE-19-0196, 19-0197-O-000065

U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA . . A: 216269802 Si.tllfa )(6); I 
Facility Code: CSOINWA t-locEn g,c; ea. lfi 
39 Y old Male, DOB: 10/23/1978 
Acc01.r11 tunbe~(b)(6)· 
08131/2018 
Allergles 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. 11\eight loss denies. Dry Mouth denies. 
11\eakness admits Cough denies. Shortness of breath at 
rest denies. Chest pain at rest denies. Palpitations denies. 
J>l>dominal Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \bmitting denies. Painful urination denies. 
Decreased urine output denies. Mlsde aches denies. Mlsde 
cramps denies. Skin breakdown denies. Difficultythinking denies. 
Reason for Appointment 
1623 E J STREET, TACOfJ,.-.,--•--~ 
Appoirimert Facility. Northwest Detertion Certer 
Appointment Provldej(b)(6); (b)(?)(C) 
1. PM SHIFT NOlE. Hunger Strike Nursing E1,0luation 
History of Present Illness 
Flowsheets (MHU): 
Upon encounter detainee was resting in bed and was willing to speak with nursing staff. Detainee reported not feeling good. 
Detainee reported all o\erthe bodyweakness but refused any medications or medical treatment Detainee refuses ,.;tals and to 
report drinking any water and refuses to report any output No other concerns '°iced at this time. Detainee is now resting quietly 
in his room. \MIi continue to monitor. 
Hungerstrike Monitoring Form 
Day. 08/2912018 
Shift: PM 
Intake PO(in ml): 0 
Intake r.J-Normal Saline (in ml): 0 
Intake r.J-LR (in ml): 0 
Intake NG(in ml): 0 
QJtput Urine (in ml): 0 
Comments: REFUSES TO USE GIVEN WA7ER PITCHER AND REFUSES TOSI\Y IF HE HAS BEEN DRINKING CR NOT. 
REFUSES TO REPCRTOUTPUT. 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEOCEF/CER 
IM1at language do }OU speak? Russian 
Interpretation pro,.;ded? Yes, Interpreter Number LION BRIDGE-# 9171 
Number Use notes field 
Language Russian 
Pain 1'6sessment 
Pain 
l'<e }OU currently in pain? No 
Narrati\e: 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
obseMtion, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
\M1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: No REFUSES TO USE GIVEN WA7ER PITCHER AND REFUSES TOSI\YIFHE HAS BEEN DRINKING 
CRNOT 
Reason for hunger strike: Wcints to be released from custody 
/ldequate supply of drinking water and other be\erages a1,0ilable: Yes 
Three meals deli\ered per day to patient Yes 
/lnyunauthori>edfoodinroom? No 
Ha\e dailyorthostatic ,.;1a1 signs been completed? Yes 
Has input and output been documented on the the M-IU Hunger Strike Monitoring Smart Form? Yes 
Vital Signs 
REFUSES vfT;>LS />ND WEIGHT. 
Examination 
General E><amination: 
GENER;>L !>PPEJ>Rl>NCE: in no acute distress, well del.eloped, well nourished. 
PSYCH: alert, oriented. 
Assessments 
Ill-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: 1. Continue with \Atal Signs e>eryshifl; Intake and OJlput Monitoring e>eryshifl; Dailyweights; Dailyorthostatic ,.;ta1 signs. 
2. /In adequate supply of drinking water and other be>erages are a1,0ilable to patient at all times. 
3. Three meals per day are deli\ered to the patient and deli\eryof meals is documented. 
4. /lll food not authori>ed by CD/Phy.;ician is remo>ed from patienrs room. 
5. Patient is not allowed to purchase food from commissary\ending machine while on hunger strike. 
6. Patient will only be released from hunger strike treatment/monitoring byCD or phy.;ician order. 
7. Patient counseled regarding the medical risks of continuing the hunger strike. 
8. Encouraged to terminate the hunger strike and eat/drink as normal. 
Appointment Providel(b)(6); (b)(?)(C) 
Bectronically signed b¥b)(6); (b)(7)(C) 
Sign off status: Completed 
2019-ICLl-00051 3382 
!RN on 08/31/201818:51:34 (Pacific Daylight Time) 
Northwest Detention Center 
1623 E J STREET 
DHS-ICE-19-0196, 19-0197-O-000066

T~r98421 Tel~i 
Pali-t: AMAR, IERGENSANA DOB: 10/23/1978 p.....,.. itot4'.b)(6); (b)(7)(C) 
Ncl.e generated by eC/inica/'Na1<s EJvR/PM Sottv.ere (,w,weC/inica/WGYks.COOjl 
IRN 08/31/2018 
2019-ICLl-00051 3383 
DHS-ICE-19-0196, 19-0197-O-000067

U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgNU Nola: 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3384 
AMAR,MERGENSANA A: 216269802 Su:i1K""b"")(-'-6)"'-: ___,,,.,........ Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II ~bei(b)(6); 
1623 E J STREET, T ACOl""',""""'*""'A..,5.,.64""2..-,-' 
DHS-ICE-19-0196, 19-0197-O-000068

U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA . . A: 216269802 Su:ll,.J;6 )(6) _I 
Facility Code: CSOINWA liiQked. lfl 
39 Y old Male, DOB: 10/23/1978 
AccOl.rll ~be~ 
1623 EJ STREET, T~ 
Appoirimert Facility. Northwest Detertion Certer 
08131/2018 
Past Medical History 
No Wedical History. 
Alle'9leS 
N.KDA 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue admits 
Fe""r denies. Headache denies. Lightheadedness admits, at 
rest, often . Seep disturbance denies. 
Hunger Strike: 
Fatigue admits, that is constant, that is 'Mll"Sening. 
Headache denies. Lightheadedness admits, SEMlral times. 
Seep Disturbance denies. 11\eight loss denies. Dry M>uth denies. 
11\eakness admits, his legs 'Mlnl hold him. Cough denies. 
Shortness of breath at rest denies. Chest pain at rest denies. 
Palpitations denies. />bdominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. \bmitting denies. Painful 
urination denies. Decreased urine output admits Mlsde 
aches admits legs. Mlsde cramps denies. Skin 
breakdown denies. Difficultythinking denies. 
History of Present Illness 
Flowsheets (M-!U\: 
Aflpolntment Provlde1(b)(6); (b)(7)(C) 
Pt continues to refuse all medical evaluation. This includes litals, VO, weights and laboratory testing including UA Pt denies 
taking a shower for 4 day.;. He denies getting out of bed. He onlywill accept a book to read. He refuses to go to the hospital to get 
evaluation. 11\e do not know the eirent of his weight loss. Pt is clear minded and goal oriented. There is no indication of 
hallucnation. He states his bodyhurts all o""respeciallyhis back. He refuses pain medication. 
Hungerstrike Mmitoring Form 
Day. 08/29/2018 
Shift: AM 
Intake PO (in ml): 0 refuses lo measure intake stales not drinking 
Output Urine (in ml): 0 REFUSED TOCO.LECTURINE. 
Output Bowel ~ments (in ml): 0 PER PT CAN NOT RECALL LAST BM 
Labs - Urine Ketones: REFUSED URINE DIP ANALYSIS 
Initials:~ 
Patient k:lentification: 
Patient k:lentification 
Patient properly identified by2 sources including: ID Badge, Verbally 
Chaperone Present? No 
IMlat language do )OU speak? Russian 
Interpretation prolided? Yes, Interpreter Number 
Number : Uonbridge 11294042 
Language Russian 
Pain Assessment 
Pain 
ke )OU currently in pain? Yes 
The pain is located Use Notes Section all over lov.er body 
The se""rityof pain is rated at 7110 
The se""rityof the pain is moderate 
The pain began 1-2v.eeksago 
The character of the pain is aching, is constant 
The associated simptoms are none 
The pain is aggravated by any physical activity, bending 
The pain is relie~ by none refused offer of medication 
Narrati"": 
Patient is on official hunger strike and is being housed in M-tU for close supen.1sion, observation, and monitoring. He is 
offered meals three times a day and litals q shift etc. 
Hunger Strike: 
Wedical Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
Wien did the official hunger strike begin? 08!25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking fluids: No 
# of day.; on hunger strike: 6 
Total 11\eight loss in pounds: 0 unknoon, patient is refusing 
Reason for hunger strike: Wcmts to be released from custody 
Housing/Isolation Location: M;dical Housing Unit 
Reason for Isolation Placement For dose supervision, observation, and monitoring 
Reliew of the Housing Placement Review housing eve,y 24 hours 
Yitai Signs 
refused. 
Examination 
General Examination: 
GENERN. !>PPEPRANCE: ill-appearing, thin, wthdrawn, alert and oriented lying beneath a blanket refusing to gel up. 
E'l'ES: dry eyes. 
OR.AL CAvflY: refused exam. 
SKIN: normal, no rashes, no suspicious lesions. 
HE.ART: refused exam. 
MJSCULOSKELETJ>l: refused exam -.ery thin. 
PS'YCH: alert, oriented, cogniti"" function intact, poor eye contact, speech diminished output, -.olume, no auditory or 
1,1sual hallucinations, thought content wthout suicidal ideation, delusions. 
Assessments 
1. Starvation, subsequent encounter - T73.0X)<I) (Primary) 
/>I-Risk for imbalanced nutrition: Less than body requirements 
Self-imposed Hunger strike. 
Treatment 
1. Starvation, subsequent encOl.rller 
Notes: Pt appears weaker, dysphoric but irritable. Pt is at risk for se""re deh)<lration consequences such as s;ocope, cardiac 
arrhythmia or death. Ptwill need to be mo""d to a M-tU observation room for closer supen.1sion. He is has a change of condition 
he will need to be sent to the hospital ER. !MIi start proceedings for forced monitoring and IVh)<lration. 
Procedure Codes 
T1013 Sign Lang/0-al Interpreter 
Follow Up 
daily 
Notes: Pt is warned of dire consquences to his actions of not mo\Ang, drinking or eating. Pt continues to refuse all care and 
water. 
Appointment Providel(b)(6); (b)(7)(C) !MD 
2019-ICLl-00051 3385 
DHS-ICE-19-0196, 19-0197-O-000069

b)(6); (b)(7)(C) 
----~-D 
Electronically signed byl(b)(6); (b)(7)(C) ~Don 09/01/201811:34:43 (Pacific Daylight Tlme) 
Sign off status: Completed 
Northwest Detention Center 
1623EJSTREI" 
l'.1>4-,maa,,......,...,=-, 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 ProgNU Not8l(b)(6); (b)(7)(C) ~D 08/31/2018 
Ncte general.ed by eOinica/W<n<s B>RIPM Sottw,re (""""eC/inica/works.CtJm) 
2019-ICLl-00051 3386 
DHS-ICE-19-0196, 19-0197-O-000070

08131/2018 
Allorglos 
N.KDA 
Review of Systems 
U.S. Immigration 
and Customs 
Enforcement 
Reason for Appointment 
1. RN day round/ Hunger Strike 
AMAR,MERGENSANA 
.. A:216269802 Su:ll~b)(6); I 
Fac1lrtyCode:CSOINWA ng,c;ea.lfi 
39 Y old Male, DOB: 10/23/1978 
AccOl.rll lunber:~)-
1623 EJ STREET, T~ 
Appoirimert Facility. Northwest Detertion Certer 
Appointment Provide (b)(6); 
/h\/7\/f"'\ RN 
Refuse to giw information related to health, but admited to ha\A3 
some weakness and lightheadeclness. 
History of Present Illness 
Flowsheets (M-tU): 
lnput/OJtput Flowsheet 
Ti me: 0700 From 07:00 to 15:00 
INPUTPO: 0 
INPUT SUBTOT/11..: 0 
OUTiPUT Urine 0 
OUTiPUTBM 0 
OUTiPUT SUBTOT/11..: 0 
Initials: l<M:J 
Hungerstri e nitoring Form 
Day. 08/3112018 
Shift: AM 
Intake PO (in ml): 0 refuses to measure intake states not drinking 
OJtput Urine (in ml): 0 REFUSED TOCQ.LECTURINE. 
OJtput Bowel 11/owments (in ml): 0 PER PT CAN NOT RECALL LAST BM 
Labs -~Ketones: REFUSED URINE DIP ANAL YS/S 
Initials: (b )( 
Patient ldenti ~'- n: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEOCfflCERon duty 
IM1at language do )OU speak? Russian 
Interpretation pro\<ded? Provider fluent in patient's native language 
Pain l'ssessment 
Pain 
Ne )OU currently in pain? Yes 
The pain is located : multiple sites:headache, backpain and leg pain, 
The sewrityof pain is rated at 7110 
The sewrityof the pain is moderate 
The pain began 4-5 days ago 
The character of the pain is aching 
The associated symptoms are v,eakness 
The pain is aggravated by none 
The pain is reliewd by other 
Describe: Pf refused any treatment 
Narratiw: 
P! in M-IU med iso4 for hungerslrike. Encounter with ptat0822 during RN day round. Laying on bed appears to be asleep. 
respirations ewn, no distress noted. Wlen this nurse called pt name he open his eyes and talk with the nurse, when this nurse 
asked how he is feeling pt stated" pl oho" which mean bed, he refused lf-3, refused assessmen~ he refused any treatments, but 
he admitted to haw weakness, lightheadedness, headache, and leg pain, this nurse offered to bring pain medication, or any 
treatrnen~ but he stated that he will not take any medications. This nurse strongly encouraged pl to drink water and educated pl 
about kidnei,s damage, and body damage if he continue do not drink water, but pl adamantly refused anything. ~so, pl stated that 
his skin is itching, but he refused this nurse to make skin assessment Pt refused to sign refusal form. This nurse instructed pl 
to inform immediately nurse or officer about any changes, or if he need anything, this nurse asked if he has any question for her, 
pt denied to haw question, but requested phone, and officer gaw phone to pl \MIi continue to monitor. 
Enoounterwith pt about 1445 Pl was in the bed, stated that he feel wea"- Pl miss meal# 28 with lunch, he continue to refuse 
water, and stated that he didnl urinated. This nurse strongly recommended and educated pt to drink water to a1.0id kidnei,s 
damage, but pl stated that he wants to be set free. ~so, pl asked for Russian dictionary, which was giwn to him. /!t 1458 
enoountered again pt was sitting on the bed and washing his teeth. Stated that he feel "ploho"which means bad. Encouraged to 
drink, but he whement refused. \MIi continue to monitor. 
Patient is oonsidered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
Wlen did the official hunger slrike begin? 08/25'2018 
Date of last meal oonsumed: 08/22/2018 
Last meal oonsumed: Breakfast 
Drinking Fluids: No 
Reason for hunger strike: Wcints to be released from custody "relase to USI\" 
/1<:!equate supply of drinking water and other bewrages available: Yes He states he refuses to drink ooteror any fluids. 
Three meals deliwred per day to patient Yes 
Lunch deliwred during current shift 0% oonsumed 
Dinner deliwred during current shift 0% oonsumed 
/lnyunauthori2edfoodinroom? No 
Haw dailyorlhostatic \<lal signs been oompleted? Patient refused, see completed refusal tom, Refused to sign refusal 
form. 
Has input and output been documented on the the M-IU Hunger Strike 11/onitoring Smart Form? Yes 
Vital Signs 
16/min 
66.5in 
Refused lf-3 and assessment 
Examination 
General Examination: 
RR 
08/31/2018 10:28:33 /'M 
H 
08/31/2018 10:28:33 /'M 
GENER/II.. />PPEAA.ANCE: in oo acute distress, well del.eloped, well nourished. 
HEAD: normocephalic. 
ClR,AL CAvfTY: REFUSED TO OPEN MOUTH, SOME LIGHT DRYNESS OF n-E LIPS NOTED . 
NECK/THYROID: nomnal, neck supple, full range of motion. 
SKIN: refuse exam. 
HEAAT: REFUSED EXA.M. 
LUNGS: REFUSED EXA.M. 
J>BDO\,EN: REFUSED EXAM. 
MJSCULOSKELET/11..: not obserwd. did shcMer. 
NEURCX..OGIC: alert and oriented ... 
(b)(6); 
(b)(7)(C) 
PSYCH: alert, oriented, cogniji,e function intact,, good eye contact, speech clear, tt-<;,ught process logical, goal 
2019-ICLl-00051 3387 
I￾RN 
I￾I￾RN 
I￾DHS-ICE-19-0196, 19-0197-O-000071

directed. 
Assessments 
/>I-Risk for imbalanc.ed nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: Detainee wrbalized understanding of plan of care and denies questions/concerns. Continue hunger strike protocol, 
encourage po food/fluids, encourage wrbalLzation of feelings. Encourage to allow staff to monitor intake and output, ,;ta1 signs, 
wt Instructed to seek staff with any needs. ¼rbalLzed understanding. Nursing Care Plan present Refer to nursing care plan for 
on-going interwntions. Detainee offered three meals per day and leaw in room for atleast20 minutes. Pdequate supplyof 
drinking water and other bewrages as ordered bypro,;der a1<1ilable. Encourage daily oral/physical h)lliene care. Detainee 
1.erbalized an understanding of education and/or treatment Voices no other concerns. 
Procedure Codes 
T1013 Sign Lang/Oral Interpreter 
Appointment Providefb)(6); __ 
Electronically signed (b )(6); /1,,,..\/7\/,...., 
Sign off status: Comple e 
on 08/31/201815:00:23 (Pacific Daylight Time) 
Northwest Detention Center 
1623 E J STREEr 
T~SA98421 "fa[. 1 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progre .. No', ... /b._.) .. 16.. )_: __ .... r'" 08/31/2018 
/lkte generated by eC/inical\M:xi<s ElvRIPM Softw3re /"""'eC/inlca/Works.com) 
2019-ICLl-00051 3388 
DHS-ICE-19-0196, 19-0197-O-000072

U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGEN~ 
A:216269802 Si.ti1 (b)(6); 
Facility Code: CSCN/1/WA Housing ea: 
39 Y old Male, DOB: 10/23/1978 
AccOllll l'unber~(b )(6) I 
08131/2018 
Allorglos 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache admits Lightheadedness denies. 
Sleep Disturbance denies. 11\eight loss denies. Dry M>uth denies. 
11\eakness denies. Cough denies. Shortness of breath at 
rest denies. Chest pain at rest denies. Palpitations denies. 
J>l>dominal Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \bmitting denies. Painful urination denies. 
Decreased urine output admits Mlsde aches denies. Mlsde 
cramps denies. Skin breakdown denies. Difficultythinking denies. 
J>OMTS-leg pain. 
1623 E J STREET, T ACOr. , .. ,'. , 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Provlde,,fb)(6); (b)(7)(C) 
Reason for Appointment 
1. tvHU NIGHT RN ROUNDS 
History of Present Illness 
Flowsheets (tvHU): 
lnput/OJtput Flowsheet 
Time: 0300 
INPUTPO: 0 
INPUT SUBTOT/11..: 0 
OUTPUT Urine 0 
OUTPUT SUBTOT/11..: 0 
Initials:•"-''~' 
Hungerstrike M>nitoring Form 
Day. 08130/.2018 
Shift: Night 
lntakePO(inml): 0PTDECLINEDTOREPCRT 
OJtput Urine (in ml): 0 PT DECLINED TOREPCRT 
OJtput mwments (in ml): 0 
Initials: (b )(6 
Patient ldentifi · . 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEO OFFICER Ka=cED 
W1at language do )OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number 
Number _. 11291556 
Language Russian 
Pain l'ssessment 
Pain 
l'<e )OU currently in pain? Yes 
The pain is located _. Head and legs 
The sewrityof pain is rated at 7110 
The sewrityof the pain is moderate to severe 
The pain began 3-4 days ago 
The character of the pain is constant 
The associated symptoms are none 
The pain is aggravated by none 
The pain is relie'VE!d by none REFUSED PAIN M=DICATION 
Narratiw: 
Pl seen in tvHU for night nursing rounds. Patient stated that he was feeling "poorly'with a 7/10 pain in his head and both 
legs. He denied all other medical complaints. Nurse encouraged patient to drink fluids and remain h)<lrated during hunger strike. 
Patient refused breakfast (27th meal). 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
Vlnen did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: No 
Reason for hunger strike: IMlnts to be released from custody 
Pdequate supply of drinking water and other be-erages available: Yes 
Three meals deliwred per day to patient Yes 
Breakfast deliwred during current shift 0% consumed 
/lnyunauthori2edfoodinroom? No 
Haw dailyorthostatic \atal signs been completed? Patient refused, see completed refusal form Refused to sign refusal 
form. 
Has input and output been documented on the the M-IU Hunger Strike M>nitoring Smart Form? Yes 
Vital Signs 
Refused \IS and weight 
Examination 
General E><amination: 
GENER/II.. !>PPE.ARl'NCE: ill-appearing, lethargic. 
SKIN: normal, no rashes, ro suspicious lesions. 
CHEST: normal shape and expansion. 
MJSCULOSKELET/11..: no deformities. 
PSYCH: poor eye contact. 
Assessments 
/>I-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: Continue hunger strike protocol, encourage po food/lluids, encourage 1.erbaliiation offeelings. Encourage to allow staff to 
monitor intake and output. \atal signs, wt Instructed to seek staff with any needs. Pro~ded patient education, 1.erbali,ed 
understanding. Patient offered three meals per day and lease in room. /\dequate supply of drinking water. Encourage daily 
oral/phy,ical h)9iene care. 
Procedure Codes 
T1013 Sign Lang/0-al Interpreter 
Disposition: /\dmitted to tvHU until medically evaluated 
Appoinbnent Providefb)(6); (b)(7)(C) r 
2019-ICLl-00051 3389 
DHS-ICE-19-0196, 19-0197-O-000073

Electronically signed bl(b)(6); (b)(7)(C) ~ on 08/31/2018 06:12:19 (Pacific Daylight Time) 
Sign off status: Completed 
Northwest Detention Center 
1623EJSTREI" 
l'. WA98421 
Tel: (b)(6); 
11-\f"?\f,,....\ 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 ProgNu No1(b)(6); (b)(7)(C) I RN 08/31/2018 
Nd.e general.ed by eOinica/W<n<s B>RIPM Sottw,re (""""eC/inica/works.CtJm) 
2019-ICLl-00051 3390 
DHS-ICE-19-0196, 19-0197-O-000074

U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgNU Nola: 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGV'ks.coojl 
2019-ICLl-00051 3391 
AMAR, MERGEN_~ 
Facility~~~~~ 
39 Y old Male,~- 1QOJ(1928 
AccOUll l'unber: (b)(6): ! 1623 E J STREET, TACOMA, WA98421 
DHS-ICE-19-0196, 19-0197-O-000075

U.S. Immigration 
and Customs 
Enforcement 
08/30/2018 
Allergles 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. 11\eight loss denies. Dry M>uth denies. 
11\eakness admits Cough denies. Shortness of breath at 
rest denies. Chest pain at rest denies. Palpitations denies. 
J>l>dominal Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \bmitting denies. Painful urination denies. 
Decreased urine output denies. Mlsde aches denies. Mlsde 
cramps denies. Skin breakdown denies. Difficultythinking denies. 
Appointment Provlder:[b)(6); (b)(7)(C) 
Reason for Appointment 
1. PM SHIFT NOlE. Hunger Strike Nursing E1,0luation 
History of Present Illness 
Flowsheets (MHU): 
Upon encounter detainee was resting in bed and was willing to speak with nursing staff. Detainee reported not feeling good. 
Detainee reported all o\erthe bodyweakness but refused any medications or medical treatment Detainee refuses ,.;tals and to 
report drinking any water and refuses to report any output No other concerns '°iced at this time. Detainee is now resting quietly 
in his room. \MIi continue to monitor. 
Hungerstrike M>nitoring Form 
Day. 08/2912018 
Shift: PM 
Intake PO(in ml): 0 
Intake r.J-Normal Saline (in ml): 0 
Intake r.J-LR (in ml): 0 
Intake NG(in ml): 0 
QJtput Urine (in ml): 0 
Comments: REFUSES TO USE GIVEN WA7ER PITCHER AND REFUSES TOSI\Y IF HE HAS BEEN DRINKING CR NOT. 
REFUSES TO REPORT OUTPUT. 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? Yes GEOCEFICER 
What language do }OU speak? Russian 
Interpretation pro,.;ded? Yes, Interpreter Number LION BRIDGE-# 2963 
Number Use notes field 
Language Russian 
Pain 1'6sessment 
Pain 
Ne }OU currently in pain? No 
Narrati\e: 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
obseMtion, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
\M1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: No REFUSES TO USE GIVEN WA7ER PITCHER AND REFUSES TOSI\YIFHE HAS BEEN DRINKING 
CRNOT 
Reason for hunger strike: Wcints to be released from custody 
/ldequate supply of drinking water and other be\erages a1,0ilable: Yes 
Three meals deli\ered per day to patient Yes 
/lnyunauthori>edfoodinroom? No 
Ha\e dailyorlhostatic ,.;1a1 signs been completed? Yes 
Has input and output been documented on the lhe M-IU Hunger Strike M>nitoring Smart Form? Yes 
VllalSlgns 
REFUSES vfT;>LS. 
Examination 
General E><amination: 
GENERl'l !>PPE.ARl'NCE: inno acute distress, well del.eloped, well nourished. 
PSYCH: alert, oriented. 
Assessments 
Ill-Risk for imbalanced nutrition: Less lhan body requirements. 
Treatment 
1. Others 
Notes: 1. Continue with \Alai Signs e>eryshifl; Intake and OJlput M>nitoring e>eryshifl; Dailyweights; Dailyorthoslatic ,.;1a1 signs. 
2. /In adequate supply of drinking water and olher be>erages are a1,0ilable to patient at all times. 
3. Three meals per day are deli\ered to lhe patient and deli\eryof meals is documented. 
4. /lll food not authori>ed by CD/Phy.;ician is remo>ed from patienrs room. 
5. Patient is not allowed to purchase food from commissary\ending machine while on hunger strike. 
6. Patient will only be released from hunger strike treatment/monitoring byCD or phy.;ician order. 
7. Patient counseled regarding lhe medical risks of continuing lhe hunger strike. 
8. Encouraged to terminate lhe hunger strike and eat/drink as normal. 
Appointment Provi,(b)( 6); (b)(?)(C) 
Bectronically signed b~(b)(6); (b)(7)(C) 
Sign off status: Completed 
2019-ICLl-00051 3392 
IRN on 08/3Q/2018 19:20:42 (Pacific Daylight Time) 
Northwest Detention Center 
1623 E J STRE£r 
DHS-ICE-19-0196, 19-0197-O-000076

1: WA98421 
Tel /h\/R\· 
x: 
Pali-I: AMAR, IERGENSANA DOB: 10/23/1978 P ........ itotefb)(6); (b)(?)(C) 
Ncl.e generated by eC/inica/'Na1<s EJvR/PM Sottv.ere (,w,weC/inica/WGYks.COOjl 
2019-ICLl-00051 3393 
!RN 08/30/2018 
DHS-ICE-19-0196, 19-0197-O-000077

U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgNU Nola: 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""1eC/inica'WGYks.coojl 
2019-ICLl-00051 3394 
AMAR,MERGENSANA A: 216269802 Su:llo'b )(6): ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II ~~1r61: I 1623 E J STREET, T WA98421 
DHS-ICE-19-0196, 19-0197-O-000078

08/30/2018 
Allorglos 
N.KDA 
Review of Systems 
U.S. Immigration 
and Customs 
Enforcement 
Reason for Appointment 
1. RN day round/ Hunger Strike 
AMAR,MERGENSANA 
A: 216269802 Su:llq(b )(6); I 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
Acc01.111 ~\rm I 
1623 E J STREET, T WA-98421 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Provlde1(b)(6); ~-
Refuse to giw infonnation related to health, but admited to ha\A3 
some weakness. 
History of Present Illness 
Flowsheets (M-tU): 
lnput/OJtput Flowsheet 
Ti me: 0700 From 07:00 to 15:00 
INPUTPO: 0 
INPUT SUBTOT/ll: 0 
OUTiPUT Urine 0 
OUTiPUTBM 0 
OUTiPUT SUBTOT/ll: 0 
lnitials:~~,<,~J Hungers nitoring Fonn 
Day. 08130/.2018 
Shift: AM 
Intake PO (in ml): 0 refuses to measure intake states not drinking 
OJtput Urine (in ml): 0 REFUSED TOCQ.LECTURINE. 
OJtput Bowel 11/owments (in ml): 0 PER PT CAN NOT RECALL LAST BM 
Labs - Urine Ketones: REFUSED URINE DIP ANAL YS/S 
Initials: J(b )(6) I 
Patient ldenti .' 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEOCfflCERon duty 
IM1at language do )OU speak? Russian 
Interpretation pro\<ded? Provider fluent in patient's native language 
Pain l'ssessment 
Pain 
Ne )OU currently in pain? Yes 
The pain is located : multiple sites:headache, backpain and leg pain, 
The sewrityof pain is rated at 7110 
The sewrityof the pain is moderate 
The pain began 4-5 days ago 
The character of the pain is aching 
The associated simptoms are v,eakness 
The pain is aggravated by none 
The pain is reliewd by other 
Describe: Pf refused any treatment 
Narratiw: 
P! in M-IU med iso4 for hungerslrike. Encounterwilh ptat0757 during RN day round. Laying on bed appears to be asleep. 
respirations ewn, no distress noted. Wlen lhis nurse called pt name he open his eyes and talk wilh lhe nurse, when lhis nurse 
asked how he is feeling pt stated" bad", he refused lf-3, refused assessment but he admited to haw weaqkness, 
lighlheadedness, headache, backpain and leg pain, lhis nurse offered to bring pain medication, or anylreatmenl but he stated 
Iha! he ,,.;11 not take any medications. \MIi continue to monitor. 
Encounterwilh pt about 1427 P!was in lhe bed, stated Iha! he feel weak. Pt miss meal #25 >Mlh lunch, he continue to refuse 
water, and stated lhat he didn 'I urinated. This nurse stronglyrecomended and educated pt to drink water to a1<>id kidney.; 
damage, but pt stated Iha! he wants to be set free. \MIi continue to monitor. 
Patient is oonsidered to be on official hunger slrike and ,,.;11 be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/220)18 
Wlen did the official hunger slrike begin? 08/25'2018 
Date of last meal oonsumed: 08/220)18 
Last meal oonsumed: Breakfast 
Drinking Fluids: No 
Reason for hunger strike: Wcints to be released from custody "relase to USI\" 
/ldequate supply of drinking water and other bewrages available: Yes He states he refuses to drink ooteror any fluids. 
Three meals deli.ered per day to patient Yes 
Lunch deliwred during current shift 0% consumed 
Dinner deliwred during current shift 0% consumed 
/lnyunauthori>edfoodinroom? No 
Haw dailyorlhostatic \<tal signs been oompleted? Patient refused, see completed refusal fon-n Refused to sign refusal 
form 
Has input and output been documented on lhe lhe M-IU Hunger Strike 11/onitoring Smart Fonn? Yes 
Examination 
General B<amination: 
GENER/II.. !>PPE.ARANCE: in no acute distress, well del.eloped, well noorished. 
HEJlD: norrnocephalic. 
OR.Al CAvflY: REFUSED 10 OPEN MOUTH, SOME UGI-IT DRYNESS OF TI-E UPS NOTED . 
NECK/THYROID: normal, neck supple, full range of rootion. 
SKIN: normal, no rashes, no suspicious lesions. 
HEART: REFUSED EXl'.M. 
LUNGS: REFUSED EXl'.M. 
J>BDOll,EN: REFUSED EXl'.M 
MJSCULOSKELET/ll: not obserwd. did shcMoer. 
NEUROLOGIC: alert and oriented., . 
PSYCH: alert, oriented, cognitile function intact,, good eye contact, speech clear, trough! process logical, goal 
directed. 
Assessments 
/II-Risk for imbalanced nutrition: Less lhan body requirements. 
Treatment 
1. Others 
Notes: Detaineewrbali>ed understanding of plan of care and denies questions/ooncems. Continue hunger slrike protoool, 
encourage po food/fluids, encourage 1.erbali,ation offeelings. Enoourage to allow staff to monitor intake and output, ,;ta1 signs, 
wt. Instructed to seek staff>Mlh any needs. 'verbalized understanding. Nursing Care Plan present Refer to nursing care plan for 
on-going interwntions. Detainee offered three meals per day and leaw in room for at least 20 minutes. A'.lequate supplyof 
drinking water and other bewrages as ordered bypro,;der available. Enoourage dailyoral/phy.;ical h>9iene care. Detainee 
1.erbali>ed an understanding of education and/or lreatmenl Voices no other ooncems. 
2019-ICLl-00051 3395 
DHS-ICE-19-0196, 19-0197-O-000079

Procedure Codes 
T1013 Sign Lang/Oral Interpreter 
Appointment ProvideNb)(6); RN 
l~-"~'~n~'=',-..-'~~r 
Electronically signed b~ .... (b_)-(6_),_·. _ __,~ on 08/30/201814:32:21 (Pacific Daylight Time) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREET 
l~,"!",l!:,'lll"'-""""'Cl..., 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 ProgNss Nola: 08/30/2018 
Ncte generated byeClinica!Wai<s EM<IFM &itw!Jre (w,w,eC/i ~m,;;m=--' 
2019-ICLl-00051 3396 
DHS-ICE-19-0196, 19-0197-O-000080

U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:llc:i=b'-")(""6"'"): __,,.,......... Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunber~ 
1623 EJ STREET, T~ 
Appoirimert Facility: Northwest Detertion Certer 
08/30/2018 
Allorglos 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache admits. 
Lightheadedness admits. Sleep Disturbance denies. W!ight 
loss denies. Dry MJuth denies. W!akness admits. 
Cough denies. Shortness of breath at rest denies. Chest pain at 
rest denies. Palpitations denies. Pbdominal Pain denies. 
Constipation denies. Diarrhea denies. Nausea denies. 
\.bmitting denies. Painful urination denies. Decreased urine 
output admits. Mlsde aches denies. Mlsde cramps denies. 
Skin breakdown denies. Difficultythinking denies. 
Reason for Appointment 
1. tvHU NIGHT RN ROUNDS 
History of Present Illness 
Flowsheets (tvHU): 
lnput/OJtput Flowsheet 
Time: 0300 
INPUTPO: 0 
INPUT SUBTOT/11..: 0 
OUTiPUT Urine 0 
OUTiPlJ,I.SUBlOT/11..: 0 
lnitials:l'.!:illfil.l 
Hungerstrike Mlnitoring Form 
Day. 08/29/.2018 
Shift: Night 
lntakePO(inml): 0PTDECLINEDTOREPCRT 
OJtput Urine (in ml): 0 PT DECLINED TOREPCRT 
OJtput Bowel Ml-vements (in ml): 0 
Initials: fh \/R I 
Patient Identification: 
Patient Identification 
Appointment Provlderj(b)(6); (b)(7)(C) 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEO OFFICER KIM 
W1at language do )OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number 
Number: 11286108 
Language Russian 
Pain l'ssessment 
Pain 
l'<e )OU currently in pain? No 
Narrati-ve: 
pt seen in tvHU for night nursing rounds. Patient stated that he had 5110 pain in his lower back. head and also felldiziyand 
weak. He declined pain medication. He denied all other medical complaints. Nurse encouraged patient to drink fluids and 
remain h)draled during hunger strike. Patient refused breakfast (24th meal). 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/220)18 
\M1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/220)18 
Last meal consumed: Breakfast 
Drinking Fluids: No 
Reason for hunger strike: 11\ants to be released from custody 
/1<:!equate supply of drinking water and other be-verages available: Yes 
Three meals deli-vered per day to patient Yes 
Breakfast deli-vered during current shift 0% consumed 
/lnyunauthori2edfoodinroom? No 
Ha-ve dailyorlhostalic \atal signs been completed? Patient refused, see completed refusal fOl1'n Refused to sign refusal 
fonn. 
Has input and output been documented on the the M-IU Hunger Strike Mlnitoring Smart Form? Yes 
Vital Signs 
Refused \IS and weight 
Examination 
General E><amination: 
GENER/II.. !>PPE.ARl'NCE: in no acute distress, well de-veloped. 
SKIN: normal, no rashes, no suspicious lesions. 
CHEST: normal shape and expansion. 
MJSCULOSKELET/11..: normal g;,il, no deformities. 
EXIREMTIES: full range of roolion. 
PSYCH: cogniti-ve function intact. 
Assessments 
.Al-Risk for imbalanoed nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: Continue hunger strike protocol, encourage po food/fluids, encourage -verbali,ation offeelings. Encourage to allow staff to 
monitor intake and output. \atal signs, wt. Instructed to seek staff with any needs. lkrbali,ed understanding. Detainee offered 
three meals per day and lea-vein room. />dequate supply of drinking water. Encourage dailyoral/physical h)giene care. 
Procedure Codes 
T1013 Sign Lang/0-al Interpreter 
Disposition: />dmitted to tvHU until medically evaluated 
Appoinbnent Providerfb)(6); (b)(7)(C) r 
Electronically signed by b)(6); on 08/30/2018 06:25:42 (Pacific Daylight Time) 
Sign off status: Comple h\/ 7 \lr.\ 
2019-ICLl-00051 3397 
DHS-ICE-19-0196, 19-0197-O-000081

Northwest Detention Center 
1623 E. J S1REE 
l'.-..,.1111t1..wU2~~ 
7\ff''\ 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 ProgNu Nola: ~b )(6); (b )(7)(C) r" 08/30/2018 
Ncl.e general.ed by eOinicat'Mrks a.R/PM Softw1re (l'M.WeClinicalw«ks.coojl 
2019-ICLl-00051 3398 
DHS-ICE-19-0196, 19-0197-O-000082

U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgNU Nola: 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGV'ks.coojl 
2019-ICLl-00051 3399 
AMAR,MERGEN~ A:216269802 Si.ti1 _b)(6); __ 
Facility Code: CSCN/1/WA Housing ea: 
39 Y ad ~I~- •~r:::: 
1623 E ~= ~½b1\~c; 1 ' ,,.~ 
DHS-ICE-19-0196, 19-0197-O-000083

U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:llDtlh \/R\· 
Facility Code: CSONVWA Housing Area: M 
39 Y ad Male, 3n!t::: 
1623EJ~~=l~E§; 
08/29/2018 
Allergles 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. 11\eight loss denies. Dry Mouth denies. 
11\eakness admits Cough denies. Shortness of breath at 
rest denies. Chest pain at rest denies. Palpitations denies. 
J>l>dominal Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \bmitting denies. Painful urination denies. 
Decreased urine output denies. Mlsde aches denies. Mlsde 
cramps denies. Skin breakdown denies. Difficultythinking denies. 
Appoirimert Facility: Northwest Detertion Certer 
Appointment Provlde~(b)(6); (b)(7)(C) 
Reason for Appointment 
1. PM SHIFT NOlE. Hunger Strike Nursing E1,0luation 
History of Present Illness 
Flowsheets (MHU): 
Upon encounter detainee was resting and sat up to speak with nursing staff. Detainee reported not feeling good. Detainee 
reported all over the bodyweakness and back pain but refused any medical treatment for the oomplaints. Detainee refuses to 
report drinking any water and refuses to report any output No other ooncems '°iced at this time. Detainee is now resting quietly 
in his room. \MIi oontinue to monitor. 
Hungerstrike Monitoring Form 
Day. 08/2912018 
Shift: PM 
Intake PO(in ml): 0 
Intake r.J-Normal Saline (in ml): 0 
Intake r.J-LR (in ml): 0 
Intake NG(in ml): 0 
QJtput Urine (in ml): 0 
Comments: REFUSES TO USE GIVEN WA7ER PITCHER AND REFUSES TOSI\Y IF HE HAS BEEN DRINKING CR NOT. 
REFUSES TO REPCRTOUTPUT. 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources i~11dioa- !O rrlge, Picture 
Chaperone Present? YesGEOa=FIC6 _b)(6); . IM1at language do }OU speak? Russian 
Interpretation prolided? Yes, Interpreter Number LION BRIDGE-# 9171 
Number Use notes field 
Language Russian 
Pain 1'6sessment 
Pain 
l'<e }OU currently in pain? Yes 
The pain is located Use Notes Section RSPCR7S BACK PAIN 
The severityof pain is rated at 7110 
The severity of the pain is mild 
The pain began 1-2 days ago 
The character of the pain is aching 
The associated S}'llptoms are ooakness 
The pain is aggravated by none 
The pain is relieved by none REFUSES mEA Tl.ENT 
Narrative: 
Patient is oonsidered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
obseMtion, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
IM1en did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal oonsumed: Breakfast 
Drinking Fluids: No REFUSES TO USE GIVEN WA7ER PITCHER AND REFUSES TOSI\YIFHE HAS BEEN DRINKING 
CRNOT 
Reason for hunger strike: Wcints to be released from custody 
/ldequate supply of drinking water and other beverages a1,0ilable: Yes 
Three meals delivered per day to patient Yes 
/lnyunauthori2edfoodinroom? No 
Have dailyorthostatic \ital signs been oompleted? Yes 
Has input and output been documented on the the M-IU Hunger Strike Monitoring Smart Form? Yes 
Vital Signs 
REFUSES vfTJ>lS. 
Examination 
General E><amination: 
GENERJ>l !>PPE.ARl'NCE: in no acute distress, well del.eloped, well nourished. 
PSYCH: alert, oriented. 
Assessments 
Ill-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: 1. Continue with \Atal Signs e.eryshift; Intake and OJlput Monitoring every shift; Dailyweights; Dailyorthostatic \ital signs. 
2. /In adequate supply of drinking water and other beverages are a1,0ilable to patient at all times. 
3. Three meals per day are delivered to the patient and delivery of meals is documented. 
4. ~I food not authori>ed by CD/Phy.;ician is removed from patienrs room. 
5. Patient is not allowed to purchase food from oommissary'vending machine while on hunger strike. 
6. Patient will only be released from hunger strike treatment/monitoring byCD or phy.;ician order. 
7. Patient counseled regarding the medical risks ofoontinuing the hunger strike. 
8. Encouraged to terminate the hunger strike and eat/drink as normal. 
Appointment Provide{b)(B); (b)(?)(C) 
Bectronically signed b~(b)(6); (b)(7)(C) 
Sign off status: Completed 
2019-ICLl-00051 3400 
IRN on 08/2912018 21:21:24 (Pacific Daylight Time) 
DHS-ICE-19-0196, 19-0197-O-000084

Northwest Detention Center 
1623 E J STREEr 
T~~ ~tb 98421 ½§8~\~-I 
Pallant: AMAR, MERGENSANA DOlk 10/23/1978 P ........ b)(6); (b)(7)(C) 
2019-ICLl-00051 3401 
08/29/2018 
DHS-ICE-19-0196, 19-0197-O-000085

U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgNU Nola: 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3402 
AMAR,MERGE~ A: 216269802 Si.tll ,~ /\~L, Facility Code: CSCN/1/WA . 
39 Y old Male, DOB: 10/23/1978 
AccOl.rll lunber~ 
1623 EJ STREET, T~ 
DHS-ICE-19-0196, 19-0197-O-000086

08/29/2018 
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:llol(b )(6); 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, 0Cll3· 1Q{2J119ZB 
AccOl.l"II lunbe~~-h~\~IR~\-·~ 
1623 E J STREET, TACOMA, WA-98421 
Appoirimert Facility: Northwest Detertion Certer 
Reason for Appointment 
1. tvH hunger strike assessment 
History of Present Illness 
Narrati"': 
Mantal Health Hunger Strike Evaluation 
Appointment Provldej(b)(6); (b)(7)(C) 
-Pt spoke: [] English; [] Spanish; [X] Oher, Russian lnterpretalk # 
-Pt identified by NI, name, ID picture 
-Session was observed/chaperoned byGEO Madical Staff member 
-[] Initial Examination;[] 14 Dayfollow-up; [] 21 Dayfollow-up 
Yes []/No[] Re,.;ewed Record 
Yes[] /No[] Patient has history of mental illness 
Yes []/No[] Pt has acurrentDSMS Diagnoses 
Yes []/No [] Pt has confirmed s/he has dedared a hunger strike. 
1. Wiatis (are)the reason(s) )OU ha"' dedared a hunger strike? 
2. Wiatdo)OU hope to accomplish by going on a hunger strike? 
3. Wiat if an>ttiing would stop )OU from this hunger strike? 
4. Our health care staff is concerned about )OUr health, we want to ensure )OU know risks of a hunger strike. 
~csw 
Yes[] /No[] Do )OU understand that )OU may die or ha"' serious, lasting medical conditions if )Ou refuse food and/or fluid? 
Pt refused to engage this pro1,1der as I asked him to tell me why he is on a hunger strike. Pt's onlyresponse was" I don1want 
to talk about it''. Mer se,.,ral attempts atlr)ing to engage this Pt, I asked him to sign a refusal form stating that he did not want to 
talk about his hunger strike purpose or reason. Pt refused to sign the refusal form. I completed the refusal form indicating that the 
Pt refused to sign. The tvHU nurse wilnessed his refusal and sign the witness line. 
Examination 
rv'ental Status: 
!>PPE.ARANCE: adequately-groomed, dressed in clean unifonn of the day. 
RELATEDNESS: suspicious. 
ATTITUDE: uncooperati"'. 
SPEECH/1...ANGU!'ClE: normal rate, rhythm, l.olume .. 
J>FFECT: blunted. 
THOUGHT PROCESS: intact. 
THOUGHT CONTENT: unremal1<able. 
PERCEPTU/IL DISORDERS: no perceptual disorder noted. 
PS'YCHOM)TOR /ICTMTY: v.ithin normal range. 
KNCM.lEDGE - INTELLECTU/IL FUNCTION: No oo.ious impairment . 
DEGREE OF AWAAENESS: v.ithin normal limits. 
ORIENTATION: person, place, time. 
CURRENT SUICID/IL POTENTI/IL: no to low acute Si risk. 
CURRENT HOMCID/IL POTENTI/IL: no to low acute risk. 
Assessments 
1. Problems related to li,.;ng in residential institution -Z59.3 (Primary) 
-Pt's Hunger Strike appears to be motivated by: 
l] Yes /[X] No: Mantal Illness 
-~ }eS e~lai n: 
[] Yes/ [] No: Political Statement or Cause 
- ~}es e~lain. 
Treatment 
1. Others 
Notes: Treatment Pro\ided: 
-Educated on the dangers of not eating/ h)drating. 
-Educated on prosodal problem soil.ing and healthywas to address concerns. 
Preventive Medicine 
POST SESSION: Updated HAS, i>HSA CD, tvH Team on assessment/ plan. 
Appointment Providerfb)(6); (b)(7)(C) I LCSW 
Bectronically signed ~(b)(6); (b)(7)(C) jcsw on 08/29/201816:16:30 (Pacific Daylight Time) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREET 
T~WA98421 Tel(b)(6 >; I 
t-iix: 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 Progre .. Notoj(b)(6); (b)(7)(C) 
Ncte generated byeOirica/Wcrks El>R'PM s,tt,.e,e (w.w,eC/inica/Works.COfTV 
fcsw 08/29/2018 
2019-ICLl-00051 3403 
DHS-ICE-19-0196, 19-0197-O-000087

U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENEJ 
A:216269802 Si.tll b)(~); _ 
Facility Code: CSCN/1/WA Housing ea: 
Acc01.111 ~t,eb)@C ! 39 Y ad~~!::: 
08/29/2018 
Allergles 
N.KDA 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue admits. 
Fe1<>r denies. Headache admits. Lightheadedness admits. 
Night sweats denies. Sleep disturbance admits. 'Mlight 
gain denies. 'Mlight loss admits. 
Hunger Strike: 
Fatigue admits. that is constant, that is 'Mll'Sel'ling. 
Headache admits. Lightheadedness admits. se-.eral times. 
Sleep Disturbance admits. 'Mlight loss denies. Dry 
Mouth admits. 'Mlakness admits. that is generalized. says he 
can not get up his legs v.oni had him. Cough denies. 
Shortness of breath at rest denies. Chest pain at rest denies. 
Palpitations denies . .Abdominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. l.bmitting denies. Painful 
urination denies. Decreased urine output admits. M.isde 
aches admits legs. M.isde cramps denies. Skin 
breakdown denies. Difficultythinking denies. 
1623 E J STREET, T 
Appoimnert Facility: Northwest Detertion Certer 
Appointment ProvldeJ'"'"b"")("-' 6
-");-'---'---'I RN ~\17\ff'\ . 
Reason for Appointment 
1. RN Day shift Nursing Round 
History of Present Illness 
Flowsheets (M-tU): 
lnput/OJtput Flowsheet 
Ti me: 0700 From 07:00 to 1500 
INPUT PO: 0 states not drinking refuses to measure intake 
INPUT SUBTOT/11..: 0 
OUTiPUT Urine O states last void 3 days ago, refuses to coiled urine 
OUTiPUTBM 0 
OUTiP~TOT/11..: 0 
Initials: b )/ 
Hungerstri e nitoring Form 
Day. 08/2912018 
Shift: AM 
Intake PO (in ml): 0 refuses to measure intake states not drinking 
OJtput Urine (in ml): 0 REFUSED TOCQ.LECTURINE. 
OJtput Bowel M>1<>ments (in ml): 0 PER PT CAN NOT RECALL LAST BM 
Labs - ~tones: REFUSED URINE DIP ANAL YS/S 
lnitials:ll22filj 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEOCFFICER w-!l7E 
IM1at language do )OU speak? Russian 
Interpretation prO\aded? Provider fluent in patient's native language 
Pain l'ssessment 
Pain 
Ne )OU currently in pain? Yes 
The pain is located Use Notes Sedion headake, /av.er back and legs, this nurse asked to assess pt, but he refused 
The se1<>rityof pain is rated at 7110 
The se1<>rityof the pain is moderate 
The pain began 3-4 days ago 
The character of the pain is intermittent 
The associated symptoms are none 
The pain is aggravated by none 
The pain is reliel<>d by none M,dication v.es given at 11:20, but pt refused, stated that he w/1 take later 
Narrati1<>: 
Pl in M-IU med iso4 for hungerslrike: La~ng on bed appears to be asleep. respirations e1<>n, no distress noted. Wien this 
nurse called his name, he rise his head and spoke with this nurse. He stated that he has headache, back pain and legs pain, 
admited to ha1<> e dinness and weakness. Refused assessment and \f-3. /!dmited that he will take pain meds, refused to go to 
hospital for evaluation. WII rontinue to monitor. /loout 10:30 M-IP met with p~ but he refuse to speak with pro~der. Per Ml 
11/alakhova 1<>rbal order T~enol 650 mg PO was offered to pt at 11 :20, but he refused, stated that he will take the medication later, 
when he will woke up. WII rontinue to monitor. Pl take T~enol about 13:00with out water, e1<>n this nurse asked se1<>ral times 
and e,plained why he suppose to drink water, howen.er he refused 1<>himent 
Enrounterwilh pt about 1431 Pl was la~ng in the bed, stated that he feel ok. but still has some pain in the body about 2-3110. 
Pl stated that he didn~ drink and eat an)4hing Pl miss meal #22 with lunch, pt stated that he wants to be set free. This nurse 
enrouraged pt and educated about to do acti~tes as tolerated, 1<>rbali:ied understanding. WII rontinue to monitor. 
Patient is ronsidered to be on official hunger slrike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
\M1en did the official hunger slrike begin? 08/25'2018 
Date of last meal ronsumed: 08/22/2018 
Last meal ronsumed: Breakfast 
Drinking Fluids: No 
Reason for hunger strike: W..nts to be released from custody "relase to US<\" 
/!dequate supply of drinking water and other be1<>rages available: Yes He states he refuses to drink v.eteror any fluids. 
Three meals deli1<>red per day to patient Yes 
Lunch deli1<>red during current shift 0% ronsumed 
Dinner deli1<>red during current shift 0% ronsumed 
/lny unauthori:ied food in room? No 
Ha1<> dailyorlhostalic ~tal signs been rompleted? Patient refused, see rompleted refusal form Refused to sign refusal 
form. 
Has input and output been documented on the the M-IU Hunger Slrike M:lnitoring Smart Form? Yes 
Vital Signs 
16/min 
66.5in 
Refused\/,$. 
Examination 
General Examination: 
RR 
08/29/2018 11 :28:20 /'M 
H 
08/29/2018 11 :28:20 /'M 
GENER/II.. JIPPEPRANCE: in oo acute distress, well del.eloped, well oourished. 
HEAD: normocephalic. 
OR.AL CAvfTY: REFUSED TO OPEN MOUTH. 
NECK/THYROID: normal, neck supple, full range of motion. 
SKIN: normal, no rashes, oo suspicious lesions. 
HEAAT: REFUSED EXA.M. 
LUNGS: REFUSED EXA.M. 
CHEST: normal, no gross rib deformity, normal shape and expansion. 
!>BDOM:N: REFUSED EXA.M. 
MJSCULOSKELET/11..: not obseiwd. 
NEURQOGIC: alert and oriented,, . 
~b)(6); 
ib)(7)(C) 
I 
PSYCH: alert, oriented, cogniji-e function intact, good eye contact, speech clear, thought process logical, goal 
directed. 
Assessments 
/>I-Risk for imbalanced nutrition: Less than body requirements. 
2019-ICLl-00051 3404 
~ 
DHS-ICE-19-0196, 19-0197-O-000088

Treatment 
1. Others 
Notes: Detainee -verbali21!d understanding of plan of care and denies questions/concerns. Continue hunger strike protocol, 
encourage po food/fluids, encourage 1.erbaliiation of feelings. Encourage to allow staff to monitor intake and output, \ital signs, 
wt. Instructed to seek staff with any needs. \krbali,ed understanding. Nursing Care Plan present Refer to nursing care plan for 
on-going inter-ventions. Detainee offered three meals per day and lea1.e in room for atleast20 minutes. Pdequate supplyof 
drinking water and other be-verages as ordered byprolider available. Encourage daily oral/physical h)giene care. Detainee 
-verbali21!d an understanding of education and/or treatment Voices no other concerns. 
Procedure Codes 
T1013 Sign Lang/Oral Interpreter 
Appointment Provide (b)(6); 
/h\17\/r'.\ 
El ctr ' II ' d ~(b )(5); e onica y sagne,1,,,,, 17 ,/(" .. , 
Sign off status: Completed 
RN 
~ on 08/29/201815:00:45 (Pacific Daylight Time) 
Northwest Detention center 
1623EJSmEEr 
r3wA98421 
TeUh)(R\ I 
Fax: 
Patient: AMAR, MERGENS.ANA DOB: 10/23/1978 Progrwsa Not,,j"-'(b'--')-'-'(6:.:.l- ... · _ ___.!RN 08/29/2018 
Ncte genersled byeC/inica!Wcxi<s Bvr<t'PM Soltw!,,-e ("""'eC/inica/Wcxi<s.com) 
2019-ICLl-00051 3405 
DHS-ICE-19-0196, 19-0197-O-000089

U.S. Immigration 
and Customs 
Enforcement 
AMAR, 
08/29/2018 
Allorglos 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. 11\eight loss denies. Dry M>uth denies. 
11\eakness denies. Cough denies. Shortness of breath at 
rest denies. Chest pain at rest denies. Palpitations denies. 
J>lxlominal Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \bmitting denies. Painful urination denies. 
Decreased urine output admits. Mlsde aches denies. Mlsde 
cramps denies. Skin breakdown denies. Difficultythinking denies. 
Reason for Appointment 
1. tvHU NIGHT RN ROUNDS 
History of Present Illness 
Flowsheets (tvHU): 
lnput/OJtput Flowsheet 
Time: 0300 
INPUTPO: 0 
INPUT SUBTOT/11..: 0 
OUTPUT Urine 0 
OUTPUT SUBTOT/11..: 0 
lnitials:libifl .. Hungers~rntonng Form 
Day. 08128/.2018 
Shift: Night 
Intake PO(in ml): 0 
Appointment Provlde,fb)(6); (b)(7)(C) 
OJtput Urine (in ml): 0 REFUSED TO USE URINAL FOR ACCURATE IIEASURAIENT 
OJtput ~-vements (in ml): 0 
Initials: Klili§J 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? 
Chaperone Name: GEOOFFIC 
Yes ~ 
b)(6) 
W1at language do )OU speak? Ru 
Interpretation pro\aded? Yes, Interpreter Number 
Number _. 11279939 
Language Russian 
Pain l'ssessment 
Pain 
/l<e )OU currently in pain? Yes 
The pain is located . BACKANDBILATLEGS 
The se-verityof pain is rated at 6110 
The se-verityof the pain is moderate 
The pain began 3-4 days ago 
The character of the pain is aching 
The associated symptoms are none 
The pain is aggravated by none 
The pain is relie-ved by none 
Narrati-ve: 
pt seen in tvHU for night nursing rounds. Patient stated Iha! he was fine but had pain in his lower back and legs. He dedined 
pain medication. He denied all other medical complaints. Nurse encouraged patient to drink fluids and remain h)(lrated during 
hunger strike. Patient refused breakfast (21st meal). 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
Vlnen did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: No 
Reason for hunger strike: IMlnts to be released from custody 
/1<:!equate supply of drinking water and other be-erages available: Yes 
Three meals deli-vered per day to patient Yes 
Breakfast deli-vered during current shift 0% consumed 
/lnyunauthori2edfoodinroom? No 
Ha-ve dailyorthoslalic \alal signs been completed? Patient refused, see completed refusal foon Refused to sign refusal 
form. 
Has input and output been documented on lhe lhe M-IU Hunger Strike M>nitoring Smart Form? Yes 
Vital Signs 
Refused \atal signs and weight 
Examination 
General E><amination: 
GENER/II.. !>PPE.ARl'NCE: inno acute distress, well de\lE!!oped. 
SKIN: normal, no rashes, no suspicious lesions. 
CHEST: normal shape and expansion. 
MJSCULOSKELET/11..: normal gait, no deformities. 
EXIREMTIES: full range of roolion. 
PSYCH: cogniti-ve function intact. 
Assessments 
/>I-Risk for imbalanced nutrition: Less lhan body requirements. 
Treatment 
1. Others 
Notes: Continue hunger strike protocol, encourage po food/fluids, encourage 1.erbali,ation offeelings. Encourage to allow staff to 
monitor intake and output, \alal signs, wt. Instructed to seek staffwilh any needs. lkrbali,ed understanding. Detainee offered 
three meals per day and lea-vein room. />dequate supply of drinking water. Encourage dailyoral/physical h)giene care. 
Procedure Codes 
T1013 Sign Lang/0-al Interpreter 
Disposition: />dmitted to M-tU until medically evaluated 
Appoinbnent Providerl(bl/6): (bl/7)/Cl !RN 
2019-ICLl-00051 3406 
DHS-ICE-19-0196, 19-0197-O-000090

Electronically signed b~~-b~)=(6~);~_ ~-~fN on 08/2912018 06:12:16 (Pacific Daylight Time) 
Sign off status: Completed 
Northwest Detention Center 
1623EJSTREI" 
T~~jf6 98421
1 x: 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 ProgNu Notaj(b)(6); (b)(7)(C) !RN 
Nd.e general.ed by eOinica/W<n<s B>RIPM Sottw,re (""""eC/inica/works.CtJm) 
2019-ICLl-00051 3407 
08/29/2018 
DHS-ICE-19-0196, 19-0197-O-000091

U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgNU Nola: 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3408 
AMAR,MERGENSANA A: 216269802 Su:llol/b \/6\ ! 
Facility Code: CSONVWA Housing Area: M 
39 Y ad Mal~it~:: 
1623E~~::=,~ fa% I 
DHS-ICE-19-0196, 19-0197-O-000092

U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA A:216269802 Su:i1ol(b)(6); I 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll lunber:~)-
1623 EJ STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
08/28/2018 
Allergles 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue admits. that is constant, that is 'Mll'Sening. 
Headache denies. Lightheadedness admits. SEMlllll times. 
Sleep Disturbance denies. W.ight loss denies. Dry M:>uth denies. 
W!akness admits. that is se-.era, that is generalized. says he 
can not get up his legs v.on, hold him. Cough denies. 
Shortness of breath at rest denies. Chest pain at rest denies. 
Palpitations denies. />bdominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. \bmitting denies. Painful 
urination denies. Decreased urine output admits. Mlsde 
aches admits legs. Mlsde cramps denies. Skin 
breakdown denies. Difficultythinking denies. 
Appointment Provlde1(b)(6); (b)(?)(C) 
Reason for Appointment 
1. RN E\€NING ROUNDS 
History of Present Illness 
Flowsheets (M-tU): 
lnput/OJtput Flowsheet 
Time: 2200 
INPUT PO: 0 states not drinking refuses to measure intake 
INPUT SUBTOT/11..: 0 
OUTiPUT Urine 0 states last void 2-3 days ago, refuses to measure urine 
OUTiPUTBM 0 
OUTiPUI..S!JSIOT/11..: 0 
Initials: l!hlIB..l 
Hungerstrike Mlnitoring Form 
Day. 08128/2018 
Shift: PM 
Intake PO (in ml): 0 refuses to measure intake states not drinking 
OJtput Urine (in ml): 0 REFUSED TOCQ.LECTURINE 
OJtput Bowel Ml-vements (in ml): 0 PER PT CAN NOT RECALL l.ASTBM 
Labs - ~tones: REFUSED URINE DIP ANAL YS/S 
Initials: ~ 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEOCFFICER 
IM1at language do )OU speak? Russian 
Interpretation pro\<ded? Yes, Interpreter Number 
Number : 11279269 
Language Russian 
Pain Assessment 
Pain 
Ne )OU currently in pain? No STATES 1HATHE IS IN PAIN BUTv'.!ILL NOTELABORA1E. 
Narrati-ve: 
M-IU med iso 3\ hunger strike: during initial rounds, detainee la~ng on bed appears to be asleep. respirations e-ven. no 
distress noted. States that he is feeling weak, has a headache, backache and his left leg hurts. will not elaborate. Patient refuses 
all nursing ph>'>ical assess men~~. medications. labs. food. water or to sign refusal form. Encouraged him to eat food and 
drink water. Refused DINNER, missed meal# 20. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
\Mien did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: No 
Reason for hunger strike: Wcints to be released from custody "release to US/I" 
/ldequate supply of drinking water and other be-verages available: Yes He states he refuses to drink ooteror any fluids. 
Three meals deli-vered per day to patient Yes 
Lunch deli-vered during current shift 0% consumed 
Dinner deli-vered during current shift 00/4 consumed 
/lnyunauthoriiedfoodinroom? No 
Ha-ve dailyorthostatic \ital signs been completed? Patient refused, see completed refusal fonn Refused to sign refusal 
fonn. 
Has input and output been documented on the the M-IU Hunger Strike Mlnitoring Smart Form? Yes 
Vital Signs 
16/min 
66.5in 
refused/00. 
Examlhatlon 
General Examination: 
RR 
08/28/2018 10:39:54 PM 
H 
08/28/2018 10:39:54 PM 
GENER/II.. JIPPEJ>RANCE: in oo acute distress. lethargic, fatigued. 
HEAD: normocephalic. 
OR.AL CAvfTY: REFUSED TO OPEN MOUTH. 
SKIN: normal, no rashes. oo suspicious lesioos. 
HEPRT: REFUSED EMM. 
LUNGS: REFUSED EMM. 
/lBDONEN: REFUSED EXAM. 
b)(6); (b)(?)(C) 
PSYCH: alert. oriented. cogniti-ve functioo intact. poor eye cootact. speech diminished output, \olume. oo auditory or 
lisual hallucinatioos. thought cootent \l.ithout suicidal ideatioo, delusioos. 
Assessments 
/>I-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: Detainee-verbaliied understanding of plan of care and denies questions/concerns. Continue hunger strike protocol, 
encourage po food/fluids, encourage -verbali,ation offeelings. Encourage to allow staff to monitor intake and outp~ \ital signs, 
wl Instructed to seek staff with any needs. 'verbalized understanding. Nursing Care Plan present Refer to nursing care plan for 
OrliJ(ling inter-ventions. Detainee offered three meals per day and lea-vein room for at least 20 minutes. Pdequate supplyof 
drinking water and other be-verages as ordered byprolider available. Encourage dailyoral/ph>'>ical h)!liene care. Detainee 
-verbaliied an understanding of education and/or lrealmenl Voices no other concerns. 
Procedure Codes 
T1013 Sign Lang/0-al Interpreter 
Appoinbnent Provide1(b)(6); (b)(?)(C) r 
2019-ICLl-00051 3409 
DHS-ICE-19-0196, 19-0197-O-000093

Electronically signed b~(b)(6); (b)(7)(C) r on 08/28/2018 22:41:00 (Pacific Daylight Tlme) 
Sign off status: Completed 
Northwest Detention Center 
1623E.JSTR:Er 
l'. WA98421 
Te /b\/6\ /b\/7\/C\ x: 
P•tl-t: AMAR, MERGENSANA DOB: 10/23/1978 P ....... ""-th)/n\· /h\/7\/C:\ !l't 08/28/2018 
Nd.e generu.ed by eOinica/WM<s a.R/PM Sottw;re (WNNeC/inicaJworks.~ 
2019-ICLl-00051 3410 
DHS-ICE-19-0196, 19-0197-O-000094

U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA .. A:216269802 Su:l1Dt(b)(6); J 
Facility Code: CSOINWA Hot.in g ,c; ea.1 
39 Y old Ma'=~- ,~Rl/1:Z: 1623 E J~~=•=/}fil~, ~ Appoirimert Facility. Northwest Detertion Certer 
08/28/2018 
Past Medical History 
No Wedical History. 
Alla ..... 
N.KDA 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue admits 
Fel.8r denies. Headache denies. Lightheadedness admits, at 
rest, often . Seep disturbance denies. 
Hunger Strike: 
Fatigue admits, that is constant, that is 'Mll"Sening. 
Headache denies. Lightheadedness admits, SEMlral times. 
Seep Disturbance denies. 11\eight loss denies. Dry M>uth denies. 
11\eakness admits, his legs 'Mlnl hold him. Cough denies. 
Shortness of breath at rest denies. Chest pain at rest denies. 
Palpitations denies. />bdominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. \bmitting denies. Painful 
urination denies. Decreased urine output admits Mlsde 
aches admits legs. Mlsde cramps denies. Skin 
breakdown denies. Difficuitythinking denies. 
Reason for Aflpolntment 
1. Hunger Strike 
History of Present Illness 
Flowsheets (M-tU): 
Aflpolntment Provide b)(5); (b)(l)(C) 
Pt has been oomplaining to the nurse of feeling weak in the legs. But he is still refusing to ha1.e his ,;tals checked to be 
e,amined or to ha1.e labs drawn. He is also refusing to go to the hospi1al. He is not urinating much at all. It is not dear if he is 
drinking fluids. Pt is offered medical care and he oontinues to refuse. He is alert in no distress but angry. He states he is firm in 
his protest 
Hungerstrike M:mitoring Form 
Day. 08128/2018 
Shift: AM 
Intake PO (in ml): 0 refuses to measure intake states not drinking 
QJtput Urine (in mi): 0 REFUSED TOCO..LECTURINE. 
QJtput Bowel Ml1.8ments (in ml): 0 PER PT CAN NOT RECALL LAST BM 
Labs - Urine Ketones: REFUSED URINE DIP ANAL YS/S 
lnitials:VhiT! 
Patient ldentitrca!i<in: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? Russian 
Interpretation pro;;ded? Yes, Interpreter Number 
Number : Uonbridge 11277330 
Language Russian 
Pain f<;sessment 
Pain 
Ne }OU currently in pain? Yes 
The pain is located Use Notes Section all over /av.er body 
The sel.8rityof pain is rated at 4110 
The sel.8rityof the pain is mild to moderate 
The pain began 3-4 days ago 
The character of the pain is intermittent 
The associated symptoms are none 
The pain is aggravated by none 
The pain is reliel.8d by none refused offer of medication 
Narratil.8: 
Patient is oonsidered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Hunger Strike: 
Wedical Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
\M1en did the official hunger strike begin? 08/25'2018 
Date of last meal oonsumed: 08/22/2018 
Last meal oonsumed: Breakfast 
Drinking fluids: No 
# of day., on hunger strike: 3 
Total 11\eightloss in pounds: 0 unknow,, palientis refusing 
Reason for hunger strike: Wcints to be released from custody 
Housing/Isolation Location: M,dical Housing Unit 
Reason for Isolation Placement For dose supervision, observalion, and monitoling 
Re-.;8\V of the Housing Placement Review housing eve,y 24 hours 
Vital Signs 
refused. 
Examination 
General E>Olmination: 
GENERl'l !>PPEJ>Rl'NCE: inno acute distress, well del.eloped, well r<JUrished. 
EYES: dry eyes. 
NECK/THYROID: l10ITT1al, neck supple, full range of motion. 
SKIN: 1101TT1ai, no rashes, no suspicious lesions. 
MJSCULOSKELET/ll: not obsen.ed. did shcMier. 
PSYCH: alert, oriented, cogniti1.e function intact, poor eye contact, speech diminished output, ldume, no auditory or 
-.;sual hallucinations, thought content wthout suicidal ideation, delusions. 
Assessments 
1. Starvation, subsequent encounter - T73.0JO<D (Pr mary) 
/II-Risk for imbalanced nutrition: less than body requirements. 
Treatment 
1. Starvation, subsequent encomter 
Notes: pt is oomplaining of feeling bad but refusing medical care. He is alert with good men1ation. Unable to make full 
assessment since he is refusing labs and e,amination. 
Procedure Codes 
T1013 Sign Lang/0-al Interpreter 
Follow Up 
daily 
Notes: Education pro,.;ded on M:ldication and Treatment pt not accepting of food or fluids 
Appointment Providej(b)(6); (b)(7)(C) IMD 
(b)(6); (b)(7)(C) 
2019-ICLl-00051 3411 
D 
DHS-ICE-19-0196, 19-0197-O-000095

Electronically signed by!(b)(6); (b)(7)(C) ~Don 08/29/2018 22:14:10 (Pacific Daylight Time) 
Sign off status: Completed 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 
Northwest Detention Center 
1623 E J STREET 
T~~wo 98421 Tol(b)(6J 
11D 08/28/2018 
NCl.e generated by eOinica/Wm<s Bvr>IPM Sottv.ere (,w,w 11110 
2019-ICLl-00051 3412 
DHS-ICE-19-0196, 19-0197-O-000096

U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A:216269802 Si.ti1c:f:b)(6); I 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll ~be~ 
1623 EJ STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
08/28/2018 
Allergles 
N.KDA 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue admits. 
Fe1<>r denies. Headache denies. Lightheadedness admits, at 
rest, often . Sleep disturbance denies. 
Hunger Strike: 
Fatigue admits, that is constant, that is 'Mll'Sening. 
Headache denies. Lightheadedness admits, 58\eral times. 
Sleep Disturbance denies. Waight loss denies. Dry M>uth denies. 
Waakness admits, that is se-.ere, that is generalized. says he 
can not get up his legs v.on, hold him. Cough denies. 
Shortness of breath at rest denies. Chest pain at rest denies. 
Palpitations denies. /lbdominal Pain denies. Constipation denies. 
Diarrhea denies. Nausea denies. l.bmitting denies Painful 
urination denies. Decreased urine output admits. Mlsde 
aches admits legs Misde cramps denies. Skin 
breakdown denies. Difficultythinking denies. 
Reason for Aflpolntment 
1. tvHU /'M RN ROUNDS\ HUNGER STRIKE 
History of Present Illness 
Flowsheets (tvHU): 
lnput/OJtput Flowsheet 
Time: 1430 
INPUT PO: 0 states not drinking refuses to measure intake 
INPUT SUBTOT/11..: 0 
Aflpolntment Provlde,(b)(6); (b)(7)(C) IRN 
OUTPUT Urine 0 states last void 2-3 days ago, refuses to measure urine 
OUTPUTBM 0 
OUTPUT SUBTOT/11..: 0 
Initials: Vbi(l 
Hungers~nitoring Form 
Day. 08128/2018 
Shift: AM 
Intake PO (in ml): 0 refuses to measure intake states not drinking 
OJtput Urine (in ml): 0 REFUSED TOCQ.LECTURINE. 
OJtput Bowel M>1<>ments (in ml): 0 PER PT CAN NOT RECALL LAST BM 
Labs - Urine Ketones: REFUSED URINE DIP ANAL YS/S 
Initials: J(b)(6)I Patient ldenti . 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEOQ=FICE~ 
IM1at language do )OU speak? Russian 
Interpretation pro\<ded? Yes, Interpreter Number 
Number : Uonbridge 11276690 
Language Russian 
Pain Assessment 
Pain 
l'<e )OU currently in pain? Yes 
The pain is located Use Notes Section lov,er back 
The se1<>rityof pain is rated at 7110 
The se1<>rityof the pain is moderate 
The pain began 3-4 days ago 
The character of the pain is intermittent 
The associated symptoms are none 
The pain is aggravated by none 
The pain is reliel<>d by none refused offerofmedicanon 
Narrati1<>: 
07:30 tvHU med iso 31 hunger strike: La:,ing on bed appears to be asleep. respirations e1en. no distress noted. 
1035 woke for \tS and assessment Lethargic and slow to speak during encounter. Patient refuses all nursing phy.,ical 
assess men~ \tS, medications, labs, food, water or to sign refusal form. He states he is feeling "not good" He say., he can not get 
up and say., he might fall down and that his legs are 1<>ryweak. Encouraged him to eat food and drink water. Teaching done to 
not make sudden position changes and mo1<> slowly and cautiously. Denies SI-HI-A\A-i 
1330 Refused lunch, missed meal# 19 
1430 Has not gotten out of bed this shift. 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
\Mien did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: No 
Reason for hunger strike: Wcints to be released from custody "relase to USI\" 
/ldequate supply of drinking water and other be1<>rages available: Yes He states he refuses to drink ooteror any fluids. 
Three meals deli1<>red per day to patient Yes 
Lunch deli1<>red during current shift 0% consumed 
Dinner deli1<>red during current shift 0% consumed 
/lnyunauthori>edfoodinroom? No 
Ha1<> dailyorthostatic \<tal signs been completed? Patient refused, see completed refusal form Refused to sign refusal 
form. 
Has input and output been documented on the the M-IU Hunger Strike M:lnitoring Smart Form? Yes 
Vital Signs 
Refused vS and wr. 
Examination 
General EJ<amination: 
GENER/II.. !>PPEAAl'NCE: in no acute distress, well del.eloped, well r<JUrished. 
HE.AD: norrnocephalic. 
OR!'l CA\ATY: REFUSED TO OPEN MOUTH. 
NECK/THYROID: normal, neck supple, full range of motion. 
SKIN: normal, no rashes, no suspicious lesions. 
HEPRT: REFUSED EXA.M. 
LUNGS: REFUSED EXA.M. 
PBDOM:N: REFUSED EX'IM. 
MJSCULOSKELET/11..: not obserl<>d. did sho,,,,er. 
NEUROLOGIC: alert and oriented ... 
PS'YCH: alert, orented, cognilile function intact, poor eye contact, speech diminished output, -.olume, no auditory or 
1.1sual hallucinations, thought content v.ithout suicidal ideation, delusions. 
Assessments 
/!I-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: Detainee 1<>rbali2ed understanding of plan of care and denies questions/concerns. Continue hunger strike protocol, 
encourage po food/fluids, encourage 1<>rbalization offeelings. Encourage to allow staff to monitor intake and output, 1Atal signs, 
wt. Instructed to seek staff>Mth any needs. 'verbali,ed understanding. Nursing Care Plan present Refer to nursing care plan for 
on-going inter,entions. Detainee offered three meals per day and lea1<> in room for at least 20 minutes. l'<:!equate supplyof 
drinking water and other be1<>rages as ordered bypro1Ader available. Encourage dailyoral/phy.,ical h19iene care. Detainee 
2019-ICLl-00051 3413 
DHS-ICE-19-0196, 19-0197-O-000097

""rbali2I!d an understanding of education and/or treatment Voices no other concerns. 
Procedure Codes 
T1013 Sign Lang/0-al Interpreter 
Disposition: /ldmitted to M-IU until medicallye,aluated 
Appointment Provider.!(b)(6); (b)(7)(C) JRN 
Electronically signed byl(b)(6); (b)(7)(C) fN, RN on 08/28/2018 at 15:42 MST 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREEr 
T~WA98421 Te@ffi5[ I 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 Progreea N-=l(b)(6); (b)(7)(C) r" 08/28/2018 
Ncte ger,,:,rtJ.ed by eOinical!Mrls ElvRIPM Sottv.ere ("""'eC/inica/Works.com) 
2019-ICLl-00051 3414 
DHS-ICE-19-0196, 19-0197-O-000098

U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:lll ..h-"\"'/R-"\'-· ___,,,.,..... 
Facility Code: CSONVWA Housing Area: M 
Acca.nt ~beb)@L I 39 Y old Mal~,·•~:::: 
08/27/2018 
Allorglos 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. 11\eight loss denies. Dry M>uth denies. 
11\eakness denies. Cough denies. Shortness of breath at 
rest denies. Chest pain at rest denies. Palpitations denies. 
J>l>dominal Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \bmitting denies. Painful urination denies. 
Decreased urine output admits. Mlsde aches denies. Mlsde 
cramps denies. Skin breakdown denies. Difficultythinking denies. 
1623 E J STREET, T 
Appoirimert Facility: Northwest Detertion Certer 
Appointment Provlde,(b)(6); (b)(7)(C) IRN 
Reason for Appointment 
1. tvHU NIGHT RN ROUNDS 
History of Present Illness 
Flowsheets (tvHU): 
lnput/OJtput Flowsheet 
Time: 0300 
INPUTPO: 0 
INPUT SUBTOT/11..: 0 
OUTPUT Urine 0 
OUTPmTOT/11..: 0 
Initials: b )( 
Hungers - · nitoring Form 
Day. 08/27/2018 
Shift: Night 
Intake PO(in ml): 0 
OJtput Urine (in ml): 0 REFUSED TO USE URINAL FOR ACCURATE IIEASURAIENT 
OJtput Bowel M>wments (in ml): 0 REPCRTS LASTBM5 DAYS AGO 
L~bs -!!unes: REFUSED URINE DIP ANAL YS/S 
Initials: (b)(6); 
Patient ldenti . 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEOO+ICEJ!l~.6)1 \Mlat language do )OU speak? R 
Interpretation pro,..ded? Yes, Interpreter Number 
Number : 324608 
Language Russian 
Pain 1'6sessment 
Pain 
/ll'e )OU currently in pain? Yes 
The pain is located .' BACK PAJN 
The sewrityof pain is rated at 6110 
The sewrityof the pain is moderate 
The pain began 1-2 days ago 
The character of the pain is aching 
The associated symptoms are none 
The pain is aggravated by none 
The pain is relie'VE!d by none 
Narratiw: 
pt seen in tvHU for night nursing rounds. Patient stated that he was fine and had no medical needs. He reported ha,..ng a 
6/10 back pain and refused medication for pain. Nurse enccuraged patient to drink fluids and remain h)drated during hunger 
strike. Patient refused breakfast (18th meal). 
Patient is ccnsidered to be on official hunger strike and will be isolated from other detainees for close supen.ision, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
Wien did the official hunger strike begin? 08/25'2018 
Date of last meal ccnsumed: 08/22/2018 
Last meal ccnsumed: Breakfast 
Drinking Fluids: No 
Reason for hunger strike: Wcints to be released from custody 
/ldequate supply of drinking water and other be-erages available: Yes 
Three meals deliwred per day to patient Yes 
Breakfast deli-ered during current shift 0% consumed 
/lnyunauthori>edfoodinroom? No 
Haw dailyorthostatic "tal signs been ccmpleted? Patient refused, see ccmpleted refusal form Refused to sign refusal 
fonn. 
Has input and output been documented on the the M-IU Hunger Strike M:lnitoring Smart Form? Yes 
Vital Signs 
Refused "tal signs and weight 
Examination 
General E><amination: 
GENER/II.. !>PPEJ>Rl'NCE: inno acute distress, well de'VE!!oped. 
SKIN: normal, no rashes, no suspicious lesions. 
CHEST: normal shape and expansion. 
MJSCULOSKELET/11..: normal gait, no deformities. 
EXIREMTIES: full range of roolion. 
PSYCH: cognitiw function intact. 
Assessments 
/>I-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: Continue hunger strike protoccl, enccurage po food/fluids, enccurage 1.erbali,ation offeelings. Enccurage to allow staff to 
monitor intake and output. "tal signs, wt. lnslructed to seek staff with any needs. \ierbali,ed understanding. Detainee offered 
three meals per day and leaw in room. A:Jequate supply of drinking water. Enccurage dailyoral/physical h)giene care. 
Procedure Codes 
T1013 Sign Lang/0-al Interpreter 
Disposition: A:Jmitted to tvHU until medicallye"8Iuated 
Appoinbnent Providefb)(6); (b)(7)(C) I RN 
2019-ICLl-00051 3415 
DHS-ICE-19-0196, 19-0197-O-000099

Electronically signed b~ ... \~""')""'\~"'"/;"",.....,_, _ __.F on 08/2812018 06:27:50 (Pacific Daylight Time) 
Sign off status: Completed 
Northwest Detention Center 
1623EJSTREI" 
T~AWA98421 0@6): I 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 ProgNu No18fb)(6); (b)(7)(C) IRN 08/27/2018 
Nd.e general.ed by eOinica/W<n<s B>RIPM Sottw,re (""""eC/inica/works.CtJm) 
2019-ICLl-00051 3416 
DHS-ICE-19-0196, 19-0197-O-000100

U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 ProgNU Nola: 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3417 
AMAR,MERGENSANA A: 216269802 Si.tll*b )(6); I 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
1623E~~::=1~~~~)~~\ .. 0L. I 
DHS-ICE-19-0196, 19-0197-O-000101

U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA A:216269802 Su:i1ctb)(6): ! 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, i'~:: 1623 EJ~~=1~16C I 
08/27/2018 
Allergles 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. 11\eight loss denies. Dry M>uth denies. 
11\eakness admits. Cough denies. Shortness of breath at 
rest denies. Chest pain at rest denies. Palpitations denies. 
J>l>dominal Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \bmitting denies. Painful urination denies. 
Decreased urine output admits. Mlsde aches denies. Mlsde 
cramps denies. Skin breakdown denies. Difficultythinking denies. 
~LY PROBLEM STATED TO THIS NURSE W/>S V'YEJ>KNESS. 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Provlde1(b)(6); (b)(?)(C) 
Reason for Appointment 
1. RN E\€NING ROUNDS 
History of Present Illness 
Flowsheets (M-tU): 
Input/Output Flowsheet 
Time: 2200 
INPUTPO: 0 
INPUT SUBTOT/11..: 0 
OUTPUT Urine 0 
OUTPETOT/11..: 0 
Initials: (b )( 
Hungers nitoring Form 
Day. 08127 /2018 
Shift: PM 
Intake PO(in ml): 0 
Output Urine (in ml): 0 REFUSED TOCO..LECTURINE. REPORTS LASTVOD 08/26/2018 
Output Bowel M>-vements (in ml): 0 REPORTS LASTBM5 DAYS AGO 
Labs -gnes: REFUSED URINE DIP ANAL YS/S 
Initials: (b)(6); 
Patient ldenti ·· · ·--_ · 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEOCFFICER 
\Mlat language do )OU speak? Russian 
Interpretation prolided? Yes, Interpreter Number 
Number _. 11273322 
Language Russian 
Pain 1'6sessment 
Pain 
Ne )OU currently in pain? No 
Narrati-ve: 
During initial rounds, detainee on cot Slates the only issue he has is that he is feeling wee"-1'6ked detainee to please 
urinate in urinal so medical staff could test urine. Detainee dedined and states that he is refusing medical care at this time. 
Encouraged to drink water and eat food. \MIi continue to monitor. Refused dinner, 17th meal. 
Patient is considered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
\Mien did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking Fluids: No 
Reason for hunger strike: Wcints to be released from custody "protest" 
/ldequate supply of drinking water and other be-verages available: Yes 
Three meals deli-vered per day to patient Yes 
Lunch deli-vered during current shift 0% consumed 
Dinner deli-vered during current shift 00/4 consumed 
/lnyunauthoriiedfoodinroom? No 
Ha-ve dailyorthostatic lital signs been completed? Patient refused, see completed refusal fonn Refused to sign refusal 
fonn. 
Has input and output been documented on the the M-IU Hunger Strike M:lnitoring Smart Form? Yes 
Examination 
General Examination: 
GENER/II.. !>PPE.ARANCE: in no acute distress, well del.eloped, well nourished. 
HE.AD: nonnocephalic. 
OR/11.. CAvfTY: REFUSED. 
SKIN: normal, no rashes, no suspicious lesions. 
HE.ART: REFUSED. 
LUNGS: REFUSED. 
PBDOMEN:REFUSED. 
EXTREMTIES: no edema, full range of ITKJlion, no clubbing, cyanosis, or edema. 
PSYCH: alert, oriented, cogniti-ve function intact, good eye contact, speech clear, thought process logical, goal 
directed. 
Assessments 
/!I-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: Continue hunger strike protocol, encourage po food/lluids, encourage -verbalization of feelings. Encourage to allow staff to 
monitor intake and output, lital signs, wt Instructed to seek staff with any needs. 1/erbaliied understanding. Detainee offered 
three meals per day and lea-vein room. A:!equate supply of drinking water. Encourage dailyoral/phy.,ical h>9iene care. 
Procedure Codes 
T1013 Sign Lang/0-al Interpreter 
Appoinbnent Providefb)(6); (b)(?)(C) fN 
2019-ICLl-00051 3418 
DHS-ICE-19-0196, 19-0197-O-000102

Electronically slgned byl(b)(6); (b)(7)(C)IRN on 08/27/2018 22:07:52 (Pacific Daytight Time) 
Sign off status: Completed 
2019-ICLl-00051 3419 
Northwest Detention Center 
1623 E J STREEr 
T~WA98421 
Tel{b)(6); ~- I 
DHS-ICE-19-0196, 19-0197-O-000103

U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:llD: !(b )(6): 
Facility Code: CSONVWA Housing Area: M 
39 Y old Male, DOB: 10/23/1978 
Acc01.111~)(6): 
08/27/2018 
Allergles 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness admits. 
S0l.8ral times. Sleep Disrurbance denies. l.'W!ight loss denies. 
Dry MJuth denies. l.'W!akness admits. that is moderate, that is 
generalized. Cough denies. Shortness of breath at rest denies. 
Chest pain at rest admits. . Palpitations denies. J>bdominal 
Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \bmitting denies. Painful urination admits. that 
is moderate. Decreased urine output admits. Mlsde 
aches denies. Mlsde cramps denies. Skin breakdown denies. 
Difficultythinking denies. 
1623 E J STREET, T WA-911421 
Appoimnert Facility: Northwest Detertion Certer 
Reason for Aflpolntment 
1. tvHU /'M RN ROUNDS\ HUNGER STRIKE 
History of Present Illness 
Flowsheets (tvHU): 
lnput/OJtput Flowsheet 
Time: 1430 
INPUT PO: 0 States has had nothing to drink for 4 days. 
INPUT SUBTOT/11..: 0 
OUTPUT Urine 0 
OUTPUT SUBTOT/11..: 0 
Initials: @:i] 
Hungerstrike Mlnitoring Form 
Day. 08126/.2018 
Shift: AM 
Intake PO(in ml): 0 
Aflpolntment Provlde1(b)(6); (b)(7)(C) 
OJtput Urine (in ml): 0 REFUSED TOCO..LECTURINE. REPORTS LASTVOD 08/26/2018 
OJtput Bowel Ml-vements (in ml): 0 REPORTS LASTBM5 DAYS AGO 
L~bs -Eb)( tones: REFUSED URINE DIP ANAL YS/S 
Initials: 
Patient ldenti ,_ . 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEOO+ICE~((b)(6);! 
\Mlatlanguage do )OU speak? Ru ,. · ·- · · 
Interpretation pro,..ded? Yes, Interpreter Number 
Number _. Uonbridge 11269244 
Language Russian 
Pain 1'6sessment 
Pain 
Ne )OU currently in pain? Yes 
The pain is located Use Notes Section stomache 
The se-verityof pain is rated at 5110 
The se-verityof the pain is moderate 
The pain began 4-5 days ago 
The character of the pain is aching 
The associated symptoms are none 
The pain is aggravated by none 
The pain is relie-ved by none 
Narrati-ve: 
10:15 tvHU M:D ISO4 Bl HUNGER STRIKE Patient la)ing on bed appears to be sleeping, no distress noted respiration 
e\en. 
11 :50 Per interpreter patient refusing all care and assessment and will not sign refusal form because "I am protesting." 
Vlnen asked what he is protesting he said "protesting, Irefuse e-veC)tl1ing" He states he feels "bad" and ''Weak". Reports last had 
BM4 day.; ago and last 10ided 2 day.; ago. He denies SI-HI-AIIH, eating or drinking. C/O pain 4/10 in chest but refused any\/$ or 
phy.;ical exam by RN. Teaching done and patient encouraged to eat and drink fluids and to carefully ambulate due to feeling 
weak. Refused to sign refusal form. 
1305 Refused lunch per Geo aficer~atientobser-ved '-Oiding in toilet 
1730 Refused dinner. --
Patient is oonsidered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
Vlnen did the official hunger strike begin? 08/25'2018 
Date of last meal oonsumed: 08/22/2018 
Last meal oonsumed: Breakfast 
Drinking Fluids: No 
Reason for hunger strike: W..nts to be released from custody "protest" 
/1<:!equate supply of drinking water and other be-verages available: Yes He states he refuses to drink v.ateror any fluids. 
Three meals deli-vered per day to patient Yes 
Lunch deli-vered during current shift 0% oonsumed 
Dinner deli-vered during current shift 0% oonsumed 
/lny unauthori>ed food in room? No 
Ha-ve dailyorthostatic "tal signs been completed? Patient refused, see oompleted refusal form Refused to sign refusal 
form. 
Has input and output been documented on the the M-IU Hunger Strike Mlnitoring Smart Form? Yes 
Vital Signs 
REFUSED vS A'ID wr. 
Examination 
General Examination: 
GENER/II.. !>PPEAAl'NCE: in no acute distress, well de-ve!oped, well nourished. 
HE.AD: normocephalic. 
OR.Al CA\ATY: REFUSED TO OPEN MOUTH. 
NECK/THYROID: nonmal, neck supple, full range or motion. 
SKIN: nonmal, no rashes, no suspicious lesions. 
HEAAT: REFUSED EXA.M. 
LUNGS: REFUSED EXA.M. 
PBDOM:N: REFUSED EX'IM. 
MUSCULOSKELET/11..: nonmal, nonmal gait, no deformities, full range or motion, good strergth and equal bilaterally. 
EXTREMTIES: no edema, full range or motion, no clubbing, cyanosis, or edema. 
NEUROLOGIC: alert and oriented .. motor strergth nonmal upper and lower extremities. 
PSYCH: alert, oriented, cognilile function intact, good eye contact, speech clear, thought process logical, goal 
directed. 
Assessments 
/>I-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: Detainee-verbali>ed understanding of plan of care and denies questions/concerns. Continue hunger strike protocol, 
enoourage po food/fluids, encourage -verbali,ation offeelings. Encourage to allow staff to monitor intake and output, "tal signs, 
wt Instructed to seek staff with any needs. \krbaliied understanding. Call bell within reach, bed in lowest position wilh siderails 
2019-ICLl-00051 3420 
DHS-ICE-19-0196, 19-0197-O-000104

up >2, brakes on. Nursing Care Plan present Refer to nursing care plan for on-going inteMntions. Detainee offered three meals 
per day and leaw in room for at least 20 minutes. J'dequate supply of drinking water and other bewrages as ordered byprmider 
mailable. Encourage daily oral/physical h>9iene care. Change of dothing/bedding offered M[)-W[)- F [). Detainee wrbali2!ld an 
understanding of education and/or treatment Voioes no other conoems. 
Procedure Codes 
T1013 Sign Lang/0-al Interpreter 
Disposition: J'dmitted to M-IU until medically evaluated 
Electronically signed ~b )(6); (b )(?)(C) I RN, RN on 08/27/201815:45:13 (Pacific Daylight Time) 
Sign off status: Completed 
Addendum: 
08/2712018 0436 p~(b)(6); (b)(?)(C) !> 1215 \Asited byChapli1(b)(6); 
Northwest Detention Center 
1 s23 E. J smsa￾r ~~ ~A98421 rel:(bJ~~; ~- I 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 Progrwu Notiii(b)(6); (b)(?)(C) lN 08/27/2018 
Ncie generaled byeOirica/Wcrlcs EM<IPM S:Jttvqe {WNNe0inicEiWorks.CCXJ1 
2019-ICLl-00051 3421 
DHS-ICE-19-0196, 19-0197-O-000105

U.S. Immigration 
and Customs 
Enforcement 
AMAR, MERGEN_~ 
Facility~~~~~ 3~c~~E:: 
08/27/2018 
Past Medical History 
No Wedical History. 
Surwlcal History 
Denies Past Surgical History 
Famlly History 
M>ther. aliw 67 ys 
Father. al iw 67 ys 
Soclal History 
Tobacco Use: 
Tobacco Use 
Do }OU now or haw }OU ewr used tobacco products? No 
....... s 
N.KDA 
HospltalzatlonlllaJor Dle9nostlc Procedure 
Denies Past Hospitalization 
Review of Systems 
Ceneral/Constitutional: 
Lightheadedness admits. 
Hunger Strike: 
Fatigue admits. Headache denies. 
Lightheadedness admits. Sleep Disturbanoe denies. v\A<light 
loss admits, is intentional. DryM>uth admits. 
v\A<lakness denies. Shortness of breath at rest denies. Chest pain 
at rest denies. Palpitations denies. Pbdominal Pain admits, 
inteimittent, epigastric. Diarrhea denies. Nausea denies. 
\.t>mitling admits. Painful urination admits. Decreased urine 
output admits. MJsde aches admits. Difficultythinking denies. 
1623 E J STREET, T 
Appoirimert Facility. Northwest Detertion Certer 
Reason for Aflpolntment 
1. Daily Rounds 
History of Present Illness 
Flowsheets (M-tU): 
Hungerstrike M>nitoring Form 
Day. 08/26/2018 
Shift: AM 
Intake PO(in ml): 0 
Aflpolntment Provlde~(b)(6); (b)(7)(C) ~D 
QJtput Urine (in ml): 0 REFUSED mcaLECTURINE. REPORTS LASTVOD 08/26/2018 
QJtput Bowel M>wments (in ml): 0 REPORTS LASTBM5 DAYS AGO 
Labs -atones: REFUSED URINE DIP ANAL YS/S 
Initials: (b )(6 
Patient ldenti · . 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number 
Number : Uonbridge 11270841 
Language Russian 
Pain Assessment 
Pain 
/>,e }OU currently in pain? Yes 
The pain is located Use Notes Section stomache 
The sewrityof pain is rated at 3110 
The sewrityof the pain is moderate 
The pain began 4-5 days ago 
The charader of the pain is aching 
The associated simptoms are none 
The pain is aggravated by none 
The pain is reliel.ed by none 
Narratiw: 
M-IU M:D ISO4 Bl HUNGER SlRIKE pt e1,0luated for medical condibon during his hungers trike. He is alert and oriented. He 
sat up from his bed when requested. He stales he is refusing food and waler due to protest of being in custody. He wants results 
from ICE on his case. He denies SI-HI-A\/H. 
He states he feels 'weak" but refuses an examination. pt is reminded as to the dangers of not eating or drinking. He is also 
reminded we will gi,e him medical care for emergencies and will ask for that permission from the judge. pt understands and 
agrees to this plan. He is reminded to talk to the nurse if his conditions worsens and we also ha,e the option of sending him to 
theED. 1305 Refused lunch per Ceo aficer ~ b)(6 atientobsen.ed '-Oiding in toilet 
Patient is considered to be on offici · r strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Hunger Strike: 
Wedical Evaluation 
Date missed meals monitoring initialed: 08/22/2018 
\Mien did the official hunger strike begin? 08/25'2018 
Date of last meal consumed: 08/22/2018 
Last meal consumed: Breakfast 
Drinking fluids: No 
# of days on hunger strike: 2 
Total v\A<light loss in pounds: 5 this 111eight loss is reflected mm, admission as he is refusing current 111eights. The date of the 
most recent 111eight was 8/22/18 and prior111eight v,,as 168# 
Reason for hunger strike: Wcints to be released mm, custody 
Housing/Isolation Location: M,dical Housing Unit 
Reason for Isolation ~acement For dose supervision, observaflon, and monitoring 
Re"ew of the Housing Placement Review housing e,-e,y 24 hours 
Vital Signs 
refuses. 
Examination 
General Examination: 
GENER/IL /IPPEJIRIINCE: in no acute distress, well del.e!oped, well r<JUrished. 
EYES: pur:,ls equal, roond, reacti,e to light and accommodation. 
OR/ll CA\KIY: REFUSED TO OPEN MOUTH. 
NECK/TH'fROID: normal, neck supple, full range of motion. 
SKIN: normal, , good turgor, warm and dry. 
EXIREMTIES: no edema, full range of motion, no clubbing, cyanosis, or edema 
NEUROLOOC: motor strength equal upper and lcmer extremities. 
PSYCH: alert, oriented, cogniti1.e function intact, good eye contact, speech clear, thought process logical, goal 
directed, , no auditcxy or '-'Sual hallucinations, thought content V>itrout suicidal ideation, delusions. 
Assessments 
1. Starvation, subsequent encounter - T73.0X)(O (Primary) 
/II-Risk for imbalanced nutrition: Less than body requirements 
Pl with a self imposed hunger strike, not drinking water. 
Treatment 
1. Starvation, subsequent encoo.rter 
Notes: 
Nurses will offer \Mais Signs: E1eryShift; Othostatic \JS Daily as needed; Weight Daily, Labs: Urine dipstick Daily, 1&0 and Weal 
M>nitoring Daily, Pro,..der Assessment qC:0 and pm; Nursing Assessment per 8 hour or as needed. Wedical will offer 
medications for pain, as appropriate. 
Procedure Cod•• 
T1013 Sign Lang/0-al Interpreter 
Follow Up 
daily 
Notes: ~ication and Treatment Plan Re1.1ewed, Patient ad1.1sed to call for the nurse if simptoms ocour., Patient 1erbali2ed 
understanding of all instructions 
2019-ICLl-00051 3422 
DHS-ICE-19-0196, 19-0197-O-000106

Appointment Provlde~(b)(6); (b)(?)(C) ~D 
b)(6); (b)(?)(C) 
D 
Electronically signed b (b )(6); (b)(?)(C) MD on 08/281201811 :03:52 (Pacific Daytight Time) 
Sign off status: Comple 
Northwest Detention Center 
1623EJSTier 
T~~A98421 Tellti}(6[ _ . I as 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 Progress Notaj(b)(6); (b)(?)(C) l•D 08/27/2018 
NcJ.e genermed by eC/inica/Wm<s a.RJPM S:fl"'8re (w.w.1eC/inica/Works.caT9 
2019-ICLl-00051 3423 
DHS-ICE-19-0196, 19-0197-O-000107

U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgNU Nola: 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3424 
DHS-ICE-19-0196, 19-0197-O-000108

0812712018 
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA .. A:216269802 Su:l1Dt(b)(6); Facility Code: CSOINWA HolJ;inn•,g;.,,. .... ea.-... ifi.-' 
39 Y kcOl.lll old Mal~,·'~!!::: ~ber(b )<5C I1623 E J STREET, T v 
Appoirimert Facility. Northwest Detertion Certer 
Reason for Appointment 
1. Hungerstrikeday2 
History of Present Illness 
Flowsheets (M-tU): 
Hungerstrike Mlnitoring Form 
Day: 08127 /2018 
Shift: Night 
Intake PO(in ml): 0 
Intake r.J-Normal Saline (in ml): 0 
Intake r.J-LR (in ml): 0 
Intake NG(in ml): 0 
QJtput Urine (in ml): 0 
QJtput Bowel Ml-vements (in ml): 0 
Labs - Sodium: 0 
Labs - Potassium: 0 
Comments: refuses all intake, induding meds and fluids 
lnitials:l'.E:S2] 
Narrative: 
Appointment Provide b)(6); 
h\/7\/f'.\ 
RN 
Both Geo and nurse 1o1sited patient Geo instructed him that he would be offerred personal POL supplies and linen and fresh 
dothing every Min, Wed and Fri. Nurse education consisted of the importance of fluid intake espedallyduring a hunger strike. He 
was re-assurred that his hunger strike would not be affected by drinking water, or taking medications. He acknowledged 
instruction but dedined to change any of his beha1o1ors. 
Patient Identification: 
Patient Identification 
Patient property identified by2 sources induding: Pidure, Verbally 
Chaperone Present? Yes 
Chaperone Name: Geo Once~ 
\M1at 
Interpretation 
language 
pro1o1ded? 
do )OU speak? 
Yes, Interpreter 
~ 
Number 
Number: 
Language Russian 11267300 
Examination 
General B<amination: 
GENERl>l !>PPE.AR!'NCE: in no acute distress. 
SKIN: nomial, good turgor, no rashes. 
MJSCULOSKELET/ll: full range of motion. 
PSYCH: alert, oriented, cognitive function intact. 
Assessments 
1. Observation for other specfied suspected conditions - V71.89 (Primary) 
Treatment 
1. Observation for other specified suspected con<itions 
Notes: Detainee-verbalized understanding of plan of care and denies questions/concerns. Continue hunger strike protocol, 
encourage po food/fluids, encourage "3rbalization of feelings. Slaff to monitor intake and output, 1o1tal signs, wt. Instructed to seek 
staff with any needs. Verbalized understanding. Nursing Care Plan present Detainee "3rbaliied an understanding of education 
and/or treatment. \.bices no other concerns other than to let medical staff know that he is respectful but will dedine nursing care. 
Follow Up 
pm 
Appointment Provide (b)(6); 
fh\f?Hr'\ 
Electronically signed (b)(6); 
Sign off status: Complelt 1
~h;t\/~ 7~'1
~r:~. '~~ 
on 08/27/2018 08:00:29 (Pacific Daylight Time) 
NorthYlest Detention Center 
1623 E J STREET 
T~WA98421 Te(b}(6); t-ax: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progreea N-fb)(6); ~- IRN 08/27/2018 
/lkte generated byeC/inica/Wcxi<s EMWM &ltw3re (w.w,eC/iricl!iWorks.~ 
2019-ICLl-00051 3425 
DHS-ICE-19-0196, 19-0197-O-000109

U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA A:216269802 Su:llOllh\/R\· I 
Facility Code: CSONVWA Housing Area: D 
39Y old Mal~, AccOllll l'unbe b )(6); 
08/26/2018 
Allergles 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. 11\eight loss denies. Dry M>uth denies. 
11\eakness admits, that is moderate, that is generalized. 
Cough denies. Shortness of breath at rest denies. Chest pain at 
rest admits, . Palpitations denies. Pbdominal Pain denies. 
Constipation denies. Diarrhea denies. Nausea denies. 
\.bmitting denies. Painful urination denies. Decreased urine 
output admits. Mlsde aches denies. Mlsde cramps denies. 
Skin breakdown denies. Difficultythinking denies. 
1623 E J STREET, T 
Appoirimert Facility: Northwest Detertion Certer 
Reason for Aflpolntment 
1. tvHU /'M RN ROUNDS\ HUNGERSTRIKE 
History of Present Illness 
Flowsheets (tvHU): 
lnput/OJtput Flowsheet 
Time: 1830 
INPUTPO: 0 
INPUT SUBTOT/11..: 0 
OUTiPUT Urine 0 
OUTiP~TOT/11..: 0 
Initials: (b )( 
Hungerstri e nitoring Form 
Day. 08126/.2018 
Shift: AM 
Intake PO(in ml): 0 
Aflpolntment Provlder:kb)(6); (b)(7)(C) jRN 
OJtput Urine (in ml): 0 REFUSED TOCO..LECTURINE. REPORTS LASTVOD 2 DAYS AGO. CBSERVED VODING IN 
TOILETX1 BY OFFICER 'M-IITE:@1305 
OJtput Bowel M>vements (in ml): 0 REPORTS LASTBM4 DAYS AGO 
Labs - Urine Ketones: REFUSED URINE DIP ANAL YS/S 
Initials: jth "" I 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEOCfflCE (b)(6); 
IM1atlanguagedo)Ouspeak? Ru 1h" 7 "" 
Interpretation pro\<ded? Yes, Interpreter Number 
Number : Uonbridge 11266744 
Language Russian 
Pain Assessment 
Pain 
Ne )OU currently in pain? Yes 
The pain is located Use Notes Section Chest 
The severityof pain is rated at 4110 
The severity of the pain is moderate 
The pain began other Refused to anS\\er questions 
The character of the pain is aching, other 
The associated symptoms are other 
Describe: Refused to anS\\er questions 
The pain is aggravated by other 
Describe: Refused to anS\\erquestions 
The pain is relieved by other 
Describe: Refused to anS\\er questions 
Narrative: 
10:15 tvHU M:D ISO4 Bl HUNGER STRIKE Patient la~ng on bed appears to be sleeping, no distress noted respiration 
e\en. 
11 :50 Per interpreter patient refusing all care and assessment and will not sign refusal form because "I am protesting." 
Vlnen asked what he is protesting he said "protesting, Irefuse e-ver")tt1ing" He states he feels "bad" and ''Weak". Reports last had 
BM4 day.; ago and last 10ided 2 day.; ago. He denies SI-HI-AIIH, eating or drinking. C/O pain 4/10 in chest but refused any\/$ or 
phy.;ical exam by RN. Teaching done and patient encouraged to eat and drink fluids and to carefully ambulate due to feeling 
weak. Refused to sign refusal form. . 
1305 Refused lunch per Geo afi b)(6), atientobser-ved '-Oiding in toilet 
1730 Refused dinner. ,i..\/"?\/ 
Patient is oonsidered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/22/2018 
Vlnen did the official hunger strike begin? 08/25'2018 
Date of last meal oonsumed: 08/22/2018 
Last meal oonsumed: Breakfast 
Drinking Fluids: No 
Reason for hunger strike: W..nts to be released from custody "protest" 
/1<:!equate supply of drinking water and other be-verages available: Yes He states he refuses to drink v.ateror any fluids. 
Three meals delivered per day to patient Yes 
Lunch delivered during current shift 0% oonsumed 
Dinner deli-vered during current shift 0% oonsumed 
/lnyunauthori2edfoodinroom? No 
Have dailyorthostatic \<!al signs been completed? Patient refused, see oompleted refusal fOl1'n Refused to sign refusal 
form. 
Has input and output been documented on the the M-IU Hunger Strike M:lnitoring Smart Form? Yes 
Vital Signs 
REFUSED vS A'ID wr. 
Examination 
General Examination: 
GENER/II.. !>PPEJ>Rl>NCE: in no acute distress, well de-ve!oped, well nourished. 
HE.AD: normocephalic. 
OR.Al CA\ATY: REFUSED TO OPEN MOUTH. 
NECK/THYROID: normal, neck supple, full range or motion. 
SKIN: normal, no rashes, no suspicious lesions. 
HEAAT: REFUSED EXA.M. 
LUNGS: REFUSED EXA.M. 
PBDOM:N: REFUSED EX'IM. 
MUSCULOSKELET/11..: normal, normal gait, no deformities, full range or motion, good strergth and equal bilaterally. 
EXTREMTIES: no edema, full range or motion, no clubbing, cyanosis, or edema. 
NEUROLOGIC: alert and oriented,, motor strergth normal upper and lower extremities. 
PSYCH: alert, oriented, cognilile function intact, good eye contact, speech clear, thought process logical, goal 
directed. 
Assessments 
/>I-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
2019-ICLl-00051 3426 
DHS-ICE-19-0196, 19-0197-O-000110

1. Others 
Notes: Detainee wrbali2Bd understanding of plan of care and denies questions/concerns. Continue hunger strike protocol, 
encourage po food/fluids, encourage wrbali,ation of feelings. Encourage to allow staff to monitor intake and ou1put, \ital signs, 
wt. Instructed to seek staffiMth any needs. \lerbali2Bd understanding. Call bell iMthin reach, bed in lowest position. Nursing Care 
Plan present Refer to nursing care plan for on-9oing inten.entions. Detainee offered three meals per day and leaw in room for at 
least 20 minutes. Mequate supply of drinking water and other bewrages as ordered byprolider available. Encourage daily 
oral/phy.;ical h19iene care. Change of dothing,bedding offered M[) -W() - F [). Detainee wrbali2Bd an understanding of 
education and/or treatment 'vbices no other concerns. 
Procedure Codes 
T1013 Sign Lang/0-al Interpreter 
Disposition: l>dmitted to M-IU until medically evaluated 
Appointment Provide~(b)(6); (b)(?)(C) JRN 
Electronically signed ~b )(6); (b )(?)(C) JRN, RN on 08/26/201817:45:21 (Pacific Daylight Time) 
Sign off status: Completed 
NorthYlest Detention Center 
1623 E J STREEr 
TACOMA, WA98421 
Teln,,m\· I 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 Progreea N""f:b)(6); (b)(?)(C) ~ 08/26/2018 
/lkte generated by eC/inical\M:xi<s ElvRIPM &Jtv.ere ("""'eC/inica/Works.com) 
2019-ICLl-00051 3427 
DHS-ICE-19-0196, 19-0197-O-000111

08/26/2018 
Review of Systems 
General/Constitutional: 
U.S. Immigration 
and Customs 
Enforcement 
Reason for Appointment 
1. DJ>JL YM-IU PRCMDER ROUNDS: HUNGER S1RIKE 
AMAR,MERGENSANA . . A: 216269802 Su:,IJi& )(6): I 
Facility Code: CSOINNA II g A ea. o 
39 Y AccOl.l'II ad ~=1~:~ ~be l§)@C I 
1623 E J STREET, T v 
Appoirimert Facility. Northwest Detertion Certer 
Appointment Provlder:-!/b~)~/6~)~: ---~I FNP 
Change in appetite denies. Chills denies. Fatigue denies. History of Present Illness Fe,.,, denies. Headache denies. Lightheadedness admits. Night 
sweats denies. Sleep disturbance denies. W.ight gain denies. 
W.ight loss denies. 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? __ 
Interpretation pro\aded? Yes, Interpreter Number 11266262 
Number Use notes ffeld 
Language Russian 
(6:30) This is a 39}0 male admitted to the M-IU due to a dedaration of Hunger strike. He states that he has been diz,yand 
lightheaded for the last three day.;. He states that the oondition is worsening. He states that he is oontinuing to refuse care or be 
assessed. 
Pain />ssessment 
Pain 
/>,e }OU currently in pain? No 
Yitai Signs 
Patient refusing litals at this time. 
Examination 
General E>amination: 
GENER/IL /IPPE/IRIINCE: in no acute distress, well del,eloped, well nourished. 
Patient refusing to be assessed at this time. 
Assessments 
1. Imbalanced nutrition: Less than body requirements [00002]- ND00002 (Primary) 
Treatment 
1. Imbalanced nutrition: Less than body requiremerts (00002] 
Notes: Patient "'rbali,es understanding of regimen. Detainee knows to return if sxworsen or ad,.,rse readion to current regimen 
is obser.ed. ~ication discussed along with teaching and administration. 
Enoouraged to eat and h}<!rate 
Educated about the risk of deh}<!ration and lack of oonsumption of food. 
Follow Up 
1D 
Appointment Provider. (b)(6); 
/h\/7\/r'\ 
Electronically signed b~..,b-)=(6~);=· ~__.!"-" on 08/26/201813:08:05 (Pacific Daylight Time) 
Sign off status: Completed 
Nortl'Mlest Detention Center 
1623 E J STREET 
T=WA98421 ldb)(6) I Fax: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progresa Notek._b--')"-(6--')'-; __ __.rNP 08/28/2018 
N(xe generaled by eOinica/Wcn<s BvR'PM Sottv,e,e /""""'eOinica/Wcn<s.com) 
2019-ICLl-00051 3428 
DHS-ICE-19-0196, 19-0197-O-000112

U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 ProgNU Nola: 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""1eC/inica'WGYks.coojl 
2019-ICLl-00051 3429 
AMAR,MERGENSANA A: 216269802 Su:llot(b \/6\ 
Facility Code: CSONVWA Housing Area: M 39 Y old Male, DOB: 10/23/1978 
AccOl.lll llun~/6\: 1623 E J STREET, T WA 911421 
DHS-ICE-19-0196, 19-0197-O-000113

U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA . . A:216269802 Su:llt!li,b)(6); I 
Facility Code: CSOINNA II g A ea. o 
39 Y old Male, DOB: 10/23/1978 
AccOl.l'II lunber:~ 
1623 EJ STREET, T~ 
Appoirimert Facility. Northwest Detertion Certer 
08/26/2018 
Allergles 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness denies. 
Sleep Disturbance denies. 11\eight loss denies. Dry M>uth denies. 
11\eakness denies. Cough denies. Shortness of breath at 
rest denies. Chest pain at rest denies. Palpitations denies. 
J>l>dominal Pain denies. Constipation denies. Diarrhea denies. 
Nausea denies. \bmitting denies. Painful urination denies. 
Decreased urine output denies. Mlsde aches denies. Mlsde 
cramps denies. Skin breakdown denies. Difficultythinking denies. 
Reason for Appointment 
1. Nocturnal Hunger Strike Nursing Assessment 
History of Present Illness 
Flowsheets (M-tU): 
lnput/OJtput Flowsheet 
Time: 0300 
INPUTPO: 0 
INPUT SUBTOT/11..: 0 
OUTPUT Urine 0 
OUTP~OT/11..: 0 
lnitials@.llfill 
Patient Identification: 
Patient Identification 
Appointment Prov1c1e9(b)(6); (b)(7)(C) 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: GE0011ic4'.b)(6); ! 
Wiat language do }OU speak? Russ,an, __ 
Interpretation pro\aded? Yes, Interpreter Number 
Number : Uonbridge #8615 
Language Russian 
Pain Assessment 
Pain 
/>,e }OU currently in pain? No 
~= Detainee denies Sl/HVA\iH. Detainee stated that he is not willing to eat nor drink. He stated that this is his protest and wants 
to get out of NVIOC. 
Patient is oonsidered to be on official hunger strike and will be isolated from other detainees for dose supen.ision, 
observation, and monitoring. 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/220)18 
\M1en did the official hunger strike begin? 08/25'2018 
Date of last meal oonsumed: 08/220)18 
Last meal oonsumed: Breakfast 
Drinking Fluids: No 
Reason for hunger strike: 11\ants to be released from custody 
l'<:!equate supply of drinking water and other be-erages available: Yes He states he relilses to drink v.ateror any fluids. 
Three meals deli-ered per day to patient Yes 
Any unauthori>ed food in room? No 
Hase dailyorlhostatic "tal signs been oompleted? Patient refilsed, see completed refilsal fom1 
Has input and output been documented on the the M-IU Hunger Strike M:lnitoring Smart Form? Yes 
Examination 
General Examination: 
GENER/II.. /IPPEARANCE: in no acute distress, well del.e!oped, well nourished. 
OR/ll CA\A'TY: normal, mucosa moist. 
SKIN: normal, no rashes, no suspicious lesions. 
MJSCULOSKELET/11..: normal, normal gait, no deformities, full range of motion, good strength and equal bilaterally. 
PSYCH: alert, oriented. 
Detainee was sitting up on his bed prior to nursing staff entering room lso4 with GEO officer Figueroa. He spoke to staff 
through the phone interpreter and e~ressed his thoughts dearly. He made good e)e oontact. He was calm and talkati-e and 
refused "tal signs and urine sample. He has no signs nor s:,mptoms of shortness of breath and is able to speak in full 
sentences without ha1.1 ng to take a breath of air. 
Assessments 
/II-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Others 
Notes: 1. Continue with \1tal Signs e-eryshift; Intake and OJtput M:lnitoring e-eryshift; Dailyweights; Dailyorthostatic 1.1tal signs. 
2. An adequate supply of drinking water and other be-erages are available to patient at all times. 
3. Three meals per day are deli>ered to the patient and deli-eryof meals is documented. 
4. ~I food not authori,ed by CDn:>hy.,ician isremol.ed from patienrs room. 
5. Patient is not allowed to purchase food from oommissar)ll.ending machine while on hunger strike. 
6. Patient will only be released from hunger strike treatment/monitoring byCD or phy.,ician order. 
7. Patientoounseled regarding the medical risks ofoontinuing the hunger strike. Education gi-en to detainee regarding the 
breakdown of cells in his body and permanent damage to major organs and e-en death with oontinued hunger strike and the 
lack of sufficient fluids. 
8. Enoouraged to terminate the hunger strike and eaVdrink as normal. 
Detainee 1.erbali,ed understanding of instructions and teaching. 
Procedure Codes 
T1013 Sign Lang/Oral Interpreter 
Notes: Continue Hunger Strike M:lnitoring Protoool in M-IU per order. 
Appoinbnent Provide1(b )(6); (b )(7)(C) 
Electronically signed b*b)(6); (b)(7)(C) 
Sign off status: Completed 
2019-ICLl-00051 3430 
!RN on 08/26/2018 03:26:52 (Pacific Daylight Time) 
DHS-ICE-19-0196, 19-0197-O-000114

Addendum: 
08/26/20180657 J><i(b)(6); (b)(7)(C) p Detainee refused breakfast today, missed 12 meals. 
Northwest Detention Center 
1623EJSffiEEJ 
T~WA98421 "ffi®J*-I 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 ProgNn No,(b)(6); (b)(7)(C) 
Nd.e general.ed by eClinica/Wm<s 8'R'PM Sattv.ere (IW.WeCiinica/Works.com) 
r 08/28/2018 
2019-ICLl-00051 3431 
DHS-ICE-19-0196, 19-0197-O-000115

U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGE~ A: 216269802 Si.tll \~ /l~L, Facility Code: CSONVWA . 
39 Y Acca.nt ad ~:i'!::: lffllbe(b )6); 
08/25/2018 
Allergles 
N.KDA 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fever denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbance denies. ~ight gain denies. 
~ight loss denies. 
1623 E J STREET, T v 
Appoirimert Facility: Northwest Detertion Certer 
Appointment Provlcle"fb)(6); (b)(?)(C) r" 
Reason for Appointment 
1. RN E\€NING SPLIT SHIFT: HUNGER SlRIKE 
History of Present Illness 
Flowsheets (M-tU): 
Patient is 39)<!11rold Russian meal and has missed 11th meal as of dinner this evening. Patient is refusing lilals, l&Os, 
labs, and weights. Refusal form was completed and submitted to Mldical Records. Patient is slating wanting to be released fro 
ICE custody as reason for hunger strike. Patient has been educated about long term efleds of Hunger Slrike. patient verbali,es 
underslanding of all instruction given and continues to slate it is his decision to do HungerSlrike. 
patient repeatedly say.; "I refuse in English.". 
Hungerstrike M:mitoring Form 
Day. 08/25/2018 
Shift: PM 
Intake PO(in ml): 0 
Intake rl/- Normal Saline (in ml): 0 
Intake rl/- LR (in ml): 0 
Intake NG(in ml): 0 
QJtput Urine (in ml): 0 
QJtput Bowel 11/ovements (in ml): 0 
Labs - Urine Ketones: absent 
Labs - Sodium: 0 
Labs - P~: patient refuses labs. Refusal from completed and submitted to medical recolds. 
lnitials:KQl(§ll 
Patient Identification: 
Patient Identification 
Patient prope~yidentified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
\Mat language do )OU speak? Russian, __ 
Interpretation prO\aded? Yes, Interpreter Number 11265221 
Number: 
Language Russian 
Pain /!ssessment 
Pain 
l'<e )OU currently in pain? No 
Vital Signs 
16/min 
66.5in 
RR 
H 
OB/25/201806:59:35 PM 
08/25/2018 06:59:35 PM 
(b )(6); N 
(b)(?)(C) -
-
N 
patient refused \Otals adamantly. Patient refused to sign refusal form. Refusal form completed and submitted to Wed1cal Records. 
Examination 
General Examination: 
GENERN. !>PPEPRANCE: in no acute distress, well del.e!oped, well nourished. 
NEURQOOC: alert and oriented, cooperative with exam, motor strength normal upper and lo.,,er extremities, normal 
exam, normal strength, tone and reflexes, sensory exam intact. 
Assessments 
1. Ineffective Coping [00069]-ND00069 (Prmary) 
Hunger Strike. 
Treatment 
1. Ineffective Coping [00069] 
Notes: Detaineeverbali21ld understanding of plan of care and denies questions/concerns. Continue hunger strike protocol, 
encourage po food/lluids, encourage verbaliiation offeelings. Encourage to allow staff to monitor intake and output. ,Atal signs, 
wt. Instructed to seek staff with any needs. \krbali,ed understanding. Call bell within reach, bed in lowest position with brakes 
on. Nursing Care Plan present Refer to nursing care plan for on-going interventions. Detainee offered three meals per day and 
leave in room for at least 20 minutes. A'.lequate supplyof drinking water and other beverages as ordered bypro,Ader available. 
Encourage dailyoral/phy.;ical h)giene care. Change of dothinglbedding offered M[] -W[] - F [ ]. Detainee verbali21ld an 
understanding of education and/or treatment Voices no other concerns. 
Procedure Codas 
T1013 Sign Lang/0-al Interpreter 
Appoinbnent Provider.l(b)(6); (b)(?)(C) ~ 
Electronically signed b (b)(6); 
(b)(?)(C) , RN on 08/251201819:00:36 (Pacific Daylight Time) 
Sign off status: Comple,li!tr-~~-~ 
2019-ICLl-00051 3432 
NorthlYest Detention Center 
1623 E J STREET 
T~§]'~~MAem 1 
x: 
DHS-ICE-19-0196, 19-0197-O-000116

Patient: A11Wt, IIERGENSANA DOB: 10/23/1978 ProgNu No (b)(6); (b)(?)(C) RN 08/2512018 
Nd.e general.ed byeClincal.Worl<s a.RJPM Softvere (1WM1eCl/=l'W1ll'l<n!m}"--' 
2019-ICLl-00051 3433 
DHS-ICE-19-0196, 19-0197-O-000117

08/25/2018 
Review of Systems 
General/Constitutional: 
U.S. Immigration 
and Customs 
Enforcement 
Reason for Appointment 
1. tvHU admission 
AMAR,MERGENSANA 
A: 216269802 Su:i1ollh \In\ I 
Facility Code: CSONVWA Housing Area: D 
39 Y old Male, DOB: 10/23/1978 
Acca.nt~m 1623 E J STREET, Tll421 
Appoirimert Facility: Northwest Detertion Certer 
Appointment P1'ovldei(b)(6); (b)(7)(C) I FNP 
Change in appetite denies. Chills denies. Fatigue denies. History of Present Illness Fe,.,, denies. Headache denies. Lightheadedness admits. Night Patient Identification: 
sweats denies. Sleep disturbance denies. W.ight gain denies. 
W.ight loss denies. 
Hunger Strike: 
Lightheadedness admits. 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? __ 
Interpretation pro\aded? Yes, Interpreter Number 11265398 
Number Use notes ffeld 
Language Russian 
This is s a 39}0 Russian male patient here due to a dedaration of Hunger strike. He was at meal 9 as of this morning 
breakfast He states that the cause of this hunger strike is because he wants to be released. He states that he is e,periendng 
dizaness and lightheadness as a result of his hunger strike. He states that these sx ha"' been present for two da)S. He states 
that these sxaregetting worse. He states that the last time he had something to drink is two da)S ago. 
Pain />ssessment 
Pain 
/>,e }OU currently in pain? No 
/>,e }OU currently in pain? No 
Pain 
/>,e }OU currently in pain? No 
/>,e }OU currently in pain? No 
11/edical Housing Unit 
/ldmission 
Dateilime for admission : 
Le"'I of Care required: M,dical Level 1 
Frequencyof1.1tal signs: Every8 hrs Inputs and outputs, dailyv,eights, orlhostatic vitals 
11/edication orders: Yes, see medication orders Daily UAs 
Diagnostic Tests/Treatment orders: Yes, see orders 
Diet 0-ders: Yes, see $pedal Needs 
/lcti1.1ties or Restriction orders: activity as tolerated 
Vital Signs 
Patient refusing to ha"' 1.1tals taken (orthostatics ). 
Examination 
General E><amination: 
PSYCH: alert, oriented. 
Refusal for exam. 
Assessments 
1. Imbalanced nutrition: Less than body requirements [00002]- ND00002 (Primary) 
Treatment 
1. Imbalanced nutrition: Less than body requiremerts [00002] 
L.AB: Urinall.sis Dipstick /Cxdered for 08/25/2018) 
I.JIB: Comprehensi"' 11/etabolic Panel /14) Cr-P- 322000 /Cxdered for 08/25/2018) 
I.JIB: CBC/Differential /No Platelet)- 115907 /Q:dered for 08/25/2018) 
Notes: Patient "'rbali,es understanding of regimen. Detainee knows to return if sxworsen or ad,.,rse reaction to current regimen 
is obser.ed. 11/edication discussed along with teaching and administration. 
Enoouraged to Eat and Ori nk 
Discussed risks of malnutrition and se"'re deh)(lration. 
Follow Up 
1D 
Appointment Providej(b)(6); (b)(?)(C) r" 
Electronically signed byl(b)(6); ~-
Sign off status: Completed 
,,.., on 08/26/201811:52:35 (Pacific Daylight Time) 
Norttt.vest Detention Center 
1623 E J STREET 
TACOMA, WA98421 
Tel:j11 ... ,,c-,. 
Fax: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progresa No~(b)(6); (b)(?)(C}~NP 08/25/2018 
N(te generated by eClinica/Worl<s E!vR'PM Soflv.e,-e (""""'eC/inica/Warks.com) 
2019-ICLl-00051 3434 
DHS-ICE-19-0196, 19-0197-O-000118

U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:lld(h \/R\· ! 
Facility Code: CSONVWA Housing Area: D 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II lunbefh\/r;\· 
08/25/2018 
Allergles 
N.KDA 
Review of Systems 
Hunger Strike: 
Fatigue denies. Headache denies. Lightheadedness admits 
to feeling lightheaded when changing position from lying 
down to standing up .. Sleep Disturbance denies. W!ight 
loss denies. Dry MJuth denies. W!akness denies. 
Cough denies. Shortness of breath at rest denies. Chest pain at 
rest denies. Palpitations denies. J>bdominal Pain denies. 
Constipation denies. Diarrhea denies. Nausea denies. 
\.bmitling denies. Painful urination denies. Decreased urine 
output denies. Mlsde aches denies. Mlsde cramps denies. Skin 
breakdown denies. Difficultythinking denies. 
Ceneral/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
FEM!r denies. Headache denies. Lightheadedness admits to 
feeling dizzy when he moves from lying down to standing 
up.. Night sweats denies. Sleep disturbance denies. W!ight 
gain denies. W!ight loss denies. 
1623 E J STREET, TACOMA,r,:,:.:;.fW+;A-9~84=2~1-' 
Appoirimert Facility: Northwest Detertion Certer 
Appointment Prov1c1~(b)(6); (b)(7)(C) 
Reason for Appointment 
1. tvHU NURSING/IOMT NOTE (HUNGER STRIKE tvOJITffi!NG) 
History of Present Illness 
Narrati"': 
S: Englist>-speaking male detainee states '1 refuse (.ital signs check), I refuse (to gi"' a urine specimen). Last time I drank 
water was three da)S ago. Last time I ate food was fi"' da)'S ago. I refuse, take that (plastic urine specimen ccntainer) away. I 
refuse (to sign a Refusal Form). I eat when I go to the outside" Patient is ccnsidered to be on official hunger strike and will be 
isolated from other detainees for dose super.is ion, observation, and monitoring. 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? English 
Interpretation pro.ided? Pallent speaks English fluenUy 
Reccrd re.iew ccnducted: Yes 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? English 
Interpretation pro.ided? Pallent speaks English fluenUy 
Reccrd re.iew ccnducted: Yes 
Pain Assessment 
Pain 
Ne }OU currently in pain? No 
Ne }OU currently in pain? No 
Pain 
Ne }OU currently in pain? No 
Ne }OU currently in pain? No 
Hunger Strike: 
Nursing Evaluation 
Date missed meals monitoring initiated: 08/220)18 
\M1en did the official hunger strike begin? 08/25'2018 
Date of last meal ccnsumed: 08/220)18 
Last meal ccnsumed: Breakfast 
Drinking Fluids: No 
Reason for hunger strike: 11\ants to be released from custody 
/1<:!equate supply of drinking water and other be"'rages available: Yes 
Three meals deli,.,red per day to patient Yes 
Breakfast deli,.,red during current shift ether DETAINEE WAS PREVICIJSL Y HCIJSED IN D-3 SEGREGATICN THIS 
MJRNINGATBREAKFASTTIM=. 
Lunch deli,.,red during current shift 0% consumed 
Dinner deli,.,red during current shift ether 
/lnyunauthori>edfoodinroom? No 
Ha"' dailyorthostatic \ital signs been ccmpleted? Patient refused, see ccmpleted refusal fom1 
Has input and output been documented on the the M-IU Hunger Strike M:lnitoring Smart Form? No; WI/ ccmplete before 
the end of the current shifl 
Vital Signs 
16/min 
66.5in 
Examination 
General Examination: 
RR 
H 
GENER/ll JIPPEJ>RANCE: alert, well hydrated, in no distress . 
OR/ll CAvflY: Refused .. 
SKIN: Refused .. 
HE.ART: Refused .. 
LUNGS: Refused .. 
ASDOMEN: Refused .. 
MJSCULOSKELET/>l: Refused .. 
NEUROLOOC: Refused .. 
PSYCH: poor eye contact. 
Assessments 
08/25/2018 02:03:59 PM 
08/25/201802:03:44 PM 
1. Imbalanced nutrition: Less than body requirements [00002]- ND00002 (Primary) 
/>I-Risk for imbalanced nutrition: Less than body requirements. 
Treatment 
1. Imbalanced nutrijion: Less than body req..iremerts (00002] 
I 
(b)(6); (b)(7)(C) 
Notes: P: Detainee was instructed on the potential health problems (dizziness, lightheadedness, possible permanent organ 
damage and death) which he mayenccunter as a result of ccntinuing to not eat foods and drink fluids. Detainee did not "'rbalize 
understanding but simply shook his head in agreement 
2. Others 
Notes: 1. Continue with \Atal Signs e"'ryshift; Intake and Q.rtput M:lnitoring e"'ryshift; Dailyweights; Dailyorthostatic \ital signs. 
2. /In adequate supply of drinking water and other be"'rages are available to patient at all times. 
3. Three meals per day are deli"'red to the patient and deli,.,ryof meals is documented. 
4. />II food not authori>ed by CD/Ph)Sician is remo~ from patienrs room. 
5. Patient is not allowed to purchase food from ccmmissar)/1.ending machine while on hunger strike. 
6. Patient will only be released from hunger strike lreatment/monitoring by CD or ph)Sician order. 
7. Patientccunseled regarding the medical risks ofccntinuing the hunger strike. 
8. Enoouraged to terminate the hunger strike and eaVdrink as normal. 
Appointment Provideib)(6); (b)(7)(C) r 
2019-ICLl-00051 3435 
DHS-ICE-19-0196, 19-0197-O-000119

(b)(6); (b)(7)(C) 
Electronically signed b (b)(6); (b)(?)(C) on 08/251201814:33:43 (Pacific Daylight Time) 
Sign off status: Comple,flon----~ 
Northwest Detention Center 
1623EJSTREI" 
i:_ ....... """'-"""'..,_~ 
Te (b)(6); (b)(?)(C) 
P•ti-t: AMAR, MERGENSANA DOB: 10/23/1978 P ....... N1b)(6); (b)(?)(C) r Nd.e general.ed by eOinica/W<n<s B>RIPM Sottw,re (""""eG/inica/works.CtJm) 
08/25/2018 
2019-ICLl-00051 3436 
DHS-ICE-19-0196, 19-0197-O-000120

08/25/2018 
Allorglos 
N.KDA 
U.S. Immigration 
and Customs 
Enforcement 
AMAR, MERGEN_~ 
Facility~~~~~ 
39 Y old Male, (b)(6). AccOl.l"II llunbe , 
1623 E J STREET, T 1h1171 trl 
Appoirimert Facility. Northwest Detertion Certer 
Reason for Appointment 
1. SEGREG\llON ROUNDS/ t,,E/ll lvOJITCRING (HUNGER S"TRJKE) 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Picture 
Chaperone Present? No 
Wiat language do }OU speak? English 
Interpretation pro\aded? Pallent speaks English fluenUy 
Segregation: 
Segregation Rounds 
ke }OU currentlythinking about killing or harming }Ourself? No 
Do}Ou haw any medical complainls or concerns at this time? No 
Appointment Provlde'fb)(6); (b)(7)(C) ~N 
Was referral made to dinical sen.1ces (lvOIM.P, Dental, M-t, Sidk Call)? No 
Examination 
Segregation: 
Segregation Evaluation: Patient has spontaneous speech and ansWE!fS questions appropriately, in no acute distress, 
well de\eloped, well nourished, Patient appears to be v.ithin normal limits of beha-.ior, affect, and cogniti1.e functioning, 
Patient does not appear to ha,e any acute or unresol\ed medical conditions that may worsen in segregation, Patient does 
not appear to h8'e acti,e psychosis, mania, suicidal idealions or l'Klmicidal ideations. 
Assessments 
Health M!intenance Related to Segregation Placement 
Preventive Medicine 
Patient educated on how to access medical/ mental health/ dental care while in Segregation. 
Notes: Per D-3 Segregation GEO officer, detainee refused meal #9 with breakfast this morning (Saturday, 08/25/2018). 
Appointment Provi,(b)(6); (b)(7)(C) r 
l(b)(6); (b)(7)(C) 
Electronically signe (b)(6); (b)(7)(C) 
Sign off status: Comp..------~ 
on 0&'25/2018 09:19:25 (Pacific Daylight lime) 
Northviest Detention Center 
1623 E J STREET 
T~WA98421 
Teljii@~: I 
Patient: AMAR, MERGENSANA DOIi: 10/23/1978 P- N::I(b)(6); (b)(7)(C) r 08/25/2018 
Nciegeneratedbye0inical~$ BtRIPMSt:itw:Jre (www IIRC&PPUK$.CUIV 
2019-ICLl-00051 3437 
DHS-ICE-19-0196, 19-0197-O-000121

U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgNU Nola: 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3438 
AMAR,MERGE~ A:216269802 Si.ti1 (b)(6); ~· Facility Code: CSONVWA . 
39 Y old Male, DOB: 10/23/1978 
1623E~~::=1~~~~)~~\""' 
DHS-ICE-19-0196, 19-0197-O-000122

U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgNU Nola: 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3439 
AMAR, MERGEN,.a.-LDU---. 
A: 216269802 Si.tll (b )(6); 
Facility Code: CSOINWA Hotlliii' h
n":ri 7
or"e,"r.' ,:r-' 
39 Y old Male, -~~....., 
AccOllll l'unbe (b)/6): I 
1623 E J STREET, TACOMA, WA98421 
DHS-ICE-19-0196, 19-0197-O-000123

08/24/2018 
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A:216269802 Su:i1ol(b)(6); J 
Facility Code: CSONVWA Housing Area: 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll lunber: ITiii(6):7 
1623 EJ STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Provlde1b)(6); (b)(7)(C) 
Reason for Appointment 
1. JIM RN, SEG RO..JNDS. 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? __ 
Interpretation pro\aded? Provider fluent in pallenrs nallve language 
Segregation: 
Segregation Rounds 
ke }OU currentlythinking about killing or harming }Ourself? No 
Do}Ou haw any medical complainls orconcems at this time? No 
Was referral made to dinical sen.1ces (lvOIM.P, Dental, M-t, Sidk Call)? No 
Examination 
Segregation: 
Segregation Evaluation: Patient has spontaneous speech and ansWE!fS questions appropriately, in no acute distress, 
well de\eoped, well nourished, Patient appears to be v.ithin normal limits of beha-.ior, affect, and cogniti1.e functioning, 
Patient does not appear to ha,e any acute or unresol\ed medical conditions that may worsen in segregation, Patient does 
not appear to h8'e acti,e psychosis, mania, suicidal idealions or txlmicidal ideations. 
Assessments 
Health M!intenance Related to Segregation Placement 
Notes: Custody report, missed 5 meals as of dinner on 08/23/2018. 
Appointment Provide1(b)(6); (b)(7)(C) !RN 
Bectronically signed b b)(6); Jr on ()8.124/2018 05:26:30 (Pacific Daylight Time) 
Sign off status: Comple h\/?\/C:\ 
Northwest Detention Center 
1623 E J STREET 
T WA98421 
Tel /bl/6): x: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progro .. Noto: kb)(6); (b)(7)(C) !RN 08/24/2018 
/lkxe generated by eC/inica/Wcrl.s a.RIPM Sottv.ere (WM'ieC/inicl!iWcrl.s.~ 
2019-ICLl-00051 3440 
DHS-ICE-19-0196, 19-0197-O-000124

08/23/2018 
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:i1kb)(6); 
Facility Code: CSONVWA Hoos ..... ,...,ng ..... Pi=e~a~: G--
39 Y old Male, DOB: 10/23/1978 
Acc01.111 ~1ieit6)(6l; 1623 E J STREET, T~ VVA-9642 I
Appoimnert Facility: Northwest Detertion Certer 
Appointment Provider: l(b)(6); (b)(7)(C) 
Reason for Appointment 
1. JIM RN, SEG RO..JNDS. 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? __ 
Interpretation pro\aded? Provider fluent in pallenrs nallve language 
Segregation: 
Segregation Rounds 
ke }OU currentlythinking about killing or harming }Ourself? No 
Do}Ou haw any medical complainls orconcems at this time? No 
Was referral made to dinical sen.1ces (lvOIM.P, Dental, M-t, Sick Call)? No 
Examination 
Segregation: 
Segregation Evaluation: Patient has spontaneous speech and ansWE!fS questions appropriately, in no acute distress, 
well de\eoped, well nourished, Patient appears to be v.ithin normal limits of beha-.ior, affect, and cogniti1.e functioning, 
Patient does not appear to ha,e any acute or unresol\ed medical conditions that may worsen in segregation, Patient does 
not appear to h8'e acti,e psychosis, mania, suicidal idealions or txlmicidal ideations. 
Assessments 
Health M!intenance Related to Segregation Placement 
Notes: Custody report, missed 2 meals as of dinner on 08/22'2018. 
Appointment Provide'4b)(6); (b)(7)(C) t• RN 
Bectronically signed b (b)(6); (b)(?)(C) 
Sign off status: Comple 
()8.123/2018 05:57:14 (Pacific Daylight Time) 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 
Northwest Detention Center 
1623 E J STRE£r 
T WA98421 
Tel: b)(6); 
08/23/2018 
/lkxe generated byeC/inica/Wcrl.s a.RIPM Sottv.ere (-~,;;:,..;:;c""""""'=;;;,------' 
2019-ICLl-00051 3441 
DHS-ICE-19-0196, 19-0197-O-000125

0812212018 
Allergles 
N.KDA 
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA . . A:216269802 Su:l1Dl{b)(6); 
Facility Code: CSOINWA HoJs .. ng....,;A"'e"'a .... o ...... 
39 Y old Male, DOB: 10/23/1978 
AccOl.l'II lunber:ftii/6i:7 
1623 EJ STREET, T~ 
Appoirimert Facility. Northwest Detertion Certer 
Aflpolntment Provldefb)(6); (b)(7)(C) IRN 
Reason for Aflpolntment 
1. Seg dearance begin meal monitoring 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Name 
Name Use notes field Lion Bridge 11247640 
Language Russian 
Pain .1>6sessment 
Pain 
/>,e }OU currently in pain? No 
Segregation: 
Segregation Clearance 
Evaluated for Segregation Placement on: 08/22/2018 
ke }OU currentlythinking about killing or harming }Ourself? No 
Do}Ou haw any medical complainls prior to going into segregation? No 
ChartRe\aew 
History of mental illness or haw any mental health encounters at current facility? No 
Unresol\ed or acute medical problems that contraindicate Segregation housing? No 
/lctionsTaken 
/l!)pointment created or telephone encounter assigned to M)/M_P, Dental, M-1, or SC? No 
Vital Signs 
97.9F 
62/min 
113173mm Hg 
16/min 
163 lbs 
66.5in 
25.91 Index 
Examination 
Segregation: 
Temp 
08/22/201802:46:49 PM 
HR 
08/22/201802:46:49 PM 
BP 
08/22/201802:46:49 PM 
RR 
08/22/201802:46:49 PM 
Wt 
08/22/201802:46:49 PM 
H 
08/22/201802:46:49 PM 
BMI 
08/22/201802:46:49 PM 
I 
(b)(6); (b)(7)(C) 
Segregation Evaluation: Patient has spontaneoos speech and answers questions appropriately, in no acute distress, 
well de\eloped, well nourished, Patient appears to be ,.,;thin normal limits of beha\ior, affect, and cognitiw functioning, 
Patient does not appear to haw any acute or unresol\ed medical conditions that may worsen in segregation, Patient does 
not appear to ha\e acti1.e psychosis, mania, suicidal ideations or homicidal ideations. 
lime at which re\iew for segregation was completed: 07:30. 
Assessments 
Health Mlintenance Related to Segregation Placement 
Preventive Medicine 
Patient educated on how to access medical/ mental health/ dental care while in Segregation. 
Procedure Codes 
T1013 Sign Lang/0-al Interpreter 
Disposition: Modicallydeared for custody 
Appointment Providei(b)(6); (b)(7)(C) F 
Bectronically signed ~(b)(6); (b)(7)(C) ~, RN on 08/22/2018 at 15:29 MST 
Sign off status: Completed 
2019-ICLl-00051 3442 
DHS-ICE-19-0196, 19-0197-O-000126

Northwest Detention Center 
1623 E J STREET 
T~r.98421 
Tel~£ I 
Patient: AMAR, IIERGENSANA DOB: 10/2311978 Prog,.u No~(b)(6); (b)(7)(C) ~ 08/22/2018 
NCl.e general.ed byeC/inica/'Na1<s EM>/PM Sottv.ere (,w,weC/inica/WGYks.coojl 
2019-ICLl-00051 3443 
DHS-ICE-19-0196, 19-0197-O-000127

U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGEN~ 
A:216269802 Si.ti1 (b)(6); 
Facility Code: CSONVWA Housing ea: 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll lunber:~ 
1623 EJ STREET, T~ 
Appoimnert Facility: Northwest Detertion Certer 
08/22/2018 
Review of Systems 
General/Constitutional: 
Fatigue denies. Fe\er denies. Lightheadedness denies. 
Ps\Chiatric: 
i>ru<ietydenies. Depressed mood denies. Homicidal 
Thoughts denies. Stressors admits, detention. Suicidal 
thoughts denies. 
Appointment P1'ovlde1b)(6); (b)(7)(C)~p 
Reason for Appointment 
1. Dietary issues 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number 
Number : 11247920 
Language Russian 
Pain .1>6sessment 
Pain 
/>,e }OU currently in pain? No 
Narrati"': 
(0725) Patient in medical e,plains he has no intentions of eating from now on. States he is protesting because he thinks itis 
taking too long for the immigration s~tem to decide of his as)!um case. States he has been in the facility for about 8 months and 
he wants to be released here in the USA He does not want to be deported. Denies SIA-ii. 
Yitai Signs 
Pain scale 
Ooutof10 08/2212018 07:45:40 PM 
Temp 
97.9F 08/2212018 07:45:40 PM 
1-R 
62/min 08/2212018 07:45:40 PM 
BP 
113173mm Hg 08/2212018 07:45:40 PM 
RR 
16/min 08/2212018 07:45:40 PM 
wt 
163.0 lbs 08/2212018 07:45:40 PM 
H 
66.Sin 08/2212018 07:45:40 PM 
BMI 
25.91 Index 08/2212018 07:45:40 PM 
Examination 
General Examination: 
GENER/IL /IPPE./IRANCE: in oo acute distress, well del.eoped, well oourished. 
HE.ART: oo murmurs, regular rate and mythm, S 1, S2 oorrnal. 
LUNGS: oorrnal, clear to auscultation bilaterally, oo v,neezes, rales, monchi. 
(b)(6); 
(b)(7)(C) 
MJSCULOSKELETi'L: oorrnal, oorrnal gait, 00 defonnities, full range of motion, good strergth and equal bilaterally. 
PSYCH: alert, oriented, cooperati,e with exam, good eye contact, speech clear, thought content without suicidal 
ideation, thought process gcal directed. 
Assessments 
1. Persons encountering health seNces in other specified circumstances - Z76.89 (Primary), Stated intention of not eating as 
protest in personal immigration case 
Treatment 
1. Persons encountering health senaces in other specified circi.mstances 
p 
-
-
p 
-
-
p 
-
-
p 
-
-
p 
-
-
p 
-
-
p 
-
-
p 
-
Notes: Discussed with patient the process for missed-meal monitoring, and if prolonged also e,plained process for hunger 
strike, induding possibility of court orders for im.oluntaryfeeding if medically necessary. Discussed with patient this steps are not 
puniti,,.,, but are meant to allow us to monitor and lryto keep his health from deteriorating if he misses too many meals. Patient 
states he understands the information pro~ded, and still e,presses his intentions not eat from now on. \MIi place patient in 
segregation unit and begin meal count No food commissary purchases will be allowed until patient resumes eating regularly. 
Patient 1.0ioed understanding and agreement 
Follow Up 
pm 
Appoinbnent Provide (b)(6); 
/h\/7\U"''\ 
Confirmatory sign off: 
~~b_)(6_);_(b_)(_7)_(C_) _~18/22/20 I 8 I 0:21 :49 AM 
(b)(6); (b)(7)(C) 
Bectronically signed (b )(6); on 08/22/2018 07:55:05 (Pacific Daylight lime) 
Sign off status: Compldi/ri!'hri"\l~ 7'=I
r.~·~' - 
2019-ICLl-00051 3444 
DHS-ICE-19-0196, 19-0197-O-000128

Northwest Detention Center 
1623 E J STREET 
i:~-..JUU""""~~ 
Tel b)(6); (b)(7)(C) 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 Prog,. .. Noao1 ... ~b_)_(6_); __ ___.IP 08/22/2018 
NCl.e general.ed by eC/inica/'Na1<s BvR'PM Sottv.ere (l'N.WeC/inica/W<rks.coojl 
2019-ICLl-00051 3445 
DHS-ICE-19-0196, 19-0197-O-000129

08/17/2018 
........ 
N.KDA 
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:llQ/b l/6) I 
Facility Code: CSONVWA Housing Area: B 
Acc01.111 ~0x$C I 39 Y ad~~ E::: 1623 E J STREET, T 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Provlclery'.b)(6); (b)(7)(C) 
Reason for Appointment 
1. Record Reliew, Case II/gt, Case Staffing 
Examination 
General Elo!mination: 
Record reliewed. Reliewed MKb )(6); IRN's encounterwilh Pt. 
-Case staffed wilh RN today. 
ffifilJ 
-I concur wilh assess men~ inter,ention and Plan. Pt was gi1.en appropriate information/education/support and in line wilh 
RN Guidelines. 
-Pt appears to be utiliiing effecti1.e coping skills; denied suicidal ideations, attempts or plan at lhe time of assessment and 
detainee is future oriented. 
-No 111H appt indicated at lhis time. 
-Patient is aware that mental heallh is a"'ilable to assist him while detained if he has any changes in his mental status. 
Staff to continue to monitor and report any changes to mental heallh or medical prolider. Continue to encourage patient to utili,e 
effecti1.e coping skills and communication skills. Mlntal heallh to remain a"'ilable as needed. 
-Pt is aware of acoess to care, lia Sick Call process, should current Plan and education fail to aid s,o;. 
Appointment Provic1e1b)(6); (b)(?)(C) 
Electronically signed ll~(b)(6); (b)(7)(C) 
Sign off status: Completed 
f>" 08/17/2018 18:47:19 (Pacific Daylight Time) 
Northviest Detention Center 
1623 E J STREET 
T~WA9842l "fa®; I 
Patient: AMAR, MERGENS.ANA DOB: 10/23/1978 Prvg,. .. Nowl(b)(6); (b)(?)(C) 
Ncte generated by eOinica/Wcxi<s E1vRIFM &ilwi,,-e (""'"'eC/inica/Works.com) 
2019-ICLl-00051 3446 
08/17/2018 
DHS-ICE-19-0196, 19-0197-O-000130

U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:lltfb )(6): 
Facility Code: CSONVWA Hous",n="g/li"'e"'a"": 8.,...... 
39 Y old Male, DOB: 10/23/1978 
AccOl.l"II i'unbel(b)(6); ! 
0811712018 
Allergles 
N.KDA 
Review of Systems 
Ps\Chiatric: 
Pru<ietydenies . .l>uditor)t'IAsual hallucinations denies. 
Delusions denies. Depressed mood admits, IM"lich is mild. 
Difficulty sleeping denies. Eating disolderdenies. Homicidal 
Thoughts denies. lnabilityto concentrate denies. Loss of 
appetite denies. Mmtal or Ph15ical abuse denies. 
Stressors admits Immigration/Legal isrues. Substance 
abuse denies. Suicidal thoughts denies. 
Reason for Appointment 
1. tvH RN /IOUL T \r\ELLNESS CHECK 
History of Present Illness 
Patient Identification: 
Patient Identification 
1623 E J STREET, ·,"'-UOiA, VVM842 I 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Provlder:!(b)(6); (b)(7)(C) 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: MEDICAL GEO OFFICER 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number 
Number Use notes ffeld 11228099 
Language Russian 
Pt was referred to tvH by medical after going to sick call do feeling depressed because there is no one in his dorm who 
speaks Russian. Pt was requesting to be moi.ed to G-3. Pl. 0952, 39 )(o male pt was seen for tvH RN wellness check. Session 
chaperoned by GEO M!dical Cfficerobsening directlyfrom outside large office window. MOx3, calm, cooperati;e, dear speech 
with full sentences, good e}e contact, neat and well groomed. Pt stated" I don\ ha;e any communication with Russian speakers. 
I would like to be moi.ed to G-3. I ha;e sent a request to custody to be moi.ed twice now". Pt denied thoughts of self￾harm/SI/HVA\/1-1. Hereported that he is eating, drinking and sleeping good. He reported that he does not participate in any 
acti\aties or interact with other detainees because he does not ha;e desire to do so. He reported that he feels safe in the dorm. Pt 
reported that he has a friend that he calls. Pt was ad\ased to send a grie1,0nce if he does not hear back from custody about 
request Discussed and issued coping skill handouts on dealing with stress. Pl. the end of the session, pt thanked this writer for 
the session and reported that he does not need tvH senices at this time. He reported that he knows how to contact medical, 
dental and mental health if he has anyproblem/concem. 
Pain ffisessment 
Pain 
l'<e }OU currently in pain? No 
Vital Signs 
Pain scale 
(b)(6); (b)(7)(C) 
Ooutof10 08/17/201801:52:30 PM 
Temp 
97.5F 08/17/2018 01 :52:30 PM 
1-R 
64/min 08/17/2018 01 :52:30 PM 
BP 
108/66mm Hg 08/17/201801:52:30 PM 
RR 
16/min 08/17/2018 01 :52:30 PM 
Wt 
165.0 lbs 08/17/2018 01 :52:30 PM 
H 
66.5in 08/17/201801:52:31 PM 
BMI 
26.23 Index 08/17/2018 01 :52:31 PM 
Examination 
General Examination: 
GENERN. !>PPEPRANCE: male, alert, pleasant, in no acute distress, .vell hydrated, .vell nourished, comfortable, calm 
and relaxed, cooperati,e. 
PSYCH: alert, oriented, cogniti,e function intact, cooperati,e v,,ith exam, good eye contact, judgement and insight 
good, mood/affect full range, no audito,y or \lsual hallucinations, speech clear. thought content v,,ithoul suicidal ideation, 
delusions, thought process logical, goal directed. 
Assessments 
1. Readiness for enhanced resilience - ND00212 (Primary) 
Treatment 
1. Readiness for enhanced resilience 
Notes: Pt acrused to send agrie1,0nce if he does not hear back from custody after his 2nd request of change of dorm 
Ptacrused to oontinue his dailyacti1Aties. e,en if he does notfeel like it Suggested to engage in a regular excessi,e, participate 
in actilities prolided at the facility as this will help with his depression. Eat something at e,e,ymeal e,en if is just little bit 
rv'aintaingood h19iene to help increase self esteem. Used RN guidelines for depression. 
2. Others 
Notes: Encouraged to del<llop an exercise /acti,,;typrogram ( walking, English ciasses ). ~so to attend religious senices. Hand 
out gi,en on stress relie,e. Return to medical if stress does not impro,e or de;elops other S)!llptoms. Pl ,erbali,ed 
understanding. Patient pro,,;ded handout on dealing with stress in_ Russian _and confirmed with detainee that he could 
understand the print Used 2008 RN Q.iidelines on Stress. 
Disposition: Detainee returned to dorm 
Appointment Providel(b)(6); (b)(7)(C) 
08/17/2018 06:47:35 PM 
2019-ICLl-00051 3447 
DHS-ICE-19-0196, 19-0197-O-000131

Electronically signed ~b)(6); (b)(7)(C) ~ on 08/17/201813:55:34 (Pacific Daylight nme) 
Sign off status: Completed 
Addendum: ~---,,---.,..--,--~ 
08/20/2018 08:43 (b)(6); (b )(7)(C) Pddressed the dorm change request issue with medical GEO officer who called 
the shift lieutena,n~ was 11,0111!□ iiuiii 11,s J,e11tdorm B1 to G3 where he has people that he can communicate with. 
Northwest Detention Center 
1623 E J STREET l'. WA98421 
" (b)(6); 
Patient: AMAR, lll!RGl!NSANA DOB: 10/23/1978 Progress Note:l(b)(6); (b)(7)(C) ~ 08/17/2018 
/1/cle generated by eC/inica/'Na1<s Bvr>IPM Softv.ere ("""'eC/inica'WGYks.COOjl 
2019-ICLl-00051 3448 
DHS-ICE-19-0196, 19-0197-O-000132

U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A:216269802 Su:i1c:fb)(6): Facility Code: CSONVWA Hous..,_.111.....,.gk""e-a,-.B.._. 
39 Y old Ma1=~-1~~31::z: 
1623EJ~~=1=e1I~::: I 
07/2812018 
Allergles 
N.KDA 
Review of Systems 
General/Constitutional: 
Fatigue denies. Fe\er denies. 
ENT: 
Blocked ear denies. Decreased hearing denies. Ear 
pain admits, affecting the right ear. Ringing in the ears denies. 
Sinus pain denies. Sore throat denies. 5'.w>l len glands denies. 
Appoirimert Facility: Northwest Detertion Certer 
Appointment Provlde'1(b)(6); (b)(7)(C)rP 
Reason for Appointment 
1.Rightearissue 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: ID Badge, Verbally 
Chaperone Present? No 
Wiat language do }OU speak? Russian 
Interpretation pro\aded? Yes, Interpreter Number: 
Number. : 11131805 
Language Russian 
Pain .1>6sessment 
Pain 
/>,e }OU currently in pain? Yes 
The pain is located : right ear 
The sewrityof pain is rated at 4110 
The sewrityof the pain is mild to moderate 
The pain began 4-5 days ago 
The character of the pain is aching 
The associated symptoms are none 
The pain is aggravated by none 
The pain is relie\ed by none 
Narratiw: 
(0749) Pl in medical 1Mth do pain in right ear for the past 4-5 day.;. States he deaned his ears IMlh a rolled up piece of paper, 
but denies injuries. Denies decreasd hearing. States he notcied some blood come out before from it Denies medication 
allergies. Denies recent URI. Deneis nasal congestion. 
Vital Signs 
4outof10 
97.7F 
61 /min 
108/66mm Hg 
16/min 
1682 lbs 
66.5in 
26.74 Index 
Examination 
General Examination: 
Pain scale 
07128/201804:23:06 PM 
Temp 
07128/201804:23:06 PM 
1-R 
07/28/201804:23:06 PM 
BP 
07128/201804:23:06 PM 
RR 
07128/201804:23:06 PM 
wt 
07/28/201804:23:06 PM 
H 
07128/201804:23:06 PM 
BMI 
07128/201804:23:06 PM 
GENER/IL. /IPPE/IRANCE: in no acute distress, well del.eoped, well nourished. 
(b)(6); 
(b)(7)(C) 
E/IRS: LEFT EAR, audit<J<Y canal clear, hearing intact to wiispered 'dJice, tympanic membrane intact, clear, light 
reflex present, RIGHT EAR, tympanic membrane intact, clear, light reflex present, hearing intact to wiispered 'dJice, 
audit<J<Y canal v,ith erythema and mild infiammation at the 6 o'clock position. 
NOSE: nares patent, septum intact, sinuses nootender bilaterally. 
NECK/THYROID: noonal, neck supple, full range of motion. 
L YlvPH NODES: no palpable adenopathy. 
HE/IRT: no murmurs, regular rate and rhythm, S 1, S2 noonal. 
LUNGS: noonal, clear to auscultation bilaterally, no wieezes, rales, rhonchi. 
Assessments 
1. /\cute contact otitis extema, right ear- H60.531 (Primary) 
Treatment 
1. Acute contact otltis externa, ri!tt ear 
Start Neom)cin-Polymyxn-HC Solution, 3.5-10000-1, 4 drops into affected ear, Olic, TID, 7 day.;, 1, KCf>: Yes, Drug Source: In 
House Pharmacy, Notes: Not required for tra-el. #1 giwn from l'HC. 
Notes: Discussed 1Mth pt Dx and Tx. ~so discussed ear h19iene. Discussed new medications IMlh patient induding dose, 
frequency and potential side effects. Sick call as needed. Patient10iced understanding and agreementlMlh plan. 
Follow Up 
pm 
Appoinbnent Provide (b)(B); 
(b)(7)(C) 
Confirmatory sign off: 
(b)(6); (b)(7)(C) 07/29/201801:09:05 PM 
(b)(6); (b)(7)(C) 
2019-ICLl-00051 3449 
-
p 
-
-
p 
-
-
p 
-
-
p 
-
-
p 
-
-
p 
-
-
p 
-
-
p 
-
DHS-ICE-19-0196, 19-0197-O-000133

Electronically slgned tf~b_)(_6_); __ ~!" on 07/281201816:29:36 (Pacific Daylight Time) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREEr 
T~~A98421 "N6JT. 1 
Patient: AMAR, lll!RGl!NSANA DOB: 10/23/1978 ProgNss No..J'b)(6); INP 07/28/2018 ~lo-..\/7\/1'"'\ . 
Ncl.e general.ed by eC/inica/Wa1<s aR/PM Safl,,ere {WNNeC/inic;iWorks.COff9 
2019-ICLl-00051 3450 
DHS-ICE-19-0196, 19-0197-O-000134

U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgNU Nola: 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGYks.coojl 
2019-ICLl-00051 3451 
AMAR,MERGE~ 
A:216269802 Si.ti1 (b)(6); ~, Facility Code: CSONVWA . 
39 Y ad ~1~3f !t::: 1623E~~::=l~ MC: I 
DHS-ICE-19-0196, 19-0197-O-000135

0412412018 
U.S. Immigration 
and Customs 
Enforcement 
Reason for Appointment 
1. DEN:sc #15- myfilling broke )<!Sterday 
History of Present Illness 
Dental: 
Dental (Subjectile) 
Location of Evaluation PaUent evaluated in clinic 
ke )OU currently in pain? No 
Patient Identification: 
Patient Identification 
AMAR,MERGENSANA 
A: 216269802 Su:i1ot(b )(~ I 
Facility Code: CSONVWA Housing ea: B 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll ~ber~(b )(6); 1623 E J STREET TP/:n .. . . - 1 • CJ ii C I 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Provlcle~(b)(6); (b)(7)(C) pDs 
Patient properly identified by2 sources induding: Wist Band,ID Badge 
Interpretation pro\aded? Yes 
Interpreter Name or Number. 340C798F 
Language Russian 
Chaperone Pres'lPl2 Yes 
Dental Assistand(b)(6); 
Yitai Signs 
Ooutof10 
96.8F 
60/min 
104168mm Hg 
16/min 
169.6 lbs 
66.5in 
26.96 Index 
Examination 
General Examination: 
Pain scale 
(b)(6); 0412412018 06:35:31 PM (b)(7)(C) 
Temp 
04/24/2018 06:35:31 PM 
1-R 
04/24/2018 06:35:31 PM 
BP 
04/24/2018 06:35:31 PM 
RR 
0412412018 06:35:31 PM 
Wt 
04/24/2018 06:35:31 PM 
ti 
04/24/2018 06:35:31 PM 
BMI 
0412412018 06:35:31 PM 
Problem focused exam, med hx completed by patient re,iewed, NKDA Toolh #15 has gross caries eldending into nen.e, 
missing restoration. Tooth has pre,ious RCT. 1 PA taken wilh lead apron on patient and re;iewed bypro;ider. Periapical 
radioluoency noted. No signs of acute distress or swelling noted. No mobility, dinical crown fractured on lingaul due to caries. 
Tooth is non response to oold stimuli. Percussion and palpation were VI.NL 
Assessments 
Tooth 15-RCT treated, chronic apical periodontitis. 
Treatment 
1. Others 
Notes: Discussed findings wilh patient recommend re;isit for extraction 15. Pt refused and signed refusal form because he 
wants to have endo re-treat. J>d,ised pl to relum to sickcall if s)fllptoms mrsen. Re;iewed Oil. Pt 1erbaliied understanding. 
Procedure Codes 
D0140 LTD ORJ>L EV/>I..UATION - PROOLEM FOCUS 
D0220 INTRAORL-PERll'P1C/>I.. 1 ALM70300 
D1330 ORJ>L HYGIENE INSTRUCTIONS 
Appointment Providle (b)(6); (b)(7)(C) DDS 
Bectronically signed b~_b_)~(6_)~; --~ps , llLM on 04,/24./2018 06:52:00 (Pacific Daylight lime) 
Sign off status: Completed 
2019-ICLl-00051 3452 
Northwest Detention Center 
1623 E J STREET 
T=WA98421 
Tel:M/6) ! 
DHS-ICE-19-0196, 19-0197-O-000136

Fax: 
Pali-t: AMAR, -RGENSANA DOIi= 10/23/1978 P ....... (b)(6); (b)(?)(C) DOS CM/2A/2018 
Nd.e general.ed byeOinica/lMYks EM>/PM Sottv.ere (,w,w·eCIT<l'mllmlll=~_. 
2019-ICLl-00051 3453 
DHS-ICE-19-0196, 19-0197-O-000137

U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA . . A:216269802 Su:lli:-,((b)(6); I 
Facility Code: CSOINNA II g A ea. a 
39 Y old Male, DOB: 10/23/1978 
AccOl.l'II ~be~ 
1623 EJ STREET, T~ 
Appoirimert Facility. Northwest Detertion Certer 
0112112018 
Allergles 
N.KDA 
Review of Systems 
General/Constitutional: 
Change in appetite denies. Chills denies. Fatigue denies. 
Fe1<>r denies. Headache denies. Lightheadedness denies. Night 
sweats denies. Sleep disturbance denies. ~ight gain denies. 
~ight loss denies. 
ENT: 
Blocked ear denies. Decreased hearing denies. Difficulty 
swallowing denies. Ear pain denies. Nosebleed denies. Ringing 
in the ears denies. Sinus pain denies. Sore throat admits, makes 
swa1Ia,,,,;ng painful, that is mild. SY.ollen glands denies. 
Respiratory. 
Chest pain denies. Cough denies. l-lemoptysis denies. Pain 
with inspiration denies. Shortness of breath at rest denies. 
Shortness of breath with eiertion denies. Sputum 
production denies. \Mieezing denies. 
Cardi0\0Scular. 
Difficultyla)'ngflatdenies. Diziiness denies. Fluid 
accumulation in the legs denies. 01hopnea denies. 
Gastrointestinal: 
Blood in stool denies. Change in bowel habits denies. 
Constipation denies. Decreased appetite denies. 
Diarrhea denies. Difficulty swallowing denies. Heartburn denies. 
Nausea denies. ~miting denies. 
M,Jsruloskeletal: 
Joint stillness denies. Leg cramps denies. M.Jsde 
aches denies. Pain in shoulder(s) denies. Painful joints denies. 
Sciatica denies. ~kness denies. 
Detainee stated he has dear secretions from the nose. 
Reason for Appointment 
1. Urgent- Cold S}'Tltoms 
History of Present Illness 
Pain /'6sessment 
Pain 
ke )OU currently in pain? Yes 
The pain is located Use Notes Section Headache 
The se1<>rityof pain is rated at 2110 
The se1<>rityof the pain is mild 
The pain began 1-2daysago 
The character of the pain is aching, is intermittent 
The associated S}'Tlptoms are none 
The pain is aggravated by none 
The pain is reliel<>d by Tylenol 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: /0 Badge, Verbally 
Chaperone Present? Yes 
Chaperone Name: O'licej(b )(6 ! 
Interpretation Pro\<ded? es 
Interpreter Name or Number. 270869GB 
Language Russian 
Narrati1<>: 
Appointment Provldefb)(6); ~-
Detainee here for urgent care complaining of a slight sore throa~ Headache, dear runny nose and musde aches X 1 day.,. 
Lungs CTI\ Throat slightly red, Ears \/\NL, Nose \/\NL. 
Vital Signs 
2outof10 
98F 
74/min 
116174mm Hg 
16/min 
172 lbs 
66.5in 
27.34 Index 
Examination 
General Examination: 
Pain scale 
01121/201809:34:36 PM 
Temo 
01121/201809:34:36 PM 
HR 
01/21/201809:34:36 PM 
BP 
01121/201809:34:36 PM 
RR 
01121/201809:34:36 PM 
wt 
01/21/201809:34:36 PM 
ti 
01121/201809:34:36 PM 
BMI 
01121/201809:34:36 PM 
GENEAA-JIPPE/>RANCE: in oo acute distress. well del.eloped, well oourished. 
HEAD: oorroocephalic. 
(b)(6); -
N (b)(7)(C) -
-
N 
-
-
N 
-
-
N 
-
-
N 
-
-
N 
-
-
N 
-
-
N 
-
EYES: pupils equal, round, reacti-.e to light and accommodation, sclera non-icteric, upper eyelids noonal, la,;er eyelids 
noonal, conj uncti\8 clear. 
NOSE: slight congestion noted, sinuses nontender bilaterally. 
ORPl CAvlTY: noonal, mucosa moist. 
THROO.T: slightly red, , pharynx noonal, tonsils noonal, lMJla midline, oo exudate. 
NECK/'TH'VROID: neck supple, 00 C8'\<Cal lymphaclenopathy. 
SKIN: noonal, good turgor, oo rashes, oo suspicious lesions. 
HEJ>RT: no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNGS: noonal, clear to auscultation bilaterally, oowieezes, rales, rhonchi. 
MUSCULOSKELET/>l: normal gait, 00 deforrrjties, good strength and equal bilaterally. 
EXTREMTIES: no clubbing, cyaoosis, or edema 
PSYCH: alert, oriented. 
Assessments 
1. Risk for Infection [spread/reactivation] [00004] - ND00004 (Primary) 
Treatment 
1. Risk for Infection [spread'reactivation] [00004] 
Start Chlorpheniramine rv'aleate Table~ 4 M3, 1 tablet as needed, Oally, e1<>ry6 hrs, 3 day.,, 12 Table~ Refills 0, KCP. Yes, Drug 
Souroe: Stock, Notes: Not required fortra1<>I 
Start /lcetaminophen Tablet 325 M3, 2 tablets as needed, Oally, e1.ery6 hrs, 3 day.,, 24 Tablet Refills 0, KCP. Yes, Drug Source: 
Stock, Notes: Not required for tra1<>I 
Notes: Per Interim RN Guidelines URI. 
1. Increase fluid intake to 2-3 liters per day. Continue to eat 4-5 sen.ings of fruit and 1<>getables per day. 
2. Increase humiditye~ure (Ha-,, detainee hang a wet towel 01<,r head of bed). Encourage taking a steamy shower. 
3. Dispensed chlorpheniramine 4mg tablets with inslructions and side effeds. 
4. Dispensed /lcetaminophen 325 mg tablets with inslructions and side effeds. 
5. Salt water gargles. 
6. Encouraged warm fluids (tea and soup) to increase the rate of mucous flow. Encouraged rest 
7. Detainee instructed on proper handwashing to pre1<>nt current spread or future infection. 
8. Detainee instructed to return to sick call if sis do not impro1<> or worsen. Detainee 1<>rbalized understanding of inslructions. 
Disposition: Detainee returned to dorm 
Appointment Provi (b)(6); 
(b)(7)(C) 
RN 
1/23/2018 10:11:01 PM 
3454 
DHS-ICE-19-0196, 19-0197-O-000138

Electronically slgne~(b)(6); __ 
Sign off status: Completed 
~, RN on 01/21/2018 20:42:33 (Pacific Standard Time) 
Northwest Detention Center 
1623EJSTier 
1: WA98421 
Te /h)/n) x: 
Patient: A111AR, IIERGENSANA DOB: 10/23/1978 ProgNu No~(b)(6); __ 
Ncie general.ed by eC/inica/Wm<s 8'A?./PM &,fly.ere (w.w.1eC/inlca/Works.COT9 
01/21/2018 
2019-ICLl-00051 3455 
DHS-ICE-19-0196, 19-0197-O-000139

01/03/2018 
Allergles 
N.KDA 
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGEN~ A:216269802 Si.tll (b)(~); _ 
Facility Code: CSONVWA Housing ea: 
39Y old Mal~,· AccOl.lll llunbe b 6 · 1623 E J STREET, T , 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Provld~(b)(6); (b)(7)(C) t 
Reason for Appointment 
1. Return from borrow out 
History of Present Illness 
Narrati"': 
Detainee returned from borrow out to: enies injury or incident during transport Denies pain. 
Pain Assessment 
Pain 
ke )OU currently in pain? No 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: Wist Band, ID Badge, Verbally 
Chaperone Present? No 
Interpretation Pro\<ded? No interpreter available during visit 
Yitai Signs 
Pain scale 
Ooutof10 01/03/201806:18:02 PM 
Temo 
97.7F 01/03/201806:18:02 PM 
1-R 
68/min 01/03/201806:18:02 PM 
BP 
119174mm Hg 0111)3/201806:18:02 PM 
RR 
16/min 01/03/201806:18:02 PM 
wt 
172.0 lbs 0111)3/201806:18:02 PM 
ti 
66.5in 0111l3/201806:18:02 PM 
BMI 
27.34 Index 01/03/201806:18:02 PM 
Examination 
General Examination: 
GENER/ll JIPPEARANCE: in no acute distress. well del.eloped, well nourished. 
Assessments 
HEJ>lTH Ml'INTl'NCE. 
Treatment 
1. Others 
b)(6); 
b)(7)(C) ~ ,_ 
,_ 
RN 
-
~ ,_ 
,_ 
RN 
,_ 
,_ 
RN 
-
~ ,_ 
,_ 
RN 
,_ 
,_ 
RN 
,_ 
Notes: Detainee informed to return to diniclsick call if needed. Detainee -erbali,ed understanding and denied anyquestions or 
concerns at this time. Detainee returned to pod. No Injuries sustained. 
Disposition: rv'edicallydeared for custody 
Ap 'ntment P 'de b)(5); po, rovi b )(7)(C) 
b)(6); (b)(7)(C) 
Electronically signed ~\~/\~/;,c, FN on01/03/201817:19:07 (Pacific Standard Time) 
Sign off status: Completed 
Northwest Detention Center 
1623 E J STREET 
T~~~A98423 ½ii@Y 1 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 p,_.... N~ 01/03/2018 
Ncte generated by eOinica!Wcxi<s ElvRIPM ~e r-eainlca/Wc.-ks.com) 
2019-ICLl-00051 3456 
DHS-ICE-19-0196, 19-0197-O-000140

U.S. Immigration 
and Customs 
Enforcement 
Tel: 
Fax: 
Patient: AIIAR, IIERGENSANA DOB: 10/2311978 ProgNU Nola: 
/\k:le generated by eC/inica/'Na1<s EJvRIPM Softv.ere ("""'eC/inica'WGV'ks.coojl 
2019-ICLl-00051 3457 
AMAR,MERGENSANA . . A: 216269802 Su:lltt'f )(6); 1 
Facility Code: CSOINNA II g A ea. a 
39 Y old Male, DOB: 10/23/1978 
AccOl.l'II ~ber~ 
1623 EJ STREET, T~ 
DHS-ICE-19-0196, 19-0197-O-000141

U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA 
A: 216269802 Su:llcj(b )(6); I 
Facility Code: CSONVWA Housing Area: B 
39 Y old Male, DOB: 10/23/1978 
AccOl.lll~)(R)· 
1212312017 
Surgical History 
Denies Past Surgical Histo,y 
Famllr History 
M:>the~ aliw 67 ys 
Fathe~ al iw 67 ys 
Social History 
Tobacco Use: 
Tobacco Use 
Do )OU now or haw )OU ewr used tobacco products? No 
Drugs/!'jcohol: 
Drugs 
Haw )OU used drugs other than those for medical reasons in the 
past 12 months? No 
/ljcohol Saeen 
Do )OU drink alcohol? No 
Haw )OU ewr been com.icted for dri\.ing under the influence of 
alcohol? No 
J>ouse History 
Ph)'Sical J>ouse 
Haw )OU ewr suffered from ph)'Sical abuse? No 
Se>O.JalJ>ouse 
Haw )OU ewr been a 1.ictim of se>O.Jal abuse? No 
Allerglee 
N.K.DA 
HoepNalutlon/llajor Dillgnoetlc Procedure 
Denies Past Hospitalization 
Review of System• 
Denies anyconcerns at this time. 
1623 E J STREET, T WA-98421 
Appoimnert Facility: Northwest Detertion Certer 
Appointment Pl'ovlder: tb)(6); (b)(7)(C) jK" 
Reason for Appointment 
1.PE-lnitial 
History of Pl'esent Illness 
Physical El0m: 
Initial Assessment 
Intake Screening was re1.1ewed? Yes 
Dental Screening 
Do)Ou haw anysignificantdental problems? no 
Do)Ou haw anydental prosthesis? none 
Madical Histo,y 
Do )OU haw Asthma? Denies 
Do )OU haw Cancer? Denies 
Do )OU haw CardiO\escular disease? Denies 
Do )OU haw Hwertension? Denies 
Do )OU haw Hwerlipidemia? Denies 
Do )OU haw Diabetes? Denies 
Haw )OU had a stroke? Denies 
Do )OU haw sei21Jre disorder? Denies 
Do )OU haw hepatitis? Denies 
Do )OU haw HIV? Denies 
Do )OU now or haw )OU e""r had any STDs? Denies 
Haw )OU e""r had Chicken Pox? No 
Do )OU now or haw )OU e""r had TB? Denies 
rvt.ntal Health Histo,y 
11/anic episodes? Denies 
Depression? Denies 
Sewre l'nl<iety) Denies 
Ps)dlosis? Denies 
Histo,yof Ps)Chotropic medications? Denies 
Suicide /lltempts/Gestures? Denies 
\Aolence towards others? Denies 
rvt.ntal Health hospitalizations? Denies 
Leaming difficulties? Denies 
Prewntatiw/Screening M'>dicine Histo,y 
Haw )OU had a colonoscopy? Denies 
Haw )OU had a DRE? Denies 
Patient Identification: 
Patient Identification 
Patient properly identified by2 sources induding: Wist Band,Pidure,VerlJally 
Chaperone Present? No 
Interpretation Pro,.ded? Yes 
Interpreter Name or Numbe~ 1457EECA 
Language Russian 
Pain Assessment 
Pain 
l'<e )OU currently in pain? No 
Vital Signe 
Ooutof10 
98.1 F 
62/min 
120/74mm Hg 
16/min 
172.4 lbs 
66.5in 
27.41 Index 
20/15 
Examination 
General EJ<amination: 
Pain scale 
12/23/201701:41:41 PM 
Temo 
12/23/201701:41:41 PM 
1-R 
12/23/201701:41:41 PM 
BP 
12/23/201701:41:41 PM 
RR 
12/23/201701:41:41 PM 
Wt 
12/23/201701:41:41 PM 
H 
12/23/201701:41:41 PM 
BMI 
12/23/201701:41:41 PM 
Vision 
12/23/201701:41:41 PM 
GENERl'l !>PPEJ>Rl'NCE: in no acute distress. well del.eloped, well r<JUrished. 
HE.AD: norrnocephalic. 
b)(6); (b)(7)(C) 
ENT: EYES: normal, EARS: normal, NOSE: normal, SINUSES: sinuses non-tender to palpation, ORAL CAVl1Y: 
normal, THROAT: normal. 
E'l'ES: pupils equal, roond, reactiw to light and accommodation. 
OR.AL CAvflY: normal, mucosa moist. 
SKIN: normal, no rashes, no suspicious lesions. 
HEART: no murmurs, regular rate and rhythm, S 1, S2 normal. 
LUNGS: normal, clear to auscultation bilaterally, no v.tieezes. rales, rhonchi. 
J>BDO\,EN: normal, bowel sounds present. soft. nontender. nondistended. 
2019-ICLl-00051 3458 
DHS-ICE-19-0196, 19-0197-O-000142

MJSCULOSKELETl'l: nonnal, nonnal gait, no defonnities, full ranged motion, gocd strength and equal bilaterally. 
PSYCH: alert, oliented. 
Assassments 
1. Enoounter for general adult medical examination without abnormal findings - ZOO.DO (Primary) 
Treatment 
1. Encounter for general adult mecical examination without abnormal firdngs 
Notes: Patient education prtl\Oded on healthylifesl}le, dental and personal h19iene and disease 
pre...,ntiorvtransmission.Discussed how to access medical, mental health and dental care ,ia sick call.Educated on 
assessment and plan; patient "'rbali2ed understanding. 
Procedure Codes 
T1013 Sign Lang/Oral Interpreter 
Disposition: Detainee returned to dorm 
Appointment Provide1b)(6); (b)(7)(C) ~ 
Confirmatory sign off: 
~l<b_)(6_);_(b_)(_7l_(C_) -~'12124/2017 09:45:30 PM 
Electronically signed by \~)(6); on 12/23/201712:42:21 (Pacific Standard Time) 
Electronically co-sgned b b)(6); (b)(7)(C) Don 12/2412017 at 09:45 PM MDT 
Northwest Detention Center 
1623 E J SmEEr 
T WA98421 
Tel (b)(6); 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 p._.... :jb)(6); (b)(7)(C) 
Ncie generated bye0irical~$ £A.RIPM &:/tvere (tKJIINC&VVdk$.fu19 
r 12/23/2017 
2019-ICLl-00051 3459 
DHS-ICE-19-0196, 19-0197-O-000143

12/19/2017 
........ 
N.KDA 
U.S. Immigration 
and Customs 
Enforcement 
History of Pl'esent Illness 
Intake: 
---i;;jtial Assessment 
Was the Pre-Screening Progress Note rel.iewed? Yes 
Patient was identified by2 sources: Picture, Verbally 
AMAR,MERGENSANA _ _ A:216269802 Su:i1Dl(b)(6); 
Facility Code: CSONWVA Hot!,,rn ogicr,,Mri&,aar.-,. ,:::-,,' 
3
~c~~~;r18 1623 E J STREET, T~ ~21 
Appoimnert Facility: Northwest Detertion Certer 
Appointment P1'ovld•i(b)(6); _. 
ff detainee was transferred from another facility, did a medical transfer summaryaccompanythe detainee? Yes 
IMlat language do )OU speak? Russian and speaks some English 
Interpretation prmided? Yes B7005397 
Chaperone Present? No 
Do)Ou haw an e-mail address? No 
M,dical Screening 
How do )OU feel today? G0C0 
/Ira )OU currently in pain? No 
Do)Ou haw any current or past medical problems? No 
/Ira )OU currently or haw )OU ewr taken any medication on a regular basis, induding o...,, the counter and herbal? No 
Do)Ou haw any allergies to indude allergies to medication or food? No 
/Ira )OU now or haw )OU e...,, been treated bya doctor for a medical condition to indude hospitaliiations, surgeries, 
infectious oroommunicablediseases? No 
In the past 2 months, ha"' )OU e~rienced any of the following synptoms continuously for more than 2 weeks? No 
Acough? No 
Coughing up blood? No 
Chest pain? No 
Fe...,,, chills, or night sweals for no known reason? No 
Loss of appetite? No 
Une,q:,lained weight loss? No 
Do )OU haw prel.ious hx of lB? No 
Haw )OU had any recent acute changes with )Our l.ision or hearing? No 
Do)Ou haw anyspecificdietaryneeds? No 
ke )OU a Transgender? No 
Haw )OU ewr had Chicken Pox? No 
0-al Screening 
ke )OU haling any significant dental problems? No 
l\lantal Health Screening 
Haw)Ouewrlriedtokill orharm)Ourself? No 
ke )OU currently thinking about killing or harming )Ourself? No 
Do)Ou haw a history of assaurnng or attacking others? No 
Do )OU haw a ph)>Sical or emotional trauma due to abuse or l.ictimization? No 
Do )OU know of someone in this facilityWhom )OU wish to attack or harm? No 
Do )OU now or haw )OU e"'r heard \Oices that other people do not hear. seen things or people that others do not see; or felt 
others were IJ)1ng to harm )OU for no logical or apparent reason? No 
Haw )OU ewr recei~ counseling, medication or hospitalization for mental health problems? No 
Haw )OU been a \actim of ph)>Sical or sexual abuse or engaged in beha,.ors thatwould put )OU at risk? No 
Do )OU feel that )OU are currenUyin danger of being ph)>Sicallyor sexually assaulted? No 
Haw )OU ewr sexually assaulted an)One? No 
Trauma Screening 
Haw )OU ewrwitnessed, e~rienced, or been confronted with an e"'nt or e"'nls that in'°l"'d actual or threatened death 
or serious injury? No 
Learning/Cultural/Religious Assessment 
Is there an',lhing important to know about )Our religious or cultural beliefs that are of concern to )OU while in detention? No 
Haw )OU ewr had difficulties learning or understanding written information? No 
Substanoe Use/Pbuse Screening 
Haw )OU ewr been treated for drug or alcohol problems or suffered withdrawal synptoms from drug use? No 
Do )OU now or haw )OU e...,, used tobacco products? No 
Do )OU now or haw )OU e...,, drank alcohol? No 
Do )OU now or haw )OU e"'r used drugs? No 
Vlt•ISlgns 
0outof10 
97.9F 
88/min 
124f79mm Hg 
16/min 
172 lbs 
66.Sin 
27.34 Index 
Ex•mln•tlon 
Intake Screening: 
Intake Exam 
Pain scale 
12119/201711:32:47 PM (b)(6); 
Temp (b)(7)(C) 
12119/201711:32:47 PM 
1-R 
12119/201711:32:47 PM 
BP 
12119/201711:32:47 PM 
RR 
12119/201711:32:47 PM 
WI 
12119/201711:32:47 PM 
H 
12119/201711:32:47 PM 
BMI 
12119/201711:32:47 PM 
Patient appears to ha"' normal ph)>Sical/emotional characteristics and no barriers to communication? Yes 
Is the patient oriented to person, place and time? Yes 
Bizarre or crazy beha,.or obsen.ed: No 
Skin Broken out in bumps/rash obsen.ed: No 
El<eessi"' sweating obsen.ed: No 
Pbnormal breathing (persistent cough, hwen.entilation, etc) obsen.ed: No 
Ph',>Sical disabilities obsen.ed: No 
l'gitation obsen.ed: No 
11/alnourished appearance obsen.ed: No 
Cuts, bruises.jaundice, lesions, scars or tattoos obsen.ed: No 
Nits or Jlcti"' lice obsen.ed: No 
Dewlopmental disabilities obsen.ed: No 
Inability to focus or conoentrate obsen.ed: No 
2019-ICLl-00051 3460 
DHS-ICE-19-0196, 19-0197-O-000144

Shaking/tremors observed: No 
Needle Tracks obseNed: No 
Does the patient wear glasses orconlads? No 
Assessments 
1. Normal lnlake Screening - 00.2 (Primary) 
Treatment 
1. Normal Intake Screening 
Notes: Tuberculosis and CXR e~lained to patient and process completed with appropriate shielding.Phy.aical elO!m scheduled 
for patient.Pccess to medical/denlal/menlal health care, grievance process e~lained to patientPatient gi1,,an the Madical 
Oienlation and Health Information Brochure and Dealing with Stress Brochure based on the language spoken bythe patient 
Patient 1,,arbali,ed underslanding of any teaching or instruction.Patient was asked if he or she had any additional questions, and 
anyquestions were addressed. 
Procedure Codes 
T1013 Sign Lang/Oral Interpreter 
Disposition: Madicallydeared for rustody 
Appointment Provide (b)(6); 
/h\/7\/r\ 
(b)(6); (b)(?)(C) 
Electronically signed (b )(6); 
/h\/7\/r"\ 
Sign off status: Completed 
RN 
RN on 12/19/2017 22:34:58 (Pacific Standard Tlme) 
Northwest Detention Center 
1623 E. J STRfB 
T~WA98421 "J?86>;_ I 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 Progrwss No~(b)(6); ~-
Ncie generaled byeOirica/Wcrlcs e.R'PM S:Jttvqe (w.w,eQinicEiWorks.CCXJ1 
~ 12/19/2017 
2019-ICLl-00051 3461 
DHS-ICE-19-0196, 19-0197-O-000145

12/19/2017 
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA . . A: 216269802 Su:lloj(b )(~: I 
Facility Code: CSONWVA Housing ea:,,, 
AccOU11~ber(bX6C ! 39Y ad ~a!t:: 
1623 E J STREET, T 
Appoimnert Facility: Northwest Detertion Certer 
History of Present Illness 
Patient k:lentification: 
Patient k:lentification 
Appointment Provlde1b)(6); (b)(7)(C) I RN 
Patient properly identified by2 sources induding: Picture, Verbally 
Chaperone Present? No 
Interpretation Prmoded? Provider fluent in detainee's na#ve language 
Pre-Screening: 
Pre-Screen 
Ti me of lvrilel 11 :05 
Was the detainee transferred from another facility? Yes 
Doiou haw a current illness or health problems? No 
Ive )OU taking any medications? No 
Ive )OU currently in pain? No 
Ive )OU afraid someone will hurt iou? No 
Do )OU want to hurt iourself? No 
\/Vere there anyoommunication barriers? No 
Examination 
Intake Screening: 
Intake Pre-Screening 
/l!>pearance: Nonna/ 
Beha1.1or. Nonna/ 
State of Consciousness: Alert 
Ease of 11/owment No no#ceab/e restrictions ordifficul#es 
Breathing: Nonna/ 
Skin: No abnonnaliues noted 
Assessments 
nomial. 
Treatment 
1. Others 
Notes: DISPOSmON - NO PRl~llY. 
Appointment Provider.l(b)(6); (b)(7)(C) IRN 
Bectronically signed b b)(6); (b)(7)(C) on 12/20/2017 at 02:24 MST 
Sign off status: Comple 
Northwest Detention Center 
1623 E J STREET 
T WA 8421 
Tel: (b)(6); 
Patient: AMAR, IIERGENSANA DOB: 10/23/1978 Progrees Nolefb)(6); (b)(7)(C) !tt 12/19/2017 
/lkxe generated by eOirica/Wcxi<s 8"R/PM Sotrv.ere (w.w,eQinice/Works.co«4 
2019-ICLl-00051 3462 
DHS-ICE-19-0196, 19-0197-O-000146

Northwest Detention Center ~b)(6); (b)(?)(C) ro 1623 E. J STREET TACOMA, WA 98421 
Tet'b)(6); (b)(?)(C) ~ax: 
Patient: AMAR, MERGENSANA 11/16/2018 
DOB: 10/23/1978 1 Sex: Male 
Address: 1623 E. J STREET, TACOMA, WA 98421 
Phone: 
Ordered Date: 10/11/2018 
Assessments: 
Lab: Urinalysis Dipstick 
Fasting: No 
Specimen: Collection Date:10/11/2018 Time: 10:43 PM Source:Urine Sample 
Clinical Info: 
Name Value Reference Range 
Leukocytes NEG 
Nitrate NEG 
Urobllinogen 0.2 
Protein NEG 
pH 7.5 
Blood NEG 
Specific Gravity 1.010 
Ketones NEG 
Billirubin NEG 
Glucose NEG 
Color YELLOW 
Clarity CLEAR 
Result: Negative 
Received Date: 10/11/2018 
Notes: 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 3463 
DHS-ICE-19-0196, 19-0197-O-000147

Northwest Detention Center l(bl(6l: (bl(7l(Cl IMO 
1623 E. J STREET TACOMA, WA 98421 
Te{bl/6) I Fax: 
Patient: AMAR, MERGENSANA 11/16/2018 
DOB: 10/23/1978 1 Sex: Male 
Address: 1623 E. J STREET, TACOMA, WA 98421 
Phone: 
Ordered Date: 10/10/2018 
Assessments: Starvation, subsequent encounter 
Lab: Urinalysis Dipstick 
Fasting: No 
Specimen: 
Clinical Info: 
Name Value Reference Range 
Leukocytes 
Nitrate 
Urobllinogen 
Protein 
pH 
Blood 
Specific Gravity 
Ketones 
Billirubin 
Glucose 
Color 
Clarity 
Result: 
Received Date: 
Notes: 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 3464 
DHS-ICE-19-0196, 19-0197-O-000148

Northwest Detention Center l(b)(6); (b)(7)(C) IMO 
1623 E. J STREET TACOMA, WA 98421 
Tell(b)(6); I Fax: 
Patient: AMAR, MERGENSANA 11/16/2018 
DOB: 10/23/1978 1 Sex: Male 
Address: 1623 E. J STREET, TACOMA, WA 98421 
Phone: 
Ordered Date: 10/10/2018 
Assessments: Starvation, subsequent encounter 
Lab: Prealbumin - 016931 
Fasting: No 
Specimen: 
Clinical Info: 
Name Value Reference Range 
Specimen Status Report 
Please note 
Request Problem 
Request Problem 
Prealbumin 
Result: 
Received Date: 
Notes: 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 3465 
DHS-ICE-19-0196, 19-0197-O-000149

Northwest Detention Center 
1623 E. J STREET TACOMA, WA 98421 
Tel: l(b)(6); I Fax: 
Patient: 
DOB: 
AMAR, MERGENSANA 
10/23/1978 1 Sex: Male 
Address: 1623 E. J STREET, TACOMA, WA 98421 
Phone: 
Ordered Date: 10/10/2018 
Assessments: Starvation, subsequent encounter 
Lab: Comprehensive Metabolic Panel (14) 1 CMP - 322000 
Fasting: No 
Specimen: 
Clinical Info: 
Name 
NTI Urine Tube (Gray) 
Specimen Identification Status 
Request Problem 
No Urine Received 
Specimen Identification Status 
No Lavender Received 
Please note 
No Micro Specimen Received 
No Specimen Received 
Specimen Status Report 
NT! 0/P Kit (PP Pink/Gray) 
Request Problem 
Request Problem 
Ambig Abbrev CMP14 Default 
Please note 
Request Problem 
eGFR If Africn Am 
eGFR. If NonAfrlcn Am 
A/G Ratio 
ALT (SGPT) 
AST (SGOT) 
Blllrubln, Total 
Globulin, Total 
Albumin 
Protein, Total 
Calcium 
Chloride, Serum 
Potassium 
Sodium 
BUN/C reatinlne R.atlo 
C reatlnlne 
BUN 
Glucose 
Carbon Dioxide, Total 
Alkaline Phosphatase 
Result: 
Received Date: 
Notes: 
Value 
l(b)(6); (b)(?)(C) IMO 
11/16/2018 
Reference Range 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 3466 
DHS-ICE-19-0196, 19-0197-O-000150

Northwest Detention Center 
1623 E. J STREET TACOMA, WA 98421 
I Fax: 
Patient: 
DOB: 
AMAR, MERGENSANA 
10/23/1978 1 Sex: Male 
Address: 1623 E. J STREET, TACOMA, WA 98421 
Phone: 
Ordered Date: 09/21/2018 
Assessments: Starvation, subsequent encounter 
Lab: TSH - 004259 
Fasting: No 
Specimen: Collection Date:09/21/2018 Time:12:01 PM 
Clinical Info: 
Name 
Ambig Abbrev CMP14 Default 
Ambiguous Test Order 
Comment: 
NTI Urine Tube (Gray) 
Please note 
Request Problem 
Request Problem 
Request Problem 
Request Problem 
Specimen Identification Status 
Specimen Status Report 
TSH 
Result: WNL 
Received Date: 09/22/2018 
Notes: 
Value 
0.977 
rb)(6); (b)(?)(C) F 
11/16/2018 
Reference Range 
0.450-4.500 u!U/ml 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 3467 
DHS-ICE-19-0196, 19-0197-O-000151

Northwest Detention Center 
16..,., e , ------ 'TAl"'OMA WA 98421 
Te~(b)(6); (b)(?)(C) lax: ' 
Patient: 
DOB: 
AMAR, MERGENSANA 
10/23/1978 1 Sex: Male 
Address: 1623 E. J STREET, TACOMA, WA 98421 
Phone: 
Ordered Date: 09/21/2018 
Assessments: Starvation, subsequent encounter 
Lab: Comprehensive Metabolic Panel (14) 1 CMP - 322000 
Fasting: No 
Specimen: Collection Date:09/21/2018 Time:12:01 PM 
Clinical Info: 
Name 
NTI Urine Tube (Gray) 
Specimen Identification Status 
Request Problem 
No Urine Received 
Specimen Identification Status 
No Lavender Received 
Please note 
No Micro Specimen Received 
No Specimen Received 
Specimen Status Report 
NT! O/P Kit (PP Pink/Gray) 
Request Problem 
Request Problem 
Ambig Abbrev CMP14 Default 
Please note 
Request Problem 
eGFR If Africn Am 
eGFR If NonAfrlcn Am 
A/G Ratio 
ALT (SGPT) 
AST (SGOT) 
Blllrubln, Total 
Globulin, Total 
Albumin 
Protein, Total 
Calcium 
Chloride, Serum 
Potassium 
Sodium 
BUN/C reatinlne Ratio 
C reatlnlne 
BUN 
Glucose 
Carbon Dioxide, Total 
Alkaline Phosphatase 
Result: WNL 
Received Date: 09/22/2018 
Notes: 
Value 
126 
109 
2.0 
40 
33 
0.2 
2.0 
4.0 
6.0 
9.0 
103 
4.1 
143 
7 
0.86 
6 
102 
28 
S2 
l(b)(6); (b)(?)(C) IMO 
11/16/2018 
Reference Range 
>59 ml./min/1.73 
>S9 mLjmln/l.73 
1.2-2.2 
0-44 IU/L 
0·40 IU/L 
0.0•1.2 mg/dL 
l.S-4.S g/dL 
3.S•S.S g/dL 
6.0•8.S g/dL 
8. 7-10.2 mg/dL 
96-106 mmol/L 
3.S-S.2 mmol/L 
134-144 mmol/L 
9·20 L 
0.76-1.27 mg/dL 
6-20 mg/dL 
6S-99 mg/dL H 
20-29 mmol/L 
39-117 IU/L 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 3468 
DHS-ICE-19-0196, 19-0197-O-000152

Northwest Detention Center 
1623 E. J STREET TACOMA, WA 98421 
Telt'b)(6): I Fax: 
Patient: 
DOB: 
AMAR, MERGENSANA 
10/23/1978 1 Sex: Male 
Address: 1623 E. J STREET, TACOMA, WA 98421 
Phone: 
Ordered Date: 09/21/2018 
Assessments: Starvation, subsequent encounter 
Lab: CBC With Differential/Platelet - 005009 
Fasting: No 
Specimen: Collection Date:09/21/2018 Time:12:01 PM 
Clinical Info: 
Name 
NTI Urine Tube (Gray) 
Request Problem 
Specimen Identification Status 
Specimen Identification Status 
Specimen Status Report 
Please note: 
Request Problem 
Ambig Abbrev CMP14 Default 
Baso(Absolute) 
Basos 
Differential Comment 
Eos 
Eos (Absolute Value) 
Lymphs 
Lymphs (Absolute) 
Monocytes 
Monocytes(Absolute) 
Neutrophlls 
Neutrophlls Absolute 
No Lavender Received 
Platelet Comment 
Please note 
RBC Comment 
Request Problem 
Request Problem 
Please note 
Bands 
Blasts/blast like cells 
Megakaryocytes 
Metamyelocytes 
Myelocytes 
Other, Lineage Uncertain 
Promyelocytes 
Hematology Comments: 
Immature Granulocytes 
Immature Grans (Abs) 
NRBC 
Baso (Absolute) 
Neutrophlls (Absolute) 
Hemoglobin 
Monocytes(Absolute) 
RBC 
Eos (Absolute) 
Hematocrlt 
MCV 
MCH 
MCHC 
RDW 
Lymphs (Absolute) 
Neutrophlls 
Lymphs 
Monocytes 
Eos 
Basos 
Immature Cells 
WBC 
Platelets 
Result: WNL 
Received Date: 09/22/2018 
Notes: 
Value 
0 
0.0 
0.0 
2.4 
13.7 
0.3 
4.64 
0.2 
41.0 
88 
29.5 
33.4 
14.4 
l.7 
52 
37 
7 
4 
0 
4.6 
187 
l(b)(6); (b)(7)(C) D 
11/16/2018 
Reference Range 
Not Estab. % 
0.0·0. l x 10E3/ul 
0.0•0.2 xl0E3/ul 
l.4•7.0 xl0E3/UL 
13.0-17.7 9/dL 
0.1·0.9 xl0E3/uL 
4.14-5.80 x l0E6/uL 
0.0-0.4 x 10E3/ul 
37.5•51.0 % 
79•97 fl 
26.6-33.0 pg 
31.5•35.7 9/dL 
12.3-15.4 % 
0.7-3.l xl0E3/uL 
Not Estab. % 
Not Estab. % 
Not Estab. % 
Not Estab. % 
Not Estab. % 
3.4-10.8 xl0E3/uL 
150-379 xl0E3/uL 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 3469 
DHS-ICE-19-0196, 19-0197-O-000153

Northwest Detention Center !(b)(6); (b)(7)(C) ro 1623 E. J STREET TACOMA, WA 98421 
Tel:1/hl/R\· I Fax: 
Patient: AMAR, MERGENSANA 11/16/2018 
DOB: 10/23/1978 1 Sex: Male 
Address: 1623 E. J STREET, TACOMA, WA 98421 
Phone: 
Ordered Date: 09/21/2018 
Assessments: Starvation, subsequent encounter 
Lab: Vitamin B12 - 001503 
Fasting: No 
Specimen: Collection Date:09/21/2018 Time:12:01 PM 
Clinical Info: 
Name Value Reference Range 
PDF Report! 
Please note 
Request Problem 
Request Problem 
Vitamin B12 1294 232-1245 pg/ml H 
Result: WNL 
Received Date: 09/22/2018 
Notes: 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 3470 
DHS-ICE-19-0196, 19-0197-O-000154

Northwest Detention Center ~b)(6); (b)(7)(C) ro 1623 E. J STREET TACOMA, WA 98421 
Te1:l(b)(6); I Fax: 
Patient: AMAR, MERGENSANA 11/16/2018 
DOB: 10/23/1978 1 Sex: Male 
Address: 1623 E. J STREET, TACOMA, WA 98421 
Phone: 
Ordered Date: 09/21/2018 
Assessments: 
Lab: Prealbumin - 016931 
Fasting: No 
Specimen: Collection Date:09/21/2018 Time:12:01 PM 
Clinical Info: 
Name Value Reference Range 
Specimen Status Report 
Please note 
Request Problem 
Request Problem 
Prealbumin 24 14·35 mg/dL 
Result: improved, WNL 
Received Date: 09/26/2018 
Notes: eclinicalworks 1 support 09/26/2018 06:09:00 : This order was created by the Interface. 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 3471 
DHS-ICE-19-0196, 19-0197-O-000155

Northwest Detention Center 
162""-"-J.<.....,..,_,"'--'"-'I.LCOMA, WA 98421 Te~~/\~k,, p-ax: 
Patient: 
DOB: 
AMAR, MERGENSANA 
10/23/1978 1 Sex: Male 
Address: 1623 E. J STREET, TACOMA, WA 98421 
Phone: 
Ordered Date: 09/21/2018 
Assessments: Starvation, subsequent encounter 
Lab: Vitamin D1 25-Hydroxy - 081950 
Fasting: No 
Specimen: Collection Date:09/21/2018 Time:12:01 PM 
Clinical Info: 
Name 
No Frozen Received 
NTI Stool 
PDF Report! 
Please note 
Request Problem 
Request Problem 
Request Problem 
Request Problem 
Specimen Identification Status 
Vitamin D1 25-Hydroxy 
Result: low 
Received Date: 09/22/2018 
Notes: 
Value 
26.8 
tb)(6); (b)(7)(C) ~o 
11/16/2018 
Reference Range 
30.0-100.0 ng/ml L 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 3472 
DHS-ICE-19-0196, 19-0197-O-000156

Northwest Detention Center l(b)(6); (b)(?)(C) lo 1623 E. J STREET TACOMA, WA 98421 
Tel:l(b)/6): I Fax: 
Patient: AMAR, MERGENSANA 11/16/2018 
DOB: 10/23/1978 1 Sex: Male 
Address: 1623 E. J STREET, TACOMA, WA 98421 
Phone: 
Ordered Date: 09/21/2018 
Assessments: Starvation, subsequent encounter 
Lab: Varicella•Zoster V Ab 1 lgG · 096206 
Fasting: No 
Specimen: Collection Date:09/21/2018 Time:12:01 PM 
Clinical Info: 
Name Value Reference Range 
Request Problem 
Request Problem 
PDF Report! 
NTI Urine Tube (Gray) 
Please note 
Specimen Status Report 
Request Problem 
Please note 
Request Problem 
Varicella Zoster lgG 237 Immune > 165 index 
Varicella Zoster IgG 
Result: immune 
Received Date: 09/24/2018 
Notes: 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 3473 
DHS-ICE-19-0196, 19-0197-O-000157

Northwest Detention Center 
167~ I. 1 C:'TDCC"T 'TAl"'OMA, WA 98421 
l(b)(6); (b)(?)(C) ~D 
Te1l(b)(6); (b)(?)(C) lax: 
Patient: AMAR, MERGENSANA 11/16/2018 
DOB: 10/23/1978 1 Sex: Male 
Address: 1623 E. J STREET, TACOMA, WA 98421 
Phone: 
Ordered Date: 09/21/2018 
Assessments: 
Lab: Written Authorization 
Fasting: No 
Specimen: Collection Date:09/21/2018 Time:12:01 PM 
Clinical Info: 
Name Value Reference Range 
Ambig Abbrev CMP14 Default 
PDF Report! 
Request Problem 
Request Problem 
Specimen Identification Status 
Written Authorization Comment 
Result: 
Received Date: 09/22/2018 
Notes: eclinicalworks 1 support 09/22/2018 12:09:00 : This order was created by the Interface. 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 3474 
DHS-ICE-19-0196, 19-0197-O-000158

Northwest Detention Center fb)(6); (b)(?)(C) ~o 
1623 E. J STREET TACOMA, WA 98421 
Tel:!(b)/6): ~ax: 
Patient: 
DOB: 
Address: 
Phone: 
AMAR, MERGENSANA 
10/23/1978 1 Sex: Male 
1623 E. J STREET, TACOMA, WA 98421 
Ordered Date: 09/19/2018 
Assessments: Starvation, subsequent encounter 
Lab: Urinalysis Dipstick 
Fasting: No 
Specimen: Collection Date:09/19/2018 Time: Source:Spontaneous Urine Sample 
Clinical Info: 
Name Value Reference Range 
Leukocytes Neg 
Nitrate Neg 
Urobllinogen 0.2 
Protein Neg 
pH 6.0 
Blood Neg 
Specific Gravity <1.005 
Ketones Neg 
Billirubin Neg 
Glucose Neg 
Color YELLOW 
Clarity Clear 
Result: Negative 
Received Date: 
Notes: 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 
11/16/2018 
3475 
DHS-ICE-19-0196, 19-0197-O-000159

Northwest Detention Center fb)(6); (b)(7)(C) I RN 
1623 E. J STREET TACOMA, WA 98421 
Tell/h\(R\ I Fax: 
Patient: AMAR, MERGENSANA 11/16/2018 
DOB: 10/23/1978 1 Sex: Male 
Address: 1623 E. J STREET, TACOMA, WA 98421 
Phone: 
Ordered Date: 09/18/2018 
Assessments: 
Lab: Urinalysis Dipstick 
Fasting: No 
Specimen: Collection Date:09/18/2018 Time:10:50 AM Source:Spontaneous Urine Sample 
Clinical Info: 
Name Value Reference Range 
Leukocytes neg 
Nitrate neg 
Urobllinogen 0.2 
Protein neg 
pH 6.0 
Blood neg 
Specific Gravity I.ODS 
Ketones neg 
Billirubin neg 
Glucose neg 
Color yellow 
Clarity clear 
Result: 
Received Date: 
Notes: 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 3476 
DHS-ICE-19-0196, 19-0197-O-000160

Northwest Detention Center 
1623 E. J STREET TACOMA, WA 98421 
(b)(6); (b)(?)(C) 
~ Tell(b)(6); !Fax: 
Patient: AMAR, MERGENSANA 11/16/2018 
DOB: 10/23/1978 1 Sex: Male 
Address: 1623 E. J STREET, TACOMA, WA 98421 
Phone: 
Ordered Date: 09/17/2018 
Assessments: 
Lab: Urinalysis Dipstick 
Fasting: No 
Specimen: Collection Date: 09/17/2018 Time:1:11 PM Source: Urine Sample 
Clinical Info: 
Name Value Reference Range 
Leukocytes NEG 
Nitrate NEG 
Urobllinogen 0.2 
Protein NEG 
pH 7.0 
Blood NEG 
Specific Gravity I.DID 
Ketones NEG 
Billirubin NEG 
Glucose NEG 
Color YELLOW 
Clarity CLEAR 
Result: 
Received Date: 
Notes: 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 3477 
DHS-ICE-19-0196, 19-0197-O-000161

Northwest Detention Center l(b)(6); (b)(7)(C) D 
1623 E. J STREET TACOMA, WA 98421 
Te~(b)(6); (b)(7)(C)~•x: 
Patient: AMAR, MERGENSANA 11/16/2018 
DOB: 10/23/1978 1 Sex: Male 
Address: 1623 E. J STREET, TACOMA, WA 98421 
Phone: 
Ordered Date: 09/16/2018 
Assessments: 
Lab: Urinalysis Dipstick 
Fasting: No 
Specimen: Collection Date:09/16/2018 Time:3:30 PM Source: Urine Sample 
Clinical Info: 
Name Value Reference Range 
Leukocytes NEG 
Nitrate NEG 
Urobllinogen 0.2 
Protein NEG 
pH 7.0 
Blood NEG 
Specific Gravity I.DID 
Ketones NEG 
Billirubin NEG 
Glucose NEG 
Color YELLOW 
Clarity CLEAR 
Result: Negative, nursing review 
Received Date: 09/16/2018 
Notes: 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 3478 
DHS-ICE-19-0196, 19-0197-O-000162

Northwest Detention Center lrh\/6} lb\/Z)(C} p 1623 E. J STREET TACOMA, WA 98421 
Tel(b)(6); (b)(7)(C) I Fax: 
Patient: AMAR, MERGENSANA 11/16/2018 
DOB: 10/23/1978 1 Sex: Male 
Address: 1623 E. J STREET, TACOMA, WA 98421 
Phone: 
Ordered Date: 09/16/2018 
Assessments: 
Lab: Urinalysis Dipstick 
Fasting: No 
Specimen: Source:Urine Sample 
Clinical Info: 
Name Value Reference Range 
Leukocytes NEG 
Nitrate NEG 
Urobllinogen 0.2 
Protein NEG 
pH 7.0 
Blood TRACE-INTACT 
Specific Gravity I.DIS 
Ketones NEG 
Billirubin NEG 
Glucose NEG 
Color YELLOW 
Clarity CLEAR 
Result: 
Received Date: 09/16/2018 
Notes: 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 3479 
DHS-ICE-19-0196, 19-0197-O-000163

Northwest Detention Center fb)(6); {b)(7)(C) ~N 
162• ~ 1 CTDCCT TACOMA, WA 98421 
~~)(6); ~ax: 
Pati~e~~'{::l 7
:.l."l!."::.l.' """"l"nl,.n-1,~,i,-;M;;E;;;R:;:G;;;E:;:N;;;S-;;A-;;N-;;A-----------------------;l;--;l~/;-;1~6:-;/:;2;;;0;-;l-;;8~ 
DOB: 10/23/1978 1 Sex: Male 
Address: 1623 E. J STREET, TACOMA, WA 98421 
Phone: 
Ordered Date: 09/15/2018 
Assessments: 
Lab: 
Fasting: 
Urinalysis Dipstick 
No 
Specimen: Collection Date:09/15/2018 Time: Source:Spontaneous Urine Sample 
Clinical Info: 
Name Value Reference Range 
Leukocytes NEG 
Nitrate NEG 
Urobllinogen 0.2 
Protein NEG 
pH 7.5 
Blood NEG 
Specific Gravity 1.010 
Ketones NEG 
Billirubin NEG 
Glucose NEG 
Color YELLOW 
Clarity CLEAR 
Result: Normal 
Received Date: 09/15/2018 
Notes: Mateas RN,lidia 09/15/2018 12:35: 16 > The result was showed to provider right away. 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 3480 
DHS-ICE-19-0196, 19-0197-O-000164

Northwest Detention Center rb)(6); (b)(7)(C) ro 
1,;~3 F l SIBFFI J~COMA, WA 98421 
Tel (b)(6): Fax: 
Patient: AMAR, MERGENSANA 11/16/2018 
DOB: 10/23/1978 1 Sex: Male 
Address: 1623 E. J STREET, TACOMA, WA 98421 
Phone: 
Ordered Date: 09/14/2018 
Assessments: 
Lab: Urinalysis Dipstick 
Fasting: No 
Specimen: Collection Date:09/14/2018 Time:10:30 AM Source:Urine Sample 
Clinical Info: 
Name Value Reference Range 
Leukocytes NEG 
Nitrate NEG 
Urobllinogen 0.2 
Protein NEG 
pH 6.0 
Blood NEG 
Specific Gravity I.ODS 
Ketones NEG 
Billirubin NEG 
Glucose NEG 
Color YELLOW 
Clarity CLEAR 
Result: 
Received Date: 
Notes: 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 3481 
DHS-ICE-19-0196, 19-0197-O-000165

Northwest Detention Center l(b)(6); (b)(7)(C) ~D 
1623 E. J STREET TACOMA, WA 98421 
Tel{h\lR\· I Fax: 
Patient: AMAR, MERGENSANA 11/16/2018 
DOB: 10/23/1978 1 Sex: Male 
Address: 1623 E. J STREET, TACOMA, WA 98421 
Phone: 
Ordered Date: 09/13/2018 
Assessments: Starvation, subsequent encounter 
Lab: Urinalysis Dipstick 
Fasting: No 
Specimen: Collection Date: 09/13/2018 Time: Source:Spontaneous Urine Sample 
Clinical Info: 
Name Value Reference Range 
Leukocytes Neg 
Nitrate Neg 
Urobllinogen 0.2 
Protein Neg 
pH 7.5 
Blood Neg 
Specific Gravity 1.015 
Ketones Tr 
Billirubin Neg 
Glucose Neg 
Color Yellow 
Clarity Clear 
Result: WNL 
Received Date: 09/13/2018 
Notes: 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 3482 
DHS-ICE-19-0196, 19-0197-O-000166

Northwest Detention Center l(b)(6); (b)(7)(C) ro 1623 E. J STREET TACOMA, WA 98421 
Tel(b)(6); I Fax: 
Patient: AMAR, MERGENSANA 11/16/2018 
DOB: 10/23/1978 1 Sex: Male 
Address: 1623 E. J STREET, TACOMA, WA 98421 
Phone: 
Ordered Date: 09/12/2018 
Assessments: 
Lab: Urinalysis Dipstick 
Fasting: No 
Specimen: Collection Date:09/12/2018 Time: Source:Spontaneous Urine Sample 
Clinical Info: 
Name Value Reference Range 
Leukocytes Neg 
Nitrate Neg 
Urobllinogen 0.2 
Protein Neg 
pH 7.0 
Blood Neg 
Specific Gravity I.DIS 
Ketones Neg 
Billirubin Neg 
Glucose Neg 
Color Yellow 
Clarity Clear 
Result: WNL 
Received Date: 
Notes: 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 3483 
DHS-ICE-19-0196, 19-0197-O-000167

Northwest Detention Center l(b)(6); (b)(7)(C) I MD 
1623 E. J STREET TACOMA, WA 98421 
Tell/h\/R\· /h\/7\/('.\ lax: 
Patient: AMAR, MERGENSANA 11/16/2018 
DOB: 10/23/1978 1 Sex: Male 
Address: 1623 E. J STREET, TACOMA, WA 98421 
Phone: 
Ordered Date: 09/12/2018 
Assessments: Starvation, subsequent encounter 
Lab: Comprehensive Metabolic Panel (14) 1 CMP - 322000 
Fasting: No 
Specimen: Collection Date:09/12/2018 Time:11:52 AM 
Clinical Info: 
Name Value Reference Range 
NTI Urine Tube (Gray) 
Specimen Identification Status 
Request Problem 
No Urine Received 
Specimen Identification Status 
No Lavender Received 
Please note 
No Micro Specimen Received 
No Specimen Received 
Specimen Status Report 
NT! O/P Kit (PP Pink/Gray) 
Request Problem 
Request Problem 
Ambig Abbrev CMP14 Default 
Please note 
Request Problem 
eGFR If Africn Am 110 >59 ml./min/1.73 
eGFR If NonAfrlcn Am 96 >S9 ml.fmln/l.73 
A/G Ratio 1.7 1.2-2.2 
ALT (SGPT) 13 0-44 IU/L 
AST (SGOT) 16 0·40 IU/L 
Blllrubln, Total 0.3 0.0•l.2 mg/dL 
Globulin, Total 2.1 l.S-4.S g/dL 
Albumin 3.S 3.S•S.S g/dL 
Protein, Total S.6 6.0•8.S g/dL L 
Calcium 8.7 8. 7-10.2 mg/dL 
Chloride, Serum 10S 96-106 mmol/L 
Potassium 3.9 3.S-S.2 mmol/L 
Sodium 14S 134-144 mmol/L H 
BUN/C reatinlne Ratio 4 9·20 L 
C reatlnlne 0.99 0.76-1.27 mg/dL 
BUN 4 6-20 mg/dL L 
Glucose 103 6S-99 mg/dL H 
Carbon Dioxide, Total 31 20-29 mmol/L H 
Alkaline Phosphatase 41 39-117 IU/L 
Result: Abnormal 
Received Date: 09/13/2018 
Notes: 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 3484 
DHS-ICE-19-0196, 19-0197-O-000168

Northwest Detention Center 
167' ~ 1 CTDCCT TACOMA, WA 98421 
Te1l(b)(6); I Fax: 
Patient: 
DOB: 
AMAR, MERGENSANA 
10/23/1978 1 Sex: Male 
Address: 1623 E. J STREET, TACOMA, WA 98421 
Phone: 
Ordered Date: 09/12/2018 
Assessments: Starvation, subsequent encounter 
Lab: CBC With Differential/Platelet - 005009 
Fasting: No 
Specimen: Collection Date:09/12/2018 Time:11:52 AM 
Clinical Info: 
Name 
NTI Urine Tube (Gray) 
Request Problem 
Specimen Identification Status 
Specimen Identification Status 
Specimen Status Report 
Please note: 
Request Problem 
Ambig Abbrev CMP14 Default 
Baso(Absolute) 
Basos 
Differential Comment 
Eos 
Eos (Absolute Value) 
Lymphs 
Lymphs (Absolute) 
Monocytes 
Monocytes(Absolute) 
Neutrophlls 
Neutrophlls Absolute 
No Lavender Received 
Platelet Comment 
Please note 
RBC Comment 
Request Problem 
Request Problem 
Please note 
Bands 
Blasts/blast like cells 
Megakaryocytes 
Metamyelocytes 
Myelocytes 
Other, Lineage Uncertain 
Promyelocytes 
Hematology Comments: 
Immature Granulocytes 
Immature Grans (Abs) 
NRBC 
Baso (Absolute) 
Neutrophlls (Absolute) 
Hemoglobin 
Monocytes(Absolute) 
RBC 
Eos (Absolute) 
Hematocrlt 
MCV 
MCH 
MCHC 
RDW 
Lymphs (Absolute) 
Neutrophlls 
Lymphs 
Monocytes 
Eos 
Basos 
Immature Cells 
WBC 
Platelets 
Result: WNL 
Received Date: 09/13/2018 
Notes: 
Value 
0 
0.0 
0.0 
l.5 
13.9 
0.4 
4.72 
0.3 
41.2 
87 
29.4 
33.7 
13.5 
l.9 
35 
45 
11 
8 
1 
4.l 
143 
rb)(6); (b)(7)(C) D 
11/16/2018 
Reference Range 
Not Estab. % 
0.0·0. l x 10E3/ul 
0.0•0.2 xl0E3/ul 
l.4•7.0 xl0E3/UL 
13.0-17.7 9/dL 
0.1·0.9 xl0E3/uL 
4.14-5.80 x l0E6/uL 
0.0-0.4 x 10E3/ul 
37.5•51.0 % 
79•97 fl 
26.6-33.0 pg 
31.5•35.7 9/dL 
12.3-15.4 % 
0.7-3.l xl0E3/uL 
Not Estab. % 
Not Estab. % 
Not Estab. % 
Not Estab. % 
Not Estab. % 
3.4-10.8 xl0E3/uL 
150-379 xl0E3/uL L 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 3485 
DHS-ICE-19-0196, 19-0197-O-000169

Northwest Detention Center fol/6\ /bl/7)/Cl ~D 
1r- - • - • -oMA WA 98421 
Te1l(b)(6); (b)(7)(C) lax: ' Patient: AMAR, MERGENSANA 11/16/2018 
DOB: 10/23/1978 1 Sex: Male 
Address: 1623 E. J STREET, TACOMA, WA 98421 
Phone: 
Ordered Date: 09/11/2018 
Assessments: 
Lab: Urinalysis Dipstick 
Fasting: No 
Specimen: Collection Date: 09/11/2018 Time:7:50 PM Source:Spontaneous Urine Sample 
Clinical Info: 
Name Value Reference Range 
Leukocytes NEG 
Nitrate NEG 
Urobllinogen 1.0 
Protein NEG 
pH 8.0 
Blood NEG 
Specific Gravity 1.015 
Ketones TRACE 
Billirubin NEG 
Glucose NEG 
Color YELLOW 
Clarity CLEAR 
Result: 
Received Date: 
Notes: 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 3486 
DHS-ICE-19-0196, 19-0197-O-000170

Northwest Detention Center ~b)(6); (b)(7)(C) D 
1623 E. J STREET TACOMA, WA 98421 
Tel:l(b )(6); I Fax: 
Patient: AMAR, MERGENSANA 11/16/2018 
DOB: 10/23/1978 1 Sex: Male 
Address: 1623 E. J STREET, TACOMA, WA 98421 
Phone: 
Ordered Date: 09/10/2018 
Assessments: 
Lab: Urinalysis Dipstick 
Fasting: No 
Specimen: Collection Date:09/10/2018 Time: Source:Spontaneous Urine Sample 
Clinical Info: 
Name Value Reference Range 
Leukocytes Neg 
Nitrate Neg 
Urobllinogen 1.0 
Protein Neg 
pH Neg 
Blood Neg 
Specific Gravity 1.010 
Ketones 40 
Billirubin Small 
Glucose nEG 
Color Other 
Clarity Clear 
Result: 
Received Date: 09/10/2018 
Notes: 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 3487 
DHS-ICE-19-0196, 19-0197-O-000171

Northwest Detention Center "):b)(6); (b)(?)(C) I MD 
1623 E. J STREET TACOMA, WA 98421 
Tel:lrh\/n\· I Fax: 
Patient: AMAR, MERGENSANA 11/16/2018 
DOB: 10/23/1978 1 Sex: Male 
Address: 1623 E. J STREET, TACOMA, WA 98421 
Phone: 
Ordered Date: 09/09/2018 
Assessments: 
Lab: Urinalysis Dipstick 
Fasting: No 
Specimen: Collection Date: 09/07/2018 Time:6:00 PM Source:Spontaneous Urine Sample 
Clinical Info: 
Name Value Reference Range 
Leukocytes NEG 
Nitrate NEG 
Urobllinogen 1.0 
Protein NEG 
pH 7.5 
Blood NEG 
Specific Gravity 1.010 
Ketones 40 
Billirubin NEG 
Glucose NEG 
Color YELLOW 
Clarity CLEAR 
Result: 
Received Date: 09/07/2018 
Notes: 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 3488 
DHS-ICE-19-0196, 19-0197-O-000172

Northwest Detention Center I\~/\~\,_, IRN 
1623 E. J STREET TACOMA, WA 98421 
Te1:l(b)(6); I Fax: 
Patient: AMAR, MERGENSANA 11/16/2018 
DOB: 10/23/1978 1 Sex: Male 
Address: 1623 E. J STREET, TACOMA, WA 98421 
Phone: 
Ordered Date: 09/08/2018 
Assessments: 
Lab: Urinalysis Dipstick 
Fasting: No 
Specimen: Collection Date: 09/08/2018 Time: Source:Spontaneous Urine Sample 
Clinical Info: 
Name Value Reference Range 
Leukocytes NEG 
Nitrate NEG 
Urobllinogen 0.2 
Protein NEG 
pH 7.0 
Blood NEG 
Specific Gravity I.DID 
Ketones IS 
Billirubin NEG 
Glucose NEG 
Color YELLOW 
Clarity CLEAR 
Result: wnl 
Received Date: 09/08/2018 
Notes: 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 3489 
DHS-ICE-19-0196, 19-0197-O-000173

Northwest Detention Center 
1623 E. J STREET TACOMA, WA 98421 
l(b)(6); (b)(7)(C) tNP 
Tel:l(b)(6): I Fax: 
Patient: AMAR, MERGENSANA 11/16/2018 
DOB: 10/23/1978 1 Sex: Male 
Address: 1623 E. J STREET, TACOMA, WA 98421 
Phone: 
Ordered Date: 09/07/2018 
Assessments: Starvation, subsequent encounter 
Lab: Phosphorus, Serum - 001024 
Fasting: No 
Specimen: Collection Date: 09/07/2018 Time: 10:04 AM 
Clinical Info: 
Name Value Reference Range 
PDF Report! 
Please note 
Request Problem 
Request Problem 
Phosphorus 2.8 2.5-4.5 mg/dl 
Result: WNL 
Received Date: 09/11/2018 
Notes: 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 3490 
DHS-ICE-19-0196, 19-0197-O-000174

Northwest Detention Center 11~11~1,c, rNP 1623 E. J STREET TACOMA, WA 98421 
~(b)(6);~· I Fax: 
Pat1en : ,..,.,,...,R1 MERGENSANA 11/16/2018 
DOB: 10/23/1978 1 Sex: Male 
Address: 1623 E. J STREET, TACOMA, WA 98421 
Phone: 
Ordered Date: 09/07/2018 
Assessments: Starvation, subsequent encounter 
Lab: Creatine Kinase 1Total 1Serum - 001362 
Fasting: Yes 
Specimen: Collection Date: 09/07/2018 Time: 10:04 AM 
Clinical Info: 
Name Value Reference Range 
PDF Report! 
Please note 
Request Problem 
Request Problem 
Request Problem 
C reatine Kinase,Total 98 24-204 U/L 
Result: WNL 
Received Date: 09/11/2018 
Notes: 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 3491 
DHS-ICE-19-0196, 19-0197-O-000175

Northwest Detention Center fbl(6); ~- rNP 162• ~ 1 CTDCCT TACOMA, WA 98421 
Tel:l(b )(6); lax: 
Patient: AMAR, MERGENSANA 11/16/2018 
DOB: 10/23/1978 1 Sex: Male 
Address: 1623 E. J STREET, TACOMA, WA 98421 
Phone: 
Ordered Date: 09/07/2018 
Assessments: Starvation, subsequent encounter 
Lab: Magnesium, Serum - 001537 
Fasting: No 
Specimen: Collection Date: 09/07/2018 Time: 10:04 AM 
Clinical Info: 
Name Value Reference Range 
Please note 
Request Problem 
Request Problem 
Request Problem 
Magnesium 1.8 1.6-2.3 mg/dl 
Result: WNL 
Received Date: 09/11/2018 
Notes: 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 3492 
DHS-ICE-19-0196, 19-0197-O-000176

Northwest Detention Center !/b)/6): (b)/7)/C) fNP 1623 E. J STREET TACOMA, WA 98421 
Tell/h\/R\· I Fax: 
Patient: AMAR, MERGENSANA 11/16/2018 
DOB: 10/23/1978 1 Sex: Male 
Address: 1623 E. J STREET, TACOMA, WA 98421 
Phone: 
Ordered Date: 09/07/2018 
Assessments: Starvation, subsequent encounter 
Lab: Prealbumin - 016931 
Fasting: No 
Specimen: Collection Date: 09/07/2018 Time: 10:04 AM 
Clinical Info: 
Name Value Reference Range 
Specimen Status Report 
Please note 
Request Problem 
Request Problem 
Prealbumin 18 14·35 mg/dL 
Result: WNL 
Received Date: 09/11/2018 
Notes: 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 3493 
DHS-ICE-19-0196, 19-0197-O-000177

Northwest Detention Center kb)(6); (b)(7)(C) fNP 1623 E. J STREET TACOMA, WA 98421 
~(b)(6); (b)(7)(C) tax: 
Pat1en : ,..,.,,...,, 1 MERGENSANA 11/16/2018 
DOB: 10/23/1978 1 Sex: Male 
Address: 1623 E. J STREET, TACOMA, WA 98421 
Phone: 
Ordered Date: 09/07/2018 
Assessments: 
Lab: No Test Indicated 
Fasting: No 
Specimen: Collection Date: 09/07/2018 Time: 10:04 AM 
Clinical Info: 
Name Value Reference Range 
Comment 
Dear Doctor, Comment 
Result: will reschedule 
Received Date: 09/11/2018 
Notes: eclinicalworks, support 09/11/2018 06:08:01 : This order was created by the Interface. 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 3494 
DHS-ICE-19-0196, 19-0197-O-000178

Northwest Detention Center 
1623 E. J STREET TACOMA, WA 98421 
l(b)(6); (b)(7)(C) ~D 
Tell(b)(6); !Fax: 
Patient: 
DOB: 
Address: 
Phone: 
AMAR, MERGENSANA 
10/23/1978 1 Sex: Male 
1623 E. J STREET, TACOMA, WA 98421 
Ordered Date: 09/07/2018 
Assessments: 
Lab: 
Fasting: 
Urinalysis Dipstick 
No 
Specimen: Collection Date:09/07/2018 Time: Source:Spontaneous Urine Sample 
Clinical Info: 
Name Value Reference Range 
Leukocytes Neg 
Nitrate Neg 
Urobllinogen 0.2 
Protein Neg 
pH 6.5 
Blood Neg 
Specific Gravity 1.010 
Ketones 80 
Billirubin Small 
Glucose Neg 
Color Other 
Clarity Clear 
Result: Abnormal 
Received Date: 09/07/2018 
Notes: Malakhova MD1Sheri W 09/12/2018 11:59:55 > late entry 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 
11/16/2018 
3495 
DHS-ICE-19-0196, 19-0197-O-000179

Northwest Detention Center 11~/l~t~, I RN 
1623 E. J STREET TACOMA, WA 98421 
Tell(b)(6); I Fax: 
Patient: AMAR, MERGENSANA 11/16/2018 
DOB: 10/23/1978 1 Sex: Male 
Address: 1623 E. J STREET, TACOMA, WA 98421 
Phone: 
Ordered Date: 12/08/2017 
Assessments: 
Lab: PPD 
Fasting: No 
Specimen: Collection Date: 12/10/2017 Time: 
Clinical Info: 
Name Value Reference Range 
Facility where PPD was completed SLRDC 
Read Date 12/10/17 
lnduration 0mm 
Impression negative 
Result: Negative, nursing review 
Received Date: 12/10/2017 
Notes: 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 3496 
DHS-ICE-19-0196, 19-0197-O-000180

Northwest Detention Center 
16..,., e , ------ TACOMA, WA 98421 
Tefb)(6); (b)(7)(C) ~ax: 
~b)(6); (b)(7)(C) IMO 
Patient: AMAR, MERGENSANA 11/16/2018 
DOB: 10/23/1978 1 Sex: Male 
Address: 1623 E. J STREET, TACOMA, WA 98421 
Phone: 
Ordered Date: 09/13/2018 
Assessments: Starvation, subsequent encounter 
Lab: Electrocardiogram (EKG) 
Fasting: No 
Specimen: Collection Date: 09/13/2018 Time: 
Clinical Info: 
Name Value Reference Range 
Result: Normal 
Received Date: 09/14/2018 
Notes: 
Patient Name: AMAR, MERGENSANA, DOB: 10/23/1978 
2019-ICLl-00051 3497 
DHS-ICE-19-0196, 19-0197-O-000181

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamlento Medico 
1. This is IC cMify that I,. rvl«(i fY\ 4~11A'1 S?t,ft>._ a dctainco alien in tre custody of 1mmigrabo Md C~stoms 
E~forcement (ICEJ. have refused 10 consent to tl'e ~ollowing: 
[ I a) .nlake Screening 
ai Valorac.cn Medica 
);f, b) Medical Tr~almenl "tii) Tratamientc M~dico 
1. Con la pr&se1le cenir.co coo yo, ___________ _ 
extranjerola) deter'do:a) bajo custocia del Servicio de ln11i9rJc10n y 
Cont·o do A<!.mnas. (IC~. s glas en. lnglh), me Jie n9-gaco a recibi~ 
to sl~ u ie ~le: 
D c) ~~:cal Procedurc(sJ ~ d) Medication(,) 
c) Procedirr.iento:s) Mcdico(sl d) Medicamen1o(s) 
Soe:ity treat:nenl or medication been re'us(J1f_!Especif1Que e. tr~iam·ento o me1icamcnto rcct,a2~da: 
, .. :6,oa :'.f' ___________ _ 
2. The hc3 ith eatl::! prolfider wliO$.G sign.ature aipp~ars. bAfr,w h,u~ 
cxplaine<J me neccesity lor :M at:>Ove deserl~ed. I urderst3nd that 
r,e possible or probable consequences or ~Y refusal irclude: 
The p~q>01e or the medic;llior, will not be achieved: 111y c011ditioA 
1nay gel wor,;e. Tl,e m,•ric:1:i,1e1 rn•y be disccntin,1~d n11d I may have 
10 g<> w ,id call for ""l" :r,11r.eclia1~ mental health needs. 
3. In a 'argu,se that I understand, I rave been informed that re:usal 
c' this trealment o· procedure may jeopardize r.,y 1cJtth anc.rcr 
life, but it is, noncth!ll?..ss, my wish that my re'usal be honore:l. I 
Mereby release the U.S. Immigration and CuSlom Er.force:-neni 
(ICE:.1, and the Unite:J States of America from a~y liability that I 
might assert lor not providing tt.e tre.st,u,nt or ;,rocedure(s) 
c·esc·ited hcrn·o. I attest I hat I am over the age o: eigh:een 
years aM I am rren·.a1ty sompGtent to exee1.;1e this release. 
IT-~ u...$94 ~ "~'2""- ·- Si nature of Cl~1aineeiFirma cfe: Detenic'J 
(b)(6); (b)(?)(C) 
b)(6); (b)(?)(C) 
Signature of .CE O~iclal (If apllicable) 
·c.ast Narre: 
AMAR, MERGENSANA 
A#: 216269802 RUSSI 
DCA:,(U 1'1/ ;-;... DOB: 10/23119/8 
Facili\Y: NWDC Tacoma. Sex: male 
2. 61 oroveador de servicios de ~alud cuya firrr.a aosrece al fin~I n1r, h~ exp· cacrn la necesidad ere 11e1Jar acabo lo e1escri10 arriba. Ent cncto 
Que las posibles c probables consecuencias de rr; nega;iya inclJyen: 
El pro~6sitn de la rnedicir•a no lograra su ol,rjt: ,·o. por lo ,11:.I ·.11 
c:s.tadc cfe J.ahid ~c-driri cmp~~mr. El sumini::~rn i1..k 1~tcdicri11u..:11cos :--,.: 
ve:ia interrnmpi<lo y dchere dirigirme a( ";ick call", para obteucr I" 
ayudJ. relativa :'I ml salud m~nl~I. 
3. En un lenguajl;) que entie~c.~, se me na info,mado <;ue la negiltiv~ d<, 
este t,a:amiento o procedirr isnto pucde porer en peligro mi salud 
y/o mi vida, sin embargo, es r,i deseo o,ue mi r.egaliva sea cur1~'id'1 
Por el prasente me:lio libero a la oncina de lmr igraciOn y A:luana, 
~CF.), y lcs Estados Uni dos de A,ne,ic~ de cuatQuier respcnsabilidnd 
q~e pudieran teoer par no ~ -o~orc,cnar el 1,atamier,10 o 
pr~oodimiento(s) aqu i cescritos. Doy fe de que soy maynr oe 
die:;iocho a~cs y q"e me e~cuen1ro en plenas f~culla~es ment2!es 
para ejecutar esta respc~sabilidad. 
L(_Q_O OCT 2 6 2018 
(b)(6); (b)(?)(C) 
/Fecha 
,BSN 
Printed Signature/ irma :on letra de 'Tlprcrn;i 
(b)(6); (b)(?)(C) 
'---"T",.,.,.....,,..,. ........,_-----t Ira de 1mpren1a 
Printed Sigr,ature 
Firs: Name: ····--7 
Country o!Orig in: 
DOB: 
IHSC Form 620-S 0112011 Page 1 of 1 
2019-ICLl-00051 3498 
DHS-ICE-19-0196, 19-0197-O-000182

JCE Health Service Corps 
Refusal Form/F ormulario de Negativa a Recibir Tratamiento Medico 
1. This is to certify that I. M-eV1V60IY'lv1\ /urY10;v 
a detained alien in the custody Immigration and Customs 
Enforcement (ICE), have refused to consent to the following: 
0 a) Intake Screening 
a) Valoraci6n Medica 
M) Medical Treatment 
l7\i Tratamiento Medico 
2. ThA health care provider whose sionature appears below has 
explained tile nccceslly for the above cJescrtbe<l. 1 under~tano met 
possible or probable consequences of my refusal include; I I 
In a language that I understand, I have been informed that re al 
of this treatment or procedure may jeop!jrdize my health and/or 
life, but it is, nar.etheless, my wish that my refusal be honored. I 
hereby release the U.S. Immigration and Custom Enforcement 
(ICE), and the United States of America from any liability thal I 
might assert for not providing the treatment or procedure(s) .. 
described herein. I attest that I am over the age of eighteen 
years and I am mentally competent to axecute this release. 
1. Con la presente certifico que yo, ___________ _ 
extranjero(a) detenido(a) bajo custodia del Servidio de lnmigraci6n y 
Control de Aduanas (ICE, siglas en inglesJ. me he negado a recibir 
lo siguiente: 
0 c) Medical Procedure(s) D d) Medication(s} 
c) Procedimiento(s) Medico(s) d) Medicamento(s) 
2. El proveedor de servicios de salud cuya firma aparece al final me ha 
expllcado la ncconldad de llitvar a cullo 10 descrlto •rr1011. ~nttcn<.Jo 
que las posibles o probables consecuencias de mi negativa incfuyen: 
3. En un lenguaje que entiendo, so me ha lnformado que la negativa de 
este tratomiGntO o procsdImtento puede poner en peliQro mi ~alud 
y/o mi vlda, sin embargo, es mi deseo que mi negativa sea cumplida. 
Por el presente medic libero a la Oficina de lnmigracion y Aduanas 
(ICE), y tos Esta.dos Unidos de America de cualquler responsabilidad 
que pudieran tener par no proporcionar el tratamiento o 
procedimiento(s) aqut descritos. Doy fe de que soy mayor de 
dieciocho alios y que me encuentro en plenas facu!tadcs mentales 
para ejecutar esta responsabilidad. 
' 
,~=-:;:;:J \()OO V\OUVo \ I /11-(2-0\<tJ ' 
iJo~I Time/Hora Date/Fecha 
(b)(6); (b)(?)(C) 
de Salud 
Printed Signature/F'rrma con Letta de lmprenta 
Signature of ICE Official (II applic:al:lle) Printed Signature 
Last Name: AmOl✓ First Name: M 6¥~~{71 VJt/1 
A#: 2. \ L,, 2b°t · 602 Country of Origin: R (/l35 (CJt 
Date of Camp Arrival (DCA): \ 2/19/2011 DOB: \0/2~/lvi?'v 
Mecllcal Clinic: .N w DC-/T ~lJ._~ vJA Sex: 'VJ°' lv ✓~-
IHSC Form 820-S 01/2011 
. ,._. ' .... 
Pagf? 1 of 1 
2019-ICLl-00051 3499 
' 
.; 
I' 
I 
i 
,, 
! 
I 
DHS-ICE-19-0196, 19-0197-O-000183

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
i. This is to certify that 1,AMAR, MERGENSANA , 
a detained alien in the custody of Immigration and Customs 
Enforcement (ICE), have refused to consent to the following: 
D a) Intake Screening 
a) Valoracion Medica 
D b) Me<lical Treatment 
b) Tratamiento Medico 
1. Con la presente certifico que yo, AMAR. MERGENSANA 
extranjero(a) detenido(a) bajo custodia del Servicio de lnmigraci6n y 
Control de Aduanas (ICE, siglas en ingles), me he negado a recibir 
lo siguiente: 
[RI c) Medical Procedure(s) 
c) Procedimiento(s) M~dico(s) 
D d) Medication(s) 
d) Medicamenlo(s) 
Specify treatment or medication been refused: /Especifique el tratamiento o medicamento rechazado: 
DINNER 
State reason: /Explique la razan: 
REFUSED. 
2. The health care provider whose signature appears below has 
explained the neccesity for the above described. I understand that 
the possible or prob.ible consequences of my refusal include: 
Without vital signs basic medical monitoring cannot be done. 
Medical conditions cannot be monitored and new me<lical condtions 
could go undetected. 
3. In a language that I understand, I have been informed th.it refus.il 
of this treatment or procedure may jeopardize my health and/or 
life. but ii is, nonetheless, my wish that my refusal be honored. I 
hereby release the U.S. lmmigration and Custom Enforcement 
(ICE), and the United States of America from any liability that I 
might assert for not providing the treatment or procedure(s) 
described herein. I attest that I am over the age of eighteen 
years and I am mentally competent to execute this release. 
refused to sign 
Signature of Detainee/Firma del Detenido 
l(b)(6); (b)(?)(C) ~ {\ } 
7 .__ ___________ _ r￾Signature of ICE Official (If applicable) 
Last Name: 
AMAR 
A#: 
216269802 
Date of Camp Arrival (OCA): 
,
1
1L I 1a 71111-~ 
Medical Clinic: l '- "' I -
NWDC 
2. El proveedor de servicios de salud cuya firma aparece al final me ha 
explicado la necesidad de llevar a cabo lo descrito arriba. Entiendo 
que las posibles o probables consecuencias de mi negativa incluyen: 
VVithout vital signs basic medical monitoring cannot be done. 
Medical conditions cannot be monitored and new medical condtions 
could go undetected. 
3. En un lenguaje que entiendo, se me ha informado que la negativa de 
este tratamiento o procedimienlo puede poner en peligro mi salud 
y/o mi vida, sin embargo, es mi deseo que mi oegativa sea cumplida. 
Por el presente media libero a la Oficina de lnmigraci6n y Aduanas 
(ICE), y los Eslados Unidos de America de cualquier responsabilidad 
que pudieran tener par no proporcionar el tratamiento o 
procedimienlo(s) aqul descritos. Doy fe de que soy mayor de 
dieciocho arias y que me encuentro en plenas facultades mentales 
para ejecutar esta responsabilidad. 
First Name: 
MERGEN SANA 
Country of Origin: 
RUSSIA 
DOB: 
10/23/1978 
Sex: 
Male 
5:00:00 PM 
Time/Hora 
GEO Offic 
Printed Signature/Firm 
Printed Signature 
lmprenta 
IHSC Form 820-S 01/2011 Page 1 of 1 
2019-ICLl-00051 3500 
DHS-ICE-19-0196, 19-0197-O-000184

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
1. This is to certify that I, AMAR, MERGEN SANA , 
a detained alien in the custody of Immigration and Customs 
Enforcement {ICE), have refused lo consent to the following: 
0 a) Intake Screening 
a) Valoraci6n Medica 
~ b) Medical Treatment 
b) Tratamiento Medico 
1. Con la presente certifico que yo, AMAR, MERGENSANA 
extranjero(a) detenido(a) bajo custodia del Servicio de lnmigracion y 
Control de Aduanas (IC!::, siglas en ingles), me he negado a recibir 
lo siguiente: 
D c) Medical Procedure(s) 0 d) Medication(s) 
c) Procedimiento(s) Medico(s) d) Medicamento(s) 
Specify treatment or medication been refused: /Especifique el tratamiento o medicamenlo rechazado: 
VITAL SIGNS and WEIGHT 
State reason: /Explique la raz6n: 
ADAMANTLY REFUSED 
2. The health care provider whose signature appears below has 
explained the neccesity for the above described. I understand that 
the possible or probable consequences of my refusal include: 
The purpose of the treatment will not be achieved: my condition may 
get worse. 
3. In a language that ! understand, I have been informed that refusal 
of this treatment or procedure may jeopardize my health and/or 
life, but it is, nonetheless, my wish that my refusal be honored. I 
hereby release the U.S. Immigration and Custom Enforcement 
{ICE), and the United States of America from any liability that I 
might assert for not providing the treatment or procedure(s) 
described herein. I attest that I am over the age of eighteen 
years and r am mentally competent to execute this release. 
Signature of ICE Official (If applicable) 
Last Name: 
AMAR 
A#: 
216269802 
Date ~\Cami Arrival (OCA): 
l'L l.li. I+ 
Medical'=:lini 
NWDC 
2. El proveedorde servicios de salud cuya firma aparece al final me ha 
explicado la necesidad de llevar a cabo lo descrito arriba. Entiendo 
que las posibles o probables consecuencias de mi negativa incluyen; 
The purpose of the treatment will not be achieved; my condition may 
get worse. 
3. En un lenguaje que entiendo, se me ha informado que la negativa de 
este tratamiento o procedimiento puede poner en peligro mi salucl 
y/o mi vida, sin embargo, es mi deseo que mi negative sea cumplida. 
Por el presente media libero a la Oficina de lnmigraci6n y Aduanas 
(ICE), y los Estados Unidos de America de cualquier responsabilidad 
que pudieran tener por no proporcionar el tratamienlo o 
procedimiento(s) aquf descritos. Doy fe de que soy mayor de 
dieciocho arias y que me encuentro en plenas facultades mentales 
para ejecutar esta responsabilidad. 
First Name: 
MERGEN SANA 
Country of Origin: 
RUSSIA 
DOB: 
10/23/1978 
Sex: 
Male 
Printed 
8:00:00AM 
Time/Hora 
(b)(6); (b)(7)(C) 
Printed Signature 
de lmprenta 
IHSC Form 820-S 01/2011 Page 1 of 1 
2019-ICLl-00051 3501 
DHS-ICE-19-0196, 19-0197-O-000185

• ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
1. This is to certify that I, ArnrAxl 1'Y'~fJ/{{'-SOvn--O\ 
a detained alisn in the custody of lmmigratioand Customs 
Enforcement (ICE), have refused to consent to the following: 
D a) Intake Screening 
a) Valoraci6n Medlca 
tJs:ib) Medical Treatment 
~) Tratamiento Medico 
1. Con la presente certifico que yo, ___________ _ 
extranjero(a) detenido(a) bajo custodia del Servicio de lnmigraci6n y 
Control de Aduanas (ICE. slglas en Ingles), me he negado a recibir 
lo siguiente: 
D c) Medical Procedure(s) D d) Medication(s) 
c) Prccedimiento(s) Medico(s) d) Medicamcnto(s) 
~fy t~atment or medication been refused: /Especiftque el tratamiento o medicamento rechazado: 
74t/L- ~~<?'.h < ~-
2. Tha health <>Rr<> provider who ca fli('l,.,Ature 0pp<>::irs below h., ll 
explained the necoesity for the above described. I understand tnat 
· robable consequences of my refusal include: 
3. n a anguage that I understand, I have been informed that refusal 
of this treatment or procedure may jeopardize my health and/or 
•
;fe, but it is, nonetheless, my wish lhat my refusal be honored. I 
1ereby release the U.S. lmrnlgralion and Custom Enforcement 
(ICE), and the United States of America from any 5ability that I 
might assert for not providing the treatment or procedure(s) 
described herein. I attest that I am over the age of eighteen 
years and I am mentally competent to execute this release. 
gna ure r/ 
Firrna del Provcedor de Servicios de Salud 
r)(6); (b)(7)(C) 
Signature of Witness/~ Testigo 
Signature of ICE Official (If applicable) 
I Last N_ame: 
---- -- ----.,_ 
• 
AMAR. MERGENSANA 
A#: 216269802 RUSSI 
DC~: 11/[ i/(7 DOB: 10/23/1978 
Facihty: NWDC Tacoma. Sex: male 
I 
2. El provMdor de servicios de salud cuya flrma aoarece al finat me ha 
explicado la neceslda<J de llevar a cabo 10 de$CTlto arrlt:>11. Entiendo 
que las posibles o probables consecuencias de mi negativa incluyen: 
3. En un lenguaje que entiendo, se me ha informado que la negaliva de 
cste tratamiento o procedimienlo puede poner en petigro rr.i salud 
y/o mi vida, sin embargo, es mi deseo que mi negativa sea cumplida. 
Por el presente medio libero a la Oficina de lnmigraci6n y Aduanas 
(ICE), y los Estados Unidos de Am~rica de cualquier responsabilidad 
que pudieran tener porno proporcionar el tratamiento o 
procedimiento(:s) aqu[ descritos. Doy fe de que soy mayor de 
dieciocho arios y que me encuentro en plenas facultades mentales 
para ejecutar esta responsabifidad. 
0'6t.?0 OCT 2 0 2U18 
Time/Hora Date/Fecha 
r)(6); (b)(7)(C) 
Printed Signature/Firrna con Letra de lmprenla 
r)(6); (b)(7)(C) 
Printed Signature/Firma con Lelra de lmprenta 
Printed Signature 
First Name·. 
Country of Origin: 
DOB: 
' 
Sex: 
IHSC Form 820-S 01/2011 Page 1 of 1 
2019-ICLl-00051 3502 
DHS-ICE-19-0196, 19-0197-O-000186

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
1. This Is to certify that I, A (y\_(l,r) ~ ~ :JW)'\-0\ 1. Con la presente certifico que yo, __________ _ 
a detained alien in the custody of Immigration and Customs extranjero(a) detenldo(a) bajo custodia del Servicio de lnmigracicn y 
Enforcement (ICE), have refused to consent to the following: Control de Aduanas (ICE, siglos en ingl~~), me he negado a recibir 
D a) Intake Screening 
a) Vatoraci6n Medica 
{lgb) Medical Treatment 
l\t>l Tratamiento Medico 
lo siguiente: 
0 c) Medfcal Procedure(s) 
c) Procedimiento(s) Medico(s) 
Specify treatment OJ medication been refused: /Especifique el tratamiento o medicamento rechazado: v, ~ .![ fiYJ«i' ~ ~ ... U•~Jvt 
State reason: /Expliq~ t, / J- f 
"I st~ 
0 d) Medic,;tion(s} 
d) Medicamento(s) 
2. Tho heallh care provider who"" signoture appoa.r~ below h""s 2. E.I ~roveedor de servlcios de s::ilud cuya firma aparece al fin2I me ha 
explained the neccesity for the above described. I understand that expllcado la neceslaad de nevar a cat:10 10 do:scrlto arrlba. Entienoo 
the possible or probable consequences of my refusal include: que las posibles o probables consecuencias de ml negativa incluyen: 
h e..o r~ h' 19 t- l \ Vl ~b-ft .JMUA 1 ~t w t' fl l,W f- .ee ~.Med @ h.' ;,t_c..Q_ 
,eldJ-~ ,e~ ±e Ju..l-e, 
3. In a language that I understand, I have been informed that refusal 
of lhis treatment or procedure may jeopardize my health and/or 
•
1fe, but it Is, nonetheless, my wish lhat my refusal be honored. I 
,ereby release the U.S. !mmigralion and Custom Enforcement 
(ICE), and the United States of America from any liability that I 
might assert for not providing the treatment or procedure(s) 
3. En un lenguaje que entiendo, se me ha informado que la negativa de 
este tratamiento o procedimiento puede poner en peligro mi salud 
y/o mi vida, sin embargo, es mi deseo que mi negativa sea cumplida. 
Por el presente medic libero a la Oficina de lnmigraci6n y Aduanas 
(ICE), y los Estados Unidos de America de cualquier responsabilidad 
qus pudieran tener porno proporcionar el tratamiento o 
procedimiento(s) aquf descritos. Doy fe de que soy mayor de 
dieciocho anos y que me encuentro en plenas facultades mentales 
para ejecutar esta responsabilidad. 
described herein. I attest that I am over the age of eighteen 
years and I am mentally competent to execute this release. 
Signafu e or Detainee/Firms del tenido 
F'''• (DK7XCJ l 
Signature of Heal( Care Provider/ 
Firma dal Proveedor de Servicios de Salud 
(b)(6); (b)(7)(C) 
a del Testigo 
Signature of ICE Official (If applicable) 
Last Name: -· -- . ------ ... 
I-
• 
AMAR, MERGENSANA ... 
r A#: 216269802 RUSSI 
DCA: \')../1~/\7 DOB: 10/23/1978 
Facility: NWOC Tacoma. Sex: male 
I 
IHSC Form 820-S· 01/2011 
First Name: 
--
Country of Origin: 
008: 
Sex: 
Page 1 of 1 
2019-ICLl-00051 3503 
1ok-/lf 
Time/Hora Dete/Fecha 
(b )(6); (b )(7)(C) 
Printed Signature 
DHS-ICE-19-0196, 19-0197-O-000187

ICE Health Service Corps 
Oral Surgery Treatment Consent 
Procedure: ___ ___::::£::,:X---"~~-=-~/.:::..~"-....:...._---'/---'r _________________ _ 
Diagnosis Qayman'slem,s): __ '8=-t.;...o .... ~:.......;;;:....:_.!.......,1.,,._ ~"'""--'------------------------
Alternatives lo Surgery: /IJ {) h 
I tmderstand that if tf1is procedure is not performed my condition may worsen resulting in complications including but not limited to: 
1. Infection 2. Pain 3. Health complicatrons beyond the present problem. 
Possible complications which have been explained to me include but are not limited to: 
1. Pain 
2. Dry socket (alveo:itis) 
3. Infection 
4. Bleeding and bruising 
8. Maxillary sinus involvement/need for additional surgery 
Q. Nerve injury resulting in temporary or permanent numbness 
1 O. Bo riy fractures 
11. Temporomandibular jOint disorder 
5. Swelling 
6. Reaction to medications 
12. Decision to leave a small piece of tooth root in the jaw when its removal 
would require extensive surgery and increased risk of complications. 
7. Injury to adjacent teeth or tissue 
I have had the opportunity to disctJss and lo ask questions about my surgery with _..._<....:..('_ ... __ -'I 
I verbally consent to the surgery as described. The ri,KS and benefits have been explained to me in a 
b)(6); (b)(7)(C) 
guarantees have been made lo me concerning the resulls of the operation or procedure. The need fo""',...,,""",.,.,.,.,.,"""'~1.Jr.fe ,s 1 
due to a pre-existing dental conditjon and therefore Immigration and Customs Enforcement (ICE) and IHSC will not be held liable 
for the outcome of lt1is procedure. Additionally, I understand that any teeth removed will not be replaced. 
DS,USPHS llltJtflt< __ 
b)(6); 
...!:z:=====i:c:===========~ 
(b)(?)(C) 
~ j/ / /z.. 
'-r------ro......,em"'b""ern"'""'cfmo""pc"'rat,.,.in_g_1e_am_) _______ ___.RDH / f ~ 
)(C) 9 ·,0:) foy 
Time 
'j .'od)-
Time 
Last Name: ,,vlo._J- First Name: 
Ml: Nationality: 
Date of Arrival: /2 9 /7 DOB: 
Facilily: Sex: 
Male 
IHSC Form 903 0712012 2019-ICL~l:lOO~stf 3504 
DHS-ICE-19-0196, 19-0197-O-000188

ICE Health Service Corps 
Dental Medical History 
I. Se~ect th ppropriate answer11eaw lllank ,f~ou do not understand the -.uest1on): 
Yes No 
1 ~ your general health geod? 
2. D Are you currently taking me<Jications? Whal? ________________________ _ 
3. 0 !'.:'.:j / Have you ever been hospitalized or had a serious illness in the last two years? Why? ____________ _ 
4. D 12/"Have you been under the care of a physician in the last two years? Explain: ______________ _ 
5. 0 flZf /Are ycu allergic lo or have you had a reaction lo any medication, drug, or latex? Whal? 
6. D Have you had any serious reaction lo dental trealment? Explain: __________________ _ 
7. D Are you taking or have you ever taken medications for weak bones (osteoporosis) such as Fosamax. Actonel, Boniva, Skelld, 
"'-' ,/Didronel? 
8. D 0 Have you over been treated with intravenous blsphosphonali,s for bone pain, multiple myeloma, or cancer 
(using medlcaUons such as Aredla, Z<lmela, Bor,efos)? 
II. Do you have or have you ever had: 
Yes 
~ Yes 
9. □ Chest pain or shortness of breath 24. □ ~ ~tomach ulcer 
10. □ ~Sw<Jllen ankles 25. D ~epatitis, or olher liver diseaso 
11. D ~eart disease or heart surgery 26. □ iabetes · 
12. □ eartattacir. 27. □ ~AIDS or HIV infec~on 
13. □ f Congenital heart defect 28. □ ~umor, caneer 14, □ Heart murmur or mitral valve prolapse 29. □ ~Radiation treatment 
15, □ ~Sb'oke 30. □ Chemotherapy 
15. □ High blood pressure 31. □ 0": Rheumatic fever 
17. □ ~ Artificial heart valve 32. □ i Anemia or other blood problems 
18, □ Damaged heart valve 33, □ ~leeding disorder or hemophilia 
19. □ ~Heart pacemaker 34. □ nyroid problem 
20, D Asthma 35, □ Arthritis 
21. □ ~uberculosis (TB) 36. □ ~•""' ~ .,;we ,;oo..., 22. □ ~Emphysema 37. □ sychialric treatment 
23. □ Artmcial joint (hip, knee, elbow, fing8f) 38. □ Systematic lupui erythematosus when? 
Ill. Wo~. ~"'" To,•;M ' 39. D Yes L..J N~ could you be pregnant or nur.;ing? 40. L..J • e_ ~ b:rth control !)ills 
IV. All Patients: / 
41. D Yes [J'No Do you have or have you had any other diseases or medical problems NOT Osted on this form? 
II so, please e~plain: -----;---;-"7---==::::::;:=======:::::;---------7--;-
~ (b)(6); (b)(/)(C) i,'42 £ 
DDS, USPHS 
P.atient/Gisardiari.Sig,Jat(l[~ 
Last Name: First Name: 
A#: Nationality: 
Date of Arrival: DOB: 
Facilily: 
NWOC 
IHSC Form 905• 07/2012 2019-ICEf1'5d~i 3505 
DHS-ICE-19-0196, 19-0197-O-000189

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
1. This is to certify that l, J\.\'V\o.,, '( I fu 2 v(/},Q. V\. C-.;,1,., ~ 1. Con la presente certifico que yo. ___________ _ 
a detained alien in the custody of Immigration and Customs extranjero(a) detenido(a) bajo custodia del Servicio de lnmigraci6n y 
Enforcement (ICE), have refused to consent lo the following: Control de Aduanas (ICE, slglas en Ingles), me he negado a recibir 
lo siguiente: 
D a) Intake Screening 
a) Valoraci6n Medlca 
0 b) Medical Treatment 
b) Tratamlento Medico 
lS! c) Medical Procedure(s) 
c) Procedimiento(s) Medico(s) 
D d) Medication(s) 
d) Medicamcnto(s) 
Specify treatment or medication been refused: /Especifique el lratamiento o medicamento rechazado: 
j&,e_\Lb \I,~\ lo'~ 
~ ~i tt> ~ k.'ltno 
Sta~te r son: /Explique la raz6n: 
}vi) ~ D 
2. The h<>alth c<>r"' provider whosa sir,inatur" appesrA bolow has 
explained the neccesity for the above described. I understand !hat 
the possible or probable consequences of my refusal include: 
;~::h:~~7;tt·~ 111, 
3. In a language that I understand, I have been informed that refusal 
of this treatment or procedure may jeopardize my health and/or 
life, but it Is, nonetheless, my wish that my refusal ba honored. I 
hereby release the U.S. Immigration and Custom Enforcement 
(ICE), and the United States of America from any liability that I 
might assert for not providing the treatment or procedure(s) 
described herein. I attest that I am over the age of eighteen 
years and I am mentally competent to execute this release. 
Signature of Detainee/Firma del Detenido 
b)(6); (b)(?)(C) 
Signature of ICE Official (If applicable) 
Last Name: - ----- ---- f--
A 
...... AMAR,MERGENSANA 
D A#: 216269802 RUSSI OCJ\·. 1~.1,q;11 DOB: 10/23/1978 
- Facility: NWOC Tacoma. Sex: male w. 
2. ti praveedor dP. servicios de salud cuya firma ::ip:mice al final me ha 
explicado 1a neceslc:lad de llevar a cabo lo de:icrno e.rrlba. Entienc:,o 
que las posibles o probables consecuencias de mi negativa incluyen: 
3. En un lenguaje que entiendo, se me ha informado que la negativa de 
esle tratamiento o procedimiento puede poner en peligro mi salud 
y/o mi vida, sin embargo, es mi deseo quo mi negativa sea cump!ida. 
Por el presente medio libero a la Oficina de lnmlgraci6n y Aduanas 
(ICE), y las Eslados Urudos de Am~rica de cualquier responsabilidad 
que pudieran tener porno proporclonar el tratamiento o 
procedimienlo(s) aqul descritos. Doy fe de que soy mayor de 
dieciocho anos y que me encuentro en plenas facultades mentales 
para ejecutar esta responsabilidad. 
Time/Hora 
Letra de lmprenta 
b)(6); (b)(?)(C) 
Printed Signature 
First Name: 
Country of Origin: 
DOB: 
Sex: 
IHSC Form 820-S 01/2011 Page 1 cf 1 
2019-ICLl-00051 3506 
DHS-ICE-19-0196, 19-0197-O-000190

. Alna v''; . /J1-e,-1-c; ~ Fl 5 ct ;-1'C,L_ 
Northwest' Detention Center · Adrt1inistrative Deten ti.on Order 
Restrictive.· ,.. 
From,: i_ 'fjtlc: I. T 
srgna ureo 
Medical notified: Yes . _c/,. No 
TI1c:ahove named individual is to be ndmittcd to Adminislrativc Detention for th~ following rcason(s}: 
___ _,,A) Is pending an investigation/hearing rule violation and reqires pm-hearing detention to 
prdtect the security and orderly operation of the facility, 
___ __,-B) Is under medical obsei:vation (medical staff must i:ommentand sign this order). 
Medical Officer (Signature); -----------
__ ....---_(C) Is pending a transfer or release. withii1 24 hours. 
Is terrninat:ing confinement in Di$cjpliJ).::i.ryDetention and has beeu ordered in Administrative 
--.--1-D) Detention by the Institution Disciplinary Panel (IDP). 
____ (E) Is a security risk to him/herself or the security of the facility. 
·,( (F) Detainee has requested ad'missionforProtective Custody. 
I hereby request placement in the. Restrictive Housing Unit for my own protection. 
I do [ l do not l ~uest a hearing concerning my detention. · 
I /;~, "l!:::J l,-
Deta .. lflee·" ,. ·o·ate· '. .. V • \ I· . ) ·r..,:· ,., -·· :,-·: .. ,; .. _, ~,, - ... ,,.. (Sig_nature) 
Details (as necessary): . . 
, . 
. . ···\ ""-.. l ½"'· ~....-\ ..,_ 
b)(6); 
Copy delivered to detainee by (Signature b)(?)(C) 
Detainee relem.ed to: Date: Time ----- ----
Origimrl: Detainee: File -White 
CC Ad~nini.stmtivc File · Yellow 
Detainee ~ Pink 
rHSC-Gold 
.ICE.-Blue 
Ad.mini &li.1th•c. Detem:i,:m Order DJS002 
2019-ICLl-00051 3507 
Authorized by: ________ _ 
042617 
DHS-ICE-19-0196, 19-0197-O-000191

i' 
DEPARTMl;NT OF HOMELAND SECURITY 
ICE Health Service Corps 
SUICIDE OBSERVATION CHECKLIST" 
Date: lO ... % .., ic/ Code and Initial Each Period 
0000-0345 0400-0745 OB00-1145 1200-1545 1600-1945 2000-2:345 
0000 0400 0800 1200 1600 2000 <i? !S~ 
0015 0415 0815 1215 1615 2015 ~-..,5"~ 
0030 0430 0830 1230 1630 2030~ •lfJ2Q 
0045 0445 0845 1245 1645 204~16~ I 
0100 . _0500 0900 1300 1700 2100 w~"i{!~ 
0-115 0515 0915 1315 1715 2115 'B/~ 
0130 ·0530 0930 1330 . 1730 2130 'l)l~ 
Code Explanations 
Location 
2 
3 
4 
1. Assigned Activity 
Bathroom/Shower 
Dayroom/Dining Room 
Hallway 
5. Missing • Start Investigation 
s Off Ward 
7 Recreation 
8 Sleeping Area/Bed 
9 
1 0. 
Behayior 
1 1. Ate MeaL'Snack 
1 2. Cooperative 
1 3. Initiates Communication 
0145 05'15 0945 1345 1745 . 2145 3/.s. (1) LI 1 4. Responds toRequesls/Commands 
" 
0200 0600 1000 1400 - 1800 2200 i 151 
0615 1815J.:.1 ~ ~15-ff fj3r). . 0215.._ . ·-·. 1.015 --- -- -1415 . - ... , 
0230 0630 1030 1430 1830 i,/1~ 2230 ~ 'G&J 
0245 0645 1045 1445 1845~/ ,~ 2245 "511S:-ffi 
0300 0700 .. 1100 1500 1900 ~/ fiti}t 2300 ~I 1st£ 
· 03j5.._ "0715 1115 .· 1515 1915'°6/ NJ 1l, 23"15 <3° /b® 
0330 ·0730 1130 - 1530 . rn3o ¾~r 2330 ~(!_JG: 
0345- 0745 1145 -1545 1945 j/~ ~2345 ras .S"G. .. 
NOTE: '"'An B.N. Progress Note Reguired a-Shift** 
Initials <:l ,_ ,ature/Title Initials 
b)(6); (b)(7)(C) (b)(6); (b)(?)(C) b)(6); no b)(?)(C) ~ 
~ 
... 'f2/h 
Last Name: -A-"11\A- \2-..-: First Name: 
µty￾1 5. Sleeping 
1 6. Walking 
D 1 7. Appears Angry/Upset 
1 S. Appears to Halluclnate!Talking to Self 
~ ·9. Asks for Harmful Object 
~ 
~ 
20. Crying 
21. Non-Communicative 
22. Not Eating 
2 3. Not Sleeping 
2 4. Self-lnflictecflnjury 
2 5. Uncooperative 
26. &+~~ 
StaChanoe . 
27. S.O. Initiated. See medical 
pro~ress notes. 
28. Placed in Restraints (refer to q 15 
Restraint Checklist) 
29. S.O. Discontinued (per Unil Chief 
and Medical Provider orders) 
30. -----------
Sianatureffitle 
P/0~ 
~ 
Nationality: Russ I~ 
Date of Arrival:= \e 71 Q;(D .- !Et- DOB: 
Facility: l{t)~W~ Sex: 
IHSC"Form 835 (8/15) Page 1 of 1 
2019-ICLl-00051 3508 
DHS-ICE-19-0196, 19-0197-O-000192

f 
..:j 
DEPARTMENT OF HOME~ND SECURl1Y 
ICE Health Service Corps 
SUICIDE OBSERVATION CHECKLIST 
Date: ,~' D .... J.-1--) ~ Code and Initial Each Period 
0000:03;5 · · 0400-0745 0800-1145 I 1200-1545 1600-1945 2000-2345 
0000 ~! b)(6); DD ri~ (b)(6) oaooYft~ b)(6); 20□ 1600 2000 
~ b)(7)(C) ,~"I 0815~. 
b)(7)(C 
0015 5 .rl'i (b)(7) II 215 1615 2015 
0030~ 1• Drt)/is 
(C) 
083□~. 230 1630 2030 
0045 '6/f.} 159/1.r 0845."D/,◄ 245 1645 2045 
I 
0100 'It. b)(6); P500~ts; b)(6); 0900 "1{ I , (b )(6) 300 1700 2100 b)(7)( b)(7)( 
0115 8'/4 µ) p515 PJ, ~) 0915 if,..; (b)(7) 315- · 1715 2115 
0130 8# bs3o 8'/"- (C) 
0930~5" ~ 330 1730 2130 
0145 ft b54S ~, II p94s.3,{~ 345 1745- 21.45 
7 7 -
0200 ~~ (b)(6); 600~ (b)(6) ;~ooog,(~ 1400 1800 2200 (b)(7)( (b)(7) 
021sf~ C) ., 6) 
615~( (C) ~015 t..'.:..... 1415 1815 2215 
D23 f",l: 630~ 11:{ M03o 1430 1830 2230 
02453/0 645~ r'/if ~045 1445 1845 2245 
-
. 030 t(~ (b)(6); 1700~/( b)(6 1100 . 1500- ·moo . 2300 (b)(7)( n· 
03.1SS'/,it. C) 1715F15 b)(7 11t5 1515 1915 2315 (C) 
o330YJi 1>3opf; 1-130 1530 1930 • 233U 
0345 ~l 11-4~ - . I~ 1145 J545 ·1945 2345 
~ 
NOTE: ~ R.N;. Progi:e_~s_t,lote Required a-Shift .. 
b)(6); (b)(7)(C) 
Initials 
b)(6); (b)(7)(C) 
Last Name: 
AIV1A l 
Firs! Name: 
Nationality: 
Facility: Al.w.o.c 
Code Explanations 
Lo_~ation 
1. Assigned Activity 
2. Bathroom/Shower 
3. Dayroom/Dining Room 
4. Hallway 
5. Missing - Sfart Investigation 
6. OffWard 
7. Recreation 
8. Sleeping Area/Bed 
9. 
10. ----------- Behavior 
11. Ate Meal/Snack 
12. Cooperative 
13. Initiates Communication 
14. Responds.to Requests/Commands 
15. Sleeping 
·1s. Walking 
17. Appears Angry/Upset 
18. Appears to Ha!lucinate/Talking to Self 
19. Asks for Harmful Object 
20. Crying 
21. Non-Communicative 
22. Not Ealing 
23. Not Sleeping 
24. 5elf-lnnicted Injury 
25. Uncooperative 
26. 
Status C!iarJ~ 
27. S.O. Initiated. See medical 
progress notes . 
28. Placed in Restraints (refer to q 15 
Restraint Ctiecklfst) 
29. S.O. Discontinued (per Unit Chief 
and Medical Provider orders) 
30. -----------
SignaturerTitle 
IHSC Form B35 (8/15) Page 1 of 1 
2019-ICLl-00051 3509 
DHS-ICE-19-0196, 19-0197-O-000193

I 
ICE Health Service Corps 
Refusal Form(Formularid de Negativa a Recibir Tratamiento Medico 
1. Tt·,s is to certify lllal i, &c:tr I med~ . a cetained ahc~ in tha custadyol(mmigrali~ a~!l....Customs￾Entorcerr.ent (ICE). have ,erused to con,;.e~1 ·to ·111c fo wing 
D a) Intake Screening , £.) Medical ea~.ent 
a) Valoracicn MMica b) Trat 100:0 Medico 
, . Cc.~ la p;e;ente certifico que yo, __________ _ 
e~tranJero(a) dctenido(a) !lajo custodia del Seniic·o de lnmigrac,6n y 
Control de Aduanas (ICE. 1iglas en ingre,1, me he nega~o · 
lo siguiente: . >\_'!-G jr, .o']'l b)(6); 
0 c) Medical Prccedure(s) l _:j(dl Medi b)(?)(C) 
c) Proccdim1ento(s) Medica(s) di Medicamento(sl 
Specify tre;t}nt or mtlcat:on been refused: /Especifique el ua1amiento o medicame~to rechaza~o: 
\~JJ u J 
State reasM: IExpliQue lvn: 
C\•rdo 
2. The t.ealth care provider w~ose signature appears beJow tias 
ex~la,ned the ~eccesily for the above described. I undc rstand that 
the possible or probatle consequences cf my refusal ir.clude: 
Tl,~ purpose of t~e n1cdica1ion will 1101 be achieved; my condition 
n•~y JICC worse. The modicntion may be di,coniinucd nnd I oiny have 
to go to sick call for any i11:media1~ mental health needs. 
3. In a lar.guai;e tha'. I understand, I have been informed that 1efusal 
o'. this treatment or proce(lure may jco~ardize my heal_th a:idlcr 
lite, bul .tis, nonel21eless. my wish lhat my refusal be ho~ored. I 
hereby release u·,e U.S. Immigration and Custom Enfarce,nent 
(ICE). and the United States of America from any ('ab:lity that I 
might assert fer noi' oroviding Ille treatment or procedure(s) 
descrited herein. I attesl tnat I am over the age of eighteen 
years and I am rrentally oo:npetent to execuie tnis release. 
S~natureofl:fetamee/Firma del Detenido 
(b)(6); (b)(7)(C) 
~--------=-"' Provide:/ 
Fi1m.:l del Prrn,eedor c Serv cios de Satud 
(b)(6); (b)(7)(C) 
s,gnature ofWitnessii'irma del estigo 
Signalu1e of ICE Official (,f app:icabteJ 
Las: N<lrne·· 
A#: 
Dale of Car. 
Meo'cat Clin 
2. El proveedor oe servicios de sa1ud OJ ya fim,a aparece al final me ha 
exi;licado la necesidad de l'evar a cabo lo descritc arriba. Entiendo 
que l<l5 posiblcs o probables cansecuencias de mi negativa lnc1•Jyen· 
El proposito de la mcdicina no lograra su ob,·j!ivo, per le ct1nl ~•i 
estnrio de .,alud pod,fa empeorar. cl suministro dt mcdicnmentos sc 
wria in1errumpido y dober~ dirigim,e al "sick call". para oblener la 
ayuda relativo • mi salud mental. 
3. En un lenguaje que e11tiendo, se me ha informado que la negativa de 
esle lr.itamiento o procec:miento pucdc poner en pe::gro mi salud 
ylo mi vida, sin embacgo, es mi deseo que rni nega:iva sea cumplida 
Por el presente medic libero a la Of:cina de lnmigraci6n y Adu an as 
(ICE'), y tos Eslados Unidos de Ame~ca de CJ.s'qc'er responsDbi1iC'ad 
que pudieran 1ener :,or no propcrcionar el tr.:itamie~to c 
procedimienlo(s) aqui descrilos. Doy le de que soy r;,tyor ce 
'1ieciocho altos y que me encuentro en ple~as iact.,tades orer,tales 
para eje c~ tar e sta response bilid ad. 
7J00 
rb)(6); (b)(7)(C) 
IfmelH?ca 
Printed Signature1Fir.11a con Letra ce lmp1c11t~ 
(b)(6); (b)(7)(C) 
...,_, __ ..,. ____ --l'1 Letra ce lmprenta 
Printed Sig na :ure 
,try al Ortgin: 
IHSC Form 820-S 0112011 Page 1 ol 1 
2919-ICLl-00051 3510 
DHS-ICE-19-0196, 19-0197-O-000194

ICE ~ealth Service Corps 
Refusal Form/Formularlo de Negativa a Recibir Tratamiento Medico 
1 . This is 1000Myt~a1 I AYl'ltrrj Mvrc,€,t) 5~ 1. Conlapresentecertificoqueyo,_...,.. _________ _ 
a detair,~ alien in 1~c custody of lmmigr&iona~d Customs c~tranjer (•I deten do(a) ~ajo custodia del Servicio ~e lnrnigr;ict6n y 
Enforcement (fCEI, Mve re/used to CQi>sent to Ille owing: Contrd de Ad~snas (ICo, ,;grasen lngl~s). me he neoacio a recibir /4 · le siguien1e: '!fa\\'@ 
0 a) Intake Screening enl D cl Medlcal PrQc;edure(sJ ,~ f8J ¢ edication(s) 
a) ValoraciO~ M~dica b) Tratam:ento Mico c) ?rccedlnciento:s) .\iledico(s) d) Medicamenlo(s: 
I 
Specify treatment or medication been rel~s,E· E .ci~q~e el trataO'. iento o medicamentc recrazado· 
rt1L(l.,stn= &-\..,J_._,.\hlo_..__,,,c.=...,.__ _______________________ _ 
State reasc,: /E,plique la ra~~l 2}:: I \\ J_, _______ ))~ iYIQ R 2.Q;l."''§, Nl\J-.15{ 
2. The hea:th aaro provlcor ....,.r.ose signa.ture gippe;irs ~G!~O'N r.as 
explained the ncocesity foe the above descriOed. I understanCI that 
the pc;ssib:e or probable consequences of my refusal lr.clude· I 
Tile pur?OSe oflhc m(dicatiun will 1101 ~• achieved; my conditio~ 
may gc•. worse. The medication inuy be Jiscon1im1ed ,11\d I,nny have 
10 QO to sick call for am· im 111e~iate mental health needk. . . I 
3. In a language lhat I understand. I have been inlormed, th.II rotusaf 
of tll:s lmatment o, procedu,e may jeopardize my heallh and/er 
life, but i! is, nonetheless, my wish that my refusal be hol\Ored. I 
hereby release the U.S. Immigration and Cuslom Enforce,nent 
(ICE). anc the United States of America from any !:ability that I 
m'g~.t t'ssert for nol providin£ the tieatmer.t or procea~ro(s) 
described here:.,. I attest lhat I am over the age of eighteen 
years and I am mentally competent to execute this release. 
Sinilu?c~eiainee/Firma 
~ del Detenido 
b)(6); (b)(?)(C) 
I 
Sil; 11a ture of W. tnessl 
Signature of ICE Official (II applicable) 
Last NaO'.,a: 
A#: 
Dale ot Camp 
Med'cal Cl,nle: 
AMAR, MERGENSANA I 
A#: 216269B0;! iwssr 
DCA: IZ/ /'I / ltDOB: 10/23/1976 
F'acrl1ty: NWOC Tacoma. Se><: male 
2. El provccdor de servicios de salud euya firm a aparece al fina; me h~ 
cxpllc.Jdo la n1;re~idad de llravar a cal:lo 10 C:e-!C~lo arriba. Ent;endo 
que las ~osibles o probables consccuenc·Js de mi negativa incluyen: 
El p<\lposito de la ,ne<licio:a no logrnrio su obc,i•i v11. 1:or lo cual rni 
estada de ,nlu d pcdria ernpe~rar. F,I s,uniniilro cie med icanic:>10, s-, 
vcria inlerrumpidu y ,'.u\ier& diriginne al "sic~ call", para ohtcn~r la 
ayud<1 rclntiva c1 111 L sal~1d mental. 
3. En~~ lenguajc que entienc!o, se me ha informado que la negativa de 
es\e lratamiento o procedim'ento puede poner en ;ie:·gro mi satui 
y/o ml vida, ~in embargo, cs mi desec que mi negativa sea cumpi:da 
Por el presente medio lite,o a la Oficina de lnmigracion y Adu an as 
(ICE}, y los Estados Unidos de Am6rjca de cualquier respansa-~ilidad 
que pudieran tener oor no prcporcionar el tratam,ento o 
procedimien1o(sl aqui descrilos. Doy fe de qce soy m~,yo, oe 
dieciocno Mos y que me encuentro en plenas tacultades mentales 
parn ejec~tar esta responsabilidad, 
-· Printed Signature/Fiima con Letra de lmprerta 
(b)(6); (b)(7)(C) 
L--r,:m,,"""'rntJ""'""""'"'=,-'con Lelia de lrr,preniii 
Printed Signa1ure 
First Na.11e: 
,of Oligin: 
IHSC Fosm 620-S 0112011 I F"age 1 of 1 
2dl19-ICLl-00051 3511 
DHS-ICE-19-0196, 19-0197-O-000195

ICE Health Service Gorps 
Refusal Form/Formulario de Negativa a ~ecibir Tratamiento Medico 
1. This is to certify that I, A. (YI[).., r J V\ S0, V\. G\ 1. Con la presente certifico que yo, 
a detained alien in the custody or Immigration d Customs extranjero(a) delenido(a) bajo cus_l_o"""di,---a_d_e,---1 s-=-e-rv-:-ic.,...io_d.,..e_l_nm-ig_ra_c-io-· n-y 
Enforcement (ICE), have refused ta consent to the following: Control de Aduanas (ICE, siglas en ingles), me he negado a recibir 
0 a) Intake Screening 0 b) Medical Treatment 
a) Valoracion Medica b) Tratamiento Medico 
lo siguiente: 
B?f c) Medical Procedure(s) 
c) Procedim!ento(s) Medico(s) 
0 d) Medication(~) 
d) Medicamento(s) 
Specify treatment or rl)edication been refused: /Esp1cifique el tratami~nto o medicamento rechazado: 
vJ--t ft. U . 5 i::vt · o 8 !-SZJ 
State reason: /Explique !:6~~ 1,./ J f I 
JI {"e..,~ .¥~1-td 
2. The he:ilth care oroviderwhose sionature appears below has 
explatneo !he necceslty ror tne c1bove oescrlbed. l uncierstano lhat 
the possible or probable consequences of my refusal~lude: 
w' r ,~ /'k.-0 /LM ~ ~ 
3. In a language that I undersland. I have been infonned that refusal 
of this treatment or procedure may jeopardize my health and/or 
life, but it is. nonetheless, my wish that my refusal be llanored. I 
hereby release the U.S. Immigration end Custom Enforcement 
(ICE), and (he United States of America from any liability that I 
might assert for not providing the treatment or pro~dure{s) 
described herein. l attest that lam over the age of oighteen 
years and I am mentally competent to execute this release. 
Signature of Health are Provider/ 
Fin-na del Proveedor de Servicios de Salud 
(b )(6); (b )(7)(C) 
Signature o 
Signature of ICE Official (If applicable) 
2. El proveedor de servictos de salUd cuya firma aparece al final me 11a 
eK.pllceao la ncc.,slai>Cl Cl"' l\evor a caoo 10 de:;crllo arriba. E.nllcndo 
que las posibles o probables consecuencias de mi negaliva incluyen: 
CD 
3. En un lenguaje que entiendo, se me ha informado quo la negativa de 
este tratamlento o proceaImIento puede poner en pellgro mi salud 
y/o mi vida, :iln embargo, cs mi deseo que mi negativa sea cumplida. 
Por el presente meclio libero a la Oficina de lnmigraci6n y Aduanas 
(ICE), y los Estsdos Unlc:tos de America da cualquler responsabi:idad 
que pudieran tener porno proporcionar el tratamiento o 
procedimiento(s) aqul descritos. Doy fe de que soy mayor de 
dieciocho al'ios y que me encuemtro en plenas facultades menta!es 
para ejccutar esta responsabilidad. 
Time/Hora 
10/u/(f 
Dat~/Fecfia 
(b )(6); (b )(7)(C) 
(b )(6); (b )(7)(C) 
letra de \mprenta 
Printed Signature 
Last NcJme: __ - ---- - --- - - - _! First Name: 
A#: AMAR,MERGENSANA 
- A#: 216269802 RUSSI 
Daleo; DCA: t'J-./\ °l/\ 1 DOB: 10/23/1978 
Facility: NWOC Tacoma. Sex: male 
Medic<! 
, 
IHSC Form 820-S 01/2011 
Country of Origin: 
DOB: 
Sex: 
I -
Pag~ 1 of 1 
2019-ICLl-00051 3512 
~'4 
i 
-I 
I 
l 
l 
l 
' I 
I 
DHS-ICE-19-0196, 19-0197-O-000196

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
1. This is to certify that 1,AMAR. MERGENSANA , 
a detained alien in lhe custody of Immigration and Customs 
Enforcement (ICE), have refused to consent to the following: 
D a} Intake Screening 
a) Valoracion Medica 
D b) Medical Treatment 
bl Tratamiento Medico 
1. Con la presenle certifico que yo,AMAR. MERGENSANA 
extranjero(a) detenido(a) bajo custodia del Servicio de lnmigraci6n y 
Control de Aduanas (ICE, siglas en ingles), me he negado a recibir 
lo siguiente: 
IZ) c) Medical Procedure(s) 0 d) Medication(s) 
c) Procedimiento(s) Medico(s) d) Medicamento(s) 
Specify treatment or medication been refused: /Especifique el tratamiento o medicament□ rechazado: 
WEIGHT AND VITAL SIGNS 
State reason: /Explique la raz6n: 
ADAMANTLY REFUSED. 
2. The health care provider whose signature appears below has 
explained the neccesity for the above described. I understand that 
the possible or probable consequences of my refusal include: 
1/Vithout vital signs basic medical monitoring cannot be done. 
Medical conditions cannot be monitored and new medical condlions 
could go undetected. 
3. In a language that I understand, J have been informed that refusal 
of this treatment or procedure may jeopardize my health and/or 
life, but it is, nonetheless, my wish that my refusal be honored. I 
hereby release the U.S. Immigration and Custom Enforcement 
(ICE), and the United States of America from any liability that I 
might assert for not providing the treatment or procedure(s) 
described herein. J attest that I am over the age of eighteen 
years and I am mentally competent lo execute this release. 
5-tL ~ 
b)(6); 
Si 
(b)(7)(C) 
&~@.~n~f~ d~'betenido ~ 
Signature of Wttne stigo 
Signature of ICE Official (Ir applicable) 
Last Name: 
AMAR 
A#: 
216269802 
Date of Camp Arriv/ ;c7( A' /0...{) 1-+' 
Medical Clinic: I , 
NWDC 
2. El proveedor de servicios de salud cuya firma aparece al final me ha 
explicado la necesidad de llevar a cabo lo descrito arriba. Entiendo 
que las posibles o probables consecuencias de mi negaliva incluyen: 
Without vital signs basic medical monitoring cannot be done. 
Medical conditions cannot be monitored and new medical condlions 
could go undetected. 
3. En un lenguaje que entiendo, se me ha informado que la negativa de 
este tratamiento o procedimiento puede poner en peligro mi salud 
y/o mi vida, sin embargo, es mi deseo que mi negativa sea cumplida. 
Por el presente media libero a la Oficina de lnmigraci6n y Aduanas 
(ICE), y los Estados Unidos de America de cualquier responsabilidad 
que pudieran tener par no proporcionar el tratamiento o 
procedimienlo(s) aqui descritos. Doy fe de que soy mayor de 
dieciocho anos y que me encuentro en plenas facultades mentales 
para ejecutar esta responsabilidad. 
First Name: 
MERGENSANA 
Country of Origin: 
RUSSIA 
DOB; 
10/23/1978 
Sex: 
Male 
9:00:00 PM 
Time/Hora 
l(b)(6); (b)(7)(C) 
Printed Signature 
' 
IHSC Form 820-S 01/2011 Page 1 of 1 
2019-ICLl-00051 3513 
DHS-ICE-19-0196, 19-0197-O-000197

MEMORANDUM 
Date: / {) / J3 /Vo 
Time: Q ~.t.JV 
To: IHSC STAFF 
. l(b)(6); (b)(7)(C) 
From: 1---=----=---------_i------- P RI NT - GEO OFFICER Dorm 
Subi: DETAINEE REFUSING MEDICAL SERVICES AND/OR 
MEDICATION 
Detainee Name: ..... f/........ vVtt .......... ,_r _____ _ 
A# ZI~ Z(p9 ~Dz.. 
Reasonable attempts have been made to have the ider::t!!!ed~ 
CV...il6tl;,_ 
detainee attend PILL LINEIMEDICAL APPOINTMENT (circle which 
one). The detainee has refused services and is refusing to 
participate in the education process with medical staff. 
Detainee Signature 
r)(6); (b)(7)(C) 
Dorm Officer Signature 
Original Side 2: Detainee D0038 2-15-20-2018 
2019-ICLl-00051 3514 
DHS-ICE-19-0196, 19-0197-O-000198

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
1. This is to certify that I, b ct¥ \~ J..A.~V\__Q\ a detained alien in the custody of Immigration and 
Customs Enforcement (ICE), have refused to consent to 
□ 
the following: 
a) Intake Screening 
a) Valoraclon Mt!idica Ill b) Medical Treatment 
b) Tratamlento Medico 
2. The health care provider whose signature appears below has 
explained the neccesity for the above described. I understand that 
the possible or probable consequences of my refusal include: 
Potential for medical problems lo go undiagnosed or untrealed 
leading to exacerbation of existing condition that may cause 
further deterioration in current state of health. 
3. In a language that I understand, I have been informed that refusal 
of this lreatment or procedure may jeopardize my health and/or 
life, but it is, nonetheless, my wish that my refusal be honored. I 
hereby release the U.S. Immigration and Custom Enforcement 
(ICE), and the United States of America from any liability that I 
might assert for not providing the treatment or procedure(s) 
described herein. I attest that I am over the age of eighteen years 
and I am mentally competent to execute this release. 
SIgnat re o Health Care Provider/ 
(b)(6); (b)(7)(C) 
Signature of ICE Official (If applicable) 
last Name: 
AMAR 
A#: 
216269802 
Date of Camp Arrival DCA : 
~i\'1 
Medical Clinic: 
CSCNWWA 
□ 
1. Con la presente certifico que yo, 
---::----,-,--::--:--,----:-----;------:--~ extranjero(a) delenido(a) bajo 
custodla del Servicio de lnmigraci6n y control de Aduanas (ICE, 
siglas en ingles), me he negado a recibir lo siguiente: 
c) Medical Procsdure(s) 
c) Proced imienlo(s) Medico(s) 
Ill d) Medicalion(s) 
d) Medicamento(s) 
2. El proveedor de servicios de salud cuya firma aparece al final me 
ha explicado la neces!dad de llevar a cabo lo descrito arriba. 
Entiendo que las posibles o probables consecuencias de mi 
negativa incluyen: 
Potential for medical problems to go undiagnosed or untrealed 
leading to exacerbation of existing condition !hat may cause 
further deterioration in current state of health. 
3. En un lenguaje que enliendo, se me ha informado que la negativa 
de este tratamiento o procedimiento puede poner en peligro mi 
salud y/o mi vida, sin embargo, es mi deseo que mi negativa sea 
cumplida. Par el presente medio libero a la Oficina de lnmigracl6n 
y Aduanas (ICE), y los Estados Unidos de America de cualquier 
responsabilidad que pudieran lener por no proporcionar el 
tratamiento o procedimienlo(s) aqul dascritos. Doy fe de que soy 
mayor de dieciocho a~os y que me encuenlro en plenas 
facuttades mentales para ejecutar esla responsabilidad. 
Jo ... ~5-1g￾11rne1Hora Date/Fecha 
Printed Signature/Firma con letra de lmprenta 
(b)(6); (b)(7)(C) 
Printed Signature 
First Name: 
MERGENSANA 
DOB: 
10/2:l/1978 
Se.x: 
M 
2019-ICLl-00051 3515 
DHS-ICE-19-0196, 19-0197-O-000199

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
-;:1::cenily ti'.;;! :. ___ j?b_~~s;~;:,·A~cori ,a-::n: r.::::::(.. ----·~~~-==~· a delaineo alien m t11e cus1ody ol lnimioration and Cu:;10111s ~xlranjero(a) delenidoca) bajo custodia def Servicio di: l,1miJraci6n 'i 
Enturcement (!CE). have reluscd Lo consent to the toL'o - • : Control de Adua,ws (ICE, siglas en lnfJICs), me 11e n<;-gad·~x;;: 6
;:;;)~- ,*b~==-~-
lo siguiente: ' '' X7XC) 
CJ a) Intake Screen,ng 
,1) V.;iloracion Med1ca 
0 c) Meolcal Procedure(s) ~, 
c) Procecfrmiento(s) M~dico(s) 1camen1oci.1 
~-
Sr•~uw;..~;.~d1ca1,~n been refused:/Espec~q11;_:1 !ratam,enlo o medicarne~~~~cl~:::~------------· - -·-· /~!_-~~~~J 
., •.• , ..... ,,.,, .... (a.u~ ,,,...,"-itd,tr who~Q '!:-i(Jr"IQtUro t:ll)c:)Q:\r~. bQfow has 
,):,rpi;:iined lhc necc~sity for U1e above described. l unaer~1ane1 ltiat 
:hQ possible or pwoalJle l;onsequences or my rerusal include: 
!~.;~'!'~;~'.'i!i~-~~·-•:~.t_i•~a~nn willnot be achieved: lhe~~~----
iJ'Cl1Jn;:_i•n.,!L'.;0! ,r,~•-.•:•'1J_t;;r :<=:solving th~ mcdic;1I r.ondition for 
•:'.'!1!ch 1he me<.lica~lnn was prescribed. 
3 In a language lhcit I understand, I ha-v;e been informed that refusal 
,.,, lhi:; treatment or procedure may jeopardize my heallh and/or 
:iie, but_ it i~, nonetheless, my wish that my refusal be honored. I 
"~rcby release the U S Immigration and Custom Enforcement 
1•CEi. a,,d th~ United States ol America from any liability lhat J 
•nighl assert lor noi nroviclmg lhe treatment or proce ure[s) 
dr,scrihci:: iicre,.~ i ;:iita:at IM! I am over the c19e ol eightt.aen 
-,c;,u,. ,111,:i i .in, ,,,e,-,::-iiiy competent to execule this 11:leas~. 
Signature c; 
f'11me1 r.l•~l f'rov.:;r,,ior ~JG Servicios do Salud 
fi:biiii)(66l:);Tt(biii°)(17li)(rr"CJ~----J!'(b )(6); j Mhlr?Vr.1r-----....._.=.J,t,,,, 
Signalure ol ICE Official (If applicaole) 
2. El Proveeaor de servicios cJe satud cuya lirma uparece ol final me h.o 
sxp1Jct1cJo ltl neccoIui.ici ~~ I1,r.,iv~,- .. Cu't:JO ,., (,ta,~,i;.rflo .... ,... ............ n, .. I0,0,'W,J, .. 
que las posibles o probables consecuencias de mi nogativa incluyen 
Desired results ol med_i_(3JJ_ion will no! be achie11~2,: ... f!!H'ffl,?Y, __ , __ , _____ __ 
prolongin9.... Mt im~~11g or resolving lhe ~e,_c~~;-~~~d!~!2!1 .. !':'! ___ ,.__ 
Which the m~ic,1lion""w-'a;:..;s:c..· ""pr'-'e;.;::i;..;:c.;..ri""be-"--'d'-. _____ _ 
3. En un lenguaje que entiendo, se me ha inrormaa<: ()I.re Iii negc.:liv;; de 
esle lralamienlo o procec/imiento puede poner en peligro mi saluc 
yto mi vida. sin embargo, es mi deseo que mi negaliv.i sea curnplida 
Por el preseote media libero a la Oficina de lnmigraci6n y Aduan;;:; 
(ICE), y los Estac.los Unidos de Amt!rica de cu.ilQuier respor,sabilto;;;; 
que pudieran lener por no proporcionar el tratamicnto o 
p<0ccdlmienlo(s) aqui descrilos-. Doy fe de que soy mayor de 
dieciocho .iio5 y que: me nnr.uenlro en plena!; l11cL1ll;ides m1:n!al,::·. 
pa,a ejecutar esta responsabilidaa. 
to= so 
·nmeJHora 
[b)(6J; (b)(7XC) f(N 
Printed Sign&ll1re/Firm;:1 co!l LetrJ do lrnprenl~ 
)(6); (b )(7)(C) 
Printed Signature/Firma con l.e ra 
Prinlad Signature 
. ____ ,. __ ·---------·--------------------,-------=------------------------·· 
; L;;st Name· /tvY"I A,. V First Name: J/h ..f,r ~ j a.,riA_,, ... ______ _ 
. _____________ ".._.l:----------------1--------....W..-------- 2, (o . 2(oq ~ Jo 2_., Country of Origin: /J-u S 51,PL 
! Date of Camp Arrival (D9A1. / 
i l "'7--/\ '1 /2-0 I 7 
t- d. I Clin' , :Me ,ca 1c: 
; NINOC 
Sex: 
________ 
Male 
--·---------------,--_ . __________ ,_,...... -.:.,. -,:_-_ ..J_'-_ -_ -_ -_-_ -_-_ -_-_-::-.-__ - _-_-_-_-_-_-... - _-_---=---- --=--:-.:-_·-·-·------- -- ·-. 
H·ISC Fenn 820-~ 01/2()11 Page 1 of 1 
2019-lCU-00051 3516 
DHS-ICE-19-0196, 19-0197-O-000200

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
1. This is to certify that !,AMAR, MERGENSANA , 
a detained alien in the custody of Immigration and Customs 
Enforcement (ICE}, have refused to consent to the following: 
D a) Intake Screening 
a) Valoraci6n Medica 
~ b) Medical Treatment 
b) Tralamiento Medico 
1. Con la presente certifico que yo,AMAR, MERGENSANA 
extranjero(a) detenido(a) bajo custodia del Servicio de lnmigraci6n y 
Control de Aduanas (ICE, siglas en ingles), me he negado a recibir 
lo siguiente: 
D c) Medical Procedure(s) D d) Medication(s) 
c) Procedimiento(s) Medico(s) d) Medicamento(s) 
Specify treatment or medication been refused: /Especifique el tratamiento a medicamento rechazado: 
VITAL SIGNS and WEIGHT 
State reason: /Explique la raz6n: 
ADAMANTLY REFUSED 
2. The health care provider whose signature appears below has 
explained the neccesity for the above described. I understand that 
the possible or probable consequences of my refusal include: 
The purpose of the treatment will not be achieved: my condition may 
get worse. 
3. In a language lhat I understand, I have been informed that refusal 
of this treatment or procedure may jeopardize my health and/or 
life, but it is, nonetheless, my wish that my refusal be honored. I 
hereby release the U.S. Immigration and Custom Enforcement 
(ICE). and the United States of America from any liability that I 
might assert for not providing the treatment or procedure(s) 
described herein. I attest that I am over the age of eighteen 
years and I am mentally competent to execute this release. 
Firma del Proveedor de Servicios de Salud 
Signature of ICE Official (If applicable) 
Last Name: 
AMAR 
A#: 
216269802 
Date of Camp Arrival !fiCA 
t v Ir~ t '::r 
Medical Clinic: t 
NWDC 
2. El proveedor de servicios de salud cuya firma aparece al final me ha 
explicado la necesidad de llevar a cabo lo descrito arriba. Entiendo 
que las posibles o probables consecuencias de mi negativa incluyen: 
The purpose of the treatrne nt will not be achieved; my condition may 
get worse. 
3. En un lenguaje que entiendo, se me ha informado que la negativa de 
este tratamiento o procedimiento puede poner en peligro mi salud 
y/o mi vida, sin embargo, es mi deseo que mi negativa sea cumplida. 
Por el presente medic libero a la Oficina de lnmigraci6n y Aduanas 
(ICE), y los Estados Unidos de America de cualquier responsabilidad 
que pudieran tener par no proporcionar el tratamiento o 
procedimiento(s) aqui descritos. Day fe de que soy mayor de 
dieciocho anos y que me encuentro en plenas facultades mentales 
para ejecutar esta responsabilidad. 
4:30:00 PM 
Time/Hora 
l(b)(6); (b)(7)(C) RN 
Printed Signature/Firma con Letra de lmprenta 
l<b)(B); {b){7)(C) loFFlCER 
Printed Signature/Firma con Letra de lmprenta 
Printed Signature 
First Name: 
MERGEN SANA 
Country of Origin: 
RUSSIA 
DOB: 
10/23/1978 
Sex: 
Male 
IHSC Form 820-S 01/2011 Page 1 of 1 
2019-ICLl-00051 3517 
DHS-ICE-19-0196, 19-0197-O-000201

• ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
1. This is to certify that l, A ('{\(1J( 1 ((\-e ( ~ \f'\ SQ.._,~ 
a detained alien in the custody of lmmigralion~d Customs 
Enforcement (ICE), have refused lo consent to the following: 
D a) Intake Screening 
a) Valoraci6n Medica 
O b) Medical Treatment 
b) Tratamlento Medico 
1. Con la presente certifico que yo, __________ _ 
extranjero(aJ detenido(a) bajo custodia del Servicio de lnmigraci6n y 
Control de Aduanas (ICE. siglas en ingli!s), me he negado a recibir 
lo siguiente: 
~ Medical Procedure(s) D d) Medicalion(s) 
c) Procedimiento(s) Medico(s) d) Medicamento(sJ 
Specify treatment or medication been refused: /Especifique el tralarnlento o medicamento rechazado: Bwoo lM\t,,u CPi e 
State reason: N(plioue la raz6o; •~ 1 ...,-
... \ o t CQN ,- w~~ , 
2. ThG hQa)lh c:irn prnvidllf who!tA Aioru,lurA Al'I'"'""' b.,low hA" 
explained the neccesity for the above described. I understand that 
the possible or probable consequences of my refusal include: 
Lrt-~ Tl~ +J)l( Af..-.:J½J,:01.+ ~J W1 Lt J N 
3. In a language that I understand, I have been informed that refusal 
of this treatment or procedure may jeopardize my health and/or 
•
fe, but it Is, nonetheless, my wish that my refusal be honored. I 
ereby release the U.S. Immigration and Custom Enforcement 
(JCE), and the United States of America from any liability that I 
might assert for not providing the treatment or procedure(s) 
described herein. I attest that I am over the age of eighteen 
years and I am mentally competent to execute this release. 
Signature of De ainee/Firma del Detenido 
-----tl)(6); (b)(7)(C) 
• FilTl'la del Proveedor de Servicios de Salud 
t)(6); (b)(7)(C) L 
Signature of Witness/Firma del Testigo 
Signature of ICE Official (If appllcable) 
Last Name: 
A#: 
te of Camp Arrival (DCA): 
~- rt ,,.ro~.-idor do Dof"'icio3 de selud cvyP tl,me ap~l'"OCo ul nnal rne ha 
explicado la necesidad de llevar a cabo lo descrito arriba. Entiendo 
que las posibles o probables consecuencias de mi negativa incluyen: 
3. En un lenguaje que entiendo, se me ha informado que la negativa de 
este tratamiento o procedimlenlo puede poner en peligro mi salud 
y/o mi vida, sin embargo, es mi deseo que mi negativa sea cumplida. 
Per el presente medio libero a la Oficina de lnmigraci6n y Aduanas 
(ICE), y los Estados Unidos de America de cualquier responsabilidad 
que pudieran tener porno proporcianar el tratamiento o 
procedimienta(s) aquf descrilos. Doy fe de que soy mayor de 
dieciocho af1os y que me encuentro en plenas facultades menta/es 
para ejecutar esta responsabilidad. 
Moo 
Time/Hora Dale/Fecha 
(b)(6); (b)(7)(C) 
b)(6); (b)(7)(C) 
1gna ure/Firma con Letra de lmprenta 
AMAR,MERGENSANA 
A#-: 216269802 RUSSI 
Printed Signature 
DCA: 12/19/2017 DOB: 10/23/1978 
Facility: NWDC Tacoma. Sex: male 
IHSC Form 820-S 01/2011 Page 1 of 1 
2019-ICLl-00051 3518 
DHS-ICE-19-0196, 19-0197-O-000202

ICE Health Service Corps 
Refusal Form/Formularlo de Negativa a Recibir Tratamiento Medico 
:. Tliis is to ceMy that I, r: r a detained alien in the custo of lmmi~rat'on and Ccsto~s::, 
Enforcement (ICE), ~.avo refused ro conser.\ to the ro:·owing; 
D a) Intake Screening 
a) Valore~i6n Medica 
~ b) Medical Treafmo:il 
b) Tralamlent<, M6dicc 
2. Th~ heallll care i,rovidar whose sigralure appears below has 
explained the neccesity fo: the above c!escribed. I understand tiat 
·,he poss::,lc; or prot>abh, t:ensequencos of my refusal includo: 
•,. Con !a proser.ta certifico que yo, ___________ , 
extra~Je,o(aJ detenldo(a) baJo custod;a del Servlclo de lmr,igrac1_6n y 
Control Ila Ac!uanas pCE, slgras en lngl~s), me t,e neg ado a rectblr 
lo siguion'.e: I 
D c) Medical Procedure(s) jg d) Medication(;) 
c) Procedlmiento(s) Mee co(s) d) Medica:nen\:><s) 
2, El proveedorc'e servicios de salud cuya firma apmcc-~ al finol ~e r,a 
exP''cado 1a necesidad de llevar a ~be lo descrito arriba. EntiJmJo 
que fas posibles o probabloG co~secuancias de mi negativa incl;uyen: 
n~ desr~.:!-e£fuct ,,f= ½(_, 'TY'0J"Afft!,,..., 
w:/1 nof- ~ ;:,a,k;..x-d-, poss-;~ r--e-S1.<tH11;3 
,'n p&'tr b,?,df{z pr rt.n t'Ar't:J AA! 
3. In a language that I understand, I have been lnforr.ied \'let mfusal 3. En ~.1 lenguajs qi;e entiendo, se me ha lnformado que la regati~a dil 
cf 1his treatment or procedure may Jeopardize my heallh and/or esle lratarnlento o ;,roccdimiento pueae poner en pellgro mi sal~d 
life, but ii is, r.or.e\heless. my wish tha1 my mfusal to honored. I ylo mi vida, sin e~oargo, es mi deseo que mi negativa sea cumplida. 
hereby release ths U.S. lm11igration and Custom l:nforcement Por el presenlo mudic libero a la Oficina da lnmigraci6n Y Aduapa, 
(ICE;>. and the Unitoo Slates of America from any liability that I (ICE), y los E;tados Unic,s de America co cualquier res~onsaMd:.d 
might nssert !or not pro•,iding the treatment or proc:educe(s) que pudieran loner porno proporcio.,ar el t:atamienlo o ' 
cescribed herein. I attest ttlal I em over the age of eighteen procedimienlo(s) aqul descrilos. Doy fo de Que soy mayor de 1 
years and I am mentally competent to execute this release. dieclocho a~os y qua me er,cuen:ro e~ ple:w.s facultac·es :nentalcs 
-(.,..:-,:, e;:H6l'f Y.s ·
1
,,.. 0 r~iOVI para eje~taresta res~o7~ilidad. ~ I 
~J. vf t~ r s:911 ~5 v-eA,s..J ,r1~~{lV~~ 10/;;1/;;ot& 
Signature of Detainaelfirr:ia eel Deten;do Tr me/Hora Date/Fecha 
1Cb)(6); (b)(7)(C) ~ I 
Signature of ICE Official (It spplic;b'e) 
Las~ Name: 
1-1 W1C<Y 
A#: 
q-llP :;!./,ff 'Z)?;;L, 
Date/ ~!JJTzrt?J 6/7 
Medical Clinic: ,vl,.L)Dc_. 
IHSC Form 820·8 0112011 
I 
!"'rui-.;;io -.llgnt.it\Jretflrrm; c;on: L.et:a Cle Imp:~ 
I 
I 
P:infed S~nalurelFirma con Lolru de lmpce~la 
I 
Prinlec Signaturo 
' F'irsl rfame: 
M e.rae-n "'¼V"O-, ' 
Coft~ Origin: i 
l,(.~5,'CA, : 
POB; I 
J ol-;;..3/ !_3_ 78' i 
' 
Sex: 
(Y)171.)e..., i 
' 
Page 1 cf 1 
2019-ICLl-00051 3519 
DHS-ICE-19-0196, 19-0197-O-000203

ICE Health Service Corps 
Sick Call Request Form 
Facility: ----!or--_N_\U_~~c..... ________ _ 
Name: ---?i.-Fnt-Y::1 .......... f\:~~ .....C=- LISI 
A#: 1..t b 2.Co q 3'.o(___ oa1e, lo/ f. fr/ 
Gender. ~ Male D Female Nationality: ----;k"""· ..,_.~'----"--';'__.,__._.IT._· __ _ 
Age: -- Housing: --+---~:t:--~----
Complaint/Reason for Request: 
-
i6 
For Official Use Only 
(This section to be co 
Date received: , o f'f 
e.) 
Form Reviewed By: __ ....._____ ="""'"'-f<._J_-1.... ____ __J 
To Be Scheduled: Today 
To Be Seen By: 0 RN 
Reviewer 
0 1-2 Days D 3-4 Days D 5-7 Days 
;a-Provider ....,..,.,,.,......,,..,~,.,.....-----1 (b )(6); (b ){7)(C) 
(b)(6); (b)(7)(C) 
19nature 
If patient is not seen same day, must have concurrence tom the next highest level provider. 
1
t/t1/r: 
Date 
O Concur O Do Not Concur Detainee should be seen: _________________ _ 
Other. 
----------------
.astNam&: 
)ate of Anival: 
:acility: 
1SC Form 700 0512012 
______ l_Fltst Name: 
AMAR, MERGENSANA 
A#-. 216269802 RUSSI 
DCA: 12/19/17 DOB; 10/23/1978 
Facility: NWDC Tacoma. Sex: male 
J 
Page 1 of 1 
2019-ICLl-00051 3520 
DHS-ICE-19-0196, 19-0197-O-000204

ICE Health Service Corps 
Refusal Formfformulario de Negativa a ~ecibir Tratamiento Medico 
1. Thlsistoccrtilylt.at1,Mttttat1::anca Airer.:..., a detained 2,;,en In 1hr. custocJ?ot lmmlg,ation arid Cusl~s 
Enforcement (ICE), have refuged to consent lo the followino; 
0 e) lnlake Saeening 
a) Valornci6n Med:ca 
O b) Medical Treatment 
b) Tratamlento Medico 
',. Coo ta presonte cartifico Que yo, __________ _ 
extranjero(a) delcnido(al ba;o c,,slodia cet Servicio de lnmigr.icibn y 
Control de Aduanas (ICE, ~iglas en lngl~s). me he neg ado a recibir 
lo siguie~le: 
CJ C) Medical Proced'Jfe{S) 
c) Procedimienlo(s) MtMicO(s) 
QI d) Medicalion($) 
d) Medlcamentc(st 
S~ecify trea.;rr,er,t or rr,ec:cation been refused: /Espec:fique el tratc.mioo'.o medicamento recharaclo: 
49.,j C,1L1,M / V a-~I) ]2 X 2::::-'85% Cornpi4nl • ~, r J 
S~: /Expl~Je la razor,: 
- w ,. n,o hcal1h c:."' P(ovider whose signature aope~rs below has 
explaine<1 lt1e neccc,lty ror the aoove ocscrlbeu. 1 1.mder,1ano ,na, 
lhe pn,;slble er probable con,<equef".ces ol my refusal include: 
Tu Je.,ia:A e:ffec.+ er£-:H,e:;t.roa{ier..Lioos 
~r1Df be... 4Ck~LCd, po:ssiblJ ce-,,¼1-li~. 
2. El provee<JOf de servldos l!e saluo cuya Ii/ma apilrece al linell mo r.,; e11:p11,;aao I.fol. noce~lda.o C10 •1e..,nr u cci~a lo dol!l&cr11G tH11b'4, en1~wocJo 
c;ue las po~ib:es a probables consr.cuenc!as de ml negat:va incluyen: 
lQ pa>c he«I¼ cce-n ec..rb au.¼, __ 3. In a lannuage th!Jt I understand, I t,a11e beeo Informed that refusal 3. En un fengu.ijo que ent;er.do. se me ha inlormado que la r.e~etiva de 
ot this :reatmenl or proced~re may Jeop~rdize my hcallh and/or os~ tr~lomlento a procg~lmlento puede poner en pei;urn mi :6lu<l 
life, bL1 ii is. nooeft.eless, my Wish fhat my relusat t:e honoreo:1. t y/o mi vida. fr, embargo, es mi desoo GU8 mi negativ~ sea c:i<npllda. 
hereby releaso !he U.S. lmmigmticn and Cu~tom Enforcement Por el presente medio libero a la Ofic.na de lnm;gcaci6rt y Aduanos 
('CE). and tne Ur,::ec States of America from any liability :hat I (IC!;.J, y lcs l,sledoo Unidos de America d8 cualqulcr respcnsaoilldad 
might essert for not ~rov.ding the treatment o: p.-nco<1uref$) QUe pudicm'l leoer por 110 proporGionar ol lratamiemo o 
da5cribed herfi'n. 1 alte~\ tt,al I arn over the age cf eighteen procoolmiento(il aqul descrttos. Doy re de que 50Y mayor de 
years and I am mentally COfJll)lllent 10 exea:le tr.i~ release. diecioc~.o ailos y que rr.c en :\Jentto er: ;,lena• fac,·:ti,ce3 mentalfls 
LJ .I : I S .L: _ ..1 para eJecutar csla respor.sabtlidad. 
f'~,f.,()"t" ( $ '4 f'"} e.tJ~U0"°1 t\,lf\C.. 
\",etS_ reft-<.<oed.-m s,5tt1 ¥1.7'5 r"eru.:5A.ll /:;J..3j)__lt/~~a, 
ido -forh"\ ., Time/Hora Dale/Fec~a 
(b)(6); (b)(7)(C) b)(6); (b)(7)(C) 
(b)(6); (b)(?)(C) j(b )(6); (b )(7)(C) 
Pr!Med Slgnat,.:re/Firma co~ Letra de Jrr,prenta 
Slgntture of ICE Official (II applicable) ? tinted Signat\Jre 
Lost tlrn/4 Name: 
r: -----------+':..:..,::~:'.l'..i~"_i'\.,.1<1:u""-'-------
FirS1 Name: 
---------
l 
::: ~~~----+-:-~--- I, 
'2.01 
IHSC Form 820,S 0112011 Pag~ 1 of 1 
2019-ICLl-00051 3521 
DHS-ICE-19-0196, 19-0197-O-000205

ICE Health Service Corps 
Refusal Form/Formularlo de Negativa a Recibir Tratamiento Medico 
1. This Is to certify that I, M,,~M,'4/\.4,, Ar<)ta f a de1ained alien In tho cuct ~mmlgration and Custo~ 
Enforcement (ICE). have re/used lo conscml to the following: 
0 a) lr,take Screening 
a) Varo,racion Wedica 
0 b) Me:lical Treatment 
b) Tratam'ento Medico 
1. Con la presertte certifico que yo, __ -,- _______ _ 
oxtronjero(a) detenido(a} bajo cus!odia del Serv:c!o de lnmrtrnciOn y 
Control de Aduanas (::;1:. slol~• ~n Ingles), me he negaoo a recitlr 
lo sfsulen1e: 
Q c) Medical Proccdum(•) _;& d) Medication(s) 
o) Procodimiento(s) Medicc(s) d) Med!camentots) 
Specii" tre_atment or m}•catLon been refused: /Especific_1.1& e~ trai,amlen'.o ~ ~dicamento rechill;ado: 
C,:;.,le-, CA::fM. w.J. v,+ D - IOQ°J" Clln-1f1, ...,.+ '.) J::'re..na-tA:I v,+~t4i n - ux:,~. c,p ... pL~ez.n+ 
~ reascn: /Expl~o la raz6n: 
<' ~'2.tl<-f>e-!:k 
~ "T:n ... heeltMI cm,-a orovidor whoco &ian::ih.HQ ac:,oo::at~ balcw has 
explainc~ tne necceslty for the atove c:escnbcd. I unu~rstano mat 
the possible or ::>robable consequences of my tefusal Include: 
2. E;I provoodor de "rvic'os de 11al~d cuya ~rma acarece al final me ha e.xpnee.~o la noOOt\ldaa do ne~ar e cet;;:r;J lo du~~dto a"loa. ent1,.,r.c1e 
que las pcsibles o probables consecuenclas de mi ne;at,va incluyen: 
--:Ille. dc22;rn:l e.ffec+ af Mot: medrCett?a,...,., ________________ _ 
1ui!I co:\: lo(:. ac.b({ic&d, no.,.25ibl.J r:::e 5/A.l.w . _-o ........ ,c,,._ ________________ _ 4 ,r J -:::; 
.1t) pmc beaLU.., OC&<Y\ ,UC...V-~ d,.,.u, e 
3. In a language that I undersl<1nd, I have been informed that refusal 3. En un lengua;e quc entiendo, se me ha lnformedo que la neg~tiva de 
of this t<ealment or procedure may jeopardize my health and/or esto lrotamiento o procedlmlento puedo ooner en peligrc mi sail.Id 
lifB, b1.1t it Is, nonatheless, my wish tMt my refusal be honored. I y/o ml vl:ia, sin embargo, as mi deseo que ml negat:va sea cumplida. 
hereby rolcase lhe U.S. Immigration e:id Custom Enforceme.it Por el present& medio libero a le OficiM de lnmigraci6n y Aduanas 
(ICE), ar.cS the United States of America from any llsbillly that I (lCE), y los Esta~os Unidos de America de cualquicr resi,onsabilided 
might o.ssert for not proViding the lreatmeni or proced~re(s) que pudieran tener pcir no proparcionar el tratamiento o 
described herein. I ottesl that I arn over the age of eighteen proce:limiento(s) aqul descritos; Dey fc de que soy meyor de 
vears and I am mentally competent to e!Cecute this release. d(ecloello e~os y que ma encuentro en plenas focul!ades mentales ? ~/e.tl1' k5 ~ >') txf;j r~ah'~ (>., V\.d, p:;ra e)Kutar esta responsal)ilidad. 
~e.-!-tc..S Y"efu~ed -6 '51fjV) --fVli.5 rtfuS4,( 
Si ature ol OetaineetFlrma del uetenlc:> -fu-r YVl.., 
14.10 
Time/Hora 
10/ 19 (,pot "Ir 
Date/Fecha 
(b)(6); (b)(7)(C) r)(6); (b)(7)(C) ~ 
Printed s1onaturn/Fim:a eon Letra ~e lmprnnta 
b )(6); (b )(7)(C) 0S lud 
b)(6); (b)(7)(C) 
._ ____ .,.... ___ -.J10n Letra de lmprenla 
Signature 0~ ICE Official \II appllca)lt) Printed Signaturo 
lt.asA-~ First Name: 
t'V'-ere:te-v)~vi..4..-
A#· ;).l4' .1Co~ ~o,;t Cou~Ori~ln: 
:> ~~ 
Datt ~tr&.t~~f, 0
1
8
b/ ~3/ 1q7 8' 
Me<l~~nbL., Sex-N)c,jc:_ 
IHSC F'orm 820-S 0112011 Pege 1 of 1 
2019-ICLl-00051 3522 
DHS-ICE-19-0196, 19-0197-O-000206

•• 
I 
Tacoma Northwest Detention Center 
Nursing Care Plans 
Detainee's name: l'rwvA '0 M w~ 'BC,t Vtlf 
Detainee A#: ?- I (a . 2 bq -~02 
Care Plan for WEIGHT LOSS 
Pagel of2 
Nursing Diagnosis: Alteration in Nutrition: less than body requirements 
Outcome: Patient remains adequately hydrated as evidenced by good skin turgor, 
urine output greater than 30 ml per hour, and moist mucous membranes. Patient 
will begin eating without complications of dehydration or malnutrition. 
Initiating Nurse 
Stam illate/Initial 
(b)(6); 
(b)(7)(C) 
(b)(6): (b)(7)(C) 
Interventions 
Document actual 
aseline weight. 
Weigh patient daily. 
Notes 
fl't'.rll'l'"l,~ L\: 
e~~ #1 date: o<o/2sP,DL'b~ ~-
#2 date: ----- #3 date: ----- #4 date: ----- #5 date: ----- #6 date: ----- #7 date: -----
Resolved Nurse 
te/Initial 
~o-=-g-°'r-."1::-! 5
::::--;------.,.,.....----,,-----------+--------1(b)(6); (b)(?)(C) 
v t.:. Record vital signs once 
(b)(6); (b)(?)(C) RN tiaily. 
Assess hydration status: 
skin turgor, mucous 
membranes, intake & 
.......... -----~-....o..+-'utput, blood pressure 
nd heart rate. 
0~ /'25/201?:) Perform urine dipstick to 
,......._ ____ ____. __i...c,-·onitor specific gravity 
(b)(6); (b)(?)(C) ordered by the 
edical rovidcr. 
.-L--~LJ,f.~.:.....,U.-----=-L..Uiscuss with patient 
ossible need for enteral 
2019-ICLl-00051 3523. 
b)(6); 
. b)(7)(C) 
OCT 1 6 2018 
!(b)(6); (b)(?)(C) IN 
1\1 
1 6 2018 
l(b)(6); (b)(?)(C) ~N 
(b)(6); (b)(?)(C) 
N. 
DHS-ICE-19-0196, 19-0197-O-000207

• 
Tacoma Northwest Detention Center 
Nursing Care Plans 
Detainee's name: rtvY1oi V H Cf~ m 
Detainee A#: .'.2. llo · 2.bCl · ~02. · ~-· -~ · Care Plan for WEIGHT LOSS 
a~ /25}2.0l<b 
fb)(6); (b)(?)(C) ~ 
Cfb /25I 2() L'b 
(b)(6); (b)(?)(C) 
Encourage patient to 
verbalize feelings. 
Provide psychological, 
spiritual or psychosocial 
assistance as ordered . 
2019-ICLl-00051 3524 
Pagc2 of2 
(b)(6); (b)(?)(C) RN 
CT 1 6 20tf 
DHS-ICE-19-0196, 19-0197-O-000208

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
1. This is to certify that I,AMAR, MERGENSANA , 
a detained alien in the custody of Immigration and Customs 
Enforcement (ICE), have refused to consent to the following: 
D a) Intake Screening 
a) Valoraci6n Medica 
0 b) Medical Treatment 
b) Tratamiento Medico 
1. Con la presente certifico que yo, AMAR, MERGENSANA 
extranjero(a) detenido(a) bajo custodia del Servicio de lnmigraci6n y 
Control de Aduanas (ICE, siglas en ingles), me he negado a recibir 
lo siguiente: 
IZ] c) Medical Procedure(s) D d) Medicalion(s) 
c) Procedimienlo(s) Medico(s) d) Medicamento(s) 
Specify treatment or medication been refused: /Especifique el tratamiento o medicarnento rechazado: 
lunch 
State reason: /Explique la raz6n: 
HUNGER STRIKE 
2. The health care provider whose signature appears below has 
explained the neccesity for the above described. I understand that 
the possible or probable consequences of my refusal include: 
may decrease nutritional value need for good health; resulting in 
weight loss below body requirements for sustenance of life. May also 
cause decreased wound healing and/or poor oral health. 
3. In a language that I understand, I have been informed that refusal 
of this treatment or procedure may jeopardize my health and/or 
life, but ii is, nonetheless, my wish that my refusal be honored. I 
hereby release the U.S. Immigration and Custom Enforcement 
(ICE), and the United States of America _from any liability that I 
might assert for not providing the treatment or procedure(s) 
described herein. I attest that I am over the age of eighteen 
years and I am mentally competent to execute this release. 
b)(6); (b)(7)(C) 
Signature Health Care Provi er/ 
Fi1TT1a del Proveedor de Servicios de Salud 
~b}[6}; ~}[?KC} 
Signature of ICE Official (tr applicable) 
Last Name: 
AMAR 
A#-: 
216269802 
Date of Campl z'.."i c
1
C)): / ? ~ I -:J-, 
Medical Clinic: ~ 
NWDC 
2. El proveedor de servicios de salud cuya firma aparece al final me ha 
explicado la necesidad de llevar a cabo lo descrito arriba. Entiendo 
que las poslbles o probables consecuencias de mi negativa incluyen: 
may decrease nutritional value need for good health; resulting in 
weight loss below body requirements for sustenance of life. May also 
cause decreased wound healing and/or poor oral health. 
3. En un lenguaje que entiendo, se me ha infarrnado que la negativa de 
este tratamiento o procedimiento puede poner en peligro mi salud 
yfo mi vida, sin embargo, es mi deseo que mi negativa sea cumplida. 
Par el presenle media libero a la Oficina de lnmigraci6n y Aduanas 
(ICE), y los Eslados Unidos de America de cualquier responsabilidad 
que pudieran tener por no proporcionar el tratam!ento o 
procedimiento(s) aqui descritos. Doy fe de que soy mayor de 
dieciocho anos y que me encuentro en plenas facullades mentales 
para ejecutar esta responsabilidad. 
First Name: 
MERGENSANA 
Country of Origin: 
RUSSIA 
DOB: 
10/23/1978 
Sex; 
Male 
12:00:00 PM 
Time/Hora 
l
(b)(6); (b)(7)(C) I . N 
Printed Signature/Firma con Letra de lmprenta 
C3Ed(b)(6); (b)(7)(C) I 
Printed Signature/Firma con Letra de lmprenta 
Printed Signature 
IHSC Form 820-S 01/2011 Page 1 of 1 
2019-ICLl-00051 3525 
DHS-ICE-19-0196, 19-0197-O-000209

~ ffi-lk'r , i'{\__s;;_ rc;:i.e VI Sa. V\.O\ 
Northwest Detention Center 
A--# QI lo ;;)J<fr 8'0 ';) - Administrative, i:Ye'tention Order 
To, ,Restrictive Housing Unit 
From:._--'-c''-~·c.•....c.·_~--~-----~-------~ 
(Printed name/ Signature of person authorizing detention) / 
Medical notified: Yes Nu 
Title:. 
The above named individual is to 'be admitted. to-Administrative Detention for the following reason(s): 
Is pending. an investigation/hearing_ rule violation and reqires pre.-hcaring detention to￾protect the Security and orderly operation of the facility. · 
____ (B) Is under medical observation _(medical staff must comment and sign this order). 
Medical Officer (Signature): --------
____ ( C) Is pending a tr'Jnsfer or release within 24 hours. 
Is terminating Confinement in Disciplinary Detention and has i1een ordered in Administrative 
____ (D) Detention by the Institution Disc'iplinary Panel (ID~). 
____ (E) Is a security risk to him/hers,elf or the security of the facility. 
'. 
./ '\ (F) Detainee has requested admission for Protective Custody. 
I hereby request placement in the, Restrictive Housing Unit for my own protection. 
I do [ ] do not Ul request a hearing concerning my detention. 
Detainee: _______ ~~----------
(Signature) 
mite: ___ -
Details (as necessary): 
' ' 
Copy delivered to detainee by (Signature) __ -" _________ _ Date/Time ---~-'-
Detainee released to: Dale: Titnc Authorized by: ________ _ ----- ---- -----
Original: Detainee File ~ White 
CC: Administrative File - YeUm.v 
Detainee - Pink 
Jl-JSC - Gold 
ICE -Blue 
DiS002 042.617 
2019-ICLl-00051 3526 
DHS-ICE-19-0196, 19-0197-O-000210

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
1. This is to certify thatl,AMAR, MERGENSANA , 
a detained alien in the custody of Immigration and Customs 
Enforcement (ICE), have refused to consent to the following: 
D a) Intake Screening 
a) Valaraci6n Medica 
0 b) Medical Treatment 
b) Tratamiento Medico 
1. Con la presente certifica que yo,AMAR, MERGENSANA 
extranjero(a) detenido(a) bajo custodia de! Servicio de lnmigraci6n y 
Control de Aduanas (\CE, siglas en in9l!!s), me he negado a recibir 
lo siguiente: 
12] c) Medical Procedure(s) D d) Medication(s) 
c) Procedimiento(s) Medico(s) d) Medicamento(s) 
Specify treatment or medication been refused: /Especifique el tratamiento o medicamento rechazado: 
lunch 
State reason: /Explique la raz6n: 
HUNGER STRIKE 
2. The health care provider whose signature appears below has 
explained the neccesity for the above described. I understand that 
the possible or probable consequences of my refusal include: 
may decrease nulrilional value need for good health; resulting in 
weight loss below body requirements for sustenance of life. May also 
cause decreased wound healing and/or poor oral health. ,. 
3. In a language that I und~rstand, ! have been infonned that refusal 
of this treatment or procedure may jeopardize my health and/or 
life, but ii is, nonetheless, my wish that my refusal be honored. I 
hereby release lhe U.S. Immigration and Custom Enforcement 
(ICE), and the United States of America from any liability that I 
might assert for not providing the treatment or procedure(s) 
described herein. I attest that I am over the age of eighteen 
years and I am mentally competent to execute thi release. 
b)(6); (b)(7)(C) 
2. El proveedar de servicios de salud cuya firma aparece al final me ha 
explicado la necesidad de llevar a cabo lo descrito arriba. Entiendo 
que las posibles o probables consecuencias de mi negativa incluyen: 
may decrease nutritional value need for good health: resulting in 
weight loss below body requirements for sustenance oflife. May also 
cause decreased wound healing and/or poor oral health. 
3. En un lenguaje que ent!endo, se me ha infonmado que la negaliva de 
este tratamiento o procedimiento puede poner en peligro mi salud 
y/o mi \Iida, sin embargo, es mi desec que mi negaliva sea cumpllda. 
Pore! presente medio libero a la Oficina de !nmigraci6n y Aduanas 
(ICE), y las Estados Unidos de America de cualquier responsabilidad 
que pudieran tener porno proporcionar el tratamiento o 
procedimiento(s) aqul descrilcs. Doy fe de que soy mayor de 
dieciocho anos y que me encuentro en plenas facultades mentales 
para ejecutar esta responsabilidad. 
-~======--==========:=""i====----c' Signature of Detainee/Finna def De nido 
error 10/07/2018 KMM 12:00:00 PM 
Time/Hora 
I o/~/2018 
__ _.L-[b~X~-);-
1
(b-)(-7~)(C-)--=~-~~~--=-----'r 
Fi1ma del Proveedor de Servicios de Salud 
r)(6), (b)(7)(C) t 
Signature of Witness/Firma del Testigo 
Signature of ICE Official (If applicable) 
Last Name: 
AMAR 
A#: 
216269802 
Date of Camp Arrival (DCAJ: 
~7-1 \ ct 
Medical Clinic: 
NWDC 
IHSC Form 820-S 01/2011 
First Name: 
MERGENSANA 
Country of Origin: 
RUSSIA 
'?A/---::J--
DOB: 
10/23/1978 
I 
Sex: 
Male 
Page 1 of 1 
2019-ICLl-00051 3527 
Dale/Fe cha 
tb)(6); (b)(7)(C) !N 
Printed Sign tu,en 1111,a w11dra de lmprenla 
Printed Signature/Firma con Letra de lmprenta 
Printed Signature 
DHS-ICE-19-0196, 19-0197-O-000211

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
1. This is to certify that 1,AMAR, MERGENSANA , 
a detained alien in the custody of Immigration and Customs 
Enforcement (ICE), have refused to consent to the following: 
0 a) Intake Screening 
a) Valoraci6n Medica 
D b) Medical Treatment 
b) Tratamiento Medico 
1. Con la presente certifico que yo, AMAR, MERGENSANA 
extranjero(a) detenido(a) bajo custodia del Servicio de 1nmigraci6n y 
Control de Aduanas (JCE, siglas en Ingles), me he negado a recibir 
lo siguiente: 
~ c) Medical Procedure(s) D d) Medication(s) 
c) Procedimiento(s) Medico(s) d) Medicamento(s) 
Specify treatment or medication been refused: /Especifique el tratarniento o medicamento rechazado: 
dinner 
State reason: /Explique la raz6n: 
HUNGER STRIKE 
2. The hearth care provider whose signature appears below has 
explained the neccesity for the above described. I understand th at 
the possible or probable consequences of my refusal include: 
may decrease nutritional value need for good health; resulting in 
weight loss below body requirements for sustenance of life. May also 
cause decreased wound healing and/or poor oral health. 
3. In a language that l understand, ! have been informed that refusal 
of this treatment or procedure may jeopardize my health and/or 
life, but ii is, nonetheless, my wish that my refusal be honored. l 
hereby release the U.S. Immigration and custom Enforcement 
(ICE), and the United Stales of America from any liability that I 
might assert for not providing the treatment or procedure(s) 
described herein. I attest that I am over the age of eighteen 
years and I am mentally competent to execute this release. 
i;.(bi.a)""(6"-'); cl.<(b,J..)(7g.)( ... C .... ) ............... La...C~ .............. d Salud 
Signature of ICE Official (If appllcable) 
Last Name: 
AMAR 
A#: 
216269802 
Date of Camp Arrival (OCA): 
{?-J '°' r '2() r-r 
Medical Clinic: \ ' 
NWOC 
2. El proveedor de seivicios de salud cuya firma aparece al final me ha 
explicado la necesidad de llevar a cabo lo descrito arriba. Entiendo 
que las posibles o probables consecuencias de mi negativa incluyen: 
may decrease nutritional value need for goad health; resulting in 
weight loss below body requirements for sustenance of life. May also 
cause decreased wound healing and/or poor oral health. 
3. En un Jenguaje que entiendo, se me ha informado que la negativa de 
este tratarniento o procedimiento puede poner en peligro mi salud 
y/o mi vida, sin embargo, es mi deseo que mi negativa sea cumplida. 
Por el presente media libero a la Oficina de lnmigraci6n y Aduanas 
(ICE), y los Estados Unidos de America de cualquier responsabilidad 
que pudieran tener por no proporcionar el tratamiento o 
procedimiento(s) aquf descritos. Doy fe de que soy mayor de 
dieciocho afios y que me encuentro en plenas facullades mentales 
para ejecutar esta responsabilidad. 
5:00:00 PM 
Time/Hora 
N 
Printed Signa ure etra de lmprenta 
(b)(6); (b)(7)(C) 
µnnteci ~1gnature/Firma con Letra de lmprenta 
Printed Signature 
First Name: 
MERGENSANA 
Country of Origin: 
RUSSIA 
DOB: 
10/23/1978 
Sex: 
Male 
IHSC Form 820-S 01/2011 Page 1 of 1 
2019-ICLl-00051 3528 
DHS-ICE-19-0196, 19-0197-O-000212

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
1. This is to certify that I, AMAR, MERGEN SANA , 
a detained alien in the custody of Immigration and Customs 
Enforcement (ICE), have refused to consent to the following: 
D a) Intake Screening 
a) Valoraci6n Medica 
D b) Medical Treatment 
b) Tratamiento Medico 
1. Con la presente certifico que yo,AMAR, MERGENSANA 
extranjero(a) detenido(a) bajo custodia del Servicio de lnmigraci6n y 
Control de Aduanas (ICE, siglas en ingles), me he negado a recibir 
lo slguiente: 
~ c) Medical Procedure(s) D d) Medication(s) 
c) Procedimiento(s) Medico(s) d) Medicamento(s) 
Specify treatment or medication been refused: /Especifique el tratamlento o medicamento rechazado: 
dinner 
State reason: /Explique la raz6n: 
HUNGER STRIKE 
2. The health care provider whose signature appears below has 
explained the neccesity for the above described. ! understand that 
the possible or probable consequences of my refusal include: 
may decrease nutritional value need for good health; resulting in 
weight loss below body requirements for sustenance of life. May also 
cause decreased wound healing and/or poor oral health. 
3. In a language that I understand, I have been informed that refusal 
of this treatment or procedure may jeopardize my health and/or 
life, but it is, nonetheless, my wish that my refusal be honored. I 
hereby release the U.S. Immigration and Custom Enforcement 
(ICE), and the United States of America from any liability that I 
might assert for not providing the treatment or procedure(s) 
described herein. I attest that I am over the age of eighteen 
years and I am mentally competent to execute this release. 
Signature of Detainee/Flrma del Detenido-
(b)(6); (b)(?)(C) 
are Provider/ 
Firma del Proveedor de Servicios de Salud 
(b)(6); (b)(?)(C) 
Signature of ICE Official (If applicable) 
Last Name: 
AMAR 
Aft.: 
216269802 
Date of Camp Arriv\ ~CA)\ \ q '~<9(r Medical Clinic: 
NWOC 
2. El proveedor de servicios de salud cuya firma aparece al final me ha 
explicado la necesidad de llevar a cabo lo descrilo arriba. Entiendo 
que las posibles o probables consecuencias de mi negativa incluyen: 
may decrease nutritional value need for good health; resulting in 
weight loss below body require men ts for sustenance of life. May also 
cause decreased wound healing and/or poor oral health. 
3. En un /enguaje que entiendo, se me ha informado que la negativa de 
este tratamiento o procedimiento puede poner en peligro mi salud 
y/o mi vida, sin embaryo, es mi deseo que mi negativa sea cumplida. 
Par el presente medio libero a la Oficina de lnmigraci6n y Aduanas 
(ICE). y los Estados Unidos de America de cualquier responsabilidad 
que pudleran tener por no proporcionar el tralamiento a 
procedimiento(s) aqul descritos. Doy fe de que soy mayor de 
dieciocho arias y que me encuentro en plenas facultades mentales 
para ejecutar esta responsabilidad. 
5:00:00 PM 
Time/Hora 
l(b)(6); (b)(?)(C) ~ 
Printed Signature/Firm a con Lelra de lmprenta 
Printed Signature 
First Name: 
MERGENSANA 
Country of Origin: 
RUSSIA 
DOB: 
10/23/1978 
Sex: 
Male 
IHSC Form B20-S 01/2011 Page 1 of 1 
2019-ICLl-00051 3529 
DHS-ICE-19-0196, 19-0197-O-000213

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
1. This is to certify that !,AMAR, MERGENSANA , 
a detained alien in the custody of Immigration and Customs 
Enforcement (ICE), have refused to consent to the following: 
D a) Intake Screening 
a) Valoraci6n Medica 
D b} Medical Treatment 
b) Tratamiento Medico 
1. Con la presente certifico que yo,AMAR, MERGENSANA 
extranjero(a) detenido(a) bajo custodia del Servicio de lnmigraci6n y 
Control de Aduanas (ICE, siglas en ingles), me he negado a recibir 
lo siguiente: 
~ c) Medical Procedure(s) 
c) Procedimiento(s) Medico(s) 
0 d) Medication(s) 
d) Medicamenlo(s) 
Specify treatment or medication been refused: /Especifique el tratamiento o medicamenlo rechazado: 
lunch and rec yard 
State reason: /Explique la raz6n: 
HUNGER STRIKE 
2. The health care provider whose signature appears below has 
explained the neccesity for the above described. I understand that 
the possible or probable consequences of my refusal include: 
may decrease nutritional value need for good health; resulting in 
weight loss below body requirements for sustenance of life. May also 
cause decreased wound healing and/or poor oral health. 
3. In a language that J undersland, I have been informed that refusal 
of this treatment or procedure may jeopardize my health and/or 
life, but it is, nonetheless, my wish that my refusal be honored. I 
hereby release the U.S. Immigration and Custom Enforcement 
(ICE), and the United States of America from any liability that I 
might assert for not providing the treatment or procedure(s) 
described herein. I attest that I am over the age of eighteen 
years and I am mentally competent to execute this release. 
Si nature of Detainee!Firma de! Detenido 
b)(6); (b)(7)(C) 
Firma del Proveedor de Serviclos de Salud 
b)(6); (b)(7)(C) __.-
Signature of Witness/Finna del Tes!igo 
Signature of ICE Official (Jf applicable) 
Last Name: 
AMAR 
A#: 
216269802 
Date of Camp Arrival (DC(il l ~ l<?(l) ,~ 
Medical Clinic: ' - l 
NWDC 
2. El proveedor de servicios de salud cuya firma aparece al final me ha 
explicado la necesidad de llevar a cabo Jo descrito arriba. Enliendo 
que las posibles a probables consecuencias de mi negativa lncluyen: 
may decrease nutritional value need for good health; resulting in 
weight Joss below body requirements for sustenance of life. May also 
cause decreased wound healing and/or poor oral health. 
3. En un !enguaje que entiendo, se me ha informado que la negativa de 
este tratamiento o procedimiento puede poner en peligro mi salud 
y/o mi vida, sin embargo, es mi deseo que mi negativa sea cumplida. 
Por el presente media libero a la Oficina de lnmigraci6n y Aduanas 
(ICE), y los Estados Unidos de America de cualquier responsabilidad 
que pudie ran tener por no proporcionar el tratamiento o 
procedimiento(s) aqul descritos. Doy fe de que soy mayor de 
dieciocho a~os y que me encuentro en plenas facultades mentales 
para ejecutar esta responsabilidad. 
First Name: 
MERGENSANA 
Country of Origin: 
RUSSIA 
DOB: 
10/23/1978 
Sex: 
Male 
12:00:00 PM 
Time/Hora 
t)(6); (b)(7)(C) rN 
Printed Slgno a,c,. .. , .. a c.011 Letra de lmprenta 
GEO OfficJ(b)( 5); (b)(?)(C) 
Printed Signature/Firma con Letra de lmprenta 
Printed Signature 
JHSC Form 820-S 01/2011 Page 1 of 1 
2019-ICLl-00051 3530 
DHS-ICE-19-0196, 19-0197-O-000214

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
1. This is to certify that I, --~-~---i---........... -,.... .... C/JJWJ\ 1. 
a detained alien in the custody of lmmi ration and 
Con la presente certilico que yo, 
-----------~ extranjero(a) detenido(a) bajo 
custodia deJ Servicio de lnmigraci6n y control de Aduanas (ICE, 
siglas en ingles), me he negado a recibir lo siguiente: 
Customs Enforcement (ICE). have refused to consent to 
the following: 
D a) Intake Screening 
a) Valoraci6n Medica 
Ill b) Medical Treatment 
b) Tratamiento Medico □ c) Medical Procedure(s) 
c) Procedimiento(s) Medico(s) 
II d) Medication(s) 
d) Medicamento(s) 
Specify treatment or medication been refused: /Especifique el tratami nto o medicamento rechazado: 
· -~'" • - 2--- efe 
~?1.-1 ~ I 1~ 1 h'J:> I { C1 __;.-hb State reason: /Explique la raz6n: · 'V ' 
"\\ /I OLP. . . li.J.--w J C'.Yl o<>1 a -rv-v-v J/Zvi~ vn o y& "'L _ 
2. The health care provider whose signature appears below has 
explained the neccesity for the above described. I understand that 
the possible or probable consequences of my refusal include: 
Potential for medical problems to go undiagnosed or untreated 
leading to exacerbation of existing condition that may cause 
further deterioration in current state of health. 
[Ar, -F' vt:-~ ~.,,. "fl "1 .t,,,.J-- -:v-, .M ~ h... 
3. In a la~hat I underslan!f. I have been informed that refus6' 
of this treatment or procedure may jeopardize my health and/or 
life, but it is, nonetheless, my wish that my refusal be honored. I 
hereby release the U.S. Immigration and Custom Enforcement 
(ICE), and the Unlled States of America from any liability that I 
might assert for not providing the treatment or procedure(s) 
described herein. I attest that I am over the age of eighteen years 
and I am mentally competent to execute this release. 
Signature of Detainee/Firma del Delenido 
(b)(6); (b)(?)(C) 
(b)(6); (b}(?)(C) 
Signature of ICE Official (If applicable) 
Last Name: 
AMAR 
A#: 
le of Camp Arrival (DGA): 
2. El proveedor de servicios de salud cuya firma aparece al final me 
ha explicado la necesidad de llevar a cabo lo descrito arriba. 
Entiendo que las posibles o probables consecuencias de mi 
negati11a incluyen: 
Potential for medical problems lo go undiagnosed or untreated 
leading to exacerbation of exis!inq condition that may cause 
further deterioralion in current state of health. 
lC~ ~ ~fl., . 3. En un Yenguaje que entiendo, se me ha informado que la negativa 
de esle tralamiento o procedimiento puede poner en peligro mi 
salud y/o mi vida, sin embargo, es mi desco que mi negativa sea 
cumplida. Por el presenle medio libero a la Ofic:ina de lnmigracion 
y Aduanas (ICE), y los Estados Unidos de America de cualquier 
responsabilidad que pudieran tener par no proporcionar el 
tratamiento o procedimiento(s) aqui descrilos. Doy fe de que soy 
mayor de dieciocho a~os y que me encuentro en plenas 
fa.cultades menlales para ejecutar esta responsabilidad. 
First Na.me: 
MERGENSANA 
DOB: 
10(23/1978 
Sex: 
M 
Time/Hora Dale/Fe cha 
b)(6); (b)(?)(C) 
Printed Slgnature/Firma con ~ tra de lmprenta 
(b)(6); (b)(?)(C) 
Printed...,Signature/firma con Letra de lmprenta 
Printed Signature 
2019-ICLl-00051 3531 
DHS-ICE-19-0196, 19-0197-O-000215

ICE Health Seryice Corps 
Refusal Form/Formulario de Negativa a Reclbir Tratamiento Medico 
1. This is to certify that I, '(OJ-.-Y\Cj}._ l{'JY\ 1. Con la presente certifico que yo, __________ _ 
a detained allen in the c y lmmi ration and Custo~s extranjero(a) detenido(a) bajo custodia del Servicio de lnmigracion y 
Enforcement (ICE), have refused to consent to the followlng: Control de Aduanas (ICE, slglas en lngl~s), me he negado a recibir 
D a) Intake Screening 
a) Valoraci6n Medica 
. ~ Medical Treatment 
b) Tratamiento Medico 
lo siguiente: 
0 C) Medical Procedure(s) 
c) Procedimiento(s) Medico(s) 
0 d) Medicalion(s} 
d) Medicamento(s) 
Specify treatment or medicatiOf been refused: /Especifique el tratam~nto o medicamento rechazado: 0 0 ~c»-h-VMC:. e..oA,-bo"-o.~" ,' p~~ 1 ~oo.ht ~~ co~ 
Stale reason: /Explique la rarr~ 
-·~ 
2. The health care provider whose signature appears below has 
explained the neccesity for the above described. I understand Iha! 
the possible or probable consequences cf my refusal Include: I 
3. In a language that I understand, I have been informed that refusal 
of this treatment or procedure may jeopardize my health and/or 
life, but it is. nonetheless. my wish that my refusal be honored. I 
hereby release the U.S. Immigration and Custom Enforcement 
(ICE), and the United States of America from any liability that I 
might assert for not providing the treatment or procedure(s) 
described herein. I attest that I am over the age of eighteen 
years and I am mentally competent to execute this release. 
Signature o ea Prov Cler 
Firma del Proveedor de Servicios de Salud 
r(6); (b)(l)(C) 
1 
_ 
s19:atUJO or"""ess,11no del T estigo 
Signature of !CE Official (If applicable) 
Last Name: 
Ail: 
Date of Camp Arrival (DCA): \ 'cJi / \ C\ 
Medical Clinic: I) UJ b c 
2. El proveedor de servicios de salud cuya firma aparece al final me ha 
expHcagg laoecesidacl de IIA\/:>C., C?bn lo donocto oc,·1-.,, Entiendo 
Potential medical problem to go iva lncluyen: 
undiagnosed or untreated, leading 
to exacerbation of existing condition 
that may cause further deterioration 
in curent state of health 
3. En un lenguaje que entiendo, se me ha inf-Ormado que la negativa de 
este tralamienlo o procedimiento puede poner en peligro mi salud 
y/o ml vida, sin embargo, es ml deseo que mi negativa sea curnplida. 
Por el presante media libero a la Oficina de lnmigraci6n y Aduanas 
(ICE), y !os Estados Unidos (le Am~rica de cualquier responsabil:dad 
que pudieran lener por no proporclonar el tratamiento o 
procedimienlo(s) aqu! descritos. Doy fe de que soy mayor de 
dieciocho arios y que me encuentro en plenas facultades menlales 
para ejecutar esta responsabllidad. 
11;51) 
Time/Hora 
RN 
PrITTI Lein, de lmprenca 
Printed Signature 
DOB: 
Sex: 
IHSC Form 820-S 01/2011 Page 1 of 1 ' 
2019-ICLl-00051 3532 
DHS-ICE-19-0196, 19-0197-O-000216

ICE Hea Ith Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
1. This is lo certify that I, A M0yc, me,_~ Q/(J <):>.~ 
a detained alien tn the custody of l~migrationnd Customs 
Enforcement (ICE), have relused to consent to the following: 
0 a) Intake Screening 
a) Valoraci6n Medica 
~) Medical Treatment 
b) Tratamiento Medico 
1. Con la presente certifico que yo, ___________ _ 
extranjero(al detenido(a) bajo custodia del Servicio de lnmigraci6n y 
Control de Aduanas (ICE, slglas en ing!t:s), me he negado a reciblr 
lo siguiente: 
0 c) Medical Procedure(s) 
c) Procedirniento(s) Medico(s) 
r¼i Medication(s) 
/' ~) Medicamento(s) 
State reason: /Explique la raz6n: f. rt 'b ab I \f\JL ~cl£~ '\ '{'p i\J~ a 
2. The health care provider whose signature appears below has 
explained the neccesity forthe above described. I understand that 
the possible or probable conse uences of my refus lncl e: 
3. In a language that I understand, I have been informed that refusal 
of this treatment or procedure may Jeopardize my health and/or 
life, but it is, nonetheless, my wish that my refusal be honored. I 
hereby release the U.S. Immigration and Custom Enforcement 
(ICE), and the United States of America from any liability that I 
might assert for not providing the treatment or procedure(s) 
described herein. I attest that I am over the age of eighteen 
yean3 and I am mentally competent to execute this release. 
~J 
~re of Delainee/Firma del Detenido 
(b)(6); (b)(7)(C) . ' 
.__-::-:----,-.,...,,-------.-,,.....rre rov er 
Finna del Proveedor Servicios de Salud 
(b)(6); (b)(7)(C) 
Signature of ICE Official (If applicable) 
Last Name: ~ 
AMAR,MERGENSANA 
I A#: 216269802 RUSS! 
... DCA: \'J/\<Jy\1 DOB: 10/23/1978 
I Facility: NWDC Tacoma. Sex: male 
-
2. El proveedor de servicios de salud cuya firma aparece al final me ha 
explicado la necesldad de llevar a cabo lo desctito arriba. Entiendo 
que las posibles o probables consecuencias de mi negativa lncluyen: 
3. En un lenguaje que enliendo, se me ha informado que la negetiva de 
este tratamiento o procedimiento puede poner en peligro mi sah.d 
y/o mi vida, sin embargo, es ml deseo qua mi negaliva sea cumplida. 
Porel presente media libero a la Oficina de \nmigraci6n y Aduanas 
(ICE), y los Estados Unidos de America de cualquier responsabilidad 
que pudieran tener porno proporcionar el tratamiento o 
procedimiento(s) aqul descritos. Doy fe de que soy mayor de 
dieciocho anos y que me encuentro en plenas facultades mentales 
para ejecutar esta responsabi\idad. 
1 .... (b-)(6-);-(b-)(-7)-(C_) __ 
20: 
x· __ 
30 
.. • ___ _Jf 
~ 
~ 
f'rln<ea :;;19nature/P'trma con L,:,tr,~ de tmprentei 
b)(6); (b)(7)(C) 
0 
P nted Signatur Firma con Letra de lmprenta 
Printed Signature 
First Name: 
Country of Origin: 
DOB: 
Sex: 
IHSC Form 820-S 01/2011 Page 1 of 1 
2019-ICLl-00051 3533 
DHS-ICE-19-0196, 19-0197-O-000217

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
·;,,;5 IS tocerlirytlu1: -~-• m.irr;t~~~'f'-rl\ a c1eiained alien 111 lhe custody of Immigration and ustoms 
Enforcr.menl (ICE). 11ave IclusmJ lo consent lo Ille fo!lowilig; 
:..J a) lnlal<c Screening 
;:i) V:iloraci6n Merlica 
[R] b) Medical Treatment 
b) Tratamiento Medico 
1. Con la presenle c~•rlifico que yr!______ _ ______ _ 
exlranjerO{a) de!enido{a} bajo custor.lia del Servicio de l;1migraci<in y 
Control de Aduurws (IC!~. slglas l?n Ingles), me he negaco a rec,llir 
lo siguienle: 
0 c) Medical Procedure(s) [8J d) Medicalion(s) 
c) Procedimfen!o(s) Medico(s) d) Medicamenlo(s: 
;;per;,fy tma11:1en1 c: 11)etl:caIior. been rnluscd: /Espccifique el tratam,ento o medicamento ;cc}1c7acto· .. /) 
-·•··---f:d._/}1.,J<k-1.l.Q.QS.-f-~ 5 . l-le..tl CGS ePJCJ'ti!:?::JLV.d_._DJiL~ _tf/otlb .. f!:1« /MS. 
~;:;.;!<! reason· li:xphque ,a r;,::61i. 
-~~..c..-'~-.e_::;;._· ----------------
J ,....,. ,, ... ,.,m, <.a.u-1.~ ,-.,o .... :c.t---Jr• _.,OAQ -.ip~oh.1,0 -'PPC=t(!: bofow has 
,~xplaincd the neccesity tor the above described. I understano tnat 
:
1
:c f)OSSible or prClbab1e consequences of my refusal include: 
r·-:,.,,,,~d.,$,1!l$_ni :"nnrc.itinn win nol oe achieved: lhereoy 
i:~~~ng. n~I ,r,~?~c~Y!'~':1.'~!-~~l~~-~'1e mcdicnl condilton for 
·:,h1ch 1he medic.1t:or._, w_._as_._p_re~s_c_ribe_dc....·-----------
3 :,i a language lhcil l understand. I halle been informed that refusal 
.)r thi5 lreotme'.1.t or proceclu~ may jeopardize my health and/or 
:iie. but ii is, nonetheless, my wish that my refusal be honored, I 
'lemby release Ille U S Immigration and Custom Entorcement 
i',:r:). 01·,d the United Stales of America from any liability that I 
rniQhl assert fOI nol wnvid1ng the treatment or proc0r1me(s) 
!l~sc.tilJt'd herein 1 :)tlosi th;:n I am over the age of eighteen 
•1c,1r~ ;ind I arl" rner::.-11:y conweteol to execute lllis release. 
. -
f X6); (b}(?XC) 
L_~::.-,:igi'!g/ia~l,,ITl;ie rn-,, •• .,..,, .. _.,...,, ____ _J~ 
F1t1~1a riel Prc,11~,r,,1nr :1ef,ervicios oc Salud 
bX6), (b}(?XC) 
essJFi,ma def Tes!igo 
2. El proveedor de seivicios de satuo cuya firma ... parece al fin-11 me h:.1 
C'Xpf\c.oClO lo nit.:t:UGIC.U.,a de nov1"lr Q c.::c.•~u •n oc.n,.c,;a•;. ....... w-,u..,..,._ r:,_4,.1
.:c:,.•.,#l,.,. 
que las posibles o probables consecuencias de ml ncyativa ir.cluyer.· 
Desired results ol m~~H_cation will not be achieved: _!!)_~_f?,:_______ ..... . 
~ing, not ime_~v~ or resolving Ille m~<if!L~~!I!..~~~'.'- ..... . 
which Ule meoicJl!on ~as prescribed. 
3. En un lenguaje que enliendo, se me ha informado que ta negafr,.;;; cl!~ 
este tratamienlo o procedimiento puede pooer en peligro mi s;;ilud 
y/o mi vida, sin embargo. es mi c:leseo que mi negativa sea cv1npikla. 
Par el presenle medio libero a la Olicina de lnmigraci6n y Aau;;n;,:; 
{lCEJ. y los Estados Unidos de America de cuolquier 1espor.sabilul,1C 
que pudicran tener por no proporcionar el tratamicnto o 
procedimienlo(s) aqul descrilos. Doy fe de QlJe soy mayor de 
dieciocho a,'tos y q,,e me cnr:uentro en plen,w fa1cull,1des 111on!r;1iF:~-
par;i ejecutar esta responsabilidad. lO/l0/ 20JS 
/{)~ 07) _JJ!/__~µ_· 0 
Time/Hora DB\11/FF:ch:.1 
bX6); (b){?)(C) 
Printnd Signature 
b)(6); (b)(?XC) 
ERROR rintei Signature 
L:._ -~Z.A b ·2'o 4' · 80.2-- : Date ol Camp Arrival {DCAJ: I 2,-./f ~ /2..-1:=> 1 7 
H-l~iC ror111 020-S 01/2011 
Sex: 
Male 
Page 1 of 1 
2019-lCU-00051 3534 
-------·, 
DHS-ICE-19-0196, 19-0197-O-000218

!CE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratam.iento Medico 
---;--.. -,s-t-5!0-Ce-.r-,i-fy-1-h;-;1~:-. __ A~·-·N\e.c~~~ V\;:--~=~;esenlf! cellific<: q~ Yt'·--- --~~===~~~ 
;; de!ained alien m t11e custody of lmmigratior. am1Jc~stoms exlranjero(aJ delenido(a) b.ijo cuslodia ool SefVicic t1o:: Jnmi;ir;idt'ln 'i 
Enlorcement {ICI:). l":ive refused to consent to U1e lai!owil;g: Control de Ad1.Iarws {ICE. slglas cm in{/1~5], me Ile n09ado a ,ec,hir 
lo siguiente; 
:.J .1) lntvke Screening IB] b) Medical Treatment O c) Medlcal Procedure(s) [8) d) Medication<~) 
,:>! V-Jloraci6n Medica b) Tratamiento Medico c) ProcedimiP.nto(s) Medico(s) d) Me<1icamen1ccsl 
:-pec:ly 1reaz;r-:11 ;~ '.neu1ca1ion been refused: /Especifique e! tratamiento o medicamenlo mci1azado: 
---·----~--~~-..B_o!?5.l. __ a,A1 d_ r'~dmly te..--~--t·_n_ef1/YJ-12M5,-- --·····--··· - ~;:;il:i r2.tsor> 11'.:.xp~que :J ,;;;'.6li. 
- dY~_S..,_...,_t-<: ......... ,·=~=----------------
,., .. · •u,,un," o,:.·uu p,..:i....,i-<1,,, ""'hO•O aionofuro :iopc.:,r~ OOIC)U.f has 
~xplained the neccesily tor lhe above described. I un ersta11C1 lhal 
,1,r: nossihle or pr0t1allle consequences of my refusal include; 
:.:~-,-~~1 •e::11i!~.<l'..'.'.'.e_1_::,!':.a(ioo v. 11 not be achieved: ther~~, .... v ___ _ 
i,r0lo~n!J. n~! ,m_2r<,•:•'1']_ ur rf:solvi~g _lh~ medicnl condition for 
•;1l~!cl1 1ne mcdi::a::c:n was .. c:fl.:.:re:.:s:.::cc..;ricab.::.e.::.d.:.... ___________ _ 
:i In a language Iha! I understand, I ha~e been informed lhat refusal 
JI this treatment or procedure may jeopardize my health andior 
iilc. but ii is. nonetheless. my wish that my refusal be henored. I 
,ereby rP.iease lhe U S Immigration and Custom Enforcement 
1•cm. and the United States of America from any liability that I 
,niglll ;:i5serl lor noi (irovid1r.g the treatment or procedure(s) 
ar::-;cribcd t1cre,r- 1 tillf:'.-t lh::it I am over tile age ol eighteen 
,,t,ar:, ;111,:i I .i1ri rn<,n,.-~l:y comoelent to execute lliis release. 
S1gn<iture o( Delc1inee/Fi«na de! Detenido 
2. El oroveeaor de servicios Cle salud cvya firma apama: al final me h;1 
cxp\lGOCJO f,;;,i lllti.'::ICvt!.uJ-.,a <Ju tl-wvnr ta e~•:.,c, IC"J ,Uuoc..'l••~ ... ~nll:u,J. t:,.,1:<,tHf•> 
que las posibles o probables coosecuencias cle mi ncgaliva incluycn· 
Desired cesu\ls or lllfQ!.ca!ion will not be ;:1chievf:.Q,..!1!.1;?el?Y_ .. ______ _ 
e,:olongmg,Pol improvi~r resolving lhe mecl,cal :::onrf1hori lo, ___ _ 
which the medic,11inn was prescribed. ___ _ _____ _ 
3. En un !enguaje que entiendo, se me ha informa<Jo que la nega1iY;; ue 
este tratamienlo o procedimiento puede poner en peligw mi_ salud 
yJo mi vida, sin embargo, es mi deseo que mi negativa sea cumpli:Ja. 
Por el presente media libero 2 la Oficina de lnmigracion y Adua:,;:,:.: 
(ICE), y los Estados Unidos de America de cualquior respor,s.ibil1m1c 
que pudieran tener por no proporcionar el lratamicnto o 
procedimienlo(s) aqui dP.scrltos. Doy fe de que :;oy rn:iyor de 
dieciocho nno:; '! que ma nncuentro en plem1~ r;1r.ull;1des mr:r.falr:~ 
para ejecutar esta responsabilidao. 
P,)(6); {b){?)(C) .,_.lb..,,l/-"-'6\:....· _Ji ____ _ 
( 0 1£,v 
Firma do! Provr-.r,,10, nE Servicios de Salucs 
)(6); (b)(?)(C) 
·-·---Siqnature ol tCE Official (If applicable) 
: L~~, Nafllfl AVV'. a_~ 
l,.-·------
i Date or Camp Arrival (DCA): 
i 
P1inleo Signalure/Firma •.:c,11 lctra <Jo lin,::rent;; 
Printed Signature 
First Name: m .tL r 7f!WI 5 tU//l)v ____ _ 
Country of Origin: f2-t1 { _(;--~ 
r;-edica\ Clinic: Sex: 
i NWD_c _____ , ____________________________ ..I._-M::a::le:::::::::::::::::::::::::::::::::::::.-::::_-::::_-:_---- - ·------------' 
------------------·----·••«....---~- -~--~------ ov2c1, Page 1 of i 
2019-/CU-00051 3535 
DHS-ICE-19-0196, 19-0197-O-000219

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
1. This is to certify that 1,AMAR, MERGEN SANA , 
a detained alien in the custody of Immigration and Customs 
Enforcement (ICE), have refused to consent to the following: 
D a) Intake Screening 
a) Valoraci6n Medica 
Db) Medical Treatment 
b) Tratamiento Medico 
1. Con la presente certifico que yo,AMAR, MERGENSANA 
extranjero(a) detenido(a) bajo custodia del Servicio de lnrnigraci6n y 
Control de Aduanas (ICE, siglas en ingles), me he negado a recibir 
lo siguiente: 
~ c) Medical Procedure(s) D d) Medication(s) 
c) Procedimiento(s) Medico{s) d) Medicamento(s) 
Specify treatment or medication been refused: /Especifique el tratarniento o medicamento rechazado: 
LUNCH 
State reason: /Explique la razan: 
HUNGER STRIKE 
2. The health care provider whose signature appears below has 
explained the neccesity for the above described. I understand that 
the possible or probable consequences of my refusal include: 
may decrease nutritional value need for good health; resulting in 
weight loss below body requirements for sustenance cf life. May also 
cause decreased wound healing and/or poor oral health. 
3. In a language that I understand, l have been infonned that refusal 
of this treatment or procedure may jeopardize my health and/or 
life, but it is, nonetheless, my wish that my refusal be honored. l 
hereby release the U.S. Immigration and Custom Enforcement 
(ICE), and the United States of America from any liability that I 
might assert for not providing the treatment or procedure(s) 
described herein. I attest that I am over the age of eighteen 
years and I am mentally competent to execute this release. 
1gnature o ea 
Finna del Proveedor de Servicios de Salud 
r'"''• (b)(/)(C) • t￾Signature of Witness/Finna del Testigo 
Signature of ICE Official (!f applicable) 
Last Name: 
AMAR 
A#: 
216269802 
2. El praveedor de selYicios de salud cuya firma aparece al final me ha 
explicado la necesidad de llevar a cabo lo descrito arriba. Entiendo 
que las posibles o probables consecuencias de mi negativa incluyen: 
may decrease nutritional value need for good health; resulting in 
weight loss below body requirements for sustenance of life. May also 
cause decreased wound healing and/or poor oral health. 
3. En un tenguaje que entiendo, se me ha informado que la negativa de 
este tratamiento o procedimiento puede pcner en peligro mi salud 
y/o mi vida, sin embargo, es mi deseo que mi negativa sea cumplida. 
Pore! presente medio libero a la Oficina de lnmigraci6n y Aduanas 
(ICE), y las Estados Unic:Jos de America de cualquier responsabilidad 
que pudieran tener por no praporcionar el tratamiento o 
procedimiento(s) aqul descritos. Doy fe de que soy mayor de 
dieciochc a~os y que me encuentro en plenas facultades mentales 
para ejecutar esta responsabilidad. 
First Name: 
MERGENSANA 
Country of Origin: 
RUSSIA 
DOB: 
10/23/1978 
Sex: 
Male 
12:00:00 PM 
Time/Hora 
Printed Signature/Firma con Letra de lmprenta 
GEd(b)(6); (b)(7)(C) 
Printed Signature/Firma con Letra de lmprenta 
Printed Signature 
IHSC Form 820-S 01/2011 Page 1 of 1 
2019-ICLl-00051 3536 
DHS-ICE-19-0196, 19-0197-O-000220

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
1. This is to certify that 1,AMAR, MERGENSANA , 
a detained alien in the custody of Immigration and Customs 
Enrorcement (ICE), have refused to consent to the following: 
D a) Intake Screening 
a) Valoraci6n Medica 
D o) Medical Treatment 
b) Tratamiento Medico 
1. Con la presente certifico que yo,AMAR, MERGENSANA 
extranjero(a) detenido(a) bajo custodia del Servicio de lnmigraci6n y 
Control de Aduanas (ICE, siglas en ingles), me he negado a recibir 
lo siguiente: 
[gJ c) Medical Procedure(s) D d) Medication(s) 
c) Procedimiento(s) Medico(s) d) Medicamento(s) 
Specify treatment or medication been refused: /Especifique el tratamiento o medicamento rechazado: 
DINNER 
State reason: /Explique la raz6n: 
HUNGER STRIKE 
2. The health care provider whose signature appears below has 
explained the neccesity for the above described. I understand that 
the possible or probable consequences of my refusal include: 
may decrease nutritional value need for good health; resulting in 
weight loss below body requirements for sustenance of life. May also 
cause decreased wound healing and/or poor oral health. 
3. In a language thal 1 understand, I have oeen informed that refusal 
of this treatment or procedure may jeopardize my health and/or 
life, but ii is, nonetheless, my wish that my refusal be honored. I 
hereby release the U.S. Immigration and Custom Enforcement 
(ICE), and the United States of America from any liability that I 
might assert for not providing the treatment or procedure(s) 
described herein. I attest that I am over the age of eighteen 
years and I am mentally competent to execute this release. 
Firma del Proveedor de Servicios de Salud 
(b)(6); (b)(?)(C) 
igo 
Signature of ICE Official (If applicable) 
Last Name: 
AMAR 
A#: 
216269802 
Date of /~p ri~t ([fj () /-=t￾Medical Clinic! -
NWDC 
2. El proveedor.de servicios de salud cuya firma aparece al final me ha 
explicado la necesidad de llevar a cabo lo descrito ar,iba. Entiendo 
que las posibles o probables consecuencias de mi negativa incluyen: 
may decrease nutritional value need for good health; resulting in 
weight loss below body requirements for sustenance of life. May also 
cause decreased wound healing and/or poor oral health. 
3. En un lenguaje que entiendo, se me ha infonnado que la negativa de 
este tratamiento o procedimiento puede poner en peligro mi salud 
y/o mi vida, sin embargo, es mi deseo que mi negaliva sea cumplida. 
Por el presente medio libero a la Oficina de l11migraci6n y Aduanas 
(ICE), y los Estados Unidos de America de cualquier responsabilidad 
que pudieran tener porno proporcionar el tratamiento o 
procedimiento(s) aqul descritos. Doy fe de que soy mayor de 
dieciocho ar'los y que me encuentro en plenas facullades mentales 
para ejecutar esta responsabilidad. 
5:00:00 PM 
Time/Hora 
~)(6); (b)(?)(C) IRN 
Printed Signane/Flrma eon Letra de !mprenta 
b)(6); (b)(?)(C) 
Printed Signature 
First Name: 
MERGENSANA 
Country of Origin: 
RUSSIA 
DOB: 
10/23/1978 
Sex: 
Male 
IHSC Form 820-S 01/2011 Page 1 of 1 
2019-ICLl-00051 3537 
DHS-ICE-19-0196, 19-0197-O-000221

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
1. This is to certify that 1. OfVl'-z,Jl 1 /VI~ en'18,:1a_ 
a detained alien in the custody of Immigration ad Customs 
Enforcement (ICE), have refused to consent to the following: 
D a) Intake Screening 
a) Valoraci6n Medica 
~ b) Medical Treatment 
b) Tratamienlo Medico 
1. Con la presente certifico que yo, __________ _ 
extranjero(a) delenido(c1) bajo custodia del Servicio de lnmigraci6n y 
Control de Aduanas (ICE, slglas en ingll!s), me he neg ado a reciblr 
lo siguienle: 
D c) Medical Procedure(s) 
c) Procedimiento(s) Medico(s) 
0 d) Medication(s) 
d) Medicamenlo(sJ 
Specify treatment or medication been refused: /Especifique el tratamiento o medicamento rechazado: -\-" 
~~ M J) ~ 3:v-R \-\ -1c\ Q ~ k½-t ¼ [y\..Q., b 
2. The health care provider whose signature appears below has 
explained the neccesity for the above described. I understand that 
the pos ible or probable cons uences of my refu al include: 
2. El proveedor de servicios de salud cuya firma aparece al final me ha 
explicado la necesidad de llevar a cabo lo descrito arriba. Entiendo 
ue las posibfes o probables consecuencias de mi negativa incluyen: 
~=t~~~~~~!±~~~~:±t~~~~~ \ 0/\ ty'\ 8 \C VV1 llr...rA.~ ·\-o u~:UsS · 
__ 
__ 
M~~-d~o-CA 
.._.f\=~=--='---"'"'-'--'---,-~--VV\..-· 
.......... eCJ2.b...A~~-h_v...._b: 
_.,,r 
___ 
...,."-.&!'-""-'-f\r:.--h;=:t-_O_c_2~S5.) 
i ____ o __ n;_,J, __ u_~_ 
r' L 
m..g 
~jV-(.A..--b 
«l ~ ~10 
f'v r 
ci 
s 
~ 
v1. 5 I----e. V\O., "'u. l,f'...e 
3. In a language that I understand, I have been informed that refusal 
of this treatment or procedure may jeopardize my health and/or 
life, but it is, nonetheless, my wish that my refusal be honored. I 
hereby release the U.S. Immigration and Custom Enforcement 
(ICE}, and the United States of America from any liability that I 
might assert for not providing the treatment or procedure(~) 
described herein. I attest that I am over the age of eighteen 
years and I am mentally competent to execute this release. 
b}(6); (b}(7)(C} 
Signature ofWitness/Firma del Testigo 
Signature of ICE Official (If applicable) 
Last Name: 
ttv 
A#: 
Date of Camp Arrival (DCA): 
I 17 
Medical Clinic: 
NWDC 
3. En un !enguaje que entiendo, se me ha informado que la negativa de 
este tratamiento o proced1miento puede poner en peligro mi salud 
y/o ml vida, sin embargo, es mi deseo que mi negativa sea cumplida. 
Porel presente medio libero a la Oficina de lnmigraci6n y Aduanas 
(ICE), y los Estados Unidos de Amerlca de cualquier responsabilidad 
que pudieran tener porno proporcionar el tratamiento o 
procedimiento(sJ a qui descritos. Doy fe de que soy mayor de 
dieciocho ai'ios y que me encuenlro en plenas facultades me11lales 
para ejecutar esta responsabilidad. 
Time/Hora 
(b)(6}; (b)(7}(C) 
LICSW CD 
Prmte SIgnature/Firma con Letra de Imprenta 
r6); (b)U)(C) 
Printed Signature/Firma COil Letra ae lmprenta 
Printed Signature 
First Name: {N\ CO V--
Country of Origin: 
DOB: 
Sex: 
Male 
IHSC Form 820-S 01 /2011 Page 1 of 1 
2019-ICLl-00051 3538 
DHS-ICE-19-0196, 19-0197-O-000222

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
1. This is to certify th.at J, 22,1:0:1 I Jv1~.-,~ 'q. 
a detained a::eo in the cuslody of lmmigratiort'ind Customs 
Enforcemenl (ICE), have refused to cor.sont to the following: 
0 a) Intake Screening 
a) Valoraci6n Medica 
0 b) Medic.al Treatm0I1t 
b) Tratamiento Medice> 
1. Con la presente certifico quo yo, __________ _ 
extranjero(a) datsnido(a) bajo custodia del Servicio de lnmigraci6n y 
Control de Aduanas (ICE. •il!fas en lngl~•), me he negado a recibir 
lo sigulonto: 
0 c) Medical Procedure(s) 
c) Procedimiento(s) MMiCO(•l 
J<r§' Medication(•) 
d) Medicamento(s) 
Specify treatment or rr.edlca~on been refused: /Especifiqve el tratamiento o medicamento rechai:ado: 
::I~feool ~ p □ (o 
State reason: /E~plique la rai6n 
PaA-i~n-1- s~+ed ''.Jo" WNL.i"\ qffcrc.d rvu.dic..n-ti""' ...fuv pcur,. 
2. The health care provider Whose signature appears below has 
explained the ooccesity for tho above described. I understand that 
the possible or p ro~~!e cons eo. uences of my ref us al in dude: 
Refusal to comply wi1h medical appointments or treatments can 
delay reoovery or prevent accurate diagnosis of potential inness￾Wrthout base~r.e info we are unable to track changes 
3. In a language tnat I understand. I ha\10 been informed that refusal 
of this treatment or procedure may jooparrlize my health and/or 
life, but ii is, nonetheless, my wish that my refusal ba honored. I 
hereby release the U.S. lmrr.igration and CtJstom Enforcement 
[!CF..), and the United States of America from any liability that I 
m,ght assert for not providing the trea1ment or pro::ed11re[•l 
cescnbed herein. I aUcsr 1hat I am over the age ofefghteen 
year.i and I am rr.entally competent to execute this release. 
Signature 01 DetaineaJFirm del Detenido 
(b)(6); (b)(7)(C) 
l(b)(6); (b)(7)(C) L 
Signature of Witness/Firma del Tesijgo 
Signature of ICE Official (It applicable) 
Last Name: , --- ---
A#: 
2. El proveedor de servicios de salud euya firma aparece al final me ha 
explicado la necesidad de llevar a cabJ lo descrito arriba. Entiendo 
que las posibles o probables consecuenciasde mi negativa incluyen: 
Refusal to comply with medical appoil'ltrnents or treatments can 
delay recovery o.-prevent accurate diagnosis of potential illness￾Wlthout baseline info we are 1mable to track changes 
3. En un languaje qoo enliendo, se me ha iMomtado que la negatlva de 
este tratamiento o procedimienlo puede poneren poligro rnl salud 
ylo mi vicla, sin embargo. es mi deseo que mi negativa sea cum;>lida. 
l'or el presoote media libero a la Oficina de lnmigracioo y Aduanas 
(ICE), y los Estados Unidos de America de cualquler responsabilidad 
qua pudieran tener porno pro;iorcionarel tratamiento o 
procedimiento(s) aqu I descritos. Doy le de que soy mayor de 
dieciocllo a nosy que me encuenlro an plenas facultades mMtales 
para ejecutar esla rooponsabilidad. 
JFirsl Name: 
Olo30 
Time/Hom 10/0'( /,"'i. 
Date/Fe cha 
b)(6); (b)(7)(C)i.:.RN::.:.... __ _ 
-ec-Pn~.n~te-d~S=i--19,__ ____ ....z-tra de lmprenta 
(b)(6); 
(b)(7)(C) 
---
Printed Signature 
AMAR, MERGENSANA 
Oate cf Camp Arrival (DCAJ: 1\#: 216269802 RUSSI 
DCA: 12/1912017 DOB: 10123/1978 
Medical Clinic: Facility: NWDC Tacoma. Sex: male 
[Male 
IHSC Form 820-S 01/2011 Page 1 of 1 
2019-ICLl-00051 3539 
DHS-ICE-19-0196, 19-0197-O-000223

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
1. "'."his is to certify lhal I, ~ 11\D rf:p., '!',. & la presente cartifico quc yo, ____ .. ·--,--,----- , 
a delai~ed alien!~ t~.e cuslody of Immigration and Cus c~ extranjero(a) delenido(a) bajo custodia de1 Servicio de lnmigraci6n y 
E nfo,oernent (ICE), have ref"scd to consent to lhe following: Cc.1trol de Aduana5 (ICE, sic las"" ing!t\s), m~ he nega:lo a recibir 
\ lo siguie~: 
D a) Intake Screenir,g M'bJ Medjcal Treatman! B'c) Medical Procedure(sJ O d) Meaication(s) 
a) Valoracion Meoica "f'/ii Tratamienlo M~dico c) Procedimienlo(s) Medico(,) d) Modio•men:n1,) 
2. The health care p,oviderwnose s'gnalu,e appears below has 
explained l1e neccc3ily for lhP. shove described. I unc'erslasd lhal 
I oossib' or Moh : 
~ 
. ·-~ 
~~+-'1-~44,.1-,!,-J,!_,_J~~~ 
,4..C'.I.l'4---jll~.....,.._I0,-4'jl,7"'--'Q')XJ.li,1 A ::, 
3. In a language lhat I understand, I have been informed t~at refusal 
al this trealment or procedure may jeopardize my heallh and/or 
life, b,t ii is, none111eIe~s, my wis!l thal my refusal be honored. I 
hereby release Iha U.S. lmrnigra~on and Cus'.om Enforcement 
:re&: aed Iha Unilcd Slates of Amerlea from any l'abilily that I 
n:ight assort for r.ol providing lhe treatment or proc..dure<s) 
dcsc,ibed herein. I a1test thal I am over lhe age of eighteen 
years and I am menially competent to execute this release. 
1rm.a dcl TnstiJo 
Signatute or ICE. Official ~r •p~m:,.ble) 
2. El proveedor de ser\l'icios d& '$alud cuya firma apa":ce ol ri:131 me ha 
e,c,plic::?.do .
1
a .ru::cPJsk1c,d de llever .a cabo lo aescruo arrilla. Erttit:;Rl1J .c:iw...,•r.,.. po.lt:alo• o p~9b,i,b1aa ....,_,..,..-=:,.,-,..c,,... aio '""l ,., .. ganva 1P'\C1u11:tn 
J. En un lenguaje que cnticndo, se me ha infOfmado q·Je la negativa ce 
este lrala:nienlo o procedimiento puede pooor en peligro mi salud 
ylo mi Vida, sin embargo, es mi deseo que mi ne,abva sea cum~lida. 
Pm el presenle n,edio libero a la Olicina de lnmlgraci6,, y Advanao 
(ICEJ, y lo, Est.1dos Unidos de America de c"alquier responsabil:dad 
q11e pe·dieran ten er por no proporc!onar el ttatarr.:ento o 
prccedimien!o{s) a qui descntos. Doy fe de G •• •"I mo~r de 
dleciccho a~os y que me enc"enlro en pl!,nas facultades mentales 
para ejecutar esla resi;onsabilidadC,~C, 
(b)(6); (b)(7)(C) 
(b)(6); (b)(7)(C) 
Prirded Sig ri,1 I 1Jrc 
IHSC Fonn 820-S 01/2011 Page 1 of 1 
2019-ICLl-00051 3540 
DHS-ICE-19-0196, 19-0197-O-000224

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
1. This is to certify that l,....._,'--"-''--""-'--"--+-.:........:,""-''-"'I,....._._=......, 
a detained alien in the custody of lmmigratio and Customs 
Enforcement (ICE), have refused to consent to the following: 
D a) Intake Screening 
a) Valoraci6n Medica 
D b) Medical Treatment 
b) Tratamiento Medico 
1. Con la presente certifico que yo, ___________ _ 
extranjero(a) detenido(a) bajo custodia del Servicio de lnmigraciOn y 
Control de Adu an as (ICE, siglas en ingles}, me, he negado a recibir 
lo siguiente: 
ff] c) Medical Procedure(s) D d) Medication(s) 
~ Procedimiento(s) Medico(s) d) Medicamento(s) 
Specify treatment or medication been refused: /Especifique el tratamiento o medicamento rechazado: 
Detainee refused breakfast. 
State reason: /Explique la razOn: 
r • - I ,, 
\ 1 0'l i?:r:' 0., t.. M-:11\---9 M. ~tc, k-, 
2. The health care provider whose signature appears below has 
explained the neccesity for the above described. I understand that 
the possible or probable consequences of my refusal include: 
~ [V):';q_ bilY>tN JM.a J.,, o 14C ,-s 6.2o/, l-tc k.;/JJ 
4uf-cier:ii3 Tor ~l"f?PCP&11Crfi 0t11 U¼iA101-/DOC 
Lo.a 1th ec <?J4'<Vl d.uth. 
3. In a language that I understand, I have been infonned that refusal 
of this treatment or procedure may jeopardize my health and/or 
life, but it is, nonetheless, my wish that my refusal be honored. I 
hereby release the U.S. Immigration and Custom Enforcement 
(!CE), and the United Stales of America from any liability that I 
might assert for not providing the treatment or procedure(s) 
described hsrein. I attest that I am over the age of eighteen 
years and I am mentally competent to execute this release. 
r)(6); (b)(7)(C) t' 
Si9"a .ue of AMI&\ Can, P"""der/ 
Firma del Proveedor de Servicios de Salud 
Signature of ICE Official (!f applicable) 
Last Name: 
AMAR 
A#: 
216269802 
Date of Camp Arrival (DCA): 
f-;;..J I q f')....()11 
Medical Cl(nic: 
NWDC 
2. El proveedor de servicios de salud cuya firm a aparece al final me ha 
explicado la necesidad de llevar a cabo lo descrito arriba. Entiendo 
que las posibles o probables consecuencias de mi negativa incluyen: 
3. En un lenguaje que entiendo, se me ha informado que la negativa de 
este tratamiento o procedimiento puede poner en peligro mi salud 
y/o mi vida, sin emb_argo, es mi deseo que mi negativa sea cumplida. 
Por el presente media libero a la Oficina de lnmigracion y Aduanas 
(ICE), y los Estados Unidos de America de cualquier responsabilidad 
que pudieran tener por no proporcionar el tratamiento o 
procedimiento(s) aquf descritos. Doy fe de que soy mayor de 
dieciocho anos y que me encuentro en plenas facultades mentales 
para ejecutar esta responsabilidad. 
First Name: 
MERGENSANA 
Country of Origin: 
RUSSIA 
DOB: 
10 / ;i.:1, I, ci,9. 
Sex: 
Male 
Time/Hora 
oqft~/µrg 
odte/~echa 
LCDRl(b)(6); (b)(7)(C) I 
Printed Signa ure/Firma con Letra de lmprenta 
(b)(6); (b)(7)(C) 
1gnature Firma con Lelra de lmprenta 
Printed Signature 
IHSC Form 820-S 01/2011 Page 1 of 1 
2019-ICLl-00051 3541 
DHS-ICE-19-0196, 19-0197-O-000225

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
1. This is to certify that ],AMAR, MERGENSANA 
a detained alien in the custody of Immigration and Customs 
Enforcement (ICE), have refused to consent to the following: 
D a) Intake Screening 
a) Valoraci6n Medica 
D b) Medical Treatment 
b) Tratamiento Medico 
1. Con la presente certifiCQ que yo, AMAR, MERGENSANA 
extranjero(a) detenido(a) bajo custodia del Servicio de lnmigraci6n y 
Control de Acluanas (ICE, siglas en ingles), me he negado a recibir 
lo siguiente: 
IRJ c)Medical Procedure(s) 
c) Procedimiento(s) Medico(s) 
D d) Medication(s) 
d) Medicamento(s) 
Specify treatment or medication been refused: /Especifique el tratamienlo o medicament□ rechazado: 
Breakfast 
State reason: /Explique la raz6n: 
Detainee stated, "I am on a hunger strike." 
2. The health care provider whose signature appears below has 
explained the neccesity for the above described. I understand that 
the possible or probable consequences of my refusal include: 
Medical condition may deteriorate, causing poor health or even 
death. 
3. In a language that I understand, I have been informed that refusal 
of this treatment or procedure may jeopardize my heaJth and/or 
life, but it is, nonetheless, my wish that my refusal be honored. I 
hereby release the U.S. Immigration and Custom Enforcement 
(ICE}, and the United States of America from any liability that I 
might assen for not providing the treatment or procedure(s) 
described herein. I attest that I am over the age of eighteen 
years and I am mentally competent to execute this release. 
Signature of I CE Official (If applicable) 
Last Name: 
AMAR 
A#: 
216269802 
Date of Camp Arrival (0CA): 
ll.. If '1 / fl 
Medical Clinic: 
NWDC 
2. El proveedor de servicios de salud cuya filTila aparece al final me ha 
explicado la necesidad de llevar a cabo lo descrito arriba. Entiendo 
que las posibles o probables consecuencias de mi negative incluyen: 
Medical condition may deteriorate. causing poor health or even 
death. 
3. En un lenguaje que entiendo, se me ha informado que la negativa de 
este tratamiento o prccedimiento puede poner en peligro mi salud 
y/o mi vida, sin embargo, es mi deseo que ml negativa sea cumplida. 
Por el presente medio libero a la Oficina de lnmigraci6n y Acluanas 
(ICE), y los Estados Unidos de America de cualquier responsabilidad 
que pudieran tener porno proporcionar el tratamiento o 
procedimienlo(s) aqul descritos. Doy fe de que soy mayor de 
dieciocho anos y que me encuentro en plenas facultades mentales 
para ejecutar esta responsabilidad. 
Q5'.t5fh,v\ 
Time/Hora 
oq/(~ lrb 
Date/Fecha 
Lcocl<bJ(6J; (bJ(7J(CJ I 
Printed Signature/Firma con Letra de lmprenta 
.... rb-)(6-);-(b-)(-7)-(C-) __ ____,~N 
Printed Signature/Firma con Letra de lmprenta 
Printed Signature 
First Name: 
MERGENSANA 
Country of Origin: 
RUSSIA 
DOB: 
10/23/1978 
Sex: 
Male 
IHSC Form 820-S 01/2011 Page 1 of 1 
2019-ICLl-00051 3542 
DHS-ICE-19-0196, 19-0197-O-000226

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
1. This is to certify that 1,AMAR, MERGENSANA , 
a detained alien in the custody of Immigration and Customs 
Enforcement (ICE), have refused to consent to the following: 
D a) Intake Screening 
a) Valoraci6n Medica 
D b) Medical Treatment 
b) Tratamiento Medico 
1. Con la presente certifico que yo,AMAR, MERGENSANA 
extranjero(a) detenido(a) bajo custodia del Servicio de lnmigracion y 
Control de Aduanas (ICE, siglas en ingles), me he negado a recibir 
lo siguiente: 
(g] c) Medical Procedure(s) D d) Medication(s) 
c) Procedimiento(s) Medico cs) d) Medicamento(s) 
Specify treatment or medication been refused: /Especifique el !ratamiento o medicamento rechazado: 
LUNCH 
State reason: /Expl!que la raz6n: 
HUNGER STRIKE 
2. The health care provider whose signature appears below has 
explained the neccesity for the above described. I understand that 
the possible or probable consequences of my refusal include: 
may decrease nutritional value need for good hea!th; resulting in 
weight loss below body requirements for sus1enance of life. May also 
cause decreasad wound healing and/or poor oral health. 
3. In a language lhat I understand, I have been informed that refusal 
of this treatment or procedure may jeopardize my health and/or 
life, but it is, nonetheless, my wish that my refusal be honored. I 
hereby release the U.S. Immigration and Custom Enforcement 
(ICE), and the United States of America from any liability that I 
might assert for not providing the treatment er procedure(s) 
described herein. I attest that I am over the age of eighteen 
years and I am mentally competent to execute this release. 
Signature of ealth are Provider/ 
Firma del Proveedor de Servicios de Salud 
r,x,,. (b)(7)(C) b --
Signalure o'rWitness/Firma del Testigo 
Signature of ICE Official (If applicable) 
Last Name: 
AMAR 
A#: 
216269802 
2. El proveedor de servicios de salud cuya firma aparece al final me ha 
explicado la necesidad de llevar a cabo lo descrito arriba. Entiendo 
que las posibles o probables consecuencias de mi negativa incluyen: 
may decrease nutritional value need for good health; resulting in 
weight loss below body requirements for sustenance of life. May also 
cause decreased wound healing and/or poor oral health. 
3. En un lenguaje que enliendo, se me ha informado que la negativa de 
este trataniiento o procedimiento puede poner en peligro mi salud 
y/o mi vida, sin embargo, es mi deseo que mi negativa sea cumplida. 
Por el presente media libero a la Oficina de lnmigracion y Aduanas 
(ICE), y las Estados Unidos de America de cualquier responsabilidad 
que pudieran tener porno proporcionar el tratamiento a 
procedimiento(s) aquf descrilos. Doy fe de que soy mayor de 
dieciocho arlos y que me encuentro en plenas facullades mentales 
para ejecular esta responsabilidad. 
First Name: 
MERGENSANA 
Country of Origin: 
RUSSIA 
DOB: 
10/23/1978 
Sex: 
Male 
11:52:00AM 
Time/Hora 
l(b)(6); (b)(7)(C) ~N 
Printed Signaf relflrma con etra de Jmprenta 
Printed Signatur e lmprenta 
Printed Signature 
IHSC Form 820-S 01/2011 Page 1 of 1 
2019-ICLl-00051 3543 
DHS-ICE-19-0196, 19-0197-O-000227

ICE Health SeNice Corps 
Refusal Form/Formulario de Negativa a Reclblr Tratamiento Medico 
1. This is to certify lhat l,AMAR. MERGENSANA , 
a detained' alien in tho custody of lmmigratioo and Customs 
Enforcement (ICE), have refused to aonsent lo the following: 
D a) Intake Screening 
a) va1oraci6n Medica 
~ b) Med,cal Treatment 
b) Tratamiento Med1ao 
, . Con la presente certifico que yo, AMAR, MERGEN SANA 
extranjero(a] detenidO(a) tlajo custodia del Servicio de lnmigraci6n y 
Conb'ot de Aduanas ~ce. ~glas enltlgles), me t.e neg ado a recitlir 
lo siguiente: 
[8] c) Medical Proccdurojs) 
c) Procedimienlo(s) M~ioo(s) 
D d) Me~ication(•) 
d) Medicamento(s) 
Specify treatment or medioation teen refused: /Especifique el tratamiento o medicarnen1o rochazoo□: 
dinner 
State reason IExplique (a raz6n: 
HUNGER STRIKE 
2. The health care provider wtiose signature appears below ha! 
ei,plained· the necoesity for the above described. I understand that 
tl1e possible orprooobkJ consequences of my refusal include: 
may decrease nut,Wonal valuo need for good health: resulting In 
weight less below body requirements for sustenance of life. May also 
cause decreased wound healing and/or poor oral healtll. 
3. In a language that I understand, I have been infomred that refusal 
of 1his trealme,,t or proce<1111e may jeopardize my hoolth and/or 
fife, but it is, nooelheless, my wish that my refusal be hooOfed. I 
hereby release the U.S. Immigration ar.d Custom Enforcement 
{ICE), and the United Sta:es of America from any liebdify lhat I 
might assert for not providing the treatment or procedure(s) 
described herein. I attest that I am over the age of eighteen 
years and I am mootatly competent to execute this release. 
Jb)(6); (b)(7)(C) l 
s.g11acute 01 UVldle§S,fltma aet l@Sfi§O 
Signature of ICE Official (If ;,ppllcable) 
Last Name: 
AMAR 
A#: 
216269802 
Dato of Camp~ (i''la / 1 !fl 11-' 
Medical Clinic: I l 
NWDC 
2. El pmveedor ce ~ervicios de salud cuye finma aparec.! al final me ha 
explicado la necesidad de i:evar a ec1bo lo descrito arriba. Entiendo 
que las posiblas o probables consocuencia, de mi negativa incluyen: 
may decrease nutritional va:ue neM for gacd health: resulting in 
weight loss below body reguiremen!s for sustenance or [le. May also 
cause decreased wouml healin9 and/or poor oral heatth. 
3. En un fenguaje que entiecido, se mo ha infomredo que la nega~vade , 
este b'alam!ento o procedimiento puede poner en peligro mi salud 
y/o mi vida, sin embargo, es mi deseo quc mi negativa sea cumplida. 
Par Bl presente rriedio libero a la Oficina de lnmigraci6n y Adtmn2s 
(ICE), y las Estados Unldos de Amt'lrica de cualquier responsabilidad 
quo pudiaran tenerpor no proporclonar el tratam'ento o 
procec!imiento(s) aqu( descritos. Doy fa de que soy mayor de 
dieciocho afios y quo me encuentro en p:enas facullades men!ales 
para e;ecutar esta responsabiliclad. 
First Name: 
MERGENSANA 
Countly of Origin: 
RUSSIA 
DOB: 
10/23/1978 
Sex: 
Mal& 
5:QO;OQ PM 
Time/Hora 
Printed Signalure/Fi<ma con Lella de lmprenta 
l(b)(6); (b)(7)(C) I 
Printed Signature/Firma oo~ Letra de lmprenla 
Printed S:gnature 
IHSC Form 820-S I 0112011 Page 1 of1 
2019-ICLl-00051 3544 
DHS-ICE-19-0196, 19-0197-O-000228

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
1. This is to certify lhat '·-/_,4;,' ..,....,=• ~ ~<,1/ ..-a _/ a detained a!'en In the custody of lm~;-,r￾En'.or:;emenl (IC:), havs refusell to conwnt to mo roIIowin~: 
O a) Intake Screer.1:)f; 
a) Vatoraci6o M~:ca 
Ob) Mecical Tre~tm.ent 
bl Tralamie1lo Medial 
~enl or,medi<:ation bee;1 
State reasc:i: /Explique la ra~n~:J 
ac,Kt,1714->o I {J__J-°g_ J . 
1. Coo la presenle certifico qua yo,--,--,--,-----.,..--,--
extraniero(a) detenido(a) bajo c:JStcdia del SeNic:o de lnmlgraei¢n y 
Control de Aduar.as 11c· ...S191., en ing;es1, me he neg ado a rcclbir 
lo siguien:e: 
0 c) Medical ?r,:,cedure(s) 
c) ProcedimientO(,) M+dicojs) 
c;id) Medicat:on:s) 
· d) McdicamenlO(c) 
------- -------------------------------------- 2. The he~lth care provicer whose signatcre appear~ below has 
e:.plair.ed lllt r.eccesity for the above desotibod. I understand that 
the possible or probab'.e consequences of my rafusal include: 
~~ h1,M,!eA4/ 
J. In a language Ir.at I understand. I have been !:ifonncd ttmt reiusal 
ol tllis t1c2t1M01 or procedure may jeopardize my :ieanh and/c: 
1,fe. but it is. nonetheless, my wish that rr.y refusal be oonored. I 
haceby release the U.S. lmmlgra~on and Custom Enfcrcoment 
(ICE). and \ho United State~ cf America ftom any liability that I 
might as,ert for net prcviding the trea:ment or ~rocecure(s) 
<lescr.":>ed heroic.. 1 attest lhat I am over '.fie age of eigt.teen 
years and I am memally competent to execulc lh\s release_ 
- d5etale71'irm ~y -+e/4--,b 
de! Oetenido ~ b)(6); 
Signature or 'l'iltness/Flrma del Tesijgo 
Signature of I CE Officiel (IC £~ptieablc) 
~ --- ---- ---
AMAR, MERGENSANA 
- Ail: 216269802 RUSSI 
Date ~C~:ll-/i'7 /11 008: 10/23/1978 
- acl!lty; NWDC Tacoma. Sex: male 
Medica1 l..i1:m.:;, 
-
2. El proveedor de servicio& de sa:ud cuya firm a lipsrece al final me ~a 
e)(l)!icado la necesidadde llevar a cabo lo dascrito arriba. !:nt'enllo 
Que las poslbles o probables coosecueocia~ <le rr,i ne;iativa inciuyen: 
3. En un lenguaje que anticndo. se me ha inf<>:mado que la negotiva de 
este tratamiento o pro::edimianto puede ponere~ peligso mi sa!;,d 
y/o mi vldo, sin embargo, es ml desao q~e ml ncgativa sea c1:.11pli::!a. 
Porel presente medio libero a la Oficina de lnmigraci6n y Aduor>as 
(ICF.), y los Estados Unldos ae America de cua!quier respon$eb',i'dad 
que ;:,udieran tuner pJr no proporcic.,ar et tra:amiento a 
prcc!!dlmlento(s) aqul desc,itos. Doy le de que soy mayor de 
dieciodlo anos y que me encuentro en plent.s facullades menl31es 
para ajecuLar esta responsabilidad. 
(}8DD 
Time/Hora 
b)(6); (b)(7)(C) N 
rante gnatorcn-- rm~ con Letrs iltt 1n1prenia 
;JwDc... 
j~/~L, V l)ahMt<on ~P.f-icer 
Printed Signsh:relfirma con Letra de lm;»cnta 
Pri~ted S·.gnaturo 
·- First Name: 
--Country of Origin: 
006: 
Sex: I 
·, 
IHSC Form 820-S 0112011 Past 1 011 
2019-ICLl-00051 3545 
DHS-ICE-19-0196, 19-0197-O-000229

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
1. This is to certify that I, AMAR, ME;RGENSANA , 
a detained alien In the custody of Immigration and Customs 
Ento«.emenl (JCE), nave refused to consent 10 the following: 
D a) Intake Screening 
a) va10taci6n MMiea 
tb tl) Medical Treatment 
b) Tratamiento Medico 
1. Con ta presanle certifico que ya.AMAR. MEl<GENSANA 
extre.njero(a) detenido(a) cajo c~todia clel Servicio c!e lnmigraci/Jn y 
Control de Aduanas (ICE. slglas en 111g1~s), mehe negado a reC:!>ir 
lo sigli!ente: 
12) c) Medical Proced'~re(s) 
c) Procedimlento(s) M<kjloo{s) 
D d) Medjcation(s) 
d) Medicamento(s) 
Specify treatment or medicabon been refused: /Espccif.q~e el tralamien1o o med!camento rechazado: 
lunch 
State reason: ~l:(ltlo la raz6n · 
!-\UNGER STRIKE 
2. The health care provider whose s:gnature appears below has 
explained the ncoocsity for the above described. l understand that 
lhe possible or probable coo sequences of my refusal inciudo: 
may d~ase nutritional value need for good hea~th: resulfing in 
weight loss below body requirements for sustenance or life. May also 
cause decreased wo1.1nd healing and/or poor oral heallh 
3. In a language thal I understand, J have been inlormed that refusal 
o! this treatment or procedure may jeopardize my health and/or 
life, but~ is, nonethe:ess, my wish that my refusal be honored. I 
hereby release the U.S. Immigration and Custom Enforcement 
(ICE), and the United States of America from any liability lhat I 
might assert for not providing the treatment or proccdure{s) 
described horoin. I attesllhat I am over the age of eighteen 
yei rs ar.cl I am mentally competent to execu le this rel easo. 
Sig altire of eiat oo/Firma del Detonldo 
(b)(6); (b)(7)(C) 
'-----------.¥1·,deu 
Firma del Proveedor de Servicios de Salud 
l(b)(6), (b)(7)(C) t 
Signature ol Witness/Firms del Testigo 
Signature of ICE Official {If applicable) 
last Name: 
AMAR 
A#: 
216269802 
OateolCampAt?l~(Of7o / /"}-
Med'cal Clinic: I ( 
NWOC 
2. El proveedor de servicios de salud cuya firrna aparece al final me ha 
e,cplicada la necasidad de llevar a cabo lo descrito arriba. Entiendo 
que las posibles o probables consecuencias de mi negativa incluyen: 
may decrease nu!rilional ~alue need for good hearth· cesulbng in 
wei<;hl loss below tody reguiremenm for sustenance of life. May also 
cause decreased wound healing and/or poor oral health. 
3. En un lenguaje que entiendo, sa ma ha inlormai.lo que la negativa de 
esle tratamiento o procedimiento ptJecie paner en peligro ml safud 
y/o mi vida, sin embargo. es mi deseo qua mi negaliva sea cumplida. 
Par el presen!e medlo libero a la Oficina de lnmigraci6n y Aduanas 
(ICE]. y fos Esmdos Unidos de America de cualquier responsabi!idad 
que pudierao tener porno proporcionarel tratamientc a 
procedimiento(s) aquf descritos. Doy fa de que soy mayor de 
dieciocho anas y q\le me encuentro en plenas facultades mentales 
para ejecutar esta responsabilidad. 
First Name: 
MERGENSANA 
Country of Origin: 
RUSSIA 
DOB 
1012311978 
Sex: 
Male 
12:00:00 PM 
Time/Hora 
G~b)(6); (b)(7)(C) I 
Printed Signatu firm a con Letra ce lmprenta 
Printed Signature 
IHSC Form 820-S 01/2011 Page 1 of 1 
2019-ICLl-00051 3546 
DHS-ICE-19-0196, 19-0197-O-000230

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Reciblr Tratamiento Medico 
1. This is lo certify lhatl,AMAR, MERGENSANA , 
a detained alien in the custody of Immigration and Customs 
Enrorccmenl (ICE). have refused to consent to the lollawing: 
D a) Intake Screening 
a) Valoraci6n M<ldica 
~h) Medical Treatment lb) Tratamiento Medico 
1. Con la presenle eertifico que yo, AMAR, MERGENSI\NA 
extranjero(a) de!enida(al bajo cuslodia del Servicio de lnmigreci¢n y 
Conlrol de Aduanas (ICE:. slgla, l!<l inijl!!s), me he negado a recibir 
lo siguiente: 
IR] c) Medical ?roceduro(o) 
c) Prooedimiento(•l Medioo(s) 
□ d) Medicati0'1(&) 
d) Medicamentc (s) 
Specify treatment or medication Ileen rofused: /Especifique el tratamienlo o medicamen!o rechaiado: 
LUNCH 
Stale reason: /Explique la razOn: 
HUNGER STRIKE 
2. The health care provider whose signature appears be!ow has 
explained the ncooesily for lhe above described. I understand that 
lhe poss Ible or probable consequences of my rofusal include: 
may decrease nuttitiooal value need for good health; resu:ting in 
~ht loss below body requirements for sustenance of life. May also 
cause decreased wound healing and/or poor oral health. 
3. In a language that I understand, I have been informed that refuse.I 
of lhis treatment or procedure may jeopardize my health and/or 
lifo, but it is, nooelheless, my wish thal my refusal be honored. I 
hereby release the U.S. Immigration ar,d Custom Enforcement 
(ICE.), and the United States of AmeMc:a from any liabitily that I 
might assert for not providing th" treatment or procedure(s) 
described herein. I attest that I am over the age of eighteen 
years alld I am mentally competent to execute !his release. 
Signature of ICE Official (II applicable) 
Last Name: 
AMAR 
A#: 
216269802 
Date cf Camp Arrival (DCA): ! LI I 4 l 2011- Medical Clinic ' \ 
NWDC 
2. El proveedor de servicios de sallld cuya firm a aparece al final me ha 
oxpl'cado la necesidad de llevar a cabo lo descrito arriba. Enliendo 
q-ue las posibles o probables consecuoncias de mi oogativa inch,yen: 
may decrease nutritional value need for good health: resulting in 
weight loss below body reguiremenls for sustenance of life. May also 
cause decreased wound healing ar.d/or poor oral heallh 
3. Ell un lenguaje que entiendo, se me ha informado que la negaliva de 
esle tratamiento o procedimiento puede poneren peligro mi salud 
y/o mi vi<1a, sin embargo, es ml deseo que mi negativa sea cump!ida. 
Por el presente media libero a la Oficina de lnmigraci6n y Aduanas 
(ICE), y Jos Estados Unidos de America de cua1quier responsabHida<l 
que pudieran tenerpor no proparcionar el lratamient0 o 
prooedimiento(s) aqul desC!itos. Doy le de que soy mayor de 
dieciocho aMs y que me encuentro en plenas facullades mentales 
para c;ccutar esta responsabilldad. 
Flr$t Name: 
MERO EN SANA 
Counlry of Origin: 
RUSSIA 
DOB: 
10/23/1978 
Sex: 
Male 
12:00:00 PM 
Time/Hora 
l<b)(6); ~N 
Printed Signalure/Flrma con etra de lmprenta 
GEd(b)( 6), - I 
Printed Signa!ure/Firma con Letra de lmpre_nla 
Printed Signalure 
IHSC Form 820-S 0112011 Page 1 of 1 
2019-ICLl-00051 3547 
DHS-ICE-19-0196, 19-0197-O-000231

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
1. This is to certify that 1,AMAR, MERGENSANA , 
a detained alien in the custody of Immigration and Customs 
Enforcement (ICE), have rerused to consent to the following:_ 
D a) !ntal<e Screening 
a) Valoraci6n Medica 
D b) Medical Treatment 
b) Tratamiento Medico 
1. Con la presente oertifico que yo,AMAR, MERGENSANA 
extranjero(a) detenido(a) bajo custodia del Servicio de lnmigraci6n y 
Control de Aduanas (ICE, siglas en ingles), me he negado a recibir 
lo siguiente: 
~ c) Medical Procedure(s) D d) Medication(s) 
c) Procedimiento(s) Medico(s) d) Medicamenlo(s) 
Specify treatment or medication been refused: /Especifique el tratamiento o medicamento rechazado: 
dinner 
State reason: /Explique la raz6n: 
HUNGER STRIKE 
2. The health care provider whose signature appsars below has 
explained the neccesity for the above described. I understand that 
the possible or probable consequences of my refusal include: 
may decrease nutritional value need for good health; resulting in 
weight loss below body requirements for sustenance of life. May also 
cause decreased wound healing and/or poor oral health. 
3. In a language that I understand, I have been informed that refusal 
of this treatment or procedure may jeopardize my health and/or 
life, but it is, nonetheless, my wish that my refusal be honored. I 
hereby release the U.S. Immigration and Custom Enforcement 
(ICE), and the United States of America from any liability that I 
might assert for not providing the treatment or procedure(s) 
described herein. I attest that I am over the age of eighteen 
years and I am mentally competent to execute this release. 
Firma del Proveedor de Servicios de Salud 
(b)(6); (b)(?)(C) 
Signature ,rma del Testigo 
Signature of I CE Official (If applicable) 
last Name: 
AMAR 
A#: 
216269802 
2. El proveedor de servicios de salud cuya firma aparece al final me ha 
explicado la necesidad de Jlevar a cabo lo descrito arriba. Entiendo 
que las posibles o probables consecuencias de mi negaliva incluyen: 
may decrease nutritional value need for good health; resulting in 
weight loss below body reguirements for sustenance of life. May also 
cause decreased wound healing and/or poor oral health. 
3. En un lenguaje que entiendo, se me ha infcrmado que la negativa de 
este tratamiento o procedimiento puede poneren peligro mi salud 
y/o mi vida, sin embargo, es mi deseo que mi negativa sea cumplida. 
Por el presente media libero a la Oficina de lnmigraci6n y Aduanas 
(ICE),.y los Estados Unidos de America de cualquier responsabilidad 
que pudieran tener par no proporcionar el tratamiento o 
procedimiento(s) aqul descritos. Doy fe de que soy mayor de 
dieciocho arias y que me encuentro en plenas facultades mentales 
para ejecutar esta responsabilidad. 
First Name: 
MERGENSANA 
Country of Origin: 
RUSSIA 
DOB: 
10/23/1978 
Sex: 
Male 
5:00:00 PM 
Time/Hora 
l(b)(6); (b)(?)(C) BN 
Printed Signature/Firma con Letra de lmprenta 
(b)(6); (b)(?)(C) 
Printed Signature 
IHSC Form 820-S 01/2011 Page 1 of 1 
2019-ICLl-00051 3548 
DHS-ICE-19-0196, 19-0197-O-000232

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
1. This is to certify that 1,AMAR, MERGEN SANA , 
a detained alien in the custody of Immigration and Customs 
Enforcement (ICE), have refused to consent to the following: 
0 a) Intake Screening 
a) Valoraci6n Medica 
D b) Medical Treatment 
b) Tratamiento Medico 
1. Con la presente certifico que yo, AMAR, MERGENSANA 
extranjera(a) detenido(a) bajo custodia del Servicio de lnmigraci6n y 
Control de Aduanas (ICE, siglas en ingles), me he negado a recibir 
lo siguiente: 
~ c) Medical Procedure(s) 0 d) Medication(s) 
c) Procedimiento(s) Medico(s) d) Medicamento(s) 
Specify treatment ar medication been refused: /Especifique el tratamiento o medicamento rechazado: 
lunch 
State reason: /Explique la raz6n: 
HUNGER STRIKE 
2. The health care provider whose signature appears below has 
explained the neccesity for the above described. I understand that 
the possible or probable consequences of my refusal indude: 
may decrease nutritional value need for good health; resulting in 
weight loss below body requirements for sustenance of life. May also 
cause decreased wound healing and/or poor oral heallh. 
3. In a language that I understand, 1 have been informed that refusal 
of this treatment or procedure may jeopardize my health and/or 
life, but it is, nonetheless, my wish that my refusal be honored. I 
hereby release the U.S. Immigration and Custom Enforcement 
(ICE), and the United States of America from any liability that I 
might assert for not providing the treatment or procedure(s) 
described herein. I attest that J am over the age of eighteen 
years and l am mentally competent to execute this release. 
(b)(6); (b)(?)(C) 
Firma del Prcveedor de Servicios de Salud r,,,. (b)(7)(C) • L 
C7 
Signature of ICE Official (II applicable) 
Last Name: 
AMAR 
A#: 
216269802 
2. El proveedar de servicios de salud cuya firma aparece al final me ha 
explicado la necesidad de llevar a cabo lo descrito arriba. Entiendo 
que las posibles o probables consecuencias de mi negativa incluyen: 
may decrease nutritional value need for good health; resulting in 
weight loss below body requirements for sustenance of life. May also 
cause decreased wound healing and/or poor oral health. 
3. En un lenguaje que entiendo, se me ha informado que la negativa de 
este tratamiento o procedimiento puede poner en peligro mi salud 
y/o mi vida, sin embargo, es mi deseo que mi negativa sea cumplida. 
Por el presente media libero a la Oficina de lnmigracion y Aduanas 
(ICE), y los Estados Unidos de America de cualquier responsabilidad 
que pudieran tener par no proporcionar el tratamiento o 
procedimiento(sJ aqui descritos. Doy fe de que soy mayor de 
dieciocho at'ios y que me encuentro en plenas facultades mentales 
para ejecutar esta responsabilidad. 
First Name: 
MERGEN SANA 
Country of Origin: 
RUSSIA 
DOB: 
10/23/1978 
Sex: 
Male 
12:00 PM 
Time/Hora 
l(b)(6), (b)(?)(C) f.N 
Printed Signature/Firma con Letra de lmprenta 
b)(6); (b)(?)(C) 
Printed Signature 
IHSC Form 820-S 01/2011 Page 1 of 1 
2019-ICLl-00051 3549 
DHS-ICE-19-0196, 19-0197-O-000233

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
1. This is to certify that I,AMAR. MERGENSANA , 
a detained alien in the custody of ln-.migration and Customs 
Enforcement (ICE), have refused to consent to the 1011owin9: 
D a) Intake Screer.ing 
a) VeloraciOn Med lea 
~) Medical Treatment 
b) Tratamicmta Medico 
1. Con la presenle certl1ico ~ue yo,AMAR, MERGENSANA 
eirtranjero(a) detenido(a) bajo custodia del Servicio de lnmigracion y 
Conlrol ds Aduanas (ICE. siglas en ingl~s), me he neg.ado a recibir 
lo sfgu,ente: 
~ c) Medical Procedure(s) D d) MedicaUon(s) 
c) Procedimiento(sJ Mec:!ioo(s) d) Medicamento(s) 
Specify treatment or medlcation been rafused: /Espocifcque el tratam :enlo o medicamenlo rechazado: 
lunc:11 
State reason: /Exp I ique la razOn; 
HUNGER STRIKE 
2. The health care provider whose signature appear.; below has 
explained the neccesily for the above desc~bed. I understand that 
the possible or probable consequences of my refusal include: 
may C:e<:rease nutritional value need for good hcallh: resulting in 
weight loss below body reguiremenls fur sustenance cl life. May a!so 
cacse decreased wound healing and/or poor oral health. 
3. In a lang11age U1at Iunderstand, thave been informed that refusal 
of this treatment or procedure may jeopardize my health alldlor 
lifo, but it is, nonetheless, my wish that my refusal he hono:cd. I 
t.ereby release the U.S. Immigration and Cus!om Enforcement 
(ICE), and the United States ct America from any liability that I 
might assert ror not providing Ille treatment or procedure(s) 
described herein. I attest lhat I am over Iha age of eighteen 
years and I am mentally competent to cxecllle this re:ease. 
Signarure of Wilness/Flrma del TesUgo 
Signature of ICE Official (II afll)licllb!e) 
Last Name: 
AMAR 
A#: 
216269802 
Date of Camp t:JJ' ;cl J rt 
Medical Clinic: . • I 
NWDC 
2. El pro\/8edor de SeNicios de salud cuya ftrma eperec:e el final me ha 
eKplicado la necesidad de lle11ar a cabo lo descrito aniba. En~endo 
que las posibles o proballles co:isecuoocias de mi aegativa lnc!uyen: 
may decrease nutritional value need for good health: resulti~Q in 
wei3ht loss below body requirements for sustenance of file. May also 
cause decreased wound healing and/or poor oral health. 
3. En un lenguaje qua entiendo, se ma ha informado qua la negaliva de 
es!e tratamicn!o o procedimienlo puede poneren peligro mi salud 
ylo mi vida, sin embargo, es mi deseo que mi negativa sea cum;,lida. 
Por el presente medio liboro a la Oficina de lnmigraciOo y Aduanas 
~CE), y los Eslados u11:dos de America de cualquier responsabil,dad 
que pudieran ter.er por no p~o;iorcionar el tratamiento o 
procedimientO(i) aqu I C:escritos, Doy fe de qua soy mayor de 
dieciocno Mes y qua me encuentro on p:esias facullades menlales 
para cjccutar es!a responsabllldad. zr, / /j 
12:00:00 PM (JQ / J, (J hl'!P? 
Time/Hora ~,_, 
Printed Signaturelf ,rnia con Letra de lmpronta 
G~\~/\~L, I 
Printed Sigr,atuf,rma con Letta de lmprenta 
Printed Signaturo 
Fir..tName: 
MERGENSANA 
Country of O~gin: 
RUSSIA 
DOB: 
1012311978 
Sex: 
Male 
IHSC Form 820-S 01/2011 Page 1 of 1 
2019-ICLl-00051 3550 
DHS-ICE-19-0196, 19-0197-O-000234

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
1. This is to certify that I AMAR, MERGENSANA , 
·a detained alien in the custody cf Immigration arid Cus1oms 
Enfofcemenl (ICE), have refused to consent to the following: 
0 a) lnlake Screening 
a) Valoraci6n MMica 
C[_b) Me,:!ical Treatment 
I bl Tratamiento M~aico 
1. Con la presenle certif,co que yo, AMAR, MERGEN SANA 
extranjero(a) detenido(a) bajo custodia del Servicio de lnmigraci6n y 
Control de Aduanas (ICE, slglMen lng~s), me lie neg ado a recibir 
!o siguiente: 
~ c) 111.edical Procedure(s) 
c) Procedimiento(s) MediCO{s) 
D d) Medica~an(s) 
d) Medicamento(s) 
Specify treatment or rr.edica~on been refused: /Especl~que el tratamioo1o o medican-,enlo recl\azado: 
dinner 
State reason! /Expllque la raz611: 
HUNGER STRIJ<E 
2. The health care provider whose signature appears below has 
explained the neccesit; for the above described. I understand that 
tt.e possible or probable consequences of my refusal Include: 
may decrease ootlitiooal value need for good health; resulling in 
weight loss be!ow body requirements fer sustenance of lite. May also 
cause de creased wound healing and/or poor oral hea Ith. 
3. In a language lhat I understand, I havo been infcxmed tha! refusal 
of this treatment or p:ocedure may Jeo~ardize my heatth and/or 
life, but ii is. nonetheless. my wish Iha! my refusal be honored. I 
hereby release the U.S. Immigration and Custom Enfercemenl 
(ICE), and the United Stales ol Amedca from any liability that I 
mighl assert for not providing lhe treatment o, procedure(s) 
describedjherein. I attest !hat I am over the age of eighteen 
Y""rs and I am mentally compclenl to execute this release. 
b)(6); (b)(7)(C) 
Firm lud 
(b)(6); (b)(7)(C) 
Signatum ol ICE Oflic'al (If ~P?ll::able) 
Las1 Name: 
AMAR 
A#: 
216269802 
Date al Camp Anival (DCA): !&J 1t:f I 1--r 
Med,cal Clinic: t l 
NVVDC 
2. El proveedor de seivicios de salud cuya ruma a;>arece al final me ha 
axplicado la nec:esidad de Jlevar a cabo lo desoito amba. Entiendo 
que las posibles o probables consecuencias de mi negativa inc'uyen: 
may decrease nutritional value need fer good health; resulling in 
weigh! loss tx>:ow bo~y requirements for suslenance of life. May also 
cause decreased wound healing and/or pocr oral health. 
3. En un lengua)e Que entiendo, se me ha informado que la negativa de 
este tratamiento o prooodimionto puede poner en peligro mi salud 
ylo mi vida, sin embargo, es ml deseo que ml negativa sea cumplida. 
Per el presenta medio libe,o a la O~cina de lnmigraci6n y Aduanas 
(ICE), y los Estados Unidos de America de ~1qu'er respOl\sabilidad 
que pudieran tener porno proporcionar el tratamienlo o 
procodimlcnlo(s) aquf descritos. Doy fe de c;ue soy mayor de 
dieciocho anos y qua me encll8ntro en plenas racultades mentales 
para e;ecular esta responsab:l:ood. 
First Name: 
MERGENSANA 
Country of Origin 
RUSSIA 
DOB: 
10/2311978 
Sex: 
Male 
5:00:00 PM 
Time/Hora 
. . J\~1\~/;,_, [RN Pnnted S19r, ru1e1111111a col\ Letra de lmprenta 
b)(6); (b)(7)(C) 
- Pri,,,.....,,,..,.,,.,,.....,,.,..,,,.,.,""".,..,,""'~ lmprenta 
Printed Sig narure 
IHSC Form 820-S 0112011 Page 1 of 1 
2019-ICLl-00051 3551 
DHS-ICE-19-0196, 19-0197-O-000235

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento M6dlco 
1. Tnfs is lo celtify that I,AMAR, MERGENSANA , 
a detained alien in thO cusoody of Immigration and Customs 
Enforcemenl (ICE), have refuse□ to consent to the follow;ng: 
D a) Intake Screenmg 
a) Valora:ion MMica 
'ffi b) Medical Treatment r b) Tratamienlo M~dico 
1. Con la presente certifico que yo, AMAR, MERGEN SANA 
extranjel'O(a) detenido(a) bajo cuslodia del Servicio de lnm:graci6n y 
Control de Aduanas (ICE, siglnen ingll!s), me he neg ado a reclbir 
lo siguiente: 
181 c) Med:cal Proceclure[s) 0 d) Medication{s) 
c) Pn:icedimiento(s) Mt\dlco(s) d) MedicamentO(s) 
Specify trea1ment or medicafon been refused: /Especifique eltratamiento o medica.mE!4'1to recha2ado: 
LUNCH I 
State reason: /E.xplique la raz6n: 
HUNGER STRIKE 
2. The health care provider whose signature appears below has 
explained the neccesily for the above described. I understand thal 
the possible or probable consequences or my refusal include: 
may decrease nutritional ~aluo need for crood t.eallh: resul6r.9 In 
weight loss below body requirements forsustenar,ce of life. May also 
cause decreased wound healing and/or poor oral heatth. 
3. In a language lhal I understand, I have been informed that refusal 
of this treatment or procedure may jeopardize my heallh and/or 
tire, but it is, nonetheless, my wish that my rofusal be honored. I 
t,eretJy release the U.S. lmmlgraUon and Custom Enforcement 
(ICE), and i.he United Statlls of America from any liability that I 
might ass~rt for not providing the treatment or prooeduretsJ 
described herein. I attest that I am over Iha age of eig htee:1 
years and I am mental'.y competent to execute this release. 
~ \e ~'c½n__ 
Signature of Detainee/firma del Oetenido 
j(b)(6); (b)(7)(C) L u.911ace1e 01 I ICDIJI OUIC I 101.0UJ 
f'irma del Proveedor do Smvicios de Salud 
b)(6); (b)(7)(C) 
Signature of ICE: Official (If applicable) 
Last Name: 
AMAR 
A#: I 2162698{)2 
Data al Camp Arrival (OCAJ: /-z_/ M / /'¥ 
Medical Clinic: I 
NWDC 
2. El proveedor de serv,cios de safud cuya firma aparece al final me ha 
explicado la necesidad de llevar a cabo lo descrito arTiba. Ellllendo 
que las posibles o probables consecuencias de mi nega~va incluyen: 
may decrease nutritional value need for gacd health; resulting in 
we:aht loss below body reguirerr.ents for sustenance of life. May also 
cause cecreased wound healing and/or poor cral heahh. 
J. En un lenguaje (lu& &nliendo. se me ha inrom1ada que la r.egativa de 
este lratamiento o procedinien!o pue~e poner eri pellgro ml salud 
ylo ml vida, sin embargo, es mi deseo que mi negativa sea cumpllda. 
Por el presente medio libero a la Oficina de lnmigraciOn y Aduanas 
~CE). y las Estados Unldos de Amt!rica de cualquiel responnbilidad 
que pudieran tener per no prcporcionar el lratamicnlo o 
procedimiento(s) aqul descritos. Doy fe de que soy mayo. ~e 
dieciccho ai\os y que me ericuentro en plenas facultades mentales 
para ejecutar osta responsabilidad. 
l'irst Name: 
MERGEN SANA 
CO\lntry or Origin: 
RUSSIA 
ll08: 
10123/1978 
Sex: 
Male 
12:00:00 PM 
Time/Hora 
J(b)(6); ~N 
Printed Signure/flrma con etra de lmpsenta 
Printed Sign alur 
Printed Signature 
IHSC Form 820-S 0112011 Page1of1 
2019-ICLl-00051 3552 
DHS-ICE-19-0196, 19-0197-O-000236

~Vf\CLr 1 !\/\~r~n·~ct V',O\ A+ 2 l & -:t (lf( 8 o :)_, Norlhw~st Detention Ceuter Administrative Detention Order 
To: Re~trictivc Housing Unh. 
Medical notified: Yes . ~- No 
Detainee name: ~~~ ,' • -,; ............ , .. ....._ ______________ _ A-l'-lilmhcc: 
The above named individual is to be admitted to Administrative Detention for the follqWing reason(s): 
____ {A) Is pending an it1vestigation/heari11g mlcviolation ·and reqires pre-hearing detentiori 10 
protect the i.ccuril y and. orderly operation of the facility. 
-=-'-· ... ,~- __ (B) Is under medical observation On.edical staff mu§t.commcnt and sign this order). 
icb)(6); (b)(7)(C) I 
Medical Officer (Signature): I.._ __________________ ___.I ____ (C) Is pending_ a lransfer or release. within 24 hours. 
1$ terminating confinement rn Disciplinary Detentjon nod has been ordered inAdmioistrntive 
'---___ (D) Detention by the Institution Disciplinary Panel (IDP). 
____ (E) Is a security risk. to him/herself or the security of the facility. 
__ __,_(F) Detainee has requested admission for Protective Custpdy. 
[ hereby request placement iu the Restrictive Housing Unit for my own protectfon. 
I do ( J do not [ ] request a. hearing concerning my detention. 
Detainee: 
-------------,-------~---- (Sign a: tu r c) 
Date: ----~ 
Dernils (as necessary): 
Copy delivered to dcl.'lincc QY (Signature) (b)(6); (b)(7)(C) Date/Time . , . /, , ..,.......--""'---+-"'-
Detainee released to: ~~-~- Date: ____ Time --~ _ Authoriz..ed by; ----'--"-'--------
Original:1)etainee File~ White 
CC: Admin,~trative File- Yellow 
Detainee - Pink 
IHSC-Gold 
ICE ~Blue 
Acl.miniStmtlve D~ttntion Or(lcr DIS002 Oi'2617 
2019-ICLl-00051 3553 
DHS-ICE-19-0196, 19-0197-O-000237

ICE Health Service Corps 
Refusal Form/Formu lario de Nogativa a Roclbir Tratamlento Medico 
1. 'Tllisl$ t)Qu1iii; ~I.AMAR, MEFIGEh!SANA, , 
.a deC:.il re= t1ten 11 1JlG Q.J:s.tod:,i c r,..., m1;1..lt1cn end :::u~~ 
.Enfan::eTIDnl<LCt:J, halfli? ,aLaeCl f'O m·s.enl to lhe to11ow!ng: 
0 ti) nta.~ Saerning 
u)'V~c~~,..~ 
D bi .,,eoice1 l rsat~ftl: 
b} Trat.lmlcnt) U~ico 
'I, Co,la MK:n:c eort.r-oo qu.i yo, ~- r.i:ERGENSANA 
~nj.!m(o) cle'.:en1dO(a) bi!.JO (U!1adi~ ~l .9elYiCil!! d!!' •-r,igracian y 
ca·1to1 O!li A.dw. ~a!I jlCt, ~lg H ~--i~lh,), M! ha ne_.;li!ld:> I. '.,e.ciblr 
h;i slgulent-t; 
IE) e) li!edic.al '!'lrcc.edure(II Oc11Msci:::B11~) 
cl Pr00fldn,lonto(IJJ.'6<::cxi") d) l.!oijlCQt('IF.>Dl;Jr,tt) 
Sp~.ly Tit:Jt-nent or rne:;;ic,;i1i:;,n b<lon rtliJ~od: 1Esp~e 1'iq(JPJ c-lll';;it.Jtrilont<.i o mgOic.noril;) ,e,c;ti1u,.w;l~Y 
tire.a~~- - - - - - -
stt1111 rac1a.:n: .'Ert)'iQOJO la ,azon: 
HWtG;I K:; TRIKE 
,. 1tl$ ~th e.1~ pro'tic•~~l\tlti.n ap~,.. befowh:il.l HL'l:t1rl9d .. 11 ,,eoo:!!o 1'y P« r~e 1t:ovs descnbt!ld. I und"en!:u1CI ~r,a! 
'.ht ~Oio,r:lt; or prt;:~tli o:mii;q1,,1ence1 or m~ rot ~s:il i"dudEt 
may c7Nn21W nlJIJltimel WIIIUl!I n...-J f« 51e«1 lw.1nl'I: l'ii!SL;ltl1'!9 1n 
~used~Med~nl'.lhe~~~ara1 hea~ _ 
3 :n11 la:,guag11 lhaoti 1.ndl!'l'!>l:ilnd, Iha·.et:,een, 1n'01m,edtht! ~al 
ol l~i:!. ~a1mintc:rprn01!d1Xll may joopan:iizo m1 heal•.h a.,Mr 
liRI. bl.A itO.. nc;illliltl1ei'ft1. m.,-wi&hthatmynrlu1al be hr;im;rrad. I
~•st,y rdf:-in-1!1 the U.S. lmrrti9flrl»n illlc! CU!l',m'I Enb·=err'E'Qt 
t1:EJ. MCI ".1'10 JMW St~;es, 01 M-OAe., P";)tn rtn:, II.it:~ fy lm.:J 
.-.lg~l ~rt 1w rVJt ~'19 lhlr L1Htmr;inl arprC,W:R[t) 
<li!!e--ti@cl t1IH<"l!r1. r a1r.,1 ll'.at I fltn c,verll'II! '1911 Cflf'!'J~-1",, 
ret1r11 ~n:11 IQ.1'1 rr,ento~)' <:om;OWnl 10 O>!CCV\At tnl$ ~t3S9. 
,, Fl~,...,,...,,,..,...,..,...,,.,._d"ll Salud 
l11slNarr(I· 
-lo#; 21em,02 
0!1~-ofCl'ltrf1"""1iwlll'O(:A)" 1:iJ1C1[r1 Me.:llc:!Jt:1.nlc-: 
~'W;IC 
ltiSCt-Offl\1:12~ 
2-El ~or dfll !>W.tiOJ<le- NJ Jd ow:a fitfflG aparec:e iii fulJI r.,o hl!I 
e:cp'.l'!'.SClti la l'leOB'!id.1111 d9hwra eabt) bdelu:1,1i,.am11.1.. t::n1:M!ln11D 
:iue ~ poilblu r) ;irDb:;able1 00f"IHK'U8m;.M :9 rr, nlii'Qoth-~ ir.~l•J'.f'l)n. 
nu1y CE'Cfi'8!e r,•J1ritane..l ,,,_UII Med f« 9:,ad hHh.tl; lll\ .. b"9 in 
.,.,Jl:i!! o:ss betaw 1::00·, ~iJrt,rne~1g. "t,r gu9~.e,n;ra ar,r,. "-'!X p11() 
ca1£1:! dl!'Cn!!S~ IWUM ,n~_; ~~~heGML -
3. En 1.n lengueje-c,ue entien:fo, te me ha ,n~«m3dl'.I c,111 lal ne,g-ilti·,a De 
cu:e 1tawr1leN=i i, prt,Cl&d-nle:,IQ ~"lit~-& p,::nc • 61'11 ~aligrtl mi a.l'IJd 
1o1omi 'iid.;I, ~ e.,b.rgo, e, .,1 ~ que .,1 JJtgativa w.a o.imp~:fa. 
Pare, p~M!lniB modiolibero a ra Olleina de lrrnigrati~ r Adu:lll'lo.l!. 
{,CE.), , IO! l;;:~1£110:ti IJr."30! do ,Ml(l,tc;Q de-e.Dl:_ittt ~~po-$;:tbllld:id 
QIA ~i&fan ll,11tr P'Ol llOp(OpQlcionar Ill b~llb 0 
pr0Ci'~,.,,Iar,1:D:,.) •~I O'l,a,~ ui,y le !Sf! q~,e u,y m<i~r cle 
:11o~;ho -'.:o, ~ ,quF;i me or.tl.l'iln4r0 en ~le~~ 1.a~l'.li'di,u-r.~•..ele, 
p21n1 ,eje:u&r ~ l'l!!~:>m:abi:ilf.ad.. 
~ 
~-- ~l.e\ra do 1mp:enta 
l~j~~~ 
I couiwv or 01191n· 
Rl$~1A 
[)(lB· ~ma~1e 
so,: 
M, .. 
3554 
DHS-ICE-19-0196, 19-0197-O-000238

ICE Health Service Corps 
Refusal Fonn/Formulario de Negativa a Recibir Tratamiento Medico 
1. This is to certify that l,AMAR, MERGEN SANA , 
a dela'ned alien in 1he custody af lmmigra,ion and Cus:oms 
Enforcement (ICE), have refused to consent to the following: 
D a) Intake Screening 
a) ValoraciOn M~dica 
~) Medical Treatment 
b) Tra,am:ento M6d:co 
1. Con la presente certiftco ciue ~o, AMAR. MERGEN SANA 
extranjero(aJ dete~ido(a) bajo custodia del Servieio de lnm:graci6n y 
Control de Acluanas (ICE, s/glas P.nlng'~s), me he ncgado a rccibir 
lo siguiente: 
[El c) Meaical Procedure<•) D d) MedicaUon(sJ 
c) Procedimiento(s) Medlco(s) d) Medicamento(s) 
Specify treatment or medication been refused: IEspe::itiquc 1cl tratamiento o medicamento rechazado: 
dinner 
S!ala reason: /E~pliquc la raz6n: 
HUNGER STRIKE 
2. Tile health care provider whose signature appears below has 
explained the necessity for the above descr:!:>ed. Iuode rs tan cl that 
tile possible 01 probable consequences al my refusal inc'.ude: 
may (lecrease nulrilianal value need fer good health; 1esulting in 
weight loss below tody requirements for sustenance of life. May also 
cause decreased wound healing and/or poor oral heallh. 
3. In a la11guase tnat I understand, I haw been informed 1hat refusal 
of !h's 1realmant or procedure may jeopardize my health ar.d/or 
life, but it is, nonetheless, my wish that my refusal be hcmorad. I 
hereby release lht, U.S. Immigration and Custom Enforcement 
(ICE), aad tl,e United States of America from any liability that I 
might assert for not providing the trt,almenl or proc.edure(s) 
described he~ein. I attest that l am over the age of eighteen 
years and I am mentally com pate nl to e)Cecula lh is release. 
~(b)(6); (b)(7)(C) 
3 CQIO I IOCIQOI 
Finn a del l'roveedor de Servicios de Salud 
ess inn a det Te sligo 
Signature of ICE Official (II applicab'e) 
LastNami,: 
AMAR 
Ml: 
216269802 
Date ol Camp A~~a~ Jltf {(}ft, !1-
Medical C!;nic: l I 
NWDC 
2. El proveedor de servicios de salud cuya fim,a aparece al final me ha 
elq)!icado la necesidad de llevar a cabo lo dcscnto arriba. EnUendc 
que las posibles o probables consecuencias de mi negativa incluyen: 
may decrease nulri6onal value r.eed for good l\eallh: resulting in 
weight loss below body tequirements for sustenance of life. May a~so 
cause decreased wound healing and/or poor oral health. 
3. En u,1 lenguaje que entiendo. se 11'.e ha infocmado Que la negativa de 
es!e lratamienlo o proced::niento pul?de poner en peligro mi salud 
ylo mi vida. sin embargo, es mi deseo que mi negativa sea cumpllda. 
Por el presente medio libero .a la Oficin.a de lnmigracion y Aduanas 
(ICE), y loo Estados Unidos de AmMca de cualquier responsabilidad 
que pudieran iener par no proporcioriar el tratamienlo o 
procadimienlo(s) aqul ooscrilos, Doy fe de qua soy mayor de 
dieciocho at\os y qua me encuentro en plerias facultades mentales 
para ejecutar esta responsabilidad. 
First Name: 
MERGEN SANA 
Country of Origin: 
RUSSIA 
DOB: 
10/2311978 
Sex: 
Male 
5:00:00 PM 
Time/Hora 
kb)/6) RN 
Printed Signature/Firma oon Letra de lmprenta 
ra de lmprenta 
Printed Signalure 
IHSC Form 820~ 01/2011 Page 1 of 1 
2019-ICLl-00051 3555 
DHS-ICE-19-0196, 19-0197-O-000239

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
1. This is to certify that I,AMAR. MERGENSANA , 
a detained alien in tne custody of lmmi9ration and Customs 
Enforcement (ICE). haVl'> refused ta consentto the following: 
0 3) Intake Screening 
a) Valoraci6a Medica 
rh.,) Mecical Treatment 
/ ~) Tratamiento Medico 
1. Con la presente oertifico que yo,AMAR, MERGEN SANA 
e><tranjero(a) dc1onido(a) t>ajo custodia def Ser.,i,;io de lnmigraci6n y 
Control de Aduanas (ICE. siglas en lngl~s), me he negado a recibir 
lo siguiente: 
18] c) Medical Procedure(s) 
c) Procedimiento(s) MMico(sJ 
0 d) Medicatioo(s) 
d) Medicamen~(s) 
Specify treatment or medication been refused: /Especifi(ltle el lratamiento o mcdicarnento rectlz.zado: 
~ff\1 L~D DINNER t1-.1~ 
State reason: /ExplJ&ig e la raz6n: <?-<Lt.1,..~ t ,,,., ✓ Pr" .:z ILJ.J!,;![_ 
2. The health care provider who$e signature appears below has 
explained tne neccesity ror the above described. I under.;tand that 
the possible or probable consequences of my refusal ir.clude: 
may decteaso nutr~ional value need for gcod health; resulting in 
weight loss below bcdy reguirements for sus!enanoo of life. May also 
cause decreased wound hea:ioo and/or poor oral heal1h. 
3. In a language that I undcrntand, I have been lnrorme'1 that refusal 
of this treatment or procedure may jeopardize my heallh and/or 
life, ootil is, nonetheless, my wish that my refusal be honored. I 
hereby release the U.S. lmmigraUon and Custom Enforcement 
{ICE), and !he United States of America from any liability that I 
mig~t assert for not providing the treatment or procedure(s) 
described herein. I attest that I am aver the age or eighteen 
years and I am mentally competent to execute this release. 
Signatura of Detainee/Firma del Date11ido 
Jb)(6); (b)(7)(C) 
rn911aRJ;e 01 L lCiliUi Gdle f 10Yl0eil 
Firma def PrO'leedor de Serv;cios de Salud 
Sign elTesfiga 
Signature of ICE Official (II applicable) 
Las1 Name: 
AMAR 
A#· 
216269802 
Date of ;'J.!{ir;o/ mt?' 
Medical Clinic: t 
NWDC 
2. El proveedar de servicios de salud euya firma aparece al final me ha 
e)(p llc.ido I a necesidad de llevar a eabo lo descrito aniba. Ent:endo 
que las posibles a probables consecuencias de mi negativa lnclliyen: I 
may decrease nutritional value need for good llealthj res11lting in 
weight loss below body requirements for sustenance of file. May also 
cause decreased wound healing andloc poor oral health. 
3. En un lenguaje que en!iendo, se me ha infomiado que la negativa de 
este Cratamlento 0 procedimiento puece poneren peligro mi salud 
y/o mi vida, s!n embargo, es mi dcsco que mi negativa sea cumplida. 
Por el presenle medic I Ibero a la Ofielna de lnmigrac:oo y Aduanas 
(ICE), y los Estados Unidos de Am~ric,; da cualquier responsabifidad 
quc pudieran te;ier porno proporcionar el lratamlento o J 
procedimlentots) aqul descritos. Doy fe de que soy mayor do 
cieciocho a~os y que me encuentro e11 plenas fa;ultades mentales 
para ejecutar esta responsabilidad. I 
L?J:f? o~!~~ ~b)(6); (b)(7)(C) bN 
Printed Signature/Firma con Lctra de lmpren1a 
etra ce 1mpre<1tl 
Printed Sjgm,ture 
IFin;tName: 
MERGENSANA 
C011ntry of or:gin: 
RUSSIA 
DOB: 
10/2311978 
Sex: 
Male I 
IHSC Form 820-S 0112011 Page 1 of 1 
2019-ICU-00051 3556 
DHS-ICE-19-0196, 19-0197-O-000240

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
1. Tnis is to certify that I, AMAR. MERGENSANA , 
a detained alien in the custcdy of tmmigratton and Customs 
Enforcement (ICE), have refused to consent to the follow:ng: 
Dal lntJl<e Screening 
a} ValoraciOn MMica 
!"Rb) Medical Treatment 
T-b) Tratamiento Medico 
1. C 01"\ ra prese nte certi ftco que yo, AMAR. MERGE NSANA 
exlfanjero(a) de1er0:do(a) bajo custodia del Servicio de lnmlgraciOn y 
Control de Aduanas (ICE, ,tglas en ingl~), me he negado a recibir 
lo siguiente· 
[g) c) Medical Procedure(sJ 
c) Procedim:ento(sJ M~dico(sl 
Specify treatment or m,,,.b"')""( 6 
.. · )"'· ............... """"d: IEspecifique el tratamiento o medicamenlo rechazado: 
LUNCH~ b)(?)(C) 
D c) Medieation(s) 
"'··"-1" 
2. The health ca:e provider whose signature appea~ below has 
explained tl'.e necceslty for tile above described. I understand that 
the possible or probilble consequences of my relusal include: 
may cecrease n•JtriUonal val~e neeu for good health: resulting in 
weight loss belcw body requirements lor sustenance of life. May also 
cause decreased wound hea~ing and/or poor oral health. 
3. In a language that I und81'Sland, I have been infmmed that refusal 
of this treatment or procedure may jeopardize my heallll and/or 
life, but It is, nonetheless, my wish that my refusal ba honored. I 
hereby release the U.S. lmm:gratlon and Custom Enforcement 
(ICE), and the United Slates of America from any liabllity that I 
might asser1 for not providing the treatrr,ent or proced~re(s) 
described herein. I attest that I am over the age of eighteen 
years and I am mentally eompelent to execute this release. 
Signature of Hea 
Fuma del Proveecordc Servicios de Salud 
(b)(6); (b)(?)(C) 
1rma del Testigo 
Signarurn of ICE Offi<;ial (II .ppMcable) 
last Name: 
AMAR 
A#: 
216269802 
Date of Ca.-np/:r, ~CA,? li'il'r 
Medical Clini~: l "{ 
NWuC 
2. El proveedor de servicios de salud cuya firma aparece al ~nal me ha 
expli<:.,do lo necesidad de llevar a c.abo lo descrilll arriba. Entiend<J 
que las posibles o probables consecuencias de mi negativa inctuyen: 
may decrease nutritional va!ue need for good health: resultir.9 in 
weight loss below body re(luirem&nts for sustenance of life. May a:so 
cause deoreased wound hearmg and/or poor oral health. 
3. En un lenguaje que enUendo, se me ha informado que la negativ.i de 
este lralamiento o procedimiento puedc por.cr en peligro ml salud 
y/o mi vida, sin embargo. es ml desee> que ml negativa sea eump'.ida. 
Por el presente medio I:1>ero ala Oftcina cfe lnm:gra<;;oo yAd11anas 
(IC=), y los Estados Unidos de America de cualquier responsabilidad 
que pud'eran tenerpor no proporcionar el tratam'ento o 
procedimiento(sJ aqul descritcs. Doy re de que soy mayor de 
die<:iocho anos y que me encuentro en plenas facultaces menteles 
para eIecutar esta responsabilidad. 
·ro· '\2,&o V I 
"Time/Hom Date/F ha rfj 
~b)(6); tN I - /h\/7\/r,\ Pnnted Sly, w,e,, Ullid Wti L trade lmprenta 
(b)(6); (b)(?)(C) 
de tmprenta 
Printed Signature 
First Name: 
MERGENSMIA ' 
Country 01 Origin: 
RUSSIA 
DOB: 
10/2311 S 78 
Sex: 
M11le : 
IHSC Form 820·S 01/2011 Page 1 of 1 
2019-ICLl-00051 3557 
DHS-ICE-19-0196, 19-0197-O-000241

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
1. This is l0 ce~ify1hat1,~a-\l /YJ,ff!i-.e0~4--- 0 detained alien in the custo~y of lmmigraf ar.d Customs 
Enforcement (ICC:). have rofused to ccnsent lo the following: 
O a) rnta~e Screening 
n) Valoraci6n Medic" 
llQ bJ W.edic2I Treatment 
bl T:atamiento Medico 
1. Con lo presente certir.co QUO yo, __________ _ 
exttanlero(a) detenido(a) bajo custooia del Servicio de lnmigraci6n y 
Con~ol de Aduanas (ICE, •l~la• e,, 1ng1~•). mr. he neg ado I recibir 
lo slgulente: 
rJ c) Meotcal Procedure(s) O d) Medication(s) 
c) Pmced'mien'.o(;) M!<fco(•) d) Medicarr.enlO{•I 
Specify 
~ 
trc~lment c, medica · n bean refused: /Es;>ecili<;ue 81 tratamier.lo o mooicarr.ento rechnzado: 
2. l"ho ha;\llh ~n"o pTov'.de, w'•u)~A cionaturo ncoo:'\f'O botow hu exp1~1noo me nec::e$lty lor rtte above deseritect. I unoef!tan~ rnat 
the pos,iole or i''o~able consequor,ces cf my relusal include: 
'-h1...u~~ ¼~ ~ ~f,,u-rJ 
_w,+o.J~-1;· 
3. ln ~ language that I understand, I have been informed :hat refusal 
or !his trea\mont or pro:edure may jeopard;ze rny heullh andro: 
li!e, but it is, ~onetheless. my wisn that my rerusal \>a honored. I 
hereby release tile U.S. Immigration and Custcm Enforcement 
(IC;), and ll',e Un~ed Statos of Ame:ica f;cm any liability that I 
rr'ght assert fer nol providing the ltc.itment or procedc:e(s) 
described herein. I attnr.l that I am over the ~oe of eightee, 
yesrs and I am mentally compatent lo execute 1111s release. 
Firm a del Provcndor di> Servicios ce Satud 
' r)(a)~:,:::~~IOQIUIC&n. 111,Meco .J..,_ig_O __ 
Signat~r& of ICE OfficiAI (II •?P1cable) 
AMAR MERGENSANA 
A#: 216269602 RUSSI 
ocA: ,i,./1 , I r1- ooa: 1012311978 
Facllity: NWDC Tacoma_ Sex: male 
rec:cal Cli~ic: 
{ 
2. Et il'"DY8odnr ~• :>o....,lo>Oo d• •alvd ~,v• r.-n ~o•-~n 4'.\t t;l"lnt '"'"' 1-..-.. exp:·.ca<10 1a necesi08d de neve:r b eeco 10 oesc;rk:o arr10•~ Enuenr1O 
que fas pos''oles o prcbnhles consecuencias de mi negativa incl•Jycn: 
:l. En un ler.guaje que entiendo, sc me ha intormado quc la negallva de 
cste tratamiento o proccdimiento puee;i p()f!Cr en peligro mi sak,J 
y/o mi vida, sin embargo, e, mi des co qua mi negaliva sea cumplida. 
Per ct presente medio Ibero a la Oficina de lnmigracl6n y Adua.111s 
(ICE;), y los Estados Unidos de AmMc.1 de cualquier responsabilidad 
que p:idieran tener porno proporelonar el trat;mienlo o 
proce:!ir.,ien10(•) aqul cescrit:is. Doy re de que soy mayor de 
<1ieciocno anos y que me enc·Jentro e:l plenas racullsde~ mcnlales 
para ejecutar esta re5port.-.abMad. 
(J7d 0 
Tine/Hora 
Printed SigoaMe/Flrma ccn l.etra de lmprenia 
(b)(6); (b)(?)(C) 
7._ ______ .....J~r, letra cie lrnprenta 
I' rir,tecl Signatu,e 
I First Name: 
CO-Jntry cf Orig:;,: 
00B: 
IHSC Form 821).S 01/2011 Page 1 of 1 
2019-ICLl-00051 3558 
DHS-ICE-19-0196, 19-0197-O-000242

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamlento Medico 
1. This is to certify ltlat I.AMAR, MERGENSANA , 
a dotaincd alian in tho custody of Immigration and Customs 
Enforcement (ICE), have refused to consent to the following: 
0 a) I nlak11 Screening 
a) Valoraci6n Ml\dica 
~ b) Medical Treatment 
b) Tratamiento MMico 
1. Con la pres&nta certilicoque yo.AMAR, MERGEN SANA 
extranJera(a) detenido(a) bajo custodia del Servicio do lnmigraci6n y 
Control de Aduanas (ICE, ,igl;,s en ingl!s). me he negado a recibir 
lo siguiente: 
D c) Medical ProcMure(s) 
c] Procedimicnto[s) MMico(•) 
D d) Medication(•) 
d) Medic.lmento(s) 
Specify lreatment or medic.ation been refused: /Especifique el lratamiento o medicamonto rcchazado: 
food 
State reason: IE><plique la ra:ron: 
ADAMANTLY REFUSED 
2. Toa hcallh caro providorwhosc signature appc,ars below has 
explained 111& nec~slty for lhe above descr:~d. I 1.mderstand that 
the possible or probable consequences of my refusal include: 
may decrease nutritional value need for good health: resulting in 
weight loss below body reguirements for sustenance of life. May also 
cause decreased wound healing and/or poor oral health. 
3. In a language that I ur.derstand, I have been inlormed thllt refusal 
of this treatment or p1ocedure may joop..rdize my heal1h and/or 
life, butit is, nonetheless, my wish that my refusal be honored. I 
hereby release the U.S. Immigration and Custo:n Enforcement 
(ICE). and the United States of America from any liability that I 
might assert for not providing the treatment or procedure[~) 
described herein. I attest that I am over the age of eighteen 
years and I em menrally competent to execute this re:ease. 
Firma del Proveedor ce Servicios d11 Sa\ud 
b)(6); (b)(?)(C) 
rma del Testigo 
Signature of ICE Official (If applicable) 
Last Name: 
AMAR 
A#: 
216269802 
OateofGampA7tD'rr0 l'2n 1 ? 
Medic.al Clinic: ' 
NWOC 
2. El provcedor do sorvicios do salud cuya finna apaiccc al final me ha 
expllcado la necesldad de llevar a cabr> lo descrito amba. Entiendo 
que las posibles o probables consecoencias de mi negativa induyen: 
may decrease nutritional value need for goad health; resulting in 
weight loss below booy regulrements for sustenance of life. May also 
cause decreased wound healing and/or poor oral health. 
3. En un lengueje qua entiendo. sa me ha infarmado que !a negativa de 
este tratamienlo o proceoimi~nto puede por.er en peUgro mi !la!·;d 
y/o mi \Iida, sin embargo, e& mi deseo que mi negativa sea cumplida. 
Par el presente media libero a la Oficina de lnmigraciOn y Aduanas 
(ICE), y las Estados Unidos de ArMrica de ccatquier responsabilldad 
que pudieran tener par no pmporcionar el tratamienlo o 
procedimlentO(s) aqu I dEl$crrtos. Doy fe de que soy mayor de 
dieciocho anos y que me encuentro en plenas facultades mentales 
pera e]ecutar esla responsabilidad. 
s ao:oo PM o ~ I~ rtzo1B 
Time/Hora itelf e ha 
l
(b)(6); kN 
Printed Sign '~" 71 rr 1 Letra c!e lmprenta 
Printed Sig nati.re 
First Name; 
MERGEN SANA 
Countl)I of Orf gin: 
RUSSIA 
DOB: 
1012311978 
Sex: 
Male 
IHSC Farm 820-S 01/2011 Page 1 of 1 
2019-ICLl-00051 3559 
DHS-ICE-19-0196, 19-0197-O-000243

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
..I'>.,,,.,,,.. ~\f'II•~ 
This is to certify that I, n11e r <ief' 5"...,,.., I'' '!'."Con la p,e,ente ca.1ifico que yo,, ___ _ a de'•ined alien in the custody of Immigration and Custcmd 
Enforcement (ICE), have relused to consent to the following: 
D a) 101:ake Screening 
a) Valoraci6n Medica 
,:&! b) 111.cd;cal Treatment 
bl Tratan,'Mlo Mo,rco 
2. ne t.ealt11 cam pmviecrwhose signature appears below h~s 
explained lhe neccesily for lhe above described. I und.,rstand t.M 
,.---!hA...tint.i:.:nla r.c...ritAha .. la ,.,,.,,,, __ ,,,.. ... ~,.,..I-•· ... -L-- l.!.-..-1.............__ 
Poten~al medical prob!em to go 
undiagnosed or untreated, leading 
to exacerbaUon of exisUng condition 
IMI may cause further deterioration 
in cu rent slate of health 
.. -, __ , ,. ,,.., ., ... ,._.,, ... ,...,.,.,,, 1111 ,~,_~,, "'"'' "'Y 111;;~1.,1,;>,;,,1 IJ..,; 1lvllVlc;;;U. I 
:,ereby release ~e U.S lmmi~ra1ion anc Custom E"fo,cerr.ent 
llCE). a'\d tile Uri•.od States of America from any liability that I 
might assert 'or not providir,g the l~atment or procedure(s) 
described herein. I a:test thal I am over l~.e age ol ei!;·,1c,,n 
years and I am mentally com,oe!ent lo execute this re~ease. 
Signature of Health C~rv Prcviderl d C 1 CI 
Sigr.ature cf ICE Offrcial (If applic,,bf•) 
edranjero(al delenido(a) bajo cus'.oo'ia del Servicio <le lnm,grnd6n v Cnntrol de Ad•Janas (ICE, sig'as en ingl~s), me he neg ado a recibir 
lo sigularite; 
0 c) Medical rrocedure(s) 
c} Pror...edimienlc,!.) M~dico,s) 
/'it'd) Medicatior:s1 
~} Mcdicam~r.tt")h) 
2. El proveedor de servic'cs de sal11d cuya firma aparec,, .al final me ha 
<>>plicodo la necesidad de llevoc • cabo lo descrito arriba. c.nliendo Cl .... 1111 ■ pc ibl- o p~b.,obla-a <:::ur,..,•r..u-nd,..,.. O:,,e l'TII n•ga1tv_. lf"IClll'),'WH, 
En un lenguaje que enlienco, se me ha in'o,rnado que la negat'va de 
est• tralamiento o procedirn'en'o pueclc poner en peli~ro mi salud 
ylo ml vida, sin embargo, es rni deseo que mi negatilla sea cumplida.• 
Per cl ~resenle med;o libero a la Oficina de lnmigracion y l\:1uanas 
(ICE}, y Jos Estado~ Unidos de Am~ri~1:1 de cualquier ,e.<ipr.nsabilidad 
que pudierar. ten.er For no p1oporcionar el tra~am,~nto o 
procedimienlc(•I aqu\ descritcs. Dey le de qu" scr, mayor te 
dieciocho acos y qc•e me encuen1ro en plenas facullades ir.entales 
para e}P.:cutnr c-sta rcspon3.abil,dad. 
SEP O 6 2018 
Time/Hera DatelFecha 
(b)(6); (b)(7)(C) RN Pr'ntt- _____ __..,,i.;..;n.:..L:..e_tr_a_:le-lm_p_re_n_t_a_ 
(b)(6); (b)(7)(C) 
D_•_I•_ of C-a-mp_A_'fiv_1_(~-A~-: _·~_-__ '7----~--+-D-O-B:---'-l-=-a_-:J..___;;;;.i_- _{{1_7_t- ____ =-- Medical Clint:: Sex: I ). ~ n. 
~woe rlllXl 
IHSC Form B20-S 0112011 Page 1 of 1 
2019-ICLl-00051 3560 
DHS-ICE-19-0196, 19-0197-O-000244

ICE Health Service Corps 
Refusal Form/Formulario de Negative a Recibir Tratamiento Medico 
1. Ttlis is to certify that I AMAR. MERGENSANA , 
a detained alien in the c,,istody of Immigration aoo Cus1oms 
Enforcement (ICE), h..va refused to consent to the followi~: 
0 a) Intake Screening 
a) Valoraci6n M~dica 
~ b} Medical Treatment 
b) Tratamie,1to M~cfico 
1. Con la presente certifi~ qlll) yo AMAR, MERGENSANA 
cxtranjero{e) deten:do(a) bajo e11slodia del SeJVicio de 1nmigraei6n y 
Control de Aduanas (ICE, s'glas en ing!esJ, me he negado a 1ccibir 
lo siguientc: 
D c) Medical Procedure(s) D d) Medication(s) 
c) Procedimiento(s) Medico(s) d) Medicamento(s) 
Specify treatment or medication been rerused: /Especifique el tratamien1o o medicamento re:llazado: 
VITALS, v..rEIGHT, FOOD, WATER.ASSESSMENT, COMMUNICATION 
Stale reason: /Expllque la raz6n: 
DETAINEE REFUSES 
2. The health care proVider whose signature appGars below has 
explained the neccesily for the a!:love described. I understand that 
lhe p:>Ssible orproba~le consequences ofmy refusal include· 
m"Y cause rr.edical dlagnosls or decline In medical diagnosis ta go 
undete::led. Unable 10 monilor chanocs In condi~on witlloul baseline 
3. In a language that I understand, I have been inJormed that refusal 
of this treatment or procedure may jeopardize my health and/or 
life, but it is, nonelheless. my wish that my refusal be honored. I 
t.ereby release the U.S. lmmigralion and Custom Enforcement 
(ICE), and the United States of America from any liability thal I 
might assert for not providing the treatment or procedure[~) 
described herein. I attest that I am over the age ol eighteen 
years and I am mentally competent to execute 1his release. 
I 
Si nature or Detainea/Fi 
(b)(6); (b)(7)(C) 
del Detenido 
L---~----~---'rovider/ 
~=L.d.Li-'?J=-...a,.....!A..l:.......ii:,· ·os de Sal~d 
b)(6); (b)(7)(C) 
L_ ________ __,dcl Testigc 
Signature o1 ICE Official (If applicable) 
Last Name: 
AMAR 
Att. 
216269802 
Date of Camp Arrival (DCA): rz.,./," I, 1-
Medical Clinic: 
N\M::>C 
2. El proveedor de serv,cios de satud cuya firrna eparece al final me ha 
expllcado la necesidad de llevar a cabo lo clcscrito arriba. EnUendo 
quo las posibles o probables consecuencias de ml negaGva incluyen: 
may cause medical diagnosi~ or decline In medical diagnosi~ to go 
undetected. Unable to monitor Changes in condition wili\oo1 llasoline 
3. En un longuaje que entiendo. se me ha inlormado que la negativa de 
este tratamiento o procedimienlo puede poner en peTigro ml salod 
ylo mi vida, sin embargo, es mi deseo que ml negativa sea C1.1mplida. 
Por el presen:e medio libero a la Oficina de lnm;graci6n v Aduanas 
(ICE), v los Estados Uni dos de Am1mca de cualquier responsabilic:lad 
qua pudieran tene< porno proporcionarel tratam:en10 o 
procedimlento(s) aqu I descrltos. Doy fn de que soy mayor de 
<lieciocho anos y que me encuentro en plenas facuttades mentales 
para ejecutar esta responsabilidad, 
First Name: 
MERGEN SANA 
Country of Origin: 
RUSSIA 
DOB: 
10/2311978 
Sex: 
Male 
(b)(6); (b)(7)(C) 
Printed Signalure/Firma con Letre c!e lmprenta 
b)(6); 
--,,.;:;:<&...;:.6,-1b)(7)(C) 
Printed Si,y,____ ..,n Letra de lmprenla 
Printed Signature 
IHSC Form 820-S 0112011 Page 1 or 1 
2019-ICLl-00051 3561 
DHS-ICE-19-0196, 19-0197-O-000245

ICE Health Service Corps 
Refusal Form/Formulario de Negativa a Recibir Tratamiento Medico 
. - /t:y\ I, <" t.11ws ,s to certify tha~ I, ~ A.~~-a 
a detai1ed alien in tne custody of tmml ration and Customs 
Enforce:11ent (ICE), have refused to consent to 11·,e following: 
0 a) Intake Screening 
a) Vt>tnraci6n Med,c~ 
_M°b) Medical Treatment 
b} Tratamiento M~dico 
1. Co:i la presente certlflco c,•Je yo,--.---,---,--,--,----,-.,.-
e~anjero(a) ce1anido(a) tajo cuslod~ del Servido de lr.-tligracifo ~ 
Cont;o: de Acuanas (ICE, olqlos M lngl~s), me ~e negaco a reciblr 
.. to sisuieritc: 
CS(c) Medical Procedure(•) 
c) Proccdir:iie~to(s) M~dico(s) 
0 d) Medication(s) 
d) Med icam on \o(s) 
Specify tteetmenl or ~edication bee~ refused: /Especlfique el tratamiento o rr,edlcamento recha~t':W _ ~ • J 
&~ &f,,.,k? N'-U--s,'"' (()½ nd 4 ~ s~S:<" l)::)~1 {.( 
i;;:;'1 [,\) '7)/ ~o., J 
h--c 
Slate reason: /Expllque ·.a raz6n: 
))Gib-&e 
nJo 4 ~ a,,0..1. ~ 
2. The health care l)(Ollider whose signature appears below has 
Explained the neccesily for :he above desc"ibed. I undcrsta:'l<i lhat 
the possible or probable consequen~s of my efusal incl e: 
O,.J,1 :t 
3. In a lanouage that I underitand, I have been informed that refusal 
of this lrtatmenl or procedure may Jeopardize my health and/or 
life, but it is, nonell1eleS5, my wish that my ,erusal bo hOnored. I 
hereby release tr.e U.S. lmml~ra~on ar,d Custom Enforcement 
(ICE), and lhe United Sta!as of America from any liability that I 
might assert !or not providir,g the trealment or prooed1;re{•) 
eescribed ~.i:rcin. I attest that I am over the age ol eighleen 
yca;s ar,d I am me~tally competent to execute this relea&e. 
2. El proveedor de seNicios de sal~d cuya rirma aparace al final me na 
e,pli06do la necesidad de llevar a cabo lo ~sailo ar,iba. Enu.ndo 
que las posibles o probables c:o:1se<:uencias de ml n~ativa induyen. 
3. En un :enguaje que entiendo, se me ha ir.formado ~Je la negativa de 
este tratamiento o procedimiento pucde pnr.er en peligro mi salud 
y/o mi vida, sir. embargo, es mi deseo ql!D mi nesa1i11a sea cumplida. 
Por ti presente medlo l'.'oero 2 la O~cina de lnmlgraci6n y Aduanas 
(ICE), y los Estados Unicos de America de cualq~:er responsab'.'.'.dad 
G:Je pudie,an tone: porno ;:>topcn:lona< el tratamiento o 
proc.dimiento{s) aqul descntos. Doy le de que soy mayor de 
diec·.ocha anos yque me ancuenlro en plenas facultades mentalcs 
para ejoa;tar esta respcrisabllid.;d. 
l£30 J!:lfl-lP 
Sic.nattJre o Delainee/Firma del Oetenido T:melHora :Jale/Feclla 
(b)(6); (b)(7)(C) 
V l(b)(6); (b)(7)(C) fN,BSN 
i Provider/ Printed s;gnature/Firma con Lctrn de lmprenta 
Firm11 del P{OV '' de Salud b)(6); 
(b)(7)(C) 
Signature of TeS:igo lmptcnta 
I 
Signawre of ICE Offic:a1 (If epp11cable) Pnr.ted Signature 
I last Name: A...v-n a.._~ 
First Name: fYJ U'(J-eA,,_ft:,,n.(,., 
A#: 
?_{lo 2-.(oq f OL Ccuntl')I of Origin: JZ-u J ~)27\__ 
Oate of Camp Arrival (DCA): / L-/, q /2,o -rj DOB: 
I<> /-z-3/, q 7 R 
I Mc~ical Cli"ic: /\JwDC-· SeK: yy,Ct/e.--, 
tHSC ~orm 820-S 01/2011 Page 1 cf 1 
2019-ICLl-00051 3562 
DHS-ICE-19-0196, 19-0197-O-000246

eMARRecord 
Name: 
DOB: 
A: 
SublD: 
MERGENSANA AMAR 
10123/1978 Sex: M 
216269802 
!(b)(6); ! 
Printed on: 
Printed by: 
Date range: 
11/16/2018 07:45 
!(b)(6); (b)(7)(C) 
( to J 
Medications On1ered for Date Range: (to) 
# On1erDate On1eredBy Medication Sig PRN DOT/KOP Start Date End Date 
b)(6); (b)(7)(C) 
1 09/12/2018 l>edialytc - I bottle Orally Daily AM for 14 day.; KOP 09/12/2018 09/25/2018 
2 09/28/2018 l>edialyte - I bottle dn-ec titres a day Orally TID for 30 day.; KOP 09/28/2018 10/27/2018 
3 09/07/2018 l>edialyte - I bottle Orally Tin-cc titres a day for 4 day.; OOT 09/07/2018 09/10/2018 
4 09/12/2018 l>edialyte - I bottle Orally Twice a day for I 4 day.; KOP 09/12/2018 09/26/2018 
5 10/12/2018 BoostVHC- I /2 box mixed Orally TID for 60 day.; OOT 10/12/2018 12/10/2018 
6 10/15/2018 Prenatal Vitamin I Orally Daily NOON for 90 day.; KOP 10/15/2018 01/12/2019 Pixed Dose 
7 I 0/12/2018 r.iber625 MG I tablet as needed Orally BLD for 90 days KOP 10/12/2018 01/09/2019 
~lcitm500/D 2 tablet with food Orally Daily NOON for 90 8 10/12/2018 D00-200 MG- KOP 10/12/2018 01/09/2019 
UNIT days 
~1::itm500/D 
9 09/26/2018 500-200 MG- I tablet with food Orally BLD for 30 days KOP 09/26/2018 10/25/2018 
l)NIT 
IO I 0/12/2018 Boost Glucose 1/2 box mixed OrallyTID for 60 days OOT 10/12/2018 12/10/2018 t:Dntrol -
11 10/17/2018 Boost Glucose I Orally BID for 30 days OOT 10/17/2018 11/15/2018 t:Dntrol -
Neomycin￾I 2 07/30/2018 Polymyxin-HC 3.5-4 drops into affucted ear Otic TID for 7 days OOT 07/28/2018 08/03/2018 
10000-1 
13 I 0/17/2018 ~stYHC- I along with a ctip of water Orally Daily NOON OOT 10/17/2018 I 1/15/2018 for 30 days 
14 09/26/20 I 8 Boost Glucose 0.5 serving mixed Orally TID for 30 days OOT 09/26/2018 10/25/2018 t:Dntrol -
15 10/12/2018 En.5ure High Protein! Orally QHS for IO days OOT 10/12/2018 10/21/2018 
I 6 I 0/12/2018 Pedialyte - I Orally Bl D for 90 days KOP 10/12/2018 01/10/2019 
I 7 09/13/2018 lrhiarrire HCI I 00 I tablet Orally BID for 5 days KOP 09/13/2018 09/17/2018 ~G 
I 8 09/13/2018 Boost Plus - I Orally BID PRN for 5 days OOT 09/13/2018 09/17/2018 
I 9 I 0/26/2018 i'\cetamnopl-en I tablets as needed Orally BID for 30 days KOP 10/26/2018 I 1/24/2018 ~00MG 
20 09/26/20 I 8 t;holecal::irerol I tablet Orally QHS for 30 days KOP 09/26/2018 10/25/2018 ~000 UNIT 
21 10/26/2018 Piber625 MG I tablet as needed Orally QHS for 14 days KOP 10/26/2018 11/08/2018 
22 09/26/20 I 8 Boost Glucose 1 /5 Orally 17.D for 30 days OOT 09/26/2018 10/25/2018 t:Dntrol -
-- -- --
23 09/26/20 18 ~iber625 MG I tablet as needed Orally BID for 30 days KOP 09/26/2018 10/25/2018 
2019-ICLl-00051 3563 
DHS-ICE-19-0196, 19-0197-O-000247

24 10/01/2018 
25 09/27/201 8 
26 09/27/201 8 
27 10/18/2018 
28 09/1 9/201 8 
# OnierDate 
09/12/2018 
Due Date 
)9/13/2018 
# OnierDate 
2 09/28/20 I 8 
Due Date 
09/28/2018 
# OnierDate 
3 09/07 /20 I 8 
Due Date 
09/07/2018 
)9/07/2018 
09/07/2018 
09/08/2018 
09/08/2018 
)9/08/2018 
09/09/2018 
09/09/2018 
)9/09/2018 
# OnierDate 
4 09/12/2018 
Due Date 
09/12/2018 
# OnierDate 
5 10/12/2018 
Due Date 
I 0/12/2018 
(b)(6); (b)(7)(C) Acetamimplx:n 1 tablets as rx:eded Orally QID PRN for 90 days KOP 500MG 
Boost YRC- 0.5 serving each rrealtirn:: Orally TIO for 14 days OOT 
~u-c High Protein 1 Orally Q HS for 14 days OOT 
Fiber625 MG 2 tablet as needed Orally BID for 180 days KOP 
OnieredBy 
(b )(6); 
(b)(7)(C) 
!Due 1inE 
!09:00 
OnieredBy 
Boost Plus -
Medication 
Pedialyte -
!Status 
!Pending 
Medication 
b)(6); (b)(7)(C) 
edialyte -
!Due Time !Status 
113:00 !Pending 
Oniered By Medication 
(b)(6); (b)(7)(C) 
Pedialyte -
IDueTime !Status 
121 :00 IPerding 
1!3:00 IPerd.ing 
!09:00 IPerding 
121 :00 IPerding 
113:00 IPerding 
!09:00 IPerding 
121 :00 IPerding 
113:00 IPerding 
!09:00 IPerding 
Oniered By Medication 
b)(6); (b)(7)(C) 
Pedialyte -
!Due Time !Status 
121 :00 IPerding 
Oniered By Medication 
l'b)(6); (b)(7)(C) st YHC￾IDueTime !Status 
121 :00 IPerding 
1 Orally TIO PRN for 30 days OOT 
Medications Administration Details 
Sig PRN DOT/KOP 
1 bottle Orally Daily AM for 14 days KOP 
IUser/DateffinE !Reason/Notes 
I I 
Sig PRN DOT/KOP 
I bottle three titres a day Orally TLD for 30 da:t-, KOP 
IUser/Datemme IReason'Notes 
I I 
Sig PRN DOT/KOP 
I bottle Orally Three titres a day for 4 da:t-, OOT 
IUscr/Datcmme IReason'Notes 
I I 
I I 
I I 
I I 
I I 
I I 
I I 
I I 
I I 
Sig PRN DOT/KOP 
I bottle Orally Twice a day for 14 days KOP 
IUscr/Datemme IReason'Notes 
I I 
Sig PRN DOT/KOP 
I /2 box nixed Orally 11D for 60 da:t-, OOT 
IUser/Daleffime IReason'Notes 
I I 
2019-ICLl-00051 3564 
10/01/2018 12/29/2018 
09/27/2018 10/10/2018 
09/27/2018 10/10/2018 
10/18/2018 04/15/2019 
09/19/2018 10/18/2018 
Start Date End Date 
09/12/2018 09/25/2018 
Start Date End Date 
09/28/2018 10/27/2018 
Start Date End Date 
09/07/2018 09/10/2018 
Start Date End Date 
09/12/2018 09/26/2018 
Start Date End Date 
10/12/2018 12/10/2018 
DHS-ICE-19-0196, 19-0197-O-000248

I 0/13/2018 121:00 IPerding I I 
10/13/2018 113:00 IPerding I I 
10/13/2018 I09:00 IPerding I I 
10/14/2018 121 :00 IPerding I I 
10/14/2018 113:00 IPerding I I 
10/14/2018 I09:00 IPerding I I 
10/15/2018 121 :00 IPerding I I 
10/15/2018 113:00 IPerding I I 
10/15/2018 I09:00 IPerding I I 
10/16/2018 121 :00 !Pending I I 
10/16/2018 IJ3:00 !Pending I I 
10/16/2018 I09:00 !Pending I I 
I 0/17/2018 121 :00 !Pending I I 
10/17/2018 113:00 !Pending I I 
10/17/2018 I09:00 IPend.ing I I 
I 0/18/2018 121 :00 !Pending I I 
I 0/18/2018 113:00 !Pending I I 
I 0/18/2018 I09:00 !Pending I I 
10/19/2018 121 :00 !Pending I I 
10/19/2018 113:00 !Pending I I 
10/19/2018 I09:00 IPerding I I 
10/20/2018 121 :00 !Pending I I 
10/20/2018 113:00 !Pending I I 
10/20/2018 I09:00 !Pending I I 
10/21/2018 121 :00 !Pending I I 
10/21/2018 113:00 IPend.ing I I 
10/21/2018 I09:00 !Pending I I 
10/22/2018 121 :00 IPerding I I 
10/22/2018 113:00 IPerding I I 
10/22/2018 I09:00 IPend.ing I I 
10/23/2018 121 :00 !Pending I I 
10/23/2018 113:00 !Pending I I 
10/23/2018 I09:00 IPend.ing I I 
10/24/2018 121 :00 !Pending I I 
10/24/2018 113:00 !Pending I I 
10/24/2018 I09:00 IPerding I I 
10/25/2018 121 :00 !Pending I I 
2019-ICLl-00051 3565 
DHS-ICE-19-0196, 19-0197-O-000249

10125/2018 113:00 IPerding I I 
10125/2018 I09:00 IPerding I I 
10/26/2018 121 :00 IPerding I I 
10/26/2018 113:00 IPerding I I 
10/26/2018 I09:00 IPerding I I 
10/27/2018 121 :00 IPerding I I 
10/27/2018 113:00 IPerding I I 
10/27/2018 I09:00 IPerding I I 
10/28/2018 121 :00 IPerding I I 
10/28/2018 I13:00 !Pending I I 
10/28/2018 I09:00 !Pending I I 
1012912018 121 :00 !Pending I I 
10/29/2018 113:00 !Pending I I 
10/29/2018 I09:00 !Pending I I 
10/30/2018 121 :00 IPend.ing I I 
10/30/2018 113:00 !Pending I I 
10/30/2018 I09:00 !Pending I I 
10/31/2018 121 :00 !Pending I I 
10/31/2018 113:00 !Pending I I 
10/31/2018 I09:00 !Pending I I 
11/01/2018 121 :00 IPerding I I 
11/01/2018 113:00 !Pending I I 
11/01/2018 I09:00 !Pending I I 
11/02/2018 121 :00 !Pending I I 
11/02/2018 113:00 !Pending I I 
11/02/2018 I09:00 IPend.ing I I 
11/03/2018 121 :00 !Pending I I 
11/03/2018 113:00 IPerding I I 
11/03/2018 I09:00 IPerding I I 
11/04/2018 121 :00 IPend.ing I I 
11/04/2018 113:00 !Pending I I 
11/04/2018 I09:00 !Pending I I 
11/05/2018 121 :00 IPend.ing I I 
11/05/2018 113:00 !Pending I I 
11/05/2018 I09:00 !Pending I I 
11/06/2018 121 :00 IPerding I I 
11/06/2018 113:00 !Pending I I 
2019-ICLl-00051 3566 
DHS-ICE-19-0196, 19-0197-O-000250

11/06/2018 !09:00 IPerding I I 
11/07/2018 121 :00 IPerding I I 
11/07/2018 113:00 IPerding I I 
11/07/2018 !09:00 IPerding I I 
11/08/2018 121 :00 IPerding I I 
11/08/2018 113:00 IPerding I I 
11/08/2018 !09:00 IPerding I I 
11/09/2018 121 :00 IPerding I I 
11/09/2018 113:00 IPerding I I 
11/09/2018 !09:00 !Pending I I 
11/10/2018 121 :00 !Pending I I 
11/10/2018 113:00 !Pending I I 
11/10/2018 I09:00 !Pending I I 
11/11/2018 121 :00 !Pending I I 
11/11/2018 113:00 IPend.ing I I 
11/11/2018 I09:00 !Pending I I 
11/12/2018 121 :00 !Pending I I 
I 1/12/2018 113:00 !Pending I I 
I 1/12/2018 !09:00 !Pending I I 
11/13/2018 121 :00 !Pending I I 
11/13/2018 113:00 IPerding I I 
11/13/2018 !09:00 !Pending I I 
11/14/2018 121 :00 !Pending I I 
11/14/2018 113:00 !Pending I I 
11/14/2018 I09:00 !Pending I I 
I 1/15/2018 121 :00 IPend.ing I I 
11/15/2018 113:00 !Pending I I 
11/15/2018 I09:00 IPerding I I 
11/16/2018 121 :00 IPerding I I 
11/16/2018 113:00 IPend.ing I I 
11/16/2018 I09:00 !Pending I I 
11/17/2018 121 :00 !Pending I I 
11/17/2018 113:00 IPend.ing I I 
11/17/2018 !09:00 !Pending I I 
11/18/2018 121 :00 !Pending I I 
11/18/2018 113:00 IPerding I I 
11/18/2018 !09:00 !Pending I I 
2019-ICLl-00051 3567 
DHS-ICE-19-0196, 19-0197-O-000251

11/19/2018 121:00 IPerding I I 
11/19/2018 113:00 IPerding I I 
11/19/2018 I09:00 IPerding I I 
11/20/2018 121 :00 IPerding I I 
11/20/2018 113:00 IPerding I I 
11/20/2018 I09:00 IPerding I I 
11/21/2018 121 :00 IPerding I I 
11/21/2018 113:00 IPerding I I 
11/21/2018 I09:00 IPerding I I 
11/22/2018 121 :00 !Pending I I 
I 1/22/2018 IJ3:00 !Pending I I 
11/22/2018 I09:00 !Pending I I 
11/23/2018 121 :00 !Pending I I 
11/23/2018 113:00 !Pending I I 
11/23/2018 I09:00 IPend.ing I I 
11/24/2018 121 :00 !Pending I I 
11/24/2018 113:00 !Pending I I 
11/24/2018 l09:00 !Pending I I 
11/25/2018 121 :00 !Pending I I 
11/25/2018 113:00 !Pending I I 
11/25/2018 I09:00 IPerding I I 
I 1/26/2018 121 :00 !Pending I I 
11/26/2018 113:00 !Pending I I 
11/26/2018 I09:00 !Pending I I 
11/27/2018 121 :00 !Pending I I 
11/27/2018 113:00 IPend.ing I I 
11/27/2018 I09:00 !Pending I I 
11/28/2018 121 :00 IPerding I I 
11/28/2018 113:00 IPerding I I 
11/28/2018 I09:00 IPend.ing I I 
11/29/2018 121 :00 !Pending I I 
11/29/2018 113:00 !Pending I I 
11/29/2018 l09:00 IPend.ing I I 
11/30/2018 121 :00 !Pending I I 
11/30/2018 113:00 !Pending I I 
11/30/2018 I09:00 IPerding I I 
12/01/2018 121 :00 !Pending I I 
2019-ICLl-00051 3568 
DHS-ICE-19-0196, 19-0197-O-000252

12/01/2018 
12/01/2018 
12/02/2018 
12/02/2018 
12/02/2018 
12/03/2018 
12/03/2018 
12/03/2018 
12/04/2018 
12/04/2018 
12/04/2018 
12/05/2018 
12/05/2018 
12/05/2018 
12/06/2018 
12/06/2018 
12/06/2018 
I 2/07/2018 
12/07/2018 
12/07/2018 
12/08/2018 
12/08/2018 
12/08/2018 
12/09/2018 
12/09/2018 
12/09/2018 
12/10/2018 
12/10/2018 
# OrderDate 
6 I 0/15/2018 
Due Date 
10/16/2018 
# OrderDale 
7 I 0/12/2018 
Due Date 
I 0/12/2018 
IJ3:00 IPerding I 
I09:00 IPerding I 
121 :00 IPerding I 
IJ3:00 IPerding I 
I09:00 IPerding I 
121 :00 IPerding I 
113:00 IPerding I 
I09:00 IPerding I 
121 :00 IPerding I 
113:00 !Pending I 
!09:00 !Pending I 
121 :00 !Pending I 
113:00 !Pending I 
I09:00 !Pending I 
121 :00 IPend.ing I 
113:00 !Pending I 
I09:00 !Pending I 
121 :00 !Pending I 
113:00 !Pending I 
I09:00 !Pending I 
121 :00 IPerding I 
113:00 !Pending I 
I09:00 !Pending I 
121 :00 !Pending I 
113:00 !Pending I 
I09:00 IPend.ing I 
113:00 !Pending I 
I09:00 IPerding I 
Ordered By Medication 
b)(6); (b)(7)(C) 
Prenatal Vitamin 
foed Dose 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
Sig PRN DOT/KOP 
I Orally Daily NOON for 90 days KOP 
IDueTime !Status IUser/Datemme IReason'Notes 
112:00 !Pending I I 
Ordered By Medication Sig PRN DOT/KOP 
(b)(6); (b)(7)(C) Fiber625 MG I tablet as needed Orally BID for 90 days KOP 
IDueTime !Status IUser/Datemme IReason'Notes 
121 :00 !Pending I I 
2019-ICLl-00051 3569 
Start Date End Date 
10/15/2018 01/12/2019 
Start Date End Date 
10/12/2018 01/09/2019 
DHS-ICE-19-0196, 19-0197-O-000253

# OrderDate 
8 10/12/2018 
Dne Date 
10/13/2018 
# OrderDate 
9 09/26/20 I 8 
Dne Date 
)9/26/2018 
# Order Date 
IO 10/12/2018 
Dne Date 
I 0/12/2018 
10/13/2018 
10/13/2018 
10/13/2018 
10/14/2018 
10/14/2018 
10/14/2018 
I 0/15/2018 
I 0/15/2018 
I 0/15/2018 
I 0/16/2018 
I 0/16/2018 
I 0/16/2018 
I 0/17/2018 
I 0/17/2018 
I 0/17/2018 
I 0/18/2018 
I 0/18/2018 
I 0/18/2018 
10/19/2018 
10/19/2018 
10/19/2018 
10/20/2018 
10/20/2018 
10/20/2018 
Ordered By Medication Sig PRN DOT/KOP 
b)(6); (b)(?)(C) Calcitnn500/D 
500-200MG- .__ ___ ___. UNTT 
2 tablet with food Orally Daily NOON fur 90 
days KOP 
IDneTinE !Status IUser/DateffinE 
112:00 IPerrling I 
Ordered By Medication Sig 
b)(6); (b)(?)(C) Calcitm 500/D 
500-200 MG- I tablet with food Orally BID fur 30 days 
UNTT 
IDne 1inE !Status IUser/Date/1inE 
121 :00 !Pending I 
Ordered By Medication Sig 
(b)(6); (b)(?)(C) Boost Gh.K;ose 
Control- I /2 box nixed Orally TIO fur 60 days 
IDne 11nE !Status IUser/DateffinE 
121 :00 !Pending I 
121 :00 !Pending I 
113:00 !Pending I 
I09:00 !Pending I 
121 :00 !Pending I 
113:00 IPerding I 
I09:00 IPerding I 
121 :00 IPerding I 
113:00 IPerd.ing I 
I09:00 !Pending I 
121 :00 !Pending I 
113:00 IPend.ing I 
I09:00 IPend.ing I 
121 :00 !Pending I 
113:00 !Pending I 
!09:00 !Pending I 
121 :00 !Pending I 
113:00 !Pending I 
I09:00 !Pending I 
121 :00 IPend.ing I 
113:00 IPerding I 
I09:00 IPerding I 
121 :00 IPerd.ing I 
113:00 IPerding I 
I09:00 IPerding I 
IReasmvNotes 
I 
PRN DOT/KOP 
KOP 
IReasoniNotes 
I 
PRN DOT/KOP 
DOT 
!Reason/Notes 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
2019-ICLl-00051 3570 
Start Date End Date 
!0/!2/2018 01/09/2019 
Start Date End Date 
09/26/2018 10/25/2018 
Start Date End Date 
10/12/2018 12/10/2018 
DHS-ICE-19-0196, 19-0197-O-000254

10/21/2018 121 :00 !Pending I I 
10/21/2018 113:00 !Pending I I 
10/21/2018 I09:00 !Pending I I 
10/22/2018 121 :00 !Pending I I 
10/22/2018 IJ3:00 !Pending I I 
10/22/2018 I09:00 !Pending I I 
10/23/2018 121 :00 IPerding I I 
10/23/2018 113:00 IPerding I I 
10/23/2018 I09:00 IPerding I I 
10/24/2018 121 :00 IPerding I I 
10/24/2018 113:00 !Pending I I 
10/24/2018 I09:00 !Pending I I 
10f25/2018 121 :00 !Pending I I 
10/25/2018 113:00 !Pending I I 
l0f25/2018 I09:00 !Pending I I 
10f26/20l8 121 :00 IPend.ing I I 
10f26/20l8 113:00 !Pending I I 
10/26/2018 I09:00 IPerding I I 
10/27/2018 121 :00 IPerding I I 
10/27/2018 113:00 IPend.ing I I 
10/27/2018 I09:00 IPerding I I 
10/28/2018 121 :00 !Pending I I 
10/28/2018 113:00 !Pending I I 
10/28/2018 I09:00 IPend.ing I I 
10/29/2018 121 :00 !Pending I I 
l0f29f20l8 113:00 !Pending I I 
l0f29/2018 I09:00 !Pending I I 
10/30/2018 121 :00 !Pending I I 
10/30/2018 113:00 !Pending I I 
10/30/2018 I09:00 !Pending I I 
10/31/2018 121 :00 IPend.ing I I 
10/31/2018 113:00 !Pending I I 
10/31/2018 I09:00 IPerding I I 
11/01/2018 121 :00 IPerding I I 
11/01/2018 113:00 IPerd.ing I I 
11/01/2018 I09:00 IPerding I I 
2019-ICLl-00051 3571 
DHS-ICE-19-0196, 19-0197-O-000255

11/02/2018 121 :00 IPerrling I I 
11/02/2018 113:00 !Pending I I 
11/02/2018 I09:00 !Pending I I 
11/03/2018 121 :00 !Pending I I 
11/03/2018 113:00 !Pending I I 
11/03/2018 I09:00 !Pending I I 
11/04/2018 121 :00 !Pending I I 
11/04/2018 113:00 IPerding I I 
11/04/2018 I09:00 IPerding I I 
11/05/2018 121 :00 IPerding I I 
11/05/2018 113:00 IPerding I I 
11/05/2018 I09:00 IPerrling I I 
11/06/2018 121 :00 IPerrling I I 
11/06/2018 113:00 !Pending I I 
11/06/2018 I09:00 !Pending I I 
11/07/2018 121 :00 !Pending I I 
11/07/2018 113:00 IPend.ing I I 
11/07/2018 I09:00 !Pending I I 
11/08/2018 121 :00 !Pending I I 
11/08/2018 113:00 !Pending I I 
11/08/2018 I09:00 IPend.ing I I 
11/09/2018 121 :00 !Pending I I 
11/09/2018 113:00 !Pending I I 
11/09/2018 I09:00 !Pending I I 
11/10/2018 121 :00 IPend.ing I I 
11/10/2018 113:00 !Pending I I 
11/10/2018 I09:00 !Pending I I 
11/11/2018 121 :00 !Pending I I 
11/11/2018 113:00 !Pending I I 
11/11/2018 I09:00 !Pending I I 
11/12/2018 121 :00 !Pending I I 
11/12/2018 113:00 IPend.ing I I 
11/12/2018 I09:00 !Pending I I 
11/13/2018 121 :00 !Pending I I 
11/13/2018 113:00 !Pending I I 
11/13/2018 I09:00 IPend.ing I I 
11/14/2018 121 :00 !Pending I I 
2019-ICLl-00051 3572 
DHS-ICE-19-0196, 19-0197-O-000256

11/14/2018 113:00 IPerrling I I 
11/14/2018 !09:00 !Pending I I 
11/15/2018 121 :00 !Pending I I 
11/15/2018 113:00 !Pending I I 
11/15/2018 I09:00 !Pending I I 
11/16/2018 121 :00 !Pending I I 
11/16/2018 IJ3:00 !Pending I I 
11/16/2018 I09:00 IPerding I I 
11/17/2018 121 :00 IPerding I I 
11/17/2018 IJ3:00 IPerding I I 
11/17/2018 I09:00 IPerding I I 
11/18/2018 121 :00 IPerrling I I 
11/18/2018 113:00 IPerrling I I 
11/18/2018 I09:00 !Pending I I 
11/19/2018 121 :00 !Pending I I 
11/19/2018 113:00 !Pending I I 
11/19/2018 !09:00 IPend.ing I I 
11/20/2018 121 :00 !Pending I I 
11/20/2018 113:00 !Pending I I 
11/20/2018 I09:00 !Pending I I 
11/21/2018 121 :00 IPend.ing I I 
11/21/2018 113:00 !Pending I I 
11/21/2018 I09:00 !Pending I I 
11/22/2018 121 :00 !Pending I I 
I 1/22/2018 113:00 IPend.ing I I 
11/22/2018 I09:00 !Pending I I 
11/23/2018 121 :00 !Pending I I 
I 1/23/2018 113:00 !Pending I I 
I 1/23/2018 I09:00 !Pending I I 
11/24/2018 121 :00 !Pending I I 
11/24/2018 113:00 !Pending I I 
11/24/2018 !09:00 IPend.ing I I 
11/25/2018 121 :00 !Pending I I 
11/25/2018 113:00 !Pending I I 
11/25/2018 I09:00 !Pending I I 
11/26/2018 121 :00 IPend.ing I I 
11/26/2018 113:00 !Pending I I 
2019-ICLl-00051 3573 
DHS-ICE-19-0196, 19-0197-O-000257

11/26/2018 !09:00 IPerrling I I 
11/27/2018 121 :00 !Pending I I 
11/27/2018 IJ3:00 !Pending I I 
11/27/2018 !09:00 !Pending I I 
11/28/2018 121 :00 !Pending I I 
11/28/2018 IJ3:00 !Pending I I 
11/28/2018 !09:00 !Pending I I 
11/29/2018 121 :00 IPerding I I 
11/29/2018 113:00 IPerding I I 
11/29/2018 I09:00 IPerding I I 
11/30/2018 121 :00 IPerding I I 
11/30/2018 113:00 IPerrling I I 
11/30/2018 I09:00 IPerrling I I 
12/01/2018 121 :00 !Pending I I 
12/01/2018 113:00 !Pending I I 
12/01/2018 !09:00 !Pending I I 
12/02/2018 121 :00 IPend.ing I I 
12/02/2018 113:00 !Pending I I 
12/02/2018 !09:00 IPerding I I 
12/03/2018 121 :00 IPerding I I 
12/03/2018 113:00 IPerd.ing I I 
12/03/2018 !09:00 IPerding I I 
12/04/2018 121 :00 !Pending I I 
12/04/2018 113:00 !Pending I I 
12/04/2018 !09:00 IPerd.ing I I 
12/05/2018 121 :00 !Pending I I 
12/05/2018 113:00 !Pending I I 
12/05/2018 I09:00 !Pending I I 
12/06/2018 121 :00 !Pending I I 
12/06/2018 113:00 !Pending I I 
12/06/2018 !09:00 !Pending I I 
12/07/2018 121 :00 IPend.ing I I 
12/07/2018 113:00 !Pending I I 
12/07/2018 !09:00 IPerding I I 
12/08/2018 121 :00 IPerding I I 
12/08/2018 113:00 IPerd.ing I I 
12/08/2018 !09:00 IPerding I I 
2019-ICLl-00051 357 4 
DHS-ICE-19-0196, 19-0197-O-000258

12/09/2018 
12/09/2018 
12/09/2018 
12/10/2018 
12/10/2018 
# OrderDate 
11 I 0/17/2018 
Due Date 
10/17/2018 
10/18/2018 
10/18/2018 
10/19/2018 
10/19/2018 
10/20/2018 
10/20/2018 
10/21/2018 
10/21/2018 
10/22/2018 
10/22/2018 
10/23/2018 
10/23/2018 
10/24/2018 
10/24/2018 
10/25/2018 
10/25/2018 
10/26/2018 
10/26/2018 
10/27/2018 
10/27/2018 
10/28/2018 
10/28/2018 
10/29/2018 
10/29/2018 
10/30/2018 
10/30/2018 
10/31/2018 
10/31/2018 
121 :00 IPerrling I 
113:00 !Pending I 
I09:00 !Pending I 
IJ3:00 !Pending I 
I09:00 !Pending I 
Ordered By Medication 
(b)(6); (b)(7)(C) Boost Glucose 
Control￾I 
I 
I 
I 
I 
Sig PRN DOT/KOP 
I Orally BID for 30 days DOT 
1Due1inE !Status IUser/DateffinE !Reason/Notes 
121 :00 IPerrling I I 
121 :00 IPerrling I I 
I09:00 IPerrling I I 
121 :00 !Pert.ling I I 
I09:00 !Pending I I 
121 :00 IPerd.ing I I 
I09:00 IPerding I I 
121 :00 IPerding I I 
I09:00 IPerding I I 
121 :00 IPend.ing I I 
I09:00 !Pending I I 
121 :00 !Pending I I 
I09:00 IPend.ing I I 
121 :00 !Pending I I 
I09:00 !Pending I I 
121 :00 IPerding I I 
I09:00 !Pending I I 
121 :00 !Pending I I 
I09:00 !Pending I I 
121 :00 IPerding I I 
I09:00 IPerd.ing I I 
121 :00 IPerding I I 
I09:00 IPerding I I 
121 :00 IPerding I I 
I09:00 IPend.ing I I 
121 :00 !Pending I I 
I09:00 !Pending I I 
121 :00 IPend.ing I I 
I09:00 !Pending I I 
2019-ICLl-00051 3575 
Start Date Encl Date 
10/17/2018 11/15/2018 
DHS-ICE-19-0196, 19-0197-O-000259

11/01/2018 
11/01/2018 
11/02/2018 
11/02/2018 
11/03/2018 
11/03/2018 
11/04/2018 
11/04/2018 
11/05/2018 
11/05/2018 
11/06/2018 
11/06/2018 
11/07/2018 
11/07/2018 
11/08/2018 
11/08/2018 
11/09/2018 
11/09/2018 
11/10/2018 
11/10/2018 
11/11/2018 
11/11/2018 
11/12/2018 
11/12/2018 
11/13/2018 
I 1/13/2018 
11/14/2018 
11/14/2018 
11/15/2018 
# OrderDate 
12 07/30/2018 
121 :00 IPerding I I 
I09:00 IPerding I I 
121 :00 IPerding I I 
I09:00 IPerding I I 
121 :00 IPerding I I 
I09:00 IPerding I I 
121 :00 IPerding I I 
I09:00 IPerding I I 
121 :00 IPerding I I 
I09:00 !Pending I I 
121 :00 !Pending I I 
I09:00 !Pending I I 
121 :00 !Pending I I 
I09:00 !Pending I I 
121 :00 IPend.ing I I 
I09:00 !Pending I I 
121 :00 !Pending I I 
I09:00 !Pending I I 
121 :00 !Pending I I 
I09:00 !Pending I I 
121 :00 IPerding I I 
I09:00 !Pending I I 
121 :00 !Pending I I 
I09:00 !Pending I I 
121 :00 !Pending I I 
!09:00 IPend.ing I I 
121 :00 !Pending I I 
I09:00 IPerding I I 
I09:00 IPerding I I 
Ordered By Medication Sig 
~~~~~Neomycin-
~b)(6); (b)(?)(C) IPolymyxin-HC 3.5-4 drops into aflected ear Otic HD for 7 days 
~[ ----~- 10000-1 
2019-ICLl-00051 3576 
PRN DOT/KOP Start Date End Date 
DOT 07/28/2018 08/03/2018 
DHS-ICE-19-0196, 19-0197-O-000260

Due Date IDueTinE !Status 
07/28/2018 121 :00 IPerrling 
07/28/2018 113:00 !Pending 
)7/28/2018 !09:00 !Pending 
)7/29/2018 121 :00 !Pending 
07/29/2018 IJ3:00 !Pending 
07/29/2018 !09:00 !Pending 
)7130/2018 121 :00 !Pending 
07/30/2018 IJ3:00 IPerding 
07/30/2018 !09:00 IPerding 
07/31/2018 121 :00 IPerding 
)7131/2018 IJ3:00 IPerding 
07/31/2018 !09:00 IPerrling 
08/01/2018 121 :00 !Pending 
)8/01/2018 113:00 !Pending 
)8/01/2018 !09:00 !Pending 
08/02/2018 121 :00 !Pending 
08/02/2018 113:00 !Pending 
)8/02/2018 !09:00 !Pending 
# OrderDate Ordered By Medication 
13 I 0/17/2018 
(b)(6); (b)(7)(C) 
Boost VHC￾IUser/DateffinE IReasmvNotes 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
Sig 
I along with a cup of water Orally Daily NOON 
tor 30 days 
2019-ICLl-00051 3577 
PRN DOT/KOP 
DOT 
Start Date End Date 
10/17/2018 11/15/2018 
DHS-ICE-19-0196, 19-0197-O-000261

Due Date 
10/18/2018 
10/19/2018 
10/20/2018 
10/21/2018 
10/22/2018 
10/23/2018 
10/24/2018 
10/25/2018 
10/26/2018 
10/27/2018 
10/28/2018 
10/29/2018 
10/30/2018 
I 0/31/2018 
I 1/01/2018 
I 1/02/2018 
I 1/03/2018 
I 1/04/2018 
11/05/2018 
11/06/2018 
11/07/2018 
11/08/2018 
11/09/2018 
I 1/10/2018 
ll/11/2018 
I 1/12/2018 
I 1/13/2018 
I 1/14/2018 
I 1/15/2018 
# OrderDate 
14 09/26/20 I8 
Due Date 
)9/26/2018 
09/27/2018 
09/27/2018 
IDueTinE !Status IUser/DateffinE 
112:00 IPerrling I 
112:00 !Pending I 
112:00 !Pending I 
112:00 !Pending I 
112:00 !Pending I 
112:00 !Pending I 
112:00 !Pending I 
112:00 IPerding I 
112:00 IPerding I 
112:00 IPerding I 
112:00 IPerding I 
112:00 IPerrling I 
112:00 !Pending I 
112:00 !Pending I 
112:00 !Pending I 
112:00 !Pending I 
112:00 !Pending I 
112:00 !Pending I 
112:00 !Pending I 
112:00 !Pending I 
112:00 !Pending I 
112:00 IPend.ing I 
112:00 !Pending I 
112:00 !Pending I 
112:00 IPend.ing I 
112:00 IPend.ing I 
112:00 !Pending I 
112:00 !Pending I 
112:00 !Pending I 
Ordered By Medication Sig 
b)(6); (b)(?)(C) Boost Gltk::ose 
Control- 0.5 setving nixed Orally TIO for 30 days .__ ___ ___. 
IDueTIDE !Status IUser/DateffiDE 
121 :00 IPend.ing I 
121 :00 !Pending I 
113:00 !Pending I 
IReasmvNotes 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
PRN 
IReason'Notes 
I 
I 
I 
2019-ICLl-00051 3578 
DOT/KOP Start Date End Date 
DOT 09/26/2018 10/25/2018 
DHS-ICE-19-0196, 19-0197-O-000262

09/27/2018 !09:00 IPerrling I I 
)9/28/2018 121 :00 !Pending I I 
)9/28/2018 113:00 !Pending I I 
09/28/2018 !09:00 !Pending I I 
09/29/2018 121 :00 !Pending I I 
)9/29/2018 IJ3:00 !Pending I I 
09/29/2018 !09:00 !Pending I I 
09/30/2018 121 :00 IPerding I I 
09/30/2018 113:00 IPerding I I 
)9/30/2018 I09:00 IPerding I I 
10/01/2018 121 :00 IPerding I I 
10/01/2018 113:00 IPerrling I I 
10/01/2018 I09:00 IPerrling I I 
10/02/2018 121 :00 !Pending I I 
10/02/2018 113:00 !Pending I I 
10/02/2018 !09:00 !Pending I I 
10/03/2018 121 :00 IPend.ing I I 
10/03/2018 113:00 !Pending I I 
10/03/2018 !09:00 IPerding I I 
10/04/2018 121 :00 IPerding I I 
10/04/2018 113:00 IPerd.ing I I 
10/04/2018 !09:00 IPerding I I 
10/05/2018 121 :00 !Pending I I 
10/05/2018 113:00 !Pending I I 
10/05/2018 !09:00 IPerd.ing I I 
10/06/2018 121 :00 !Pending I I 
10/06/2018 113:00 !Pending I I 
10/06/2018 I09:00 !Pending I I 
I 0/07/2018 121 :00 !Pending I I 
I 0/07/2018 113:00 !Pending I I 
I 0/07/2018 !09:00 !Pending I I 
10/08/2018 121 :00 IPend.ing I I 
10/08/2018 113:00 !Pending I I 
10/08/2018 !09:00 IPerding I I 
10/09/2018 121 :00 IPerding I I 
10/09/2018 113:00 IPerd.ing I I 
10/09/2018 !09:00 IPerding I I 
2019-ICLl-00051 3579 
DHS-ICE-19-0196, 19-0197-O-000263

10/10/2018 121 :00 IPerrling I I 
10/10/2018 113:00 !Pending I I 
!0/10/2018 I09:00 !Pending I I 
IO/I 1/2018 121 :00 !Pending I I 
10/11/2018 113:00 !Pending I I 
10/11/2018 I09:00 !Pending I I 
10/12/2018 121 :00 !Pending I I 
10/12/2018 113:00 IPerding I I 
10/12/2018 I09:00 IPerding I I 
10/13/2018 121 :00 IPerding I I 
10/13/2018 113:00 IPerding I I 
10/13/2018 1()9:00 IPerrling I I 
10/14/2018 121 :00 IPerrling I I 
10/14/2018 113:00 !Pending I I 
10/14/2018 I09:00 !Pending I I 
I 0/15/2018 121 :00 !Pending I I 
I 0/15/2018 113:00 IPend.ing I I 
I 0/15/2018 I09:00 !Pending I I 
10/16/2018 121 :00 IPerding I I 
I 0/16/2018 113:00 IPerding I I 
I 0/16/2018 I09:00 IPend.ing I I 
I 0/17/2018 121 :00 IPerding I I 
I 0/17/2018 113:00 !Pending I I 
10/17/2018 I09:00 !Pending I I 
I 0/18/2018 121 :00 IPend.ing I I 
I 0/18/2018 113:00 !Pending I I 
I 0/18/2018 I09:00 !Pending I I 
10/19/2018 121 :00 !Pending I I 
10/19/2018 113:00 !Pending I I 
10/19/2018 I09:00 !Pending I I 
10/20/2018 121 :00 !Pending I I 
10/20/2018 113:00 IPend.ing I I 
10/20/2018 I09:00 !Pending I I 
10/21/2018 121 :00 IPerding I I 
10/21/2018 113:00 IPerding I I 
10/21/2018 I09:00 IPerd.ing I I 
10/22/2018 121 :00 IPerding I I 
2019-ICLl-00051 3580 
DHS-ICE-19-0196, 19-0197-O-000264

10/22/2018 
10/22/2018 
10/23/2018 
10/23/2018 
10/23/2018 
10/24/2018 
10/24/2018 
10/24/2018 
10/25/2018 
10/25/2018 
# Order Date 
15 10/12/2018 
Due Date 
I 0/12/2018 
10/13/2018 
10/14/2018 
I 0/15/2018 
I 0/16/2018 
I 0/17/2018 
I 0/18/2018 
10/19/2018 
10/20/2018 
# OrderDate 
16 I 0/12/2018 
Due Date 
I 0/12/2018 
# OrderDate 
17 09/13/2018 
Due Date 
)9/13/2018 
# OrderDale 
18 09/13/2018 
113:00 IPerrling I 
!09:00 !Pending I 
121 :00 !Pending I 
113:00 !Pending I 
I09:00 !Pending I 
121 :00 !Pending I 
IJ3:00 !Pending I 
I09:00 IPerding I 
113:00 IPerding I 
I09:00 IPerding I 
Ordered By Medication Sig 
b)(6); (b)(?)(C) 
~urc High Protcin1 Orally QHS fur 10 days .__ ___ ___. 
IDue 1ime !Status IUser/Dateflime 
121 :00 !Pending I 
121 :00 IPerding I 
121 :00 IPerding I 
121 :00 IPerding I 
121 :00 IPend.ing I 
121 :00 !Pending I 
121 :00 !Pending I 
121 :00 IPend.ing I 
121 :00 !Pending I 
Ordered By Medication Sig 
b)(6); (b)(?)(C) 
edialyte - I Orally BID for 90 days 
IDueTime !Status IUser/Datemme 
121 :00 IPend.ing I 
Ordered By Medication Sig 
(b)(5); (b)(?)(C) Thamre HCI 100 
MG I tablet Orally BLD for 5 days 
IDue 1ime !Status IUser/Datemme 
121 :00 !Pending I 
Ordered By Medication Sig 
b)(6); (b)(?)(C) 
>Ost Plus - I Orally BLD PRN fur 5 days 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
PRN DOT/KOP 
OOT 
IReas01vNotes 
I 
I 
I 
I 
I 
I 
I 
I 
I 
PRN DOT/KOP 
KOP 
IReasowNotes 
I 
PRN DOT/KOP 
KOP 
IReasowNotes 
I 
PRN DOT/KOP 
OOT 
2019-ICLl-00051 3581 
Start Date End Date 
10/12/2018 10/21/2018 
Start Date End Date 
10/12/2018 01/10/2019 
Start Date End Date 
09/13/2018 09/17/2018 
Start Date End Date 
09/13/2018 09/17/2018 
DHS-ICE-19-0196, 19-0197-O-000265

Due Date 
09/13/2018 
09/14/2018 
)9/14/2018 
)9/15/2018 
09/15/2018 
09/16/2018 
)9/16/2018 
09/17/2018 
# OrderDate 
19 10/26/2018 
Due Date 
10/26/2018 
# OrderDate 
20 09/26/20 18 
Due Date 
09/26/2018 
# OrderDate 
21 I 0/26/2018 
Due Date 
10/26/2018 
# OrderDate 
22 09/26/20 I 8 
Due Date 
)9/26/2018 
09/26/2018 
09/27/2018 
)9/27/2018 
09/27/2018 
09/28/2018 
)9/28/2018 
)9/28/2018 
09/29/2018 
09/29/2018 
)9/29/2018 
)9/30/2018 
IDueTinE !Status IUser/DateffinE IReasmvNotes 
121 :00 IPerrling I I 
121 :00 !Pending I I 
!09:00 !Pending I I 
121 :00 !Pending I I 
!09:00 !Pending I I 
121 :00 !Pending I I 
!09:00 !Pending I I 
!09:00 IPerding I I 
Ordered By Medication Sig PRN DOT/KOP 
(b)(6); (b)(7)(C) Acctaminoph::n 
500MG I tablets as reeded Orally BID for 30 days KOP 
IDueTinE !Status IUser/DateflinE !Reason/Notes 
121 :00 !Pending I I 
Ordered By Medication Sig PRN DOT/KOP 
(b )(6); (b )(7)(C) Choleealciferol 
2000UNIT I tablet Orally QHS for 30 days KOP 
!Due TIDE !Status IUser/DateffiDE !Reason/Notes 
121 :00 !Pending I I 
Ordered By Medication Sig PRN DOT/KOP 
(b)(6); (b)(7)(C) 
Fiber625 MG I tablet as needed Orally QHS for 14 days KOP 
IDueTiDE !Status IUser/DatemDE 
121 :00 !Pending I 
Ordered By Sig 
l(b)(6); (b)(7)(C) 
Medication 
~st Glucose 
ntrol- I /5 Orally Tl D for 30 days 
IDueTiDE !Status IUser/DatemDE 
121 :00 !Pending I 
113:00 !Pending I 
121 :00 !Pending I 
113:00 IPend.ing I 
!09:00 !Pending I 
121 :00 !Pending I 
113:00 IPend.ing I 
!09:00 IPend.ing I 
121 :00 !Pending I 
113:00 !Pending I 
!09:00 !Pending I 
121 :00 !Pending I 
!Reason/Notes 
I 
PRN DOT/KOP 
DOT 
IReasoniNotes 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
2019-ICLl-00051 3582 
Start Date End Date 
l0/26/2018 11/24/2018 
Start Date End Date 
09/26/2018 10/25/2018 
Start Date End Date 
10/26/2018 11/08/2018 
Start Date End Date 
09/26/2018 10/25/2018 
DHS-ICE-19-0196, 19-0197-O-000266

09130/2018 113:00 IPerding I I 
09130/2018 I09:00 IPerding I I 
10/01/2018 121 :00 IPerding I I 
10/01/2018 113:00 IPerding I I 
10/01/2018 I09:00 IPerding I I 
10/02/2018 121 :00 IPerding I I 
10/02/2018 113:00 IPerding I I 
10/02/2018 1()9:00 IPerding I I 
10/03/2018 121 :00 IPerding I I 
10/03/2018 113:00 !Pending I I 
10/03/2018 I09:00 !Pending I I 
10/04/2018 121 :00 !Pending I I 
10/04/2018 113:00 !Pending I I 
10/04/2018 I09:00 !Pending I I 
10/05/2018 121 :00 IPend.ing I I 
10/05/2018 113:00 !Pending I I 
10/05/2018 I09:00 !Pending I I 
10/06/2018 121 :00 !Pending I I 
10/06/2018 113:00 !Pending I I 
10/06/2018 I09:00 !Pending I I 
I 0/07/2018 121 :00 IPerding I I 
I 0/07/2018 113:00 !Pending I I 
I 0/07/2018 I09:00 !Pending I I 
10/08/2018 121 :00 !Pending I I 
10/08/2018 113:00 !Pending I I 
10/08/2018 I09:00 IPend.ing I I 
10/09/2018 121 :00 !Pending I I 
10/09/2018 113:00 IPerding I I 
10/09/2018 I09:00 IPerding I I 
I 0/10/2018 121 :00 IPend.ing I I 
I 0/10/2018 113:00 !Pending I I 
I 0/10/2018 I09:00 !Pending I I 
10/11/2018 121 :00 IPend.ing I I 
10/11/2018 113:00 !Pending I I 
I 0/11/2018 I09:00 !Pending I I 
I 0/12/2018 121 :00 IPerding I I 
I 0/12/2018 113:00 !Pending I I 
2019-ICLl-00051 3583 
DHS-ICE-19-0196, 19-0197-O-000267

10/12/2018 !09:00 IPerding I I 
10/13/2018 121 :00 IPerding I I 
10/13/2018 113:00 IPerding I I 
10/13/2018 !09:00 IPerding I I 
10/14/2018 121 :00 IPerding I I 
10/14/2018 113:00 IPerding I I 
10/14/2018 !09:00 IPerding I I 
10/15/2018 121 :00 IPerding I I 
10/15/2018 113:00 IPerding I I 
10/15/2018 !09:00 !Pending I I 
10/16/2018 121 :00 !Pending I I 
10/16/2018 113:00 !Pending I I 
10/16/2018 I09:00 !Pending I I 
10/17/2018 121 :00 !Pending I I 
10/17/2018 113:00 IPend.ing I I 
I 0/17/2018 I09:00 !Pending I I 
I 0/18/2018 121 :00 !Pending I I 
I 0/18/2018 113:00 !Pending I I 
I 0/18/2018 !09:00 !Pending I I 
10/19/2018 121 :00 !Pending I I 
10/19/2018 113:00 IPerding I I 
10/19/2018 !09:00 !Pending I I 
10/20/2018 121 :00 !Pending I I 
10/20/2018 113:00 !Pending I I 
10/20/2018 I09:00 !Pending I I 
10/21/2018 121 :00 IPend.ing I I 
10/21/2018 113:00 !Pending I I 
10/21/2018 I09:00 IPerding I I 
10/22/2018 121 :00 IPerding I I 
10/22/2018 113:00 IPend.ing I I 
10/22/2018 I09:00 !Pending I I 
10/23/2018 121 :00 !Pending I I 
10/23/2018 113:00 IPend.ing I I 
10/23/2018 !09:00 !Pending I I 
10/24/2018 121 :00 !Pending I I 
10/24/2018 113:00 IPerding I I 
10/24/2018 !09:00 !Pending I I 
2019-ICLl-00051 3584 
DHS-ICE-19-0196, 19-0197-O-000268

I 1 0125/2018 
# Order Date 
23 09/2612018 
One Date 
)9/2612018 
# OrderDate 
24 10/01/2018 
One Date 
10/01/2018 
# OrderDate 
@9:00 IPerding 
Ordered By Medication Sig PRN DOT/KOP 
(b)(6); (b)(?)(C) Fiber625 MG I tablet as needed Orally BID fur 30 da~ KOP 
IDne Time !Status IUser/Dateffime IReason'Notes 
121 :00 !Pending I 
Ordered By Medication 
(b)(6); (b)(?)(C) Acetamimpl-cn 
~---~500MG 
I 
Sig PRN DOT/KOP 
I tablets as tl.'leded Orally QID PRN fur 90 da~ KOP 
IDneTime !Status IUser/Dateffi1re IReason'Notes 
113:00 !Pending I I 
Ordered By Medication Sig PRN DOT/KOP 
25 09/27/2018 (b)(6); (b)(7)(C) BoostVHC- 0.5 serving each ll'Caltirre Orally TIO fur 14 da~ OOT 
One Date IDne Time !Status IUser/Dateffime IReason'Notes 
)9/27/2018 121 :00 IPerding I I 
09/28/2018 121 :00 !Pending I I 
09/28/2018 113:00 !Pending I I 
09/28/2018 I09:00 !Pending I I 
)9/29/2018 121 :00 IPend.ing I I 
09/29/2018 113:00 !Pending I I 
09/29/2018 I09:00 !Pending I I 
)9/30/2018 121 :00 (Pending I I 
)9/30/2018 113:00 !Pending I I 
09/30/2018 I09:00 !Pending I I 
10/01/2018 121 :00 !Pending I I 
10/01/2018 113:00 IPend.ing I I 
10/01/2018 I09:00 !Pending I I 
10/02/2018 121 :00 !Pending I I 
10/02/2018 113:00 !Pending I I 
10/02/2018 I09:00 IPerd.ing I I 
10/03/2018 121 :00 !Pending I I 
10/03/2018 113:00 !Pending I I 
10/03/2018 (09:00 (Pending I I 
10/04/2018 121 :00 IPerding I I 
10/04/2018 113:00 !Pending I I 
10/04/2018 I09:00 !Pending I I 
10/05/2018 121 :00 (Pending I I 
10/05/2018 113:00 !Pending I I 
2019-ICLl-00051 3585 
Start Date End Date 
09/26/2018 10/25/2018 
Start Date End Date 
10/01/2018 12/29/2018 
Start Date End Date 
09/27/2018 10/10/2018 
DHS-ICE-19-0196, 19-0197-O-000269

10/05/2018 !09:00 IPerding I I 
10/06/2018 121 :00 IPerding I I 
10/06/2018 113:00 IPerding I I 
10/06/2018 !09:00 IPerding I I 
10/07/2018 121 :00 IPerding I I 
10/07/2018 113:00 IPerding I I 
10/07/2018 !09:00 IPerding I I 
10/08/2018 121 :00 IPerding I I 
10/08/2018 113:00 IPerding I I 
10/08/2018 !09:00 !Pending I I 
10/09/2018 121 :00 !Pending I I 
10/09/2018 IJ3:00 !Pending I I 
10/09/2018 !09:00 !Pending I I 
I 0/10/2018 113:00 !Pending I I 
I 0/10/2018 !09:00 IPend.ing I I 
# OrderDate Ordered By Medication Sig PRN DOT/KOP Start Date End Date 
26 09/27120 18 
(b)(6); (b)(?)(C) 
'.°nsure High Protein IOrally QHS for 14 days OOT 09/27/2018 10/10/2018 
Due Date IDue Tinr !Status IUser/Datcmnr IReason'Notes 
)9/27/2018 121 :00 IPend.ing I I 
)9/28/2018 121 :00 !Pending I I 
09/29/2018 121 :00 !Pending I I 
09/30/2018 121 :00 !Pending I I 
10/01/2018 121 :00 IPend.ing I I 
10/02/2018 121 :00 !Pending I I 
10/03/2018 121 :00 !Pending I I 
10/04/2018 121 :00 !Pending I I 
10/05/2018 121 :00 IPend.ing I I 
10/06/2018 121 :00 !Pending I I 
10/07/2018 121 :00 !Pending I I 
10/08/2018 121 :00 !Pending I I 
10/09/2018 121 :00 !Pending I I 
# OrderDate Ordered By Medication Sig PRN DOT/KOP Start Date End Date 
27 I 0/18/2018 (b)(6); (b)(?)(C) Fiber 625 MG 2 tablet as needed Orally BID for 180 days KOP 10/18/2018 04/15/2019 
Due Date IDueTinr !Status IUscr/Datemnr IReason'Notes 
I 0/18/2018 121 :00 IPend.ing I I 
# OrderDate Ordered By Medication Sig PRN DOT/KOP Start Date End Date 
2019-ICLl-00051 3586 
DHS-ICE-19-0196, 19-0197-O-000270

28 09/1 9120 I 8 b)(6); (b)(?)(C) Boost Ph.is- I Orally 11D PRN for 30 days DOT 09/1912018 10/18/2018 
Due Date IDueTinE !Status IUser/DateffinE IReasmvNotes 
09/1912018 121 :00 !Pending I I 
0912012018 121 :00 !Pending I I 
)912012018 113:00 !Pending I I 
)912012018 I09:00 !Pending I I 
0912112018 121 :00 !Pending I I 
0912112018 113:00 !Pending I I 
)912112018 I09:00 !Pending I I 
09122/2018 121 :00 IPerding I I 
09122/2018 113:00 IPcrding I I 
09122/2018 !09:00 IPerding I I 
)912312018 121 :00 IPerding I I 
09123/2018 113:00 !Pending I I 
09/23/2018 !09:00 !Pending I I 
)9/24/2018 121 :00 !Pending I I 
)9/24/2018 113:00 !Pending I I 
09/24/2018 I09:00 !Pending I I 
09/25/2018 121 :00 !Pending I I 
)9/25/2018 113:00 !Pending I I 
)9125/2018 I09:00 !Pending I I 
09126/2018 121 :00 !Pending I I 
09/26/2018 113:00 !Pending I I 
)9/26/2018 I09:00 IPend.ing I I 
09/27/2018 121 :00 !Pending I I 
09/27/2018 113:00 !Pending I I 
)9/27/2018 I09:00 IPend.ing I I 
)9/2812018 121 :00 IPend.ing I I 
09/28/2018 113:00 !Pending I I 
09/28/2018 !09:00 !Pending I I 
)9/29/2018 121 :00 !Pending I I 
)9/29/2018 113:00 !Pending I I 
09/29/2018 I09:00 !Pending I I 
09/30/2018 121 :00 !Pending I I 
)9/30/2018 113:00 IPend.ing I I 
)9/30/2018 I09:00 !Pending I I 
10/01/2018 121 :00 !Pending I I 
2019-ICLl-00051 3587 
DHS-ICE-19-0196, 19-0197-O-000271

10/01/2018 113:00 IPerding I I 
10/01/2018 I09:00 IPerding I I 
10/02/2018 121 :00 IPerding I I 
10/02/2018 113:00 IPerding I I 
10/02/2018 I09:00 IPerding I I 
10/03/2018 121 :00 IPerding I I 
10/03/2018 113:00 IPerding I I 
10/03/2018 I09:00 IPerding I I 
10/04/2018 121 :00 IPerding I I 
10/04/2018 I13:00 !Pending I I 
10/04/2018 I09:00 !Pending I I 
10/05/2018 121 :00 !Pending I I 
10/05/2018 113:00 !Pending I I 
10/05/2018 I09:00 !Pending I I 
10/06/2018 121 :00 IPend.ing I I 
10/06/2018 113:00 !Pending I I 
10/06/2018 I09:00 !Pending I I 
I 0/07/2018 121 :00 !Pending I I 
I 0/07/2018 113:00 !Pending I I 
I 0/07/2018 I09:00 !Pending I I 
10/08/2018 121 :00 IPerding I I 
10/08/2018 113:00 !Pending I I 
10/08/2018 I09:00 !Pending I I 
10/09/2018 121 :00 !Pending I I 
10/09/2018 113:00 !Pending I I 
10/09/2018 I09:00 IPend.ing I I 
10/10/2018 121 :00 !Pending I I 
10/10/2018 113:00 IPerding I I 
I 0/10/2018 I09:00 IPerding I I 
10/11/2018 121 :00 IPend.ing I I 
I 0/11/2018 113:00 !Pending I I 
I 0/11/2018 I09:00 !Pending I I 
I 0/12/2018 121 :00 IPend.ing I I 
I 0/12/2018 113:00 !Pending I I 
10/12/2018 I09:00 !Pending I I 
I 0/13/2018 121 :00 IPerding I I 
I 0/13/2018 113:00 !Pending I I 
2019-ICLl-00051 3588 
DHS-ICE-19-0196, 19-0197-O-000272

I 0/13/2018 !09:00 IPerding I I 
10/14/2018 121 :00 IPerding I I 
10/14/2018 113:00 IPerding I I 
10/14/2018 !09:00 IPerding I I 
10/15/2018 121 :00 IPerding I I 
10/15/2018 113:00 IPerding I I 
10/15/2018 !09:00 IPerding I I 
10/16/2018 121 :00 IPerding I I 
10/16/2018 113:00 IPerding I I 
10/16/2018 !09:00 !Pending I I 
10/17/2018 121 :00 !Pending I I 
10/17/2018 IJ3:00 !Pending I I 
I 0/17/2018 I09:00 !Pending I I 
I 0/18/2018 113:00 !Pending I I 
I 0/18/2018 !09:00 IPend.ing I I 
Patient Name, MERGENSANAAMAR DOil, 10/23/1978 &tbnj::b)(6); IA: 21626g8m 
Powered By eClinical\Vorks LLC. 
2019-ICLl-00051 3589 
DHS-ICE-19-0196, 19-0197-O-000273

AMAR,MERGENSANA 
SublD: j(b)(6); I 
A216269802 
Room: Scgrc~tion 
Bcd:Room I 
BcdTwc: 
AD:\IISSIO:\' 
ORD[RS 
Infirmary Admissions 
Tacoma MHU 40 Years,M Provider: !(b)(6); (b)(?)(C) 
Inf Adm Date: -I 0/26/2018 0016 
Followup Status: -
Inf Prov. Discharge Date: -11/05/2018 14:31 
Inf Phy. Discharge Datc:-11/05/2018 14:31 
309.28 Adjusttnmt disonler \\ith nixed anxiety and depressed nnod 
ORDER DATE 
N/AOther 
ORDER DATE 
:\On:s 
DATE RFASOI\ !\OTIS 
ORDER BY 
ORDER BY 
DEfAil.S 
DETAIL<; 
Doci.nrent generated by eClinicalWorks ® Sofhvarc (vAvw.eClinicalWorks.com) 
2019-ICLl-00051 3590 
DHS-ICE-19-0196, 19-0197-O-000274

Infirmary Admissions 
Tacoma MHU 
AMAR,MERGENSANA 40 Years,M P vid · l"'"(b""')(.,.6)=· (,....,b)""'(7,,...,)(,.,,.C,.....) --, SubIDj(b )(6); _ I ro er. . . ' . A 216269802 Inf Adm Date. -09/22.12018 03:23 
Followup Status: - Room: Med Tso 2 
Bcd:Bed I 
Bed Type: 
AD:\IISSIO:\' 
ORD[RS 
N/AOther 
ORDER DATE 
:\on:s 
ORDER BY 
DATE REASON !\'OTIS 
Inf Prov. Discharge Date: -IO/I 7 /20 I 8 09:26 
Inf Phy. Discharge Date: -10/17/2018 09:26 
DETAIL', 
Docutrent ~nerated byeClinicalWorks ® Soflware (\V\V\v.eClinicalWorks.com) 
2019-ICLl-00051 3591 
DHS-ICE-19-0196, 19-0197-O-000275

Room: Resp Iso I 
Bcd:Bed I 
BcdTwc: 
AD:\IISSIO:\' 
ORD[RS 
Infirmary Admissions 
Followup Status: -
In£ Prov. Discharge Date: -09/22/2018 03: 17 
In£ Phy. Discharge Datc:-09/22/2018 03:17 
T73.0XXD Staivation, subsequent encom1ter 
ORDER DATE 
N/AOther 
ORDER DATE 
:\On:s 
DAU: RFASOI\ !\OTIS 
ORDER BY 
ORDER BY 
DITAILS 
DITAIL~ 
Doci.nrent generated by eClinicalWorks ® Software (vAvw.eClinicalWorks.com) 
2019-ICLl-00051 3592 
DHS-ICE-19-0196, 19-0197-O-000276

Subject ID Kb)(6); 
1,,..\/7\/~, I 
ORDER TO DETAIN OR RELEASE ALIEN 
TO: (NAME and TITLE of Person in Charge of Facility)~)( 6); 
b)(7)(C) I 
(Name of Facility) -rll Cu "'l u. ·:tr/[. Pf.v,:.PH-'1.J Q;ik/ 
Please LJ Detain 00 Release Date I Time 
/( /is-/213 1 szi--
Name of Alien AMAR, MERGENSANA File Number 
A216269802 
Age I Date of Birth (Mo.Day.Yr.) I Sex I Nationality I. Foreign Address 36 AVIDUEVA ST. KHURl\MSRA, IVOLGINSKI D 
40 10/23/1978 M RUSSIA r , b)(6); (b)(7)(C) 
Nature of Proceedings ISigna~ ., .. -•------·--- ------------ REMARKS: 
'- /' 
Signature of (b)(6); (b)(7)(C) Title Office 
._; )_',,J) ~, s· II-ft /:-.- e..:1 , <j/ /tu,,,."1 'l 
Form 1-203 (I 
UNITED STATES DEPARTMENT OF HOMELAND SECURITY 
2019-ICLl-00051 3593 
DHS-ICE-19-0196, 19-0197-O-000277

File No. 
Housing 
Detainee 
Location 
Northwest Detention Center 
Property Release Receipt 
A- 216269802 
H •IJ 109 A 
AMAR MERGENSJ 
Y5/ lnventorv Officer kb)(6); lfr)v7\fr, 
12/20/17 BOX# 928 1 PR SHOES/S 3 PR PANTS/S 1 
JACKET/S 1 SUITCASE/S 1 PR HEADPHONES/S MISC 
PAPERWORK/S 5 OFFICIAL DOCUMENTS/ICE 1 
PASSPORT/ICE 1 I.D/ICE 1 SOCIAL SECURITY 
CARD/ICE 2 BANK CARDSN 1 CELLPHONEN 21 
FOREIGN COINSN ___ l PR BOOTS/S 1 
NAIL CLIPPER/S 1 PR GLOVES/S 1 CHARGER/S 1 PR 
SHOESTRINGS/S 3 PR SOCKS/S 1 PR GLASSES/S 1 
BELT/S 1 UNDERWEAR/S 1 PR SHORTS/S 4 HATS/S 7 
SHIRTS/S 1 COAT/S MISC TOILETRIES/S COTTON 
SWABS/S 1 SMALL BAG/S 1 MICRO SD CARD/S 1 
PHONE CASE/S 
Total Items 
I certi 
b)(6); (b)(7)(C) 
Detainee Signature I Date , b)(6); (b)(7)(C) 
Supervisor Signature I Date / 
2019-ICLl-00051 3594 
terns. 
ate 
1gnature I Date 
/(·is- r· 
I /-;3:S:/i 
DHS-ICE-19-0196, 19-0197-O-000278

Booking/Release Report 
Northwest Detention Facility 
11/25/2018 
Booking No: fbJ(6); (b)(7)(C) Agency: ICE 
Detainee Name 
AMAR, MERGENSANA 
Eyes 
BRO 
Home Address 
Booking Officer 
l<b)(6); (b)(7)(C) 
Release Officer 
(b)(6); (b)(7)(C) I 
A Number 
216269802 
Hair 
BLK 
Housing Assignment 
H-NA, 109 A 
Identifying marks 
ASIAN/PAC IF 
Weight 
150 
Classification 
LOW 
Date 
12119/2017 
11/25/2018 
(b)(6); (b)(7)(C) 
Time 
11:05 am 
Time 
1:22 pm 
ir-if:·/r 1--------
Detainnee's Signature I Date - Officer's Signature / Date 
2019-ICLl-00051 3595 
DHS-ICE-19-0196, 19-0197-O-000279

.'JetSubjectStatusHistoryGrid Page 1 of 1 
Status Start Date End Date Comments Created Updated 
Bv Bv 
RELEASE APPROVED BY ICE MUIRHEAD VIA 203. 
RELEASED 11/25/2018 DETAINEE NOT PRESENT, INFORMED BY ICE TO (b)(6); (b)(7)(C) 13:22:00 STANDBY ON PROPER1Y [HOLD Tll FURTHER NOTICE] 
11/25/18@ 1322, AFALAVA 
ACTIVE ON· 12/19/2017 11/25/2018 
SITE 11:05:00 13:22:00 
http://geotrack/Subjects/GetSubjectStat@i~QJtYl(rod5tJlprj'iJQfileid=Obe8341a-1064-4c... 11/26/2018 
DHS-ICE-19-0196, 19-0197-O-000280

1. FAMILY NAME (0¢'ll Lettas) · 
AMAR, MBRGENSANA 
4. Alias 
7.li1hDate 
10/23/1978 
9.Sex 
Iii Mae Female 
11. Ale Number 
A216 269 802 
Int Name MidcleNane 
8. Birth Place N/A, RUSSIA 
10. <Y:£/WA '!:svf!Jj 
Iii Yes □ No (Explain) 
12. Bero DatePostro 
SIGMA Bvent: l' 1140 
2. PIJe 
39 
3. '-· _nyctotlzenship 
RUSSIA 
s. Date Appreherxled 
December 2, 2017 
13.0NS 14 Medcal PJert Yes (Explain) 
□ Yes Iii No 14A. 
A 
B 
C 
16. ADMITTED BY: (b)(6); (b)(7)(C) 19. REU:ASED10: Dep:rt 22. Rt Irdex Print- rn 
17. SEARa-lB) IN 20. RB.EASED BY: 
18. DATE ADMITTED. 21. DATE RB.EASl:D: 
24. Rerncrts: Subject rD: !(b)(6); (b)(7)(C) r ER-CF / RUSSIA 
FORM 1-385 (08/01/07) ALIEN BOOKING RECORD 
UNTlcD ST ATES DEPARTMENT OF H0~1EI.ANO SECIJRJTY 
2019-ICLl-00051 3597 
Bvent No: l(b)(6); (b)(7)(C) 
23. Rt IrdexPrint-Q.t 
DHS-ICE-19-0196, 19-0197-O-000281

Booking/Release Report 
Northwest Detention Facility 
12/19/2017 
Booking No: (b)(6); (b)(7)(C) 
Agency: ICE 
Detainee Name 
AMAR. MERGENSANA 
Eyes 
BRO 
Home Address 
Booking Officer 
rb)(6); (b)(7)(C) 
1 
Release Officer 
A Number 
216269802 
Hair 
BLK 
Housing Assignment 
IN-NA, NA 101 
Identifying marks 
ASIAN/PAC IF 
Height 
62 
Weight 
150 
Classification 
LOW 
b)(6); (b)(7)(C) 
Date 
12/19/2017 
(b)(6); (b)(7)(C) 
\1 /1 \......--" 
De~ainnee's Signature I Date 
2019-ICLl-00051 3598 
Time 
11:05 am 
!i.!ng 
\7\\8 
I Date 
DHS-ICE-19-0196, 19-0197-O-000282

12/19/2017 10:47:05PM 
GENERAL INFORMATION - ---· 
Subject Id: 
Last Name: 
First Name: MERGEN SANA 
Middle Name: 
Race: ASIAN/PACIFIC ISLANDER 
Sex: MALE 
Height: 62 
Weight: 150 
Birth Date: 10/23/1978 
Arrival Date: 12/19/2017 
Enroll Date: 12/19/2017 
Housing: IN-NA-NA-NA-101 
STATUS HISTORY 
Northwest ICE Processing Center 
SUBJECT PROFILE 
-- -- --- .. 
Type: ICE 
Status: ACTIVE ON-SITE 
Status Date: 12/19/2017 11:05:00AM 
Classification: LOW 
Gang: 
Religion: NONE 
Eye Color: BRO 
Hair Color: BLK 
Alternate Id: 
Citizenship: RUSSIA 
~ 
ACTIVE ON-SITE 
Start Date/Time 
12/19/2017 11 :05:00A~ 
End Datefrime ~ 
ICE 
COMMENTS 
Subjectld 
l(b)(6); 
- . .... - -- --- - . 
Arriva 
True 
Comment Comment By Comment Date/Time 
CHARGES 
Charge 
WARRANTS/DETAINER$ 
VISITORS 
SCARS / MARKS 
Description 
PROPERTY 
Title 
BAG/TAG 
EMERGENCY CONTACTS 
Charge Date Case Number Docket Number Disposition 
Warrant Number Issued Dt Detainer Type 
Relationship 
Location 
Location Cd Comments 
NO CASH, (1) CHECK#2546 $1533.35(F). 
Relationship 
2019-ICLl-00051 3599 
DHS-ICE-19-0196, 19-0197-O-000283

12/19/201i 
File No. 
Housing 
Detainee 
Location 
A- 216269802 
INIIJ NA 101 
Property Witheld Receipt 
Northwest Detention Center 
AMAR MERGEN SJ 
BAG/TAG ______ lnventorv-0!:(icer 
--- / '-----~ 
b)(6); (b)(7)(C) 
~ , 
NO CASH, (1) CHECK#2546 $1533.35(F). 
\___C- _ _J - . 
(b)(6); (b)(?)(C) 
Total Items 
t list;ng of All ltems~?Jtft "'°f" /·z11 n 
/' Deta;nee s;gnatu,e I Date ( ~-.--~,...,.-,::~------~-....,-r : ,· d '- J _ b)(6); (b)(7)(C) L/ i \ 
tb)(6); (b)(7)(C) I rt/21 (; 7 
Supervisor Signature / Date Staff Signature / Date 
2019-ICLl-00051 3600 
DHS-ICE-19-0196, 19-0197-O-000284

Nort11west Detention Ce11ter 
Property Receipt 
The following items of property have been issued to Last Name: AMAR 
------------
_2_ Blanket ($5.15 ea.) 
_1 _ ID Card ($0.06 ea.) 
_1 _ ID Wristband ($0.40 ea.) 
First Name: MERGENSANA 
ID#: 216269802 
_2_ Shirt ($4.25 ea.) _o_ Bra (Females only, $1.70 ea.} 
_2_Trousers ($5.40 ea.} _0 _ Panty (Females only, $0.66 ea.) 
_1 _SWeatshirt($5.04ea.) _1 _Sandals ($1.73 pr.) 
_1 _ Mattress ($38.31 ea. rec'd in pod} _1 _ 5'M?atpants ($6.35 ea.} _1 _Tennis Shoes ($4.94 pr. ttneeded) 
_1 _Pillow($7.15ea. rec'd in pod) _4_T-Shirts($1.20ea.) _1 _TONels ($0.92 ea.) 
_1 _ Pillow Case ($0.55 ea.} _4_ Socks ($0.38 pr.) _1 _ Laundry Bag ($3.17 ea.} 
_2 _ Sheets ($1.70 ea.) _4_ Unden.Year (Males only, $0.99 ea.) _1 _ Radio ($8.00 ea. rec'd in pod) 
_1 _ Handbook/Orientation and ICE National Detention Handbook BOX# ________ _ 
_ 1 _ Personal Hygiene Items (1 each- Cup, Deodorant. Toothbrush, Toothpaste, Comb and Ear Bud for the Radio) 
These items will be returned at the time of departure from the facility. Failure to properly maintain these iterm or to return 
items at the time of departure may result in a charge against my accmmt. 
Btos arti I ulos seran vueltos a la hora de la sa/ida de la faci/idad Fa/ta de nnntener correctamente estos articulos ode 
culos a la hora de sa/ida puede dar lugar lDUl carga contra ni cuenta. 
! 
i 
Original: Del?inee File 
CC: Detainee 
INT007NCR 
2019-ICLl-00051 3601 
12119(2011 
Date'Fecha 
12/19/2017 
Date 
Revised 30AUG16 
DHS-ICE-19-0196, 19-0197-O-000285

Northwest Detention Center 
Orientation Checklist 
The following NWDC Orientation items have been presented to: 
Last Name: AMAR 
First Name: MERGENSANA 
ID#: 216269802 
.JL How to contact ICE x._ Availability of Pro Bono Legal Services X 
x Basic Responsibilities _K Sexual Abuse / Assault X 
.JL Living Conditions _x Official Counts x.. 
.JL Accessing Medical Care x._ Law Library x.. 
...K_ Barbering Services -1f. Personal Hygiene and Hygiene Items K. 
...x_ Religious Services ..z._ Commissary K. 
_x_ Visiting _x Correspondence/ Packages K. 
.x._ Grievance System _.K Disciplinary System and Sanctions X 
.x._ Detainee Dress Code ~ Staff- Detainee Communications X 
i ~tainee Telephone PIN# and Instructions for use. 
✓ J/1~ 12/19/2017 I ..._ • 
b)(6); (b)(7)(C) Date/Fecha 
12/19/2017 - Date 
0 . \.. I n / F·1 I // ngma .;-J:letamee I e \ _..,, 
CC: Detainee '--/ 
Page 6 of 6 
2019-ICLl-00051 3602 
Use of Kites 
Classification 
Meals 
Clothing Exchange 
Telephones 
Voluntary Work Program 
Recreation 
Appeals Process 
MSDS 
INT006 30AUG 16 
DHS-ICE-19-0196, 19-0197-O-000286

12/20/201i Property Witheld Receipt 
File No. 
Housing 
Detainee 
Location 
A- 216269802 
B 1 117 A 
AMAR 
YS/1783841 
Northwest Detention Center 
MERGENSJ 
lnventorv Office (b)(6); (b)(7)(C) 
12/20/17 BOX# 928 I PR SHOES/S 3 PR PANTS/SI JACKET/SI SUITCASE/S 1 PR 
HEADPHONES/S MISC PAPERWORK/S 5 OFFICIAL DOCUMENTS/ICE I PASSPORT/ICE I 
I.D/ICE 1 SOCIAL SECURITY CARD/ICE 2 BANK CARDSN I CELLPHONEN 21 FOREIGN 
COINSN /I M I PR BOOTS/S I 
NAIL CLIPPER/S J PR GLOVES/S I CHARGER/S I PR SHOESTRINGS/S 3 PR SOCKS/S I PR 
GLASSES/St BELT/S 1 UNDERWEAR/SI PR SHORTS/S 4 HATS/S 7 SHIRTS/SI COAT/S MISC 
TOILETRIES/SCOTTON SWABS/St SMALL BAG/SI MICRO SD CARD/St PHONE CASE/S 
Total Items Condition of Property 
I c~rtify that the ab,ove /s a correct listing of All Items that were removed from my possession at the time I was placed in 
Jail. . ,r ~v , (b)(6); (b)(7)(C) . >< I::? - -;; a ,--; t ) --:+ l:i 
I 
Supervisor Signature/ ' Date 
2019-ICLl-00051 3603 
DHS-ICE-19-0196, 19-0197-O-000287

Subject ID Kb)(6); (b)(7)(C) I SIGMA Bvent: 17284140 
ORDER TO DETAlN OR RELEASE ALIEN 
T~ (NAME and TITLE of Person In Charge of Facility)(')~ 
(Name of Facility) \J \\J De 
Please ~ Detain u Release 0
r 1/ /Q /r1 I Time 
Name of Alien t Flllt Number 
Mergeneana AMAR •?1 II, """ ft AA 
Event No =l(b)(6); (b)(7)(C) 
Age I Date of Birth(Mo.Day.Yr.) Sex I Nationality I Foreign Address I 
39 10/23/1978 M RUSSIA 
Nature of Proceedings I ~i! (b)(6); (b)(7)(C) 
Expedited Removal - credible Fear 
REMARKS: 
l \ 
FIN 'l(b )(6); (b )(7 )( C) SERVED M444, IN OHS CUSTODY PENDING CREDIBLE FEAR INTERVIEW WITH ASYLUM OFFICER. 
(b)(6); (b)(7)(C) 
Signature of Offi TIile Office 
(b)(6); I 
\11 
CBPO SNO/SYS 
Form 1-203 (Rev. 08/01/07) \ UNITED STATES DEPARTMENT OF HOMELAND SECURITY 
2019-ICLl-00051 3604 
DHS-ICE-19-0196, 19-0197-O-000288

U.S. Department or Homeland Security 
SIGMA Event: (b)(6); 
Subject ID : (b)(?){C) Record of De ortable/lnadmissible Alien 
Family Name (CAPS) 
AMAR, Mergensana 
First 
P=pon Number and Country or hsuc 
s .. 
M 
Hair 
BLK 
Eyes 
BRO 
Cmphcn 
MED 
Co1J11uy orCuiunship 
RUSSIA (b)(6); RUSSI 
Height 
62 
Weight 
150 
U.S. Address 
DHS CUSTODY 
Number, Stre,~ City, Province (Sllltc) and Counuy or Pcrmrutent Residence 
Passenger Bouded 11 
SAN YSIDRO, CA 
Scars and M&rlc:s 
(b)(6); (b)(?)(C) Single 
Divorced O Married 
Widower C S an.ted 
or Location/Apprehension 
36 AVIDUBVA ST. KHURAMSHA, IVOLGINSKI D, RUSSIA ISP 
DmorBinh 
10/23/1978 
City. Pro,incc (SL>te) 111d Counuy of Birth 
N/A,RUSSIA 
NlV Issuing Post and NIV Number 
None 
Oite Visa tssucd 
None 
Immigration Record 
NEGATIVE - See Narrative 
cc 
Age: 39 
j""ropri11c) 
1.:.:l<b~)(-'6).:.;;(a...:bl.:..(?~i<c-')c.- _____ _,IRuss1A 
Monies DudProperty in U.S. Not in lmmcdialc Possession 
None Claimed 
N:une and Address of (Lan)(Currcnt) U.S. Employer 
01.te of Action Location Code 
12/02/2017 SND/SYS 
<\RI!) Form: CT>'l"' Md No.) lifted O Not lifted 0 
Soc.iii Security Account Name 
None 
Social Security Numbtt 
None 
Criminitl Record 
None Known 
b)(6); (b)(?)(C) 
Fi ngCfJ)rintedl 11D Y cs O No 
Type of l;mploymcnt 
Systems Oiccls See 
Narrative 
Sal")I 
Atft.:ear 
SYS 
NbsB BOYSON 
D11cJl-tour 
12/02/2017 1331 
Stacus When Found TRAVEL/SEEKING 
Nwnbc.r and Nationaliry of Minor Olildrcn 
0 
es. Nationality, and Address. if Known 
TIONALITY: RUSSIA 
Ch,rge Code Words(s) 
I7Al 
Employed from/lo 
Hr 
Narrative (Outline parliculars under whieh alien wu located/apprehended. rnclude de1aih not shown. above regarding time, place and manner of last cnlry, 111emptcd entry, or any other entry, and 
elements which eslablish administralivc and/or criminal violation. lndiute means and rou1c of travel lo interior,) 
RECORDS CHECKED 
[~:~,,.[~N I-831) 
Alien has been advised of communication privilc 
Distribution: 
A-FILE 
(b)(6); 
b)(?)(C) 
Left Index fingerprint Right Index fingerprint 
b)(6); (b)(?)(C) 
(D 
Received: (Subject and Documcn\1) 
Officc}b){6); {b)(7)(C) I I 
on: December 2, 2017 
Disoosition: Expedited Removal w 
Examinin• orr.cer: (b)(5); (b)(?){C) 
2019-ICLl-00051 3605 
(time) 
,,-Credibl (b)(6); 
(b){7)(C) 
DHS-ICE-19-0196, 19-0197-O-000289

U.S. Department pf Homeland Security Continuation Page for Form _ 1
_
2
_
1
_3 _____ _ 
Alien's Name 
AMAR, Mergensana 
b)(7)(E) 
SECTION CODES 
212a7AiI 
FUNDS IN POSSESSION 
United States Dollar 1456.00 
Mexican Peso 150.00 
.µ~~~~-~Date 
12/02/2017 
Event No: 
12/02/2017 SUBJECT APPLIED FOR ADMISSION INTO THE UNITED STATES VIA THE SYS POE. SUBJECT 
REQUESTING POLITICAL ASYLUM. SUBJECT WAS TOT SYS AEU. SERVED WITH AN M444 AND DETAINED IN 
DHS CUSTODY PENDING CREDIBLE FEAR INTERVIEW. 
On or about December 2, 2017 at approximately 0532 hours, a Russian national and citizen, 
Mergensana AMAR (DOB: 10/23/1978) applied for entry into the United States via the 
pedestrian lanes at San Ysidro Port Entry. AMAR presented his Russian passport to the 
primary inspection Customs & Border Protection Officer (CBPO} and requested asylum. AMAR 
was then secured and transported to the San Ysidro Admissibility Enforcement for further 
processing. 
On December 2, 2017, CBPO ~~~~L-, egan working on AMAR' s case. During an oral interview and 
sworn statement conducted y CBPO Buyson in the Russian language, using inter reter 
#230215-K~)(6);___ I from INTERPRETERS UNLIMITED, and witnessed by CBP Officer (b){6); AMAR 
freely and voluntarily stated his full name as Mer ensana itizen an national of 
Russia. He stated he changed his birth name of (b)(6);(b)(7)(C) to his current name for a 
religious purpose. AMAR claims he was born in urams a, Ulan-Ude, Buryatia, Russia on 
October 23, 1978. AMAR stated he is married n · ially and has two children, one from 
a revi age. His current wife, (b)(6);(b)(7)(C) (DOB: 01/04/1989) share a daughter 
b){6);(b)(7)(C) (DOB: 10/13/2012). His previous marriage was from 2010-2014, to!(b)(6); r 
(b)(6);(b)(7)(C) and they share a daughter, 1b){6);(b)(7)(C) J (DOB: 2010). Both of his children and 
wives are citizens and nationals of Russia. they all still reside in Russia. AMAR stated, 
he hopes to bring over his family once he gets settled in America. 
AMAR stated his mother and father are still alive and residing in their hometown. He 
claimed his mother and father were born in Russia and are both Russian citizens. He claimed 
they are now both retired with pensions. His mother is a retired nurse and his father is a 
retired auto mechanic. AMAR stated his father did serve in the old Soviet Army for two 
years as regular soldier in an artillery unit. AMAR stated he has four siblin s one er 
and h others. He provided thei (b)(6); (b)(7)(C) 
(b)(6); (b){7)(C) B · /1977) , b)(6); (b)(7)(C) )(6); 
(b)(6); (b)(7)(C) (DOB: 01 1987 L....--- ......... ----.--.cr--.---=---;----'1r,·,.,;;·-;.,.--':":·~~ 
88 He stated they were all born an ng in Russia, with no known 
plans of migrating to the United States. 
AMAR claimed to have completed five years of college at East Siberian State Technological 
University, in Ulan-Ude, Russia, earning a diploma in Economics. He claimed to own a 
businesJ1.L~..,...~~-~xing and selling cars. He claimed to have never worked in his field of 
educati b)(5); (b)(7)(C) d he had not served in the Russian military. He claimed he had no 
desire. ON NEXT PAGE) 
Signature Title 
b)(6); (b)(7)(C) CBPO 
___ 2 of __ 5 _ Pages 
Form 1-831 Continuation Page (Rev. 08/01/07) 
2019-ICLl-00051 3606 
DHS-ICE-19-0196, 19-0197-O-000290

U.S. Department .of Homeland Security 
Alien's Name 
AMAR, Mergensana 
Continuation Page for Form _r_2_1_3 ____ _ 
File Number A216269802 
SIGMA Evellj(b){6); (b)(7)(C) 
Event No: I 
I Date I 1210212011 
to serve. He stated, there is no mandatory condition to serve after completing college. 
He did state, he had attended college at a military department, and after completion, they 
were given an option to sign a contract to enlist in the military, but he refused. AMAR 
also claimed he did receive about a month long worth of training during college. The 
military trained them in physical fitness, firing, manipulating and assembly and disassembly 
of the AK-47. During that month, they were taught physical fitness, shooting and marching. 
AMAR claimed they did not learn any hand to hand combat or other martial arts. AMAR claimed 
he studied on his own since a child. He said he had studied Free-Style wrestling, Combat 
Sambo, boxing and some mixed martial arts. 
AMAR provided his last address and contact information as such; home address: 36 Avidueva 
St. Khuramsha Village, Ivolginski District, Bunyatia Republic, Russia. Personal contact 
information: mobile phone: 4b)(6); (b)(7)(C) Jand email: JCb)(6); (b)(7)(C} ~ He also 
provided his social media adt.uuucs, vxueL, ~hatsApp and YouTube: MERGEN AMAR and on his 
VKontakte: Altan Khan. 
AMAR stated he speaks Mongolian, Russian, Ukrainian, and a little of English, Bulgarian, 
Korean, Chinese and Japanese. AMAR stated he learned some of those languages during his 
travels to South Korea, Japan and Mongolia. He claimed the trips were both for business and 
leisure. He stated he had visited.South Korea, six different times, and stayed 
approximately one month each time, during the years 2004-2017. He had visited Japan one 
time for one week in 2008 and he had ten different trips that lasted approximately two weeks 
each time from the years 2007-2016. AMAR claimed to have never sought out aid or refuge in 
any other country. He claimed to not have citizenship, residency or·a change of status in 
or from any other country. He claims to not have requested or been granted residency or 
refuge from any country. He did state he had applied for a U.S. Visa in January 2016 and 
was refused. AMAR did state his reason for applying for the Visa was to use it to come in 
to the United States, to stay and claim asylum. 
AMAR claimed he is a Russian citizens but is ethnic Mongolian. He claimed to practice 
Shamanism and is part of a political party or movement called, "Independence of Buryatia". 
The party's intention is to gain the land and freedom back from Russia, which they believe 
belong to Mongolia. AMAR claims to have been persecuted in Russia for his religious and 
political beliefs. He stated they are not allowed to use their ethnic language, practice 
their customs and other cultural traditions. He says the government oppresses them and does 
not provide resources to them. He claimed he had been tortured in 2015, when the FSB 
(Federal Security Service) detained and tortured him. He claimed to have been hit with 
pouches filled with sand and was hit on his hand causing some injury to his middle finger on 
his right hand. He also claimed to be attacked by "Skinheads", hitting him with a metal 
pipe near his eye. He claims there are no reports of the incidents, attacks or hospital 
visits because they (FSB & Russian Government) forbid it. 
AMAR stated he left Russia on November 29, 2017 on Aeroflot to France on a 4hr flight. He 
was in Paris, France for l ½ hours for a transit flight on Air France to Cancun, Mexico. He 
stayed in the Imperial Laguna Hotel in Cancun for 2 days. Then he flew for 3 or 4 hours 
(there was a time change) on Volaris airline to Tijuana. He stayed overnight in a hotel 
that was 10km from the airport. He didn't recall the name of that hotel, but said he may 
have some information in his luggage. The next morning, he came immediately to the border 
and walked to San Ysidro Port of Entry pedestrian entrance. AMAR stated he planned the trip 
on his own, without the help of an agent or smuggler. He said he traveled alone and didn't 
meet up with anyone on any part of the trip. He claimed he started off the trip with 
$1000.00 USD in cash and has a debit card available. 
AMAR stated he is claiming asylum in the United States because the U.S. holds a high value 
for b)(6); (b){l)(C) " claimed he is looking fo:i: financial opportunities in the United 
Stat ~med he would like some military training or preparation so he could 
help ~c. He claimed he would go back and fight after the training, if the 
U.S. NEXT PAGE) 
Signa 
JOSE BUYSON 
I Title 
CBPO 
Fonn 1-831 Co~tin~ation\age (Rev. 08/01/07 
3 5 ___ of ____ Pages 
2019-ICLl-00051 3607 
DHS-ICE-19-0196, 19-0197-O-000291

U.S. Department _of Homeland Security 
Alien's Name 
AMAR, Mergensana 
Continuation Page for Form _ 1_
2_
1_
3 ____ _ 
File Number A216269802 
SIGMA Eve~b)(6); (b)(7)(C) 
Event No: I 
I nate 
12/02/2017 
authori~ed him to. He also claimed he would like the opportunity to own his own business 
in the United States. 
AMAR stated he does not have any pending immigration petitions with the US Naturalization 
Services. He stated he has never had legal documents to enter or reside in the United 
States. AMAR stated he has not requested asylum from any other country. AMAR admitted that 
he is fully aware that he is required to have a valid entry document to enter the United 
States. AMAR claimed he has never been removed or deported from any country. AMAR claimed 
he has not committed any criminal acts or has any criminal records in any country. AMAR did 
claim he belongs to the group, "Independence of Buryatia", which is fighting for their 
independence from Russia. He claimed he would love to overthrow the Russian government, but 
does not have the resources. 
AMAR stated he is not and does not know anyone that is associated or a member of any 
terrorist organization or groups. AMAR stated he has never been approached or recruited by 
a terrorist group or organization. AMAR claimed he has not been approached or recruited to 
work in espionage or to spy on other countries by any foreign agency, entity, or government, 
but he would like to work for the U.S. government and would do anything they asked of him. 
When asked the questions of fear, AMAR stated he does hav~ fear about being returned to his 
home country and or being removed from the United States. AMAR understood that he will be 
detained for an indefinite period of time pending a decision on his application for asylum. 
AMAR claimed he understood he will be interviewed by an asylum officer or an Immigration 
Judge. AMAR understood he would be removed from the U.S. and barred from entering the 
United States for a period of five years or more if his application for political asylum is 
denied. AMAR stated he understood all the questions that were asked of him and answered 
CBPO Buyson•s questions voluntarily. 
At the end of the interview, AMAR wanted to add some additional information. He stated he 
had used other names in the past. During the interview, CBPOl(b)(6);-· 3ked questions about 
AMAR's past travels and would refer to AMAR's current passport which showed only one trip to 
south Korea. AMAR was asked if he had additional passports and their location. AMAR 
claimed he has an older and expired international travel passport from Russia back ~t home. 
AMAR was asked if he also used different dates of birth with these other names, and he 
claimed he did not. AMAR was also asked if he claimed to have used other citizenships on 
his passports, like Mongolia, China, Japan, South Korea or anywhere else, and he claimed no. 
The names he provided are: Mergensana AMARZAYA and used it during 2007-2008. He also used M 
Maxim KIM during 2004-2007. 
AMAR stated that his intended destination in the United States is New Jersey, where his 
friend, ~b)(6); (b)(7)(C) I lives. He provided the address of: rb)(6):(b11rnCl I. 
Edison, .. u v00.1.,. He a.Lso orovided Kb)(6); (b)(7'b)(S)':'"(b)(7)(C) let information: phoneTI,b)(6); (b)(7)(C) I and 
email: l(bl(6l; (bl(7)(C) I AMAR claimst' ' is a friend from his home town. AMAR 
saidl(b)(6); (b)(7)(C) 1<1oes know he is on his way to the United States. AMAR claimeq(b)(6); (b)(7)(C) !did 
not ne~p n1m 1n any way during this asylum process. 
REMARKS: While detained at the Admissibility Enforcement Unit at the San Ysidro area of 
operations,· AMAR was provided with meals, sleeping cushions and a blanket. AMAR was also 
questioned about his well-being by successfully answering the In-Processing Health Screening 
Form and denies any major impeding health issues during the time of processing under 
Department of Homeland Security/Customs and Border Protection's custody. 
DISPOSITION: Mergensana AMAR appears to be inadmissible to the United States pursuant to 
section 212a7AiI of the INA, as amended. AMAR was provided with a list of legal services. 
AMAR was served with an M-444 and taken into DHS custody pending a credible fear interview 
with 
••• (COi PAGE) 
Signatur (b)(6); (b)(7)(C) I I Title 
CBPO 
I 
___ 4 of ___ _ 5 Pages 
Form 1-831 Continuation Page (Rev. 08/01/07) 
2019-ICLl-00051 3608 
DHS-ICE-19-0196, 19-0197-O-000292

U.S. Department .of Homeland Security Continuation Page for Form _ 1
_
2_
1_3 ____ _ 
Alien's Name File Number A216269802 I Date 
AMAR, Mergensana SIGMA Eve,(b){6); (b)(l)(C) I 12/02/2017 
Event No: 
*********NOTHING ELSE FOLLOWS********* I 
(b)(6); (b)(7)(C) 
Signature I Title 
Kb )(6); (b )(7)(C) I CBPO 
5 of 5 Pages 
· Fonn 1-831 Continuation Pa~~- g ( Rev. 08/01/07) 
2019-ICLl-00051 3609 
DHS-ICE-19-0196, 19-0197-O-000293

Classification Determination and Notice of A 
Name: AMAR 
Based upon infonnati 
criminal convictions, 
classification level: 
A#: 216269802 
e committing authority regarding your history, including prior immigration violations, prior 
assault, and disciplinary convictions in other institutions, you have been assigned the following 
MEDIUM LOW 0 MEDIUM HIGH HIGH 
This designation will be used to detennine your unifonn, housing assignment, visiting hours, and participation in facility programs. 
You have the right to appeal your classification designation to the Classification Review Officer. The Classification Review Officer 
will review your appeal and forward a recommendation to the Associate Warden. The Associate Warden will make a determination 
regarding your appeal within five business days. You will receive notification of that determination within ten business days. If you do 
not agree with the decision of the Associate Warden, you may furthe appeal the decision to the Warden. The decision of the Warden 
is final and may not be appealed. 
D YES (appeal fonn provided) 
12/19/2017 
Date 
12/19/2017 
Date 
e ermmac1on e a Clasificaci6n y la Nota de Derechos de Apelaci6n 
El nombre: A#: 
Basado sobre la informaci6n proporcionada por la autoridad que comete con respecto a su historia, inclusive infracciones prev ias de 
inmigracion, antes de convicciones criminales, los modelos previos del asalto, y de las convicciones disciplinarias en otras 
instituciones, usted ha sido asignado el nivel siguiente de la clasificacion: 
? ? BAJO 0 MEDIO-BAJO 0 MEDIO-AL TO ALTO 
Esta designacion se usara para determinar su unifonne, la tarea que alberga, horas visitantes, y la participaci6n en programas de 
facilidad. 
Usted tiene el derecho de apelar su designacion de la clasificaci6n al Oficial de la Revision de la Clasificaci6n. El Oficial de la 
Revisi6n de la Clasificaci6n revisani su apelaci6n y adelantar una recomendaci6n al Asistente de Alcaide. El Asistente de Alcaide hara 
una determinaci6n con respecto a su apelaci6n dentro de cinco dfas habiles. Usted recibira la notificaci6n de esa detenninaci6n dentro 
de diez dias habiles. Si usted no concuerda con la decisi6n del Asistente de Alcaide, usted puede apelar ademas la decisi6n al Alcaide. 
La decision del Alcaide es final y no puede ser apelado. 
Hagalo desea apelar su clasificaci6ndesignation? 
La Firma del detenido 
Provea Firma 
NO 
12/19/2017 
La fecha 
12/19/2017 
La fecha 
Page 2 of 6 
D SI (forma de apelacion proporcion6) 
? 
2019-ICLl-00051 3610 
DHS-ICE-19-0196, 19-0197-O-000294

NortTHWEST DETENTION CEN'1.~R 
Detainee Classification Worksheet 
!8J Initial D Reclassification D Special Classification 
NAME: AMAR, MERGENSANA A#: A216269802 
D. 0. B.: 10/23/1978 
(b)(6); (b)(7)(C) 
Classified By: 
Gender: MALE DATE: 12/19/2017 
I. 
Language: (English Y /~ther: i\vt,,C/41~ 
Severity of Charge/Conviction Associated with the ICE Encounter: 
(Use severity of offense scale) 
NONE ................................................................................... . 
LOW ..................................................................................... . 
MODERATE ........................................................................... . 
HIGH ................................................................................... .. 
HIGHEST ............................................................................... . 
SCORE::ri-' 
0 ~ 
2 ] 
4 [ l 
6 [ l 
7 [ l 
2. Single Most Serious Conviction in the Individual's Criminal History 
SCORE:~ 
3. 
4. 
5. 
6. 
7. 
(Excluding Item I) 
None >15 Years 10-15 Years 5-10 Years 
Highest 0 5 5 6 
High 0 5 5 6 
Moderate 0 I 2 3 
Low 0 0 0 I 
Additional Prior Convictions (Excluding Items I and 2) 
NONE .................................................................................... . 
1-2 misdemeanors, no felonies ........................................................ . 
3-4 misdemeanors, or 1 felony ........................................................ . 
5 or more misdemeanors, or 2 felonies .............................................. . 
Supervision History: 
NONE ................................................................................... . 
Walk-away or attempted escape from an unsecured facility, absconding, 
bond breach, violations of prior voluntary departure orders or conditions of 
supervision or prior revocation of supervision .................................... . 
Escape or attempted escape from a secure facility ................................ . 
Security Threat Group (STG) 
The individual has no known membership or affiliation with an STG ........ . 
The individual is a member of an STG ............................................ . 
History/Pattern of Violence/Assault (Two or more arrests) 
15 or more years ago or none ........................................................ . 
Over 10 years and less than 15 years ago ......................................... . 
Over 5 years and less than 10 years ago ........................................... . 
Within the last 5 years ............................................................... . 
Number of Sustained Disciplinary Infractions Involving Violence 
or Behavior Representing a Threat to the Facility(Institution(s) ) 
None .................................................................................... . 
One ...................................................................................... . 
Two ..................................................................................... . 
Three or more .......................................................................... . 
Check if data not available ........................................................... . 
< 5 Years 
7 
6 
4 
2 
SCORE:0
* 
dT1 
2 [ ] 
4( ] 
SCORE,0
# 
3 [ ] 
7 [ ] 
SCORE:
0
~ 
;ft 
SCORE:
0
4 
~Jj 
/.3 [ ] 
5 [ ] 
SCORE:tr 
o l 
] 
4 [ ] 
6 [ l 
eel> 
TOTAL CUSTODY CLASSIFICATION SCORE, --12-
2019-ICLl-00051 3611 
DHS-ICE-19-0196, 19-0197-O-000295

CUSTODY LEVEL GUIDELINE RANGES: (check one) 
If there is no arrest or conviction for a violent offense, Use this scale only if the person has an arrest or 
Use this table. conviction for a violent offense on the High or 
LL LowCustodv 0-2 Highest scale with an * next to it on the Severity 
- Medium-Low Custody 3-5 of Offence Scale sheet. 
Medium-High Custody 6-11 I Medium-High Custody 0-6 
High Custody 12+ I High Custody 7+ 
SAAPI Potential: (check one) ~UB-THRESHOLD [ ) VICTIM [ )ABUSER [ ) MIXED 
If the Officer makes a custody recommendation outside of the custody level guideline range above, provide the 
rationale and include aggravating/mitigating circumstances that were considered in the decision below: 
Recommendation outside the Guideline Ranges: 
)LOW [ ] MEDIUM-LOW [ ] MEDIUM-HIGH [ ) HIGH 
Officer Signature _________________ _ Date: ___ / __ / __ _ 
In the section below, check the custody level of the individual's housing assignment, following the guidance 
provided in the instructions, F. Housing Assignment. 
For purposes of housing medium-custody individuals with low-or high level custody individuals, use the following 
guidelines: 
Medium-Low may be housed with low custody individuals; 
Medium-High may be housed with high-custody individuals; but, 
Low custody individuals may never be housed with high-custody individuals, or medium custody individuals who 
have any history of assaultive or combative behavior. 
If the individual is to be placed in administrative segregation, a copy of the administrative segregation order shall be 
immediately provided to the Field Office Director or his designee, as required by Standard 2.12 "Special 
Management Units." 
If the designee decides to override the Officer's custody level recommendation, provide the rationale below: 
FINAL HOUSING ASSIGNMENT CUSTODY LEVEL: 
[ ) MEDIUM-LOW [ ] MEDIUM-HIGH ]HIGH 
r)(6); (b)(7)(C) 
Facility Administrator Designee: --IL-..-----------..,o::s,----' 
Detainee Classification Worksheet CLOOI 
2019-ICLl-00051 3612 
[ ) ADMINISTRATIVE 
Date: f ?--1 _jJ_; ___LJ_ 
2-24-2017 
DHS-ICE-19-0196, 19-0197-O-000296

N<7~ THWEST DETENTION CENr-,R 
Detainee Classification Worksheet 
Reclassification 
NAME: AMAR, MERGENSANA A#: 216269802 
D. O. B.: 10/23/1978 Gender: 0 F l&I M DATE: 3/8/2018 
Classified By: 
I. 
2. 
3. 
4. 
5. 
6. 
7. 
b)(6); (b)(7)(C) 1-------- Language: (English~/ N) Other: 
Severity of Charge/Conviction Associated with the ICE Encounter: 
(Use severity of offense scale) 
NONE ................................................................................... . 
LOW ..................................................................................... . 
MODERATE ........................................................................... . 
HIGH .................................................................................... . 
IDGHEST ............................................................................... . 
Single Most Serious Conviction in the Individual's Criminal History 
(Excluding Item l) 
None >15 Years 10-15 Years S-10 Years 
Hi2hest 0 5 5 6 
Hi~h- 0 s s 6 
Moderate 0 1 2 3 
Low 0 0 0 I 
Additional Prior Convictions (Excluding Items I and 2) 
NONE .................................................................................... . 
1-2 misdemeanors, no felonies ........................................................ . 
3-4 misdemeanors, or 1 felony ........................................................ . 
Sor more misdemeanors, or 2 felonies ............................................. .. 
Supervision History: 
NONE ................................................................................... . 
Walk-away or attempted escape from an unsecured facility, absconding, 
bond breach, violations of prior voluntary departure orders or conditions of 
supervision or prior revocation of supervision .................................... . 
Escape or attempted escape from a secure facility ................................ . 
Security Threat Group (STG) 
The individual has no known membership or affiliation with an STG ....... .. 
The individual is a member of an STG ............................................ . 
History/Pattern of Violence/Assault (Two or more arrests) 
15 or more years ago or none ........................................................ . 
Over 10 years and less than 15 years ago ......................................... . 
Over 5 years and less than 10 years ago ........................................... . 
Within the last 5 years ............................................................... . 
Number of Sustained Disciplinary Infractions Involving Violence 
or Behavior Representing a Threat to the Facility(Institution(s)) 
None .................................................................................... . 
One ...................................................................................... . 
Two ..................................................................................... . 
Three or more .......................................................................... . 
Check if data not available ........................................................... . 
SCORE: O 
OV} 
2{ 4 c J l © I 
6[ ] t--
7 [ ] 
SCORE: 0 
< S Years 
7 
6 
4 
2 
SCORE:ITG 
0 [ ] 
1 J 
2 [ ] 
4 [ ] 
SCORE:---2}__ 
0 [/] 
3 [ ] 
7 [ ] 
SCORE:~ 
OV] 
5 [ ] 
SCORE:ri· 
0 [ ] 
2 ] 
3 [ ] 
5 [ ] 
SCORE: ___Q_ 
ov1 
2( J 
4[ ] 
6 [ ] 
D 
TOTAL CUSTODY C !CATION SCORE:~ 
~ 90-120 Day Review: 
,&90- 120 Day Review: 
Classification Officer Signature: 
Classification Officer Signature: 
b)(6); (b)(7)(C) 
D 90-120 Day Review: Classification Officer Signature: L--~======-----
Date,fieft 
Date: -L. W 
Date: __ 
2019-ICLl-00051 3613 
DHS-ICE-19-0196, 19-0197-O-000297

CUSTODY LEVEL GUIDELINE RANGES: (check one) 
If there is no arrest or conviction for a violent offense, Use this scale only if the person has an arrest or 
Use this table. conviction for a violent offense on the High or 
K'\ Low Custody 0-2 Highest scale with a * next to it on the Severity of 
Medium-Low Custody 3-5 Offence Scale sheet. 
Medium-High Custody 6-11 I Medium-Hil!h Custody 0-6 
Hi!?h Custody 12+ I Hi11h Custodv 7+ 
SAAPI Potential: (check one) )<,] SUB-THRESHOLD [ ] VICTIM [ ] ABUSER [ ]MIXED 
If the Officer makes a custody recommendation outside of the custody level guideline range above, provide the 
rationale and include aggravating/mitigating circumstances that were considered in the decision below: 
Recommendation outside the Guideline Ranges: 
]LOW [ ] MEDIUM-LOW ] MEDIUM-HIGH [ ] HIGH 
Officer Signature ________________ _ Date: __ / __ / __ _ 
In the section below, check the custody level of the individual's housing assignment, following the guidance 
provided in the instructions, F. Housing Assignment. 
For purposes of housing medium-custody individuals with low-or high level custody individuals, use the following 
guidelines: 
Medium-Low may be housed with low custody individuals; 
Medium-High may be housed with high-custody individuals; but, 
Low custody individuals may never be housed with high-custody individuals, or medium custody individuals who 
have any history of assaultive or combative behavior. 
If the individual is to be placed in administrative segregation, a copy of the administrative segregation order shall be 
immediately provided to the Field Office Director or his designee, as required by Standard 2.12 "Special 
Management Units." 
If the designee decides to override the Officer's custody level recommendation, provide the rationale below: 
FINAL HOUSING ASSIGNMENT CUSTODY LEVEL: 
~LOW [ ] MEDIUM-LOW [ ] DIUM-HIGH 
(b )(6); (b )(7)(C) 
Facility Administrator Designee: -----1 
Detainee Classification Worksheet CL004 
[ ] HIGH 
2019-ICLl-00051 3614 
[ ] ADMINISTRATIVE 
Date: _:l__;L /f' 
2-24-2017 
DHS-ICE-19-0196, 19-0197-O-000298

INT AKE/CLASf,.-,.'ICATION PREA SUPPLEMENT 1'"QUESTIONAIRE 
La Toma/ La CLASIFICACION FORMA PREA SUPLEMENT ARIA 
Have you ever been arrested for a fill.! crime? 
Ha sido detenido alguna ves por crimen sexual? 
2. Have you ever been the victim of a sex crime? 
Ha sido alguna ves victima de algun crimen ~? 
3. Have you ever been incarcerated? 
Ha sido usted alguna ves detenido? 
a. If yes, how many convictions. 
Si es si, cuantas convicciones. 
b. If yes, what crimes were you convicted of: 
Ye 
Si es sf, que crimenes a sido usted conden6: ______________ _ 
c. Did you have any disciplinary actions in any facility? Yes 
A tenido usted alguna acci6n disciplinaria en alguna facilidad? 
d. If yes, for what: 
Si cs si porque: __________________________ _ 
4. Is there any reason to believe that you would be in any type of 
danger if you were placed in general population? 
Hay alguna razon decreer que estaria usted en peligro si usted 
fuera colocado en la poblaci6n general? 
a. If yes, explain why: Si es si, explica por que: _______________________ _ 
S. Are you now or have you ever been affiliated with a gang, either 
inside or outside of a correctional/detention facility? 
6. 
Usted a sido afiliado a alguna pandilla, a dentro o fuera de una 
correctional/ a alguna facilidad de detencion? 
Optional Question/ Pregunta opcional 
Do you self-identify as Lesbian, Gay, Bisexual, Transgender or lntersex? 
4Se autoidentifica como Lesbiana, Gay, Bisexual, Transgenero or Intersexo? 
If yes, list response: 
En caso afirmativo, responda a la lista: ______________ _ 
AMAR 216269802 
(Detainee Name) (A-Number) 
Page 5 of 6 
2019-ICLl-00051 3615 
No 
DHS-ICE-19-0196, 19-0197-O-000299

2019-ICLl-00051 3616 
DHS-ICE-19-0196, 19-0197-O-000300

Request to 
~- r--
e,Posta e to•DetaineeAccount or Pro ).lndi ent Pasta e 
Date Submitted 1 /1.r5 J 11, 
. . r 
·:y￾Pod~ [So Note _____________ 0-: 
Detainee Name (Last, First) Ak!'a·r-Me~eltt SQlna 
Number of Pieces Submitted Legal /" Personal , --~ D Officer Acknowledge Receipt 
Orlglnal - Detainee Pink-Mail Room 00-036 
2019-ICLl-00051 3617 
DHS-ICE-19-0196, 19-0197-O-000301

7/1/2018 
File No. 
Housing 
Detainee 
Location 
Property Witheld Receipt 
A- 216269802 
B 1 117 A 
AMAR MERGENS.t 
Y0S/2020016 
Northwest Detention Center 
lnventorv Officer )(6); 
b)(7)(C) 
07/01/2018-ACCESSED PROPERTY TO RETRIEVE ITEMS REQUESTED VIA KITE. DETAINEE 
LOOKING FOR PAPERWORK/DOCUMENTS, COULD NOT LOCATE PAPERS. DETAINEE 
REQUESTED FOR HIS EARBUDS ... DETAINEE RECEIVED (1) PAIR OF BLACK EARBUDS FOR 
KOP ON 7/1/18,~~~~~;r, I 
Total Items (b)(6); (b)(7)(C) 
-( · l l 
Supervisor Signature / Date 
L___~--:--:-:--:---___J-~J Staff Signature I Date 
2019-ICLl-00051 3618 
DHS-ICE-19-0196, 19-0197-O-000302

6/20/2018 
File No. 
Housing 
Detainee 
Location 
A- 216269802 
B 1 117 A 
AMAR 
Y0S/2019280 
Property Witheld Receipt 
Northwest Detention Center 
MERGENSJ 
lnventorv Officer (b)(6); th "7\lr'\ 
06/20/2018-ACCESSED PROPERTY TO RELEASE ITEMS AS REQUESTED VIA KITE. WHEN 
ACCESSED PROPERTY DETAINEE ONLY WANTED PAPERWORK FOR KOP. DETAINEE 
WANTED TO RELEASE PHONE, I INFORMED DETAINEE PHONE HAS ALREADY BEEN 
RELEASED ON 6/13/18. DETAINEE DOES NOT WANT 
TO RELEASE ANY OTHER ITEMS TO ANYONE. PER DETAINEE. 06/20/201~(b)(6); (b)(7)(C) 
(b )(6); (b )(7)(C) 
Total Items 
eabovelsaco .. •ctllstingofAllltemsGt u>1·w· In u 0() 
1 
t 
___ ;..u,a;~~-IAJ.¥ .... r-e/_D_a_te ____ ;}) f6'--~-=--=--=--=--=--=--=-~(-b)-(6-);-(b-)(7_)(_C_)__.. ____ w-r·l_O~ 
2019-ICLl-00051 3619 
DHS-ICE-19-0196, 19-0197-O-000303

.-.--~~-.,~~VJ~J~"t-°;!~1!'-l't.:J"'~{~~~,r'~~ty.l'ME~~~~~~~~@·•,i\t41SJ?C'1,"'i;,.0 •. ~
11~~~§:~~~;:-,~~p,.:f::-iS,,,,:}~-,~~;_;c:~·~,r,~~ 
0 · t'?rthwest Deteruion Cen-~ · \\~yp. (Q-2-0· (1> 
Detainee Req&estto-Reliiise· Property and/or Funds 
Detainee Name: Amu_ M~rge.nsa.n~ A#-: f/6 f.6'-/ go f.. Dorm: 6-/ 
RELEASE OF FUNDS ';I RELEASROFPROPERTY 
Cash 1$ Description: f'LII' ~·'~ -- ,, ,. Check/Monev Order I$ '• 
I / 
J ~-- "-· 
Release to: Release to: (b)(6); (b)(7)(C) 
If release is by mail, provide mailing address here ( detainee s are responsible fot•po~tage ): 
"t-,·. 
(b)(6); (b)(7)(C) 
Date ·--. .. __ 
NOTE: This authorization will expire in 14 days from the date entered by the detainee. 
-- (b)(6); (b)(7)(C) 
.M 
,0 
R 
e receiv.:ed-the ~hove listed item(s): ') 
. , l(b)(6); (b)(7)(C) 
Date. Released By Date 
DO 005 NCR 07-21-10 -. 
tiltitii.;ifi,Q,'-• J!i!;i?.'.Gl..l\'a:,;i;:s:rcJ;:·. -:;:;,;:.,..~. ;s::;. ··:!lZ·m;.;;ll'..m~~!:i25lii=:ll:i:--.:?I· !i,.,·', ,~·· ~-·".,sill·:·itM;,'.!C!~,i,~b-- ~~~~~l~,r?-t¥ri¼.~"¢.,&v~~hf:j~\~),;-;t'<5m;i,;..:i·~t,:,.~ .. ~~~~ ,~1
~~..:j''¾•;,~~m;,,n1i;~rt~t:1::~·-·~-&¾~~;f.,;.;'%~-~;&i\' 00·~1 
2019-ICLl-00051 3620 
DHS-ICE-19-0196, 19-0197-O-000304

6/13/2018 
File No. 
Housing 
Detainee 
Location 
Property Witheld Receipt 
A- 216269802 
B 1 117 A 
AMAR MERGENS.t 
Y05/ 
Northwest Detention Center 
Inventory Officer b)(6); 
b)(?)(C) 
6/13/18-ACCESSED VALUABLE PACK TO RELEASE CELL PHONE AT FRONT DESK TO LIYA 
PJAMILOVAAT THE DETAJNEE'S REQUESTib)(6); (b)(7)(C) I 
Total Items Condition of Property 
I certify that the above is a correct listing of All Items that were removed from my possession at the time I was placed in 
Jail. ~- (b)(6); (b)(?)(C) -- 5<' ~ ______ lo ~I.J-19 
t Oetaiooo s•rx•J: (b)(fXC) I 1. -\ 3
,, :i' 
----------'--0----------
e 
Supervisor Signature/ Date ate 
2019-ICLl-00051 3621 
DHS-ICE-19-0196, 19-0197-O-000305

5/2/2018 
File No. 
Housing 
Detainee 
Location 
Property Witheld Receipt 
Northwest Detention Center 
A- 216269802 
B 1 117 A 
AMAR MERGEN SJ 
VOS lnventorv Officer b)(6); (b)(7)(C) 
5/02/2018 ACCESSED VALUABLE PACK WITH DETAINEE TO RETRIEVE PHONE NUMBERS 
OUT OF HIS CELLPHONE PER HIS KITE REQUEST. DETAINEE RETRIEVED PHONE 
NUMBERS OUT OF PHONE.f b)(6); (b)(7)(C) I 
Total Items Condition of Property 
I certify that the above is a correct listing of All Items that were removed from my poss~~~~~ ......... yas placed In 
Jail. 
X. ---;:~!:::::=======,-------,~"'f-l￾Su isor Signature/ Date 
2019-ICLl-00051 3622 
(b)(6); (b){7)(C) 
Staff Signature/ Date 
5-
DHS-ICE-19-0196, 19-0197-O-000306

3/21/2018 Property Witheld Receipt ~ 
Northwest Detention Center 
File No. 
Housing 
Detainee 
Location 
A- 216269802 
B 1 117 A 
AMAR 
VOS 
MERGENSJ 
lnventorv Officer b)(6); 
)(7)(C) 
03/21/2018-ACCESSED VALUE PACK TO RETRIEVE INFO AS REQUESTED VIA KITE. 
DETAINEE RECEIVED CARD INFO ON 03/21/2018 (b)(6); (b)(7)(C) 
'Total Items Condition of B perty 
above Is a conect listing of All ltej; ?-;;J p•• &om bJ(fiJ; ~xn1c1 
u t-1/{t te 
SupervlsL--~--' /Date gnature / Date 
2019-ICU-00051 3623 
DHS-ICE-19-0196, 19-0197-O-000307

~--- Property Witheld Receipt ~-\ 3/17/2018 
Nortbwe5t Detention Center 
File No. A- 216269802 
Housing B 1 117 A 
Detainee AMAR MERGENSJ 
Location OPEN VALUE PACK lnventorv Officer b)(6); 
h\f7\tr'\ 
DETAINEE WAS ALLOWED TO DOWNLOAD CONTACT NUMBERS FROM ms I-PHONE. 
Total Items Condition of Property 
I certify that the above is a correct listing of All Items that were removed from my possession at the time I was placed in 
Jail. (b)(6); (b)(?)(C) 
z,/r7/1,5 
l 
Deta µs;J:;.,;zJl!.WJ1:1,1ure / Date (b)(6); (b)(?)(C) nature/ Date 
J . / t------~-- ____ 17/1 iJ (b)(?)(C) · Or rtf iJ 
--------, 
Supervisor 1gnature / Date ..... ,.,----~nature / Date 
2019-ICLl-00051 3624 
DHS-ICE-19-0196, 19-0197-O-000308

f'\: .. ..... I • 
..-..1 d"· : ;Re uest to c( -~ 
Date Submitted JO--q, 21-(, 9..o\R Pod '2,\..A,-:--
Detai,.e Nam)(Last, ~lrst) Mergen Sa no, .Amo t 
Number of Pi tes Submitted 2- Leg~I V Personal 
Note_·_--______________ _ 
A# 21b'2.b9 f?. o2 
Original - Detainee Yellow- Records Pink - Mall Room 00-036 1-26-17 
-----·- ·--------------
2019-ICLl-00051 3625 
DHS-ICE-19-0196, 19-0197-O-000309

2019-ICLl-00051 3626 
~ 0 
<..> 
LU 
..J 
;:;:: 
~ a 
ii: 
0 
DHS-ICE-19-0196, 19-0197-O-000310

·.__ 
Northwest Detention Center 
Tacoma, Washington 
Information Re ort 
(b)(6); (b)(7)(C) 
Page / of To: (Supervisor) ----r-;:::::::;=:::1.-:--:=,:::-:--.---_...J -- --
From: CJ JI}, · · ~ '----,-)<_
7
)(-C)-:: te: 1:i.../46 Time: / ~) f, Location: _/J_/_/ __ _ 
Subject: C. ,:,.,,v--1-r?-"' ~~,n/. Information Report Number: _____ _ 
/1-2£ "2.1 6' 2b ~ g-o 2-
Persons Involved: 1. 2. 
Narrativ 
b)(6); 
b)(7)(C) 
Officer Print Name: 
Action Taken: 
~----- -----
)(C) 
'4a11 ... _. 
3. 
... --····-
b)(6); (b)(7)(C) 
-,op ro" ... -
·&¥ 
(b)(6); (b)(7)(C) (b)(6); (b)(7)(C) 
Supervisor Print Name: Sil!Ilature: 
IN 001 020110 
2019-ICLl-00051 3627 
I 
Date/? /;1-i/ /I 
/ - //(' 
I , 
DHS-ICE-19-0196, 19-0197-O-000311

:•• 
' '.' j :- J.. ,: 
!. ! : 
'· I •• 
:-h~k 
Special Nee s F rm 
i 
,.S. In{migration 
d Ctj.stoms ri.forcrment 1 Special Needs Form 1;:,}. 
i-·1 (;";( -------+--+-----.----------, 
FACILITY: Northwest 
DetenUon Center 
SubtD: (b )(6); ( \/7\U'\ 
th patient•alrecord and I have found that patient wm 
·ng Special Nkda/Speclal Requirements ! 
I 
I 
Page Io~~ 
i 
j 
1. Diet - Geo : Dfetfor Health 
(OlabatesJHypercholet;terolemla/Hyper 
( 09/2.6/2018 - 11/30/2018 ) , , 
2. Housing : Cleared for housing in segrE I 
( 10/1612018-10/1•6/2018) . ! 
3. Diet- Geo: PM Snack ( 10/17/2018 - . · 
01131 /2019 ) , ,: 
4. Diet - Geo : Pureed ( 1 ?101/2018 • 1171>.~ 
5. Housing : Discharge f~om MHU ( 11(0i;l 
11/0512018) ' I ~n 
6( Special AccommodaUons/Restrictio(,s: 
Remove from MH Observation ( 11 /0$'/: 
11/05/2019) : ,; . . 1
=1 
. . : 11 
t 
!:·i;I] 
: I I 
~S-6 UJ4 ::· 
, '--1 0~-.. ,i ~ r ~I ,.,,...<b'""'l<6,.,...l;..,,..<b=lu=lcc=,.__ _____ --, : .J\ I 
11\~ it i 
;·-
i l 
1.: 
; http://proda p.e -icehea~th.org/mobiledoc/jsp/Corrections/SpecialN~eds/PrintSpeciaINee:.. 11/5/20-~8.1 
~ a6ed ~0096LL£~Z ewo:ie1 JClMN 4neaH 3JI LQ:9~ !HOZ ~o AON 
2019-ICLl-00051 3628 
DHS-ICE-19-0196, 19-0197-O-000312

NoJ-1:hwe:;t Detention Center 
Detainee Name 
Special Instructions 
(b)(6); 
h\f7\f 
Daily Log for Medical ISO 
Ail 21 <, 1.. 
(b)(6); 
1-/o-"--'3~-----+---1~--t----t(b)(7)(C) ~--l--l-----!----l~ii:.L..~..:;.i..,:~=c:!.L.__c:::;....::=,.tM-J 
IOj}lts"" 
I Detainee Name 
Enter the TIME for Recreation. 
A if Accepted, R for Refused - NS for Not on Schedule - D for Denied by Warden (Must be supported by documentation) 
2019-ICLl-00051 3629 
Cell: 
11'2..o 
I Cell: 
02/01/16 
DHS-ICE-19-0196, 19-0197-O-000313

/\-tax• t)'k~~··- a4. u~ 'Z.loq eoz 
Northwest Detention Center Daily Log for Medical ISO . \ 
1'--"'..-,...a:1-~,-----t---+---t----t1(b)(6); 
(b)(7)(C) 
~-'----1---4----1---r----t--'t:'I IJ--4--1~-f=rr....:.L~':#J,.J.J.-....JWWU.~~-H 
io/(L 0~ 
/ ./ 
if± 
fl(_S oU 0 
IM, ,~s￾M1h -J {ii<& 
;011~• 
\.. 
Enter the TIME for Recreation. 
A if Accepted, R for Refused• NS for Not on Schedule - D for Denied by Warden (Must be supported by documentotiou) 
02/01/16 
2019-ICLl-00051 3630 
DHS-ICE-19-0196, 19-0197-O-000314

• Special Needs Form 
U.S. Immigration 
and Customs 
Enforcement 
PATIENT NAME: AMAR, 
MERGENSANA 
A: 216269802 
Special Needs Form 
FACILITY: Northwest 
Detention Center 
,,Kb)(6); SublDtbl(?)(Cl I 
I have reviewed the patient's record and I have found that patient will 
need the following Special Needs/Special Requirements 
Electronically 
signed by: 
14:59 
Print 
Name/Daterrlme 
rb)(6); (b)(7)(C) 
(b)(6); (b)(7)(C) 
2019-ICLl-00051 3631 
Page 1 of 1 
1. Diet- Geo : Diet for Health 
(Diabetes/Hypercholesterolemia/Hyper 
( 09/26/2018 - 11/30/2018 ) 
2. Housing : Discharge from MHU ( 10/16, 
10/16/2018) 
3. Housing : Discontinue Hunger Strike 
Monitoring ( 10/16/2018 -10/16/2018) 
10/16/2018 
DHS-ICE-19-0196, 19-0197-O-000315

Nov 01 2018 09:40 ICE Health NW:-- Tacoma 2537796005 
Special Needs Form 
U.S. 1!1]ll1ligration 
and Cus~oms 
Enforcelµent 
Special Needs Form I 
PATIENT NAME: FAClti.lTY: 
Northwest 
Dete~tfon 
Cent~r 
AMAR, 
MERGENSANA 
A: 216269802 Subl : 
(b)(6); (b)(7)(C) 
I have reviewed the patient's re~ord and I have found 
that patient will need the followl11g Special 
Needs/Special Requirements ; 
Electronically 
signed by: 
(b)(6); (b)(7)(C) 
09:40 
Print 
Name/DatefTlma 
page 
(b)(6); (b)(7)(C) 
1. Diet - Geo : P 
(11/01/2018 -
Page 1 of I 
DOS 
(b)(6); (b)(?)(C) 11/1/2018 
2019-ICLl-00051 3632 
DHS-ICE-19-0196, 19-0197-O-000316

' I , _____ 
, Special Needs Form 
U.S. Immigration 
and Customs 
Enforcement 
Special Needs Form 
PATIENT NAME: AMAR, 
MERGENSANA 
FACILITY: Northwest 
Detention Center 
A: 216269802 
I have reviewed the patient's record and I have found that patient will 
need the following Special Needs/Special Requirements 
Electronically 
signed by: 
(b)(6); (b)(?)(C) 
22:40 
Print 
Name/Datemme 
Page 1 of 1 
1. Diet - Geo: PM Snack ( 10/1712018 -
01/31/2019) 
2. Housing : Place on suicide watch in 
safety cell, issue safety smock and 
blanket, mattress on floor, food: no 
saran wrap/utensils (10/26/2018 -
10/26/2018) 
l
(b-)(B-);-(b-)(?-)(_C_)-------~~~bH:AJY~-"d~~---------110/26/2018 
. 2019 ICLI 00051 JeJJ 
DHS-ICE-19-0196, 19-0197-O-000317

• Special Needs Form 
U.S. Immigration 
and Customs 
Enforcement 
Special Needs Form 
PATIENT NAME: AMAR, 
MERGENSANA 
A: 216269802 
FACILITY: Northwest 
Detention Center 
I have reviewed the patient's record and I have found that patient will 
need the following Special Needs/Special Requirements 
Electronically 
signed by: 
r)(6); (b)(?)(C) 
-- -- . - ·- 15:23 
Print 
Name/Date/Time 
b)(6); (b)(?)(C) 
Page 1 of 1 
1. Diet- Geo: Diet for Health 
(Diabetes/Hypercholesterolemla/Hyper 
(09/26/2018 -11/30/2018) 
2. Housing : Cleared for housing in segre 
(10/16/2018 -10/16/2018) 
3. Diet- Geo : PM Snack (10/17/2018 - 01/31/2019) 
4. Housing : Mental Health Observation; I 
house in segregation (10/27/2018 -
10/27/2018) 
Ll<b_><-
6
l-,<b_><_?l_<c_l _________ 2,ro1"'1•1-q9:r.1rcrcn1.umoiro,,,s;-,•1-3~s::;:3:i-z4r----------~11012812018 
DHS-ICE-19-0196, 19-0197-O-000318

r 
U.S. Immigration 
·and Customs 
Enforcement 
Special Needs Form 
I 
PATIENT NAME: AMAR, 
MERGENSANA 
FACILITY: 
Northwest Detention 
Center 
A: 216269802 Subl~b)(6); (b)(7)(C) I 
I have reviewed the patient's record and I have found that patient 
will need the following Special Needs/Special Requirements 
Housing : Mental Health Observation; OK 
to house in segregation {10/27/2018 • 
10/27/2018) 
Electronically signed by: 
! l(b)(6); (b)(7)(C) ~0/27/2018 
I __ ._ ... _u"----------1 
r-Prlnt Name/OatcfTime I 
(b)(6); (b)(7)(C) 
Special Needs: MH Observation in MHU 
-Mental Health Observation with 10 min staggered [irregular] 
custody checks 
-May have personal property in room 
-May have commissary In room 
-Encourage recreation: MUST continue custody irregular 
checks while pt is in recreation yard. 
-Encourage self-care/hygiene. 
-May have TV, radio, X-box, phone, books 
ROUNDS: 
RN per shift 
Provider per day 
Vitals: per day 
2019-ICLl-00051 3635 
DHS-ICE-19-0196, 19-0197-O-000319

· Special Needs Form 
U.S. Immigration 
and Customs 
Enforcement 
Special Needs Form 
PATIENT NAME: AMAR, 
MERGENSANA 
FACILITY: Northwest 
Detention Center 
A: 216269802 Subl0:l(b)(6); (b)(7)(C) 
I have reviewed the patient's record and I have found that patient will 
need the following Special Needs/Special Requirements 
Electronically 
signed by: 
(b)(6); (b)(7)(C) 
22:40 
Print 
Name/Date/Time 
r)(6); (b)(7)(C) 
2019-ICLl-00051 '.3636 
Paget' of 1 
1. Diet- Geo: PM Snack (10/17/2018 -
01/31/2019 ) 
2. Housing : Place on suicide watch in 
safety cell, issue safety smock and 
blanket, mattress on floor, food: no 
saran wrap/utensils ( 10/26/2018 - 10/26/2018 ) 
10/26/2018 
DHS-ICE-19-0196, 19-0197-O-000320

U.S. Immigration 
and Customs 
Enforcement 
Special Needs Form 
r------ -·1··----- -- 1 PATIENT NAME: AMAR, FACILITY: . 
I 
MERGENSANA Northwest Detention 
Center 
I 
r--:::;· 216269802 I 
SublD: (b)(6); 
e.:'""-""'-'-7"-'\/f'c_;\'---' 
I have reviewed the patient's record and I have found that patient 
will need the following Special Needs!Special Requirements 
Housing : Mental Health Observation; OK 
to house in segregation (10/27/2018 -
10/27/2018) 
i--- Electronically signed by: 
r--------- - j fb)(6); (b)(7)(C) 110/27/2018 
I us.59 
L___ Prin_t_N_a_m-e/_D_a-te-/T-im-e----1 
i )(6); (b )(7 )(CJ 
Special Needs: MH Observation in MHU 
....... 
-Mental Health Observation with 10 min staggered [irregular} 
custody checks 
-May have personal property in room 
-May have commissary in room 
-Encourage recreation: MUST continue custody irregular 
checks while pt is in recreation yard. 
-Encourage self-care/hygiene. 
-May have Pf, I &I ) I J, hone, books 
ROUNDS: 
RN per shift 
Provider per day 
Vitals: per day 
AJo TV 
pe./ 
1rv1 fl- p D. , 
i L>-Lil. o Pf ! l/~o ,..t. 0 
2019-ICLl-00051 3637 
DHS-ICE-19-0196, 19-0197-O-000321

Northwe:st Detention Center Daily Log for Medical ISO 
Detainee Name /J.M. y.l.R_ I A# -Z...<Gq I 
2..{(o I Cell: /1,,t~- l. /.: ., .a; 3'02 
Special Instructions J.kj,,).,;~/'" :f J-r I /,t-' , 
[};T;T:·~~~f ~.:~:~~~~?~~~~?~f ~~~~~?;.:.:~ ~~C :-::;;::~:-: ~-::~:::l:~ ., ::~--~ -~;,~~~~i:-~f:0~f-~)!~:'.~-~i~AI0f§?ir·:~-~~!-_-·~-~iit:~~~{f;~;-~J □ Special Watch Namel(b)(6); (b)(7)(C) I Date8'- 2 s--I~ 
Purpose: Title 1 
f'~ I),./ I Time /e li. 
.. --:,~-r•,r-t-~-:: .. . ,. --;·.-:---r-·•:#-i, 
l~•t -~J{r,· A~!,'_iJfF).~J:l,(•~1J.'. 21 _tj";i'·'.~;~r. ..,__ :, •• '• _,_1_ ••• •-•u- .'., • --,;;;u .. -- . ' .. - - ·.'· , 
-- -· . - -- - . ~ -~ 
Date 
I IOCJ 
z_ 
'"&i1s I 2-'f5-
lb-</. 14'$ 
--- '4FI l/--Cf }1e4,{ 06 1 , 
,,,,- b)(6); 2_ C) r/ 
l<>ctW 
b)(7)(C) 
Jt1s· ..:1- V,.J.r. lJ,vJ o~o 
✓ 
--- (cJ(c) 
. /?. 12i., 
----
Cell: 
Enter the TIME for Recreation. 
A if Accepted, R for Refused - NS for Not on Schedule - D for Denied by Warden (Must be supported by documentation) 
02/01116 
2019-ICLl-00051 3638 
DHS-ICE-19-0196, 19-0197-O-000322

Northwest Detention Center Daily Log for Medical ISO 
fl.l<J 
1v.o 
F--/~-+----+---+----t----t---11b)(6); 
10 lo b)(7)(C) I <-/.5 
l￾w/, c)jcJ L 
) ,, 
Ju It. 
Enter Ilic TIME for Recreation. 
A if Accepted, R for Refused - NS for Not on Schedule- D for Denied by Warden (Must be supported by documentation) 
02/01/16 
2019-ICLl-00051 3639 
DHS-ICE-19-0196, 19-0197-O-000323

Northwest Detention Center 
.Defainee Name Cell: 
~T,;'v:';;F,:'-.7·;'"';••':C:"'"';,:";':-",-,•·:-~,,...,.;-1.T-7"~·.~·~,..-,71r-;::;s-:::::7;'.'';;-J::::,,;; '";JC,;1';0·7:;,~~~;•;,;,grw:~-~ 
;~ji :.::,•:~;:':_,,· .;.~ ·. ·_,_..•.,, ·->./;:;'i'<f/ff.(c):~;~!.i.\'.~;W~~ii;'., . .'.: • .. :.:.;-.~_:·,:: ~·.·:•'. _,/:.~· ,@i:E'.:.%?-~~'J.ll..lJG)~1~@.~,,!l.W;hJq ~~ ~-'-'~ ~~::i,.--:-•, ;;•.-.·_i.-_·..:"1_::.::~--~U~~-~~ .:),_..:::.~-~ .... :_ _ _; ___ ~.:-.~:...:.!:!;-~L: ·J:-1:~~ :..·:.:-::'6~~1,.:!l<i~ ~~-·--1~-&:&~.:~b~~ ~- - ~~~ 
0 Special Watch Name1(b)(6); (b)(7)(C) I Date ~i('-ts￾Purpose:· Title /)~.S R_;,J Time t2. ~..-
Name Date 
Unit, Book Out, etc Title Time 
lY)<\ 
A￾o·etainee Name A# Cell: 
Enter the TIME for Recreation. 
A if Acccplcd, R for Refused - NS for Not on Scbcdulc-D for Denied by 'Warden (Must be supported by documentation) 
02/01/16 
2019-ICLl-00051 3640 
DHS-ICE-19-0196, 19-0197-O-000324

/.).U'\-14/Z 
Northwest Detention Center 
:d:" z._{t;_ ~.CZ 8't! z_ 
Daily Log for Medical ISO 
~µ..x..-1----4---l----=+--,--_....,......._,,___+--l--+-l---+-'-_,..._,~......,_""""'-'=-------r<b)(7)(C)1-+- ____ --1-.:...=~ 
. .,f 
fZ 
Enter the TIME for Recreation. 
A if Accepted, R for Rcfused-NS"for Not on Scbedulc_-D for Denled by Warden (Must be supported by documentation) 
02/01/16 
2019-ICLl-00051 3641 
DHS-ICE-19-0196, 19-0197-O-000325

Northwest Detention Center 
Defainee Name 
Purpose:· 
Name 
Unit, Book Out, etc Title 
(b)(6); 
l-#-.a....;_.-+---+---+---+--t--1(b)(7)(C) 
Enter the TIME for Rccrcallon. 
·A#', -~ 
Daily Log for Medical ISO 
Title 
Date 
Time 
A# 
A if Accepted, R for Refused - NS for Not on Schedule-D for Denied by Wnrden (Must be supported by documentation) 
2019-ICLl-00051 3642 
Time n.,z.-S￾Cell: 
02/01/16 
DHS-ICE-19-0196, 19-0197-O-000326

Northwest Detention Center · Daily Log for Medical ISO 
b)(6 d;d¥1 ..,+ 0. 
J.c--+---t---t---+---lt6)(71---+---+-~-+-----1-'----------"'"Wlll 
f 11-s ..,;- v.J,,,, < ..,.,J 
b)(6); 
l-"+-...,__-+----+---+---+----+-1-t.b,)(7)(C) l---+--+----f=-:.....~-"-"-'-.....;;...=----:..:..=~--"'---..,..--1 
(b)(6); 
~1-=--f----+---+----t----+---1·b)(7)(C) 
b)(6); 
1-+,-1-+---+---+---+----i(b)(7)(C) 
Enter the Tlllffi for Recreation. 
A if Accepted, R for Refused - NS.for Not on Scbedulc_-D for Denied by Wnrden (Must be supported by documentation) 
2019-ICLl-00051 3643 
- I'/ 
;7u3 
l'H.O 
02/0J/16 
DHS-ICE-19-0196, 19-0197-O-000327

Northwest Detention Center Daily Log for Medical ISO 
_Defainee Name 
Purpose:· Title f'ifJ h Time I 22. i.....-
~.,.--,;;;;' .. r,.?-z.•1'?;'7 ::;-;;-,c;;~~-~·:-:-.ir:w•~-.~,--:-~=- -~ r,,:'7;v;.,:;;:-~:: -::~::;-:>~ ~:z~~]lli• .-· ~, ~--~,~~·~~~~~SB: t¥ii~t~~)J~~l~~{T~{t 
t,;J~•J...i.•·.; Ao, .. ....__........ .. ... ~ _...._:_i 
,X ----Jo ::tf~_}:·;;,:: .... - _ _,,. 
N?~f~'@V.~!~!~~~lf~'.=~~~iJ;~s~t 
____ , __ .;..;...,. ___ ~-----'""----·---· :. __ ' ':'_:-//;2l, , :;·: ----~ / )J~~A!~I(i_~~~1~ji~:! - - - ~·~~ 
Name 
Unit, Book Out, etc Title 
b)(6); 
J--!:!c.1L...-i----+--~::__-4....,,___~(b)(7)(C) 
Enter the TIME for Rccrc:1tion. 
(b)(6); 
(b)(7)(C 
" Date 
Time 
A# 
A if Accepted, R for Refused - NS for Not on Scbedule-D for Den.led by Warden (Must be supported by documcotation) 
2019-ICLl-00051 3644 
Cell: 
02/0)/16 
DHS-ICE-19-0196, 19-0197-O-000328

Northwest Detention Center 
j 
, od') J (b)(6); 
)IQ-,71 lb~ (b)(7)(C) 
Enter the TIME for Rcc1·cation. 
Daily Log for Medical ISO 
Aif Acccplcd, R for Refused - NS.for Not on Scltedulc_-D for Denied by Warden (Musi be supported by documcnt~lion) 
2019-ICLl-00051 3645 
02/01/!6 
DHS-ICE-19-0196, 19-0197-O-000329

Northwest Detention Center 
_Defainee Name 
Purpose:· 
,--. 
I 
Daily Log for Medical ISO 
~"'<'"f-~::-7:'J~?~-?' '~~;;-:,r·,:s-,;.~; -~.":~ :--7:'·,:-'"":T"~-:,;;-; ~-: ':-'<'~' -~ --;:-;;':':::-:11~•~'."1"'~~,r"'ry?, ·.,~,,.r..•~7,7•1'7?r.. • - -.,., .... ;~; 
~-?~t~c}~(c)~T~~\~¥1
~Jfil-~~.r":) ~--::::. ·:;.: ,; :~J'.j}f;tJ'iJ!l'~li~}['y,:tSr'l:;,,::.nf::tt~.:i'.;'. .. '·:·. ··. _, '.: · .. :: . ';·; :,'.' '.-~if~'t. ,.,, _.,i·-~JJ(@'.t~~'j§J'.,_;t;1y'l)k1 ~~~:,;"'~ 1::JS:.:.~ .... ~ .. d_':;,;..,... ~:.: .. ~!.:•~,.L---·_ -.!.";.._,, ___ ,_;:._:_.:_.~_._ _,_,.__'.!._...;!..~_:._,....,•,:~.:.., .. ¥_._,• l :t_:• .1.,.•,.• ... ;b .• !/:,.......!".L.:, • :..""-"'\.,cl..,:'~i1'...u.~u,;~1.,d~~~ 
Name Date 
Unit, Book Out, etc Title ., Time 
Enter the TIME for Recreation. . 
A if Accepted, R for Refused• NS for Not on Schcdulc-D for Denied by Warden {Must be supported by documentation) 
02101/16 
2019-ICLl-00051 3646 
DHS-ICE-19-0196, 19-0197-O-000330

Northwest Detention Center Daily Log for Medical ISO 
(b)(6); 
l-'-"----'-¼--~-----=---+----+----tll{b)(7)(C) 1---+---+-'--~½-=-->==--'--M:...........:.=e,'-'--f\,-:=j 
I/ 
I c 
Enter tl1c TIME for Rccre:ition. 
b)(6); 
b)(7)(C) 
A if Accepted, R for Refused - NS.for Not on Schedule_- D for Dented by Wnrdcn (Must be supported by documentation) 
2019-ICLl-00051 3647 
02/01/16 
DHS-ICE-19-0196, 19-0197-O-000331

Northwest Detention Center 
_Det'ainee Name 
Purpose:· 
Name 
Unit, Book Out, etc Title 
b)(6); 
~'-><----l-----+----+--t--t-1''b)(7)(C) 
Enter the TIME for Recreation. 
Daily Log for Medical ISO 
Date 
Time 
A if Accepted, R for Refused - NS for Not ou Schedule- D for Denied by Warden {llfost be supported by documentation) 
2019-ICLl-00051 3648 
Cell: 1:;,,- I 
-nu< 
l 70 
Cell: 
· · 02/01/!6 
DHS-ICE-19-0196, 19-0197-O-000332

.. AJJl!+f. 
No·rthwe~ Detention Center Daily Log for Medical ISO 
,J 
(b)(6); 
f-=JL!:::.!.+----f----=---t---+--t-l---t--t---l-+--t,ei..-.c,q..,.""""'-.1....-....Lll.=i,!llhl------i(b)(7)(C) i--.---1---~~-1 
Enter the TIME for Recreation. 
A if Accepted, R for Refused- NS'for Not on Scbedulc.-D for Denied by Warden (Must l>e supported by document:ttion) 
02/01/16 
2019-ICLl-00051 3649 
DHS-ICE-19-0196, 19-0197-O-000333

Northwest Detention Center Daily Log for Medical ISO 
Detainee Name ,h}.N\.A-/t Cell: ... J. '"e. -
Special Instructions 
Purpose: Title f llS' R,J Time , "2.2 r￾J,.i ., ,;- r ,... , . ' . ..,_ - ... ·-- ,- --
:·~· '(t.ac h\:~j\).~ft_l~_~:r:_;~!~--;11_:;r;!_t )_: ·t;t~:~,~•,!_:'•·1 P/!? ·/,?,.,(.:; -~'.:~~:~•:-.. - ' • I• • •·, 1 • ' 
~--..... : ··-· .. . ·- - ------. ---••-'•- .. -- .... _ ........ -- -
Unit, Book Out, etc 
o½:3 
o7uD 
Cell: 
Enter the TIME for Recreation. 
A if Acc,eptcd, R for Refused• NS for Not on Schedule - D for Denied by Warden (Must be supported by documentation) 
02/01/16 
2019-ICLl-00051 3650 
DHS-ICE-19-0196, 19-0197-O-000334

j)-Mti,/Z 
Northwest Detention Center 
{}{' 
i, '/'-7 
q-1tp 
Enter the TlME for Rccrc:itlon. 
p.. 
b)(6); 
b)(7)(C} 
(b}(6); 
(b}(7)(C) 
~ 
---.., 
-;?I~ 2~1 ~0"2-. 
Daily Log for Medical ISO 
R. ,1,,J Cu-- (1.. • wl 
.1e-J .~ I.So-l 
(Jc)£. "' JI> Ne•e•.f?c£' 
C,ei( lk£-2.. 
-A.-io O°"f-;;;;, ~ 
A if Accepted, R for Refused• NS for Not on-Schedule - D for Denied by Warden (Must be supported by documentation) 
2019-ICLl-00051 3651 
·0V 
c.JJ 
a[,{j) 
Ot'O:;> 
---- 1114(., 
\7'20 
Oi.,3<? 
02/01/16 
DHS-ICE-19-0196, 19-0197-O-000335

Northwest Detention Center Daily Log for Me'd:ical ISO 
) . .sJ,,.., /. . Special Iiistructjoos· ·.r·:---/1-t:.1~_.i.,_~--~-'-•"l-<-"-------,-----,------------------1 . . . . . 
Name Date 
Unit, Book Out, etc Title Time 
b)(6); 
f->.l,....._-t----t---t----t----1t--;·b)(7)(C)H--l--+---+.:::.i.....:.L....;...:.;=-.::=.....:..::,~=:,..;..,.,,-'-1 
lf--L---t---t---+---t---1t---t-1(b)(6); 
(b)(7)(C) 
f lot . PIJ.s /fA-/J .fAtW 1-cJ ~ 
b)(6); 
l--"=-+---+-----if---+----t-1(b)(7)(C) 
n·etainee Name 
Enter the TIME for Recreation. 
~ 
A if Accepted, R for Refused - NS for Not on Scbedulc - D for Denied by Warden (Must be supported b)• documentatlon) 
2019-ICLl-00051 3652 
Cell: 
· 02/01/16 
DHS-ICE-19-0196, 19-0197-O-000336

.. --I+# -2-r 0 ::Lb I .j?o l-- _,_ 0GD)-
f. ~c. ~;trd <l"t.5 
Northwest Detention Center Daily Log ~or Medical ISO 
t) 0 
I.. 
13o:J 
· Enter the Tll\fE for Rccrcn.tion. 
A if Accepted, R for Refused - NS"for Not on Schedule_ - D for Denied by Wnrden (Musi be supported by documentation) 
0210]/16 
2019-ICLl-00051 3653 
DHS-ICE-19-0196, 19-0197-O-000337

Northwest Detention Center Daily Log for Medical ISO 
Cell: ~-L. 
Special Instructions 
~-.,·,,,.r ~, .. - .~ ·:-:--· •.. ,. , .. :7,;~--=- ., "'·' .. -:;-,·~ --,---:-:=-r,-..;-~.-, .... ,.. ~~1:,.--:;--.-"-:--~"=··"'i .... ~~ r~!lWlJ.ffirr~i- c:~i ;:]•:;,it;-;·,;,.~ -., :.:. "i,:'.;· • '. t11Ji]J'.£,(0))•)H1.X(j::Th~-,. · : ~ ··: ..... .-,-:· .:: ':. \·, .;;.,( ~S~.i~F,-1,j.W,'jji)ic):l'fr,7.ri.:@-J:~~~~~#t••>t ,;_r;,r; R~~~-m: ~.ur'· __ ..,._. ,_:!..::!r~,._z;.~· . .M:..,;;_;~; ... ~ .'..L~~...:.:"~~.:......·~~.~-~i: .. ~.: .... :./.t-'°-'·1:.-._,;..· ... ;.:.. ... r; · ,:~:;,: ~t•:·:iz:.~1,:. 1!.,_.,.~~.::ti.!~,•i.' .i~;,'~;-::~~ ,~ *-
Purpose:· 
Unit, Book Out, etc 
Enter the TIME for Recreation. 
-Special Watch 
Name 
Title 
(b)(6); 
(b)(7)(C) 
(b)(6); (b)(7)(C) 
"Name lb)(6); (b)(7)(C) 
Title f'NJ /l.J 
Date 
Time 
A if Accepted, R for Refused• NS for Not on Schcdule-D for Denied by Warden (l\1ost be supported by documentation) 
2019-ICLl-00051 3654 
I Date 03"·· 27,--t r 
Time /l.Z.. y--
otot 
r.J± 
Cell: 
02/01/16 
DHS-ICE-19-0196, 19-0197-O-000338

Northwe~t Detention Center Daily Log for Medical ISO 
Enter the TIME for Rccrc.-ition. 
A if Accepted, R for Refused• NS.for Not on Schedule_- D for Denied by Warden (Must be supported by documentation) 
02/01/16 
2019-ICU-00051 3655 
DHS-ICE-19-0196, 19-0197-O-000339

Northwest Detention Center Daily Log for Medical ISO f'IGP.,.l... 
,-------------------,---------------,------~::J 
Defiiinee Name AH AR. A# .lJ6 :J..6 C/ 't50.:L.....: Cell:~ 
Purpose:· 
Name 
Unit, Book Out, etc Title 
(b)(6); 
i..q...;...._-t---+---t---1--i-l(b)(7)(C) 
(b)(6); 
(b)(7)(C) 
b)(6); 
b)(7)(C) 
Title t{S RU 
Date 
Time 
/~i-u!.-......l~-----+---+---+---+---+--+---+-+--+-1-'a="'"-l=· >=.....::~.:....:.:........i..;..:;~---1 
/l.<. -hJ 4.y 
A# 
Enter the TIME for Recreation. 
A if Accepted, R for Refil\ed - NS for Not on Schedule- D for Denied by Warden (?t'fosl be supported by documentation) 
2019-ICLl-00051 3656 
Time /..l-~ 
Cell: 
02/01/16 
DHS-ICE-19-0196, 19-0197-O-000340

d2 o)-
Northwest Detention Center Daily Log for Medical ISO 
)(C) 
(," 
tz1<;r 
~J.,f 
O,~t._,~-·hfik. '"'/W!: 
~jj· 
l (b)(6); 
(b)(7)(C) / 
n4S" 
01-10 
..,,.. 
jA{U '"".J,(_ /JIIJ 
93i~ I} 
"t:3 P: /l..~"2) 
~ th, fl< {,h<- 4 ~ y ~ 
~-7-- 130) 
r,no 
ii,,) (b)(6); 
(b)(7)(C) ~ 
Enter the TIME for Recreation. 
A if Accepted, R for Refused• NS for Not on Schedule - D for Denied by Warden (Must be supported by documenlation) 
02/01/16 
2019-ICLl-00051 3657 
DHS-ICE-19-0196, 19-0197-O-000341

Northwest Detention Center Daily Log for Medical ISO 
:Detainee Na.me n. ¼ · Cell: /Jd-
.. 
Spe.cial Instr~cti6ns · 1--· •• ,... -"/J::..,c1"-'.,).~• .""'.'-----'2-..:P::."-="F-----------------'---------------1 
Purpose~ 
Name Date 
Unit, Book Out, etc Title Time 
b)(6); 
___;;""---l---+--+---+---t--i'b)(7)(C)1-1---1~-+---t-,-.,.-'---'-"'"c-----u.-,q.----1 
Detainee Name 
nter the TIME for Rccrc,ition. 
if Accepted, R for Refused - ~S for Not on Schedule - D for Denied by Worden (Must be supported by documentation) 
2019-ICLl-00051 3658 
I Cell: 
02/01/16 
DHS-ICE-19-0196, 19-0197-O-000342

Northwe~t Detention Center Daily Log for Medical ISO 
)(C) 
Enter the TIME for Recreation. 
A if Accepted, R for Refused• NS'for Not on Schedule_- D for Denied by Warden (Must be supported by documentation) 
02/01/16 
2019-ICLl-00051 3659 
DHS-ICE-19-0196, 19-0197-O-000343

Special Needs Form 
U.S. Immigration 
and Customs 
Enforcement 
Special Needs Form 
PATIENT NAME: AMAR, 
MERGENSANA 
FACILITY: Northwest 
Detention Center 
A: 216269802 SubfDl(b)(6); (b)(7)(C) I 
I have reviewed the patient's record and I have found that patient will 
need the following Special Needs/Special Requirements 
Electronically 
signed by: 
03:19 
Print 
Name/Date/Time 
rb)(6); (b)(7)(C) 
2019-ICLl-00051 3660 
Page 1 of I 
1. Hunger Strike : Admit to medical 
housing unit for hunger strike 
monitoring (08/25/2018 - 08/25/2018 ) 
8/26/2018 
DHS-ICE-19-0196, 19-0197-O-000344

Special Needs Form 
\ .___. 
U.S. Immigration 
and Customs 
Enforcement 
Special Needs Form 
PATIENT NAME: AMAR, 
MERGENSANA 
FACILITY: Northwest 
Detention Center 
A: 216269802 SublD:l(b)(6); ~-
I have reviewed the patient's record and I have found that patient will 
need the following Special Needs/Special Requirements 
Electronically 
signed by: 
(b)(6); (b)(7)(C) 
B 
11:07 
Print 
Name/Date/Time 
rb)(6); (b)(7)(C) 
20 I 9-ICLl-00051 3661 
Page 1 of 1 
LJYf 11Zl ,- ~r;,-tj 
1
ru> lf.s 
1. Housing: Refusing to eat: Single Cell 
Housing. No commissary food/beverar 
in cell. Document all food/beverage int 
(08/22/2018 -11/30/2018) 
2. Hunger Strike : Admit to medical housi 
for hunger strike monitoring ( 08125120 
12/3112018) 
3. Diet - Geo : Diet for Health 
(Diabetesll-iypercholesterolemia!Hyper 
(09/26/2018 -11/30/2018) 
9/26/2018 
DHS-ICE-19-0196, 19-0197-O-000345

Oct 16 2018 16:37 ICE Health NWOC Tacoma 2537796005 
~pecial Needs Fonn __ 
• 
1jJ'.S. Immigration cµid Customs 
Enforcement 
Special Needs Form 
PATIENT NAME: AMAR, 
MERGENSANA FACILITY: Northwest 
Detention Center 
A: 216269802 
I have reviewed the patient's record and I have found that patient Will 
need the following Special Needs/Special Requfrement:e 
ElectronlcalJy 
slgn&d by: 
(b)(6); (b)(7)(C) 
16:35 
Print 
Name/Datetnme 
page 1 
Page 1 of l 
b)(6); (b)(7)(C) 10/16/2018 
2019-ICLl-00051 3662 
DHS-ICE-19-0196, 19-0197-O-000346

Northwest Detention Center AdmTnistrative Detention Order 
To: Restrictive Housing Unit Date: Cf ·ZZ· It, 
From: -------lb)(6); (b)(7)(C) Title: ---=Si:;...G=....;;;1_- __ _ 
(Printed n.__ _ __,,....-__ ....,,..,..son authorizing detention) 
Medical notified: Yes ___;ts:_ No 
Detainee name: -~A._....rA~=A...,K,......_ _______________ _ A-Number: ztleZrlitCf'!oz 
The above named individual is to be admitted to Administrative Detention for the following reason(s): 
____ (A) Is pending an investigation/hearing rule violation and reqires pre-hearing detention to 
protect the security and orderly operation of the facility. 
._., """..><'-"--_(B) Is under medical observation J(me~w.~ ii,Wft.JI"'' tom went and ,;en ·•::...nulecl l 
Medkal Officer (S;gnature), L--------------,~.-- ___ __. 
___ (C) ls pending a transfer or release within 24 hours. 
Is terminating confinement in Disciplinary Detention and has been ordered in Administrative 
(D) Detention by the Institution Disciplinary Panel (!DP). ----
(E) Is a security risk to him/herself or the security of the facility. ----
(F) Detainee has requested admission for Protective Custody. ----
I hereby request placement in the Restrictive Housing Unit for my own protection. 
I do [ ] do not [ ] request a hearing concerning my detention. 
Detainee: __________________ _ Date: ____ _ 
(Signature) 
Details (as necessary): tn If <A (rr-V\~ 
. . . (b)(6); (b)(7)(C) Copy delivered to detamee by (S1gnature)-1 ___________ ..>--- Dateffime 9-Z2· ,sit /a,~ , 
Detainee released to: AAe0 \'%) Date: ~ ·1JldK Time O"i'"t.1- Authorized by: _\J.O\.l-'--5_u ____ _ 
Original: Detainee File - White 
CC: Administrative File - Yellow 
Detainee - Pink 
IHSC- Gold 
ICE- Blue 
Administrative Detention Order DIS002 042617 
2019-ICLl-00051 3663 
DHS-ICE-19-0196, 19-0197-O-000347

Special Needs Form 
U.S. Immigration 
and Customs 
Enforcement 
Special Needs Form 
PATIENT NAME: AMAR, 
MERGENSANA 
FACILITY: Northwest 
Detention Center 
A: 216269802 Subl~(b)(6); (b)(?)(C)J 
I have reviewed the patient's record and I have found that patient wlll need the 
following Special Needs/Speclal Requirements 
Electronically 
signed by: 
00:53 
Print 
Name/Date/Time 
rb)(6); (b)(?)(C) 
2019-ICLl-00051 3664 
Page 1 of 1 
1. Housing : Admit to Administrative SEG 
for medical reasons ( 09/22/2018 • 
09/22/2018 ) 
2. Housing : Refusing to eat: Single Cell 
Housing. No commissary food/beverage 
Items In cell. Document all food/beverage 
Intake ( 08/22/2018 • 08/22/2018 ) 
3. Hunger Strike : Admit to med I cal housing 
unit for hunger strike monitoring 
( 08/25/2018 • 08/25/2018 ) 
9/22/2018 
DHS-ICE-19-0196, 19-0197-O-000348

Northwest Detention Center Investigation Report - #: 
Amar 
Name of Detainee 
MED ISO 
Living Unit 
NIA 
A#216269802 
A-Number 
Code(s) 
09/2212018 
Date of Incident 
NIA 
Code(s) 
MED ISO 
Place of Incident 
NIA 
Code(s) 
Name of Investigating Officer: J,\i!,~a.i.,1hrz61~i,..::..i.,_,.__ ______ _ has advised Amar A#216269802 
Detainee 
That he/she has the right to remain silent at stages of the interview process, but, that silence may be used to draw an 
adverse inference against him/her at any stage of the interview process. However, silence alone may not be used to 
support a finding that he/she witnessed a prohibited act. 
Detainee Statement and Attitude during the Interview: 
Detainee Amar A#216269802 was calm when I spoke to him. He understood he was going to segregation just for medical 
ISO overflow (D-3). There nothing further to report at this time. 
Other Facts about the Incident: 
Detainee Amar A#216269802 received a copy of the segregation order 
Investigator's Comments and Conclusions: 
NIA 
Date and Time Investigation 
Completed: 
CC: Warden/ Associate Warden 
Classification I Records 
Investigation Report 
09-22-2018/ 0130 
Captain Disciplinary Lieutenant 
Business Office (as appropriate) 
DIS 011 
2019-ICU-00051 3665 
ICE 
11-05-07 
DHS-ICE-19-0196, 19-0197-O-000349

\ 
.....__._ 
Northwest Detention Center Daily Log of Special Housing Detainee 
Detainee_Name: Cell: .Q 
Name 
Unit, Book Out, etc Title PHS Time 092..2. 
·--- -- ·-----·- -- - --- --- -·· --- -------
Enter the.TIME for Recreation. 
A if,\cceplcd; R-for Refused· --'NS-for·Nol on Schedule- D for Denied by Warden (Must be supported by documentation) 
08/03/11 
2019-ICLl-00051 3666 
DHS-ICE-19-0196, 19-0197-O-000350

Booking/Release Report 
Northwest Detention Facility 
9/22/2018 
Booking No: b)(6); (b)(7)(C) 
Agency: ICE 
Detainee Name 
AMAR, MERGENSANA 
Eyes 
BRO 
Home Address 
Booking Officer 
b)(6); (b}(7)(C) 
Release Officer 
A Number 
216269802 
Hair 
BLK 
Housing Assignment 
M-IN, 1 A 
Identifying marks 
B!il 
ASIAN/PACIF 
Weight 
150 
Classification 
LOW 
Date 
12/19/2017 
Time 
11:05 am 
I!!!!!. 
Detainee's Signature / Date Officer's Signature / Date 
2019-ICLl-00051 3667 
DHS-ICE-19-0196, 19-0197-O-000351

NL.THWEST DETENTION CENl..-~ 
SPECIAL MANAGEMENT UNIT CELL INSPECTION / SEARCH 
DETAINEE, k_1Nv'K'r:? 
DATE/ TIME ENTERED: q_!..~z;,:::.:1,:::..·....Ll e,~~~~~---...1...C,L,L.;..___.L......_._-'-7!._ __ (b )(6); (b )(7)(C) 
OFFICER CONDUCTING INSPECTION: L----------,~-__J---
I UNDERSTAND THAT I AM RESPONSIBLE FOR ANY DAMAGE THAT I CAUSE DURING MY 
PLACEMENT IN SMU. I ALSO UNDERSTAND THAT I AM SUBJECT TO DISCIPLINARY ACTION 
TO INCLUDE RESTITUTION FOR ANY DAMAGE I CREATE. 
I UNDERSTAND THAT THE CELL HAS BEEN SEARCHED PRIOR TO MY OCCUPANCY AND 
THERE IS NO CONTRABAND IN THIS CELL ANY CONTRABAND DISCOVERED DURING MY 
OCCUPANCY I WILL BE HELD ACCOUNTABLE FOR. 
I AGREE THAT THE FOLLOWING DEFECTS/ DAMAGE WERE PRESENT ON THE DATE:: 
NOTED ABOVE. 
LIST ALL DEFECTS/ DAMAGE BELOW: 
b )(6); (b )(7)(C) 
DETAINEE SIGNATURE 
DATE/ TIME REMOVED: _7_._z_z_._1_f_~_0_'?_2_2.. __ _ 
LIST ALL DEFEGTS / ~AGE BELOW: t. . il/4 / hV Vetvt A-b~ QeFt;-L-(J 
r 7 
.,..., / I 
b)(6); (b)(7)(C) 
DETAINEE SIGNATURE J 
I l/ 
SEGO06 
5-4-2015 
2019-ICLl-00051 3668 
DHS-ICE-19-0196, 19-0197-O-000352

Special Needs F m 
PATIENT NAME: 
MERGENSANA 
A: 216269802 
.S. Ii$rlgration 
dC~toms 
orc¢m.ent 
Special Needs Form 
FACILITY: Northwest 
Detention Center 
SublDJ(b )(6); _. 
-.. ' 
Page 1 of 1 
I have reviewed the patient's ~ord and I have found that patient will 
need the following peclal N~da/Speclal Requirements 
Electron I cally 
signed by: 
b)(6); (b)(7)(C) 
11:07 
Pr1nt 
Name/Oate/Tlme 
b)(6); (b)(7)(C) 
a6ed 
2019-ICLl-00051 
1, Housing: Refu&lnJJ to eat Single Coll 
Housing. No comrplssary foodlbevera{ 
In cell. Document pll food/beverage Int 
(08/22/2018 • 11/30(2018 ) 
2. Hunger S1rlke : A<trnit to medical housi 
for hunger strike monitoring ( 08125/20 
12131/2018) 
3. Diet • Geo : Diet for Health 
{Dlabetes/Hypercliolesterolemla/Hyper 
( 09126/2018 - 11/30/2018) 
9/26/2018 
£0096LLE£Z ew0Je1 ::x:JMN lJlte.iH 3JI o~:H 8~0Z 9Z d<ls 
3669 
DHS-ICE-19-0196, 19-0197-O-000353

Special Needs Po 
PATIENT NAME: A 
MERGEN SANA 
A: 216269802 
Special Needs Form 
FACILITY: Northwust 
Detention Center 
· SublO:"-kb.:..:)(6...;.)a...; ___ 
I have reviewed lhe ent's recqro and I hava found that pallent wtll need the 
following Special Ne s/Speclal Roqulrementa 
Eklctroriblly 
signed by: 
b)(6); (b)(7)(C) 
00:5:3 
Print 
Name/Dai.mm. 
b)(6); (b)(7)(C) 
Page 1 of 1 
1. Housing : Admit to A~mlnlstratlva SEG 
for medical reasons ( 09/22J201 B - 09/22/2018 ) , 
2. Housing : Rfft.191ng tQ eat: Single Cell 
Hou1lng. No comml~,y food/beverage 
Items In cell. Documetttall food/beverage lntal(e ( 08/W2018-08/22/2018) 
3. Hunger Strllat : Adm Hi to medical housing 
unit for hunger strike monitoring 
( 08/2512018 • 0812512018) 
9/22/2018 
a6ed goo96LL£gz ew0Je1 :xJMN l!l1eaH 3JI £g:oo g~oz zz das 
2019-ICLl-00051 3670 
DHS-ICE-19-0196, 19-0197-O-000354

Northwest Detention Centl!i--- Adri'fhr.-.strative Detention Order 
To: Rest;ictive Housing Unit 
From: b)(6); (b)(?)(C) Title: __ ;;-_•_-___ _ 
( orizing detention) 
~---------,------,,,--~----' 
Medical notified: Yes No 
Detainee name: A ~A-~ l WI ur~rl <ANA- -L-----'-----,., --"--'J=-+--'-'....::..;___;_;_:c._ ___ _ 
The above named individual is to be admitted to Administrative Detention for the following reason(s): 
____ (A) Is pending an investigation/hearing rule violation and reqires pre-hearing detention to 
protect the security and orderly operation of the facility . 
./ ___ (B) 
___ (C) 
ls under medical observation t,j'Jfll;/R/f, mus=• .; .. ,.;, ""'"" 
Medical Officer (Signature): 
Is pending a transfer or release within 24 hours. 
Is terminating confinement in Disciplinary Detention and has been ordered in Administrative 
____ (D) Detention by the Institution Disciplinary Panel (IDP). 
____ (E) Is a security risk to him/herself or the security of the facility. 
____ (F) Detainee has requested admission for Protective Custody. 
I hereby request placement in the Restrictive Housing Unit for my own protection. 
I do [ ] do not [ ] request a hearing concerning my detention. 
Detainee: __________________ _ Date: ____ _ 
(Signature) 
Details (as necessary): .... 'J../-<'--.!.~-'-'-""---'-'""-"a..:.·'"""J,.__--'.,,,·"'=,N..,___L-...!'------...L-.,e_.!L_=....,_-F--""-"~-'-'=-=-lf----
------------------1(b)(6); 
(b)(?)(C) 
----------------
Copy delivered to detainee by (Signature) 
Original: Detainee File - White 
CC: Administrative File - Yellow 
Detainee - Pink 
IHSC- Gold 
ICE- Blue 
Administrative Detention Order D1S002 
2019-ICLl-00051 3671 
Date/fime ela) d 0 a8a1 
Authorized by: __._\...._\t,_~=C=-----
042617 
DHS-ICE-19-0196, 19-0197-O-000355

Special Needs Form 
U.S. Immigration 
and Customs 
Enforcement 
Special Needs Form 
PATIENT NAME: FACILITY: 
Northwest 
Detention 
Center 
AMAR, 
MERGENSANA 
A: 216269802 SublD: 
l(b)(6); (b)(?)(C) 
I have reviewed the patient's record and I have found 
that patient will need the following Special 
Needs/Special Requirements 
r)(6); (b)(?)(C) 
2019-ICI I-QQQ51 3672 
Page I of I 
-· 
1. Housing : Admit to 
Administrative SEG for 
medical reasons 
( 08/22/2018 - 08/22/2018 ) 
2. Housing : Refusing to eat: 
Single Cell Housing. No 
commissary 
food/beverage items in 
cell. Document all 
food/beverage intake 
( 08/22/2018 - 08/22/2018 ) 
8/22/2018 
DHS-ICE-19-0196, 19-0197-O-000356

Northwest Detention Center 
SMU 
Detainee Personal Property Receipt 
Name: --~A~M.-~-~--------
# 
Owned Items 
Article 
Belt 
Brassiere 
Cao, Hat 
Coat I Jacket 
Comb 
Dress 
Driver's License 
Ev cf lasses 
Eveelass Case 
Gloves 
Pants / Slacks 
Pen 
Purse 
Rin2 
Shirt I Blouse 
Shoes 
Shoes, tennis 
Shorts 
Skirt 
Slip 
Socks 
Sweater 
Sweat Pants 
Sweat Shirt 
T-Shirts 
Undenvear 
Disposition 
S - Storage 
K- Keep 
D - Damaged 
Disp 
Original: Detainee File 
Admin. Lt. 
Property 
Detainee 
# 
I 
Owned Items Owned Items 
Article Disp # Miscellaneous 
Wallet Lbt.s o.f \.a .... \ rr.m.-s 
Watch I nt» .. 1nn+M~" ~--:.h'oil 
I Oh,,. Mt,14-t \/ d1i1o1 I _..5 
" '('~,L) -.3/u.J 
I 'ik,.:,"/ wlud 
I C?~« 1(:.11 - P.... Nt:- V 
Hveiene Items 
Deodorant 
Nail Clinner s 
Shampoo 
Shave Lotion 
Soao 
Soao Dish 
Toothbrush 
Toothpaste 
The above proper was received for storage by: 
b)(6); (b)(7)(C) 
Detainee's Signature 
All of the above property was returned to me: 
Detainee's Signat;,, ....... ---, (b)(6); 
(b)(7)(C) 
Officer: ---i 
Diso 
\I_ 
s 
s 
5 
,S 
K. 
te 
Date 
Date 
SEG 005 111308 
2019-ICLl-00051 3673 
DHS-ICE-19-0196, 19-0197-O-000357

-..,.___; . Northwest Detention Center 
!} I -.f'.l 
Daily Log of Special Housing Detainee 
I)etainee Name: AM.AP- I A# 2-H, ~ go 2.. I Cell: 103 
Special Instructions 
~ {;"t:y<- lu...cN<-rt>R 
:1t=:-,:;--~---~- -~l~~~~ .. ·:-- ~2.... ·:::·-.·~·-··· -~---.-. ~-- ~ · • -.~--,, .. -.~r: ··~.: ~----·--~.---~---· :~--. - ~-:--.• _ .. ·--:-· ·ij?\1t-:§tVt~rctr·~,:;:; 1-:;.,- •,. • - • • ..... .., a,\:;1::~1..}~-Ul,~\qt,;~H'..,1.\:1 . __ L .. ~1::\.::,: ~\t:n•:.1t)~~'1U\'tr..:i 1~h!fca},u,t~'11L i ~: ~...:-~~~~_!-.. \ !ii.::· ~~--a---·!.. ~ · ~--"'~- _____ J ....... ____ ._ .. • '--· ·.. - ...__:"'_, • : __ , -2..~i~- -~...!..:.:.....~.1~~1z_e~~i 
[8]Administrative Detention Special Watch Disciplinary Sanction Name: Date: i ·l?.- { 8 
cNn~C) eE.L\... 082.t 
p~opERT-t tN'lleNT01Z-1eo Ii¼? 
(L (l (L (L R ~rus-e o Tfl-AV ~ 
R. R. (b )(6); 
(b )(7) i.tR.t SlO t:>i'nha¥ ::A 2, 
y(_/1.) Jc_ ·1w1<.Ali{J 
I 0 
~.., ~ '2- ~) 0800 
b)(6); R 1:t. S 
R e_ b)(?)(C) 
IC. ~5 /1D ····- --·-- --· -- - ---
b)(6); DlaID 
1>1SS' IZ IZ- 2- b)(?)(C) a8t.\ 
ii o<D 
Enter the TIME for Recreation. 
A ir Accepted, R for Refoscd - NS ror Not on Schedule- D for Denied by Warden (Must be supported by documentation) 
08/03/11 
2019-ICLl-00051 367 4 
DHS-ICE-19-0196, 19-0197-O-000358

Northwest Detention Cenf.A!' ..---_ 24-Hot,!F-4ef :nistrative Detention Review 
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 
On 8/23/18 · · 
Date 
L ill~4!~~'b~~!Jtir.~.,J::':::::"ru.;::::--- , Did a 24 Hour Review of the Administrative Detention status of 
ev1ewing Officer) 
Amar 
Name of Detainee 
Supervisor Authorizing Placement: 
216269802 
A-Number 
Reason for Administrative Detention: Medical overflow - meal monitoring 
The following factors were reviewed with the results as Indicated: 
1. Does the reason for initial placement remain valid? 
2. Does the detainee pose a threat to himself? 
3. Does the detainee pose a threat to others? 
· 4. Does the detainee pose a threat to property? 
5. Does the detainee pose a threat to security? 
6. Is the detainee defiant towards authority? 
7. Is the detainee unwilling or unable to live in the general population? 
8. Is the detainee's habitual conduct, language, or behavior of a type, which may 
provoke or instigate stressful/violent situations amongst the general population? 
Reviewer's Comments: 
~~ l I 
l I 
[ I 
l l 
l l 
[ iY 
l I 
NO 
l l 
[ i.f' 
[vt" 
[ ..--t 
[ '-1"' [ ...-r 
l l 
[ ..,y 
Detainee is housed in RHU as medical overflow only. Detainee is on a self-declared hunger strike because of being 
housed in this facility. Medical does not have enough room in their area, so he is housed in RHU for meal monitoring 
purposes. Once Medical staff have deemed necessary, he can be moved to either medical isolation or back to general 
population. Detainee understands why he Is placed in RHU. 
I state that the initial reason for my placement in Protective Custody (PC) no longer remains valid. I am requesting 
removal from PC status. Translation in the Spanish or other language provided by 
Detainee Signature: DatefTime: -------------
Recommendation: [ vf G-!:"~ ........ ....a.uminlstratlve Detention [ ] Release to Population 
Reviewer Signature: _.__ ___ .....,______ DatefTime: g-t~--I?$' \\ f>/0 
[ ✓ cc (b}(5}; (b)(7)(C) strative Detention Status 
[ ] RE ration 
Original: Detainee restricted housing unit file 
24 Hour Administrative Detention Review DIS 015 11/15/2016 
2019-ICLl-00051 3675 
DHS-ICE-19-0196, 19-0197-O-000359

N'-- . _ ,WEST DETENTION CEN'. _ 
. . 
SPEelAL'MANAGEMENT UNIT CELL INSPECTION/ SEARCH 
,Zti:,q 
oETAINEE: __ A_M_4~(Z.-----r---- A#: z.1~ ~z,i to-z.. 
DA TE/ TIME ENTERED: _.......:rf.... •_2._2._·_t _l _...,_/---;:;:::=.::;=;;:::;:;~~_____:C;_E_L;_L:--,- __ /_o_3 __ 
-
---1l(b)(6); (b)(7)(C) 
OFFICER CONDUCTING INSPECTION: : 
I UNDERSTAND THAT I AM RESPONSIBLE FOR ANY DAMAGE THAT I CAUSE DURING MY 
PLACEMENT IN SMU. I ALSO UNDERSTAND THAT I AM SUBJECT TO DISCIPLINARY ACTION 
TO INCLUDE RESTITUTION FOR ANY DAMAGE I CREATE. 
I UNDERSTAND THAT THE CELL HAS BEEN SEARCHED PRIOR TO MY OCCUPANCY AND 
THERE IS NO CONTRABAND IN THIS CELL. ANY CONTRABAND DISCOVERED DURING MY 
OCCUPANCY I WILL BE HELD ACCOUNTABLE FOR. 
I AGREE THAT THE FOLLOWING DEFECTS/ DAMAGE WERE PRESENT ON THE DATI; 
NOTED ABOVE. 
LIST ALL DEFECTS/ DAMAGE BELOW: 
No D<F£ c..rS: ,/ OA-~+C, E 
JbX6J; (bX7XCJ 
ENTERING SEARCH OFFICER'S SIGNATURE 
DATE/TIME REMOVED: z3··l'} ,\\> \\Ol,P 
LIST ALL DEFECTS / DAMAGE BELOW: 
r•J; b)(7XCJ 
DETAINEE SIGNATURE EXITING SEARCH OFFICER!$ SIGNATURE 
SEG006 
5-4-2015 
2019-ICLl-00051 3676 
DHS-ICE-19-0196, 19-0197-O-000360

I 
j 
i 
t 
' ' 
187372 
!. 
I 
:• (b)(6); (b)(7)(C) 
NORT~WEST DETENTION CEN ___ ..._,i~~ 
Evidence / Search Report ··, .. ,_ 
< . 
03/1.8/13 
2019-ICLl-00051 3677 
DHS-ICE-19-0196, 19-0197-O-000361

Request ~Cbl(5J; (bl(7J(CJ 
Profile Photo: 
Audit Photo: 
Detainee Info 
Name: Mergensana Amar (1978-10-23) 
Booking Number: 216269802 
Nationality: 
Submitted Date: 11/06/18 21:34 
Submitted from Location/Room: NA106H/H3 SEG 
Current Location/Room: NA106H/H3 SEG 
Facility: Taco.ma, Wa 
Form Info 
Category: GEO 
Form: Book Request 
Request Info 
Status: CLOSED bib)(6); ~ Facility Deadline: 11111718 23:~ 
Summary of Request: 
Books on Russian 
Detalls of Request: 
Please enter the Tltle of the book you would like.: 
Detectives · 
Please enter the language for the _book you are requesting.: 
Russian · ·• 
~-=-=.;;.;.;...;;,,-.c.=~rovlde.the author of the book that yo~ a're requesting.: 
11/08/18 15:00 (b)(6); (b)(7)(C) 
11/06/18 21:34 Mergensana Amar 
Changed Status 
Submitted New 
We don't have any books by those-authors at this time. 
Tomorrow we wlll forward a new Russian book by Orhan 
Pamuk, "A Strangeness In My Mind." Check with the dorm 
officer tomorrow after mall has been distributed. When 
finished with this book, please return to Law Library. Thank 
you. 
From 'Open' to 'Closed' 
Books on Russian 
2019-ICLl-00051 3678 
DHS-ICE-19-0196, 19-0197-O-000362

i .. 
' I 
I 
' ► t 
l 
i 
' I 
I i: ·. 
\ 
1' 
I 
I 
i 
I 
i 
I 
! 
226292 
DO009-NCR 
r- \ -- -/i ~THWEST DETENTION CENTER. v '":: I • -· 
· Evidence / Search Report 
/J￾03/18/13 
2019-ICLl-00051 3679 
DHS-ICE-19-0196, 19-0197-O-000363

. .,_, ' l,. _ , NORTHWEST DETENTION <;EN1: . ~ 
2 2 S "3 Q l · Evidence / Search R-ePo.rt ·•" w~ 
Location (Unit, Cell or Area) 
16to 
I .. 
•·· 
~-l·,--·::/;:~----:-. .-- -- -;- -:,. - ~--~--- .-------- ~. -.-.l:-~--;:r.-./~~!:'::;~~';·fr-:.t_;~'~·::---}~lt-1_. __ ~:t=:~~ 
L -___ -. _,-__ 
: _. __ 
... ---•... ::·;_\ }}_ ::·>::;~:Jf;! 
f X 
' 
I 
l •· --
DO 009-NCR 03/18/13 
2019-ICLl-00051 3680 
DHS-ICE-19-0196, 19-0197-O-000364

187300 :-~-~ORTHWEST DETENTION CENT£'. 
Evidence / Search Report 
Location (Unit, Ctl\ or Area) i-l￾H -:l-r/Ou Time 
(b )(6); (b )(7)(C) b)(6); (b)(7)(C) 
. 
~., 
~-..~ 
.:~. 
(b)(6); (b)(7)(C) 
DO009-NCR 03/18/13 
2019-ICLl-00051 3681 
DHS-ICE-19-0196, 19-0197-O-000365

226288 
("· NORTHWEST DETENTION CEN'.~~--- '· 
· .:..,. Evidence / Search Report -~\ =-· I 
i 
I 
! 
' 
I· 
f:'~ > '•< .~• .•~~; • •\ •,( • • . •••:;~=•- •-, • r • • • • • • --•• • • -~•:• •-,~ - •• ,': ••,•••_ ~: 3~ .• :_ ''.' -•:.••:•:?~:~?~~ 
f'.: .. .. --- ·······•'·.•··••· .. ,. :.: .. ,,Lj ·: .... :.:··.·{;;j --
i 7 rtA \f? --t;-tJ._jh ,~ 
i 
I 
'· r 
' I • 
I· 
r 
i 
I. 
i 
! 
: 
.. 
.... ' 
: 
-
DO 009-NCR 03/18/13 
2019-ICLl-00051 3682 
DHS-ICE-19-0196, 19-0197-O-000366

t:a.a:cc~ =-•Wt_ .-ssws:;.J>"~~':~--~.-.r~~"' -J~,:~-~ 
: ·r;JiTHWEST DETENTION CENTER .. •\ . . : .... ~- ··.Jr Evidence / Search Report ~-·· 
·--f-• 
Location (Unit, Time 
I 
(b )(6); (b )(7)(C) 
--.,- ~ _.. ~ ~--;. • --:0--Y____..._ -
,....... . .' :,,;. .. , 
ond1tfo». ~ etc))' ·
,.: :£..~. : ._, ):, 
t 
, .. 
l . 
.... ·~. 1---------------------~----+------+--+--+-----'--l 
'• --. 
1--------:--:: ... ,.-,-,-_ ---------------~---+------+--+--l------l ~ 
.. . . 
DO009-NCR 
2019-ICLl-00051 3683 
DHS-ICE-19-0196, 19-0197-O-000367

Special Needs Form 
PATIENT N ME: AMAR, 
MERGENS NA 
- .. ·-~---·· --··--••4-+• --
FACILITY: 
Northwest Detention 
Center 
I have revlew d the patlent's rocord and I have found that patient 
wfll need the ollowlng Special Needstspeclal Requirements 
Housing: Me tar Health',0bservatlon; OK 
to house ins rogalion·( 10/27/2018 - 10/27/2018) 
,-·-····-·-··-- .. ---..----··· j I Electro lcillly si911itd by: ,. ... ______ ·- -·- . ··-··-·· 
; (b)(6); (b)(l)(C) '2712018 
i ··-···· ---··- _ ..... --.. --------·- .. Print ame/Datertlme ___ ··- j 
b)(6); (b)(7)(C) 
Si:,edal Needs: MH Observation In MHU 
-Mental Health Observation with 10 min staggere~ [irregular) 
custody checks 
·May have personal property in room 
-May have commissary in room 
-Ericourage recreation: MUST continue custodv ir eizular 
checks while pt is in recreation yard. 
-Encourage self-care/hygiene. 
-May have lV, radio, X-box, phone, books 
ROUNDS: 
RN per sh!ft 
Provider per day 
Vitals: per day 
~ a6ed 
2019-ICLl-00051 3684 
DHS-ICE-19-0196, 19-0197-O-000368

Oct 28 2018 16:28 ICE Health NWP.:~Tacoma 2537796005 
Special Needs For¢t 
•·· ·,. US. Immigrat oil ai:tdCustoins 
lll .I, · E.rlforcement 
PATIENT NAME: AMAR, 
MERGEN SANA 
A: 216269602 
Snei: ial Needs Form 
FACIUTI : Northwest 
Det:entiol I Center 
Sub1D[(b)(6); (b)(7)(C) I 
I have reviewed the patient's record and have found that patient will 
need the followlng Spoclal Needs/Spec~ I Requiremenb 
Electronlcally 
stgnoc by: 
(b)(6); (b)(7)(C) I ,.,, .. .., .. v "' 
15:18 
Print 
Name/Date/TI me 
page .•--.. 
Page 1 of 1 
1. Diet-Geo': Dletforl~ealth 
(Dlabetealj-fyperchol~terolemia/Hyper 
( 09/2612018 -11130/: 018) 
2. HouSing : ¢leared f< housing In segrE 
( 10/1612018 -10116/: 018) 
3. Diet. Geo~': PM Snack (10/17/2018. 
01/311201 ) 
4. Housing : Mental He dth Observation; 1 
house In segregatlo (10/27/2018 -
10/271201~) 
(b)(6); (b)(7)(C) 
(b)(6); (b)(7)(C) I 10/28/2018 
2019-ICLl-00051 3685 
DHS-ICE-19-0196, 19-0197-O-000369

( 
I 
I· 
I 
I' 
207068 
,· 
DO009-NCR 
NOR'.fHWEST DETENTIONf CEJ\~-,R 
Evidence / Search R~port · 
. .. 
·.·:'\::--•: .. 
. : ···.,:·· 
ni=TA1t,11::i:: i::11 i:: 
2019-ICLl-00051 3686 
Time 
/1ooo 
03/18/13 
DHS-ICE-19-0196, 19-0197-O-000370

.. 
' I• 
-- -----·--- ·4--·----· 
207053 
" '., 
DO 009-NCR 
i, ~,_____NORTHWEST DETENTION CENTJ: I • . ·'• - · Evidence / Search Report -·-· . -::, . 
DETAINFF FIi I= 
2019-ICLl-00051 3687 
I 
r 
{ 
03/18/13 
DHS-ICE-19-0196, 19-0197-O-000371

187281 
DO009-NCR 03/18/13 . ·:J<. _:·. 
2019-ICLl-00051 3688 
DHS-ICE-19-0196, 19-0197-O-000372

Oct 17 2018 22:19 ICE Health NWOC...Jacoma 2537796005 
Special Needs Form · 
•
usr··•· • • illlm~ti,on. ··· 
· and Custoins 
~.... Erl.forcfflle:nt 
PATIENT NAME: AMAR, 
MERGENSANA 
A: 216269802 
Special Needs Form 
FACILITY: Northwest 
Detention Cenwr 
Sub19(b)(6); 
I have reviewed the patient'& record and I have found that patient wlll 
need the following Special NeedslSpeclal Requirements 
Electronlcally 
signed by: 
(b)(6); (b)(?)(C) 
13:59 
Print 
Name/Date/Time 
page~ 
age 1 of l 
1. Dlet-G : Diet for oat 
(Dia Hyperc este lemla/Hypet 
( 09126/20 8 • 11/30 18) 
2, Diet· Ga : PM Sna ( 1 17/2018 • 
01/31/201 ) 
(b)(6); (b)(?)(C) 
b)(6); (b)(?)(C) 10/17/2018 
2019-ICLl-00051 3689 
DHS-ICE-19-0196, 19-0197-O-000373

Request ~<bJ<5); (bl<7l<Cl 
Profile Photo: .. Detainee Info 
Name: Mergensana Amar (1978-10-23) 
Booking Number: 216269802 
Nationality: 
Submitted Date: 10/04/18 16:18 
Audit Photo: 
Submitted from Location/Room: 1S2M/Medical 
Current Location/Room: 1S2M/Medical 
Facility: Tacoma, Wa 
Form Info 
Category: GEO 
Form: Book Request 
Request Info 
Status: CLOSED by . .,,kb.:,.:.)(6-:-"-);=-=c-::c,--' 
Facility Deadline: 10/09/18 23:59 
Summary of Request: 
Books on Russian 
Details of Request: 
Please enter the Title of the book you.would like.: 
Detective 
.Please enter the ianguage for the book you are requesting,: 
Russian 
H known, please provide the author. of the book that you are requesting.: 
Akunin, Abdullaev 
10/05/18 16:51 
10/04/1816:18 Mergensana Amar 
Changed Status 
Submitted New 
Hopefully we will get some new Russian books In the 
mall next week. As soon as we have a Russian 
detective book, I will make suro you get It. Sorry I 
don't have anything but Tolstoy to offer at the 
moment. Thank you for your patience. Take care. 
From 'Open' to 'Closed' 
Books on Russian 
2019-ICLl-00051 3690 
DHS-ICE-19-0196, 19-0197-O-000374

Request <b><5>; {bl<7><ci 
Profile Photo: , .. 
-
.. 
Audit Photo: 
Detainee Info 
Name: Mergensana Amar (1978-10-23) 
Booking Number: 216269802 
Nationality: 
Submitted Date: 10/04/18 14:52 
Submitted from Location/Room: IS2M/Medical 
Current Location/Room: IS2M/Medical 
Facility: Tacoma, Wa 
Form Info 
Category: GEO 
Form: Barber Shop 
Request Info 
Status: CLOSED byJ%~~lal Facility Deadline: 1 23:59 
Summary of Request: 
Hair cutting ne.eded 
Details of Request: 
, 
I want a haircut: 
Yes 
10/0SttB 06:27 b)(6); 
1--------1b1)(7)(C) 
Staff Response We are trying to get you over this morning. 
10/05/18 06:27 Changed Status From 'Open· to 'Closed' 
10/04/18 14:52 Mergensana Amar Submitted New Hair cutting needed 
2019-ICLl-00051 3691 
DHS-ICE-19-0196, 19-0197-O-000375

Request 1b)(6); (b)(7)(C} 
Profile Photo: . Detainee Info 
Name: Mergensana Amar (1978-10-23) 
Booking Number: 216269802 
Nationality: 
Submitted Date: 10/04/18 14:59 iL 
Audit Photo: 
Submitted fTom Location/Room: 152M/Medlcal 
Current Location/Room: l52M/Medical 
Faclllty: Tacoma. Wa 
Audit Photo 
Form Info 
Category: GEO 
Form: Property 
Request Info 
Status: CLOSED bw 
Faclllty Deadllne:2.,:59 
Summary of Request: 
My earphones remained In unit 03 103. Where my thing? 
Detalls of Request: 
What Is your request?: 
property· requests only 
Loss my earphones (b(ack). 
PA'tE/Rfo1E"•J."';,f ~ 
10/04/18 17:36 :0)(6); 
~:. USEl\f • .,._=;;;, 
b)(7}(C) 
10/04/18 17:36 
10/04/18 14:59 Mergensana Amar 
r~:~CJION• 
Staff Response 
Changed Status 
Submitted Now 
·-.> .,._ .,. 
1,~ --.-~ ;[,~.-; .:."1? DETAll:S:;~ ~ : ,.,.;7~ .. -.. :·~---;;~ 
10/04/2018-Plcaso submit II Loss1Da----A n-perty form 
(ask your pod officer for this form)l(b}(6);_ I 
From 'Open' to 'Closed' 
My earphon- remained In unit D3 103. Whore my thing? 
2019-ICLl-00051 3692 
DHS-ICE-19-0196, 19-0197-O-000376

Request #bl( 6>; (bl(7J(Cl 
Profile Photo: 
Audit Photo: 
~-.. 
-~-
~ ~ ¥ -, ":.~ •• 
~-.. . ~ ..-.: 
Detainee Info 
Name: Mergensana Amar (1978-10-23) 
Booking Number: 216269802 
Nationality: 
Submitted Date: 09/28/18 17:57 
Submitted from Location/Room: 1S2M/Medical 
Current Location/Room: 1S2M/Medlcal 
Facility: Tacoma, Wa 
Form Info 
Category: GEO 
Form: Barber Shop 
Request Info 
Status: CLOSED b~(~/\~);_ l 
Facility Deadline: 10/02/18 23:59 
Summary of Request: 
I want to barber~hop. 
Details of Request: 
I want a haircut: 
Yes 
10/02/18 08:30 Statt Response We wlll schedule yo·u for Thursday 10/4 
10/02/18 08:30 Changed Status From 'Open' to 'Closed' 
09128/18 17:57 Mergensana Amar Submitted New I want to barbershop. 
2019-ICLl-00051 3693 
DHS-ICE-19-0196, 19-0197-O-000377

Request (bl(5>: (b)(?)(c) 
Profile Photo: ._,i,· Detainee Info 
Name: Mergensana Amar (1978-10-23) 
Booking Number: 216269802 
Nationality: 
Submitted Date: 09/28/18 18:01 
Audit Photo: 
Submitted from Location/Room: IS2M/Medical 
Current Location/Room: IS2M'Medical 
Facility: Tacoma, Wa 
Form Info 
Category: GEO 
Form: Book Request 
Request Info 
Status: CLOSED by"-~b.;...)(6 ___ ); __ _, 
Facility Deadline: 10/03/18 23:59 
Summary of Request: 
Books on Russian. 
Details of Request: 
' ' 
Ple11se ente~ the Title of the book you would like.: 
Detectives; action. -
Please enter the language for the book you are requesting.: 
Russian 
H known, please prOYide the author of the book that you are requesting.: 
10/01/18 09:58 (b)(6); Staff Response 
(b)(7)(C) 
10/01/18 09:58 Changed Status 
09/28(1818:01 Mergensana Amar Submitted New 
We have one Russian book In our ln11entory, 
"Bruderschaft with Death," by Boris Akunln. We will 
bring the book to you In the Medical unit today. 
From 'Open' to 'Closed' 
Books on Russian. 
2019-ICLl-00051 3694 
DHS-ICE-19-0196, 19-0197-O-000378

' .. 
272510 
Location (Unit, Cell or Area) 
/ll. e.l -1St:J 
!. .. -
I 
I 
t 
OIV'f... "iA,;,l-
-
NORTHWEST DETENTION CENTER 
Eviden~e I. Search Report . . 
8/A,4 , .Ju J'71.-J TPt.JL 
Distribution: Original: Adniin Lt. Yellow: Detainee File Pink: Detainee 
- . .. - -- .. .. 
: 
.. 
'I?' 
DO 009-NCR 03/18/13 
2019-ICLl-00051 3695 
: 
I . ,. 
.?J,4--
DHS-ICE-19-0196, 19-0197-O-000379

i 
Northwest Detention enter .\,'I 
Detainee Request Form 
(S ·r-·•t'•. · • ., ... )d' 'D ·t · --·a ) , 1 ·." '1 \\ 'I l, ·.\ ,-u.,~Q1 !~J5~art!J~lq.t),ut h~\~~'lf~D.!~~~A ~1 .-.f. 
Alien N~mB-er (N~I!!!!ro de ~xti:_anjero): Detainee Name (Norµbre de I)etenido): · 
A. 2:f(;, £_69 f02... (LasrNam.~..: A:pprlµp9} ·. (J?irst'Name r:-Nom~r,e',Primero) 
A'~ a.··r Me~,;r~_,n~~-n~ . ·. . , - - ·. . ~•'" ,,. I 
Living Unit Bunlc Number Date (Pecha): Nationality (Nacionalidad): 
(Domµtorio): (Numbre litera)r . 
fLllS:stA . -CA,\.\ . •, . D~ ,;1._ ~ --l V ' . ' 
~~ .(~~:. .. ,.~l-1... .. \, . . .. .. .. .. -· Note: 'Incbrrect or-incomplete mfonnatlon will resull'-m no response·.and ,the return of this. form.'-, 
· Informac:ion que esta'iri~ortecta o incorhpleta no reciblra•una·respuesta--la vuelta.,de ·esta forma. , · .. IO I ' !. •~ •. '"• < o ,\ • ' ,f~ 0, • \ .•• I ! • • • 
Type of Reques~: [ ] ICE (Imrnigracion) [ ] Mail (Correo) [ ] Property (Propiedad) 
[ ] Emergency,Phone Call,(Em~rgen~ia'T~l~fono) . [ ] R~ci-eation.(Recre~cion) 
[ ] Finance (Dinero) [ ] Work Request (Trabajo Soicita~ibn) [. ] Barber_.(Barbe[o} 
. ~i k·~ Co~~~~,~\~commis~a) ._·}. ].Cl~~~ificatio~'.~~pear~~.I.:#if,i~~cion) · . ,. ~' (..d) 
[- ·] -~ood (Conuda) [ - ] Notary (Notano) [ ]Copies (C.9p1~s} f1J Qt.her,(Otro) . .. .. · 
[ , ].Religiqµs.Piet / Cornmi;m.Fare, (Di7t~ Religiosa / Pre~i~, <;.o~u~). [ ] Chapl~in (Qapellan) 
Request (Solicitiicion): _______ ...:.,_ ____ --'---------'-'----'------'-----'-' ·, 
Vlsl f to ec bra rd 
SEP 2 4 2018 
Detainee•Signature,(Firma,Detenido) 
~~pon~e:. --'--_.· ·S--""--c--=-· (µ_aJu:.........,.;:c· .- ._lvf!._._· --'---~--,-, -----'L-+1f-------~'-f-+(t __ k_----,-_ 
Original • Detainee Response 
KITE 001 
rX6); (b)(7)(C) ~ .. 
.._,..'t ______ _ 
- Staff Sigiiatµre .·.· 
Copy-Detainee File Copy Responder-File Copy 
2019-ICLl-00051 3696 
pate 
102710 
DHS-ICE-19-0196, 19-0197-O-000380

~---- Aug 26 2018 04:50 ICE Health NWOC ,· ima 2537796005 
Special Needs Fonn 
•• US. Inpmigration l~ q and C'1,Stoms \~:Jt Enforoement 
PATIENT NAME: AMAR, MERGENSANA 
A: 216269802 
Special Needs Form 
FACILITY: Northwest 
Detention Center 
Sublf(b)(6); (b)(7)(C) I 
I have reviewed the patient's record and I have found ttiat patient will 
need the following Special N,ecb/Speclal Requirements 
Electronlcally 
signed by: 
(b)(6); (b)(?)(C) 
8 
03:19 
Print 
Name/Dale/Tlme 
rb)(6); (b)(7)(C) 
2019-ICLl-00051 3697 
page 2 ~--. 
Page 1 of I 
; 
1. Hunger S~ike : Adi' it tomedical 
housing ~nit for hu ger shike 
monltorl11{1 ( 08/251 18 • 08/25/2018 ) ; 
8/26/2018 
DHS-ICE-19-0196, 19-0197-O-000381

276676 
Location (Unit, Cell or Area) 
I - ll7e 
NORTHWEST DETENTION CENTER -
Evidence / Search Report 
[ ··- . - . . ~~ • . . '. . . - •. - -·· •. • .• ·- ·11-. - . ·-· .•• 
i - - ~-
: ' I : ' ' ; 
. . ' ! ,, ' 
. , •• l i • • 
Distribution: Original: Admin Lt. Yellow: Detainee File Pink: Detainee 
DO 009-NCR 03/18/13 
2019-ICLl-00051 3698 
DHS-ICE-19-0196, 19-0197-O-000382

' .. I 
i 
i 
' I. 
l ·. 
I 
i 
I 
..... 
· · Northwest.De.tention Center 
Alien Number (Numero de Extranjero): Detainee Name (Nombte de Detenid.o): 
A·· :·fl_1 ~ ~ '2. 6 '3 _ :g·o.~ . :{La~t Nf1IDe~-<Ap_p:elli'do}''.(F~~~~-~arr,ie 
~ 
__ :~o~o~e:1:'ri~-~roY..· 
11ror_r~~1a11.:;,,· ~~""""'"""-
Living Unit 
(Do~torio): 
J::;~' 1· 
Bunk Number 
(Numbre litera): 
1·1 -:r··-
·Date (Feclfa): '' .Nationality'_'{Nacioiiau'dad): 
· o i .,08 .9;.~3 · ::,Q/U S:5/ A- · 
Note: ,. Incorrect .or. i~complete:inf.ormation will ~esuiq[l,IlQ te.$pQl_lS~ and,th.e· retµrn ,gf, tti1s fo,qn_i, · ... '. ' '.' 
··· lnformacion qz jncorrec~a-~ i~c,om~l.eta· n~, ~ec~b~a u~a-respuesta la vuelta·:de ~sta: ~~nna .. 
Type of Request: [ ] ICE (Immigrac1on) . [ ·] Mall (Correo) [ ·] Property (Prop1edad) 
[ . ],~m~rgenc/J?-hone Calr(~mexg~n~ia TelefoQCi) _, [_' ] ~~creatiqri (R.¢~re'~cion) . · . 
[ 
[ 
] Firiance (Djµero) [ ·. ] WorkJ~-~q~~st_ (Trabajo,.~disit~c~op.~ [ ] .l;Hirb~r ,(~~b:~fPf: .· .. . 
] ·comrilissary· (Commisarar ' [ · J Classification. Appeal .(Classificaci9n) . · ' : '. -... . • .,,. , . ; \ , ' ~• " . • .. '\l' \ • 1 • • 
] Food (C;mida)-[ ··] Notacy'(Notario) [ ·]'Copies'(C3:>pias): '[ •·j-other{Ofro) '·· - . -
] R~ligio:us pi~t/. Co~on f<lfe (Dieta R,eligios~ I Prepio Comlin) [ ] Ch~plain·(CapelJan) _ 
. ' 
' 
.R~ponse:. 
&: 
. . ,... .. ·-;: .·. -------~------,----_:__-=~=~--~-----'--....:___::....__......:...· _;:·•,..:.::-- b )(6); (b )(7)(C) · . ·. 
1/i 
Original.-Detainee Response KITEOOI . . Copy• Detainee File Copy Responder-File Copy 
102710 
2019-ICLl-00051 3699 
DHS-ICE-19-0196, 19-0197-O-000383

- . -.-.-~...:...::--~~" ..:?--.,f:?"-•·•'"·- ~-- ., •· • ~~,----•-'• .• ·" -- ........ ,..,.,.:,.,,...•., ~•,..,.u~.-="~~/ ... ....--.._--..t..-.. ..... ~~..:,._. ...... :.. •• ~~_.,.--:::;;._.;;- ~.!~:~ 1""~ r [ " >,,;· ).,, Detainee·KJquesi:,F()rm 
1 'I'lor.thwest.Detention C~p.ter -,(S·p_U~it3',i9~~~~i~et~m·dQ),. . --;· I . 
I 
i 
I" 
Detainee Name (Noi:nbre·ae:Detenido): 
(Last. N~e''" cJXppeµid:o )"-1. (Ffrst Name..:.: Noinbre·Prime'ro) ' A ~ a r :,MiV1f. 0€A\ sa.~ (1. ,. '· . 
Living Unit 
(Dormitorio):· · 
Bunk Number-
(Numbre iitera): · 
Date (Fec'ha)': . ' Nationality '(Naciohalidad): · ·· ' 
t_.; ~t·· .. ,,,, -:r oa.10. 2o1'J {dU$SIA 
Note: --. Incor:(~ct.or mc~mplet~)nfonnauon w1ll-result,m,rio.:~~spgnse_;:m(th_e reu~r, gf_4'ii§,fOfl'1: •. . . ;. : 
- .. ,Jnfo~acion.que esta in~orreGta.o incompleta•n·o recibira,una-respuesta la vuelta•de esta forma .. , . -
.. Type of ~eqQest: [ ] ICE (Immigracion) [ ] Mail (Correo) [ ] Property (Propiedad) 
[ J.E.me.rg~j.i~y.~hone Call,:(:E;~~fgehqiaTeiefono) ·-c._ .JR~c~~*t}QI!- (~~~Ft;~c~on) ._.,. _:' ·. 
[ ] Finance(Dinero) [ 'J.W6rk_Reque.sJ{Tr~baj6:~oicitacioii) ''( ] ·Barber (B~b:er9)· 
.. __ :· :; ~::7i!:;~~ 0
1;;~,~ <i~:~~~•ti;~;r:~~~;1f ~~f' (0;~ _ 
[ JReligi~us :pie~/ Co~on ·F¥e (Dieta Religiosa / Precio.Coniun). [ ] C4aplaiq.(Cape1Jan) ., , -.• 
R~~~r·cSoi_icl~~iQD):• :~ 6 - LT -__ ----Oh-_ q~ _--<-
-✓. - . ·.· . ' 
J. u:oL ~ Li~ --lei /J-Of ~ / ,~ f=-;j:Jfl62e +h~~ 
1~l) 
'' I .. _. 
~espon_se: · _, ----f-/_ 1 _________ .....,;.__ -,-- ________ ...,___ 
! ' ~~ ~D ~Q:1 M'\. 4-' ,;::>~.A-'\O~_t ~ -~--~(LG-;~ ;-o~P, 
~ ('x\))c&'\3. V\~btl•-rv\~_{t,t>{ ~ '()V\ \N 'vl.-~ ~ D~ '?,!. ~ ·· 
:,·t·; ',' / ,,".,.· .. ·.----··---·'..,.,.....___..-'--'"'----, 
b )(6); (b )(7)(C) 
Original • Detainee Response 
KITEOOI 
Copy- Detainee File Copy Responder-File Copy 
2019-ICLl-00051 3700 
102710 
DHS-ICE-19-0196, 19-0197-O-000384

Request #J(b)(6); (b)(7)(C) 
Audit Photo: 
Detainee> Info 
Name: Mergensana Amar (1978-10-23) 
Booking Number: %_li~~BQ2 
Natlonallty: --'~- Submitted Date: 07/26/18 15:59 
Submitted h'om Location/Room: 1117B/Bl 
Current Location/Room: 1117B/Bl 
Faclllty: Tacoma, Wa 
Form Info 
Category: GEO 
Form: Book Request 
Request Info 
Status: CLOSEO b¥b)(6); ~ Faclllty Deadline: U//31118 23:5 
Summary of Request: 
Detective on Russian 
Details of Request: 
Ploeua ---tile Tide eltlle ..... ,,_ _... lllca.: 
Omah,e 
PtNse enter the lanpage for tbe -- ,_ .. -..iesUav ! 
Russiltn 
If known, please provide the author of the book that you are requesting.: 
If you have finished reading tho Russian dotectlve novels by , Abdull~yev, pleHe rrll.lm them tD Law library. When we 9e-t additk>c,,11 9'\U.Sl~t1 :::>ock.s l"lto o-ur lnwentory. we wlll do 
. our be$l to fo,.,..•rd them to your dorm. At this time, 
however, we do not hnve any detective books tor yc,u to 
:borrow. Thank 70\I tor your ~t1enc.e. 
------------ -----------~ 
CNN)edSQC,s :om11u10:2a :._ ______ _._ ______ ..,_ _______________________ -- : 07/26{18 15:59 
2019-ICLl-00051 3701 
DHS-ICE-19-0196, 19-0197-O-000385

G . b)(6); (b)(7)(C) 
nevance 
Profile Photo: ,• .T' Detainee Info 
Name: Mergensana Amar (1978-10-23) 
Booking Numbe~~; -~ 
Nationality: 
Submitted Date: 07/19/18 09:21 
Audit Photo: 
Submitted from Location/Room: 1117B/81 
Current Location/Room: 1117B/81 
Facility: Tacoma, Wa 
Fonn Info 
Category: Medical 
Form: Medical 
Internal Tag: Not a grievance 
Grievance Info 
------------------------····-·-·-·-·-· ---
Grievance ID#: = =; bJ,bk~;itiu!t 
Grievance Level: 1 
Detainee can repty: No 
Disposition@ 1: Not a Grievance 
, Summary of Grievance: 
I need absorbent cotton stick for ear 
Details of Grievance: 
Ear 
~~•-:- .;.... ..... •..... ~~ . i.~ ~A~~ 
07i24/18 13:46 (b)(6); Staff Response (b)(7)(C) 
07/24/18 13:46 Changed Status 
07/24/18 13:45 Changed Disposition 
07/24/18 13:43 Set Tag 
07/19/1811 :40 (b)(6); Changed Level 
b)(7)( 
07/19/1811:40 
C) 
Changed Disposition 
07/19/1811 :40 Recategorization 
-
07/19/18 09:21 Mergensana Amar Submitted New 
... ....,.....~~ - ~-- ..... -~ "' DJ:TAff.S ......... .- ..........,_...,,...,..,._,,___i 
Please go to sick call for any medical , dental or 
mental health Issue or request. Sick call ls dally at 
0530 Thnnk you 
From 'Open' to 'Closed' 
Changed the disposition value for level 1 from to Not a 
Grievance 
Changed tag to Not a grievance 
Defaulted level to 1 due to recategorization to a grievance 
form 
Defaulted disposition to "Undecided" due to 
recategorization to a grievance form 
Changed Category and Form from 'Medical 
(Request)/Pharmacy Refil' to 'Medical 
(Grievance)/Medical' 
I need absorbent cotton stick for ear 
2019-ICLl-00051 3702 
DHS-ICE-19-0196, 19-0197-O-000386

Request #A(b>< 5>; <bl(7J<c> 
Profile Photo: .... 
Audit Photo: 
Detainee Info 
Name: Mergensana Amar (1978-10-23) 
Booking Number:\ 21~]:op 
Nationality: 
Submitted Date: 07/09/1813:52 
Submitted from Location/Room: 11178/81 
Current Location/Room: 11178/81 
Facility: Tacoma, Wa 
Fonn Info 
Category: GEO 
Form: Book Request 
Request Info 
Status: CLOSED b 
Facility Deadline: .,.,.,....,..,...,.,,.:::tr' 
Summary o4 Request. 
Books on Russian 
Details of Request: 
Ple~se enter trye Title of the book you would like.: 
Detective, action 
Please enter the language for the book you are requesting.: 
Russian 
H known, please provide the author of the book that you are requesting.: 
Abdullaev, Akunin, Koretsky, Topol, Neznansky, Sukhov 
07110/18 13:20 
07/10118 13:20 
07 /09118 13 :52 Mergensana Amar 
ta · esponse Sorry, we do not have any other Russian books In our 
Inventory to tend at this time. 
Changed Status From 'Open' to 'Closed' 
Submitted New Books on Russian 
2019-ICLl-00051 3703 
DHS-ICE-19-0196, 19-0197-O-000387

274151 
NORTHWEST DETENTION CENTER 
Evidence / Search Report 
i 
Distribution: Original: Admin Lt. Yellow: Detainee File Pink: Detainee 
DO009-NCR 
2019-ICLl-00051 3704 
03/18/13 
DHS-ICE-19-0196, 19-0197-O-000388

Request ~Cb){5); (b)(7)(C) 
Profile Photo: . ,,r ~ 
Audit Photo: 
l . . 
,~ ~r, •' 
Detainee Info 
Name: Mergensana Amar {1978-10-23) 
Booking Number: 216269802 
Nationality: 
Submitted Date: 07/04/18 07:21 
Submitted from Location/Room: 1117B/81 
Current Location/Room: 1117B/81 
Facility: Tacoma, Wa 
Fonn Info 
Category: GEO 
Form: Book Request 
Request Info 
Status: CLOSED bYJ(b)(6); l 
Facility Deadline: o 718/18 23:59 
Summary of Request: 
. Detectives on Russian 
Details of Request: 
Please enter the Title of the book you would like.: 
Detective's stories 
Please enter the language for the book you are requesting.: 
Russian . 
H known, please provide the author of the book that you are requesting.: 
Detectives 
1-..-·. i:Jj.lElfuje. '" -,,,. ;. D~Ejir-: ~-:~ >< AQ1'!QNi, ,,_ ,i',s,i·_~ -"'QEfJJ~;, • ..::i:- ... . ' • ·It'. '\'i-t• H -i;.,r'i, . 'f;iJ, ;.' 
07/06/1810:16 (b)(6); Staff Response We wlfl forward the Russian language suspense 
(b){7)(C) novel, "Treasurer," by Chlnglz Abdullayev. Please 
check with the donn officer today alter mall has been 
distributed. 
07/06/18 10:16 Changed Status From 'Open' to 'Closed" 
07/04/18 07:21 Mergensana Amar Submitted New Detectives on Russian 
2019-ICLl-00051 3705 
DHS-ICE-19-0196, 19-0197-O-000389

Request #fb><6>; (b)m<c> 
Profile Photo: Detainee Info 
Name: Mergensana Amar (1978-10-23) 
Booking Number: 216269802 
Nationality: 
Audit Photo: 
Submitted Date: 06/30/18 22:40 
Submitted from Location/Room: 11178/81 
Current Location/Room: 11178/81 
Facility: Tacoma, Wa 
Fonn Info 
Category: GEO 
Form: Property 
Request Info 
Status: CLOSED b1/b\/6\ I 
Facility Deadline: 07/03/18 23:59 
Summary af Request: 
Need take phone number in my baggage 
Details of Request: 
What is your request?: 
property requests only 
Note paper in my baggage 
07,'01/18 08:08 ' b)(7)(C) 
07/01/18 08:08 
06/30/18 22:40 rgensana Amar 
Staff Response 
Changed Status 
Submitted New 
07/0112018--Detalnee was given access to his property 
• to retrieve Items requested via kite. Detainee did not 
locate the papers he needed but did request for his 
earbuds •.. Detain b)(6
)" pair of black earbuds 
for kop on 7/1/18 h\mir.i 
From •open' to 'Closed' 
Need take phone number In my baggage 
2019-ICLl-00051 3706 
DHS-ICE-19-0196, 19-0197-O-000390

Northwest Detention Ce~ter 
Detainee '4uest Form 
(SoUcitacion de Detenido) 
Alien Number (Numero de Extranjero): Detainee Name (Nombre de Detenido): 
A (J..{6 1-61 - 2'01- (Last Name - Appellido) (First Name - Nombre Primero) - AJN\O\.V' M ~ r'i/, e vt so.. YI q 
Ljving Unit Bunk Number Date (Pecha): Nationality (Nacionalidad): 
(Dormitorio ): (Nurnbre litera): 
b.11.1r /2/JS SI /I &-1 111 
Note: Incorrect or incomplete mformat1on will result m no response and the return of this form. 
Informadon que esta incorrecta o incompleta no recibira una respuesta la vuelta de esta forma. 
Type of Request: [ ] ICE (Immigracion) [ ] Mail (Correo) 9(1 P10perty (~roi5tedad)-
[ ] Emergency Phone Call (Emergencia Telefono) [ ] Recreation (Recreacion) 
[ ] Financt? (Dinero) [ ] Work Request (Trabajo Soicitacion) [ ] Barber (Barbero) 
[ ] Commissary (Commisara) [ ] Classification Appeal (Classificacion) 1), (/lQ ( S' uVl 
] Food (Comida) [ ] Notary (Notario) [ ] Copies (Copias) l)<] Other (Otro) ~ 6 « 4 io-/2. 7 
[ ] Religious Diet/ Common Fare (Dieta Religiosa / Precio Comun) [ ] Chaplain (Capellan) 
Request (Solicitacion): ---'-M----'W"'-'--~-------------------
J w~ .,-i ~ lM,, ~eY'I. book's 
f 
Detainee Signatur~ (Firma Detenido) 
Response: _S_e.._e.,,_ a_ffi_adi_-_ecf'_~P:-r_,_·r1_i_~ __ l'~--is~,_~ __ s_e.._- ____ _ 
elee--frt>nical/y via Ta/ton tt?vble.:t: 
b)(6); (b)(7)(C) 0- /5-/8 
1gnature Date 
Original - Detainee Response 
KITEOOI 
Copy- Detainee File Copy Responder-File Copy JUN 1 5 2018 
1027IO 
2019-ICLl-00051 3707 
DHS-ICE-19-0196, 19-0197-O-000391

' .. . -: . ..-.• 'I',.•- ............... ... 
i• ... --• 
Northwest Detention Center 
Detainee Request Form 
(Solicitacion de Detenido) 
Alien Number (Numero de Extranjero): Detainee Name (Nombre de Detenido): 
A 2_,16 - Z.69 SO£. (Last Name - Appellido) (First Name -Nombre Primera) - A w-c,...r f1 er <J e vt s. a. rt °'" 
Living Unit Bunk Number Date (Fecha): Nationality (Nacionalidad): 
(Dormitorio ): (Numbre litera): 
12 Ru sstA 8-1 11 ':(. 6. 10. 
Note: Incorrect or incomplete information will result in no response and the return of this form. -
lnformacion que esta incorrecta o incompleta no recibira una respuesta la vuelta de esta forma. 
Type of Request: [ ) ICE (Immigracion) [ ) Mail (Correo) [ X'1 Property-(Propiedad) 
[ ) Emergency Phone Call (Emergencia Telefono) [ ] Recreation (Recreacion) 
[ ) Finance (Dinero) [ ) Work Request (Trabajo Soicitacion) [ ] Barber (Barbero) 
[ ) Commissary (Commisara) [ ] Classification Appeal (Classificacion) 
J Food (Comida) [ ] Notary (Notario) [ ] Copies (Copias) [ ] Other (Otro) 
[ ] Religious Diet/ Common Fare (Dieta Religiosa / Precio Comun) [ ] Chaplain (Capellan) 
Request (Solicitadon): _ __;]:;._._-"'~><--=--=-____.f,""",,;.£-Ck=--~=="----'~'------'-----'-'""--- .. 
bA, ~ ~ I 
i. ~ 
~ .,, ~ ,, ·, . '~ 
~ll~(.A».,U.1111 3, 
~ 
- -,-
lt~u_~'I 
so~ 
Detainee 
~ 
Signature(Fimrn Detenido) 
Response: You aeecl +0 f,· / / Oc{f ()J? Q,u frwri'·-cc.1-,oa tu rcoeve. 
pc.cko9c,, O, ?raycc+-y fc1<nt1 -lo vwve-br;:,k5 Yev1+ ,..,, 
Original • Detainee Response 
KITEOOI 
Jb)(6); (b)(7)(C) 
· Staff Signature 
Copy• Detainee File Copy Respondcr•File Copy 
2019-ICLl-00051 3708 
(o-17·/t 
Date 
102710 
DHS-ICE-19-0196, 19-0197-O-000392

\, 
Detainee Request Form 
·· Northwest Detention Center (Solicitacion de Detenido) 
Alien Number (Numero de Extranjero): Detainee Name (Nombre de Detenido): 
A 2, 16 _ 2..~9 _ i 02. (Last Name - Appellido) (First Name-Nombre Primera) 
A 11"'-o_ II' fv112 ri e. V\ :sc,.. i-1 c:\ .. 
Living Unit · Bunk Number Date (Fecha): Nationality (Nacionalidad): 
(Dorrriitorio ): (Numbre litera): 06, Olf. 13 /!,uSS/A /!; - 1 11-:/- -, 
Note: Incorrect or incomplete information will result in no response and the return of this form. 
lnformacion que esta incorrecta o incompleta no recibira una respuesta Ia vuelta de esta forma. 
Type of Request: [ ] ICE (Immigracion) [ ] Mail (Correo) [/iProperty (Propiedad) · 
].Emergency Phone Call (Emergencia Telefono) [ J Recreation (Recreacion) 
[ ] Finance (Dinero) [ J Work Request (Trabajo Soicitacion) [ ] Barber (Barbero) 
[ ] Commissary (Commisara) { ] Classification Appeal (Classificacion) 
[ ] Food (Comida) [ ] Notary (Notario) [ ] Copies (Copias) [ ) Other (Otro) 
[ ] Religious Diet/ Common Fare (Dieta Religiosa / Precio Comun) [ ] Chaplain (Capellan) 
Request (Solicitacion): _______________________ _ 
io 
Detainee Sibetenido) 
31,L--brv<l L11 11 L. ,r. n12 tJ... 11.-0Y1 t D Le.. n 117 '< Response: ---=:.__ ___ ___:.7';,__ '_ 1 _.....,fc:__lk:-f __ Vl _________ M'-----~----""-....:::.,_--
Original • Detainee Response 
KITEOOI 
r6J; MV)(CI 
Staff Signature 
Copy- Detainee File Copy Responder-File Copy 
2019-ICLl-00051 3709 
Date 
102710 
DHS-ICE-19-0196, 19-0197-O-000393

261291 
Location (Unit, Cell or Area) 
/, 
.0 
NORTHWEST DETENTION CENTER 
Evidence / Search Report 
-t1}TII01~;~~-~1UDJ~?'r).'P]~~n:~ffj)iit .. ~ .. ~.J~- I e::.,., :;'·.··. >· .. ·. . ... ., _,;-\i¾t•,,, • :,.,.,-,,_;,,,;,,-,;:.<~i••·"', .,,, _,;, ,;,--:h<J'-':;,'!<:,-cr,'.,\fj~~- ,, - · •.• ,· , ·., .•. ):,-'.ill_m~i,1,S,1,1 c11 .. 1_0,11,~-·~- '""''P.c'"'~'-'•,p c.' -.-.,\-:' •. , --~,--.•~,J-•·, "':\0"', .. ~,, ~~-:;,: ·~-t ;.:•' .. -·· ..... · ~ ~, --;~ ..-.. '!_·----·.... ,- l --";.~f-~:--::/":,. _ _.,:.t_p/\.: . .::.··~~:fr;;r:•·, ~:-... ~ :'i")_f.-.A~!QJ-..Jfi: .P}/(J . 
! '.-:·,:.;· :· ;:; (tJJ!'.Ji~,b ..$f.l;l'.!J}st2t/.1l~~) ,,~)r}J!l ;;,j m.1.e_tsl.s.Y)9J\:'.0¥;~-l;: 0 .,:.,.1~:,(,i:t1~i~~;:.:-;..,}f:d~:t;s'11 i~r 
b~~~~::-"~i.; :~}l-.....'t :,~.L .:~:...,_.;:;,;.~~~~•..:.:..i-'~~•=~l: l°d~i:t.~'.?ti~~~;;;~ -~~h~~~~~d}!~t~Ql~~~~t!:.!c~~ .. ~ 
-r/7- rA j) f <,;i ; .,Jl:-- .i. -- /V/;.. , \ .. 
' 
.. 
, 
··, I 
• 
Distribution: Original: Admin Lt. Yellow: Detainee File Pink: Detainee 
/ 
DO 009-NCR 03/18/13 
2019-ICLl-00051 3710 
DHS-ICE-19-0196, 19-0197-O-000394

Food Handler Form 
U.S. Immigration 
and Customs 
Enforcement 
Page 1 of 1 
4r\ 
\-
Department of Health Inmate Food Handler's Certificate 
PATIENT NAME: AMAR, MERGENSANA FACILITY: Northwest Detention Center 
A: 216269802 
Electronically signed by: 
j(b)(6); (b)(?)(C) I 05iOOiZO lb Vi.JO 
Print Name/Date/Time 
SublD: 
(b)(6); (b)(?)(C) 
DEPARTMENT OF CORRECTIONS COPY 
RECEIPT OF NOTIFICATION OF 
PATIENT'S FOOD HANDLER CERTIFICATE 
I have reviewed patient's record and found (his) (her) general health to be 
satisfactory for assignment in food handling, preparation and service 
areas or in the bakery. 
l(b)(5); (b)(?)(C) 5/8/2018 
2019-ICLl-00051 3711 
DHS-ICE-19-0196, 19-0197-O-000395

IOTCHEN WORKER ORIENTATION CHECKLIST 
b)(6); R I . d R I . fi th ki h b)(7)(C) u es an egu at1ons or e tc en. 
_:_Job Description 
· Equipment Safety: Slicer, Chopper, Mixer, and use of Tools 
Cleaning $afety: Use ofladder, mop bucket., wet floor signs 
Chemical usage review of all lvIDS materials · 
Fire Extinguishers: location and use 
First ·Aid procedures 
Warning others when c·arrying bot foods 
Proper procedures for lifting . 
• Personal hygiene: hand washing, boots, hairnets, and gloves 
+ Designated eating, ~g, and smoking areas in the kitchen 
Evaluation Program . ::1ihiiiITJ 
kb)(6); I ' . 
- All STAFF are to be trained in the areas listed above as well as those listed below. 
G·EO 
The GEO Group 
(g~~~(C) se of cooking equipme~t: stoves, kettles, tilt skillet;fryers, and steamers, can opener 
...........,.--, se of gloves when mixing foods (salads) . 
Cleaning products stored and kept away from food products. 
,.,,..(b,-,,.,,)(6,,_); TT'emperature control, portion control, recipes 
(b)(7)( r., 
I have.been instructed in all the areas listed above and understand my job duties.and re~ponsibilities. 
DETANIEE SIGNATURE & I..D. # 
COOK/SUPERVISOR'S SIGNATURE 
2019-ICLl-00051 3712 
, 
I 
DATE O ~.1V. IJ 
DATE ~ I ( t 1.'-6 '
Updated 1/13/2017 
DHS-ICE-19-0196, 19-0197-O-000396

· The GEO Group, Inc. 
THE GEO GROUP INC 
INITIAL/HAZARDOUS COMMUNICATIONS SAFETY TRAINING 
DEPARTMENT: FOOD SERVICE 
NAME: . Af.h(l\.y ~lk{f'.~ei\:~;u,g 
JOB TITLE: --------'----- SHIFf: --------
INITIAL SAFETY TRAINING 
DATE OF ASSIGNMENT: OE;, l'f.0 . ./ i DATEOF~G: 0~.r/'0.1'x 
SUBJECTS COVERED DURING INITIAL JOB SAFETY TRAINING: 
*PROCEDURES FOR REPORTING ACCIDENTS, INJURIES, AND HAZARD ON THE .JOB. 
*IDENTIFICATION OF HAZARD SPECIFIC TO JOB ASSIGNMENT 
*DEMONSTRATIONS ON THE PROPER WAY TO PERFORM JOB DUTIES 
*DEMONSTRATIONS ON THE PROP~ OPEl_lATION OF EQUIPMENT 
** ADDmONAL TRAINING PROVIDED: . 
HAZARDOUS COMMUNICATION TRAINING 
· I, A ~o--v Me futar ~0"9 have been provided informa~o~training in the use _2nd 
handling of the _Ji dous chemicals in my particular work area. Training has been 
conducted in accordance with OSHA HAZARD COMMUNICATIONS STANDARD, 
29 CFR 1910.1200. I further signify by my signature that I have received all training 
that is stated within this document. 
- ·r6);(D1m,c, i C,r;;;_ ,(0_ .1 ll. 
S1gna-1:11.e o.< uamic; Date 
TRAINER'S CERTIFICATION 
I, below signed individual, hereby certify that I have in~tructed. the.abo.ve-signed 
individual in the above stated INITIAL JOB SAFETY TRAINING AND·THE USE 
AND-HANDLING OF HAZARDOUS CHEMICALS as required by OSHA standards, G . . 
(b)(6); (b)(7)(C) 
ramer ·»ate 
68 
2019-ICLl-00051 3713 
DHS-ICE-19-0196, 19-0197-O-000397

KITCHEN WORKER RULES AND REGULATIONS The GEO Group, Inc. 
11 Hairnets or head covering supplied by GEO Group must be worn while working in the kitchen 
and during service of the meal. 
• Kitchen worker's fingernails must be trimmed and clean, wear clean clothes and boots supplied 
for working in the kitchen. · 
o Plastic gloves will be worn when handling raw food in preparation. 
Q Horseplay and fighting will not be tolerated in th~ kitchen. 
• Kitchen workers will abide by all the Rules & Regulations of the facility while working in the· 
kitchen. 
• There will be no eating in the kitchen except at your scheduled mealtime in the designated eating 
area. 
o There will be no drinking m·any food preparation area. All drinks are to be consumed in the 
designated eating area. 
• Use of th_e office telephone is strictly prohibited. 
o . No use of abusive or foul language iri the kitchen, loud hollering in the kitchen will not be 
tolerated. 
" All workers will abide by their posted work schedules and duties. 
·Any worker that operates equipment shall do so only after being instructed on the prop~ method 
and safety precautions. Any resident using equipment without training will be dealt with in 
accordance with facility disciplinary proce~s. · 
o All workers are subj~ to pat down search upon entering the kitchen and complete strip search 
wh~ leaving the kitchen ~rding to the facility rules and regulations. Upon entering the 
kitchen you will give up your ip cards. 
o -All workers attempting to remove food or other products from the kitchen, ODR, or storage areas 
for any other reason than tmder the direction of GEO personnel sh~ be dealt with in accorda:pce 
with facility disciplinary procedures. 
• Facility instructions given by the 900k supervisors will be followed immediately without 
argument. Any disa~eem,~nt wth a supervisor's orders can be discussed after the task is 
completed .. !w-Y re~ to do your job will be cause for immediate disciplinary action. 
o.£. 10 .1 P 
IDNo. Date 
69 
2019-ICLl-00051 3714 
DHS-ICE-19-0196, 19-0197-O-000398

. SANITATIO~ PRACTICES IN FOOD HANDLING 
The GEO Group, Inc. 
0 Always wash bands before handling food, after using fue toilet, after using handkerchiefs or 
tissues, after handling garbage, cleaning agents, or poisons, anci after handling dirty dishes. 
o Never lick fingers or thumbs when preparing and serving foods. 
0 Avoid putting hands on face, nose or hair or running fingers through hair. 
,. Always wear a hair net or bead covering when W<:>rking in food service area to keep hair 
away from food. 
• Keep fingernails clipped and clean. 
• A,.void wearing soiled aprons and outer gannents. 
• Do not cough or sneeze near food or dishes. 
• Use disposable tissues and throw them away immediately. · 
o Treat and report sores, rashes, boils or other skin eruptions to the supervisor immediately 
upon reporting to work. 
• Touch only the handles of forks, knives, spoons used in preparing food, serving trays Qr 
setting tables .. 
o Do not toµch the rims of glassware and cups. 
· o Do not Plll: fingers mside mixing bowls, plates and saucers. 
. . 
• Use tongs or scoops for placing ice in ~ses or pitchers. 
ct Use tongs for serving pastry, rolls or bread. 
• Use utensils for serving one food product ~nly, do not exchange utensils for serving other 
foods. 
• Report.suspected food-borne illnesses to· supervisor or manager who can contact the local 
health department. 
~ .---
2/f 6°1..6 9 P 1J '2.. OL. lfJ. 1.J' 
$ignatureofTrainee ID# ·DATE 
r•l; (bl(7J(Cl l ... c,.-: __ ...,__ 
70 
2019-ICLl-00051 3715 
DHS-ICE-19-0196, 19-0197-O-000399

-see 
The GEO Group, Inc. 
HANDWASHING PROCEDURES 
Food Service Employees shall clean their hands and exposed portions of their arms with a 
cleaning compound designed for such use by vigorously rubbing together the ~s of 
their lathered hands and a.ans for at least 20 seconds and th~rougbly rinsing with water 
paying p~cular attention to the ar~as underneath the fingernails and between the fingers. -
• Everyone working in food service will wash their hands upon entering the kitchen. 
• After touching bare hum.an body parts other than clean hands and clean exposed 
portions of arms. ' 
.i After using the toilet room. 
• After coughing, sneezing, using a handkerchief or tissue, eating or drinking. 
o · After using soiled equipment of utensils. 
• During food preparation, as often as necessary to remove soil and contamination and 
to prevent cross contamination when changing tasks. 
a. When switching between working with raw foods and read-to-e_at foods. 
" After engaging in actjvities that contaminate the hands. 
\ . 
111 - · Immediately before putting on gloves to serve meals. 
l have_ rea4 this procedure and will comply. 
~ 21() 2-(,CJ i O 2.. · 
SignatureofTrainee ID # 
DC .10. ·f J'. 
Date 
(b)(6); {b){7)(C) 
71 
2019-ICLl-00051 3716 
DHS-ICE-19-0196, 19-0197-O-000400

_ The GEO Group, Inc. 
SANITARY RULES 
e All equipment should be cleaned and sanitized before use. 
• All equipment for mixed salads, especially for egg, meat, fish or potato salad should 
be thoro11gbly chilled before preparation. 
o Food should be prepared as quickly as possible; keeping to a minimum the length of 
time they are ·held at room temperature · 
• -Foods should be stored in the _refrigerator (walk-in) in shallow pans to expedite · 
cooling. In containers of 2, 5, or IQ gallon capacity, only the outer surfaces of food 
will cool rapidly. The-center portion will remain for hours at a temperature that will 
allow bacterial growth. 
• Foods should be refrigerated to 45 degrees Fahrenheit or below; or heated to 140 
degrees Fahrenheit or above immediately after the preparation process. 
• At the cafeteria counter or tray assembly line, food mixtures should be served in 
small batches, rather than from large containers that would have to remain op. the 
· serving line two or more hours. . 
. . 
e Leftover foods that are to be kept should be cooled by frequent stirring and 
refrigerated in shallow pans immediately afte~ cooling. Foods that have stood for 
several hours at room temperature cannot be considered safe and free from 
contamination and cannot be made so by refrigeration. · 
Date 
72 
2019-ICLl-00051 3717 
DHS-ICE-19-0196, 19-0197-O-000401

Gee> 
The GEO Group, Inc. 
EQUIPMENT SAFETY 
& Only use equipment you have been properly trained to use. 
0 Pay attention when using any kitchen equipment 
. . 
• No plastic aprons by hot equipment 
o No bulky ·garments n~ equipment. 
o Be sure safety devices are in place_ and use guards. 
e Tum machines off before making any adjustments or when walking away for any 
length oftinie . 
. o Be sure electrical equipment is grounded and the cord and the p~ug are in good 
condition. 
Q Be sure yo~ hands are dry and feet are not in water·when ~g electrical equipment 
Ii Use equipment only for its intended purpose. 
o Report any problems to your supervisor, such as equipment not working, overheating, 
or :frequently .tripping circuit breakers. 
\') · bo not use extension cords without.asking your supervisor. 
. . . 
~ Turn machines off and unplug ~fore cleaning. 
<ii Unplug by grasping the plug, not the cord. 
,, After cleaning, reassemble and test it out. 
~ --
Signature .of Tramee ID# Date 
I 
73 
2019-ICU-00051 3718 
DHS-ICE-19-0196, 19-0197-O-000402

The GEO Group, Inc. 
HAZARDOUS CHEMICAL.TRAINING ACKNO'WLEDGEMENT 
You have th~·right to information concerning chemicals that 
.yo~ may be· exposed to in your wo~kplace. 
Mate~ial Safety Data Sheets (MSDS} are available to all 
employees, inmates, their designated representatives, and 
treating health ·care professionals upon request. 
Ail containers of haza.rdous chemicals must be labeled with 
chemicai n~es(s), appropriate warnings, and manufacturers 
name and address. 
You may -~ot be discharged.from your job or disciplined for 
seeking information about·any hazardous chemical. 
If personal protective equipment- or special instruction(~) is 
needed before u·sing · a chemical, ·this information will pe 
provided by your supervisor~· 
Use all chemical(s) according to 'the manufacturer's· 
re.commendations .. 
. If you have any questions ask your supervisor. 
I have received the Hazard Communications training as 
de~cribed-in the Written Hazard Communication Program. 
ee ID# 
74 
2019-ICLl-00051 3719 
o~. 40. 1~ 
DATE 
DHS-ICE-19-0196, 19-0197-O-000403

1-IAZAROOUS CHEMICAL TRAIN1,.J ACKNOWLDEMENT 
CHEMICAL DATE OF TRAINING SIGNATURE OFTRAINER · SIGNATURE OF TRAINEE 
WRITE IN CHEMICAL b)(6); (b)(7)(C) 
USED IN FS .. 
UTE N FOAMY 
(j~. 
b)(6); (b)(7)(C) 
CRANBERRY ICE BODY (J ~ (i WASH t . . . . ' 
I 
BIORENEWABLES 
GLASS CLEANER -I 
SANI-T 10 PLUS 
SANITIZER 
KOOL KLEEN (FREEZER 
CLEANER) .. 
GS NEUTRAL 
DISINFECTANCT 
-· 
SPARCLEAN SURE STEP 
GREASE EXPRESS 
(OVEN CLEANER) 
SPARCLEAN ALL 
TEMPERATURE POT 
AND PAN DETERGENT 
MEDALLION 
LIMEAWAY 
(b)(6); (b)(7)(C) 
SPARCLEAN POT AND b )(6); (b )(7)(C) 
O';". r/V. I ,1 ~ I-
.. 
PAN DETERGENT￾2019-ICLl-00051 3720 
DHS-ICE-19-0196, 19-0197-O-000404

· .. 
The GEO Group, Inc. 
EQUIPMENT TRA1NING 
An initial training session was held concerning the safe operation/use of the below listed . 
equipment utilizing existing standard operating procedures (SOPs). My supervisor had also: 
demonstrated the proper use of the equipment, tools; ~cl/or machinery I will be using to 
compiete my assigned job duties~ I have been advised of specific hazards involved wit:4 my 
job so that I may perform my job under ~eneral supervision. 
(Trainee initial next to equipment) 
-~_BLENDER 
-· BRAISJNGPAN 1 CAN OPENER, MA;NUAL 
COFFEE/TEA URN -- DISHWASHER, Muli-tank 
·DISHWASHER, Single-tank 
DOCK, Mechanical . 
. FOOD W AS1E DISPOSAL 
----- ---t- GRILL 
-- KETI1,E, Steam 
KETrLE, Self-.contained 
MEAT SLICER 
~---,DELI SLICER 
\~~~~\c) R 
OBILE FOOD CART i OVEN, Convection. · 
OVEN,Gas 
OVEN.Deck 
__J_ ·o~. Rotating/Reel 
_,__ ·PALLET JACK __ POWERHEAD, 
bl(6l; SLICER/SHREDDER 
b)(7l(Cl PROOFER BOXES 
_,__ RANGE/OVEN 
----SERV1NG LINE 
----3 COMPARTMENT SlNK 
----TRAY MAKE-UP LINE 
TOASTER 
VEGETABLE PEELER. 
-!'"""'-_,VERTICAL CUTI'ER (VCM): . (b)(6); 
· . · (b)(7)(C) 
,;:;:Elt:=... ~FOOD HOLDING CABINETS (Refrigeril-...,.._.._.. Warmer, Pass-tbru, Tray 
b)(6); Delivery Cart) . b (7)(C) 
l, the l.indersigned, have received an initial training session on the above equipment, tools 
and/or_ machinery in detail by my supervisor. . 
. . 
I acknowledge tliat I have been instructed to talk to my supervisor prior to the use of any 
equipment, tools and/or machinery on which lbav~ not Qeen properly trained. ' 
1:;ignature of Trainee . ID# DATE· 
b)(6); (b)(7)(C) 
..,£ i.rruner 
76 
2019-ICLl-00051 3721 
DHS-ICE-19-0196, 19-0197-O-000405

The GEO Group, Inc. 
KITCHEN WORKER SKILLS CHECKLIST 
I am. familiar with the proper sanitation and cleaning m~thods for the following: 
b)(6); 
)(7)<C FLOORS 
__ WALLS 
FREEZER --
-- LOADING DOCK 
(b)(6); TRASH CANS )(7)(C) 
___ MO!> ROOM 
DISHROOM 
-b)(~6)'--;--, EQUIPMENT 
)(7)(C) (including slicer~ ovens, 
'-----' skillets and kettles) 
I am familiar with the following procedures: 
. . 
__ The proper way to pick up h~vy boxes or bags to eliminate back strain. 
. . 
__,_ The correct way to walk when in the kitchen area to avoid falls. 
The proper use of tools (knives) to avoid cuts. 
DATE 
SL_ ______ __. 
78 
I. 
2019-ICU-00051 3722 
DHS-ICE-19-0196, 19-0197-O-000406

. . 
~• -~THWEST DETENTION CEl .ER 
DETAINEE JOB DESCRIPTION 
JOB TITLE: DISHWASHER 
W0RKAREA: Kitchen 
NORMAL WORK HOURS: 
PAY SCALE/ GRADE: 
AM Shift or PM Shift. Shift will be assigned by Food Service Manager 
$1.00 per day/ Semi-skilled 
CAPSULE JOB DESCRIPTION: To assist in the cleaning of all dishes and to keep area clean at all times. 
SPECIFIC WORK DUTIES: . 
I. Clean off trays of all debris, tossing food remains into trashcan. 
2. Ensure that plasti<? cups, bowls and sporks ~ washed and not thrown into the trash. 
3. Empty trash cans in dish area, stack trays in storage rac~ keeping work area thoroughly cleaned. · 
4. Ensure the dishwasher is cleaning prope!lY and all temperatures are up to specifications . 
.5. Monitor dish soap use and refill as necessary, following all safety instructions and posted 
operational rules. 
6. Inventory cups and sporks after ~ch meal. 
7. Break down the dish machine and clean all pipes and the out side after each meal. 
8. Follow all safety instructions and posted operational rules .. 
9. Anything that any Food Service Supervisor may ask you to do. 
SPECIAL REQUIREMENTS: . Medical Clearance and must be able to lift 30 lbs. 
TRAINING REQUJREMENTS: 
1. 
2. 
3. 
TERMINATION - Typically requires an Incident Report 
-1. Failure to follow Safety Procedures 
2. Failure to follow Supervisor's instructipns 
3. Unexcused absenteeism 
4. Misconduct, horseplay, etc. 
5. Theft . 
6. Unsatisfactory W: ork: Performance 
Note: Not all work duties may be listed; other duties may be assign~ as deemed nece~sary. 
. o{:. -1 D . 1? . 
(b)(6); (b)(7)(C) Date 
2019-ICU-00051 3723 
DHS-ICE-19-0196, 19-0197-O-000407

JOB TITLE: 
WORK AREA: Kitchen 
li._ ~THWEST DETENTION CENTER 
DETAINEE JOB DESCRIPTION 
COOK/PREP/SERVER 
NORMAL WORK HOURS: BRE~AST, LUNCH~ DINNER. Shift will _be assigned by Food ~ervice Manager 
PAY SCALE/ GRADE: $1.00 per day I Semi-skilled 
CAPSULE J.OB DESCRIPTION:To assist in cooking a ,day's meal and keeping the area clean at all times. 
SPECIFIC WORK DUTIES: 
1. Follow all recipe cards completely, no deviation without prior approval. 
2. Assist in the setup of the foQd line. 
3. Assist in tlie serving o(tbe meal, dishing out the proper portions, 
4. Check with Cook's to verify the utensils needed for service. 
5. Keep the serving line and are?, clean of debris and free of obstruction. 
6. Check the daily menu for items that need to be prepped for upcoming meals. 
7. Label all food items that were prepped and for which meal 
8. Clean and sanitize all work area upon completion of prepping. 
9. Maintain coxµmunication with Facility and detainee staff to ensure.there is enough food for the population. 
IO. Assist in the preparation of all food products, slicing.meats and canned goods. 
1 i. Place·Jabels on all leftovers indicating date, time, and temp·erature. when items(s) are returned to the cooler. 
12. Clean all ovens, stoves, grills, kettles, and surrounding work areas, floors, walls, etc. after each meal. 
13. Follow all safety instructions and po_sted operational rules. · 
14. Anything thafany Food Service Supervisor may ask you to do: 
SPECIAL REQUIREMENTS: . Medical Clearance and must b~ able to lift 30 lbs. 
TRAINING REQUIREMENTS: 
I. Department orientation 
2. Hazardous communications training 
3. Safety briefing 
4. Equipment/tools traimng 
TERMINATION -Typically requires an Incident Report 
1. Failure to follow Safety Procedures 
2. Failure to follow Supervisor's instructions 
3. Unexcused absenteeism 
4. Misconduct, horseplay, etc. 
S. Theft/Unsatisfactory work performance· 
Note: Not all work duties may be listed; other duties may be assigned as deemed necessary. 
21G 2..6CJJV{]__ 
(b)(6); (b)(7)(C) #) 
e 
I 
Date 
Updated 1/13/2017 
2019-ICLl-00051 3724 
DHS-ICE-19-0196, 19-0197-O-000408

Equipment/Tool/Machinery/Safety Initial Training 
The GEO Group, inc. 
Department: Food Service Department Date: VS_ t/,f) <{)8 
Job Assignment: Cooks, Prep, Server, Dishwasher, 
poVpans · · 
' ' 
An initial training session was held concerning the sa!e operations/use of the'below 1\sted equipment utilizing existing standard 
operating procedures (SOP). My supervisor has also demonstrated the proper use of the equipment/tools/machinery I will be 
. using to complete my assigned job assignment. I have been advised of specific h~ds involved with my job so that I may 
perform my job under general supervision and we have discussed specific safety issues associated wi~ each area and the 
equipment used. 
Industrial Grill: Operate and clean grill 
Can Opener Operation 
Cleaning Dishwasher 
Assemble and disassemble dish machine 
Operate machine 
Clean 
Steam Table Operate 
Clean 
Walk-in Refrigerator · 
Clean: scrub floors, walls 
Check all containers; closed, clean 
Convection Oven 
Operation of . 
Clean: Inside, ou~ide, top, under 
Mixing Machine 
Operation of 
Clean; Mixer, around, under mixer base 
Steaml(ettle Operate grill Clean grill: Coffee/fea Um 
Opriate grill qlean grill:· 
Garbage Disposal Operate machine Clean 
: Deli slicer 
Operation of 
Clean: Inside, outside, top, under 
Updated 1/13/2017· 
2019-ICLl-00051 3725 
DHS-ICE-19-0196, 19-0197-O-000409

Walk-in Freezer 
Clean: scrub floors, walls 
Check all c·ontainers;. closed, clean 
Tilt Grill 
Operatio~ of 
Clean: Inside, outside, top, under 
Chemical Disbursement System Operation of 
Storage Racks 
Proper placement of food 
storage 
Cleaning 
Holding O~ens . 
·operation 
· Cleaning 
Microwave 
Oven Operation 
Cleaning 
Prep~on Guidelines; Food shall be prepared with minimal manual contact. Foodservice workers shall ~ash fresh fruits 
and vegetables with fresh water prior to cooking. Proper teinperatures_for both hot and cold foods will be maintained 
according to guidelines. · 
General Cleaning Procedures 
Moist cloths for wiping food spills on kitchen and food-contact surfaces on equipment shall be clean, rinsed frequently in 
sanitation solution, and used solely for this purpose: They ·shall soak in the sanitizing solution between uses. · 
Moist cloths used for non-contact swfaces like counters, table tops, and shelves shall be cleaned, rinsed, and stored the 
same way as the m<;>ist cloths used on food-contact surfaces. They shall be used on non-food-contact surfaces only. 
The overall goal of a quality .food service program is to provide nutritious and appetizing meals, efficiently and 
within budgetary restrictions, manpower resources, equipment and physical layout Nutritional ·ne~ds are diverse · 
because of differences in age, activity, physical condition, sex and medical considerations.-
Detaince's Name and A#: /Date 
FSM or D.esignee Signature: ---,,·'1£~~~~~-L'J...A..L--'i.i......tJ 'g 'o ~L /D;tei OS-.10 . 1 2 . s-t,,\,£J .· . l understand, have r~ceived an initial IIL _______ ,.,..,..,....t;tated equipment/tools/machinery in detail by my 
;upervisor. I understand my responsibilities as a worker, and those responsibilities ofmy employer. In addition, I 
icknowledge that I have been instructed to confer with my supervisor prior to the use of any equipment/tools/machinery I 
lave no knowledge as to the safe operation of. 
. Updated 1/13/2017 
2019-ICLl-00051 3726 
DHS-ICE-19-0196, 19-0197-O-000410

l. 
z. 
3. 
4. 
. 5. 
6. 
7. 
8. 
9. 
VOL~ER WORK PROGRAM AGR-- 'MENT 
Io order to have a job, yon must complete a physical 
Detainees that participate in the Volunteer Work Program are not permitted to work in excess of 8 
hours daily, or 40. hours a week. Scheduled days off will be assigned and taken. 
Detainees are required ~o work when schedn1ed and participate in all work-related training. · 
Unexcused absence, unsatisfactory work performance, or participation in a serious. infraction, e.g. 
fighting, is canse for removal from a work assignment Workers are expected to be ready for work · 
· at the required time. · · 
Thef~ or possession of CO'.!}traband obtained as an opportunity of a work assignment is cause for 
removal from a work assignment 
Detainees must adhere to all safety regulations and to all medical and grooming standards associated 
with a work assignment. · 
Compensatfon shall be Sl.00 per day. 
Primary factors that impact hiring are 'classifica~on level, attitude, behavior, and physical ability to 
perform the job. · 
Volunteering detainees will not be denied work based on race, religion, sex, physical or mentar 
handicaps or national origin. 
SAFETY BRIEFING 
2 •. 
3 •. 
4. 
5. 
6; 
7. 
8. 
9 •. 
10. 
11. 
Personal Protective Equipment (PPE) i.e., gloves,· protective eye wear, must be used when required 
by Material Safety Data Sheets to avoid eye or skin injury or irritation. 
Before using/ operating any equipment. you must be trained in its use and safe operation. 
· Before using/ handling chemicals, you must receive information from the Material Safety Data Sheet 
(MSDS) for that product and be trained in its use. Tnining will be conducted in accordance with 
OSHA HAZARD COMMUNICATION STAND.ARD, 29 CFR 1910.1200. 
If chemicals get in your eyes, Dash with water. Notify an officer. He/she will get you to medical 
attention immediately. · 
If chemicals get on your skin, Dush with wat.er. Notify an officer. He/she will get you to medical· 
attention immediately. · · · · 
If yon inhale chemical fumes that cause you respiratory distress, notify an officer. He/she will get · 
you to me~cal attention b:iunedia~y. · 
When ~g objects, bend at the knees, keeping your ba~ straight and face the obj~t squarely. 
Keep your head and eyes looking forward as you lift. Keep the object close to your body to maintain 
. your cent.er of gravity and reduce the strain on your back. If objects are heavy; do not lift them 
alone. .Get help. Notify your supervising officer that you need help. Do not lift the obj'~ by 
yourself. . 
When handliug heavy, rough or sharp objects, wear the sturdy work gloves that are provided.· · 
When cutting weeds, vines or bushes, w~r the safety eyewear and gloves that are pn~vided. · 
Kitchen workers assisting with the serving of food must wear a hair net, a beard net (if yon have a 
beard), white uniform, appropriate footwear and plastic/ rubber gloves. · · 
·To stop the spread of ccilds, flu and other diseases, do not go to work if you are sick.. Wash your · 
hands with soap and water before reporting' for work. Do not touch bands with other: deqtinees while 
w_orltjng. Wash your hands immediately after handling unclean objects. Change your gloves 
immediately if they become contaminated. · 
· Your safety is our· highest priority. Please ask for the safety equipment if it is not immediately provided for 
your detail. .We thank you for your important contn"bution to maintaining this facility. 
I, ) ; 0. ,_ M-v~a I( ~ • A# 2_161..b9 n 2- have read, 
~~er;stand, and agree to ~with. the above listed rules, regulations, and safety requirements. I have 
received and understand safety training regarding my work assignment. 
. ·fh_~ ~ . oL.1o. If_ 
/ (Detainee Sig=ture) (Date) 
D0019 3-6-14 . 
2019-ICU-00051 3727 
DHS-ICE-19-0196, 19-0197-O-000411

Northwest Detention Center· 
Detainee kitchen worker hygiene and grooming standard~ 
Report to work in a clean uniform ll;S specified by the correctional facility. 
Hair restraints are to be w~m at all times in the production, storage, and serving areas_. 
Jewelry is not to be worn, other than a watch or a wedding ring. 
Practice personal cleanliness: 
• Take a bath or shower daily. 
• Brush your teeth at ieast twice a week. 
• Use a deodorant 
• Wash your _hair at least once a week and keep it neat. 
• Keep your nails· clean and well- ~ed. 
• Wear clean under clothes daily: 
Avoid touching }'.Our face, hair or nose. Do not touch scratches or pick at open wounds. 
Wash hands frequently especially after having performed one of these activities. 
• Using the restroom. 
• After coughing ·o_r sneezing into your bands. 
• Touching your nose, hair or fuce. 
• Changing into detainee uniform. 
• After handling box~s, crates or packages. 
• After handling garbage. 
• After: handling anything. 
Report all injuri~ to the kitchen staJ:t: examples cuts, burns, falls etc. · 
. Report to the kitchen staff when you are sick with a cold or if you have diarrhea· or any oth~r 
symptoms. 
Do not handle food with out wearing a clean pair of gloves. 
When preparing of the food, always use clean utensils such as tongs, spoons, forks etc. 
When using scoops from tjle flour, rice, sugar bins etc. Make sure the handle is fucing up when placed 
back in the bin. 
When making biscuits, dinner rolls or loaves of bread and you have to use your hands. Use a pair of 
disposable gloves ·and discard them when ever they are dirty. · 
I have read, and understand, and agree to abide to_ all of the standers stated above. 
Detainee signature 
Kitchen staff signature _ 
2019-ICLl-00051 3728 
Date or: . 1 D. f 2 
Date ?J 1 \ \ I.~- , ' 
Revised 1/13/2017 
DHS-ICE-19-0196, 19-0197-O-000412

Northwest Detention Center 
Detainee Rules &Regµlations 
Training. 
1. Hair nets & Beard nets will be worn at all times upon entering the kitchen. 
2. After changing into kitchen uniform & putting on the boots, your bands will be 
washed- No exception. 
3: No horse play or swearing it is prohibited. 
4. There is no eating or drinking allowed on the kitchen floor. 
· 5. Eating or. Drinking is allowed only in the detainee l?realc room. 
6. Detainees are forbidden to leave the kitchen without proper permission from: staff. 
7. Report all injuries immediately to the kitchen staff. 
8. The eye wash station is located next to the detainee break room. . 
9. If you are sick and can not work you will have to go to medical during sick call on 
Monday thru Friday at 0600hrs to get cleared again. 
10. If you are caught stealing you will be written up and removed from the work list 
pending a hearing. . · · 
11. MSDS book is located in the detainee break room. . 
12. The chemical supply door will only be opened when the officer or kitchen staff is 
present at the door. · 
13. The fire escape route is posted on the kitchen wall. · . 
14. Do not over lo~d the garbage bags when cleaning trays. We do not.want any one 
to get hurt lifting them. · · 
· 15. The small garbage cans next to the hand sinks are not to have garbage put in 
them. Hand paper towels only. Do not remove the lids. 
16. All detainees will' be searched prior to leaving the kitchen. 
17. No detainees will operate any equipment until properly trained. 
18. The kitchen •office is off limits to all detainees -No exception. 
19. One detainee at a time in the restroom. 
20. Gloves will be worn at all times when handling food. . . . . 
b)(6); (b)(7)(C) 
GNATURE. 
1/13-2017 
2019-ICLl-00051 3729 
DHS-ICE-19-0196, 19-0197-O-000413

~ 
0 
...>. 
(!) 
.!... 
() 
C 
I 
0 
0 
0 
01 
...>. 
(,) 
--..J 
(,) 
0 
Jl!, v ~11.:l!.11aa.on Jl.-t@~U:e 
You Are Here* : · · · 
Primary Route -;> 
Secondary Route -+ 
Extinguisher J 
EyeWash ~ 
' -.:: ~ :···1 ·! r 
i .. 
... / ~-,! . ;: ~ll I!.(( ~F-fi.;lr ·-:.:-~r· ·, 
., 
&-;;;•" ti) .2:=11 ~ 
.. ·~•- .......... _____ -
'· e 
. : 
. ~~: 
I Northwest Detention Center I Route Evacuation 
Usted Esta Aqui * 
i _,, .. 
;' ',I 
. · ., 
1 
Rutc1: Prim.aria ---+ . 
· Ruta Secondaria ~ 
· Extintor .J 
· ~avado de Ojos e . 
-'-~1 rxq(_ ~-~ .~• 
. l f "c::=:=;;====:.'7-':,. _:;;:. =
Ir-- l~:=::!!7=- ~-. . , ,-. ,1'\i1 .UN11
• 
. WI~~~ ;~t□□□□gl!J r ~I~ ~ I' n .... 
~, ~lid II 
~<IJ Fl I Ill- ~ 
DHS-ICE-19-0196, 19-0197-O-000414

•---•--•••-•• ••••-~• ... •• , ......... .._ ~~--••w.•- •••---·-<.-•--••-- .... -
. . 
Detainee Request Form 
Northwest-Detention Center (Solicitacion de Detenido) .. 
Alien Number (Numero de Extranjero): Detainee Name (Nombre de Detenido):°"' 
A t.46 £.€9 _ 80t (Last Name - Appellido) 
A ;,t'\.c;l I" 
(First Name-Nombre Primero) - /vf e Y' <J. e V\...Sa.. na... .. 
;:_ 
Living Unit Bunk Number Date (Fecha): Nationality (Nacionalidad): .. 
(Dormitorio ): (Numbre Iitera): RUSS//+ /3 I 1{ 1 o~. f~. 1! 
Note: Incorrect or incomplete infonnatlon will result m no response and the return of this form. 
Informacion que esta incorrecta o incompleta no recibira una respuesta la vuelta de esta forma .... 
Type of Request: [ ] ICE (Immigracion) [ v; Mail (Correo) [ ] Property (Propiedad) 
] Emergency Phone Call (Emergencia Telefono) [ ] Recreation (Recreacio"n) 
[ ] Finance (Dinero) [ ] Work Request (Trabajo Soicitacion) [ ] Barber (~arbero) 
[ ] Commissary (Commisara) [ ] Classification Appeal (Classificacion) 
[ ] Food (Comida) [ ] Notary (Notario) [ ] Copies (Copias) [ ] Other (Otro) 
[ ] Religious Diet/ Common Fare (Dieta Religiosa / Precio Comun) [ ] Chaplain (Capellan) 
Request (Soli~itacion): --=]~_\v_o_u _I cl=-~',_· k..:...~--------'~---Gt--'--lA_t__,o'--M'--"-"o-'-'b=-1'-'e"'-12.-+-l --
~ c.a.n._ -/;-~ ~@-p -z.i ne. 
,, 
$0 
Detainee Signature (Firma Detenido) 
Response: 'f ~ ue ( -s o.o ~ Wf rcrJ ~f\ S'(V\OL! A: ~ AA 12u • .J 
I lbte°ib 'li'W'lla 1 . · I l'\A1 ,5, 1ij1S .
·, 
-----1r)(6); (b)m(C) ~ 
ucmt 01gnaca1cs::> 
BY:-------------
ongina1. Detainee Response Copy- Detainee File Copy Responder-File Copy 
KITEOOI . 
2019-ICLl-00051 3731 
1027!0 
DHS-ICE-19-0196, 19-0197-O-000415

Mail - #2,894,233 
From: MERGENSANA AMAR (216269802; NA) Date Submitted: 05/16/2018 10:12 AM 
Housing Area: B 1 Date Received: 05/16/2018 10: 18 AM 
Assigned To: Mail Status: CLOSED 
Urgent: No 
Re uest 
I would like read automobile, motor car, track magazine. Thank you 
Res b)(6); (b)(7}(C) n 05/16/2018 at 10:19 AM 
We will look mto t 1s. 
Printed on 05/17/2018 at 7 :02 AM Page 1 of 1 
2019-ICLl-00051 3732 
DHS-ICE-19-0196, 19-0197-O-000416

Northwest Detention Center 
Refusal to Work Form 
Date: ;/ly{ff . Detainee Name: ffe/2 #" Y-
(b)(6); (b)(?)(C) 
Officer's Name: 
1gnature 
If a detainee refused to work his or her assigned shift for medical reasons, then this form must 
be turned in to Medical and the detainee is not allowed to go back to work until medically 
cleared. 
Medic~I (forward form to Classification Officer when completed) 
D Detainee cleared for duty in Kitchen 
Or 
D Detainee NOT cleared for duty in Kitchen 
Date: ________ Signature:_-_____________ _ 
Printed Name ·-------------
This section must be used if detainee REFUSES to work their assigned voluntary work detail. 
The form is to be forwarded to the Classification Officer. · 
~Detainee refuse to work 
Detainee Signatu-re: ----1,~f- --~--/\._ ___ - _______________ _ F￾D0026 021010 
2019-ICLl-00051 3733 
DHS-ICE-19-0196, 19-0197-O-000417

268621 
0 0 
NORTHWEST DETENTION CENTER 
Evidence / Search Report 
Distribution: Original: Admin Lt. Yellow: Detainee File Pink: Detainee 
DO 009-NCR 03/18/13 
2019-ICLl-00051 3734 
DHS-ICE-19-0196, 19-0197-O-000418

---
PREA Vulnerability Reassessment Questionnaire 
Detainee Name: AMAR, MERGENSANA A#: 216269802 
Date of Arrival: 12/19/2017 Gender: D F !El M 
b)(6); (b)(l)(C) 
Date of Review: ~\ii\\~ 
Staff Nameffitle: ------L--.-.---_,_____________ Housing: ----- B-1 
1. File Review - Has the detainee received any infractions for sexual misconduct, filed any grievances 
related to threats of sexual assaults, or received new infonnation from external agencies since 
admission that would increase the detainee's likelihood of being vulnerable to victimization? 
Comments: 
2. Do you identify as Lesbian, Gay, Bise~ual, Transgender, or Intersex? 
If yes, list response: _______ _ 
Is the detainee perceived to be Gender Nonconforming? o Yes 'No 
Comments: 
YES 
Yes 
3. Since you have been in this faciyty, have you ever been beaten up or threatened with being beaten up? 
Response: o YES ~O 
Comments: 
4. Since you have been in this facility, has anyone forced or threatened you to engage in sexual activity? 
Response: o YES 'rfNO 
Comments: 
5. Do you fear continued placement in general population? Response: YES 
Comments: 
Additional Comments: 
Note: A "yes" response to questions 1, 3, 4 or S requires prompt referral to a PREA Committee/Classification 
Member for review and follow-up. Completed forms will be retained in the detainee file. Rev. 9/1/15 
2019-ICLl-00051 3735 
DHS-ICE-19-0196, 19-0197-O-000419

Food Handler Form 
U.S. Immigration 
and Customs 
0 Enforcement 
Department of Health Inmate Food Handler's Certificate 
PATIENT NAME: AMAR, MERGENSANA FACILITY: Northwest Detention Center 
A: 216269802 SublD: ._!(b_)(6_); __ ~ 
DEPARTMENT OF CORRECTIONS COPY 
RECEIPT OF NOTIFICATION OF 
PATIENT'S FOOD HANDLER CERTIFICATE 
Page I of I 
Electronically signed by: 
~b)(6); (b)(7)(C) 
05106120 18 0 I !38 
I have reviewed patient's record and found (his) (her) general health to be 
satisfactory for assignment in food handling, preparation and service 
areas or in the bakery. 
Print Name/Date/Time 
~b)(6); (b)(7)(C) I l . s1812018 L.,_ ____________ 2""0'rll~9--t,IC~tr-tl_...,.0,,.,.0f"l105~1r--3~7M3ce6--------~ 
DHS-ICE-19-0196, 19-0197-O-000420

Worker Program - #2,860,529 
I .__, 
From: MERGENSANA AMAR (216269802; NA) Date Submitted: 05/07/2018 3:43 PM 
Housing Area: Bl Date Received: 05/07/2018 3:51 PM 
Assigned To: Voluntary Work Program Status: CLOSED 
Urgent: No 
Re uest 
Original Request ... 
I would like to work in the kitchen. 
Res Classification (bl(5>; (bl(?)(Cl n 05/07/2018 at 3:52 PM 
Sent to medical for clearance, we w1 you of the results. 
Printed on 05/08/2018 at 7:57 AM Page 1 of 1 
2019-ICLl-00051 3737 
DHS-ICE-19-0196, 19-0197-O-000421

\_; 
Detainee Request FQrm 
Northwest Detention Center :c·-,·('~itdicita1'ihn 'dP~'li\etenftlo \ ·. :·· 
\,·u,~, .... ,~n d-. t"lf\ 01 ,.,,1 \ ~1't\,h"'tu-·.,, -.n:-..""fti('~~ _,. .... ~ M ........ n ""~~.u .... ~,i ........ \ 
Note:1<:~· Incorrect·ol;'incomplete information wilhresult-.in, no·r~sponse /Hid the return of.'!his .forn:p·,, , • · · .. 
. . Infoinia~ion que'esta inc_orrecta o inc6mpleta no r~cibira·una respuesta la vuelta·ae estaforma. · · • \ ~ • ' t ' • :--: ~-1· ' .:-·-~ •
Type of Request: [ ] ICE (Immigracion) [ ] Mail (Correo) [ ] Property (Propiedad) I ~ ,· ·c • , • ' .• ·• • •• • ·1 . • • • ) (uJ · • • 
[ ] Emergency Phon.e?Call (Eroe,rgen.cia.1'elefqno). [ ] l{ecr~~ti.9~n (Recr~aci~r) . , . • 
[ 1 .Finari~~"(binei-o) ,; . ( :>(], w.~~~ '.~tN~est (Tr~~_ajo S,9kti~c;i9~)' '·[. 1 Bii:~er' (~i~~'~p j: ... ·:, . ·. , ·,,,• '•• 
0 i', \ ' 1 \ , ,; • . I • • .: 
[\ J. ~ommiss;icy (Commisara) ; . [ ., ] qas'siQc_a~oi]'.Appeal (9lassificaciop.)·:., . . 
[ . ] Foo'd '(Coinid_a) [ ' ·] Notary (Ncitruio) \ [ 't Co'pies '(Cpkt~~) ;.J ] ,Oi!fer (Otfa)'.. . I •• ,-~; 
[ ] R~ligious_piet I COI)llllOn,Fare.(Qi~ta RefifilQS~.( :preci~ Cp~1,1.n). [] <;nap,l~ip_ (~~P,~t!an) · •. ,, . . ~ ~ . 
Req~~i (S.oJicitaciori): _1,0 __ 0~· r_.J,___, __ . 1...,M"-'---_.,,k:.....,i....,/l"'-· c:,_h:..>.'...,..;o-Li,i1-··_· ~-~--''---'·•_·· _· ·_· --'~-
,,. 
:,-:. : ... 
• • .- r •, ' • • 
-DetafueiSignanire (Firma:Detenido) · 
Resp9gse: .· _" _________________ · . _ _._.·•,_·- _· ________ _ 
SEf\J'TTCfMEBICAL -·-· 
Original , Detainee Response 
KITEOOI 
.. · •\/ •' 
. _FQ.~~PL~R~NQI;., 
YOU WILL BE. NOTiFIED 
(b)(6); (b)(7)(C) 
Copy-· Detainee File Copy Responder-File Copy 
2019-ICLl-00051 3738 
102710 
DHS-ICE-19-0196, 19-0197-O-000422

,c· ... • 1. • • 
Living Unit Bunk Number Date (Fecha): Nationality (Nacionaiidad):-· '" 
(Dpripj~~-,,·,01).:. ". (rumqte,y_:!te_'r.a):. 1 •. ' .. • •. ··111 •. ' ' 
-- ' .. ' . ' . . • . il)'U ss ) 'A • f', 'J) 1 r· - 1(::/-. • 01/;!ilJ..:~. 201-8•.. . . • i! ,:-:K•. ·- ., ./rt .. -01..;.. r.a t,,n1,1", , , . \,, \..,,\, ~t.1 ~-\. ,.o ., ,.\ ... t .......... ,, ....... .,,..,. •• ··• , _,.,. .. -~ .~ -, ..... ., .... • ........ ~ -, ..•.. " , ............. , , ....... ,._ .... ,•_. ------------------------------"'"-!o----------------- Note:1.,\)lrt:correwor:,incomplete ihf9r.mation will result,in •nO:f!!Sponse:~nd:the.·retum·of'thls.foim,,,.. . ' ,. .. · .,. ' . 'Informaciori qul esta·inC:ofrecta oincompleta no recibira unairesptie.sta·.1a vuelta,ae esta fonna ... 
T~pe ~f ~eq~es~·:. [ /iICE (lmmigra~i~~) [ ·. ] Mail (Correo) [ ] Property (Propiedad) ·. , r . . • . • - . _. , . -
[ ] ~mer,genq-y;l~hone:Call (Em€;.rgenJ<ja T,el~fono), [. .. ] R~qr~~~iQ~,(Re<;:ftJ}.eiop.).,, .. . • • . . ·~_.)1:~-..,-,,.:~.;~l~:..,~' 1. 1 •·'Hl\, 1
\ 1
;;_:i>'•· 1 \·•1;l, ... 1 ,jorl••-• 1 ,r ,:n· 1 ,, ,,. ,,•.r·••1·,t~1• · 
. [ ] Finance (Dinero) .[ ] Wo.r.~ :R-~Y~~t {'I);~bajo ·~.oicitacfon)'1 [.. ] Bru:ber .(B~oero) . .. -~-· 
[ · J CQnjmhi,~.(CollJ.fui~ar~) . ( :: \r.¢(a1~1h~atjq~ Appear(¢1.ii~.t~s~ci911Y'.::.,.' J\ ":,,';:: . '. • • • \ 
[ S,#9~~'('Comi'd~) 't 'I] N6tacy (Notirio)" [ ''] Copies (Cop~as? [ ] dt!ie.r _(Q.~o).',. ,.'·\~i~;· 
( . -J.~el~~}o,us:,Di~~ /.~nn~o11.f:~re/P,iy~a- .. ~~1~.gjpsa,/g~eclo.C.~W.l:1P) [ · ].q~_.ml~i~ (G~_pelJa~). : 
; ·~ - .,. , ...... ., j, • • 
brr f h. Ci,i J:t' 'E; i'~i·te ..... £9? 
,C
0
~t>C f'Q" .•:· . . ''. W\ y lvw ·yec· _fo•'f·• {'be ....- _.-
_.. r_, 
Yoe,. So J:· .. 
'"\ ., ..... _ !" .•. · .. ·.• 
Detam'ee .Signatuie. (Firma ·oetenid9) 
i!,espon~~= __ · 't--=---W_,..;._- -~-'_\,_·· .....;;.Q-=\..... ~\_\,cz.""--· --=-~-........ ·{;.;;;...0,1 __ <\-_ .. -~--- \.\-+-··~·~---'.· ·=-.. ·~-
--------------
Original • Detainee Response 
KITEOOI 
Copy-Detainee File 
)(6); (b)(l)(C) 
Copy Responder-File Copy 
2019-ICLl-00051 3739 
,_ 
102710 
I 
I 
I 
I 
' ' 
. '··-
. i 
. · l 
.·., 
l 
I 
. I 
DHS-ICE-19-0196, 19-0197-O-000423

. . 
·, '~?Northwest Detention Center 
Living Unit Bunk Number Date (Pech.a): 
(Dorfni.ton6): ·'' "(Ntiriibr'e-'Jitera): • ·· i ./ , ,. ·· . -11 ~- . . ·_ :b.if. rt.s. 2,0,1 K .'-i,l,ll°'\ ·,•,\i(.I\'".('\ 'J tli .. 11 ,\\~")\, .• ~, ,\•,,,,.\)t'\ •••• - ,,t 1,h, ,,..,,.,,,._., ... , , ., , \,-<i--• \ 
Natfonaltty (Naciorialidad): 
-· NOte: ·-~ l!fc~rrect'or41ncOrilplete (1hf0Frilatton \VIlkresult 111n·notresponse•and the return. .of·!lJ.is,{orrn.' •. . 
. ·,. · Informacion ·que1esta·incorrecta o incoinpleta no·recibira una respuesta-la vuelta 'de esta forma: · .- • ~ • < • •• • ·• I ,' • • 0 • \:. 4 
Type.<,fRe4µest: [\/]ICE (Immigracion) [.. J Mail (Correo) [ J Property (Propiedad): , .. . . '- . !:( r { - - - 1."~ ' • •• '• •a • • I 
[ ] Er:nergency. }?hone Call (Epie.r-gencia.Tel_efono) [ J R~reati9p;(Recrea.~i9µ) .. • .:::1 1 , ·:, ..... ,•• • I ~--• .. ,.:-,,. ;: , ' • , .·, 4 ' 10:\j :t, ... ." f 1; ·\"J ,,-. ·' , , 
· [ . ] _Finance (Dinero) .,.,[ ·]!Wio(lc-.Reque~qJ:rapajo:Soi¢j~acjqn)., ,[. .. ] Barber:.(~_~b.ej9):, 
' 1S: :,:_,; .·, -•~ ~ , , :;· • , .•·~1\ 1\• -~ , • , .. •, u •· \ 
[ ..,];..Cqgwµ~s~ (Comjnisara:),: . [ ,i· ] Clas~ifi~a~ion 4ppeal (q~~~-~~acion) .... . ••,.. -... . ··-
[_·;J\#1Arcc~~ida)''. c .,1 Notfu!y'(Notari~) '[ 1 Copies (ci>P.l~.s)..J.· 1 Otli~~::(9.~())' t;_·;:,. r:':'.:'/; 
( .. j R.~_lfgious.Di.et /.Coi:nm!;m·F¥e,;(Dieta:Religio~~ / Prec~o.Comqn). ['_ ],Ch,~plai~ (c;ap~llan) 
Detainee Signature (Finna Deierud<;>) 
~esp.oils¢:, --'~..1--l'-_~l,.q.· 7....!.&l<.!..:•\i....._·l:.:.;\f\...~·'i:.,.,:•~V:,.,._' t;_ .. _;\.i;;-.a,~,'-')~"""- --')?',,:=~-.C........:G::...;:~;...c.- •. +. ~-:--'-e-;.-----'-,,....,.,------::--·....,...· \'.' · 
... , ': ~-
Original - Detainee Response 
KITEOOI 
b)(6); (b)(?)(C) 
Copy-Detainee File Copy Responder-File Copy 
2019-ICLl,-00051 37 40 
'\•. · .... , ,, 
102710 
! 
I • J 
I ..... 
, I 
• I ;., 
· I 
l 
I 
I 
DHS-ICE-19-0196, 19-0197-O-000424

r, . •\0_ 
:Detainee:Requ~s( Form 
:.;.I,,~'<:'.'' ' 
· · · '-:~o:rthwesf Detention Center. -.,~-.. , · · ·:,:,IJS~~~;.~~i«!~ 4~~~~_t~m4Q)'.~;:: <: 
Alien Number (Numero de Extranjero): Detainee N~e (Nombre de Detenido): · . -- -
. ',, A :.lfG ;•!_:·ti.'~ ·_ ··sot '! :u~astNa~e"~AQpellid?Y- 1 ~i-~st Nariif/'_N6¢~,reP1¢e~o) 
·· •· · ·· _ ,A~V' · ._/t,~r-9etts0-'fla_ ·'. ; 
-Living Unit Bunk Number Date (Pecha)': .. Natioriaiiiy" (Naci9nal1dad): .. ' ... ·. ·-
-(~on_niiorio): ·(Numoi:e·Iitera): . 
{;,} I I' 7 ., _ _ -o ~. ~ I . 1 i - - 1 '.t).. - ,. • .. ••• • ..... 
N'ote: \ Incorre<;:t.or mcornplete"informat1on Will resultm no respoi_ise}Ul(f¢eietum~oHhisJoi-:rn .. ' 
· · - Infonnacion que esta incorrecta o incompleta no recibira,.una respuesta la vuelta·cde esta·forma.; 
Typ~ of Request: . [ ] ICE (Immigracion) [ . ] Mail (Cmr~~) .-· [ \/J Pr~perty (~;opiedad)' -
[ ] ~inergenc;:y ~hone-Ca1l.(J;;iµergenda,Telef?~o) [ .] Rec~eflti?n (Rec;:r~acioJl). : 
[ (Finahce (Dinero) ... [ ::JWdrkl{eqµ~~t (Tr~bajc(~o~fitat'Io~Y,\'(, ] B:~.~et"(mulefo)°-' ' 
,[ "] t~~~siiiy (Coi:n~sara) .• [ . ] Ciassificat~oi' ~P.i:>~at·(q,ass~cacion)_:.' . : . _ ... . \ 
_[ i·fb~d'.(t'omida)· t J Ntitary (Nothlio) ·[ . ].'Copi_es'(Goi>t~tt 1 dilier·cq)fo) /, · ·~ 
'[. .) ·~~ligious-_Diet I Common Fare (Dieia Religiosa / Prec;:io Comu.n)_ [ ] Chaplain .(Capellan) .. 
Detajn~ Signatµr~:.(Finna:' Det_eQido) · 
Rl!Sp'<iPSe: he,\Q~ e-e rok C::1'1.PJ rl 0/-i e, 'r,, W krc ~u f' ~'. c~!\f /~o"-e ~ · ' ~ ~ . -~ . . · . 
b)(6); (b)(7)(C) 
,,. 
L---,---,-----,- ....... ---i,or--~u.re ... .; .. .-. 
'priginal • J;)etainee R~sponse 
KITEoot'· , Copy-Detainee File 
102710 
' .... 2019-ICLl-00051 3741 -.• ... 
·. -1 
I 
I 
l 
.! 
"i 
I 
1 
l 
I 
! 
I 
t 
·I 
i 
i 
DHS-ICE-19-0196, 19-0197-O-000425

, . ' . ,~--,1 
· -"· ·• ··Northwest Detention .Center 
Note: n\,fucorrect,O(•incorilplete infoFiilation will,result,in ·no1r.~sponse.~nd·,the retum-,of1!h,is-{orm.',·i· , \,•\,'I 
· ._ " '.Jhforriia~ion'.'cjl!eiesfa ihc.drrecta ;o iricompleta no recibita•una•respiiesta la-vuelta,de esta forma:" ·· ;-· -""' ' . . . . . . . . .· .. ' .. . . . . . , 
Type of Requ~st: [ ] ICE (Immigracion) ] Mail (Correo) [ VJ Prop:rt~ (P;~pi~dad)' ·- ' : • ~ ._,_ ;t. , ,.·.: • • .- ~, .J • ,, . ' ., -~ • 
[- ] Emergenc;y,Phone Call.~Em~~g(:Q~ia,TelefQl).o). ,(, ] R.ecr~~tjop,(Re~::'rei9i9.n},: 
[ ,, ] Fin~~e ·(DinerQ) . [ · ] Wiork)i~que,§t(T~~pajo',$.qjpi~Gi9~)-: · [: . ] B#.Be~ (~~q~~P)u , . .'1 •; l ,i~\I ,t.1,\ '\\I\\ I •i 1, '"':;11 t'•' I" ' ,•.i'f \ , .. 0
',1 '\ \, \ t .. t• \ ! , • 1 1 ,t"• ,..,(l\1• • ' ••~•-• 1 , .',• ; 
[ . JCorpmis~ai:y.(C.ommishl:~) [ .. :] Cl~~ificatii::m APP.ea! (Cl~~~~~ac;Jon) , .. • .:.: _•; . .. , : .\ .. 
f F~q~ (C~mida) [ .. ] N6"tary '(Notari~)"' [ I .• ]'C6pies'°(C9pl~Y~\ . ] ()"tti'~} (9~~.t' ·. :·:·:.· ··'.\· :\
[ . ] ~~ljgipus._Diet I c;:~mll)op. f'.are, (P.l~t~-_ReH~os.~, I ~~~~jp. <;0111µ,n) [ · ] ,(;_ha13l~jp_ .. (9ap~lla~)'" · -. · • ."• 1· . .• 
.fukre. .. -~ .. ri/fa'ne__ .: .r,;[j·~··e.i·/ ·. '. .... , 
~- ~ -~·• -~ .. .. ,',
, ... ~ I -1'+·•. 1 __ '? . ? ;. '"'~e:~:t ·~•··-~-~g ~u+,r: 
Original - Detainee Response 
KITEOOI 
'ft ·I ' • '•i. f 
~ 
b)(6); (b)(7)(C) 
Copy-Detainee File Copy Responder-File Copy 
2019-ICLl-00051 3742 
'..Date.'. t\ _, 
102710 
DHS-ICE-19-0196, 19-0197-O-000426

268S16 
~- ' i 
~ 
I ' ) 
~ 
NORTHWEST DETENTION CENTER 
Evidence / Search Report 
Distribution: Original: Admin Lt. Yellow: Detainee File Pink: Detainee 
DO009-NCR 
2019-ICLl-00051 3743 
03/18/13 
DHS-ICE-19-0196, 19-0197-O-000427

.. ·- .. --------
.o .r. ~-Northwest Detention Center • l• :. ~ t. ·: ..... , , .,.'l !.'H •\\-\•\(I l•"\ . .. . ,.-.~<.ou•,',,'1 • i ·•,no"\• .. . Alien Num~~r.(Numero de.e.xtranjero): Detainee Name (Nombre de Detenido):· •· J • • ,,. •• ''•• j ' ~(L~t.~.bn~ - AppdlHM) (F!r,st Nani~::: 1
~0.mb,re, Ptlm~ro)· A 1
L16 'LG9 io z.- - - -i.·.,( ~~ ... .. #1-e v Jf . .e._.t .. 
s~'),~· ' .. .. .. ··•· 
Living Unit Bunk Number Date (Fecha)°: Natfonallty .(Nacionalidad): 
(DdtiruJ~n6'): .. · (Ntirhbi"e'litera): · .. 
../?. VS.Sf A . . ~ ; .. , .. 0 .. 
~1\_ 1,ii\h -..~\1 l\ih 7 
· 1-f ':f ,OI(, Q.!!i.,tlO-{ 8 . ., 
lll ,,t •. ,l" .'ti\ ~ •. , •• ,~. u,, - , ....... \,.~ ·,,, ........ .. ' ......... ' ... ~ ' .,. .. , •. .. ~. - . .1 _ ........ , ... . . • . 
Note:< Incorrect or ineomplete information will result in no response pod-the.return of-this form.. .· 
. Infoi'macion que'esta incorreda o incompleta no recibira una respuesta·Ja vuelta·ae·estaforrna._ · 
Type of.Request: .[ ; ICE -(~gracion) [ .] .Mail (Correo). [ ~roperty (Pr~~iedad;,,: , .-
[ 
[ 
r 
]-Emergerwy Phone Call (Emergencia Telefono) [ l Re~ri~~~~.(Recr~~~ion) . ·-.. 
J Ffo~n~·e (Di0
hero)• .,.[ . J \V~rk ~~quest'(Trab~JO $oiJit~cion) t· 1 Bat6e.~.(~~~9J; .. ; : .. ,.: 
]-°Coi;imi,ss~y .(~ommisar~) : [ ... , '1 q~s;~i_fi~ati.61_1, Appear <¢.ias~gicacion{. · : .,: . ·. ., ... , ·. - . 
[ .. fFo~h·ctomida) .- [ J Not.icy (No'tli'ii~f'[ J Copi'~s·(¢~p.f~s) ·'L. ') t)'~~UPi6J'-:,\. ',\ · ··:·,.,,;~',:-' 
[ ] ~yijgious.Diet I c;ommon Fare (Diet<c1 _Religiqsa / .Ptesio Comurr) . [ · ] CJ,iaplaj!\.(<";ariel!\1})'::! ,_ 
Requ~((S6jid~:cio';.);:_.· I .w~~i .. -lei.bl o... (~ 
~.~ ,_ · .. _ .. .. .. ' 
~-
---'----------'------'-------.......:...------'------,---'-c-----'---,--•·· 
Original - Detainee Response· 
KITEOOI 
l: 1
.' •'.l. ,_; ·, ••• • 
betainee· Signat.uri (Firina D~etenido). 
b)(6); (b)(7)(C) 
Copy-Detainee File Copy Responder-File Copy 
102710 
2019-ICLl-00051 37 44 
. j 
I 
. 
DHS-ICE-19-0196, 19-0197-O-000428

NORTHWEST DETENTION CENTER 
CORRESPONDENCE I PACKAGE REJECTION NOTICE 
TO: Detainee Name: _AYY\~__..,Q ....... __ ( __ ,~\\J\~R-'0_gt~n-s~oru~'-----
Housing Unit: D\ 
A-#: 
-
---l(b)(6); (b)(7)(C) 
FROM: : Date: 3hf:t)\.P 
C> 
-.,;~~J;J.1JL--1Jle.ID!l'..LtL..re.:~£ed..a..Jll9.(~4'1 I correspondence addressed to you from: 
---
This correspondence/ publication/ package is being rejected by Policy for the following reason(s): 
[ ] Depicts, describes, or encourages activities that could lead to physical violence; 
[ ] Information regarding escape plots, plans to commit illegal activities or to violate ICE or 
NWDC rules or guidelines; 
[ ] Information regarding the production or flagrant use of drugs or alcohol; 
(',L-----------~ (Date) 
Original: Detainee File/ White 
Cc: Property Room Officer/ Canary Detainee/ Pink Sender / Goldenrod 
020807 
2019-ICLl-00051 3745 
DHS-ICE-19-0196, 19-0197-O-000429

Date: ~, J °J / (f:' 
SUBJECT: Contraband/Unauthorized Mail 
To Whom It May Concern: 
aee 
11le GIO Group, Inc. 
Northwest 0..nOon Cetlter 
182S East J Street 
Tacoma, WA 118421 
www.geogroup.com 
Please be advised that during our screening of Northwest Detention Center detainee mail, we 
came across correspondence and/or itein(s) which are unauthorized, or considered contraband. 
Per Northwest Detention Center policy, the item(s) will not be allowed to enter the facility. 
The item(s) will be returned to the sender. 
Sincerely, 
b )(6); (b )(7)(C) 
sistant Warden 
o w e tion Center 
GEO Group, Inc. 
2019-ICLl-00051 37 46 
DHS-ICE-19-0196, 19-0197-O-000430

· ' ~orthwest Detention. Center 
Bunk Number Date (Fech-a): ' Nationaii "Nacionalidad · .... 
(Nuinb~e··~tera): · , , 
,. J/7-Jr...~, ..... · .. :~::~Pf.'2. -.Ct; 
Note::)~, _orrect·oi: incomplete information wilhresult in·no response and the·return of-this form:, 
'. •·1
· 'Infdrritaciori• que'esta incorrecta o incom·pleta no recibira-una respvesta la vuelta,de esta forma:- . _...- .. . . 
·, -·· 
Type of Request: [ -7--iee{In:unigl'acion)' [ ] Mail (Correo) [ )(] Property (Propiedad) 
[. ] Emer,gency Phone Call,(Emerg~n,~ia Telefono). [ ] Recr~ati61;1 (Recr_e~Gigp.) • :.,_ . ·. 
[ 1 F
1
inan~~ (Dfner~) l ·1-wo~k R~Ue$t ci\!lbajo Soicita~ion), [ J Ba(~~?(i3iµ-t>~lo) .. ,. 
[. 
[ 
[ 
- ,', > ;\' • •• • • • r • • •.t I ,~ ' • . • <' • ' • ' t • I' ,Tl.;• ' \ 
] .~9mmissa1;y, (Commj_s_trra) .. ; [ .. ] Clas~ificati<?.P-. Appeal (Gl#~.i~cacion) : ,. , . 
] food (Comida) [ ] N"otary (N<i_tarlot[ ] Copies· (Cppias)-'. [ ·] Oth<r~ (q!fo),. . . . . ... , .... ,,
]~Reltgi9ys Diet/.c;qmmon. F.are (Dieta ~eligi_osa f Precio Com~n) [ ].Chaplain (~-~P,el~an) 
I ., I :, 
•Requ~t.\csoji~itacio.~>=·· ·£:: Nfell .. :.ro ~o ro.-.. ·»fy PEiiPfxfx 
,. ""· 
14,-.jo <o6, m,y C/£12/1 0/.go 11ums£{<.. ~ pr(y ·, 
. k1'1'( 1 fl;wtEf<, lie w,'-,..__· ~ · Hi:Bc '3~·j_ 1 -ct· iN 
T/1£ Yn. dl.t/,1:-16 , r llfJ V £ ewe, r /.,!) N r'lf< 12a y . _fJNO I NEE.12 
/ 
. (b)(6); (b)(7)(C) 
I 
.· .. 
Original - Detainee Respons6 , 
KITEOOI 
Copy-Detainee; File Copy Responder,Filc Copy \ ·:· '. 
2019-ICLl-00051 3747 ' . .I 
DHS-ICE-19-0196, 19-0197-O-000431

.. "{• 
,_.;·'/,; 
' Northwest Detention Center .·,n,• 
Deb\hiee :Riquest ·Form 
(S9J.l~lt»:~in~ ·'tJ~·:1:I~tlmJJ.g.),_ . ·:.·:. 
Ali~n.Number (Numero 9e Exi:ranjero): Detainee Name (Nombre de Detenido): . 
~ g { (;, _ 2-6'9 _'.3-oi (L,~st.~ain~.-Apr:elliao)_., CI;frs.t Name .;Nom~r~ Prim~ro): 
·~-- ·, .. , · · · , · :Mef si.en<:a f"\a · A-111,fa r ·· ··, · .. · 
Living Unit Bunk Number Date (Fecha): Nationality (Nacionalidad): 
(Doril).itorio): (Ntiinbre 'Ii tera): ,. · · .. 
G.j :,,.n. ~H,\\:J .... , ... ::. '?~·ff·:~~13._ -~R.{J~_st.A _,i;•_:· ....... : .... ·· :.· 
Note:, ·· 1ncorrector,incomplete information will result,in no r~sponse·and the return of this.form: i - • . 
· Informa~ion ·tjqe esta -incorrecta o incompleta no re'cibira:una-respuesta Ia vuelta-de esta forma. 
Type of Request: [ ] ICE (Immigracion) [ ] Mail (Correo) ~ Property (Propiedad) 
r 1 E~ergency Phone Call.(Emergen~ja T.el~fono) c . 1 Rec;e~~~9"n,(B.ecrea~ion). ·· · • '. IJ • • .' •;• t , • • • • ·, ' 
] Finance (Dinero) [ ] Work R~uest (Trabajo So_icitac~on) -[ . ] B~~e~ (~arbero) .. · • ' ,, I l J , '• \" o I • \. I;' :I\ ,l" · J l • "' • , , 
[ ] Co~issary ((;on'lmisara)., [ .]G}assJficati◊n Appeal (Cl_assfijcacion) 
[ ] Foo;q (Comida) [. }Notary (NotariJ) [ ] Copies (Copia~f' [ J o"i.h~~ (CJtrC!):: > .. · . [ . J ReµgiousDiet / <?oriuno~ Fare,(J;?.i.~t.a ~t;~igiosa I Precio C.~qiµ~J [ ] Chfpla.in (C~P.~Han) - I' 
Request (S0Jicita'ci9n): .' f}el(o t;/ y I· T [AJ4IVJI/ .fg_ 1 ( e. a . 
\t\u LvJo t \I s;::y<b '.\IV\ 1.tv :t) ¾-J~ ~ \'\ o~ • .. ,. - :- ' 
R~pmi~~=.. bd-a:, n-ee. .f <;.:-tt;~ .. e: \f::f J. 
p~ov\e. ·· 
Original - Detainee Response 
KITEOOI 
b)(6); (b){7)(C) 
Copy-Detainee File 
. )'~ ~,r . ••• ~...,•i••·· .... 
. Detainee Signature (Firma,D.etenido) 
~y\.o'\c ~ci)W' kc\ q &\'.-· Cf . ' I. 
Date· 
Copy Responder-File Copy 
102710 
2019-!CLl-00051 3748 
., 
j 
. I 
. I 
. I 
l 
i 
! 
.• 1 
·.i 
• I 
DHS-ICE-19-0196, 19-0197-O-000432

a 
-0 ..... 'r.-
0 
Detitinee Request Form . 
Northwest Detention Center :_ . I 1,H '\. '• ·t ..i, ·, ,J,,, ,h, •\' r. i~1 ot -.,-.;· :•, .... \,l hr\ • •, ,I( ,, n::,t• .. ,r\ ~, h "'L" ~ •" , ,,, ' { I , ··,: (~dJiti(a'.'~ibg:-de·»et~P.1t.'Q.}' ~ 
Alien Number (Numero de Extranjero): Detainee Name (Nomore de Detenido): ~ . .. . . 
(La~~:Name -. A~pellicJ.?t '<f:lrs(Name\: ~9'rp6ri~ -~tjw,~~o). , A, 1,,( 6 - £.6 <J - -80fl 
.. M erg. e'vtSl'-t,a _i ·A·~~-r I•.,.-; 1 .\ - .- ... ' .. . . 
Living Umt Bunk Number Date (Fecha): Nationality (Nacionalidad): 
(DohnftorioJ: (Numbre_:~tera): · ,, .. }; '• '. '•; "1 f I I .-: 
RU<;Sf A ' 
.~,/ 11.7-' o '!> .,19·. -1..o < 2 - ;, •lf"':.t•'l--. ,·. ; •1 (-. ··~ '' • • 't.. , .... 1 • _,, .. ' . ... .. " ·- ' .. ~ ' .. ~ ... ~ .. . •. ,,., 
Note:', \ In-correct .or.,incomplete information. will· result in no ·response and the return of this form'.'. • , · . 
. l!'lfo_i:macion que1
esta incorrecta o incompleta no recibira una·respuesta-la vuelta de·esta forrna::: 
T-ype of Request:. [ ] ICE (Immigracion) [ ] Mail (Correo) [ \/:)Property (P;opieda~)_-_ - ( . . 
:<. [ ] Emergency. J>hone. Gall (E111,~rgen~i.a .Telefono) [ . ] Re,cr~a~o~~{Rec.n:~~~ion). , , .,, .. : ' ' L' -. • j' ~ ' •', ~.· •. i ! • 1 • • l : ' ' 1 I , • •. • . : } • • 1 • • -. , 
[ ] Finance (Dinero) .[. J Work Req~est (Trabajo_~oidtac~on) [. ] Barber,(Bat;~f~o)' 
[ ].Co~missary (C9mrriisara):. [ .,] Glas·s.ific;a~~o~ Appeal '((I~~~~ficacion) '. _ _..·· i i ·: .. ·:· . • ..•. 
\\' .;i:,l'l•\i,I• ', , \ ' • .1 I , • , , "::' , • • •• \<:. 
[ ] Fo~d-(_Comida) [ ] Notary (Notario) [ ] Copies (Copias)" [ . ] Other (Otro) . 
[ J-R~,f gic;,,~s pi~t I Gqmm~n ~;ire, (pi~!a.R~_4g~e,sa / Pr:ecio G~q)p,n) [ ] r~ap_l~in (C~p.~l\an) -
Req~esi::(s;µdt~cion): . , _./(£1lo-. '$:0-. . I. L,Jo,nf,;. ··ta:te c::L 
' 
11-u k'.?lher /vow. ·. ""'~ i.ef'? p ~oh, .. 
Original - Detainee Response 
KITEOOI 
ri 
•· (b)(6); (b)(7)(C) 
Copy- Deta.incc File Copy Responder-File Copy 
2019-ICLl-00051 37 49 
· .. ' 
\, • r •-'• •' 0 ,,\ 
,. ' ...... 
· . .102710 
' . ·-~-~~:-::: 
···-
.1 
' 
: ! 
. ' 
• I 
DHS-ICE-19-0196, 19-0197-O-000433

Other Request - #2,671,666 
From: MERGENSANA AMAR (216269802; NA) Date Submitted: 03/15/2018 2:16 PM 
Housing Area: Bl Date Received: 03/15/2018 2:16 PM 
Assigned To: Admin. Assistant Status: CLOSED 
Urgent: No 
Re uest 
I would like a Russian to English learning book please. 
(written on paper kite by detainee, dated 3/4/18) 
03/15/2018 at 2:20 PM 
Sorry, we do not ave any ex a Russian-English dictionaries to lend. A Russian-English 
dictionary was provided to your dorm book cart in January, so check the book cart, or ask other 
detainees who may have borrowed it. The book is intended for all to share. 
You may want to sign up for Law Library, as they have dictionaries in various languages which 
may be used while in Law Library. 
Your other option is to fill out a package authorization form and ask a friend or family member to 
send a soft cover book to you. If your request is approved, you will have up to 30 days to receive 
the package. 
Printed on 03/16/2018 at 7:32 AM Page 1 of 1 
2019-ICLl-00051 3750 
DHS-ICE-19-0196, 19-0197-O-000434

"I' 
~:,-~ 
: ·_ -Notthwest.DetentioJ1,Center .,,\ ~ .... ~., • o I \\~ ;, .. , • , H ••u~ •\\\ ii\ \,l•t \. h "'" f,11 \ \ I~\ , "\t'" t It'-' I ~,,;'IH .I I.•. I 
' 0 . Detainee -Request Form 
. ·. ·. ,.::{Stilicit~cinn·"d~ .. ,.f!~tenido} .. ·\· - Alien Numbe_r,(Numero.de,Extranjero): Detainee Name (Nombre de'Betenido): 
A t-16 P..€/3 ft).Q; ~~~st:Naw,e - App~llia9ti.(f,.i~s.t Name :;c-N~-ip~flr, Pri~,~ro) - - f-1 ~ ti~ <Z VtS_"'-"1 ~.:--,•A :~a r ~ · · .. : ', IC 
.• .. Living Unit Bunk Number Date (Pecha): Natio.riality (Nacionalidad): ., 
(Dormitorip ): · (Nuinbre'Iitera): ,. ' ' '' i 
;i, .·' ·-. •• ·.1 .. , ... '~q· 2,(J1"i {?,qJ$/J ,, 
[!, 1 11::f. A." ... • 0.' - I 1•-.. 
1,·-.· •.• ....... ,:--.. ... C -.. .. ' . ,\. "'• ., ' • .... u •• - .. , . - ·-..... . - . ' 
Noie:1·,
1
•In'correcit·oi: incomplete information .will result.in ,no response-and·the return-o£'µiis form.,,· >..· , 
Inforrilaciori que esfa incorrecta ·o focompleta no recibira una·respuesta'la vuelta·de esta forma.- .: 
Type.of Re~uest: [ ] ICE (Immigracion~. [. ; M~~l (Correo) [.v(rrop~~Y ~Pr~pi~dad) . t •• • 
" . [ ] Emergency Phone Call,(Emergencia,Tel~fqno) [.. ] Recr~~tj.on·.w,ecre~~f9.n) · .·, : . 
r . l Financ~ (Dinero)' f l Worlc Request (Tiabajo'Soicita~iori) . c . i Bai6~.{(Bai-be.~o). 
[ · ] Co~tn{$sary (Comri)isara) '\ [ ', ] 'c;ias$ificati<;m Appeal .(P~~-~wcacion) .,.•·,1:. ,'. ,· \ .. [ j F?6:a'(Cornida) [ ] Notary (Notiirio) [ ] Co"pi~s '(Cog!'a~)': t . ·1 Oth«i<◊~6) ;_:, 
[ .:,],R~.lf~9us D,let_/.C(_)TT1JllOfl ~are,(DiettR~Jigipsa / Pr~cio1C~JJ1~n) [ ] c~.aJ?,laiµ (G;;tp,elJan)• 
Requ~t.(S.Qliclitlcfon):, , .Hi flo. s c. ,v,-, · 1 .•. 1 .. \.Jct iti:.,'. ±q,..k: 42 ... ,~-~ · ..... :... :~.. -
<"a.rd )' \i\mbe v:: J~n ~ ~ ( i,~ _fe J~ vt J 
~ ~- ·.~¾wrl' 
· 0\ '$. lt 
Original: Detainee Response 
KITEOOI 
b )(6); (b )(7)(C) 
Copy-Detainee File 
,I 
'' 
·n .. ~ ... . . · ... ~ .... . Detainee\Signature (Firma-Oetenidqt, .. flee~-- 1D .'· ... i. · ·•• •. -
... ···®' ~a__· 
ure 
~(10 Ir~. 
D te . -.. . 
Copy Responder-File Copy 
!02710 
20f9~1CU-00051 3751 
. 
I 
I 
.· 1 
• I 
I 
:l 
i 
• I 
-., ! 
I 
I •• I 
•·' "j 
' I 
DHS-ICE-19-0196, 19-0197-O-000435

' '--,F" 
Detainee Request Form 
Northwest Detention Center -•• l" &•..,.: \)' .,. 1Y -~ \ (SoJicitacipo. •~ n, -....-,~ "''"' ,,.,..,Hll t \ • \n ..... 1,,\1,., ....... • ..... ,._, ,11 ·de· Det~mdo) .... -
Alien Number. (Numero de Extranjero ): Detainee Name (Nombre de Detenido):_ · . ·, ·:1.2:. ~!• •>1b t:·. , ~.:,-: .. .- · , .·,,: ' ., • • 1 1 • 11 '1 •• 1;. ! M : r • • • • ~, • - • , , , •, • ~ : l I 
._A 2-16 - 2-69 - 20-t :(1:?'~t Name· - APPrllido)_. (fftst Name·- .N9mb~~ Prifi1_ero) 
.· A~10.r . MerJI~ VlS~ nq .. 
-Livi1:1g 1:Ji:tit Bunk Number Date (Fecha): ·. Nationality (Nacionaiidad): -
(Dbrmitorio)': (Ntimbre ~Iitera): 
· ~V~S-J A ,. : ·, 
03. Of(. 2-018 ,&. I -::~i" ua-~; .. .-.,. -. : ,. .,. , .. ' . ' ,J r ~•.~ ;, •, .. . , .. < .... .. ., . ... -. 'i, ~- .. . ·'· • •• 1.~ ••• ' ' 
Note:· ·Incorrect·or i_ncomplete information will resuIHn no r~sponse and the return.of this.form., . .. 
· Infoimacion que. esta incorrecta o incompleta no recibira una respuesta Ia vuelta de esta forma . 
• Type of Request: [ ] -ICE (Immigracion) [ ] Mail (C~ [ ] Property (Propiedad) 
c ) E~ergency Phon~·call.(Emergenci<t·Telefono) c 4 Recreat!<:>r. (Recfr~~~iQn) ..: · . ,• 
[ j Finan~~ (D1nero~. [ ] Wo~k R.:qu,~~t-~T.r~bajo Soi~it~cio'n)~.'( . 1 B~~~r'(Bar~~io~ . · . .- J{ 
[ ] Commi_ssW-)' (COIIlJlliSar_a) .. [ ] Cl,assificatio.il App_e~l (Classificacion) · . , . · .~ l 
[ .. ]'Fo~r(Comida) [ . ] Notary (Notario) [ ] Copies (Co2ia,s~·· (. ] d.'$.~~ (Oir6). ';,p.\V}'i'l.9 "Y)~i 
)~:g'.ou~ ,~i~t: ~mmonlare (Diota Religios~ / P,recio :,omun/ [ ~~~n:~~~ellaD) .• f 
Requ~st1(So.licitacion): ~T . 1.,1.X.y\S) L, ~. ~ . J2vh,\ot,J 4-o ·---~ Y\').A:,s. 8: :: . 
• • I 
.,. 
/ 
----~---------------------------, / ./ Y, 
Detainee· Signatut:e (Firrna'Detenido). 
R~pons~: .S'u..-: t:L~~ed-prt'n._fe.d -re.··sp~·-,--
Original - Detainee Response 
KITEOOl 
...... (b )(6); (b )(7)(C) 
~taff S,ignature .. 
Copy-Detainee File Copy Responder-File Copy 
2019-ICLl-00051'· 3752 
102710 MAR 1 5 2018 
- -1 
• I 
I 
! 
I 
i 
DHS-ICE-19-0196, 19-0197-O-000436

271981 
Location (Unit, Cell or Area) 
E> \ I \=1-A-
-
,. 
' ' 
NORTHWEST DETENTION CENTER 
Evidence / Search Report 
... - - ---· ·- --- . -·----- --~ - --- - - - - .. - - --· .. 
~~ ti..,\_..- (1-J -r-~ ..,.._ 
•. 
' 
·" .. 
Distribution: Original: Admin Lt. Yellow: Detainee File Pink: Detainee 
DO 009-NCR 03/18/13 
2019-ICLl-00051 3753 
-·· 
LS; /k-
" 
.. 
DHS-ICE-19-0196, 19-0197-O-000437

·. DO 009-NCR · 
r .·-y- .... ::~ORT~WEST DETENTION CENTlc~.Y _ .. 
··· Evidence / Search Repor.t · " 
2019-l&blA0005=1, i: 3754 
· · 03/18/13 
: I 
i 
· I 
I ··1 
.! 
I 
I 
. I 
1 
1 
I 
! 
DHS-ICE-19-0196, 19-0197-O-000438

. ~ 
~102 
,. -- .-- ., ..... /[_'NORTH~T I?ETENTION CEM-TU 
· ·Evidence/ Search Report~· -· 
~f~t;:·~~~E! ~~-~ ~2~~---~:-~ ~~~~?- :~~ :: ··:~~ ~-~- · ·.- = --- ... ,. • • ·• - . - -. --: i.-; · _ - · ·-:~ .. f-~ -· · : ~ ~,-·. - ~~~~-~? ·· .... _ ~=~:i~ 
ifl,~t:::: ::;~_ :.;::L} ·--· ;:--~•C••~'--~~-... _.· -~~'-. -' • , ... L. : _J 
·D0009-NCR·· 03/18/13 
2019~ici~t..0005411 i: 3755 
! 
I 
j ·-· - -·1 
I 
j 
1 
I 
I 
.. j 
i • • I 
I 
I 
I 
·I 
I 
I 
I 
I 
I 
DHS-ICE-19-0196, 19-0197-O-000439

~ . - :. ~. . .. ..~.,-
Northw~st Detenti~_n-Ce~ , , .. :~, ..· ~ ::L.·r:.CS~H~ltfflt~jQp·: <J:~~~¢t~~!i~)tf·::: · · 
Ali~n Num_~er·(~umero d:·~x:,tr~tro)_ - :De. __ le Nanie ~o~~J:~~~ peteni?,o):-: ·. ,_, . .,,- . 
-A t/_l 6 __. - 't-6 g _·::go iz,t ,; . -~A_ast Y· e-:1):r·~·~~t·.,cy:1.fs.tN~i;.'!lfof~~~.Pmp~fO) 
.· ,,. ' . , . , · ' \ ·
1
~-::1, '' ~a V' l ~.W-·~~~~1\-~ '. 
Living Unit Bunk Numbe~ Dat, _·(Fecha): Nationijity {Nacionali'aad): ... 
(Doijnitdrio):' '· (Numbre Iitera): . · / · 
D _ 1· 1. £. If. 0
£.01 F g_(!) SS IA , : l ,>~ 
Note: foc·orrect or incomplete' iofonriation ·wil,,r~su)t in 110·!~spon{e_;m~ tb.i retu(ii'.Qf. this foiin:.. ·. 
• ·Informacion que·esta•incorrecta o il)£9mpleta-no recibifa una respuesta la,vuelta·de est,;i forma;· 
Type of-~eques~: [ ] ICE (~,:on) [ _ ] MaJ(C~~eo) . [ ] Property (P~opiedad) . 
l ] E~e;gercy Phone Call ;(J;:i~~rg~ncia, Telefdn.9) ... [. ] Rec're~~i9r (Re~r~:aciqn)_. I. . 
[ :_ l Finance (Diil~ro). [ 1·wo~k Requ~st '(Trabajo:Soicitaci9n) . [ ){J B¥ber (B~b~r~)-
[ . l Cori,.mtss,aty. ((;!:n~misar~). [ . .-tG.(<1-ss1fi~atj?~-~ppe~'(Cl~~~W:¢aciqn) .-_·. . · .. · 
'[ -. ] Fooa (Comida) .. [. ] Notary (Notruio) [ ] Copies:(-C&pi4sf. [ l Q'Qi~r (9tr,~),_ I , ·• 
[ ] R~l-~~~us Diet/ C_ommon Fare (Dieta Religiosa /.Precio Comun) [ ] Chaplait_r (Cap~Uan) 
. .s 11..o (?. . _I :-\.(i"O 5 ,. ·.·. 
In Joo~,-... peopl~ .. --~o, 
'. . I ~ • 
. •. ;. :.~·· 
·--.. :;: 
I 
. . I _________ "-~...,- '-'--,-----------,-----;;,__-----,------•...,,.-,·_= -:---,/(~:/)/~:'.;.;::: l 
~--------------,--·.:·.·>:-:-._::~::_..-: l 
-,-- -,;-. . .· I 
IVED 
. !AN 2 5· 2018 .D~t~n.Y. Signatrir,~ ..(F'.innal)~ten1do) 
Resp·Qn~--~~. _.a..,_'---'--~--..:..-:.- .. ~ . .:...__ ____ ,,_·_·---,-.-----=----.,...-----,----.,...-----,--
. '' 
~~~~,, • r.~ ,.:, • ... . -
• • 'Original - Detainee Response 
KITEOOl 
/. 
( 
; 
: Copy- Detainee Rle Copy Responder-File Copy 
2019-ICLl-00051 3756 
Date· 
102710 
'•,. 
j 
:1 
I 
i 
I 
I 
i 
I 
I 
I 
1'j 
I 
' 
DHS-ICE-19-0196, 19-0197-O-000440

(b)(6); (b)(7)(C) 
Request 
ProflJe Photo: f ;,-.r• Detainee Info 
Name: Mergensana Amar 
Booking Number: 216269802 
Submitted Date: 01/05/18 20:51 
Submitted from Location/Room: 1117B/Bl 
Current Location/Room: 1117B/Bl 
Facility: Tacoma, Wa 
Form Info 
Category: GEO 
Form: Property 
Request Info 
Status: CLOSED by b)(6); (b)(7)(C) 
Faclllty Deadline: "------
Summary of Request: 
I need a helmet from my luggaje. 
Details of Request: 
What Is your request?: 
property requests only 
--· --
Help please. I need helmet from my luggaje, because I am feeling a lot of cold at the ears. 
01/06/18 09:46 (b )(6); (b )(7)(C) Changed Status From 'Open' to 'Closed' 
01/06/18 09:22 Staff Response no personal hats allowed. 
01/05/18 20:Sl Submitted New I need a helmet from my luggaje. 
2019-ICLl-00051 3757 
DHS-ICE-19-0196, 19-0197-O-000441

Request t(blC5>; CblC7HcJ 
Profile Photo: T" Detainee Info 
Name: Mergensana Amar 
Booking Number: 216269802 
Submitted Date: 01 /05/18 20:51 
Submitted from Location/Room: 11178/81 
Current Location/Room: 11178/B 1 
Facility: Tacoma, Wa 
Audit Photo: 
Fonn Info 
Category: GEO 
Form: Property 
Request Info 
Status: CLOSED b (b)(6); (b)(7)(C) 
Facility Deadline: 01 10/18 15:59 
Summary of Request: 
I need a helmet from my luggaje. 
Details of Request: 
What is your request?: 
property requests only 
Help please. I need helmet from my luggaje, because I am feeling a lot of cold at the ears. 
01/06/18 09:22 Staff Response no personal hats allowed. 
01 /05118 20:51 Mergensana Amar Submitted New I need a helmet from my lugga]e. 
2019-ICLl-00051 3758 
DHS-ICE-19-0196, 19-0197-O-000442

2·58763 
I \l'OR:THWEST DETENTION CENTI , L---_, "'-:- Evidence / Search Report 
• I 
I 
I 
! 
' i--------,---------------+--_.:.._-....:..J-_-t---l-----1-~ j 
D0009-NCR ·03/18/13 . · 
2019-l©tt~u i= 3759 
DHS-ICE-19-0196, 19-0197-O-000443

Commissary- #2,424,169 
From: MERGENSANA AMAR (216269802; NA) Date Submitted: 12/20/2017 7:19 AM 
Housing Area: Bl Date Received: 12/21/2017 10:46 AM 
Assigned To: Finance Status: CLOSED 
Urgent: No 
Re uest 
Original Request ... 
hi good morming commisary can.t login plaese reset face photos 
Note by Mst~i~/~,_, Ion 12/21/2017 at 10:56 AM 
I have sent a message to Taltonff elemate. This request will remain open and I will let you know 
what when I get a reply from them. 
Response by Ms{~l~lcq ~n 12/21/2017 at 12:30 PM 
This is the response that I received, if you would like your pin number changed, please send a 
separate request. 
Talton's reply: 
"Resetting facial verification is not available at this time. Please make sure you are in a well-lit 
area when you are attempting to log into the tablet. Please also be sure to check your pin number 
and that it is being entered correctly." 
Printed on 12/22/2017 at 6:46 AM Page 1 of 1 
2019-ICLl-00051 3760 
DHS-ICE-19-0196, 19-0197-O-000444

VOL 1 -- 'ER WORK PROGRAM AGREE!\ ~T 
1. In order to have a job, you must complete a physical. 
2. Detainees that participate in the Volunteer Work Program are not permitted to work in excess of 8 
hours daily, or 40 hours a week. Scheduled days off will be assigned and taken. 
3. Detainees are required to work when scheduled and participate in all work-related training. 
4. Unexcused absence, unsatisfactory work performance, or participation in a serious infraction, e.g. 
fighting, is cause for removal from a work assignment. Workers are expected to be ready for work 
at the required time. 
5. Theft or possession of contraband obtained as an opportunity of a work assignment is cause for 
removal from a work assignment. 
6. Detainees must adhere to all safety regulations and to all medical and grooming standards associated 
with a work assignment. 
7. Compensation shall be $1.00 per day. 
8. Primary factors that impact hiring are classification level, attitude, behavior, and physical ability to 
perform the job. 
9. Volunteering detainees will not be denied work based on race, religion, sex, physical or mental 
handicaps or national origin. 
SAFETY BRIEFING 
I. Personal Protective Equipment (PPE) i.e., gloves, protective eye wear, must be used when required 
by Safety Data Sheets to avoid eye or skin injury or irritation. 
2. Before using/ operating any equipment, you must be trained in its use and safe operation. 
3. Before using/ handling chemicals, you must receive information from the Safety Data Sheet (SDS) 
for that product and be trained in its use. Training will be conducted in accordance with OSHA 
HAZARD COMMUNICATION STANDARD, 29 CFR 1910.1200. 
4. If chemicals get in your eyes, flush with water. Notify an officer. He/she will get you to medical 
attention immediately. 
5. If chemicals get on your skin, flush with water. Notify an officer. He/she will get you to medical 
attention immediately. 
6. If you inhale chemical fumes that cause you respiratory distress, notify an officer. Re/she will get 
you to medical attention immediately. 
7. When lifting objects, bend at the knees, keeping your back straight and face the object squarely. 
Keep your head and eyes looking forward as you lift. Keep the object close to your body to maintain 
your center of gravity and reduce the strain on your back. If objects are heavy, do not lift them 
alone. Get help. Notify your supervising officer that you need help. Do not lift the object by 
yourself. 
8. When handling heavy, rough or sharp objects, wear the sturdy work gloves that are provided. 
9. When cutting weeds, vines or bushes, wear the safety eyewear and gloves that are provided. 
10. Kitchen workers assisting with the serving of food must wear a hair net, a beard net (if you have a 
beard), white uniform, appropriate footwear and plastic/ rubber gloves. 
11. To stop the spread of colds, flu and other diseases, do not go to wo rk if you are sick. Wash your 
hands with soap and water before reporting for work. Do not touch hands with other detainees while 
working. Wash your hands immediately after handling unclean objects. Change your gloves 
immediately if they become contaminated. 
Your safety is our highest priority. Please ask for the safety equipment if it is not immediately provided for 
your detail. We thank you for your important contribution to maintaining this facility. 
I, AMAR __ ___, A# 216269802 have read, 
understand, and agree to comply with the above listed rules, regulations, and safety requirements. I have 
received and understand safety training regarding my work assignment. I am volunteering to work and I 
have ~ot been threatened, coerced or intimidated into participation. 
/ t~~ 12/19/2017 
✓ ~etainee Signature) (Date) 
t Page 1 of 6 
2019-ICLl-00051 3761 
DHS-ICE-19-0196, 19-0197-O-000445

-.vortihwesti Detiention Cef'ttier 
Acknowledgementi ofi Free Five Minutie Telephone Call 
Reconocimientio de llamadas tielefi6nicas gratiuitias de cinco 
minutios 
hereby acknowledge tihati I have been notified tihati iti is m, 
responsibilitiy tio notifiy fiamily members oft my location ifi I so desire. 
understiand tihati I will be provided witih one firee phone call on tihe Taltic 
Communications phone systiem. 
Por la presentie rEEonozco que he side notificado de que es mi 
responsabilidad de notificar a los miembros de la fiamilia de mi locaci6n si 
asi lo deseo. Entiendo que se me proporcionara una llamada tielefi6nica 
gratiuitia en el sistiema tielefi6nico Taltion Comunicaciones. 
Last Name: AMAR 
First Name: MERGENSANA 
ID#: 216269802 
12/19/2017 
Date/Fecha 
12/19/2017 
Date 
Page4of6 
2019-ICLl-00051 3762 
DHS-ICE-19-0196, 19-0197-O-000446

;z:-.,,.. c, ti q,1 .J· u1v 
;hS--1</ 
2019-ICLl-00051 3763 
(b)(6); (b)(7)(C) 
Kb)(6); I 
kb)(7)(C) 
DHS-ICE-19-0196, 19-0197-O-000447

1 
2 
3 
4 
5 
6 
7 
8 
Case 3:18-mc-05016-BHS Document 4 Filed 09/06/18 Page 1 of 3 
The Honorable Judge Benjamin H. Settle 
UNITED STATES DISTRICT COURT FOR THE 
WESTERN DISTRICT OF WASHINGTON 
AT TACOMA 
9 IN THE MATTER OF: NO. 3:18-mc-05016-BHS 
EMERGENCY EX PARTE MOTION 
TO PROVIDE INVOLUNTARY 
MEDICAL TREATMENT 
lO MERGENSANAAMAR 
11 File No. A216-269-802 
12 
13 
14 The United States Department of Homeland Security, Immigration and Customs 
15 Enforcement (hereafter "ICE"), by and through the United States Attorney for the Western District 
16 of Washington, has filed an ex parte motion for an order permitting ICE to immediately provide 
17 involuntary hydration and medical treatment for Mergensana Amar, No. A2 l 6-269-802, who is 
18 
currently being held as a civil detainee at the Northwest Detention Center in Tacoma, Washington. 19 
20 Based on the declarations of Dr. Shei Malakhova and Supervisory Detention and Deportation 
21 Officer Tim Petrie, the Court finds that there is sufficient cause to believe that without the requested 
22 
23 
24 
medical testing and treatment, Mr. Amar is in danger of irreparable injury, and possible death. 
Therefore, IT IS HEREBY ORDERED that ICE may undertake necessary medical treatment 
25 and testing to save Mr. Amar's life and prevent injury to him, including: 
26 
27 
28 
1. 
2. 
involuntary hydration through administering intravenous (IV) fluids; 
physical examination with daily weight assessments and frequent vital sign checks; 
ORDER GRANTING EMERGENCY EX PARTE MOTION 
TO PROVIDE INVOLUNTARY MEDICAL TREATMENT- I 
2019-ICLl-00051 3764 
UNITED ST A TES A HORNEY 
120 I PACIFIC AVENUE, SUITE 700 
TACOMA, WASHING TON 98402 
(253) 428-3800 
DHS-ICE-19-0196, 19-0197-O-000448

1 
2 
3 
4 
Case 3:18-mc-05016-BHS Document 4 Filed 09/06/18 Page 2 of 3 
3. laboratory tests at least every 48 - 72 hours consisting of: 
a. Complete metabolic panel. This test reveals an increase in markers of kidney 
function in view of any renal injury. The panel tests include: BUN (blood urea nitrogen), creatinine 
5 level, urinalysis and proteins. It also reveals electrolyte disturbances as potassium, phosphate, 
6 magnesium and glucose levels can lead to heart arrhythmias. 
7 b. Complete blood count. This test reveals the hemoglobin level. 
8 
c. Urinalysis, which reveals the presence of ketones, blood and crystals in the 
9 
10 
urme. 
11 d. Magnesium and phosphate levels to assess deficiency after day 13 of a hunger 
12 strike. 
13 e. Electrocardiogram, if the patient shows elevated potassium, is necessary to 
14 
15 
treat conditions which can lead to lethal arrhythmias. 
16 f. Creatine kinase (CK) levels determine whether CK levels increase. CK is an 
17 enzyme found inside muscle cells and should be measured as it is released into the blood, when the 
18 muscle cells rupture. The increase in CK as a result of the destruction of muscle tissue can lead to 
19 
20 
21 
acute renal failure and death. 
g. Pre-albumin levels. Pre-albumin is used as a marker for nutritional status 
22 evaluation, and levels will decrease over time the longer a patient fails to consume adequate 
23 nutrition. The pre-albumin level con-elates with patient morbidity and mortality risk. Normal pre￾24 
albumin is 15-35 mg/dL. When pre-albumin falls to 5-1 lmg/dL, significant morbidity risks exist 
25 
26 and aggressive nutritional support is necessary. 
27 IT IS HEREBY FURTHER ORDERED that if Amar continues to refuse the necessary 
28 medical treatment and monitoring, ICE and medical staff at the Northwest Detention Center may use 
ORDER GRANTING EMERGENCY EX PARTE MOTION 
TO PROVIDE INVOLUNTARY MEDICAL TREATMENT-2 
2019-ICLl-00051 3765 
UNITED ST A TES A HORNEY 
120 I PACIFIC AVENUE, SUITE 700 
TACOMA, WASHING TON 98402 
(253) 428-3800 
DHS-ICE-19-0196, 19-0197-O-000449

Case 3:18-mc-05016-BHS Document 4 Filed 09/06/18 Page 3 of 3 
1 soft medical restraints to assure the safety of Amar and the medical staff when administering the 
2 necessary treatment. 
3 
4 
5 
6 
ICE is directed to provide a copy of this order to Mr. Amar forthwith. 
Dated this 6th day of September, 2018. 
7 
8 
9 
10 
11 
12 
13 Presented by: 
14 
15 ANNETTE L. HA YES 
16 United States Attorney 
17 /s/ Lisca Borichewski 
18 
LISCA BORICHEWSKI 
Assistant United State Attorney 
19 700 Stewart Street, Suite 5220 
Seattle, WA 98101 
INH. SETTLE 
United States District Judge 
20 Telephone: (206) 553-7970 
21 Fax: (206) 553-4073 
E-mail: lisca. borichewski@usdoj.gov 
22 
23 
24 
25 
26 
27 
28 
ORDER GRANTING EMERGENCY EX PARTE MOTION 
TO PROVIDE INVOLUNTARY MEDICAL TREATMENT- 3 
2019-ICLl-00051 3766 
UNITED ST A TES A HORNEY 
120 I PACIFIC AVENUE, SUITE 700 
TACOMA, WASHING TON 98402 
(253) 428-3800 
DHS-ICE-19-0196, 19-0197-O-000450

November 21, 2018 
MEMORANDUM FOR: l(b)(6); (b)(7)(C) I 
Assistant Field Office Director 
THROUGH: b)(6); (b)(7)(C) 
Office of E1,force111e111 and Remol'(I/ Operations 
tl.S. Dcparlmcnl or llomcland Security 
1623 fa1st J Street Suite 2 
Tacoma. WA 98421 
U.S. Immigration 
and Customs 
Enforcement 
Supervisory etention and Deportation Officer 
FROM: b)(6); (b)(7)(C) b)(6); (b)(7)(C) 
SUBJECT: Mergensana AMAR/ Alien Registration 
On November 15, 2018 at 1117 hours, I was asked via email by Supervisory Detention and 
Deportation Officerfbl(6); (b)(7)(C) lfl had talked to detainee Mergensana AMAR, with Alien 
Registration No. 216269802, regarding his removal from the United States. I replied to SDDO 
(b)(6); mt I had not disclosed to AMAR of his scheduled removal date. 
/h\/7\/1.\ 
At 1216 hours, I was instructed via email by SOD )~\)~\; .. , to talk to AMAR as soon as possible 
and to let him know that he is being removed from the United States. Soon after receiving the 
email, she reminded me once again in-person to talk to AMAR thus explaining that he would be 
removed from the U.S. 
At the first opportunity, l proceeded to the segregation dormitories (H-Unit) to talk to AMAR, where 
he was currently housed. When I arrived at H-unit, I instructed GEO officers to open the door to the 
room in which AMAR was being housed. AMAR was then placed in handcuffs as standard 
procedure when transferring a detainee outside their room while in segregation. I acknowledged 
AMAR by verbally stating his name and he replied by nodding. I then instructed him to follow me 
into the supervisor's office within (H-unit). 
At the interview, I used an ERO Language Services interpreter via telephonel<bl( 5l; (b)(?)(C) !Reference 
No.!(b)(6); (b)(7)(C) ~ the Russian language. Before asking any questions to AMAR, I asked the 
interpreter to communicate with the detainee so that l could make sure they both understand each 
other. The interpreter communicated with AMAR and his response indicated they understood one 
another. I then proceeded with the interview and introduced myself to AMAR as the officer 
currently in charge of his case. 
During the interview, I asked AMAR if he knew the status of his immigration case and if he was up￾to-date with the most recent decision. AMAR replied that he had not received any update on his 
2019-ICLl-00051 3767 
DHS-ICE-19-0196, 19-0197-O-000451

case. I then informed AMAR that ICE had received notification of his case appeal decision from the 
Board oflmmigration Appeals. 1 told AMAR that the BIA had dismissed his case appeal and was 
now a final order of removal. Furthermore, that arrangements would take place to proceed with his 
removal from the United States to Russia. AMAR replied that he cannot return to Russia because he 
was afraid. 
I reminded AMAR that his case was adjudicated with the immigration court and that an immigration 
judge had rendered a removal order, and that he did appealed the decision of the Immigration Judge 
with the Board oflmmigration Appeals. However, the result was that the BIA had dismissed his case 
and that I had to proceed with his removal. I explained to AMAR that as an immigration officer, had 
no decision on the result of his case. 
AMAR acknowledged that he understood. 
Furthermore, I asked AMAR ifhe would like to make a request for property to be sent to him by a 
family member. AMAR replied that he had no family in the U.S. Once again, I asked ifhe would 
like to make a request for property to be sent to him by a friend. AMAR replied that he had no 
friends in the U.S. 
The interview concluded, and l notified GEO so that AMAR could be escorted back to his housing 
unit. 
Following the interview, at the first opportunity, I notified SDDQ(b)(6); ~- ~hat AMAR had been 
informed in-person of his current case status and of future removal. That AMAR was disappointed 
with the news but, that he was aware and understood that he was being removed from the United 
States to Russia. 
ft b . fi SDD (bl<5 A er ne mg > h l ft h h d ffi d ld h (b)(?)(C) ort y a er, s e approac e me at my o ice an to me t e news 
that AMAR had made a smct e attempt and that it appeared to be a severe injury. I was very 
disturbed at hearing the news. 
2019-ICLl-00051 3768 
DHS-ICE-19-0196, 19-0197-O-000452

< 
. , CERTIFICATE OF DEA TJ+· • 11.IJJJ-JJI 
CERTFICATE NUMBE (b)(6); (b)(7)(C) 
FIRST AND MIDDLE NANE(S): MERGENSANA DABAEVICH 
(AST NAME(S): ~ 
COUNTY OF DEATH: PIERCE 
DATE OF DEATH: NOVEMBER 18, 2018 
HOUR OF DEATH: 02:45 PM 
SEX: MALE AGE: 40 YEARS 
SOCIAL SECURITY NUt.t3ER: UNKNOWN 
HISPANIC ORIGIN: NO, NOT SPANISH/HISPANIC/lATINO 
RACE: MONGOLIAN 
BIRTH DATE: OCTOIER ~ 1971 
' BIRTHPt.ACE: K~HA RUSSIA 
MARITAL STATUS: SINGLE, NEVER MARRIED 
SPOUSE: NOT APPLICABLE 
OCCUPATION: ENTREPENEUR 
INDUSTRY: BUSINESS 
EDUCATION: BACHELOR'S DEGREE 
US ARMED FORCES: NO 
INFORMANTfb)( 5; (b)(?)(C) J 
RELATIONSHIP: FAMILYACClOAINT CE 
ADDRESS: 340419TH AVES, SEATTLE, WA 98144 
CAUSE OF DEATH: 
.A: ANOXIC ENCEPHALOPATHY 
INTERVAL: • 
B: HANGING 
INTERVAL: • 
t: 
INTERVAL: 
D: 
INTERVAL: 
OTHER CONDITIONS CONTRIBUTING TO DEATH: 
DATE OF INJURY: NOVEMBER 15, 2018 
HOUR OF INJURY: 03:06 PM 
INJURYATWORK: NO 
.... 
t> 
PLACE OF INJURY: INSIDE CELL AT ICE NORTHWEST DETENTION 
CENTER 
LOCATION OF NJURY: 1623 EAST J STREET 
CITY, STATE, ZIP: TACOMA, WASHINGTON 98421-1602 
COUNTY: PIERCE 
DESCRIBE HOW INJURY OCCURRED: HANGED HIMSELF WITH BED SHEET 
\/TRANSPORTATION IJURY, SPECFY: NOT APPLICABLE .. '
PLACE OF DEATH: HOSPITAL 
DATE ISSUED: 02'2812019 
FEE NUMBE~\~!\~/;_J 
FACILITY OR ADDRESS: ST. JOSEPH MEDICAL CENTER 
CITY, STA TE, ZJP: TACOMA, WASHINGTON 98405 
RESIDENCE STREET: 1123 E J STREET 
CITY, STATE, ZIP: TACOMA, WA 98421 
INSIDE CITY LIMITS: YES COUNTY: PIERCE 
TRIBAi.RESERVATiON: NOT APPLICABLE 
¥:Jf;GTH OF TIME AT RESIDENCE: 11 YEARS 
FATHEIWARENT:,(b)(6); (b)(7)(C) 
MOTHER/PARENT L-----------~ 
~THOD OF DISPOSITION: CREMATION 
PLACE OF DISPOSITION: SOUTH SOUND CREMATORY 
CITY. $TATE: LACEY, WASHINGTON 
DISPOSITION DATE: DECEMBER 11, 2018 
FUNERAL FACILITY: FUNERAL ALTERNATIVES OFWASHINGTON· 
FEDERAL WAY 
ADDRESS: 31919 6TH AVES, STE 200 
CITY, STATE, ZJP: FEDERAL WAY, WASHINGTON 98003 
FIJNEAAL DIRECTOR: (b)(6); (b)(7)(C) 
MANNER OF DEATH: SUICIDE 
AUTOPSY: YES 
WERE NlfOPf;f FN>INGS AVAILABLE TO COf.f>LETE 
CAUSE OF DEATH: YES 
DID TOBACCO USE CONTRIBUTE TO DEATH: NO 
PRE~Y STATUS IF FEI.W..E: NO RESPONSE 
CERTFIER N.6ME: (b)(6); (b)(7)(C) , Ill 
TITLE: CORONE'..._..-------~ 
CERTIFIER ADDRESS: 3819 PACIFIC AVENUE 
CITY, STATE, ZIP: TACOMA, WA 984187929 
DATE SIGNED: NOVEMBER 26, 2018 
CASE REFERRED TO ME/CORONER: NO 
FILE NUMBER:~b)(6); I 
ATTENDING PHYSICIAN: NOT APPLICABLE 
. . 
DHS-ICE-19-0196, 19-0197-O-000453

A Pierce Countv ~ Medical Examiner'~~;ce 
3619 Pacific Avenue 
Tacoma, Washington 98418 
rb)(6); (b)(7)(C) 
A:216269802 
l(b)(6); (b)(7)(C) IMD 
Medical Examiner 
!(b)(6); (b)(7)(C) !D 
CONFIDENTIAL INFORMATION Associate Medical Examiner 
THIS COPY IS INTENDED FOR Medical J~!,;~~.(~~~;:!s 1V1a11age1 
ATTENDING PHYSICIAN 
ACCESS ONLY 
PER RCW 68.50.105 
POSTMORTEM EXAMJNATION REPORT 
MEDICAL EXAMINER CASE #: 
NAME OF DECEASED: 
DATE OF EXAMINATION: 
LAW ENFORCEMENT AGENCY AND CASE#: 
CAUSE OF DEATH: 
MANNER OF DEA TH: 
(b)(6); (b)(7)(C) 
Mergensana Dabaevicb A.mar 
November 26, 2018 
Tacoma Police Department 
18-319-01418 
Anoxic encephalopathy due to banging 
Suicide 
CERTIFIED COP 
g/FNFIDQDllil~'TIAL 
E ,ntv~TION R Rew 68.S0.10 
EX~ 
2019-ICLl-00051 3770 
DHS-ICE-19-0196, 19-0197-O-000454

A:216269802 
FINAL DIAGNOSES: 
Abrasion of the neck. 
Respirator brain. 
Acute bronchopneumonia and bronchitis, widespread. 
Fatty change of the liver, severe. 
OPINION: 
18-2308 
MERGENSANA DABAEVICH AMAR 
CONFIDENTIAL INFORMATION 
THIS COPY IS INTENDED FOR 
ATTENDING PHYSICIAN 
ACCESS ONLY 
PER RCW 68.50.105 
This 40-year-old man-was found hanging in his locked cell at the Northwest Detention Center. 
He was resuscitated, and regained circulation, but never showed any neurologic response. He 
was pronounced brain dead on the third hospital day, and extubated_. 
Autopsy examination shows an abrasion of the neck consistent with the history. Anatomic 
findings include brain autolysis consistent with prolonging circulation following brain death, 
fatty change of the liver, and widespread pneumonia, likely the result of aspiration. Toxicology 
testing is negative for alcohol and other drugs. 
Death is due to anoxic encephalopathy secondary to hanging. 
(b )(6); 
· (b)(7)(C) 
Medical Examiner 
:Z 2- -fr S :Pl 1 
Date 
2 
2019-ICLl-00051 3771 
CERTIFIED COPY 
CONFIDENTIAL 
INFORMATION 
ER RCW 68.50.10 
DHS-ICE-19-0196, 19-0197-O-000455

A:216269802 
EXTERNAL EXAMINATION: 
18-2308 
MERGENSANA DABAEVICH AMAR 
The decedent is received in a body bag clothed only in a hospital gown. He is 66 in. tall and 
weighs 160 lbs. The hair is brown. The eyes are brown with jaundiced sclera. The teeth are 
natural. Rigor is not detectable. Livor is purple and posterior. The body is cold. 
There is evidence of medical intervention. There is a two-lumen central line in the right arm. A 
foley catheter is present. There are punctures and bruising in the left antecubital fossa. There is 
a purple bruise on the posterior left forearm consistent with _an attempted vascular access. 
There are multiple healing rounded lesions on the anterior abdomen, right side greater than left. 
There is a scar on the left knee. 
Injuries: 
There is a band of brown discoloration around the front and both sides of the neck. It is faint, 
approximately 1/4-in. in average width. It cants upward on both sides of the neck as it proceeds 
backward. The discoloration is more prominent on the left than the right side of the neck. 
There is no internal injury of the neck. 
There is faint discoloration of the right periorbital region, possibly representing a bruise. 
INTERNAL EXAMINATION: 
Body Cavities: 
The serosal surfaces are smooth and glistening. Approximately 600 cc of blood-tinged fluid are 
present in the right chest cavity. Approximately 100 cc of blood-tinged fluid are present in the 
left chest cavity. The abdominal cavity contains approximately 50 cc of clear, straw-colored 
fluid. 
Head: 
The scalp does not have evidence of injury. The skull is intact. The brain weighs 1640 g. The 
meninges are thin and delicate, with no evidence of inflammation or hemorrhage. The brain 
itself is soft and discolored consistent with respirator brain. 
Neck: 
The hyoid bone is not fused but not fractured. There is no associated hemorrhage. There is no 
hemorrhage of the strap muscles. The larynx is clear. The thyroid gland is of the usual size and 
configuration. 
3 
2019-ICLl-00051 3772 
DHS-ICE-19-0196, 19-0197-O-000456

A:216269802 
Cardiovascular System: 
18-2308 
MERGENSANA DABAEVICH AMAR 
The heart weighs 390 g. The coronary arteries arise in the usual locations. There is a short 10% 
concentric lesion of the left anterior descending artery and no other significant atherosclerotic 
disease. Serial sections of myocardium do not show evidence of acute nor old infarction. The 
valves are normally formed. The descending aorta is intact and does not have significant 
atherosclerotic disease. 
Respiratory System: 
The right lung weighs 1120 g, left lung weighs 1290 g. The lungs are firm and noncompliant 
with diffuse patchy light discoloration. Sections of both lungs sink when placed into formalin. 
Liver, Gallbladder, Pancreas: 
The liver weighs 1920 g. It is light in color. The gallbladder contains liquid green bile. The 
pancreas is unremarkable. 
Spleen and Lymph Nodes: 
The spleen weighs 260 g and is unremarkable. There are no prominent lymph nodes. 
Genitourinary System: 
The right kidney weighs 200 g, left kidney weighs 220 g. The kidneys are normally formed and 
do not have focal lesions. The bladder contains 6 cc of urine. The bladder mucosa has multiple 
punctate hemorrhagic lesions consistent with a foley catheter. The prostate is unremarkable. 
Endocrine System: 
The adrenal glands are autolyzed. 
Digestive System: 
The gastrointestinal tract is intact. The stomach contains 70 cc of liquid. An appendix is present 
and unremarkable. 
Musculoskeletal System: 
There is a sternal fracture consistent with resuscitative efforts. 
Toxicology: Specimens are subqritted for toxicologic analysis. A separate report will be issued. 
Histopathology: Sections are submitted for microscopic analysis. 
Block 1 contains: heart and right lung. 
Block 2 contains: left lung and liver. 
Block 3 contains: kidney and brain. 
4 
2019-ICLl-00051 3773 
DHS-ICE-19-0196, 19-0197-O-000457

A:216269802 
MICROSCOPIC EXA.l\UNATION: 
18-2308 
MERGENSANA DABAEVICH AMAR 
Heart: There is no evidence of acute nor old infarction. 
Lung: Sections of lung show diffuse alveolar damage with widespread acute bronchitis and 
bronchopneumonia 
Liver: There is a severe degree of fatty change. 
Kidney: No pathologic diagnosis. 
Brain: Autolyzed. 
TBC: aa 
Dictated: 11/26/2018 
Transcribed: 11/26/2018 
Finalized: 02/20/2019 
RETENTION: 
Blood, body fluids, tissues, and physical/trace materials that may be collected (the exact samples vary by case) 
during the examination are routinely held in accordance with our retention policy prior to biohazard disposal, unless 
transferred to a laboratory or other agency by the Medical Examiner's Office, or otherwise released by special 
arrangement. 
5 
2019-ICLl-00051 377 4 
DHS-ICE-19-0196, 19-0197-O-000458

... A:216269802 
Attention: Dr. l<bl(5l; (bl(7J(C) 
TOXICOLOGY LABORATORY 
WASHINGTON STATE PATROL 
2203 Airport Way South Suite 380 Seattle, WA 98134 
(206) 282-6100 FAX No. (208) 282-6145 
TOXICOLOGY TEST REPORT 
Agency: Pierce Co Medical Examiner 
Address: 3619 Pacific Ave 
Tacoma, WA 98418-7929 
Tox Case#: l(b)(6J; (b)(7J(Cl I Case Type: Death Investigation Report Date: 2/12/2019 
Agency Case#: l(b)(6); I 
llh\17\lr.\ Subject Name: Amar Mergensana 
Evidence: The following evidence was submitted to the Laboratory b*b)(6); ~-
Examiner on 11/29/2018 via USPS-1st Class Mail: 
jot the Pierce Co Medical 
(1) ST-18-14358-A: VPink, Blood- Hospital 
Volatile Analysis Results: 
ST-18-14358-A: Blood. Hospital 
ST-18-14358-Awas tested by Headspace -Gas Chromatography for the presence of acetone, ethanol, 
isopropanol, and methanol on 01/31/2019. The following result was obtained: 
None Detected 
Drug Analysis Results: 
ST-18-14358-A: Blood - Hospital 
ST-18-14358-A was tested by Enzyme Multiplied Immunoassay Technique (EMITI for the presence of 
amphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine metabolite, and opiates on 
01/04/2019. The following result(s) was obtained: 
None Detected 
(test conducted by !(bl(6l: (bl(7l(Cl forensic Scientist 2) 
COMMENTS 
All testing was performed by th1J Forensic Scientist listed b1Jlow except as oth1Jrwis1J indicatfJd. The Forensic 
Scientist has technically revilJwed al/ re/fJvant pages of testing documentation in the case record. 
Examined by: Reviewed by: 
1~)(6); (b)~)(C) 
Forensic Scientist 1 
Date: 02. I.Ji._ t 2019 
l
(b)(6); (b)(7)(C) I. 
_______._ ____.r 
~:;:we)- ,J}_ _l V\_ ID) rn ® rn O W ~ ® 
ill FEB 1 9 20i9 ~ 
[R1.0-20160614) Page 1 of 1 I IIIII II 111111111111111 
Reque$//D: ST-18-14358-0001 
2019-ICLl-00051 3775 
DHS-ICE-19-0196, 19-0197-O-000459

Tacoma Police--Dipa-rtment-----,-n-c-id_e_n_t_N_o_. -18_3_1_9_0_1_4_1_8_.2 ________ Page 1 of 3 ; 
Supplemental Report Jurisdiction Agency: Tacoma Police Department ~-·-----j 
. ----------,--,----,-------,---::-""7""-------:=-:--;---:---:------:-::--:-----:--:-------------- PDA: Homeland Security: Subject: Attempted Suicide 
IBR Disposition: Active 
Forensics: 
Case Report Status: Approved 
Related Cases: 
Case Report Number 
Non-Electronic Attachments 
Attachment Type 
Location Address: 1623 E J St 
Agency 
City, State, Zip: Tacoma, WA 98421 
Contact Location: 
Recovery Location: 
CB/Grid/RD: 180 - Tacoma 
Case Management 
Disposition: ~------------, 
Reporting By/Date: b)(B); (b)(?)(C) 11/15/2018 20:11 :40 
Reviewed By/Date: 1/15/2018 20:31:59 
Additional Distribution 
Location Name: ICE NW DETENTION CENTER 
Cross Street: 
City, State, Zip: 
City, State, Zip: 
DistricVSector: TA 14 - Tacoma 
Occurred From: 11/15/2018 14:45:00 Thursday 
Notes: 
Occurred To: 11/15/2018 15:06:00 Thursday 
Offense Details: 0805 - Suicide - Attempted 
Domestic Violence: No Child Abuse: Juvenile: 
Count 
Completed: Completed 
Criminal Activity: 
Gang Related: No/Unknown 
Crime Against: Hate/Bias: None (No Bias) 
Using: 
Location Type: Corrections Facility/Jail 
Total No. of Units 
Entered: 
Entrance 
Compromised: 
Entry Method: 
Suspect Description: 
Suspect Actions: 
Notes: 
Other Entity 01: Amar, Mergensana 
' Aliases: 
DOB: 10/23/1978 Age: 40 
Height: 5' 2" Weight: 150 
Address: 1623 E J St 
Type of Security: 
Evidence Collected: 
Sex: Male Race: Asian/Pacific 
Hair Color: Black 
County: 
Islander 
Tools: 
PDA: 
Ethnicity: Non-Hispanic 
Eye Color: 
Phone: 
Call Source: Assisted By: (b)(6); (b)(?)(C) 
Phone Report: 
Insurance Letter: 
Entered On: 11/15/2018 19:54:58 
Approved On: 11/15/2018 20:33:05 
Adult/ Juvenile Clearance: 
Additional Distribution: 
Validation Processing Distribution Date: 11/15/2018 
By: A UT OMA TED POLICY 
Notified: 
Entered By: 
Approved By: 
Exceptional Clearance: 
Exceptional Clearance Date: 
Other Distribution: 
County Pros. Atty. Juvenile 
City Pros. Atty. Military 
Records has the authority to ensure correct agency, CB/Grid/RD, and District/Sector are incorporated 
in the report. 
2019-ICLl-00051 3776 
Other 
DSHS 
CPS 
Pre Trial 
Supervisor: 
Printed: November 26, 2018 - 3:45 PM 
Printed B (b)(6); (b)(7)(C) 
DHS-ICE-19-0196, 19-0197-O-000460

Tacoma Police Department Supplemental Incident No. 1831901418.2 Page 2 of 3 
Report 
Jurisdiction Agency: Tacoma Police Department 
City, State Zip: Tacoma, WA 98421 
Other Address: 
Resident: Full - Time Resident 
SSN: 
Country: 
Occupation/Grade: 
Driver License No: 
Attire: 
Driver license 
State: 
gray sweatpants; white brief underwear 
SMT: 
Entity Type: Other Individual 
Entity Notes: 
Other Entit 04:(b)(5); (b)(?)(C) 
Aliases: 
DOB: Age: 00 
Height: Weight: 
Address: 1623 E J St 
City, State Zip: Tacoma, WA 98421 
Other Address: 
Reporting Statement 
Obtained: 
Sex: Male 
Hair Color: 
County: 
Country: 
Race: Unknown 
Resident: Nonresident Occupation/Grade: Detention Officer 
SSN: 
Driver License No: 
Attire: 
SMT: 
Entity Type: Other Individual 
Driver License 
State: 
Reporting Statement 
Obtained: 
Business Phone: 
Other Phone: 
Employer/School: 
Place Of Birth: 
Driver License 
Country: 
Complexion: Medium 
Facial Hair: Unshaven/Stubble 
Facial Shape: 
PDA: 
Ethnicity: Non-Hispanic 
Eye Color: 
Phone: (b)(6); (b)(7)(C) 
Business Phone: 
Other Phone: 
Employer/School: Northwest 
Place Of Birth: 
Driver License 
Country: 
Complexion: 
Facial Hair: 
Facial Shape: 
Detention Center I 
GEO 
Entity Notes: 
·-------------------------------------------·---·--·------·-·_i 
Other Entit 05 (b)(6); (b)(7)(C) 
Aliases: 
DOB: Age: 00 
Height: Weight: 
Address: 1623 E J St 
City, State Zip: Tacoma, WA 98421 
Other Address: 
Resident: Nonresident 
SSN: 
Driver License No: 
Attire: 
SMT: 
Entity Type: Other Individual 
Entity Notes: 
Other Entit 06: (b)(6); (b)(7)(C) 
Aliases: 
DOB: 
Height: 
Address: 
Weight: 
1623 E J St 
Age: 00 
Sex: Male Race: Unknown 
Hair Color: 
County: 
Country: 
Occupation/Grade: Detention Officer 
Driver License 
State: 
Reporting Statement 
Obtained: 
Sex: Male 
Hair Color: 
County: 
Race: Unknown 
2019-ICLl-00051 3777 
PDA: 
Ethnicity: Non-Hispanic 
Eye Color: ~~~~.,,..,....----, 
Phone: (b)(6); (b)(7)(C) 
Business Phone: 
Other Phone: ,__ _____ _., 
Employer/School: Northwest 
Place Of Birth: 
Driver License 
Country: 
Complexion: 
Facial Hair: 
Facial Shape: 
Ethnicity: 
Eye Color: 
Phone: 
Detention Center I 
GEO 
PDA: 
Non-Hispanic 
Printed: November 26, 2018 - J:45 PM 
PrintedB. b)(6); 
DHS-ICE-19-0196, 19-0197-O-000461

Tacoma Police Department Supplemental Incident No. 1831901418.2 Page 3 of 3 
Report 
Jurisdiction Agency: Tacoma Police Department 
City, State Zip: Tacoma, WA 98421 
Other Address: 
Resident: Nonresident 
SSN: 
Driver License No: 
Attire: 
SMT: 
Entity Type: Other Individual 
Entity Notes: 
lnvesti ative Information 
Means: 
Vehicle Activity: 
Country: 
Occupation/Grade: Detention Officer 
Driver License 
State: 
Reporting Statement 
Obtained: 
Motive: 
Direction Vehicle Traveling: 
Business Phone: j(b)(6); (b)(7)(C) Other Phone: L.. _____ ____. 
Employer/Schoof: Northwest 
Place Of Birth: 
Driver License 
Country: 
Complexion: 
Facial Hair: 
Facial Shape: 
Detention Center I 
GEO 
I 
I 
I 
_J 
. ·--··· _______________________________________ ____. 
Narrative: On 11 /15/18 at 1532 hrs I (Office (b)(6); patrol unit P250) arrived at incident address 1623 S J 
St, Tacoma, WA 9821 (NW Dete~tion Ce (b)(?)(C) cide attempt by 01/AMAR, MERGENSANA in cell 
Reviewed By: 
#106. Upon arrival, I waited at the south most gate of the facility and then followed TFD M-3 (which was 
leaving when I arrived) to St. Joseph's Hospital. 01 /AMAR was placed into trauma room #18. Arrival at St. 
Joseph's Hospital was 1541 hrs. 
01/AMAR was placed into the care of Dr l~/1~);,,_, nd the charge nurse was R (b)(6); (b)(?)(C) 
was informed that 01/AMAR had a heart rate but was not able to breath on his own. 
l(b)(6); _ Informed me that 01/AMAR would be laced into "ICU" (Intensive Care Unit) until he could be seen 
by neurologists to check for brain activity. R _b)(6);~- aid 01/AMAR is believed to be "brain dead." She 
stated they believed 01/AMAR to remain in his current condition and the neurologist might not be able to 
evaluate 01/AMAR until tomorrow. 
Upon looking at 01 /AMAR, I found no signs of trauma. I confirmed this by two of the medical 
personnel working on 01/AMAR, who said they had not seen any trauma on 01/AMAR's body. His clothing 
(gray sweatpants and white brief underwear) was removed. 01 /AMAR had on a "C-Collar" which medical 
staff said they would not take off for concern of a broken neck. Myself and one of medical personnel looked 
around and through the gaps in the "C-Collar" and found nothing on 01/AMAR's neck. 
N~ ?>etention Center sent two Detention Officers to guard 01/AMAR. They were Detention Officer 
Fbl(6l <bl(7l<Cl ) 6), . bnd Detention Office~(b)(6); (b)(?)(C) I They remained on scene after I left and stated 
there would be continue guard duty for 01/AMAR while 01/AMAR was at the hospital. 
Detention Officer~b)(6); ~- I via phone and through detainee records found that 01/AMAR had last 
eaten at 1100 hours andad not taken any medication since last week. He informed me that 01/AMAR was 
originally brought and detai ··yon 12/19/17 at 1105 hours. 01/AMAR was booked into the 
facility by Detention Office b)(6); (b)(7)(C) 
~~ _ _,_1--:;advised Officefb)(6); (b)(7)(C) rnd Sgt1L..(b_)(_6)_; (_bl_< 7)(C_) __ -'pf 01/AMAR'S condition. See Officer 
fo)(6); !general repor\: 101 101 u 1e1 ue,a11s. P-"~"~' . 
r)(6); (b)(7)(C) 
Reviewed Date: ! ____________________________________ _i 
Printed: November 26, 20 a...:.....wL2.J:::aa:..1. 
Printed 
2019-ICLl-00051 3778 
DHS-ICE-19-0196, 19-0197-O-000462

Tacoma -Poiice-Departinent Incident No. 1831901418.1 Page·1 of 3--i 
lncidentR __ e_,p_o_rt _________ J_u_ri_sd_i_c_ti_o_n_A_g_e_n_cy_:_T_a_c_o_m_a_P_o_l_ic_e_D_e_p_a_rt_m_en_t ___________ l 
PDA: Homeland Security: Subject: Attempted Suicide ·---~-~ 00 :::i r 
IBR Disposition: Active 
Forensics: 
Case Report Status: Approved 
Related Cases: 
Case Report Number 
Non-Electronic Attachments 
Attachment Type 
Location Address: 1623 E J St 
Agency 
City, State, Zip: Tacoma, WA 98421 
Contact Location: 
Recovery Location: 
CB/Grid/RO: 180 - Tacoma 
Case Management 
Disposition,...:~__,,...,.,,,,,.,..,.-,---------. 
Reporting By/Datel(b)(6); (b)(7)(C) 111/15/2018 21 :05:58 
Reviewed By/Date_ r/15/2018 21:18:02 
Additional Distribution 
Location Name: ICE NW DETENTION CENTER 
Cross Street: 
City, State, Zip: 
City, State, Zip: 
DistricVSector: TA14 -Tacoma 
Occurred From: 11/15/2018 14:45:00 Thursday 
Notes: 
Occurred To: 11/15/2018 15:06:00 Thursday 
Offense Details: 0805 - Suicide -Attem ted 
Domestic Violence: No Child Abuse: Juvenile: 
Count 
Completed: Completed 
Criminal Activity: 
Gang Related: No/Unknown 
Crime Against: Hate/Bias: None (No Bias) 
Using: 
Location Type: Corrections Facility/Jail 
Total No. of Units 
Entered: 
Entrance 
Compromised: 
Entry Method: 
Suspect Description: 
Suspect Actions: 
Notes: 
Type of Security: Tools: 
Evidence Collected: 
c...> Q_ .... a. 
co ct) 
Q:::I 
.... - ~z 
.... 0 
~-
.... 
I 
I ·----------------------------------------------·-' 
Other Entity 01: Amar, Mergensana 
j Aliases: 
DOB: 10/23/1978 Age: 40 
Height: Weight: 
Address: 1623 E J St 
Sex: Male Race: Asian/Pacific 
Islander 
Hair Color: 
County: 
PDA: 
Ethnicity: Non-Hispanic 
Eye Color: 
Phone: 
Call Source: Assisted By: fb)(6); (b)(7)(C) I 
Phone Report: 
Insurance Letter: 
Entered On: 
Approved On: 
AdulV Juvenile Clearance: 
Additional Distribution: 
Validation Processing 
11/15/201818:47:38 
11/15/2018 21:18:10 
Distribution Date: 11/15/2018 
By: AUTOMATED POLICY 
Notified: 
Entered By: 
Approved By: 
Exceptional Clearance: 
Exceptional Clearance Date: 
Other Distribution: 
County Pros. Atty. 
City Pros. Atty. 
Juvenile 
Military 
Records has the authority to ensure correct agency, CB/Grid/RD, and DistricVSector are incorporated 
in the report. 
2019-ICLl-00051 3779 
Other 
DSHS 
CPS 
Pre Trial 
Supervisor: 
Printed: November 26, 201 A • .1•A'- 0 11.1 
Printed Bv~b)(6); 
DHS-ICE-19-0196, 19-0197-O-000463

Tacoma Police Department Incident Incident No. 1831901418.1 Page 2 of 3 
Report 
Jurisdiction Agency: Tacoma Police Department 
City, State Zip: Tacoma, WA 98421 
Other Address: 
Resident: Full - Time Resident 
SSN: 
Driver License No: 
Attire: 
SMT: 
Entity Type: Other Individual 
Entity Notes: 
Country: 
Occupation/Grade: 
Driver license 
State: 
Reporting Statement 
Obtained: 
Business Phone: 
Other Phone: 
Employer/School: 
Place Of Birth: 
Driver License 
Country: 
Complexion: 
Facial Hair: 
Facial Shape: 
--·-·---------------------------------------
Other Entit 02: (b)(5); (b)(7)(C) 
Aliases: 
DOB: 6/29/1992 Age: 26 
Height: Weight: 
Address: 
City, State Zip: 
Other Address: 
Resident: Full - Time Resident 
SSN: 
Driver License No: 
Attire: 
SMT: 
Sex: Male Race: White 
Hair Color: 
County: 
Country: 
Occupation/Grade: secuty officer 
Driver License 
State: 
PDA: 
Ethnicity: Non-Hispanic 
Eye Color: 
Phone (b)(6); (b)(7)(C) 
Business Phone: 
Other Phone: 
Employer/School: Northwest 
Place Of Birth: 
Driver License 
Country: 
Complexion: 
Facial Hair: 
Detention Center 
Entity Type: Other Individual Reporting Statement Facial Shape: 
Obtained: I 
Entity Notes: ______________________________________ __J 
Other Entit 03 (b)(6); (b)(7)(C) 
Aliases: 
DOB: Age: 40 
Height: Weight: 
Address: 1623 E J St 
City, State Zip: Tacoma, WA 98421 
Other Address: 
Resident: Full - Time Resident 
SSN: 
Driver License No: 
Attire: 
SMT: 
Entity Type: Complainant 
[_ __ Entity Notes: 
lnvesti ative Information 
Sex: Male Race: White 
Hair Color: 
County: 
Country: 
Occupation/Grade: 
Driver License 
State: 
Reporting Statement 
Obtained: 
PDA: 
Ethnicity: Non-Hispanic 
Eye Color: 
Phone: r::(b...,.)(,.,,.6):-; (.,,..b.,..,,)(7"'")(""C,,.-)---, 
Business Phone: 
Other Phone: 
Employer/School: 
Place Of Birth: 
Driver License 
Country: 
Complexion: 
Facial Hair: 
Facial Shape: 
.__ ____ ___. 
---··--7 Means: Motive: i 
• Vehicle Activity: Direction Vehicle Traveling: J ------------------------···-··--
,-------,:=----,-----------------------------------------·-·--··--·- Synopsis: 
Narrative: (b)(6); I was dispatched to the listed address re; a suicide attempt at the Northwest Detention Center. © 
(b)(7)(C) alled 911 and reported that a detainee had hanged himself. CPR was in progress. Upon arrival, TFD 
Printed: November 26, 2018 - 3:45 PM 
'--------------------------------'-----------:..:Pr.~in:.:.te=::!d~S"'l(b)(6); (b)(7)(C) 
2019-ICLl-00051 3780 
DHS-ICE-19-0196, 19-0197-O-000464

Tacoma Police Department Incident Incident No. 1831901418.1 Page 3 of 3 
Report 
Jurisdiction Aaencv: Tacoma Police Department 
was on scene including Medic 1. Employees at the facility were video recording the paramedics. (0) Amar 
was transported to St. Joseph's hospital. PPq{b)(6); ~allowed the medic unit to the hospital. Sgt (b)(6); 
responded to the scene. 'k"..,""' 
(O~is an employee at the facility. He stated that he started his shift today at 1500 hours. He 
began conductifigchecks of the individual cells in the segregated protective unit. (0) Amar was alone in cell 
#106 which was locked. At 1506 (O)kb)(6); requested that cell #106 be opened. He observed (0) Amar 
seated on the floor inside the cell with his feet facing the door. He had something covering his head. He 
observed that there was a ligature around his neck. When the cell door opened, (OJ(bl(6l: ~nd another 
employee went inside and picked up (0) Amar to take the tension off the ligature. Another employee cut the 
ligature in two places. One cut was made near the bed frame corner of the top bunk where the ligature was 
attached. 
Forensics responded for photographs. There were two surveillance cameras in the area of cell 
#106. They were on each end of the corridor. Cell #106 was in between the position of the two cameras. 
There was a third camera on the second floor that may also have a view of the area. Forensics 
photographed the scene and collected evidence. Employees at the facility recorded forensics taking pictures 
and collecting evidence. The ligature was collected. It was in two pieces. One piece was on the floor near 
the door. The other was on the table inside the cell. The ligature appeared to be made of the same material 
as the bed sheet. It appeared to be similar in color and texture. The ligature appeared to be made of strips 
of the sheet fabric that was braided. The sheet from the bed was examined and photographed. There were 
documents inside the cell on the top bunk that appeared to be a copies of internal documents of the facility. 
It was titled; Evidence/Search Report. The report dated 11 /8/18 indicated that the bed sheet removed from 
the cell on that day had been ripped into thirds. It appeared that (0) Amar may have been collecting the 
fabric material since 11/8/18. 
~~-~:e-~i~w-e_d_B_y_: ----------------------------Re_v_ie_w_ed--Da-te_: _____ -_--_-_·--_-_-_--.Jl 
Printed: November 26, 2018,.:-..Jh.:.·hl..c:..a.LL. 
Printed B : (b )(6); 
2019-ICLl-00051 3781 
DHS-ICE-19-0196, 19-0197-O-000465

----t~b--X=6);:=:(b)(7=)(=C=) =======1 ----
----1--~ ~ ~~--~-?17·- ~- ~ 
--~s~-- --- -
____ ,.__:_~ -~~--- - v-J-t...-_ ~ ~ 
_ b)(6); (b)(7)(C) 
----- L----:--_____.Lve>Y, ~rJ - ~- - -
------1----.t"'-.u.,,~ ~~-.(_ -~ ~~-'c:_~--~~ 
---->-- -vt:-~-~- - - - -- - - -- - --
--4-~-~;-~--~~ ~~-~ -...t__L.v~ - -
_________ ~~------vi~_::::_ ~ bi¼_ ~ ~~ ~ "1... 
-------+---~~ ~ -=ii_ -~~~ ~ ~ ~-
-----..---~'i::'--_r\,..,_~dSL ___________ - - -- - -- -
-----~ ~ ~ ~~--4- ~ 0&~ ~ ..p-,·Lt~ -:::=/ u..2~ 
~-+- - /Y--(~ {o ~ I j;,i,J _,t,),v_~'-r -~. ~ --
~ ~-±__ ~_:jc-_~VV'...,... ~-c~ o'::'.:.'_::-'--_(...< ~ _AM _r7/[ 
~-~-~ ~ ~~-~ -lo ~74-·--- ~- ~ 
____ __, -~-~u_c.__f _ _.½_3-·~-L~f--....: .. - - - - - - -
-----1-d~ ~~- ~-~-&-~ ~::::-.A.."e.~ -I=-
---- l~-4(;~-'d-~-~?, ~ ~~-/ ~ ~s ~ :f- C-...c.. 
-------1-t_b_lo_~~------- -- - - ~--
-~-~--&~--f'-d- ~ ~--u..s ~~ 
-----1 ~~- - ------ - -- -- - - - -
------f-~~ _M~~~ ~ lJ-.- ~~·, ~ 
-L--~-~~ ~~~-&_~-0 ~~6-- _d---.! ~ ~- --
-----~~e_~_:1::__~-.A -~~<5--(_...,L-L ~. - - -
I _ (b)(6); (b)(7)(C) 
L---- ~-
.:::f>..__ 
- ~ 
, ~ 
- _-
. M 
-g· 
_J> ~ , 
-
!:' ~ 
- ~)(6);(b)(7)(C)\ -+-- ----~ -~ j!~ ri:--' -lo ~- 7- u}~_ 
~ ,,. (b)(6);(b)(7)(C) S:2..(j- ......., ~ ..J. ___ _ ,~-. 1 f:> -~-- b;;;,::..::v-7\/r\7--___.1 ,-- - -f -r - - -,-=:~_ ~ I- '-'-'f_ 
J b){6);(b){7)(C) L--&A~, ~ ~ J ~ • -,-.L,o4cs - '--_____ .]_~ ~-- -- - - ~- r_ ~~-
------ -------- - ---~---
°LOt9::ICU-0OO51- 3782 
DHS-ICE-19-0196, 19-0197-O-000466

I 
I ~(;__~ ~~ ~-1-{~ ..fa--pr.--~ 
.. ~~ ~n-+ ~ ~ ,,._:_~ ~/?~ ~ ~ 
~ J1..,,. fb)(6); (b)(7)(C) 1~1-~ .. . . d 
-~ ~-~+ ol<J ~ti~-¥ -- ,n,--,. iJ,v-'i; ,r-~, b,._,.,,/. 
~s ~ ~-~ p(,~·..-{ ~-
-~plfc:-~'==5~ ~ td ~ /4-r--n----> ~ bP s. ,sL,,,...,,u< .. A .. r' 
J 1 ~( ,,.,1 c,-p,e -- ~ ~~l.tg ~+- l,?A....-,.,,< ~--1-c:I 
I 
,. ,., _,\,¼...-,•l--c.JJ .J --h b' 
u 
- .... ~.:::1---1 A-•'.':-f'~~ I 4J~f"f ~- ""- ~ ~ ~-
~tJ£.--..~~~ ~ I ~ ~-ef I: +.....I- ~-...de 
7'1..,,-.,_ ~ ¼L trl- ---1./4 (7L...,,-~ 
,i-Q ~ 
v--.: --,..;._,,,_ - ~ L- / 
~ - ...,,._A,~ ~-: ~ .../4....lA_ ~• <.• ) - ~ cAA-;,(,---1.....,of-~ ...A--<-c..,,'.s: - ~ 
l J .,,__.__,~H ~ Cf'> /2._ ~ ......._ ~,t).,._:,/- A,,,..."..-4-:f ) 
~&.;;tbia ~ t.A.f)n--- ~ ~ ,. ~-- • .,,, 1 
,,.----- .--- (b)(6); (b)(7)(C) I ~ ~ Jb)(6); (b)(7)(C) IJ..c.... _,(b)(6); (b)(7)(C) 1- I ,,vu.A (,V I ,:;,l,,..-fz.-.lA..,l..,( /(b)(6); (b)(7)(C) 
A-u-Ls ½lJ- LA· ur ~ ,b)(6); (b)(7)(C) fb)(6); (b)(7)(C) I ~ cc.+ ( ,..f-z,,J 
L-v 4-o~ ~~)(6); ➔ ~ ..... + d---o (:A.,<.,--vv--(....,,--J-f-._;,( ~ ~~ -~ o..--U 
{b){7)(C) I V 
Jt-( VbM I 
\ _J - 'V' 
2el"19-ICO-ffOOsr-37a3 
DHS-ICE-19-0196, 19-0197-O-000467

---- ·/frQ A-A-0-~ --~--✓~ ~ ~~-~ ~-
---- -1r~ ~s._ -- - -- -- -
-------- ~~~ ~-uy'fr_j)_ - -
---f~-~~( _ _&'~ '1~~ b--- ~~J -K!lld 
----~~/-~ ~-~ v---_ ~-- - -tfrp_ ~~ ~·c 
----*------ ----- -- ---- -_..,_IS_-_~ ff ~i--~,_(£_ (b)(6);(b)(7)(C) =-i-'!:"'4-4-_ - - -
--- ~t--0 - - - - - - ~ - -
----~ ~~-~19 ~ - - - - -
---- ~ f'2-o-t: ~_'-r--O_l-v_~ ~-~ -!:-fr~s_ - -
-_~4::.~ ~v~~- ___ -vv/-_______ - ~ -
-----~M.,__ ___ ...:::: w~ -- -- -~} J; -- ~~ - ~ -
----- ~ ~-- --- -~ - -~~-- - -- --
----:L~~"-1-~ ~ ~~-~L~-~--~--
---- ~P 5 -~(2,.- - -- - -~------- -- - -
----1-'c,,poG-<-IZ..--_h~-~--,-&-L...,~·.j __ ~ ~~<!ff-~ 
-----+---')..,'\:~ ...±__..d-t-~ p.,i,J_ -::7_ ~--_.,,,~ _i,I_A.o ~c...A--t---'( ---
----- ~-ad:;':!:::::. ~- -- - - - ~~ - - -
-----~---vv-J~_v<AJ ~~_f.o-~ -~ ~-~ ~ -~ - -
----- 1J!..t....A-1:>_N\,,UW ~ ~ ~~-
- - - --- w-:_~ 7A.A.A_-to -~ .,_; ~ ~-: -- - - -- -- -- - -
------ ~-'h~ ~r~~d_-~~~~ jg ot't:,_~ --
_________ ...v1s1J ~ - - -- - ----- - - ---- -
~ ~ .,A.A...k__:,?.r,,..4,,._ _j-:_~-~ _on,-/ =-~ ~ L<.. 
~ -~ ~-~ ~ ~~_b. k ~ 
_____ ...,....._._~P_--b:.h.--'v\.-Ok -~'!'l_ tA:.~ '--<-_.l ~s-. ~d-c--l>F -
---e-~-~¾-~- - - ------- -- - - - -- -- ___ ---r~t;;i...·~__j __ d..'L.-1..A.A_ .:tb.,_,f vl<-p~ U/Vl~i-~ ~ ~c&u 
------+l--"~-1--L fft>P Cd~-&.. ~~~-"f\-.-,...-~ ~ ~~~-
_____ vt___ -- --- - ~ ----- --
• ~ ~ ~o~C~~ 4J.vvi-~- IA..J-#Vl),._,J. -
DHS-ICE-19-0196, 19-0197-O-000468

~ <A>-(;VJ ~~ ~~ ,d.A--cd .....,J.-.-<. ~~-
... 
~ ~ t---~ <>-t. ,'--1_ ~~ ~ 
----..--~A blc.. ~ -~ ~ ~ ~~~< ~ 
-----~l,../4-. ~~ '&--r-t/5_~ ~c..,. _______ _ 
------1-J---< e...e~ ,;__ ~ ci~kb p:-"f/ ~- ---f!' {/ c,._.1.-(I 
~cA ~~~~_;c_~~"--'-~:...._-----------
@illiffi 
________ o_µ.,,( __ ~~ ~CAJ ~f <· 
~s ~~ ~ ~-~~~~---
~ ~~ 7t-( ··~l,(,;' ~ ~ .,,f'?:4./½ef 
------'-~~---'n,.___.-=-=----"'-""---'~-tv fA...hv.1 u...._f:;i.._ ________ _ 
'i/4. e,,&...L/ ~ ~ Pl-- ,.. _ J - ~ 
~ ~~ ~ ~ '6 ~ ~ )J...;.., dL. ~~, ~ {" 
____ ____µ~a.&-.......L..::.==1-....t:.A..A~_;~~e::!:::::l.;fl,.--y.:::::::::·::::::,d=-1._,,,!_• _..D_~,-..., 4 ~ .- h-c-,,c.. ~ l:i:j 
----~~ ~~ ~-,,/------------
( 
{ - (b)(6); (b)(?)(C) 
-- ---,---====+======---_Jl-vvu~°J-~...c...----------
-----+------=-....!....:J,_(.___J= o1 _________ -----------
C--c.A- ~~ 1---g?,.,, +-~---h. ~~ - (( ,~. ~ Kb~b}(7)(C) ~J 
------+--------=----~-'- I l--r..f. +<-~~S I qe. · - ~~-- _ 
___ --4- __ ____:,,0'r--'-.:..:..-=_....;_~ ~{f------------
-----+---~~c.....J..~~- - ~. /4,._/(s 1 A.&----.fuc~ 
f\t~ -~rt ~~·s: ~ ~>e- $~ -
------+-~~_____!,,:~~--~=--"- I= tf Cd>E .AA.fk.-1- ~~ ~z 'ta--......_ 
----~~ ftrD __ _ 
-----+---·_:;.~-=~-~9;J~tfooost":r-;85 :d--vv:1~ ~~, I ~- ,I • ·,. •. . - .L- ,, .L.. - ., _. <;. • wJ"v'\,./V~l~~~~~~:b::::~~~ -~-,_;~ 
DHS-ICE-19-0196, 19-0197-O-000469

--~/ (- I Lr•J;(b)(l)(C) k-r_R+' 
-
=--~~- -=t-,,,__-:?~~~~~]-~- l ~~~ -f~~-"1'<--
J-
-P'_:____~ - ---- ~-7_ - -- - -- - - - -
____ ...._ __ -_~0-cl-A- __ ~_-1:_ __ ~ A:::-~ -~I±- ___ _ 
-----1---- l~15.)_-__,J.._.t_ ~11~ 1- ~-~--~·0----1= ~-~--t￾b)(6);(b){7)(C) -r~-~--~ -~--~~-~ ~ f ~~-f» -
L---""""- tl_ -~ ~t)~ - - ----- - -- - - - - - -
_±f:~J-,__ ----=~-~---r?-'_1(5- ..f_~·"""-=~S _.,,µ.,_c4:_ ~ -- -- ,~ ~ I u . . ~~ 'r --LAL~-~-~ ,...,._~~-~~ ~' ~ -~~ -
-~ L~ -~ <A - -- -- -- - - - - -- - -
~ T~~ ~-~~ 4~~--1-f--~ ·-:! 1-::-~- --
______ v~u_j_# __ o ~-==- ~.A <---t--.. ~ + ~ d _ 
____ -~-, ·, $1 rt-ad 0 '7J -~-~-v:_~--~-~-- _ 
-----t-o~s-f- /\Lr!- ~ ~ ~~ 7 _d~i-d_-~ _Q~----
-----~ ~ .A..A'. c,.. '<;; -~ - _f tf:;e, ~ -~-- ~, ~ 
----4-----'A-_ ~ - . ~..e:..1s _u.-1 r ~ 1=._ ~ ~ -~±._....:._t-_ __ 
(A_ ~1- ~-~ ~-1 -~~~~_p_~ -'-1 ~ _ ~ ~~_tr--DF _v-1/~t..:::I _ _ 
-~-~~-~ w-u-A °-~-~-~_::_h-f_~_ ----
------,' ~~ ~ .A.A~ ~r. _ ~ c,.A-J.t...,,. .. L._ _,(,__ -~ _ 
____ jg_~__tJ--i ~6=.fu __ ~~--~-~-:si- __t._.__ -»-f-.'/( ---
------' ~~ ~ ----- -- --- ------ - - ---
---- -,I (b)(6);(b)(7)(C) ~-f"".J.! ~ ~-- ~-- __ __ __ _ 
---- : t°'; (b)(l)(C) J ,L...~ -f - ~- _'j--'!._ ~ r~ ~ ----- ----~- -~ r~ ~ ~-- - - - - - - - ____ _j _ _p_ J 1_4 ·.....,___.__:_ ":'7---::7 cl;f:!.l:~ ef ~ 7 'f,-,..,__ ,._L,_ _f~ -
-----1-"fl-rio-Lf.5,___~-~+-~ -~- ~ ~s -~~ __ _ 
----~*_±p::>l--1f_4'~,-~ ~ ~"- ---- ---
____ -TL ~'i::'.:_d-_~~ -~~ -~~:r- f'-'11s ~ -~ -
---- ~j_ ~ ; ~ ~'r'- .,,___ I -~ - ~f GI_ L_·.,.V\_ ~·~'a -~ -- 1 . . l 
~~--f!:!-I_.$ ____ 201~1CLI-00Q51 3786 ------ -
I ----.- ~--~-~ A~.J-.. • , 
DHS-ICE-19-0196, 19-0197-O-000470

~)(6); (b)(7)(C) ~---'-l--1-Ll ______ _J]i--=-l-=C-O~P-.-7-r---'-N----'--,'-------------------
~(; --
----+---------'i,d...t.,(_-=---f~Ml~~ ~ ~ ·~~~~::::::::::::~~I,..--(=--=~:=:::.::::::'.'.:::'.::::!....':::=----
~ 
_____ J 7-st - "1--f M-A,,~ ~-CA.,1---p_M:!.:_,..,,"'1 -:,-~~·,..____ __ 
~~__, 
____ J { 7 e_p~X6); CbXlXC) 
-Lf-roto 
L-A￾L ~ (.,,,.,,. ~f,-.,, ~k.. ;tz_ I ~ 1-A 
~ 
-----~~--~~~~:c:_-=~:=:::!:::~:.=::.!.~~~~~~------------
J> 
--------- ~IL [bX6); (bXlXC) ] ~ -4·,,,_ £~ /-' 37:> c,_.,.,._ ~~ 
-----+------'---':....:;__ ~ ~ ~ JC-A ·,..-v...c:;_ ~ ~f. .__: 
J, ~~ ~ 
~ (b)(6); (b)(l)(C) 
~1 4 .M--r-~~~~-4!=.~:::....__..n.l:~~~'-~-<~~:::::.=:~~~~-
., ~ - --7 ~ a./2 ,v,-;/ ~ 
-----l--------~~-=-=--:-,~~~~ ~C:h-~ 
-----+--------":!:::::::::-.:::::-..::f'_:_~ - c-<.A.ASt,..,-.: S ~s 7 ~ ~ r~J r 
-------1-----~~-------~--~ ~ ~ 
u..l ~ ~ k ~ ~ '-<,..,..,___~~ 
----1----1= ~ ~~ p::~~--' l,_4_¼_-fu_Jd __ _ 
-------t-------2019:cfetl-00051 3787 ______________ _ DHS-ICE-19-0196, 19-0197-O-000471

J--~<_s--~-~-~ _S'~:s-- l----;:---7--- -- ---,-- ~ 3 ~ ----- --- --- - - - - - --
lb)(6); (b)(7)(C) 
::r w4-v,. ~-1/'--f--(. _~_s __ v-.:,7 ~ l:.~·A h>-3 / J .. J3 *-_ ~~ k~ -- - -- - - - - -
------~ .. ~ _ ...,.,:,,fe. ~ - ~-Al-( - ~ ~ <»-"-~ ~~---
-l n. _ ~ i ~u..{S ~-~ __ _ 
I . ~ ~ -...,_. --c/,_.,.-<...,.- -1-· <-.A_/ ~_c'-<,- --t_ f-~ - - . 
---~- ~-~ ~--~ ~- ~ ~--~--~~--
____ •"::f--~-'f..-·Ck~ ~ -~...:._'ffe~ -~-~- -
____ J~~~ t--~ ~~ _/ _ ~~ -~. A_ ~ku_~ --
--- -b 4- ----- - ----- - ---- - - - -- - - - --- - --------f-E> ·-tA4--<. ~Vl cA~ J: _~! ? ---7> ~ _n---~ 
-------L- 't ~~ ~~- CAA-< __ ~.A.f/~--- - - ---- -- - - - --
------1 ..z..rt!).~p·~-~ ~~- __ tM-,<_~j __ V::-- ~--=-· 
1--f__u - --- ------- -------- ------ _____ ~+~ .f.-..J...,..c ~@ i-.-110 ~ __ _ 
------,-~~~~- - _ji,y 1_{,).)~ ~~~~~C) ~A __ /- Cu~£.__~ 
-------+1 b)(6);(.b)(7)(C) ~ ~f>{;]?_~ _ _:_1..--.~ ~t- ~-
------------ - - -------------------
----+--------------------- -----------
-------------- ---- - --- ---- --
------- - -- --
- ---------- - -- -----
-------- -- - -
DHS-ICE-19-0196, 19-0197-O-000472

r)(6);(b)(7)(C) I c~~0_f.~~---=---- o#-ec.-__ 
_ - ~ ~~-~<---_/e.'2...]::::>_ - - - - - -
C&(;_ ("y,-f' ~ - ~·~ :;2.-o~~ -t ~- '1.AA-~ ~ 
___ 4 __ ... b a-~ --i -/f--C,,(./4_-4 e-u~· ~ _jJ ~ _"ft, .u.,,<- _ 
______ --1.i=_ {_ o-v0 . - -- - - - -
--------- ~- -?-~ 1r?-·u..,._ w--:.1! ~~-j-1f ·~ ·r -
-- ~~· -- ----- ----
) w-,'// J..Ai-J-< h--. us - ~ c..r-..,f- --- - --- J - ~ 
- -
------+-i:.:..:.:.~-~·~~ ~ ~13 ~- - --
\(JJ_,_~r ~ ~ ~cJ..._./=, ~ 1,._,,_-,,,,. ~'-----
c...L_D..._:_ .I?oo k-..-q, ~-~ ~ -c-<.., ~ -{o ~ .'J 
- ---+-~ql &-~-/ ~I ~ ,( \ ~CAAr ~ - --
f- -- -- --
1~ • I • • ./ I / 
----,=~~~-~~ ~ ?3="""e.-L c,..,;/_uu ~/-~ 
~ vis-_~ 7o ~ __________ _ 
------+--='c-.:.-~~~-~~ -) ~ ~ ~/A-,U- ~'-S- -
~_,__ ~1- Z> ~ -=-~-r-b_ ~- - - - -
---- (µ~~ ~- ~-L~ _i.,..;,4-o ~ ~+ __ 
------t=-~ ~ -~ ~ ~- ~~i-~--_..,...:, .-<--,~-< < ,4- ~ 
~w--s --- -- - -----
- -- - --
- --- - - <;1:=1~:.__ ~r: --
- - AL-v#" ~ -~j k e..,~bX6l. ~X7XCI 
--- ,. 
-
- - -
-
--
- - ----~ 
---
-2019-ICLl-00051. 3789_ ------
DHS-ICE-19-0196, 19-0197-O-000473

--
>- /,1 A-r~ c/ ~ _L 
b)(6); (b)(?)(C) 
..... -, / t::1_""'" ~ c--,(..,( 
~ 
I~ ~ ~A ~ ~~ w-<-a 
I 
d.,.~-~ {;;M~ ~ ol+--<.-~ ~ 
,,,__J,._,._ 'k>(A. ~--b ~ d--V :'u-~ o<..-i) ~~-
<,...., ~ -----<.. J 
I 
~ --c_,._.L,( ~d-<.A... c.,....., 
>~ ~~ ~- W::'.':·~ 
- -j>'c(_J--h....:~ V:... A .... ,,J-.;;. ~~ ~ ...... ob -
I-~ ~;-,,. ~ ~(~ ~ ~c. ~ ~ rY'- - ~ 
,,/ ,:-
v 
;-- -
. 
~ 
_,y-,,( 
....... ~ 
FF~~ ~ c,.,,,,,,.J ~< ~ +11----<-L-(> 
~ ~ 
~ ~ 
~ ___,I__A.,( :f:-.-e,( _ 
~ ~ ~6-- e;-.J-,( ~ ~ ~~ ~ 
A ,I LA I A 
y (J 
--
_. I Z) n-e,(_ a ~ ~ ~ vi_ ~ ~~~~ 
-~ ~ ~ v._d~ ~ .'4-.e.f'~ ~ ~1....- -
,~ ~ ~ ~ ~ _£ c,U._~ ~~A·/~~ f 
~·rv-
.. 
/ 
201 g:JCLl-000-51 3790 
DHS-ICE-19-0196, 19-0197-O-000474

c-f'R- ~ 'd - 6L~ ~if .2-~~, ri-c.-U" f-<- ~(7(A.,,.c ~ 
-~ ~~--~--
-~ 1--v-cy ~ ~ C--<l_· b c1.o BL~ ~_/Ilse. __,( 
-~ ~~ ~ 
------+--~~~-+·,..,_J ~H ~-~ e.,d>@__~~ ~~ 
----1 ~~ J, ~1a 7 -~ ... ~~ tv..'c ~~~-- y ~ -
---' -~- _1,-....t ~s; s;n--,t...-1-,~s- __,f_~_j.,~c ~ __ 
---- ~ Pv-,e,,c.. ~ --r~-~ 0f6-"- cgl~lici ~ _l)o' r ~~ ~ t
~/ ~·~ fJrv-__ , Z ~~ ~ c..y-v,f·L~ __!__~_ 
---- -17A,,V(-..·0-1,._;:t,,_ o-ct..-- ~ ~ 'fr-<- - ,, "fl--'-1~\ ~4 ~ 
- - -~-bo ~~ d,,...._,'i C,f"/2-'' ' - --
____ -1 ~ 1J ~~- -AA-cl-<. '0-~ tA-·_~c ➔ 
---- I ~~ ~ ~~ ~ ~~_i_l'Y\~ ·~-
~~~ /'rFDD f ~ (__~ ~~ .t ~ ~~ 
__ ------i~~{b)(6);(b)(7)(C) ,~ ~ &fr-/_'--- ./, .J,.., ... ;,,,,_ ~ v(...-<-L,//)_ 
,. . A,1v _ _,_.,, . - +i .;, . . ~ 1--< c;L, ....L.. ...J 
,~ 
,I Ad tt. S' 
I~ - . - - ~-~ - -- t ~ T~ -~u-<.-rs-~.,.,,....~~ ----
~~,y~,,.L .~ /rt__ a._ ..M.f~~~ _...-<._ ~ ~f:'1-
~ ~--IA-<,,(.. ·s- ~ ~ cvt,. ~ ~ c,I._... 
__ 1-'1-t3 ...Jk,,~~ - rce,_gw1 w~,, ,1 -. c...o~s: 
1
_1_/-kc..,, C/4--l.A~ ---'---~-
__ Pf.r,.tf-C,u.A.,s~·~ ~-__1w...,f_/c-oPs /o :L~L~f~ 
_., ~ .,.,u. {, '/(<;_ #, ~ ~~:cf ~ ~~ (A.I_~ 
L.....---,......,--....,....r----- ~ e...cA~·t·~ t..-t' e. 
o~ 4- --~ _3_,....c..,..fv..~ M<s: ~-~--
k ~ 4 -~-~~ f~-u~AA-~ ~ ~~ 
---- --~~.SL-eA ,-,,__ ~ i,~ ~f-o - - ---
______ -fl---t-~ --~- o-~~,~~- /"-A- !:,oi/1A... ~ '1..--I'--. __ 
~ ~ ~ i__·V\,A.,"-~ --1 Tu. ._,.,_____., ...,._.,/ iS --"'-<-.,_,._ ~ L_ ~ ~ ___,__,_ c.,_., ,,__,___/ 
____ ~ Ft ~i I #: - 1 - ;;;.. ~+-~~ ~ "--of l'-D'V-(. _ 
~ ~ -+---t ....-,l......,' rv-- j _ ob... ~ ---) ~ ~ 1 c,l • - h . - I 
~---~, - -- ·· 0- ~ 2019:rcu-<100s1 ;:sr91- -- - ~-- --
w ~ A.~.,,- A * 
DHS-ICE-19-0196, 19-0197-O-000475

~----+--~r....,~~==--·.::,__~ ____,,_u--v..:::..!~...!..-=.:=--'6 ~ - ~ ~ aA. --::t- ~ 
--A..<_ (!..4 > , 4 --te, ~ h-- 'f -
-------+------""-~ ~---- ~ J 
. (..,,,,.A,c.-t.A..-u{ ~ ~ 
--£,,(,...,L ~ 
~ of' 
b 61-1:4 <1J ~~) 
',\.A' u- - ~ {_p ck (.;(~ ~ 
~ 
-------1-.e::u' __._/ ~~~::::L..-----=_,{_~~;.,:es.__r_~~J:='.'.-...!:::'.~~ -""'~-:b-1-.:........;;;~'-------C=~~'<frr--,,1- _-----(---=---::....._-
~ --d:t ~~ 1---a {H a.. ~ J.-<-c-u...-
~ \,~ t-,,_ 
CA,A-{~i-.....:~------------------------
C- rs$-v..-ul <Z A.-,, f C<..-~ ~ ~ -~ ftkc.., 
~ ~ ~ -1 
-------+---~=~~~...,..._..,-="--~ ~ ~ 1- 1'~ ..A..~--:P---
------;l:=====::::=====£1'~~·~ dA--< ,le, 
b)(6); (b)(7)(C) ~wfo ~ o-f> -- r v￾J-s-v - ~ cl~-~- ~ ~ ,t_ ~ • 
WT9- C 1-0005.1 37 z::=-
-1'>.A A..(),,... ~ &.. J).._u,,L '---' lA¼l-{ ~ ~ ~ 
DHS-ICE-19-0196, 19-0197-O-000476

-~ . 
---p,·, f ~ _ I..A~twh 
· 1-& ~)(6); (b)(l)(C) vtl .- l~~ - - L - ,-LL--,,.... _____ __J/ /k4-._ R ti - - -_c,,p £e,,-/ ~~ ~ll~-
_______ - cA2@ ----- - -- --- - - -- --~ 
------~~~1 - -- - ---- -- -- -
------~~~~-f.·rr-<._ - _tl:s; ~~,.,...._ b--e.~ lc:1: j__C-LA,. 
------t--'-~o-:t~_~lo1- ':'6~'"~-~--- ~~~ ~-J. __ 
I
~ -~- ~ _c,.,w~ '"C-~- ~'-6 -..,,.. ( ~ -
---~-~'/l- ~-)-- - --- -- - ---
-------,-.--fJ.µ.,y-v-_j_~~~ _JC,.,.~ 'Aef)~ ~1 ~-
-----+--'~-~ ~-- /-.CL--t~ul-~-~ -~--::!- / 
--------+--- ~~ ~~,L.A.·~ -- - - -- -- --- - ~ 
-- -~ _J_ '-<A_~ ~ _.!:_ J<.~ 1- ~ i--...1-o ~ ~ I_ k__ _ 
<1,nA-LJ &_ ...,vvJ.-v-- ~T:1- ~~ 
-=-~~ -==-<;:_SK_ _7--~_ i..:,J..:-( ----p~-.:b~- -
------- _--_syv,.,c.A./4.,J. - ~,_J_h.~-~, ~----- - ~~ __ c.v-_~-~ ~ ~ ~-~-P~~i- ____ ..........4,...c_r::...__~-~~~c,u-~ ~ .i?--~~-~<A-i:!--~-~· _Lfl-<_•7 
~~ ~ 1 _ <A ~~ P.--_~.,;µ..-,v,. ~-~s0:d ~ff-_ --~--.A_-' ~,f," . ~)_ - - -- -- - -- - - -- -
--- - - - -- - -- -- -- - -
b)(6);(b)(7)(C) L...,_,(__~ _ ~-~ ~~~":.f_~ 
----1---=:t-~~ ~~ ~ ~- ~~-0-<l--~---
-----+--- µ.i <[;'~_~_t:M-..<~-~~ ~ s--n,<.. -lo_ --
-----~-~ --------- -- - -- --
-------- - -
------.:c.+J"""1.r': ·v<·cA.,{__~ ~ ~- ~-~ -~ ~'s ~,- --
______ c.e~ ~,~~-~~ _J. />-. d.-v--u-r,·-'1 _d.--0~~ --
-----~ {~-~~ --- - --- -- -- -- ----- -
-------~~ -t ~~ -+------~.0-'~ ~ -~.__f=. -- -
---~ ~-~-b:;J-frls ~-~~~-~ ~~-~~ 7 _ 
___ l ~.1u-~ 1-~-~~·~~- ---
l ~nd- - -~' _-v-<A- -f~~ -~ ~~ -~ r ck.._ ~- ~c..-'--
-~---1-~-~ _o- -~-~-~tnB7GQS000~1 ~~dA·.,_ b~s _ _ DHS-ICE-19-0196, 19-0197-O-000477

r(6); (b)(7)(C) 
-----1-----LcJ:2R... 
- ~- ;;LJ2J { ;)- ---=--------- -----
___ _____,_~ ~ -_~_,__ ~ ~u...1 ~ hrf>... s-Js __ _ ~ I 
-----1-- ~ ~ f~~ (,:; ,--<{,-~~ ~<: ~ LC ~~ 
----~___.,%~ cA-, ~fv. ~+ 
- Sv ~ ~~t-, ~ ~ ~ /o 
-----+------l'.~r.A=_~__s_~·+ ~ c/{1-2_<;:~ ~ -------1----::::_../4,:.=..ci5:\---MA-=- ~o-~ 0---\. ~ t ~ f-<-
----------'-'~~ ~~ ~ ~ rr~-.-,-"=-"'-'------- ~ - 4.-L-c.-'i ~ 
~ ~· ")'\..,d.._ ~i....___S'::r::--u=---=----=++-<--f==-....;:;~:c......::;.....:;;._:;..iF--L-....!!~==~-----
-----+' =.,S Lu~· .S~-=-~~~~~7~ {?4 c/4-. · t b lee Ce.A --p ,,._,,(..,_½ ~ '.s 
-----I---=-~..::...!...: 
b)(6); (b)(7)(C) 
l<-<J ~- ~ t.J.-- T> i,..-t... - ~ 
------+--'<~:e.-..d<~=::::::::..t-==::_!~ ·-b:, .,..: ~ ~ ~ ~ r,.A 
____ ___t=--~~~::::::'.'.~~~-=::1--~:-:=....~·~.:::?- '/; ti~ ~ J-<_ d,-.,.&L-. ·-1 ~ ~ 
------!--'~~--=---.:. ~-~~ ~fs -"7 ~ 7~ 1-'r- ~ c.---/4 
i,,..., ~ 
-----t---=-:P~~~~~~---=~~~~~~~~(j~~ - V:Y:j ·11 ~ ~ 
-----.....-Ii<..:..:~::..... ~ 'r~ f)~ ~ e-ry ~ tv - d--1-c-~ 
------4---=1'~~ -~ +U-,,(._L_~ /2~---'-~-·..._ __________ _ 
----~--_-_TL- ~ ~ ,__ ~ '4 ~ ~ ~ ~ 
-----i--------6o==-_-.,::..:::~ -rzi Ul 4 T>--½j ~ --(7~ <-A-. ~c..-c..._;,,<....,_ ___ _ 
~ ~ --- -- ------ --------
~ ~77! ~ S-cr---1-jL.,_----==~f.:::....~=-=:::::.._..:::c:...~===,,~--
-----1-------fu-=-~4~--n--.,,_..:.._..:_-:_::..:.__.!:.(..~S'__:s s flJ.. Cs-~· A-f ~'f•--~1 u-.-....f-) --
~ ~·~ <-f1..-...A. ~-~ ~ ~ 
~~~ --------- 79 2019-ICLl-00051-3 -
-----1-----=i---=-~--=-....:..... ~ ~t:.I -h-~ i 
DHS-ICE-19-0196, 19-0197-O-000478

-~'.L¾~-P-~ i ~-s:_~_~v- -r0~t 
-----~- ~-~~~- - -- - - - - -
~:_~c}--~~ ~ ~J ~ ~-
~~~- ( -~·--t_~ ~--ol,-0-~ ~-
-----+-~~ -tro - - - - - - -
-----+---'..L.A"""'--~J. '-'~~ ~ ~::_ ~ ~ -½-~ ~( ~- ____ ___µ:,..,,--,.~ k -~ :f -~ - ~-,- ~ J6- . .,<.._.-.., ~ £ 
____ ..._ol-o ~n,...;7 _ ~_j_-~ -" uu-c..ls_" _ ~-- _ 
_____ ,_4L._ ~_MM._~ ~-=~0:/ ~~ ·4 -~//-<..,A. l.( ~ 
---------+-'~~ _..,.:., _~ o-"L _•-1-,::d . _ _ _ _ _ _ _ 
-----~ '--'"' +_•-~-~~-~ ~S_ r-v-vt ~- ,,._.,,_I 
c..-c4 ~ ~- Ps~c/4..:{ ~ ~ ~~_Lvv--{_ ~ ✓-~~--
~------4-~::...=~__,__~...AA..--L..ll½L_ - ---- - --- - -- - - -
~~~s ~IH.~~ ~--~ ~ ~~~ 
-----~-~-~- -- -- ----- - -- -- ---- -
--------,-~- ~ ~ ~ ~-/- ~ ch)~ 
-------~- :/!.t{n0-~ -------- --- -------
-----1------------------ -
------------------------- --- - - -------
------------------------------
--------+------------------------- -
--- -------- ----------------
-------,------------------------- - --
-----------------------
------------------- ----- --
---------
DHS-ICE-19-0196, 19-0197-O-000479

L~t,., t2Q_ (b )(6); (b )(7)(C) 
- II ..., . I 
- R to I c.oc,...,.A ~ ~-- =rt:X6); (b)(7)(CJ J--~ I ,._,_.,_ i ¼ ~ {- ...L.,_......_ 
----t ~,a.o-J£,_~~ f v--~-"--'--·-~----------- -----
---~· ~ ..,.: ~~~~ - ~ ~_,_t½q ____ _ 
-----+---'~~~-b LA Jo ~ _,_bd_..:...__ ______________ _ 
C7;> 
-----+=~~:=....:....:; c.-J ~. ~ ~ --f.-.-~ h. ~ - ....... 
V\ s ~ ~ fr<_ ~ '-
·/---'-------------- ~ 
{ {-' (b)(6); (b)(7)(C) 
___ _,_____,I.P,::::_____i.iL-------,-'~b~-----------------
h 
---------4~~-~~ ~o N,f- h~-~-------------
- ~ '5.. ~ ~ s. ~ I S" ~~ ~ 
~ 
. 
.J ~ ~ ~-"--
- ~ ~~ ~~ ~1'~ v---/t--<A-.~----
------4---_.:1.....-)==-~~-I--~ ~ {~ ~~-~~-------
1
~- ~ ~ 'R't-~~~s"f'~M-t. {I --Yok 
-------+-- -'-~---~--l----MrfA..-1. ~ (,,,/-( .....,.,. / I 
DHS-ICE-19-0196, 19-0197-O-000480

-----+--71Pp..,t-s ~ ~,f,,;.....::L. e.,,f'/2_r~-D't-<.J~ ~ ~-
I ~ ...J.. ~ . . .A /J' . ----- --=tr-==-~ ~---f:L_-~- - - --
----1-6#--~ ~-~ -~--=-~~~ -=-._/4_,,_ fG,U5_ -
____ bt>'s: ~ P-<-i_~ ~--/,,.;~~L--~~--
--~ J ~tr; . 
------~-~~-~~-Jr &(_ ~c-_.(__r_~ 7 ~ -t 
-----F~-~- -~-~~~~/'~ ~~-
______ f_-6,_~ ~-~-- - - - - - - - - - -
____ _j_gh---=---~ fs~__L.,. -~ ..::J..-.,}_ -f'~ ~C--<-~_~A _ .-.....c__ __ _ 
----;__~~-~71-. th-_~-~~ "f\.-t._f~· 
----------~ ~ft-~s-~~ ~ -~- --
( ( ~ ~ l( ~ & ~ I' ~6---l--<- ~--
__________ ---<.,.(..,<.,"'-"'-"i-- J'L--. - ~ ( -- -- --- - - - -- -- -
---- - - --~ -~~- -_~_f __ f'~_ ?_ 2._ {(~ .. ~~ 
-----+- _ - _____ c::pn- _ ~ ~ /J 7 +I B ± c. I b _ _ __ _ 
____ .__, r,J~_(b)(6);(b)(7)(C) _ ~-~......-U fL_,. ~I_:::<--~ ~-~.S.f?~---
____ l_~ +-~~ ~-~ - - -- -- - -- - -- c 'f w-'--~~ ~ -/,~ -;, -~ ~ f... -~ .,-,,t_,,Lf'~, ---
--- - ~ ~~ ~5~~..,._, '-( ~__:j~ -
----- ~-~~ ~~ ~ ~.:_~·r- --~~ 
. 
~-----t---- ~c·f. •,J.. --~ - ~ ·c,.,,,.._~_!:-~ ...&-~~ r - ---
-------1-------=--~r;~ -h--L - ~ _::-;> -"'-~ u ~ ~--3 J- - --
-----f-------~-~~ s --~--f?-~ - 1/ ~ -~ --
____ _._ __ -~ --~ -~ --1' ~~ f ~ _u..- 1_L<. ~~~-
----~~-----~---r--- ~ ' ...A.A..Q~ ~ ~- ,:_· -a1T - - --- ----
~-----.-~...k..~--~ ~ ~, l~o ~-- -'-t ~_:,t> _ _ _ -~ ~ ~ ~ .. ----'---¾__Y..i)_ __ ~~- --¥- -- -~ 
-----~Y.-=- ~~-0 ~c.,.-1--,~ -~ -----------
------+---- -- - - - - - -
-201-9-IGLl-00051 -3797 -- --- ---
DHS-ICE-19-0196, 19-0197-O-000481

__ __,_/_,_( -_l, l)(6); (b)(l)(C) 
- to 
] >< . J ~ ~ ._ 
~-
------+--------=-~--=--'----/-->_ c:..e...,t...e - .,A._.,( rs- fu ~ ~ ~s ~-
-------+----11-------=8=--------=---=---------!.1~ J- - c-6 )f-: ~. ~ ~ ~ ~ 
f)dw-<-<.-4_~~~~~ 
G;P - y· ~w~-~-~&....;_.......,,/..~----------
~ s-1•-- ~Vl ~ ~ ::h=. i-:-='----------
-----t------L-=0-=-lr-r)..:::.......;:.k,.._-'--~ s ~ ~ ~~ /'r- ' 
w ,V-1 ~A J>--t. .,___s-Y ~ ~ - £~ 
---~~ ~ f?/O 7{tl~ ~<) 
- VJ~ fl-t-C-L ~ 
-----1-------ft..-<_ ~f-~-------------------
~ ~-- "-' ~ ~ ~r-1--.: 
--------+---'~==- -~=...5."---------------------------
~ 
~ ~-
• 'cd ~ rV(_ _____________ ----~-- .,__~<A.A$ : (1) ~ ~ ~l,1--iv ~ ~---
------+----..:j:1..e=-~cA.,-=--=-:./ ~ 0-... I,::) t,,,1-·vv- cvl ~ Q ~--
-----1------1-,.:...._;;__.:;::_;_.~;_ G 1..,._,1_,_ 0 ~ --s.f.v.-g:, 12-
e+--U ~ ~ ~ ~ ~k 
'-~- :+ AW-ftt,:ocroo1-~19~------------
DHS-ICE-19-0196, 19-0197-O-000482

-- J_f-=-=----1p_f""''(b'~"c, ~o - - - -- - -- - - -
_______ _:::_ C&A_ tfcA:>~ -1'(2-_ps- __ -- _ -- ---
___ ____ -:__{.u7- ~ ""~ -~ c_pJ.. J _ s~ r~:s-~_ 1 t:,_ 0_ ~ _ 
' ~- ~::...=....-__oL~Q- --- --- -
=--=---- I ~l;:_.r -= t,~::}' d _ 0AA- _ ~ ~ ~~ -_ 
------t-----'--1·rvi_,____.;..~-= ·-f-~~-~ ~ ~_:_h_!_c£ - C-=L'6'c.e.71_ -
----~-'~~ v----'(; rc..-t ....-L./4.c::./·s - ----- -- - -- --
------J---·_{_Q£__ ~ ,'? ~ ~ ~ - -IA.Y' l r ~---<-<-C-. ~-
__0:-A- ~i I '-fr_t r ':'.:::._ LU i _ ~. _ _ _ 
~__g--_ ~-i"-L-L ~ ~ /( ~1. ~ -f-~ -
-------~~- ~~ ~-;4.-.,kf:) ~~~ _f;._';f-~ ~f,._- -
-----1-~---- -
_____ :-~~ ~~ ~ ➔ 12,f' 0~c-v... ~ ~ _Q S ,-.o,f ----+-,/~-~ ~~ ....,tv..;~ I _le£ ~. -/-J-c._, -- - --
---t----- -- - - - - - - - -
___ o(~ ~ ~ ·y--<-i~ aA,V~- 7 ~- ~ .,,__, -
----...l.A~!..V~~. ~3-<(_~-y ~ ~ ~-~ 
-------4-A-- ~ "--'l. ~ -lo ~I'> -- ~-- -- ----
----t~~-~---1'-~~ ~·~~ btc._~_ 
-----+~~ _!!:;,:- r-" ~tf--U--,~~ ~ 6-.. ..M-i>~ 
-----1-~ v..H--c--.--f:--<. ~~-~ ~ -----
~~ - - ----
----~~~..:&..;-to_~~-{ 6~~ 
------l--£U.:-r~~c.._~0:::!.. ~ 
~pl J~ c.-. ...<.. ~ 0-e-~ -~ ~ _k _ 
---·--+- ~ 
~ 
-~ ~~ ~~- -~ ~ ~ tt-~-- - ''f-•~ ·, _L ~ ,L,- ~ /. . . ----- - - - -o. ----- .,--::,,r-- - ,~ -- d ~1- ~ - -
~--r _lh_ ~- ~-~ ~s..-..J...::f-__ 1_._/4v,_~- ~-~1-::- -
-----.J---------2019-ICLI-OOOSt- 3799 ---- -- --
DHS-ICE-19-0196, 19-0197-O-000483

B-~ 
.J 
- ~3b ~ 
·- ~ ~~.L~~~T,- -- L.- ~bhA ~~ , ~~1=~ 
~ ~ ~ J A(:~~J,p.-.,._.;'( ~~ + r--+ ,..._ ~·I,-
1r-~ p~~~ 
~ ~f;) ...,(_,,t_ f"\..,U..,v fA-12~ 
4 V 
n~-l• A ' 
~~~ 
J 
·- - -
2019-1cu-=-ooosr-3800 
DHS-ICE-19-0196, 19-0197-O-000484

lp{,-.J'cA.._'--uL~s~e:r-l_1h..Af-..·~ ) ~ _ 
~~ ~~~-
(b)(6); (b)(?)(C) ~ ..,__.:, ~- ~ I-~ +.~ __ 
-!-_s~ ~-1'- L ··--
....._ ___ __,~ P..Av~~ ~f ~ 1-o ~ ~ 
--------~. ~&A-
______ - C¼·~::1_~ 
------~~ ~~ 1,~ ~~ ~ _±!::.1-
~~ ~~) (b)(6); (b)(?)(C) ~ ~ cf--. ,:;A--~/ 
~~ ~ ~ I I --- -- I ___ -"-~1- ~ -4....6, .. ,~ ~~ 
------t--~~~ _fl(6};(b)(7)(C) jc..,JY (--r)(6);(b}(7)(C) I ~ ~ 7JL.. _ ----1---~- ~~~~ ~ ~-IL,/ ~-~ p_J - ,a_, ... ---~ 
- ~ h I.;,_~ -+~_c.....,·_~ - 7 ~·c.-tA..s:__ fi,,d 
---r~-=~f 7'-=]~, ,,,___,,,_~~ f.y>t-u..,_ 
- - ~ ~ t ~-('...<..-\ 1.t • u. f~ ·~ ~ bty~ f--~o c1'..~ 
-----r i -~ ~ i.-,\.A. ....-1..,L(._~ ~ ~ - ~ ~ . ~ ~-~ l~~r~- ---- --- -- - ~~~= b)(6); (b}(?)(C) 
-~ la1 V ~ ~'-.:_~. le1) ~ 
i----- --- -- - - - ----
--- _,. ~ l(b)(6);(b)(?}(C) I~~ ~-,_ ~- .:i_J ~-
-----~ ~ p/tls u-/lf' _'] ~s~ ~'/Jj. ~-~ s-~ 
IY~,...__.._,A_I ~ ~-1-L~ ~-~ -p.>llc_ ~-
-----1--->1=~•"' I~ ~ .c.-.....J/_ ~-~ ~ ~ 
L f: ~--,- ~ ~ ~~ 1......,,( _y- '--' . j,~ -- V 
- - - -- -
- -- - - -- - - ---
-
- - - -- -
-2019-ICLl-00051- 3801 
DHS-ICE-19-0196, 19-0197-O-000485

IL-(b)-(6)-; (b)(7-)(C_> ___ _.~ ~i--j ~ ·~ 
_____ ....-vi.AA--_ c/4.._ A/.) /6-::::_li ~~~ih--="'----------- ----; . -----+---"~ ._A...,(_'-P ~ +~ ~ ~ - ~ -1f,__~---=--
-f-:vL.-3 ~ ~-1,-~ ~~ 
--------t----1,;,~-~ ~ uU 
h ~~~--
____ _:t:::.A~'t.-1::-r-/4J.. ~s-hL &-f ~ 7:---¥ 
c..,t._d l--..-1 ~re.. '--✓ -'--<. .. 
----+-----=-~~ ~ ~---=c..<.-d~-----~----
----+--=-~----"--'-~_=-c d-<__~~ ~ ,_~-~ - - ~-~ 
----+-- -~ ~- k ~ '14-<-if' ~ ~ ~~ -
~ ~~ ~ ~ ¥-' j - ~ -k c...U--< ~ ~~s=-----
----+-=d..c~ ~ l r~ ~ ~ 
~~~~~~:/-I=,~, -
-----'!:fr-CM. ~ ~ h.--uf.~-<-<I~ ~v,~ 1-- , .. .. '" 
-----+-~---!,._;;;;___~~_c.:__-~ c...a-e .f:. vf~ ~ ~ ol C...f-,,-- -
-----~-½--A. --k 6-,. ~~;,, ,:.t.,{_ c--+---6-v-.d( ~-
-----t-.Ll!::!~~...!'.~~~::::!:.._~~~· ~ ~ ( SSb---< I Lo.-.~~ ~ ,_J. 
~ L- ~ ~It::. - _ ,:;/4.:, ~ c.,,- 6 ~ ·~ 
_____ ___,_/_/- s fb){6);(b)(7)(C) I --2!:--------------- _______ -__5_~\.A_) 
-----_h~~ 
- &()-,._ ~ (, F---'-'""'-'-=--'-· ------------------
_________ 4t-,·~ ( ~- 5 / - ~ ~ -=-~--=,---~-----
~ ~ I- ~ -/,:, ~ ./p ..A...A-C... •--t ~ __J,~~~-==-:.1.·+~~~--- -----~ -- - 20"19-ICLl-00051 3802 - --, 
-----~•-A,(.-S'y-,_~ 11--L 
DHS-ICE-19-0196, 19-0197-O-000486

----+----- ----- ----
------ - --
---- -------
- _J_l-5_ (b)(6);(b)(7)(C) ~ 6~~3- --- -- --- ------ - J -~-i-~-~,,__C--<... ~I 
-------+-'4p,_ ~ -~~-,.,,--£~ i:_ ~ ~. ~ ~ U, ~~I 
-- L..-L~- ~I/-~~-~ _le~ ~ ~ ~ cH) ~ ::> 
/ bt . ..L. . . ( .L .LA.. 
---,---,/~ - .____ -~~~ ~ -~ - - - --
~- - ~- ~-~-~ X-_Lr<?b;J --~ -
~-~ 
<A.,,-~~ 
~~ 
• 
r- ~ 
- - - - ~ 
-- ~~-
--- ~ -r'c~ - -
~b~ . 1--~ . Ph.~• --~1~---- --- - ----- CP/i,,=,--"5c,IP<1,S,-(~-
~ le£ J-=-' p( ~ v--:_ 4 r 1'-±<f pA ~ ~ L~ 
__ _ 1
3-o ~r-_ ~-~ ~~ ~s-h..-...,::,1 _w--AA....~-
_____ /:k ~U-<J._b ~~~-~~~_; - -. -
----~r- ~-~~ -~ ~~-s- /4 ~ t..., -
~--- ~-- . 
~ ~ ~- ~ ~ ~ _.JU,;-.. ~ ~-
----~~ ~YV<-< {dYv-(_ p/_ I».,_ ~1-u--d' ---- · ~ ~r--1= ~ 3~ ~ ~-~ 7- ~ ~~:..,} 
---~~~~ -~_.f.c sc::> 7 ~--'---'~ - - - -- ~~ ~ ~~~ ~~-0_ - - - --
-----~ ~ ~ ~l~ ~ ~ ~d-< ~ r J ~ ~ -
-------l--.a:'.~-__,_,_vV-- ~)-~-~~~ ~-~ ~ t-7-
-----11-~~~ ~ o ~-~&>--~ ~- ~ 
--+--""24 ~ ~-~ ~~ ~- ~ ~s. 7 6__~--
-- - ~ 15-_~ ------- - -- - - ~ ! L'-'-_~ ~ i3-~~ ~ 3u.:: ~ 
t ----- _2019dCLl-00051-3803 -
DHS-ICE-19-0196, 19-0197-O-000487

//-5 -- l(b)(6); (b)(7)(C) ]>__'-«.- _______________ _ 
' 
-------+- __ -_t:,J- 7'fvvv t /2.if~ {,,v----4 ~ 
_____ _,_,- ~,~ ~~---------------
~-----i-H.t ~-~~~ ~ r>-- C/ - I ~ ~ ~ -/.~ - - -- - !3 , '~ ---"--- --
.. ~ ~ ~ ~17·; ;;p;y;:;_ ~ - ~ ~~ 
-------~ ~s:,'-L.~--=--c...-11'-<-__________ ---------
~----!---· CeL\(b)(6); (b)(7)(C) I --k (_,,,( ~ -k ~ 1 I'---------
------4- ~ ~ ~J..-~ ~(P~ ./:, <.A.-A:J.._·,,....e __ ~ ______ _ 
-----+-_f-5f "-CA-~ - ~ ~ f'r--<. ---~~ 
------l-..L:..:~~~_l/\-,:~~~ ---r-,_,f ~~ nc:d ~ 
-----=~~....::£1.~~-$.~~-~~i::!1::!:1 ~w ~-+ ~ o---- ~ ~~ +·~t 
-----+---- ------------------------
::) b~~~~ic) ~ / ~a,.,:+ ~ ~ )¥=~="-_,_'( __ _ 
---~~~~'.'::::;.._~ :;) ~k 9 ~ c;47-r.. ~ 
------+--"-1.,...,..-""S-'-~ -fu M ~ ta ~-~---=--------------
-----~ '),Vs=-~ q -( .J-t.. ~n,c,l-< ~ ~ 
------4-T}-c-,--- ~~ ......_ ~ ~ ~ ~ 
---------- ~ wh (-"'-~- ,,tl--<..____.~,.____,l-'--~~----------
t§>(6) I _/ . ____ ____. ~1Lr)(7)(C) eo u ~ tE. d-o ~~~ ~-
-------1--.:;.q_.(.. ,b.,,k- ...._ ~ ·d - - ----o ~ ~~ 
------+-~~ ~-~ tr U,I_ kk ?d ~'--------
----~~=--~~-J.1::-dri:--:::t::.--k=-~ I hr~-==--~.....!:'.~~~~~~~-
------1--LV.~-=-~====..L-.....;ol,..e= L-d ~ : S ~ /0 ~._,_ ______ _ 
--::l--< ~ ~/-. b)(6);(b)(7)(C) t fix_) ~c..- ~ ~Y;. 
____ ...,__ ~~-°6-- ~-------------- l)Q 5£9. d ~ ' o.-+ ~ .+--R... 
--------+----+---- 2019-ICLl-00051~8<J2.---------------
DHS-ICE-19-0196, 19-0197-O-000488

-----
------~- _ UA..AS~_--f!2ifr =~~-ft->rc_'i_,,-~i(A.A..(_ ~ ~ 
-----rt:,v.-,V\-~~-------
----------t--"c,t.AA-~½ ~~~ ~-~-c--,,....,,. ~- ~-----
----- ~. ~-~- ---~ ~ ~ ,.__,/...~ ...... ~ -~ ~ ·---
---- ~ "'-4 0- ~?.-9_ ~-~- ~ - --- --
--- ---+- --- ---- - -
-----+----------- -------------~-----· 
---------
---------- ---- ---- ---- --- - -- - -- - ----
-- - -- - ---
--------------- --- - -- ---
-----
-----
----- ---- ~-----------
-- - ---
------------ - --2019-ICU;;0O051 3805 -
DHS-ICE-19-0196, 19-0197-O-000489

l-s (b)(6); (b)(7)(C) ___ ..___-"'--+_,. 
--------~~c...-~-~ _f>-----'--""------------------
------- s '/2- ~<; 
~-----_£A.A--f.'b.J ~id- :=pv (A-+! ~ - ~ ~>-----
C-<. ~Y"'- ~ ~ ~~ s￾1
_cJ_I_Lt_·_~-_., _______ _ 
-------~--c,._;-~~ - ~ ~ ~r p,._ ~ ~~--
-----1-=::l.:::!4~~ .-fo-: :::::i:x ~ ~ ~ - 1~· j ~- .. ------
-----1---------=,~:;..__:_ ~ <A_ ~ c--11 ~hV::= 1~· ~ ~--
--------~ 
_____ --+-_M/~~-L ~~-
~-1:'t--~-~ 
1ut 'e< ~'>" ~ ~b. 
~ 
~~ 
~C-4 ~ 
- ~ 
____ ___J_~~~.:::J____(_J,( ~~"!::._::::_~~~/I _..;;, l,,._.;;, i--~ 0.-,' ......-e_ ~C--<,A.. -:> 
--L_,_U').._ ~ 
- ----'-+--=--'---'-=..,____-'-'-"-~ ~~ - ~ ~ t..:t,_ ~k ,~ 
~0..--~ 
---I----+-'.,...=-..,~,.___-
-I-"-<--~~~ 
- {.. ...:.. ~ - e.. c..-~ 
~J~ 
(_ ~-G 
-k ~ 
-tv. ~ 67 't 
~ 
O ~ .,,_ ~ 
~ ~ 
& ~~ k~-tA-t.. - --~ ~J= ~ ~ 
-~ N ~ 'h--- ~ 6-(_ ~~ .. J 
~ ~ ~ ~t>- ~- -
~+ 
---
---- -l=-""c:...:..;~=-r--
+--='-=----~--::e-~-~i,~--..5:¥-~~ 
,_ - -t. ~--- I I -~-- {,.,_;i,,_J-
-~ 
~~ ~ ~ --to --- ~-~~ 
~-~ ~~-~~ ~,_(_,._ ~~ ,___;~--
____ .....::i:.._-c:::::1~~---"~~~~~~=--' e,.,y- f-:.-~ --f-.,s,{ ~ -~ 
~ ~_JLb)-(6)_; (b-)(-7)(_C> ___..J--,.;~:....;;_.;--=--=--J>-_'----"--"-~....;__--"'--~--
-----t-'u l ~ b ~ ~'--------'~'--'----'--=----~--~--------
=ii_ _.,k ~ ..A,l,c,, 'ol ~ · tfY.6JA5, 4-& ~ ~ 
~ -. - e,,.._M LL---"YY"' ~ ~ _ .,..__ - C; e• I Q ~ I..._ 
DHS-ICE-19-0196, 19-0197-O-000490

,~ .'-- I c.,(...,<...A,t I vv,...{ 
-~ 
~ 
/ ~ tat-ft-.. ~ "'-8-->-~ 0-.. £,._, 
~½ P\,,,. ½t-~ vJ/--6..A.~ 
- -/- - ----- - - -
~ -d:.~ ~ ~/--.-,I ~~ "'-- 0--- ~ 
~~ ;, ~-~- ~~t.. l /s , 1--~- ~ 
~~ -~ __u-,1..-~~ ~~ -- J 
- 1,...-o'tfv.. -~ u.-½-~ ~ . r'v-- ¼J-C._s;;_--4_ '-1f· 
[?]lL u.._,u _M-<.A.~_ ~~-~~ ~,l~ 
A~ -- D - ~~ _. CA.A ~ V\h--'-- ~-
- -
- - - - - - -
-
----- - -- - - -
- -- - - -
-
--- - - - -
- ~ 
- - -
-- --
- - --- - - -
-- --
- -- -- -
- -- -- -- -
- - -- ---
--
- - - -
- -- -
-
- ---- -204-9-ICLl-00051 3807 --
DHS-ICE-19-0196, 19-0197-O-000491

(b)(6); (b)(7)(C) 
-----1----~lr_s: I ~~'---'==-=.,__---------------
____ ____,f---'"--=~hL ___________________ _ 
-----+---=~),,,,,A.4A~---"h.-Ar~ -,-~~ c.-+-~1 (2- =~..----
~ r ~-=..a,_ ___ - ------~~ 
____ t-_,,,.,.-=:..-L(b-)(6-);_(b)-(7)-(C_) _J-~ ~ C..:.., J_, ~c.. t-~ ~ 
v-c ~'~·-£ v'-v ~e ~-~ ~ 
----~~----'-__,-~i-=----=.~.:_:..::._:=. __{/.~ ~c '--"{ ~~'< ~1'-d . ~. ctf-4&:-:-:--~-.=c~~ ~A ~v---f_.;,ft.c. -.:;, 
---'-< Cv 
~ 
. 
(...,,_~f-~"-<- ____________ -------
~ 
d.-e---v-< eu-.o crp--v- e,J-'£-__ ~ tr I: 1= d - ~ 
__t....t'-._ ~ ~ ~~ ~ l cX ~ 
-----H_b)(6);(b)(7)(C) ~ ¥r--~ ~..J ~~ ....._ ~ ~ 
.L---,,.,.......,,..,.,=,-----1 
b)(6); (b)(7)(C) b D ._/...:, ~ 1 ( ( 
(2.. - ~ c--<--
l\1:::0- c..-j>e_ 
-~--+-'~~=--
--------!--~~ lA.--lt--v~ ~ ~~ ~( (/'.,~ ~ 
----~...p0.. ~?-( ~ <!ff24-Y h ---< ~ ~ ~R. 
--------1~-·_[½,v/- ~t/__....-(..A...,b:-,L-1.-,:c__ ____ _ 
~~- ' . ___ ,___ - - C-c,..A-~v tp.~ 9 ~ •~ ~R.,_ 
----1---l<'--'--'~·pt,....f__~ <k ~ ...__; ~ ~ 
NiAJ<,,t ~~~---~~ ~L~k. -t. ho<-t_ ~----'--
-~ -~-r-' ( c.JiMA - /L,(.,0-&:::,, ~ ~ .J> d-v ~ 
~~ ~ ~ ~l)_o_~~~ ~~ -1.o ___ ~
} ~' ~ ,,,_...,,_, ~ J-....-,..,1 ...u.v-,:..,____ ...,_._ .;_ 
-----
~ 4
q__~ 
-. -
.>0---c-c.A 
. 201~-ICU-00051-38-08 .:.......f ~ ~ • .,...., ~~ 
- ---
~ ---
---- ~~ :f:!:-::vl~~.s-+ 
DHS-ICE-19-0196, 19-0197-O-000492

-----
~ ~ ~ ~; -f-, -~ ....),-._J_eA._ v-.'_ ~j .H C, :5 ~ ~ 
~-~-~~- -- - - -
(1.,,,-__±f ~ L. ~ ~ .:__ ~ ~ ~ L,t'-=-.!. ~ ~ bl"--
~-u ~-~~-uh~~~ 
-----~~-/- ~ ~ ~~ e,,v---<_~1-·~ 
-----·-- _- V""'~•~-- - -~ -
- ol ~ -~ ~ -/7.--"'-7!' ~f-f. ~ ~ ~ 
------ ~-.,,.v--eJ-c~c<.._. ~ ~~-~~- ~-,._.(__ - --
------~ ~·'i_. -~ ~ ~ ~ (.,,.,~ µt-..-v,·.,,_,,_<" -~,.,..~-
________ tA._ --- - - - - - -- - -- - -
-----+------~~-t~ ~ ~-- -
-- --- - ~-'--l----~L,._,·~~~ 
-------~----- '=P=f· ~r~+ ~ ~---f ~-~----'-~~ ~-~-4~ --fhll~ ---=::_ __ _ 
---- I ~-v,.,~-~~---- --- -- --- - - -
-~;-v-d...A~~,~ -1- ~o .-AAl-~_ 
---- ·r--"::::!:J~"b_k.)_ ___ ~_ ----
_____ - fbl(6),(b)(7)(C) ~~ ~ -~ ~, -~ ~A-'<. -°&- __ 
-----r-~s_~~ e{ ~ ~ ...-Y-.t>'-J. I ~ ~LJ ~ __ 
~--~ ~ 1 { -4-G,,(_ ~ ~~ ~ ~ -
-----1----,~-~M- ~-~ f~ ~ ~-~../... __ 
-------+=....,,b-v,..""'--·~~~~~ ~-- - - -
.,,M,,,_~ - ~~-~ +11~-¥-J/c__s-dc-,,. ~~--- -·~* __.h,,,.._·~1~~ ~ ~~~ -- - ---- ~~-~ -~"&-~- ~-~-~'- ~-...S-- . ------+t(b)(6);(b)(7)(C) ~~r'v-- _________ _ ------ 1.___----1 
------+---=-! ~ -~ -~-fc.. _o---u.. ~ o<A/1.-~-~ ~~~~-
-----~- -- -- --------- -----
------L+-'~ D~_...,J--..,e. ~ -0~~ ~ ~-,..:__--<. ~- -
-~---r- (c..-t ~ ~ - -- -- ---
----------
DHS-ICE-19-0196, 19-0197-O-000493

b)(6); (b)(7)(C) ~ ~ f' l ( li...,.'e.-L 
------+--,_,-r-/.. G_~b ) ~ ~ ~ ~~ ../.. ~---
------+--'-'-'=-"'-~ ~ -bo -..JL-oc/4 ~~ -A-½J ~ ~ --- -----~Bvl~ ~(~~ 
-----+--'~~ 1-.-v-f ,oA.-0 -r- { { _c,.,,..-U - -t½-- £--A$ }J- -t-"'---'--'------ -- - _l I ~ /1.AAA.~~ ~ f If>_-,._ _____ _ 
-------------==- ~~ ~ ~-~s_ ½- ~ s-----------
--------~ ((- < ,,_,__,,._ ~ ~,~r "°""' ~---
----~.,,..,, ~ ~-"'-'~ k~ ~---
---~~~~~-~ ~J--~~~~~-~-
------1-',.d...t..;::...,,~ ~ ~ ~ ~ ~ "'->1--e..S: 
----+-""'--"d.,,...'~·+ ~ ~ ~-D ~ ,~~~~ 
==-__,_{ l--s_---+--~(bJ<6J• (bJ~J<CJ ~[ ...... 7>_stJ...,..._CA_t'Mvi~=<"====--------------
- ~f -=--/;)__ ~~-1~ ,k/--i ~ v-( £~,:... 
- ~ Lo 1h-1----vl..: 6 · 1--<..A..,, 
._,_, 
-----+---""'J1,vµ_...:;__.:c.;;.,..;;:___ -{y__b,. I ~ - l,v....; • ( - ~ ~ 
- ~- ~-f----,J...:., ol,,,..,,lt.,,._ ~ _..,,.___p --L ~/ ~ - -J ~~ •• ~ ~- ~,, ---------~~-~~~- I ---,-i-T- =--«-
~~-!:-~~~:::!:=l~&_ _____________ _ 
~/,;)... - ~. ~--<. LAH<4---d.~ '~ 
---------&--:--~~ ~e-J..·~----- -----
-----+~~L~cd_t..A.._ ~ v-- ~ 6 ~ ~ _.-,. t......s-
-----+--'~--C.-~--------------
-------1--.-J.A-q?~ ~--k ~ ~~..;, :¾' 1- ~ 1~ 
------+- _ __,__'_c..AA.1-A ___ ~_yd _::_f.:=:::::::~1/)~· ~~~C-(__~<!...-~~----------
----~~ ~ f ~j ~~--~-~-~----d~~~·,~~~-s~~~~----
------+----"~ ~-f~ 6.A..·c /,S"~~ {,4.-,s-f-v\ ~ ± io~=-)..__ ___ _ 
~ • 
<.r-- ~ ~ -< -----~-- DHS-ICE-19-0196, 19-0197-O-000494

_ _L [-s. _ r)(6); (b)(7)(C) 
'------::---------_J 
------1~- --=-~ ~~ -- - I~~'<; - - -- - --- - ;"\ - -
--- --+---- _ -::_SI~ "] - 7: :3 0 " ~'=j ~--c,.,{.,_ 1L -_z : 3 o_{ ~< M--T,_ J __ _ 
--y--~ -~\-(A.JI~~ - -
-, -~ I=-&?-c..ev-i ~~VI--~ -~ I v-.--- ------o/~~ 
-d~~~r..... b~ ~~~ ~ 1- l,t--.--1_ 
-- vl-J.- ,..,_-(_ b ~ -
-- ----~ f--~ ~~ r-'-2---<.-<r/,. LF ~ ,...,__ I, .-1- -
-----l, ~-~~t,,...A~~,:::-oo ~~~ -~ '-h,(a,( ~c ~ ~ 
--- _ _2t-c..-:1) ~~ ~-~_b,~, --t ~ ½~ 
;,, u,1--1t,.,._~ ~~.,,<..._'c--(_ -- -
----1-~ ~-~ ~ -le, ~ ~ r I - - -
~ ----1> ~ CA.M ~ ~ (.A.A..~~ ==1~ -r~---~ -=----=---= 
-----~~±-· ~ tr~-~-~~ _£Y- ~ c...,-...1,.. ~ 'o1.-.. -L -
---- ~- ~ o-tt''c,<A( --/4 ~ ~~ -- ---
~~s. ~~ ~~ a.h~_l-f ~ 
-+---'-?""'~4 ~- ~~ ~ "----<>/--,i_' ~---
-- ---====1--~ ~ '- -f-,~ ~ ~ ]Ju·~ --k-~ ~~ --.. ~-
_._,J kf,--- ~R- -- -- -- -- - - -
____ __., _ ~ t_~_~_j_ ~-h_ ""--f' ~cf_ o..±-- e,,r~, av 
-- _5}-...t.., -/u. L - ~-~ ..-<.L~~b-. l-i.~_ I Lt.,--1-~ ~~ 
~'1 >v -- b '"=8 _ _ _ _ _ _ 
-----~ 1 s _,A.;Vl~ C2.J> /?;__ --~ 'c,1-A- _:I_ ~~--1-o ~ _ 
·1-2 ~~ -l,., ' ------ ~) -71~· -- ~ <-4-~~ -- ,- - - --
~ ~-~~ 1; ~ ~~~-fo - Pl-_ -
------t-Cf_ll t-~~~~ ~ ~ ~ --6:, _A.-~ 
-----~r---t ~ {}<./J ~----=-~·,!l._ o--1-~su ·- ~ ~ ~{ 15_ oV---1 -~ ~4 .._,I-_ ->"-'l's L.d- -
-----+-r2--~ - ~C....r~-i iL~ ~i,,,.,/ ~ ~ ~ ~•~_:J __ . 
-----;~~ i=:> ~-2trl'B-~~051~ ;4-<,'---.,..._~ ~-
• I 
DHS-ICE-19-0196, 19-0197-O-000495

Office of Information Governance and Privacy
U.S. Department of Homeland Security
500 12th St., SW
Washington, D.C. 20536
www.ice.gov
January 29, 2021
Erica Lai
Cohen & Gresser LLP
2001 Pennsylvania Ave. NW
Suite 300
Washington, DC 20006
RE: American Oversight v ICE. 19-cv-01817-RCL
ICE FOIA Case Number 2019-ICLI-00051
Sixteenth Interim Release
Dear Ms. Lai,
This is the Sixteenth interim response to your client’s Freedom of Information Act (FOIA) 
requests to U.S. Immigration and Customs Enforcement (ICE), dated June 21, 2018, given the 
tracking number 2019-ICLI-00051. Your clients are seeking the following: 
• A copy of ICE’s initial report on the May 2018 death of ICE detainee Roxana Hernandez
(also listed in DHS records as Jeffry Hernandez), which ICE was required to publish by
June 24, 2018.
• A copy of ICE’s final report on the May 2018 death of ICE detainee Roxana Hernandez
(also listed in DHS records as Jeffry Hernandez), which ICE was required to publish by
July 24, 2018.
• Responsive records include, but are not limited to, records related to the care, treatment,
discipline, and abuse of Ms. Hernandez, as well as reports or reviews of Ms. Hernandez’s
death. The records containing the factual information relied upon for ICE’s public
statements regarding Ms. Hernandez’s death and detention are also responsive.
• A copy of ICE’s initial report on the November 2018 death of ICE detainee Mergensana
Amar.
• A copy of ICE’s final report on the November 2018 death of ICE detainee Mergensana
Amar.
• Responsive records include, but are not limited to, records related to the care, treatment,
discipline, forced-feeding, and involuntary hydration of Mr. Amar, as well as reports or
reviews of Mr. Amar’s death. The records containing the factual information relied upon
for ICE’s public statements regarding Mr. Amar’s death and detention are also
responsive. Please provide all responsive records from March 1, 2018, through the date of
the search.
U.S. Immigration 
and Customs 
Enforcement 

Page 2 of 3
ICE has considered this request under the FOIA, 5 U.S.C. § 552, and processed 517 pages of 
potentially responsive records. ICE has determined that 2 pages was deemed non-responsive.
ICE has determined that 492 pages will be withheld in full. ICE has further determined that
portions of 23 pages will be withheld pursuant to Exemptions 6, 7(C), and 7(E) of the FOIA, 5 
U.S.C. § 552 as described below.
 
ICE has applied FOIA Exemptions 6 and 7(C) to protect from disclosure the names, e-mail 
addresses, and phone numbers of ICE and DHS employees contained within the documents, as 
well as the names, and other personally identifiable information of other individuals contained 
within the records.
FOIA Exemption 6 exempts from disclosure personnel or medical files and similar files the 
release of which would cause a clearly unwarranted invasion of personal privacy. This requires a 
balancing of the public’s right to disclosure against the individual’s right to privacy. The privacy 
interests of the individuals in the records you have requested outweigh any minimal public 
interest in disclosure of the information. Any private interest you may have in that information 
does not factor into the aforementioned balancing test.
FOIA Exemption 7(C) protects records or information compiled for law enforcement purposes 
that could reasonably be expected to constitute an unwarranted invasion of personal privacy. 
This exemption takes particular note of the strong interests of individuals, whether they are 
suspects, witnesses, or investigators, in not being unwarrantably associated with alleged criminal 
activity. That interest extends to persons who are not only the subjects of the investigation, but 
those who may have their privacy invaded by having their identities and information about them 
revealed in connection with an investigation. Based upon the traditional recognition of strong 
privacy interest in law enforcement records, categorical withholding of information that 
identifies third parties in law enforcement records is ordinarily appropriate. As such, I have 
determined that the privacy interest in the identities of individuals in the records you have 
requested clearly outweigh any minimal public interest in disclosure of the information. Please 
note that any private interest you may have in that information does not factor into this 
determination.
The ICE FOIA Office applied FOIA Exemption (b)(7)(E) to protect from disclosure an internal 
law enforcement sensitive investigative technique. The release of this information would 
disclose investigative techniques and procedures, and could be reasonably expected to risk 
circumvention of the law.
FOIA Exemption 7(E) protects records compiled for law enforcement purposes, the release of 
which would disclose techniques and/or procedures for law enforcement investigations or 
prosecutions, or would disclose guidelines for law enforcement investigations or prosecutions if 
such disclosure could reasonably be expected to risk circumvention of the law. I have determined 
that disclosure of certain law enforcement sensitive information contained within the responsive 
records could reasonably be expected to risk circumvention of the law. Additionally, the 
techniques and procedures at issue are not well known to the public.

Page 3 of 3
If you have any questions about this letter, please contact Assistant U.S. Attorney Benton 
Peterson at Benton.Peterson@usdoj.gov or 202-252-2534.
Sincerely,
Senior Paralegal, ICE FOIA for
Fernando Pineiro Jr.
(A)FOIA Officer
Enclosure: 515 pages

From: ~rb_)C6_);_Cb_l(_7l_CC_l ____ ~ 
Sent: 11 Mar 2020 11:35:07 +0000 
To: rb)(6); (b)(7)(C) I 
Subject: FW: AutoRecovery save of AMAR Detainee Death Review Healthcare and 
Security Compliance Analysis FINAL (2) 
Attachments: AutoRecovery save of AMAR Detainee Death Review Healthcare and Security 
Compliance Analysis FINAL (2).docx 
Good morning, 
I haven't looked at the last version, with your res onses yet, but here you go. Before I send anything to 
~)\~1;,.,, I am going to send all the versions back to i~li~licl I'm hoping she will work them into one 
because I cannot. It would have been far cleaner to just send us all her questions at once. 
Thanks, 
Fromfb)(6); (b)(7)(C) 
Sent: Tuesday, March 10, 2020 9:59 PM 
Tofb)(6); (b)(7)(C) 
Subject: AutoRecovery save of AMAR Detainee Death Review Healthcare and Security Compliance 
Analysis FINAL (2) 
Finally!!! I finally completed my first draft of AMAR! I'm so happy I could cry. 
I had a few follow up questions. I'm sorry for all the versions of my comments. G 
(b)(6); (b)(?)(C) 
ect1on 1e 
Office of Professional Responsibility 
Immigration and Customs Enforcement 
950 L'Enfant Plaza, SW 
Washington, DC 20536 
(b)(6); (b)(7)(C) 
2019-ICLl-00051 4316 
DHS-ICE-19-0196, 19-0197-P-000001

Page 4317 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000002

Page 4318 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000003

Page 4319 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000004

Page 4320 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000005

Page 4321 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000006

Page 4322 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000007

Page 4323 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000008

Page 4324 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000009

Page 4325 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000010

Page 4326 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000011

Page 4327 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000012

Page 4328 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000013

Page 4329 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000014

Page 4330 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000015

Page 4331 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000016

Page 4332 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000017

Page 4333 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000018

Page 4334 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000019

Page 4335 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000020

Page 4336 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000021

Page 4337 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000022

Page 4338 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000023

Page 4339 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000024

Page 4340 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000025

Page 4341 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000026

Page 4342 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000027

Page 4343 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000028

Page 4344 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000029

Page 4345 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000030

Page 4346 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000031

Page 4347 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000032

Page 4348 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000033

Page 4349 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000034

Page 4350 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000035

Page 4351 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000036

Page 4352 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000037

Page 4353 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000038

Page 4354 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000039

Page 4355 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000040

Page 4356 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000041

Page 4357 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000042

Page 4358 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000043

Page 4359 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000044

Page 4360 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000045

Page 4361 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000046

Page 4362 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000047

Page 4363 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000048

Page 4364 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000049

Page 4365 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000050

Page 4366 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000051

Page 4367 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000052

Page 4368 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000053

Page 4369 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000054

Page 4370 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000055

From: ~l(b_H6_);_(b_)(_7)_(c_) ----~ 
Sent: 17 Mar 2020 21:12:53 +0000 
To: l(b)(6); (b)(7)(C) I 
Subject: RE: AMAR DDR 
Attachments: AutoRecovery save of AMAR Detainee Death Review Healthcare and Security 
Compliance Analysis FINAL (2) CC MEDICAL responses round 4 (JJ).docx 
Here it is! &#128522; 
Fro~(b)(6); (b)(7)(C) 
Sent: Monday, March 16, 2020 4:38 PM 
Tofb)(6); (b)(7)(C) 
Subject: FW: AMAR DDR 
D b t t (b)(6); o your es o me fh\mrr., deadline. If you can't, I will deal with it. 
Frorrj(b )(6); (b )(7)(C) 
Sent: Monday, March 16, 2020 2:40 PM 
To:l(b)(6); (b)(7)(C) 
Subject: AMAR DDR 
. (b)(6); HI (h\(7\(C:\ 
I completed my review of both documents and consolidated the questions to one document. I identified 
medical questions in green, security in purple, and items I need to work on in yellow. 
I have two interviews that I'm unable to determine when they occurred because they weren't on the 
original interview list, but mayb~o ~ (b)(6); ill have a better idea by comparing their interview 
/h\/7\/1.\ 
notes with the attached interview sched . officers that I can't determine when they were 
interviewed were Officer i~\i~\rci n i~!i~!ir, Any help on this would be greatly appreciated. 
Please provide a response to the remaining medical questions by COB tomorrow. 
Regards, 
l(b)(6); (b)(7)(C) 
Section Chief 
Office of Professional Responsibility 
Immigration and Customs Enforcement 
950 L'Enfant Plaza, SW 
Washington, DC 20536 
rb)(6); (b)(7)(C) 
2019-ICLl-00051 4371 
DHS-ICE-19-0196, 19-0197-P-000056

Page 4372 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000057

Page 4373 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000058

Page 4374 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000059

Page 4375 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000060

Page 4376 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000061

Page 4377 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000062

Page 4378 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000063

Page 4379 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000064

Page 4380 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000065

Page 4381 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000066

Page 4382 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000067

Page 4383 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000068

Page 4384 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000069

Page 4385 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000070

Page 4386 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000071

Page 4387 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000072

Page 4388 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000073

Page 4389 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000074

Page 4390 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000075

Page 4391 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000076

Page 4392 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000077

Page 4393 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000078

Page 4394 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000079

Page 4395 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000080

Page 4396 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000081

Page 4397 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000082

Page 4398 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000083

Page 4399 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000084

Page 4400 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000085

Page 4401 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000086

Page 4402 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000087

Page 4403 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000088

Page 4404 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000089

Page 4405 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000090

Page 4406 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000091

Page 4407 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000092

Page 4408 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000093

Page 4409 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000094

Page 4410 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000095

Page 4411 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000096

Page 4412 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000097

Page 4413 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000098

Page 4414 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000099

Page 4415 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000100

Page 4416 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000101

Page 4417 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000102

Page 4418 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000103

Page 4419 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000104

Page 4420 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000105

Page 4421 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000106

Page 4422 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000107

Page 4423 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000108

Page 4424 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000109

Page 4425 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000110

Page 4426 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000111

From: 
Sent: +0000 
To: 
Cc: 
Subject: RE: AMAR Dental Refusal 
or both of the documents you emailed me. 
f b)(6); (b)(?)(C) 
.5eCLIOI I Ci 11e1 
Office of Professional Responsibility 
Immigration and Customs Enforcement 
950 L'Enfant Plaza, SW 
Washington DC 20536 
b)(6); (b)(?)(C) 
Fronjb)(6); (b)(?)(C) 
Sent: Wednesday, February 26, 2020 7:08 PM ~f )(6); (b){7)(C) 
SuD)ett. AIVIAR oema1 Re1usa1 
Hey,Kb)(~); ___ I I attached the progress note from the dentist noting the refusal and tha )~()~(;r, igned a 
refusal form. I can't find the actual signed refusal form either. 
2019-ICLl-00051 4427 
DHS-ICE-19-0196, 19-0197-P-000112

From: ~fb_)(6_);_(b_)(7_)(_C_) ----~ 
Sent: 29 Feb 2020 13:43:01 +0000 
To: rb}(6); (b)(7)(C) l 
Subject: RE: AMAR Detainee Death Review Healthcare and Security Compliance Analysis 
FINAL (2) CC Responses to round 1 questions 
Attachments: AMAR Detainee Death Review Healthcare and Security Compliance Analysis 
FINAL (2) CC Responses to round 1 questions EM follow up.docx 
\~)\~\--, as a very long way to go on this report before she leaves ERAU. Responses are attached. 
From~(b)(6); (b)(7)(C) 
Sent: Friday, February 28, 2020 4:58 PM 
~~r(6); (b)(7)(C) 
Subject: RE: AMAR Detainee Death Review Healthcare and Security Compliance Analysis FINAL (2) CC 
Responses to round 1 questions 
Hey, 
1111 get this t ~)\~/;,,,, o see if she can answer questions in her bailiwick before she leaves for th ~li~lic:, 
DDR next week. As for the property issue, at the time we were not applying deficiencies to Expecte 
Outcomes. Even if we had, I'm thinking (11)(2) and (7) are a stretch. 
Beyond the property issue, I know you will accept this in the spirit in which it is intended: some of your 
questions suggest you may (for reasons I understand) be applying current expectations to a report 
produced more than a year ago. 
Fro~(b)(6); (b)(7)(C) 
Sent: Friday, February 28, 2020 4:26 PM 
To:l(b)(6); (b)(7)(C) 
Subject: AMAR Detainee Death Review Healthcare and Security Compliance Analysis FINAL (2) CC 
Responses to round 1 questions 
H (b)(6); 
/h\/7\/r\ 
I have a few more questions, I still haven't made it to October. Blah. 
The personal property is going to need to be addressed somehow. I've deleted my questions that I'm 
good with. I kept a few and didn't provide a comment because I still need to review it in depth a bit 
more. 
I'm teleworking Monday through Wednesday next week to knock out this report. 
Regards, 
l(b)(6); (b)(7)(C) 
Section Chief 
2019-ICLl-00051 4428 
DHS-ICE-19-0196, 19-0197-P-000113

Office of Professional Responsibility 
Immigration and Customs Enforcement 
950 L'Enfant Plaza, SW 
2019-ICLl-00051 4429 
DHS-ICE-19-0196, 19-0197-P-000114

Page 4430 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000115

Page 4431 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000116

Page 4432 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000117

Page 4433 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000118

Page 4434 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000119

Page 4435 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000120

Page 4436 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000121

Page 4437 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000122

Page 4438 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000123

Page 4439 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000124

Page 4440 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000125

Page 4441 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000126

Page 4442 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000127

Page 4443 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000128

Page 4444 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000129

Page 4445 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000130

Page 4446 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000131

Page 4447 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000132

Page 4448 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000133

Page 4449 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000134

Page 4450 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000135

Page 4451 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000136

Page 4452 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000137

Page 4453 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000138

Page 4454 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000139

Page 4455 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000140

Page 4456 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000141

Page 4457 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000142

Page 4458 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000143

Page 4459 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000144

Page 4460 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000145

Page 4461 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000146

Page 4462 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000147

Page 4463 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000148

Page 4464 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000149

Page 4465 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000150

Page 4466 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000151

Page 4467 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000152

Page 4468 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000153

Page 4469 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000154

Page 4470 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000155

Page 4471 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000156

Page 4472 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000157

Page 4473 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000158

Page 4474 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000159

Page 4475 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000160

Page 4476 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000161

Page 4477 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000162

Page 4478 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000163

Page 4479 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000164

Page 4480 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000165

Page 4481 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000166

Page 4482 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000167

Page 4483 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000168

Page 4484 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000169

From: 
Sent: 
To: 
Subject: 
FINAL (2) 
fb)(6); (b)(7)(C) I 
9 Mar 2020 20:53:17 +0000 
~b)(6); (b)(7)(C) I 
RE: AMAR Detainee Death Review Healthcare and Security Compliance Analysis 
Attachments: AutoRecovery save of AMAR Detainee Death Review Healthcare and Security 
Compliance Analysis FINAL (2)(JJ).docx 
l\~!\~L, ~esponded to the best of my notes and recollection. 
Fro~(b)(6); (b)(7)(C) 
Sent: Monday, March 9, 2020 10:02 AM 
Tq(b)(6); (b)(7)(C) 
Subject: FW: AMAR Detainee Death Review Healthcare and Security Compliance Analysis FINAL (2) 
Again, I haven't looked at the questions yet. 
Fronfb)(6); (b)(7)(C) 
Sent: Friday, March 6, 2020 4:05 PM 
Tofbl(6); (b)(7)(C) I 
Subject: AMAR Detainee Death Review Healthcare and Security Compliance Analysis FINAL (2) 
(b)(6); 
(b)(7)(C) 
I didn't make any progress, but as promised, attached are my questions. If you could please provide me 
a response to the questions by Wednesday, March 11th that would be great. 
Thank you! 
rb)(6); (b)(7)(C) 
Section Chief 
Office of Professional Responsibility 
Immigration and Customs Enforcement 
950 L'Enfant Plaza, SW 
Washington DC 20536 
(b)(6); (b)(7)(C) 
2019-ICLl-00051 4485 
DHS-ICE-19-0196, 19-0197-P-000170

Page 4486 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000171

Page 4487 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000172

Page 4488 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000173

Page 4489 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000174

Page 4490 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000175

Page 4491 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000176

Page 4492 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000177

Page 4493 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000178

Page 4494 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000179

Page 4495 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000180

Page 4496 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000181

Page 4497 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000182

Page 4498 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000183

Page 4499 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000184

Page 4500 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000185

Page 4501 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000186

Page 4502 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000187

Page 4503 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000188

Page 4504 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000189

Page 4505 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000190

Page 4506 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000191

Page 4507 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000192

Page 4508 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000193

Page 4509 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000194

Page 4510 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000195

Page 4511 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000196

Page 4512 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000197

Page 4513 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000198

Page 4514 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000199

Page 4515 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000200

Page 4516 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000201

Page 4517 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000202

Page 4518 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000203

Page 4519 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000204

Page 4520 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000205

Page 4521 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000206

Page 4522 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000207

Page 4523 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000208

Page 4524 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000209

Page 4525 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000210

Page 4526 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000211

Page 4527 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000212

Page 4528 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000213

Page 4529 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000214

Page 4530 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000215

Page 4531 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000216

Page 4532 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000217

Page 4533 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000218

Page 4534 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000219

Page 4535 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000220

Page 4536 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000221

Page 4537 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000222

Page 4538 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000223

Page 4539 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000224

Page 4540 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000225

From: .... l(b_)(_6)_; <_b)_(7_)(C_l ____ __, 
Sent: 12 Mar 2020 15:42:56 +0000 
To: fb)(6); (b)(7)(C) I 
Subject: RE: AutoRecovery save of AMAR Detainee Death Review Healthcare and 
Security Compliance Analysis FINAL (2) 
Attachments: AutoRecovery save of AMAR Detainee Death Review Healthcare and Security 
Compliance Analysis FINAL (2) {002)(JJ).docx 
Here is what looks like the last of the medical questions. I wish I had been able to answer more of the 
security questions, but it will be easier fol(b)(6); I 
Fromfb)(6); (b)(7)(C) 
Sent: Wednesday, March 11, 2020 7:35 AM 
Tq'.b)(6); (b)(7)(C) I 
SubJect: FW: AutoRecovery save of AMAR Detainee Death Review Healthcare and Security Compliance 
Analysis FINAL (2) 
Good morning, 
I haven't looked at the last version, with your responses yet, but here you go. Before I send anything to 
l\~/\~1:~. I I am going to send all the versions back to~~/~~/;,.., I'm hoping she will work them into one 
because I cannot. It would have been far cleaner to just send us all her questions at once. 
Thanks, 
(b)(6); 
(b)(7)(C) 
From:fb)(6); (b)(7)(C) 
Sent: Tuesday, March 10, 2020 9:59 PM 
To: l(b)(6); (b)(7)(C) 
Subject: AutoRecovery save of AMAR Detainee Death Review Healthcare and Security Compliance 
Analysis FINAL (2) 
Finally!!! I finally completed my first draft of AMAR! I'm so happy I could cry. 
I had a few follow up questions. I'm sorry for all the versions of my comments. @ 
rb)(6); (b)(7)(C) 
Section Chief 
Office of Professional Responsibility 
Immigration and Customs Enforcement 
950 L'Enfant Plaza, SW 
Washington, DC 20536 
rb)(6); (b)(7)(C) 
1 
2019-ICLl-00051 4541 
DHS-ICE-19-0196, 19-0197-P-000226

Page 4542 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000227

Page 4543 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000228

Page 4544 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000229

Page 4545 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000230

Page 4546 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000231

Page 4547 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000232

Page 4548 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000233

Page 4549 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000234

Page 4550 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000235

Page 4551 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000236

Page 4552 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000237

Page 4553 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000238

Page 4554 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000239

Page 4555 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000240

Page 4556 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000241

Page 4557 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000242

Page 4558 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000243

Page 4559 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000244

Page 4560 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000245

Page 4561 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000246

Page 4562 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000247

Page 4563 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000248

Page 4564 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000249

Page 4565 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000250

Page 4566 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000251

Page 4567 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000252

Page 4568 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000253

Page 4569 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000254

Page 4570 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000255

Page 4571 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000256

Page 4572 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000257

Page 4573 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000258

Page 4574 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000259

Page 4575 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000260

Page 4576 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000261

Page 4577 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000262

Page 4578 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000263

Page 4579 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000264

Page 4580 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000265

Page 4581 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000266

Page 4582 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000267

Page 4583 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000268

Page 4584 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000269

Page 4585 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000270

Page 4586 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000271

Page 4587 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000272

Page 4588 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000273

Page 4589 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000274

Page 4590 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000275

Page 4591 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000276

Page 4592 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000277

Page 4593 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000278

Page 4594 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000279

Page 4595 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000280

From: l(b)(6); (b)(7)(C) 
Sent: 9 Mar 2020 16:16:16 +0000 
To: 
Subject: 
l<b)(6); (b)(7)(C) I 
RE: Dental Deficiencies 
So thefb)(6); __ ~eport's footnote could be removed to avoid misunderstanding. I recall pondering this 
because it refers to the mouth but not the oral cavity. I favor the dental examination. 
Fromfb)(6): (b)(7)(C) 
Sent: Monday, March 9, 2020 10:05 AM 
To:1(b)(6); (b)(7)(C) 
Subject: RE: Dental Deficiencies 
The thing is, ou \~)\~);,--, report does say there was an examination of the mouth. I thought maybe I 
added that somehow, but just looked at your original report and it's there. Let me know if you think we 
should take that reference out of the narrative and leave the deficiency. 
From~(b)(6); (b)(7)(C) 
Sent: Saturday, March 7, 2020 7:58 AM 
To: ICb)(6); (b)(7)(C) 
Subject: Dental Deficiencies 
Good morningl/b\/6\ I The simple answer to Evelin's question regarding the difference in dental findings 
between AMAR ancf;b)(6); Js that the AMAR record has a thoroughly completed form with dental 
diagram from the San Luis RDC titled Dental Assessment, dated just a day or two prior to his transfer to 
NOC; therefore a second physical exam, also done at San Luis, was not necessary when he arrived to 
NOC. b)(6); (b)(7)(C) record does not even mention an oral exam. 
2019-ICLl-00051 4596 
DHS-ICE-19-0196, 19-0197-P-000281

From: ~b)(6); (b)(7)(C) I 
Sent: 9 Apr 2020 16:00:26 +0000 
To: l(b)(6); (b)(7)(C) i 
Subject: RE: Security Report: AMAR 
That sounds good to me. 
From~(b)(6); (b)(7)(C) 
Sent: Thursday, April 9, 2020 8:40 AM 
~=~b~~:: (:)~~)~C~CUr lty Ke pm(. AIVIAK 
I see what you are saying, but read it a little differently because it first says medical staff shall complete 
a report, then in the same sentence, goes on to say all staff shall. I don't know why the standard would 
limit the requirement to just medical staff since in suicides, officers play a lead role in the response and 
have a lot of pertinent information. I'll share your thoughts and see which way ERAU wants to go. I 
will let you know because it may have implications for DDRs underway. 
Thanks! 
Fromfb)(6); (b)(7)(C) 
Sent: Thursday, April 9, 2020 8:31 AM 
To:!(b)(6); (b)(7)(C) 
Subject: RE: Security Report: AMAR 
That section is one of those very poorly written ones. Kb)(5) 
l(b)(5) 
l(b)(5) 11 am fine if the AOC is changed, but I .__ ____________________ ___. 
have qualms about it. 
Good morning! 
I 
I admit I didn't know this section was in SSH-SP&I, but I'm thinking it fits. You can be b)(6); idn't know h\/7\/r"\ 
of it either. Thoughts? 
(b)(6); (b)(7)(C) 
Fromtb)(6); (b)(7)(C) 
Sent: Wednesday, April 8, 2020 10:38 AM 
Tq(b)(6); (b)(7)(C) 
Subject: RE: Security Report: AMAR 
b)(6); 
b)(7)(C) 
For one of the AO Cs re: Sgt~\~!\~!;_~, Fnd Officer )~;)~\le:, n ~ii~irci lease see the Significant Self￾Harm and Suicide Prevention and Intervention Standard (V)(I), last paragraph. Let me know your 
thoughts. 
2019-ICLl-00051 4597 
DHS-ICE-19-0196, 19-0197-P-000282

Regards, 
rb)(6); (b)(?)(C) 
section cn1er 
Office of Professional Responsibility 
Immigration and Customs Enforcement 
950 L'Enfant Plaza, SW 
From:~b)(6); (b)(?)(C) 
Sent: Wednesday, April 8, 2020 8:57 AM 
Tc*b)(6); (b)(?)(C) 
Subject: RE: Security Report: AMAR 
(b)(6); 
fh\17\ff"'\ 
\~!\~);,,_, ompleted her review of the Amar DDR and had a few edits. I'm going to work on that today and 
go throug~(b)(6); __ !working papers. 
I don't think there are any "get-backs" that I needed to provide you, but if I'm mistaken let me know. 
With that, can you please provide a cleaned up version of CC's Amar report this week? 
Regards, 
l(b)(6); (b)(?)(C) 
Section Chief 
Office of Professional Responsibility 
Immigration and Customs Enforcement 
950 L'Enfant Plaza, SW 
Washington, DC 20536 
r)(6); (bl(7)(C) 
Fromfb)(6); (b)(?)(C) 
Sent: Friday, March 20, 2020 10:59 AM 
To,b)(6); (b)(?)(C) 
Su Jed: RE: Security Report: AMAR 
Hi, 
Attached is the report witj(b)(6); __ ~esponses to remaining questions. I am guessing you will need a 
cleaned up version when all is said and done. We can talk more about that later. 
2019-ICLl-00051 4598 
DHS-ICE-19-0196, 19-0197-P-000283

Have a SAFE trip!! 
b)(6); 
h\(7)/C:\ 
From~(b)(6); (b)(7)(C) 
Sent: Friday, March 20, 2020 9:21 AM 
Tofb)(6); (b)(7)(C) 
Su6Ject: RE: Security Report: AMAR 
This was actually very helpful. Thank you! 
I . t dl(b)(6); I t th A t 25th t 'th RN (b)(6); JUS nee 1
b)(WC\response o e ugus encoun ers w1 (b)(?)(C) 
b)(6); 
1-..\/7\/1""'\ 
l(b)(6); (b)(7)(C) 
Section Chief 
Office of Professional Responsibility 
Immigration and Customs Enforcement 
950 L'Enfant Plaza, SW 
Washington DC 20536 
~b)(6); (b)(7)(C) 
Frortj(b )(6); (b )(7)(C) 
Sent: Thursda March 19 2020 6:58 PM 
To (b)(6); (b)(7)(C) 
nd I'll be set. 
A . d h . (b )(6) . . I s promise , ere I lhlf 7 ,
1
r: s ongina report. I kicked remaining medical questions on the merged 
report to fbl(~); I 
(b)(6); 
b 7 C 
2019-ICLl-00051 4599 
DHS-ICE-19-0196, 19-0197-P-000284

From: 
Sent: 
To: 
Cc: 
Subject: 
Attachments: 
~b)(6); (b)(7)(C) 
27 Feb 2020 00:08:05 +0000 
b)(6); (b)(7)(C) 
AMAR Denta Re usa 
AMAR Dental Refusal.pdf 
Heyl(b)(6); 11 attached the progress note from the dentist noting the refusal and that AMAR signed a 
refusal form. I can't find the actual signed refusal form either. 
2019-ICLl-00051 4600 
DHS-ICE-19-0196, 19-0197-P-000285

04/24/2018 
U.S. Immigration 
and Customs 
Enforcement 
Reason for Appolntmont 
1. DEN:sc #15-my filling broke )<!Slefday 
History of Present IUnoss 
tl!!ali!!: Dental (Subjectile) 
Location ol Ewlualion Pavenr evaluated in dinic 
"'8¥JU c1mendyin pain? No 
f'iiticpt klcntification: Patient ldenbfication 
AMAR,MERGENSANA . A: 216269802 &Jlll,6 )<6); 1 
F3clityCodo:CSOM.WA I lil!jRCd.D 
39 Y old Male, DOB: 10/23/1978 
A<:coonttunbor~ 
1623EJSTT5:T,T~ 
Appoirtmcnt Facility: Northwest Detention Center 
Appointment Provider:J(b )(6); __ . ~,DDS 
Patient prope~yidentified by2 sources including: Wist Band.ID Badge 
Interpretation PIO"ded? Yes 
Interpreter Name or Number. 340C798F 
language Russian 
Chaperone Present? Yos 
Dental /!6sistant !lh \/R\· 
Vital Signs 
Ooutof10 
96.8F 
60/min 
1~mmHg 
16/min 
169.61bs 
66.51n 
26.96 lnclex 
Examination 
General E>@minatmn: 
Pain scale 
04fl4/2018 06:35:31 M1 (b)(6); (b)(?)(C) 
Temo 
04fl4/2018 06:35:31 M1 
~ 
04fl4fl01806:35:31 M1 
BP 
04fl4fl018 06:35:31 M1 
RR 
04fl4fl018 06:35:31 M1 
WI 
04fl4/2018 06:35:31 M1 
~ 
04/24/2018 06:35:31 f,M 
BIii 
04/24fl018 06:35:31 f,M 
Problem focused e,am, med hxoompleled by patient re\iewed, NKDA Tooth #15 has gross caries e>tencing 1n1D nerw, 
missing restoration. Toolh has pr..,;ous RCT. 1 PA taken v.ilh lead apron on palienl and re\i'™ld bypro,.;der. PeriapicaJ 
radloluoencynoled. No signs ol acute dislress or swelling noted. No mobility, dinical CtOYm fra<:lured on lingaul due ID caries. 
Toolh is non response to cold stimuli. Perrussion and palpation were 'ANL 
Assessmonta 
Tooth 15-RCT treated. chrooc apical periodontitis, 
Treatment 
1, Others 
Notes: Discussed findings v,th pa~ent. reoommenc r..,;s,1 for e.:raaion 15. Pt refused anc signed rellsal form because he 
wants to ha\e enco ,_l J>dlised pt ID return to sic:kcall ~ S)fflptomS 'Mll'Sen. Re"ewed 0-il. Pt-ert>alillld understanding. 
Procedure Codes 
D0140 LTD CR/!!. EVPlUATIOII -PROOLEMFOCUS 
D0220 INTR"CR-PERIPPICl'l 1 ALM70300 
D1330 CR/!!. H'IGIENE INSTRUCTIOIIS 
Appointment Providefb)(6); (b)(?)(C) 1>°5 
Bectronlcally signed (b)(6); 
Sign off status: Compl th \!?\If""\ 
2019-ICLl-00051 
• OLM on 04/24/2018 06:52:00 (Pacific Daylight Time) 
Northwest Detention Center 
1623 E J STTeT 
T~WA9B421 
Teij§f{6); ! 
4601 
DHS-ICE-19-0196, 19-0197-P-000286

Page 4602 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000287

Page 4603 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000288

Page 4604 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000289

Page 4605 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000290

Page 4606 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000291

Page 4607 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000292

Page 4608 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000293

Page 4609 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000294

Page 4610 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000295

Page 4611 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000296

Page 4612 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000297

Page 4613 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000298

Page 4614 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000299

Page 4615 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000300

Page 4616 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000301

Page 4617 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000302

Page 4618 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000303

Page 4619 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000304

Page 4620 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000305

Page 4621 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000306

Page 4622 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000307

Page 4623 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000308

Page 4624 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000309

Page 4625 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000310

Page 4626 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000311

Page 4627 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000312

Page 4628 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000313

Page 4629 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000314

Page 4630 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000315

Page 4631 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000316

Page 4632 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000317

Page 4633 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000318

Page 4634 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000319

Page 4635 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000320

Page 4636 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000321

Page 4637 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000322

Page 4638 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000323

Page 4639 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000324

Page 4640 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000325

Page 4641 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000326

Page 4642 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000327

Page 4643 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000328

Page 4644 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000329

Page 4645 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000330

Page 4646 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000331

Page 4647 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000332

Page 4648 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000333

Page 4649 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000334

Page 4650 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000335

Page 4651 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000336

Page 4652 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000337

Page 4653 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000338

Page 4654 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000339

Page 4655 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000340

Page 4656 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000341

from: l(b)(6); (b)(7)(C) I 
Sent: 19 Mar 2020 22:53:22 +0000 
To: ..... l(b_)(6_);_(b_)(7_)(_C) ______ __, 
Subject: AMAR 
Attachments: AMAR Detainee Death Review Healthcare and Security Compliance Analysis 
FINAL CC Responses 03.19.20.docx 
Here's the latest iteration of AMAR. Remaining questions for you center around 8/25, I think. \~)\~1;,.,, s 
pretty sure correction is needed, but I'll leave it to you to decide once you've revisited the record. If we 
need to do a re-write for that date, no biggie. I need to submit a cleaned up version anyway. 
FYlj\?/\~/;_Jand !(b)(5); _ hecided it will be most efficient to have,~/\~/~ send in all her working papers and 
any video for both AMAR and(b)(6); lrather than send her bubbles. Accordingly, I wrote tol(b)(6); ~-I 
tonight, We will hope for the best, 
Thanks, 
l(b)(6); 
/b)/7)/C} 
2019-ICLl-00051 4657 
DHS-ICE-19-0196, 19-0197-P-000342

Page 4658 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000343

Page 4659 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000344

Page 4660 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000345

Page 4661 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000346

Page 4662 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000347

Page 4663 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000348

Page 4664 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000349

Page 4665 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000350

Page 4666 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000351

Page 4667 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000352

Page 4668 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000353

Page 4669 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000354

Page 4670 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000355

Page 4671 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000356

Page 4672 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000357

Page 4673 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000358

Page 4674 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000359

Page 4675 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000360

Page 4676 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000361

Page 4677 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000362

Page 4678 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000363

Page 4679 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000364

Page 4680 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000365

Page 4681 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000366

Page 4682 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000367

Page 4683 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000368

Page 4684 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000369

Page 4685 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000370

Page 4686 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000371

Page 4687 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000372

Page 4688 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000373

Page 4689 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000374

Page 4690 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000375

Page 4691 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000376

Page 4692 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000377

Page 4693 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000378

Page 4694 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000379

Page 4695 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000380

Page 4696 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000381

Page 4697 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000382

Page 4698 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000383

Page 4699 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000384

Page 4700 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000385

Page 4701 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000386

Page 4702 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000387

Page 4703 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000388

Page 4704 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000389

Page 4705 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000390

Page 4706 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000391

Page 4707 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000392

Page 4708 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000393

Page 4709 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000394

Page 4710 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000395

Page 4711 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000396

Page 4712 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000397

From: 
Sent: 
To: 
Cc: 
Subject: 
Attachments: 
l(b)(6); (b)(7)(C) 
26 Feb 2020 23:07:17 +0000 
(b)(6); (b)(7)(C) 
opy o s e 1ca Transfer Summary from San Luis 
AMAR Transfer form from San Luis Regional Detention Center.pdf 
H )~()~(;r, here is the copy you requested. @ 
2019-ICLl-00051 4 713 
DHS-ICE-19-0196, 19-0197-P-000398

~lw, ReglonaIDeten1loa & Support~ . 
. Medleal Intake Packet L:A.LE eoa 1ua 
Medleal Transfer Smu.ms1ry 
Departure Date: · . ~ .. \ ~ • ~ -==t- Destin 
Seadlng:Fadlfi,t SanLuia ~Bl Defent{O?, & Support OIAtBt Gender: 
1, General laf'onnatton1 
~- for Travel by Orou.ad TtaaspQ~m: ti! Yes □· No . 
. Cleared for Travel by~Trsnsportation: ~ Yes O No . 
~for~ Cmtody=~ioal .. Me4ical~~ y~ 0 . 
~yes,iypo □ ~~□ .~' .
2. 'I)iltarsaJpffi 8ldg T.t(T§T) t PPD: 
Date l'laeed Date Read Size In mm: 
. ~-- l9:::C>B•.9Cf-t-: .1?:lo .. ~IT "r''-'"" - - - 111..- -r-tJ 1'.GRA nv a -• - -e\• 
l=P9sillve I& Neptlvo Date: -Iv 0 
~ Indetenntnate / Borderlfnl . ..,_____________ ,..._ _ __, 
. Symptom Screeplpg nr apptleableli 
18 Ibo patlcaibeillg 1reated mr~o- D Yes. 
Seleot Qptions: . , . . 1"\ . t,J"CloaNd for genoral deteotion populadon · 
rJt{ot clll!fCd~guezal cletoatiOJ! ~puJalian .0 Being trealecUbr TB. .. · . · · · · 
~ aimchod TB CaseMiuJjlJomarit documentati.m:>, . 
Date: I ~.C>'=f-fl-. 
. ~:□Positive ~~~. . Chest !:AY doge with!• J!IIUYP!i 
Date: fvlfc · m,Sinalilng 
0N~ve.~naJa1entY'fm. · . ' o~~w~ _·. ~~-fo~~-~- . ·· .. , 
• _ • ____ , ... __ . _: .. _ ;_._. _ .• --· .• :. __ .. ___ .,...,. -- ........ ---,1,1,1,ote: Datas llsied ~must be within.one year of · . . b)(6); (b)(7)(C) lk 1raDSfcr. ... . ·. · . ·. _- . · · .. ·• 
Health :A.uthorll;y 'cieanm cc: · • • • • .. 
. :: :_ ; .: , .. , .. •·. : -~. 
· OE(! 19 20fl · . ' ' ------ . · . • ·. ~. -~~~~1D~~:~11ilH~Jtl1D(ap.rob~ ·. - 1JRGENT · '· • · 
. ' . . . ,: .; . ,~~-:_ . .#';WC:, ,•· . . . :. 
. ··-·. • Medlratloa_. · ·. :.~ ·. ~ · lmtrac:doas for-me(mdv.de. proper time for · admbditi-aftcnil' · · · . · : · ..... 
·.' ,__-- . . · /II V /V. 1,,,.,,' · 
. .. . . ./, .. 
--
i 
, i 
.. ~--; ,••: .. ,. - 1---, ____ ...._ _ __,,,..4......:..._-1-____,;~I---,--~----------.....;....~_;_-~- ,, ·.· ~:· ·.· 
.f.--:"'. . •. , . . . ·••. . ~ . . . . . . . 
. · · · · Lase J.rfrst Name . ·· • 
·. ·. AMAR,Mmt~SA.N.A ·: ·: .. 
·.,. traellltys SmLm . . 
I • •' + 
·-DOA. ·cou 
12/1/17. •, . . . . ~ ' . 
10;2011 ' . ~---•': . ..... 
2019·1CL1·00051 4714 
.. •' 
·- ":. P/age11 of22 , . . ·~ .. 
. .. ,! 
:i 
DHS-ICE-19-0196, 19-0197-P-000399

~lws Regloual Detention & Support ca.Jr 
Medleal Intake Paebt 
Mecllca1 Traufer Sammaey (eoat.) 
6. Bealtheare'.roDOW'!lJpi 
Recoat(wlehm6montb8)Teat~--,----------....,C..--------
RBceut (wifhla 6 ~) llosp~•-----=----+--,-----____;_ _____ _ 
RecommondodFuturaLabWolk:_· -------,..;-......,,.;:.....-=----------
PendfniSpeotaityAppointmoat(s~ .... ·------:---r-:=--ir-k-7'------'----------
Recommended SpeGialty Appo~t{a):._- -----,---11-,1+1-f&----------
Raq~ Im~iate~·Up:._· ____ -,,,c. _ __,f...lL.--------_.;..--
7. ~Ne~~~~tlGr.._.UU'IS1aD· 
. . · An there my neclical,, dental. or IIUJll1Bl CODdltlon lbat mlricts the 1enQfh of time the patient can_ bo 011.nvol 
8tatutl0Yes 0No. Reason(a) · 1eagthoftravel1bml: __________ _ 
·Does tho patient havo 1111)' speolal that oacc:,itlng atail'should bo aware on D Yes D No· . .Jf so. whal? . - . . . . . Equlpment ~ t,y. • .Aulhorlt.Y Q Other Bqwpmeat owned 1,y 0.Modlcal Authority D Other · 
-Patient y,,IJI koop' · llt upon arrival at ~atl".11? DY es D No. . : ; · · · 
Is theie any med .equipment Nqqfmf to IICCOIDplUi)' 1he )Sdie?t dudllg tmel? D Yeii D No 
, . If so. what' . . ·. . . . i 
. · ·_Atefl,fJY tprecauti~~during~ 0Yos0No· . · .• i 
. - p,r41· •· ltk. -1118~-~-t::-~~ - . · ···· ,~~ --I .. ; •.'<. :.: .. - . _ _." ::•.•--• • •., ::._' • •. • •,. • •, . ••. ,_' :·.•. •.: ,. .. .. , .I 
_8. Mllldooal <;om~ta: (¥ark1h_rougb.if,oo_ ~ are·~) Aimcbadd~pagea_or~calteemdsaa ' : · ·-. . . : "needed,· . .. '· . .' . . . . . ·... . ..... ·. . .. ·., 
. :·. 
I•• • 
Printe4Namo. & Titlo .. : ;. . . . ... .... ·- • : • t 
.. - ' .·.· .. 
• : I • •. •• • :,• • •. • .. ;. •• 
. -· 
2019-ICLl-00051 4 715 
DHS-ICE-19-0196, 19-0197-P-000400

From: 
Sent: +0000 
To: 
Subject: 
This may be a question only ~!~~t., an answer, but here it is in case you can. 
From:,lC6); (b)(7)(C) 
Sent: ~onda;, March 16, 2020 4:26 PM 
To[b)(6); (b)(7)(C) 
Su Ject: RE: MAR DDR 
Also need to find out when AFOD (b)(6); as interviewed. Hopefully(b)( 6); o~(b)(6); lvill be provide a 
/h\/7\/('_\ lh\17\tr' . . 
least a day they think it might have occurred on. 
Thank you! 
l(b)(6); (b)(7)(C) 
Section Chief 
Office of Professional Responsibility 
Immigration and Customs Enforcement 
950 L'Enfant Plaza, SW 
Washington, DC 20536 
rb)(6); (b)(7)(C) 
( , 
From: l(b)(6); (b)(7)(C) I 
Sent: Monday, March 16, 2020 2:40 PM 
To:1Cb)(6); (b)(7)(C) 
Subject: AMAR DOR 
H' (b)(6); 
I (b)(7)(C) 
I completed my review of both documents and consolidated the questions to one document. I identified 
medical questions in green, security in purple, and items I need to work on in yellow. 
I have two interviews that I'm unable to determine when they occurred because they weren't on the 
original interview list, but maybelCb)(6); (b)(?)(C) lwill have a better idea by comparing their interview 
notes with the attached interview schedule. The officers that I can't determine when they were 
interviewed were Officerfb)(6); ~n9\~/\~/;,., rny help on this would be greatly appreciated. 
Please provide a response to the remaining medical questions by COB tomorrow. 
Regards, 
2019-ICLl-00051 4 716 
DHS-ICE-19-0196, 19-0197-P-000401

rb)(6); (b)(?)(C) 
Section Chief 
Office of Professional Responsibility 
Immigration and Customs Enforcement 
950 L'Enfant Plaza, SW 
Washington, DC 20536 
(b)(6); (b)(?)(C) 
2019-ICLl-00051 4 717 
DHS-ICE-19-0196, 19-0197-P-000402

From: 
Sent: 
To: 
Subject: 
Sigh. 
From:l(b)(6); (b)(?)(C) 
l<b)(6), (b)(?)(C) I 
11 Mar 2020 13:51:28 +0000 
l<b)(6); (b)(?)(C) 
FW: AMAR DDR 
Sent: Wednesday. March 11. 2020 9:50 AM 
T~(b)(6); (b)(?)(C) 
Subject: AMAR DDR 
I just uploaded the AMAR death certificate and autopsy to SharePoint so you can include in your report. 
Regards, 
l(b)(6); (b)(?)(C) 
Section Chief 
Office of Professional Responsibility 
Immigration and Customs Enforcement 
950 L'Enfant Plaza, SW 
Washington, DC 20536 
(b)(6); (b)(?)(C) 
2019-ICLl-00051 4 718 
DHS-ICE-19-0196, 19-0197-P-000403

From: 
Sent: 
To: 
Cc: 
~b)(6); (b)(7)(C) I 
28 Feb 2020 22:09:38 +0000 
b)(6); (b)(7)(C) 
Subject: e ainee ea Review Healthcare and Security Compliance Analysis 
FINAL (2) CC Responses to round 1 questions 
Attachments: AMAR Detainee Death Review Healthcare and Security Compliance Analysis 
FINAL (2) CC Responses to round 1 questions EM follow up.docx 
OOPS. I hit send before done. I intended to also say that we will all do our best to answer your ~~-~ 
questions, but no promises. ~and/o(b)(6); 
~ notes may provide as much illumination as (b)(6); ,,._,m,r-, (b)(7)(C) 
ani~~mic, I ~--~ 
Cc 
Su 
Responses to round 1 questions 
Hey, 
I'll get this toKb)(6); !to see if she can answer questions in her bailiwick before she leaves for th (b)(6); 
/h\17\lr.\ 
DDR next week. As for the property issue, at the time we were not applying deficiencies to Expecte 
Outcomes. Even if we had, I'm thinking (11)(2) and (7) are a stretch. 
Beyond the property issue, I know you will accept this in the spirit in which it is intended: some of your 
questions suggest you may (for reasons I understand) be applying current expectations to a report 
produced more than a year ago. 
Fronfb)(6); (b)(7)(C) 
Sent: Friday, February 28, 2020 4:26 PM 
Tol(b)(6); (b)(7)(C) 
Subject: AMAR Detainee Death Review Healthcare and Security Compliance Analysis FINAL (2) CC 
Responses to round 1 questions 
Hi b)(6); 
h\/7\/f'\ 
I have a few more questions, I still haven't made it to October. Blah. 
The personal property is going to need to be addressed somehow. I've deleted my questions that I'm 
good with. I kept a few and didn't provide a comment because I still need to review it in depth a bit 
more. 
I'm teleworking Monday through Wednesday next week to knock out this report. 
Regards, 
2019-ICLl-00051 4 719 
DHS-ICE-19-0196, 19-0197-P-000404

l(b)(6); (b)(7)(C) 
Section Chief 
Office of Professional Responsibility 
Immigration and Customs Enforcement 
950 L'Enfant Plaza, SW 
2019-ICLl-00051 4 720 
DHS-ICE-19-0196, 19-0197-P-000405

Page 4721 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000406

Page 4722 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000407

Page 4723 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000408

Page 4724 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000409

Page 4725 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000410

Page 4726 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000411

Page 4727 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000412

Page 4728 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000413

Page 4729 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000414

Page 4730 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000415

Page 4731 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000416

Page 4732 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000417

Page 4733 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000418

Page 4734 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000419

Page 4735 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000420

Page 4736 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000421

Page 4737 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000422

Page 4738 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000423

Page 4739 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000424

Page 4740 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000425

Page 4741 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000426

Page 4742 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000427

Page 4743 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000428

Page 4744 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000429

Page 4745 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000430

Page 4746 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000431

Page 4747 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000432

Page 4748 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000433

Page 4749 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000434

Page 4750 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000435

Page 4751 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000436

Page 4752 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000437

Page 4753 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000438

Page 4754 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000439

Page 4755 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000440

Page 4756 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000441

Page 4757 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000442

Page 4758 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000443

Page 4759 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000444

Page 4760 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000445

Page 4761 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000446

Page 4762 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000447

Page 4763 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000448

Page 4764 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000449

Page 4765 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000450

Page 4766 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000451

Page 4767 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000452

Page 4768 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000453

Page 4769 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000454

Page 4770 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000455

Page 4771 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000456

Page 4772 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000457

Page 4773 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000458

Page 4774 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000459

Page 4775 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000460

From: .... rb_)(-6)_; (bl_<?_)(C_l ___ __, 
Sent: 11 Mar 2020 01:59:22 +0000 
To: l(b)(6); (b)(?)(C) I 
Subject: AutoRecovery save of AMAR Detainee Death Review Healthcare and Security 
Compliance Analysis FINAL (2) 
Attachments: AutoRecovery save of AMAR Detainee Death Review Healthcare and Security 
Compliance Analysis FINAL (2).docx 
Finally!!! I finally completed my first draft of AMAR! I'm so happy I could cry. 
I had a few follow up questions. I'm sorry for all the versions of my comments. Q 
fb)(6); (b)(?)(C) 
Section Chief 
Office of Professional Responsibility 
Immigration and Customs Enforcement 
950 L'Enfant Plaza, SW 
Washington, DC 20536 
Office: (202) 7 (b)(6); 
Cell: {202) 425 ~li~lcc) 
2019-ICLl-00051 4 776 
DHS-ICE-19-0196, 19-0197-P-000461

Page 4777 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000462

Page 4778 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000463

Page 4779 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000464

Page 4780 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000465

Page 4781 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000466

Page 4782 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000467

Page 4783 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000468

Page 4784 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000469

Page 4785 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000470

Page 4786 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000471

Page 4787 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000472

Page 4788 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000473

Page 4789 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000474

Page 4790 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000475

Page 4791 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000476

Page 4792 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000477

Page 4793 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000478

Page 4794 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000479

Page 4795 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000480

Page 4796 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000481

Page 4797 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000482

Page 4798 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000483

Page 4799 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000484

Page 4800 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000485

Page 4801 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000486

Page 4802 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000487

Page 4803 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000488

Page 4804 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000489

Page 4805 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000490

Page 4806 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000491

Page 4807 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000492

Page 4808 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000493

Page 4809 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000494

Page 4810 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000495

Page 4811 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000496

Page 4812 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000497

Page 4813 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000498

Page 4814 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000499

Page 4815 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000500

Page 4816 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000501

Page 4817 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000502

Page 4818 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000503

Page 4819 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000504

Page 4820 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000505

Page 4821 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000506

Page 4822 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000507

Page 4823 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000508

Page 4824 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000509

Page 4825 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000510

Page 4826 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000511

Page 4827 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000512

Page 4828 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000513

Page 4829 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000514

Page 4830 
Withheld pursuant to exemption 
(b )(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-P-000515

Office of Information Governance and Privacy
 U.S. Department of Homeland Security
500 12th St., SW
Washington, D.C. 20536
www.ice.gov
February 23, 2021 
Erica Lai 
Cohen & Gresser LLP 
2001 Pennsylvania Ave. NW 
Suite 300 
Washington, DC 20006 
RE: American Oversight v ICE. 19-cv-01817-RCL 
 ICE FOIA Case Number 2019-ICLI-00051 
Seventeenth Interim Release 
 
Dear Ms. Lai, 
This is the Seventeenth interim response to your client’s Freedom of Information Act (FOIA) 
requests to U.S. Immigration and Customs Enforcement (ICE), dated June 21, 2018, given the 
tracking number 2019-ICLI-00051. Your clients are seeking the following: 
• A copy of ICE’s initial report on the May 2018 death of ICE detainee Roxana Hernandez 
(also listed in DHS records as Jeffry Hernandez), which ICE was required to publish by 
June 24, 2018. 
• A copy of ICE’s final report on the May 2018 death of ICE detainee Roxana Hernandez 
(also listed in DHS records as Jeffry Hernandez), which ICE was required to publish by 
July 24, 2018. 
• Responsive records include, but are not limited to, records related to the care, treatment, 
discipline, and abuse of Ms. Hernandez, as well as reports or reviews of Ms. Hernandez’s 
death. The records containing the factual information relied upon for ICE’s public 
statements regarding Ms. Hernandez’s death and detention are also responsive.
• A copy of ICE’s initial report on the November 2018 death of ICE detainee Mergensana 
Amar. 
• A copy of ICE’s final report on the November 2018 death of ICE detainee Mergensana 
Amar. 
• Responsive records include, but are not limited to, records related to the care, treatment, 
discipline, forced-feeding, and involuntary hydration of Mr. Amar, as well as reports or 
reviews of Mr. Amar’s death. The records containing the factual information relied upon 
for ICE’s public statements regarding Mr. Amar’s death and detention are also 
responsive. Please provide all responsive records from March 1, 2018, through the date of 
the search. 
A\11 ICA 
PVERSIGHT 
U.S. Immigration 
and Customs 
Enforcement 

Page 2 of 3
ICE has considered this request under the FOIA, 5 U.S.C. § 552, and processed 505 pages of 
potentially responsive records. ICE has determined that 1 page was deemed duplicate. ICE has 
determined that portions of 504 pages will be withheld pursuant to Exemptions 6, 7(C), and 7(E) 
of the FOIA, 5 U.S.C. § 552 as described below. 
ICE has applied FOIA Exemptions 6 and 7(C) to protect from disclosure the names, e-mail 
addresses, and phone numbers of ICE and DHS employees contained within the documents, as 
well as the names, and other personally identifiable information of other individuals contained 
within the records. 
FOIA Exemption 6 exempts from disclosure personnel or medical files and similar files the 
release of which would cause a clearly unwarranted invasion of personal privacy. This requires a 
balancing of the public’s right to disclosure against the individual’s right to privacy. The privacy 
interests of the individuals in the records you have requested outweigh any minimal public 
interest in disclosure of the information. Any private interest you may have in that information 
does not factor into the aforementioned balancing test. 
FOIA Exemption 7(C) protects records or information compiled for law enforcement purposes 
that could reasonably be expected to constitute an unwarranted invasion of personal privacy. 
This exemption takes particular note of the strong interests of individuals, whether they are 
suspects, witnesses, or investigators, in not being unwarrantably associated with alleged criminal 
activity. That interest extends to persons who are not only the subjects of the investigation, but 
those who may have their privacy invaded by having their identities and information about them 
revealed in connection with an investigation. Based upon the traditional recognition of strong 
privacy interest in law enforcement records, categorical withholding of information that 
identifies third parties in law enforcement records is ordinarily appropriate. As such, I have 
determined that the privacy interest in the identities of individuals in the records you have 
requested clearly outweigh any minimal public interest in disclosure of the information. Please 
note that any private interest you may have in that information does not factor into this 
determination. 
The ICE FOIA Office applied FOIA Exemption (b)(7)(E) to protect from disclosure an internal 
law enforcement sensitive investigative technique. The release of this information would 
disclose investigative techniques and procedures, and could be reasonably expected to risk 
circumvention of the law. 
FOIA Exemption 7(E) protects records compiled for law enforcement purposes, the release of 
which would disclose techniques and/or procedures for law enforcement investigations or 
prosecutions, or would disclose guidelines for law enforcement investigations or prosecutions if 
such disclosure could reasonably be expected to risk circumvention of the law. I have determined 
that disclosure of certain law enforcement sensitive information contained within the responsive 
records could reasonably be expected to risk circumvention of the law. Additionally, the 
techniques and procedures at issue are not well known to the public. 
If you have any questions about this letter, please contact Assistant U.S. Attorney Brenda 
Horowitz at Brenda.Gonzalez.Horowitz@usdoj.gov or 202-252-2512. 
AMERICAN 
PVERSIGHT 

Page 3 of 3
Sincerely, 
 
 
Senior Paralegal, ICE FOIA for
 Fernando Pineiro Jr. 
(A)FOIA Officer 
Enclosure: 504 pages
ROLANDO 
VELASCO JR
Digitally signed by 
ROLANDO VELASCO 
JR 
Date: 2021.02.23 
13:51:05 -05'00'
AMERICAN 
PVERSIGHT 

DHS-ICE-19-0196, 19-0197-Q-000001
From: 
Sent: 
To: 
Cc: 
Subject: 
Attachments: 
l(b)(6); (b)(7)(C) 
26 Feb 2020 23:07:17 +0000 
(b)(6); (b)(7)(C) 
opy o s e 1ca Transfer Summary from San Luis 
AMAR Transfer form from San Luis Regional Detention Center.pdf 
H (b)(5); h . th t d a lh\17\IC:\ .. ere 1s e copy you reques e . ~ 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 4831 

DHS-ICE-19-0196, 19-0197-Q-000002
~Im, ReglonaIDeteD1loa & Support~ . 
. Medleal Intake Packet L:A.LE eoa 1111 
Medleal Transfer Smu.ms1ry 
Departure Date: · . ~ .. \ ~ • ~ -==t￾Seadlng Fadlfi,t San LuJa ~Bl Defent{O?, & Support CaatBt 
1, General laf'onnatton1 
~- for Travel by Orou.ad TtaaspQ~m: ti! Yes □· No . 
. Cleared for Travel by~Trsnsporta1ion: ~ Yes O No . 
~for~ Cmtody=~ioal .. Me4k:al~~ y~ 0 . 
~yes,iypo □ ~~□ .~' .
2. 'I'liltamJipffi 8ldg Tpt(T§T) t PPD: . Date l'laeed Date Read Size In mm: 
=o Date: •N'l:A-· 
Jndetenntnate / Borderlfnl . 
. Symptom Screeplpg nr applleableli 
18 Ibo patlcaibeillg 1reated mr~- No- □ Yes. Date: 1 ~.C>'=f-fl-. SeleotQptiona: . . -. . 
t,J'CloaNclmrgenoraldeteotionpopuladoo · ~ . ~: Positive ~~~ . 
~ot clll!fCd ~genezal cletoadOJ! ~puJation · . Chest x-ray doge wlthl11 w:mu, O Being trealecUbr TB. ··. · · · · · • D · ' • fA- ·· · · • ,;.,;. ~abchodTB CaseMmJ!lpmaritdocumentat1.0J:>,. ate: JVnc. . m,Screali""'6 
· · · · 0 N~ve. ~na1a1entyitm. . . 
--- - ·-·--· .......... -· -· - .. -···. -----•··. -·-
. ~~-fo~~-~- · :·;-•(b-)(6~-;;-(b-)(~-)(C_) __ _._L't • ~-~-w~ . 
• Dams l1sied ~must be wilhin.onoyear of .. -·-.. ~~::....:..· ....::.·· ·____;__·_;_· :.:...·:,_· ....:....· _·:..._--1 
i 
. i 
.. 1----------~ i.=-= • .... • -
0Et!19 20fl · : Health ~uthorll;y -~~.CC:· . ~ • • . · ·: · 
:·.·. _ ..... ·... .- ,._ . ·. -~- --~It! .. : ., . " ..: ·. .. . 
· ... ·· ~. -~~~~1D~~:~trillleaJt11D(aposeilProb~ ·. . 1JRGENT · '·. · · · .,_ 
. ' . . . ,: . ; . ,~~-- :_ . . ~:, ,•· . . . :. ' . .._ .• ~t~ ~ . •. . ., ~ ~ '., . . - .. . .. , . . .... 
-! 
·' 
.,_.,. :4..-.: . ·:: .: , :. )j;.'7imk>· .·· .. ~ .. --u11 .• :~ ·_. -~ . . . •· •·.··.;./•-· 
..... -: \ ...... - ~. •• • • ... ~:' •••• • •• ••• • • • ~.. ■ ■ ' ... 
· · .5, Corrent ~~dona: ~As1All:(N(UDO,Doaap,i>IRctfoaa '° layman'• 1erins) · · ·. 
· ·. · .CMcJ:°qff~on&qut,vifforC.:.i,p~ ·: ·:. · _-· •'·• ·' · · · · · ..... • . • .. • • • ■ • • 
. ··-·. . .... ..... · .. ::-... ~ 
,__-- . . · /II V /V. 1,,,.,,' · • 
. .. . . ./. . . . . ~ '•; .· . : .. ' . ' . . . - ~-;...._---.,,..4-....:......-+--......:...---+------:.---------'--......;..~~-~- .• ·.· ~:· ·.-
.v. . ... . ■ • ·••. • ~ • 
. . .. . . . 
. · · · · Last J.rfrst Name . ·· . 
·. ·. AMAR,Mmt~SAN.A ·: ·: .. 
I • •' + 
·m # •. · ·-DOA. ·cou ·· ICE/ODs 2162$802 Jl,/J/17. ·: · ·. ·_ 
2019-ICLl-00051 4832 
.. •' . .. ,! 
:i 

DHS-ICE-19-0196, 19-0197-Q-000003
6. Bealtheani:roDO\V'!'Upi 
~lm Regloual Detention & Support ca.Jr 
Medleal Intake Paebt 
Mecllca1 Traufer Summary (coat.) 
Recoat(wkhhl6montb8)Teat~--,----------....,C..--------
RBceut (wifhla 6 ~) llosp~•-----=----+--,-----____;_ _____ _ 
Recommondodfutura LabWodc _· ------___,,;....-....,...i~.,----------
PendruiSpeotaity Appointmoat (s~ .... ·------:---r-:=--ir-k-r------'----------
1\ecommended SpeGlalty Appo~t{a):._- -----,---A-fff-f&----------
Raq~ Im~iate~·up:._· ____ -,,,c. _ __,f-lL.--------_.;..--
7. ~Ne~~~~tlGD!._.UU'IS1aD· 
. . . . · An there my medical. dental. or IIUJll1al condldon lbal mlricts the 1enQfh of time the patient can_ bo 011.nvol · . 8tatutl0Yes 0No. Reasoa(a) · 1eagthoftravel1bml: __________ _ 
·Does tho patient havo any l)Jeolal that oacoitlng ataft'Bhould bo aware on D Yes D No· . .1t so. whal? . · · • · . · · 
Equlpment~ t,y. • .Aulhorlt.Y Q Other Bqwpmart owned 1,yO.Mocltca1 Authorlcy □ Other · 
-Patient y,,IJI koop' · llt upon arrival at ~;.t1".ll? DY es D No_ .: ; · • · 
Is theie any med .equipment Nqqfmfto accompali)' 1he )Sltie?t dudllg tmel? D YGi D No 
· ·lfso. what' · · ♦ • ~ • • • ' 
. · ·.Atefl:8Y tprecauti~~during~ 0Yos0No· · · i . . . ~~DH4.td ~~-~fllll:~ . - . . ..... ,~~ -· I . . P1r4'dlUUOD8 .a.eeded·fpr the es,coitlngstaff.. . . . .. . . l 
. ~'~~~~~~~~~~)-~~~~~col~~ ::, ·• : ·1 
: 1·:::::~ ... ~~.~i~~ : . . . . . .; :.· . . . . . . . . . . • ··1·; .i . . . . . ·- .... ·A~. - --~ - -. ,,. :.-· .. ~. 
~°)·• • •• • . . ·_.. ·, . ~ •• - • • __ ,... :' • :-.11 .. : .,:N· ~-- :· . . . :-.. ~.-_.:··':-. 
· 9: ~e ~ ~_ciy: ~i:h cf ~cti~s fyr_~~ ~1~:Medlca1 ~.- :; :.-..~ .. ~_;_: :. . .. :· · ; · · · · · · · . :· ·□ Colll:tJ)unity Rcisourco lamm!ation, ifappllcab!e · : • . -.. 
. . . '. . . . :_:, ~-."~ . --~ :,'. · ........ : \.: ,-:_ :. : :·< .... _.:. ,.~~. ·: : .:_:/ . .. .· ";_ . : .. 
SendbigPapility P~"t o~~~~ ~cal ~i · · , · ' ·· · . . • • • -. • • .,, • • • • • • • ,, • •• • # • • • • - • • •• •• ' ...... •• ~ • 
b)(6); (b)(7)(Ci. . • . • ~ :,n,o 627~2101 . .. . . ·, •. : . ., ... 
. · ~ .- ·· .. ~ :· . . ! ... :: . . . ! •• 
• · b)(6); (b)(?)(C) , , ·:· .. ' ... 
_ Printe4Namo.&T1tlo.: :. . : '.; . . . ·.'.· ·:_ :·.:: ~ .. · .::.:·:·•·.:. :•: ··:· : .. ·. ; "< .. ·. ,_· . . . ... .... ·. . . 
.. . . ,. . ~--------' 
• : I • •. •• • :,• • •. • .. ;. •• 
-·· . · Lut lint Name · "· ~ ·. ·. · mi# · · ."-DOA Co . . DOB 
Ar✓- f '"4 CJw-. 
pVERSIGHT 2019-ICLl-00051 4833 

DHS-ICE-19-0196, 19-0197-Q-000004
From: 
Sent: 
To: 
Subject: 
Attachments: 
Importance: 
Maybe this will help? 
j(b)(6); (b)(7)(C) 
Unit Chief 
ERAU - OPR - ICE 
(O) 202-732 
(C) 202-423 
b)(6); (b)(7)(C) 
10 A; 202017:26:15 +0000 
fb)(6); (b)(7)(C) I 
FW:MAR DDR Executive Summary (002) 
AMAR DDR Executive Summary (002).doc 
High 
From: !(b}(6); (b)(7)(C) Pice.dhs.gov> 
Sent: Tuesday, May 7, 2019 9:40 AM 
T<fbl(6); (b)(7)(C) l@ice.dhs.gov> 
Subject: FW: AMAR DDR Executive Summary (002) 
Importance: High 
b )(6); 
b)(7)(C) 
l
1
m out today bu~lso wanted a status added to the ES. Like, "signed by AD1
' with "FOIA or OPLA". Or 
sure how many options there are. 
Sent with BlackBerry Work 
(www.blackberry.com) 
j
(b)(6); (b)(7)(C) L 
From._ _ ____________ __,.~~i_ce_._d_hs~.g~o_v> 
Date: Tuesday, May 07, 2019, 9:35 AM 
To:l(b)(6); (b)(7)(C) l!.hs.gov> 
Cc:_ fuice.dhs.gov>, fb)(6); (b)(7)(C) 
ICb)(6); (b)(7)(C) ~ice.dhs.gov>, ll.:;!(b:.Lll(:::..t.6l.l..l; (:::..t.bl...:.C7.1.1.lCC;;:,,l~-------le~.a=n=s·=g~ov> 
Subject: AMAR DDR Executive Summary (002) 
(b)(6); 
H (b)(7)(C) 
I have a couple of questions on this summary that we need addressed as soon as possible so that we can 
get these to Waldemar, in prep fo \~)\~\--, budget hearing. 
Thanks! 
b)(6); 
irector 
ICE Office of Professional Responsibility 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 4834 

DHS-ICE-19-0196, 19-0197-Q-000005
(202) 732¥b)(B~ 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 4835 

DHS-ICE-19-0196, 19-0197-Q-000006
I 
Office of Professional Responsibility ... 
Inspections and Detention Oversight D1v1s10n 
U.S. Immigration 
and Customs 
Enforcement 
---=======================================~==================i b)(5) (b)(5) 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
'' ,, 
'' '' '' '' '' '' '' '' '' '' '' '' '' '' '' '' '' '' '' '' 
'' '' '' '' '' '' '' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' 
L_ _________ -------;_ 
/\Mlf IC'AI\ 
pVERSIGHT 2019-ICLl-00051 4836 

DHS-ICE-19-0196, 19-0197-Q-000007
Office of Professional Responsibility ... 
Inspections and Detention Oversight D1v1s10n 
b)(5) 
U.S. Immigration 
and Customs 
Enforcement 
L_ ___________ .....,_ 
' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' 
(b)(5) 
-
/\Mlf IC'AI\ 
pVERSIGHT 2019-ICLl-00051 4837 

DHS-ICE-19-0196, 19-0197-Q-000008
From: icb)(6); (b)(?)(C) 
Sent: 7 Apr 2020 15:16:04 +0000 
To: l(b)(6); (b)(?)(C) I 
Subject: FW: AMAR DDR Report 
Attachments: AMAR DDR Report (003) ss.docx 
i<b)(6); (b)(?)(C) 
Unit Chief 
£RAU - OPR - ICE 
(0) 202-73 (b)(6); 
(C) 202-42 (b)(?)(C) 
From: fb)( 6); (b)(?)(C) l@ice.dhs.gov> 
Sent: Tuesday, April 7, 2020 11:10 AM 
To: ~b)(6); (b)(7)(C) jPice.dhs.gov> 
Subject: RE: AMAR DDR Report 
(b)(6); 
(b)(?)(C) Here you go! Really minor edits and a few questions. I'm leaving now; heading to the office. 
I will give you a call when I return home. Thanks 
F l
(b)(6); (b)(7}(C} b rom: ..... ______________ .._:..::ic.::.e:..::.dc:..:h"'"'s.'°g~ov.> 
Sent: Friday, March 20, 2020 11:53 AM 
To: (b)(6); (b)(?)(C) ice.dhs. ov> 
Cc b)(6); (b}(?)(C) ice.dhs. ov> 
Subject: AMAR DDR Report 
(b)(6); 
(b)(7)(C) 
My apologies for the delay. Attached is the AMAR DDR. There are still a few outstanding items that 
we're waiting for Creative Corrections to provide and I've identified those areas with a comment bubble. 
Creative Corrections is overnighting me their working papers so I should have them soon. 
Regards, 
rb)(6); (b)(?)(C) 
Section Chief 
Office of Professional Responsibility 
Immigration and Customs Enforcement 
950 L'Enfant Plaza, SW 
Washington, DC 20536 
Off · {202) 7 (b)(6) ice. (b)(7)(C) 
Cell: (202) 425 ,...._ _ ___, 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 4838 

DHS-ICE-19-0196, 19-0197-Q-000009
Detainee Death Review Report 
Mergensana Dabaevich AMAR 
Date ofDeath: November 18, 2018 
Alien File Number: 216 269 802 
Joint Integrity Case Management System (TICMS) #: 201901489 
March XX, 2020 
U.S. Immigration and Customs Enforcement 
Office of Professional Responsibility 
2019-ICLl-00051 4839 

DHS-ICE-19-0196, 19-0197-Q-000010
b)(5); WIF Draft 
/\Mlf IC'AI\ 
pVERSIGHT 
llPage 
2019-ICLl-00051 4840 

DHS-ICE-19-0196, 19-0197-Q-000011
DETAILS OF REVIEW 
b)(5); WIF Draft 
/\Mlf IC'AI\ 
pVERSIGHT 
21Page 
2019-ICLl-00051 4841 

DHS-ICE-19-0196, 19-0197-Q-000012
b)(S); WIF Draft 
/\Mlf IC'AI\ 
pVERSIGHT 
31Page 
2019-ICLl-00051 4842 
(b)(S) 
, 
: : 
'' '' '' '' '' '' '' '' '' '' '' JI 
I 
i 

DHS-ICE-19-0196, 19-0197-Q-000013
b)(5); WIF Draft 
/\Mlf IC'AI\ 
pVERSIGHT 
41Page 
2019-ICLl-00051 4843 

DHS-ICE-19-0196, 19-0197-Q-000014
(b)(5); WIF Draft 
/\Mlf IC'AI\ 
pVERSIGHT 2019-ICLl-00051 4844 
(
~ b)(5); WIF Draft 
a 
( 
' ' ,, 
,, 
I 

DHS-ICE-19-0196, 19-0197-Q-000015
b)(S); WIF Draft 
/\Mlf IC'AI\ 
pVERSIGHT 
61Page 
2019-ICLl-00051 4845 

DHS-ICE-19-0196, 19-0197-Q-000016
b)(5); WIF Draft 
I 
I 
-
/\Mlf IC'AI\ 
pVERSIGHT 
71 P a g e 
2019-ICLl-00051 4846 
(b)( 5) 
3 
' ' ' , 
' ' ' , 
' ' ' ' ' ' ' ' ' ' ' ' ' ' ' , 
' ' ' ' ' ' ' ' ' ' ' ' ' ' 

DHS-ICE-19-0196, 19-0197-Q-000017
(b)(S); WIF Draft 
53 See eCW Progress Note by RN Yamane, dated August 25, 2018. 
54 See Care Plan for Weight Loss, dated August 25, 2018. 
/\Mlf IC'AI\ 
pVERSIGHT 2019-ICLl-00051 4847 
SI Page 

DHS-ICE-19-0196, 19-0197-Q-000018
September 4, 2018 
b)(S); WIF Draft 
/\Mlf IC'AI\ 
pVERSIGHT 
91Page 
2019-ICLl-00051 4848 

DHS-ICE-19-0196, 19-0197-Q-000019
b)(5); WIF Draft 
/\Mlf IC'AI\ 
pVERSIGHT 
lOIPage 
2019-ICLl-00051 4849 

DHS-ICE-19-0196, 19-0197-Q-000020
b)(5); WIF Draft 
/\Mlf IC'AI\ 
pVERSIGHT 
.1.1 I Cl 5"" 
2019-ICLl-00051 4850 

DHS-ICE-19-0196, 19-0197-Q-000021
,.,,..,.,, October 26, 2018 . ~=~~----------1::(,:b)(-5) ---~] b)(5); WIF Draft 
/\Mlf IC'AI\ 
pVERSIGHT 2019-ICLl-00051 4851 
12 I P a g e 
! 
! 
I 

DHS-ICE-19-0196, 19-0197-Q-000022
b)(5); WIF Draft 
/\Mlf IC'AI\ 
pVERSIGHT 
Bl Page 
2019-ICLl-00051 4852 

DHS-ICE-19-0196, 19-0197-Q-000023
b)(5); WIF Draft 
/\Mlf IC'AI\ 
pVERSIGHT 
14 I P a g e 
2019-ICLl-00051 4853 
b )(5) 
' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' 
I 
' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ! 

DHS-ICE-19-0196, 19-0197-Q-000024
b)(5); WIF Draft 
/\MEf IC'AI\ 
pVERSIGHT 
lSIPage 
2019-ICLl-00051 4854 

DHS-ICE-19-0196, 19-0197-Q-000025
b)(5); WIF Draft 
/\Mlf IC'AI\ 
pVERSIGHT 
16 I P a g e 
2019-ICLl-00051 4855 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
'' '' '' '' '' '' '' '' '' '' '' : : 
'' '' '' '' 
. I 
I 

DHS-ICE-19-0196, 19-0197-Q-000026
~~~----------------7_,J'X'_l (b)(5); WIF Draft _ --------
/\Mlf IC'AI\ 
pVERSIGHT 2019-ICLl-00051 4856 
171Page 

DHS-ICE-19-0196, 19-0197-Q-000027
b)(S); WIF Draft 
/\Mlf IC'AI\ 
pVERSIGHT 
181Page 
2019-ICLl-00051 4857 

DHS-ICE-19-0196, 19-0197-Q-000028
(b)(S); WIF Draft 
/\Mlf IC'AI\ 
pVERSIGHT 
19 I P a g e 
2019-ICLl-00051 4858 
' ' ' ' ' ' ' ' ' ' ,, 
,, 
,, 
b)(S) 
/!L ___________ _ ,, 
,, 
,, 
,, 
" ,, 
,, 
" ,, 
" ,, 
,, 
,, 
:: " 
,, 
,, 
" ,, 
,, 
" ,, 
" ,, 
,, 
" " ,, 
" " " : " 
. 
i 
i 
' 

DHS-ICE-19-0196, 19-0197-Q-000029
==,--,,;-::;::-;;----------------------7r)(S) b)(S); WIF Draft 1 _______ _ 
/\Mlf IC'AI\ 
pVERSIGHT 2019-ICLl-00051 4859 
20IPage 

DHS-ICE-19-0196, 19-0197-Q-000030
b)(S); WIF Draft 
/\MERICAi\ 
pVERSIGHT 
21 I P a g e 
2019-ICLl-00051 4860 

DHS-ICE-19-0196, 19-0197-Q-000031
(b)(S); WIF Draft 
/\MERICAi\ 
pVERSIGHT 
22 I P a g e 
2019-ICLl-00051 4861 

DHS-ICE-19-0196, 19-0197-Q-000032
b)(5); WIF Draft 
/\Mlf IC'AI\ 
pVERSIGHT 
23 I P a g e 
2019-ICLl-00051 4862 
' ' 
! 
(b)(5) 
::,~------------
:: 
u 
u 
H 
" :: 
I I 
:: 
" ;; 
:: 
:: " 
" H 
H 
l 
i 

DHS-ICE-19-0196, 19-0197-Q-000033
(b)(5); WIF Draft 
/\MERICAi\ 
pVERSIGHT 
24 I P a g e 
2019-ICLl-00051 4863 

DHS-ICE-19-0196, 19-0197-Q-000034
From: l(b)(6); (b)(7)(C) 
Sent: 11 Mar 2020 13:38:08 +0000 
To: l(b)(6); (b)(7)(C) I 
FW: AMAR Death cert & autopsy- CONFIDENTIAL 
Amar death certificate & autopsy.pdf 
Subject: 
Attachments: 
Importance: 
~(b)(6); (b)(7)(C) 
Unit Chief 
ERAU - OPR - ICE 
(O) 202-732 
(C) 202-423 
High 
Fro~b)(B); (b)(?)(C) pice.dhs.gov> 
Sent: Friday, April 5, 2019 11:18 AM 
To: J(b)(6); (b)(7)(C) 1,dhs.gov> 
Cc: ~-------------~ce.dhs.gov> 
Subject: FW: AMAR Death cert & autopsy- CONFIDENTIAL 
Importance: High 
Sensitivity: Confidential 
Good morning Ma'am, 
Please see attached, as requested. 
R/ 
l(b )(6); (b )(7)(C) 
l(b)(6); (b)(7)(C) 
CAPT,OSPHS 
IHSC Investigations Unit Chief, RN 
DHS/ICE/ERO/IHSC ~~ 
610 W. Ash St., Ste.~/\~/;", 
San Diego, CA 92101 
(619) 338- (b)(6); ffice 
(202) 321- ~JU>< B 
(866) 833-7133 Fax (secure) 
Warning: T """'UJY'ont is UNCLASSIFIED//FOR OFFICIAL USE ONLY (U//FOUO). It ns information that may 
be exempt fr c1~-e--Yllll · ••• 552). It is to be controlled, stored, 
handled, trans ~.,,.,, __ ---.-::c--;_:;--..:::_1.-. ing to FOUO information and 
is not to be rel -know" without prior 
approval of an 10n o I o the media, either in 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 4864 

DHS-ICE-19-0196, 19-0197-Q-000035
J
(b)(6); (b)(7)(C) 
From .__ _____ __. 
Sent: Friday, April 5, 2019 8:00 AM 
Tj(b)(6); (b)(7)(C) f ice.dhs.gov> 
SubJect: AMAR Death cert & autopsy 
Ma'am, 
Please see the attached requested documents. 
~(b)(6); (b)(7)(C) 
CDR, USPHS 
Investigative Analyst 
IHSC Investigations Unit 
DHS/ICE/ERO/IHSC . (b)(6); 610 W. Ash St., Swte /b\(7)/ 
San Diego, CA 92101 
(o }619-3 b)(6); 
b)(7)(C) 
ice.dhs. ov 
Warning: Th FIED//FOR OFFICIAL USE O s information 
that may be nta.......-:.t . 552). It is to be 
controlled, s tTI!~Qft:a'f11d th OHS policy 
relating to F I who do not have 
/\MERICAi\ 
pVERSIGHT 
,or approval of an aut onze of this report 
o e media, either in written or verbal form. 
2019-ICLl-00051 4865 

DHS-ICE-19-0196, 19-0197-Q-000036
~ 
' 
·, CERTIFICATE OF DEATJ+-· 11.IJJJ-JJI 
CERTFICATE NUMBER: 2011-054225 
FIRST AND MIDDLE NANE(S): MERGENSANA DABAEVICH 
(AST NAME(S): ~ 
COUNTY OF DEATH: PIERCE 
DATE OF DEATH: NOVEMBER 18, 2018 
HOUR OF DEATH: 02:45 PM 
SEX: MALE AGE: 40 YEARS 
SOCIAL SECURITY NUt.flER: UNKNOWN 
HISPANIC ORIGIN: NO, NOT SPANISH/HISPANIC/lATINO 
RACE: MONGOLIAN 
BJRTH DAtE: OCfOIER 23_ 1971 
: BIRTHPt.ACE: KHU{Wt$HA RUSSIA 
MARITAL STATUS: SINGLE, NEVER MARRIED 
SPOUSE: NOT APPLICABLE 
OCCUPATION: ENTREPENEUR 
INDUSTRY: BUSINESS 
EDUCATION: BACHELOR'S DEGREE 
US ARMED FORCES: NO 
INFORMA!(b)(6); (b)(7)(C) I 
RElA TIONSHIP: FAMILY ACQUAINTANCE 
ADDRESS: 340419TH AVES, SEATTLE, WA 98144 
CAUSE OF DEATH: 
.A: ANOXIC ENCEPHALOPATHY 
INTERVAL: • 
B: HANGING 
INTERVAL: • 
t: 
INTERVAL: 
D: 
INTERVAL: 
OTHER CONDITIONS CONTRIBUTING TO DEATH: 
DATE OF INJURY: NOVEMBER 15, 2018 
HOUR OF INJURY: 03:06 PM 
INJURYATWORK: NO 
.... 
t> 
PLACE OF INJURY: INSIDE CELL AT ICE NORTHWEST DETENTION 
CENTER 
LOCATION OF NJURY: 1623 EAST J STREET 
CITY, STATE, ZIP: TACOMA, WASHINGTON 98421-1602 
COUNTY: PIERCE 
DESCRIBE HOW INJURY OCCURRED: HANGED HIMSELF WITH BED SHEET 
\fTRANSPORTATION IJURY, SPECFY: NOT APPLICABLE 
. . ' 
' . , 
PLACE OF DEATH: HOSPITAL 
DATE ISSUED: 02'2812019 
FEE NUMBER: 2715 
FACILITY OR ADDRESS: ST. JOSEPH MEDICAL CENTER 
CITY, STA TE, ZJP: TACOMA, WASHINGTON 98405 
RESIDENCE STREET: 1123 E J STREET 
CITY, STATE, ZIP: TACOMA, WA 98421 
INSIDE CITY LIMITS: YES COUNTY: PIERCE 
TRIBAi.RESERVATiON: NOT APPLICABLE 
lf.NGTH OF TIME AT RESIDENCE: 11 YEARS • 
FATHEIWARENT: l(b)(6); (b)(7)(C) 
MOTHER/PARENT: L_ __________ _, 
~THOD OF DISPOSITION: CREMATION 
PLACE OF DISPOSITION: SOUTH SOUND CREMATORY 
CITY, $TATE: LACEY, WASHINGTON 
DISPOSITION DATE: DECEMBER 11, 2011 
FUNERAL FACILITY: FUNERAL ALTERNATIVES OFWASHINGTON • 
FEDERAL WAY 
AOORESS: 31919 6TH AVES, STE 200 
CITY, STATE, ZJP: FEDERAL WAY, WASHINGTON 98003 
FVNEAAl DIRECTOR: DAVI> D. MCNEIL 
MANNER OF DEATH: SUICIDE 
AUTOPSY: YES 
WERE MJTOPfff FN>INGS AVAILABLE TO COf.fllETE 
CAUSE OF DEATH: YES 
DID TOBACCO USE CONTRIBUTE TO DEATH: NO 
PREGNANCY STATUS IF FEMALE: NO RESPONSE 
CERTFIER N.6ME: THOMAS B. CLARK, IU 
TITLE: CORONER/ME 
CERTIFIER ADDRESS: 3619 PACIFIC AVENUE 
CITY, STATE, ZIP: TACOMA, WA 984187929 
DATE SIGNED: NOVEMBER 26, 2018 
CASE REFERRED TO ME/CORONER: NO 
FILE NUMBER: 18-2308 
ATTENDING PHYSICIAN: NOT APPLICABLE 
LOCAL DEPUTY REGISTRAR: CHARA RIM 
DATE RECEIVED: DECEMBER 11, 2018 
. . 

DHS-ICE-19-0196, 19-0197-Q-000037
A Pierce Countv ~ Medical Examiner'~~;ce 
3619 Pacific Avenue 
Tacoma gton 98418 
(253) 7 FAX (253) 798-2893 
CONFIDENTIAL II~FORMATION 
THIS COPY IS INTENDED FOR 
ATTENDING PHYSICIAN 
ACCESS ONLY 
PER RCW 68.50.105 
A:216269802 
!(b)(6); (b)(7)(C) jlVID 
Medical Examiner 
(b)(6); (b)(7)(C) D 
A 
b)(6); (b)(7)(C) 
Medical Examiner Services Manager 
POSTMORTEM EXAMJNATION REPORT 
MEDICAL EXAMINER CASE #: 
NAME OF DECEASED: 
DATE OF EXAMINATION: 
LAW ENFORCEMENT AGENCY AND CASE#: 
CAUSE OF DEATH: 
MANNER OF DEA TH: 
18-2308 
Mergensana Dabaevicb A.mar 
November 26, 2018 
Tacoma Police Department 
18-319-01418 
Anoxic encephalopathy due to banging 
Suicide 
CERTIFIED COP 
CONFIDEN'flAI, 
INFORMATION 
ER Rew 68.S0.10 
EX~ 
/\Mlf IC'AI\ 
pVERSIGHT 2019-ICLl-00051 4867 

DHS-ICE-19-0196, 19-0197-Q-000038
A:216269802 
FINAL DIAGNOSES: 
Abrasion of the neck. 
Respirator brain. 
Acute bronchopneumonia and bronchitis, widespread. 
Fatty change of the liver, severe. 
OPINION: 
18-2308 
MERGENSANA DABAEVICH AMAR 
CONFIDENTIAL INFORMATION 
THIS COPY IS INTENDED FOR 
ATTENDING PHYSICIAN 
ACCESS ONLY 
PER RCW 68.50.105 
This 40-year-old man-was found hanging in his locked cell at the Northwest Detention Center. 
He was resuscitated, and regained circulation, but never showed any neurologic response. He 
was pronounced brain dead on the third hospital day, and extubated_. 
Autopsy examination shows an abrasion of the neck consistent with the history. Anatomic 
findings include brain autolysis consistent with prolonging circulation following brain death, 
fatty change of the liver, and widespread pneumonia, likely the result of aspiration. Toxicology 
testing is negative for alcohol and other drugs. 
Death is due to anoxic encephalopathy secondary to hanging. 
(b)(6); (b)(7)(C) 
Medical Examiner 
/\Mlf IC'AI\ 
pVERSIGHT 
:Z 2- -fr S :Pl 1 
Date 
2 
2019-ICLl-00051 4868 
CERTIFIED COPY 
CONFIDENTIAL 
INFORMATION 
ER RCW 68.50.10 

DHS-ICE-19-0196, 19-0197-Q-000039
A:216269802 
EXTERNAL EXAMINATION: 
18-2308 
MERGENSANA DABAEVICH AMAR 
The decedent is received in a body bag clothed only in a hospital gown. He is 66 in. tall and 
weighs 160 lbs. The hair is brown. The eyes are brown with jaundiced sclera. The teeth are 
natural. Rigor is not detectable. Livor is purple and posterior. The body is cold. 
There is evidence of medical intervention. There is a two-lumen central line in the right arm. A 
foley catheter is present. There are punctures and bruising in the left antecubital fossa. There is 
a purple bruise on the posterior left forearm consistent with _an attempted vascular access. 
There are multiple healing rounded lesions on the anterior abdomen, right side greater than left. 
There is a scar on the left knee. 
Injuries: 
There is a band of brown discoloration around the front and both sides of the neck. It is faint, 
approximately 1/4-in. in average width. It cants upward on both sides of the neck as it proceeds 
backward. The discoloration is more prominent on the left than the right side of the neck. 
There is no internal injury of the neck. 
There is faint discoloration of the right periorbital region, possibly representing a bruise. 
INTERNAL EXAMINATION: 
Body Cavities: 
The serosal surfaces are smooth and glistening. Approximately 600 cc of blood-tinged fluid are 
present in the right chest cavity. Approximately 100 cc of blood-tinged fluid are present in the 
left chest cavity. The abdominal cavity contains approximately 50 cc of clear, straw-colored 
fluid. 
Head: 
The scalp does not have evidence of injury. The skull is intact. The brain weighs 1640 g. The 
meninges are thin and delicate, with no evidence of inflammation or hemorrhage. The brain 
itself is soft and discolored consistent with respirator brain. 
Neck: 
The hyoid bone is not fused but not fractured. There is no associated hemorrhage. There is no 
hemorrhage of the strap muscles. The larynx is clear. The thyroid gland is of the usual size and 
configuration. 
/\Mlf IC'AI\ 
pVERSIGHT 
3 
2019-ICLl-00051 4869 
(b)(6); 
(b)(7)(C) 

DHS-ICE-19-0196, 19-0197-Q-000040
A:216269802 
Cardiovascular System: 
18-2308 
MERGENSANA DABAEVICH AMAR 
The heart weighs 390 g. The coronary arteries arise in the usual locations. There is a short 10% 
concentric lesion of the left anterior descending artery and no other significant atherosclerotic 
disease. Serial sections of myocardium do not show evidence of acute nor old infarction. The 
valves are normally formed. The descending aorta is intact and does not have significant 
atherosclerotic disease. 
Respiratory System: 
The right lung weighs 1120 g, left lung weighs 1290 g. The lungs are firm and noncompliant 
with diffuse patchy light discoloration. Sections of both lungs sink when placed into formalin. 
Liver, Gallbladder, Pancreas: 
The liver weighs 1920 g. It is light in color. The gallbladder contains liquid green bile. The 
pancreas is unremarkable. 
Spleen and Lymph Nodes: 
The spleen weighs 260 g and is unremarkable. There are no prominent lymph nodes. 
Genitourinary System: 
The right kidney weighs 200 g, left kidney weighs 220 g. The kidneys are normally formed and 
do not have focal lesions. The bladder contains 6 cc of urine. The bladder mucosa has multiple 
punctate hemorrhagic lesions consistent with a foley catheter. The prostate is unremarkable. 
Endocrine System: 
The adrenal glands are autolyzed. 
Digestive System: 
The gastrointestinal tract is intact. The stomach contains 70 cc of liquid. An appendix is present 
and unremarkable. 
Musculoskeletal System: 
There is a sternal fracture consistent with resuscitative efforts. 
Toxicology: Specimens are subqritted for toxicologic analysis. A separate report will be issued. 
Histopathology: Sections are submitted for microscopic analysis. 
Block 1 contains: heart and right lung. 
Block 2 contains: left lung and liver. 
Block 3 contains: kidney and brain. 
/\Mlf l / I\ 4 
pVERSIGHT 2019-ICLl-00051 4870 
(b)(6); (b)(?)(C) 

DHS-ICE-19-0196, 19-0197-Q-000041
A:216269802 
MICROSCOPIC EXA.l\UNATION: 
18-2308 
MERGENSANA DABAEVICH AMAR 
Heart: There is no evidence of acute nor old infarction. 
Lung: Sections of lung show diffuse alveolar damage with widespread acute bronchitis and 
bronchopneumonia 
Liver: There is a severe degree of fatty change. 
Kidney: No pathologic diagnosis. 
Brain: Autolyzed. 
TBC: aa 
Dictated: 11/26/2018 
Transcribed: 11/26/2018 
Finalized: 02/20/2019 
RETENTION: 
Blood, body fluids, tissues, and physical/trace materials that may be collected (the exact samples vary by case) 
during the examination are routinely held in accordance with our retention policy prior to biohazard disposal, unless 
transferred to a laboratory or other agency by the Medical Examiner's Office, or otherwise released by special 
arrangement. 
/\Mlf IC'AI\ 
pVERSIGHT 
5 
2019-ICLl-00051 4871 
(b)(6); (b)(7)(C) 

DHS-ICE-19-0196, 19-0197-Q-000042
... A:216269802 
Attention: 
Agency: 
Address: 
TOXICOLOGY LABORATORY 
WASHINGTON STATE PATROL 
2203 Airport Way South Suitel(b}(leattle, WA 98134 
(206) 282~ N/i:i21JL) 282~145 
TOXICOLOGY TEST REPORT 
xaminer 
3619 Pacific Ave 
Tacoma, WA 98418-7929 
Tox Case#: ST-18-14358 Case Type: Death Investigation Report Date: 2/12/2019 
Agency Case #: 18-2308 Subject Name: Amar Mergensana 
Evidence: 
l(b)(6); I 
The following evidence was submitted to the Laboratory byt(b)(7)(C) lot the Pierce Co Medical 
Examiner on 11/29/2018 via USPS-1st Class Mail: 
(1) ST-18-14358-A: VPink, Blood - Hospital 
Volatile Analysis Results: 
ST-18-14358-A: Blood. Hospital 
ST-18-14358-Awas tested by Headspace - Gas Chromatography for the presence of acetone, ethanol, 
isopropanol, and methanol on 01/31/2019. The following result was obtained: 
None Detected 
Drug Analysls Results: 
ST-18-14358-A: Blood - Hospital 
ST-18-14358-A was tested by Enzyme Multiplied Immunoassay Technique (EMIT) for the presence of 
amphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine metabolite, and opiates on 
01/04/2019. The following result(s) was obtained: 
None Detected 
(test conducted by Madison Fuller, Forensic Scientist 2) 
COMMENTS 
All testing was performed by thi, Forensic Scientist listed bi,Jow except as othi,rw/si, lndicatfJd. The Forensic 
Scientist has technically revifJwed al/ reltwant pages of testing docu,ni,ntation in the case record. 
Examined by: 
rb )(6), (b )(7 X C) 
Forensic Scientist 1 
Date: 02- I...JL._ t 2019 
Reviewed by: 
Jb)(6); ~)(7XC) 
Reviewer t?I. 
Date: -1:_,Jl_ ,_l __ \fo)rn ® rn aw~® ill FEB 1 9 20i9 ~ 
/\MU £R1.o-20160614J Page 1 of 1 I IIIII II 1111111111111111 
Reque$//D: ST-18-14358-0001 PVERSIGHT 2019-ICLl-00051 4872 

DHS-ICE-19-0196, 19-0197-Q-000043
From: 
Sent: 
f b)(6); (b)(7)(C) I 
28 Feb 2020 22:09:38 +0000 
To: 
Cc: 
rb)(6); (b)(7)(C) 
Subject: FW: AMAR Detainee Death Review Healthcare and Security Compliance Analysis 
FINAL (2) CC Responses to round 1 questions 
Attachments: AMAR Detainee Death Review Healthcare and Security Compliance Analysis 
FINAL (2) CC Responses to round 1 questions EM follow up.docx 
OOPS. I hit send before do1A , iotAodAd to ;;,lea c;;;,,r that we will all do our best to answer y . b . b)(6); (b)(7)(C) .d h 'II . . b)(6); (b)(7)(C) questions ut no prom1ses.__ _______ __,notes may prov, e as muc I ummat1on 
and (b)(6); (b)(7)(C) .__ ___ _. 
From: irhvm- 1h11111r:1 
Sent: Friday, February 28, 2020 4:58 PM 
To: l(b)(6); (b)(7)(C) jice.dhs.gov> 
Cc:l(b)(6); (b)(7)(C) ~sociates.ice.dhs.gov> 
Sul>Ject: RE: AMAR Detainee Death Review Healthcare and Security Compliance Analysis FINAL (2) CC 
Responses to round 1 questions 
Hey, 
I'll get this t (b)(6); o see if she can answer questions in her bailiwick before she leaves for the b)(6); 
/h\/ DDR next wee (b)(S) 
b)(S) 
Beyond the property issue, I know you will accept this in the spirit in which it is intended: some of your 
questions suggest you may (for reasons I understand) be applying current expectations to a report 
produced more than a year ago. 
F ); (b)(7)(C) 
s'">Ll' .................. .lool.JL., ........ ..w.J..J ......... .JL...6 .......................... ;:i;... ....... ....LLL_~ 
T ssociates.ice.dhs. ov> 
S h-m....-r..,.....,,..,.,...,..........,...=,...,'"TT..,.,TT"'T'l"F"'!l'T'F"'!l.,.....,..,,....,,,.T'T'ricare and Security Compliance Analysis FINAL (2) CC 
Responses to round 1 questions 
(b)(6); (b)(7)(C) 
I have a few more questions, I still haven't made it to October. Blah. 
The personal property is going to need to be addressed somehow. I've deleted my questions that I'm 
good with. I kept a few and didn't provide a comment because I still need to review it in depth a bit 
more. 
I'm teleworking Monday through Wednesday next week to knock out this report. 
Regards, 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 4873 

DHS-ICE-19-0196, 19-0197-Q-000044
b)(6); (b)(7)(C) 
ect1on 1e 
Office of Professional Responsibility 
Immigration and Customs Enforcement 
950 L'Enfant Plaza, SW 
Washington, DC 20536 
Office: {202) b)(5); (b)(?)(C) 
Cell: (202) 42 ___ ~ 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 487 4 

DHS-ICE-19-0196, 19-0197-Q-000045
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4875 
Page 1 

DHS-ICE-19-0196, 19-0197-Q-000046
(b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4876 
Page 2 

DHS-ICE-19-0196, 19-0197-Q-000047
(b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4877 
Page 3 

DHS-ICE-19-0196, 19-0197-Q-000048
(b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4878 
Page 4 

DHS-ICE-19-0196, 19-0197-Q-000049
b)(S); WIF Draft 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative. ~c•rr ct111s 
/\Mlf IC'AI\ 
pVERSIGHT 
(b)(S) 
Page 5 
2019-ICLl-00051 4879 

DHS-ICE-19-0196, 19-0197-Q-000050
NIF Draft; (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative. ~c•rr ct111s 
/\Mlf IC'AI\ 
pVERSIGHT 2019-ICLl-00051 4880 
Page 6 
, 
, 
, 
, 
, 
, 
, 
, 
(b)(5) 

DHS-ICE-19-0196, 19-0197-Q-000051
b)(5); WIF Draft 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative ~c•rr cti11s 
/\Mlf IC'AI\ 
pVERSIGHT 
Page 7 
2019-ICLl-00051 4881 
_, (b)(5) / 
,, 
I 
" ,, 
" ,, 
" " " " 
: " f l 
"' ', '' '' '/ 
' ' '/ 
I : 
: ' 
. I 
'' '' '' '' '' '' '' '' ,, 
/ 

DHS-ICE-19-0196, 19-0197-Q-000052
(b)(5); WIF Draft 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative. ~c•rr ct111s 
/\MEf IC'AI\ 
pVERSIGHT 
Page 8 
2019-ICLl-00051 4882 
' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' f l 
' ' ' ' ' ' ' ' '' '' '' '' ,, 
/ 
(b)(5) 
/:L ___________, 
f 
! 
I 
I 

DHS-ICE-19-0196, 19-0197-Q-000053
b)(5); WIF Draft 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative ~c•rr cti11s 
/\Mlf IC'AI\ 
pVERSIGHT 
Page 9 
2019-ICLl-00051 4883 
' ' ' ' ' , 
' 
! ', 
' 
. 
'. . ' '' ' 
. . ''. '' '' . ' 
(b)(5) 
:: ~----------~ . ' 
'' . 
'. ' '' .' '' 
. '' ' '' . '. ' ' 
. .. '
' . . ' 
' f 
! 
i 

DHS-ICE-19-0196, 19-0197-Q-000054
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4884 
Page 10 

DHS-ICE-19-0196, 19-0197-Q-000055
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4885 
Page 11 

DHS-ICE-19-0196, 19-0197-Q-000056
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4886 
Page 12 

DHS-ICE-19-0196, 19-0197-Q-000057
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4887 
Page 13 

DHS-ICE-19-0196, 19-0197-Q-000058
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4888 
Page 14 

DHS-ICE-19-0196, 19-0197-Q-000059
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4889 
Page 15 

DHS-ICE-19-0196, 19-0197-Q-000060
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4890 
Page 16 

DHS-ICE-19-0196, 19-0197-Q-000061
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4891 
Page 17 

DHS-ICE-19-0196, 19-0197-Q-000062
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4892 
Page 18 

DHS-ICE-19-0196, 19-0197-Q-000063
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4893 
Page 19 

DHS-ICE-19-0196, 19-0197-Q-000064
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4894 
Page 20 

DHS-ICE-19-0196, 19-0197-Q-000065
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4895 
Page 21 

DHS-ICE-19-0196, 19-0197-Q-000066
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4896 
Page 22 

DHS-ICE-19-0196, 19-0197-Q-000067
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4897 
Page 23 

DHS-ICE-19-0196, 19-0197-Q-000068
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4898 
Page 24 

DHS-ICE-19-0196, 19-0197-Q-000069
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4899 
Page 25 

DHS-ICE-19-0196, 19-0197-Q-000070
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4900 
Page 26 

DHS-ICE-19-0196, 19-0197-Q-000071
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4901 
Page 27 

DHS-ICE-19-0196, 19-0197-Q-000072
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4902 
Page 28 

DHS-ICE-19-0196, 19-0197-Q-000073
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4903 
Page 29 

DHS-ICE-19-0196, 19-0197-Q-000074
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4904 
Page 30 

DHS-ICE-19-0196, 19-0197-Q-000075
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4905 
Page 31 

DHS-ICE-19-0196, 19-0197-Q-000076
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4906 
Page 32 

DHS-ICE-19-0196, 19-0197-Q-000077
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4907 
Page 33 

DHS-ICE-19-0196, 19-0197-Q-000078
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4908 
Page 34 

DHS-ICE-19-0196, 19-0197-Q-000079
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4909 
Page 35 

DHS-ICE-19-0196, 19-0197-Q-000080
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4910 
Page 36 

DHS-ICE-19-0196, 19-0197-Q-000081
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4911 
Page 37 

DHS-ICE-19-0196, 19-0197-Q-000082
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4912 
Page 38 

DHS-ICE-19-0196, 19-0197-Q-000083
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4913 
Page 39 

DHS-ICE-19-0196, 19-0197-Q-000084
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4914 
Page 40 

DHS-ICE-19-0196, 19-0197-Q-000085
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4915 
Page 41 

DHS-ICE-19-0196, 19-0197-Q-000086
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4916 
Page 42 

DHS-ICE-19-0196, 19-0197-Q-000087
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4917 
Page 43 

DHS-ICE-19-0196, 19-0197-Q-000088
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4918 
Page 44 

DHS-ICE-19-0196, 19-0197-Q-000089
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4919 
Page 45 

DHS-ICE-19-0196, 19-0197-Q-000090
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4920 
Page 46 

DHS-ICE-19-0196, 19-0197-Q-000091
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4921 
Page 47 

DHS-ICE-19-0196, 19-0197-Q-000092
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4922 
Page 48 

DHS-ICE-19-0196, 19-0197-Q-000093
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4923 
Page 49 

DHS-ICE-19-0196, 19-0197-Q-000094
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4924 
Page 50 

DHS-ICE-19-0196, 19-0197-Q-000095
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4925 
Page 51 

DHS-ICE-19-0196, 19-0197-Q-000096
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4926 
Page 52 

DHS-ICE-19-0196, 19-0197-Q-000097
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4927 
Page 53 

DHS-ICE-19-0196, 19-0197-Q-000098
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4928 
Page 54 

DHS-ICE-19-0196, 19-0197-Q-000099
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 4929 
Page 55 

DHS-ICE-19-0196, 19-0197-Q-000100
From: l(b)(6); (b)(7)(C) 
Sent: 2 Mar 2020 14:06:53 +0000 
To: rb)(6), (b)(7)(C) I 
Subject: FW: AMAR Detainee Death Review Healthcare and Security Compliance Analysis 
FINAL (2) CC Responses to round 1 questions 
Thoughts?? 
fb)(6); (b)(7)(C) 
section cn1er 
Office of Professional Responsibility 
Immigration and Customs Enforcement 
950 L'Enfant Plaza, SW 
Washington, DC 20536 
Office: (202) 732 b)(6); 
Cell: (202) 425 ,~/\~\~, 
From:fb)(6); (b)(7)(C) 
Sent: Frida Februar 28 2020 4:58 PM 
To: b)(6); (b)(7)(C) 
I associates. ice .d hs .gov> 
e.dhs.gov> 
Cc: ~ (b)(6); (b)(7)(C) .................. ------------~ ssociates.ice.dhs.gov> 
Subject: RE: AMAR Detainee Death Review Healthcare and Security Compliance Analysis FINAL (2) CC 
Responses to round 1 questions 
Hey, 
Beyond the property issue, I know you will accept this in the spirit in which it is intended: some of your 
questions suggest you may (for reasons I understand) be applying current expectations to a report 
produced more than a year ago. 
From:l(b)(6); (b)(7)(C) lice.dhs.gov> 
Sent: Friday, February 28, 2020 4:26 PM 
To: fb)(6); (b)(7)(C) rssociates.ice.dhs.gov> 
Subject: AMAR Detainee Death Review Healthcare and Security Compliance Analysis FINAL (2) CC 
Responses to round 1 questions 
Hi (b)(6); 
(bl(7)(C) 
I have a few more questions, I still haven't made it to October. Blah. 
The personal property is going to need to be addressed somehow. I've deleted my questions that I'm 
good with. I kept a few and didn't provide a comment because I still need to review it in depth a bit 
more. 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 4930 

DHS-ICE-19-0196, 19-0197-Q-000101
I'm teleworking Monday through Wednesday next week to knock out this report. 
Regards, 
b)(6); (b)(7)(C) 
ect1on 1e 
Office of Professional Responsibility 
Immigration and Customs Enforcement 
950 L'Enfant Plaza, SW 
Washington, DC 20536 
Office: (202) 7 i~\i~\(C) 
Cell: (202) 425 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 4931 

DHS-ICE-19-0196, 19-0197-Q-000102
(b)(6); (b)(7)(C) 
From: 
Sent: 12 Mar 2020 22:47:52 +0000 
To: rb)(6); (b)(7)(C) 1 
Subject: FW: AMAR 
I just got off the phone with (b)(6); nd we discussed how we 're going to move forward. /h\/7\/f:\ 
We'll all good. Just gotta keep e all rolling. 
l(b)(6); (b)(7)(C) 
Section Chief 
Office of Professional Responsibility 
Immigration and Customs Enforcement 
950 L'Enfant Plaza, SW 
Washington, DC 20536 
Office: 202 7 (b)(6); 
Cell: 202 425 (b)(?)(C) 
(b)(6); (b)(7)(C) 
associates.ice.dhs. ov> 
As stated in this email to b)(6); meant to copy you. I'm at a loss as to what to do to but am in 
h . h (b)(6) b . h\/7\/C:\ 
touc wit (bl(?l(C a out 1 • 
(b)(6); 
(b)(7)(C) 
From: 
+
(b)(6); (b)(7)(C) b 
Sent:hursday, March 12, 202 6:30 PM 
Totb)(6); (b)(7)(C) ~ice.dhs.gov> 
Su Jett: AIVIAR 
I'm sorr ~\i~\ici I tried my best, but there are too many iterations of this report to follow your 
questions on each and make sure I have Joyce's answers and provide the input I can on security 
questions. I do understand why you wanted to send your questions a piece at a time, but as it 
turns out, that has challenged my ability to provide answers in a cogent fashion beyond all 
imagining on either of our parts. I thought I was good through what I thought was round 3, but 
looking at round 4, I am not at all sure. I'm at a loss as to what to do. I may have no choice but 
to start from scratch. If that proves necessary, I'll need a lot of time to reconstruct i~\i~\(C) nd 
my replies onto one version. I know you appre · every minute Is end on t 
away fromKb)(6); bnd (waiting in the wings\~/\~/;,_, Note I copied b)(5); (b)(?)(C) 
because contract timeframes are at stake. 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 4932 

DHS-ICE-19-0196, 19-0197-Q-000103
Again, sorry. Believe me, I wanted to be done with this round of AMAR tonight. 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 4933 

DHS-ICE-19-0196, 19-0197-Q-000104
From: 
l(b)(6); (b)(7)(C) 
Sent: 23 Dec 2019 14:11:27 +0000 
To: l(b)(6); (b)(7)(C) I 
Subject: FW: Detainee Death Reviews - Open JICMS Cases 
(b)(6); (b)(7)(C) 
Just a heads up, below are the cases that were still open and assigned t ~/\~t., or the IG. The cases that 
were non-lG, were reassigned to me and I've close1(b)(6); (b)(7)(C) ~ the remaining, we're 
still working on the DDR report. 
Regards, 
f b)(6); (b)(7)(C) 
Acting Section Chief 
External Reviews and Analysis Unit 
Office of Professional Responsibility 
Immigration and Customs Enforcement 
950 L'Enfant Plaza, SW 
Washington, DC 20536 
Office: (202) 7 (b)(6); 
Cell: (202) 425(b)(?)(C) 
FromP)(B); (b)(?)(C) ke.dhs.gov> 
Sent: Friday, December 20, 2019 5:11 PM 
To:l(b)(6); (b)(7)(C) ice.dhs.gov> 
Subject: RE: Detainee Death Reviews - Open JICMS Cases 
Hkb\(6)1
• ~ 
I transferred all of them but the two with OIG. If the IG is investigating them and has taken them for 
investigation, they have to stay that way until we receive the Black Book from them. 
Thanks 
(b)(6); (b)(7)(C) 
._l'b-)(6-);-(b-)(7-)(-C) _____ ____.rHPP 
Section Chief 
Investigative Operations, Joint Intake Center 
Office of Professional Responsibility 
Immigration and Customs Enforcement 
Washington, DC 
Office: (202) 73~(b~)(=6)-; ~ 
Cell: (202) 27 (b)(?)(C) 
tb)(6); (b)(7)(C) fyice.dhs.gov 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 4934 

DHS-ICE-19-0196, 19-0197-Q-000105
From:l(b)(6); (b)(7)(C) Pice.dhs.gov> 
Srt: Thursday December 19 2019 9·03 AM 
T .(b)(6); (b)(7)(C) ~.dhs.gov> 
Subject: RE: Detainee Death Reviews - Open JICMS Cases 
Good morning "(b)(6); 
Here are the JICMS cases related to detainee deaths that can be reassigned to me: 
201 (b)(6); Investigation Open - OHS ICE IG Liaison (b)(6); (b)(7)(C) 
(b)(7)(C) 
7 IG Assigned to 
Agent, ISU 
201 b)(6); (b)(7)(C) nvestigation Open - ICE OPR Office of Detention 
8 CE OPR Assie:ned to Oversight (ODO) 
f~l(6); 
h\/7\/1.\ I 
201 b)(6); Investigation Open - OHS ICE IG Liaison b)(7)(C) 
8 IG Assigned to 
Agent, ISU 
201 (b )(6); Investigation Open - ICE OPR Office of Detention 
8 (b)(7)(C) 
ICE OPR Assigned to Oversight (ODO) 
ftii(6);7 
201 201901 Detainee Open - ICE OPR Office of Detention Mergensana Amar 
9 489 Death Review Assigned to Oversight (ODO) 
Alison 
201 (b)(6); Detainee Open - ICE OPR Office of Detention (b)(6); (b)(7)(C) 
9 
(b)(7)(C) 
Death Review Assigned to Oversight (ODO) 
l(b)(6); I /h\/7\/r'\ 
There are two that are assigned to Agent, ISU, but I'm not sure if they should be reassigned to me 
because of the case type. Those cases were detainee deaths and we have completed our review of their 
cases, but I'll you determine if it should be. 
Regards, 
~b)(6); (b)(7)(C) 
Acting Section Chief 
External Reviews and Analysis Unit 
Office of Professional Responsibility 
Immigration and Customs Enforcement 
950 L'Enfant Plaza, SW 
Washington, DC 20536 
Office: (202) 7 ~im(C) 
Cell: {202) 425~-~ 
Froml(b)(6); (b)(?)(C) lce.dhs.gov> 
Sent: Wednesday, December 18, 2019 4:44 PM 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 4935 
-
-
-

DHS-ICE-19-0196, 19-0197-Q-000106
Sure, send me the list and I will take a look and see what's what and reassign them. 
b)(6); (b)(?)(C) 
Sent with BlackBerry Work 
(www.blackberry.com) 
Fr~(b)(5); (b)(?)(C) lice.dhs.gov> 
Date: Wednesday, Dec 18, 2019, 4:41 PM 
Tcfb)(6); (b)(7)(C) Fe.dhs.gov> 
Subject: Detainee Death Reviews - Open JICMS Cases 
H (b}(6); (b)(?)(C) 
I was trying to assign a few open JICMS cases to myself, but I'm receiving an error message. If I gave you 
a list of the open JICMS cases, would you be able to assign them to me? 
Thank you, 
l(b)(6); (b)(?)(C) 
Acting Section Chief 
External Reviews and Analysis Unit 
Office of Professional Responsibility 
Immigration and Customs Enforcement 
950 L'Enfant Plaza, SW 
Washington, DC 20536 
Office: (202) 7 (b)(5); (b)(?)(C) 
Cell: (202) 425...._ __ _, 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 4936 

DHS-ICE-19-0196, 19-0197-Q-000107
From: 
Sent: 
To: 
Cc: 
Subject: 
Attachments: 
(b)(6); (b)(?)(C) 
~b)(6); (b)(?)(C) 
10 Apr 2020 12:33:24 +0000 
rb)(6); (b)(?)(C) 
1 
AMAR DOR Draft Report Ready for FO Review 
AMAR DOR Report (for FO review).docx 
The AMAR DOR Report is attached and ready for FO review. Thanks. 
l(b}(6); (b}(?)(C) 
Unit Chief 
External Reviews and Analysis Unit 
Office of Professional Responsibility 
Immigration and Customs Enf,W-QgIIll.!{lt 
(0) 202-732-~{C) 202-423 ~im(C) 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 4937 

DHS-ICE-19-0196, 19-0197-Q-000108
Detainee Death Review Report 
Mergensana Dabaevich AMAR 
Date ofDeath: November 18, 2018 
Alien File Number: 216 269 802 
Joint Integrity Case Management System (TICMS) #: 201901489 
April XX, 2020 
U.S. Immigration and Customs Enforcement 
Office of Professional Responsibility 
2019-ICLl-00051 4938 

DHS-ICE-19-0196, 19-0197-Q-000109
TABLE OF CONTENTS 
Details Of Review ........................................................................................................................................ . 2 
Immigration And Criminal History ......................................................................................................... .. 2 
Chronology Of Events ................................................................................................................................. 3 
Exhibits ....................................................................................................................................................... 25 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 4939 
llPage 

DHS-ICE-19-0196, 19-0197-Q-000110
(b)(5) 
/\MERICAi\ 
pVERSIGHT 
21Page 
2019-ICLl-00051 4940 

DHS-ICE-19-0196, 19-0197-Q-000111
(b)(5) 
31Page 
/\M~H l /\I\ 
pVERSIGHT 2019-ICLl-00051 4941 

DHS-ICE-19-0196, 19-0197-Q-000112
(b)(5) 
/\MERICAi\ 
pVERSIGHT 
41Page 
2019-ICLl-00051 4942 

DHS-ICE-19-0196, 19-0197-Q-000113
b)(5) 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 4943 
l(b)(6); (b)(?)(C) I 
SI Page 

DHS-ICE-19-0196, 19-0197-Q-000114
b)(5) 
/\MEf IC'AI\ 
pVERSIGHT 
61Page 
2019-ICLl-00051 4944 

DHS-ICE-19-0196, 19-0197-Q-000115
(b)(S) 
/\MERICAi\ 
pVERSIGHT 
71Page 
2019-ICLl-00051 4945 

DHS-ICE-19-0196, 19-0197-Q-000116
b)(5) 
SI Page 
/\M 1.. Al\ 
pVERSIGHT 2019-ICLl-00051 4946 

DHS-ICE-19-0196, 19-0197-Q-000117
(b )(5) 
91Page 
/\M~H l /\I\ 
pVERSIGHT 2019-ICLl-00051 4947 

DHS-ICE-19-0196, 19-0197-Q-000118
(b)(S) 
lOIPage 
/\M~ 1.. Al\ 
pVERSIGHT 2019-ICLl-00051 4948 

DHS-ICE-19-0196, 19-0197-Q-000119
(b)(5) 
/\MERICAi\ 
pVERSIGHT 
lllPage 
2019-ICLl-00051 4949 

DHS-ICE-19-0196, 19-0197-Q-000120
(b)(5) 
/\MERICAi\ 
pVERSIGHT 
12 I P a g e 
2019-ICLl-00051 4950 

DHS-ICE-19-0196, 19-0197-Q-000121
(b)(5) 
/\MER ( Al\ 
pVERSIGHT 
Bl Page 
2019-ICLl-00051 4951 

DHS-ICE-19-0196, 19-0197-Q-000122
b)(5) 
/\Ml, -. "I\ 
pVERSIGHT 2019-ICLl-00051 4952 

DHS-ICE-19-0196, 19-0197-Q-000123
(b)(S) 
/\Ml I\ 
pVERSIGHT 2019-ICLl-00051 4953 

DHS-ICE-19-0196, 19-0197-Q-000124
b)(5) 
I 
/\MERICAi\ 
pVERSIGHT 
16 I P a g e 
2019-ICLl-00051 4954 

DHS-ICE-19-0196, 19-0197-Q-000125
b)(5) 
17 I P a g e 
/\Mt:J l Al\ 
pVERSIGHT 2019-ICLl-00051 4955 

DHS-ICE-19-0196, 19-0197-Q-000126
(b)(5) 
/\MERICAi\ 
pVERSIGHT 
181Page 
2019-ICLl-00051 4956 

DHS-ICE-19-0196, 19-0197-Q-000127
(b)(5) 
/\MERICAi\ 
pVERSIGHT 
191Page 
2019-ICLl-00051 4957 

DHS-ICE-19-0196, 19-0197-Q-000128
(b)(5) 
/\MER ( Al\ 
pVERSIGHT 
20IPage 
2019-ICLl-00051 4958 

DHS-ICE-19-0196, 19-0197-Q-000129
(b)(5) 
/\MERICAi\ 
pVERSIGHT 
21 I P a g e 
2019-ICLl-00051 4959 

DHS-ICE-19-0196, 19-0197-Q-000130
(b)(5) 
/\MERICAi\ 
pVERSIGHT 
22 I P a g e 
2019-ICLl-00051 4960 

DHS-ICE-19-0196, 19-0197-Q-000131
(b)(S) 
/\MERICAi\ 
pVERSIGHT 
231Page 
2019-ICLl-00051 4961 

DHS-ICE-19-0196, 19-0197-Q-000132
(b)(S) 
/\MERICAi\ 
pVERSIGHT 
24 I P a g e 
2019-ICLl-00051 4962 

DHS-ICE-19-0196, 19-0197-Q-000133
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 4963 
251Page 

DHS-ICE-19-0196, 19-0197-Q-000134
From: 
Sent: 
To: 
Cc: 
Subject: 
Attachments: 
. (b)(6); 
H1 (b)(7)(C) 
~b)(6); (b)(7)(C) I 
9 Apr 2020 20:36:26 +0000 
l(b )(6); (b )(7)(~) I 
AMAR DOR Report (003) ss 
AMAR DOR Report (003) ss.docx 
Attached is the AMAR DOR report with my response to your questions and a few other edits. Let me 
know if you have any questions. 
Regards, 
j<b)(6); (b)(7)(C) 
section cn1er 
Office of Professional Responsibility 
Immigration and Customs Enforcement 
950 L'Enfant Plaza, SW 
Washington, DC 20536 
Office: (202) (b)(6); 
Cell: (202) 42 (bl(?)(Cl 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 4964 

DHS-ICE-19-0196, 19-0197-Q-000135
Detainee Death Review Report 
Mergensana Dabaevich AMAR 
Date ofDeath: November 18, 2018 
Alien File Number: 216 269 802 
Joint Integrity Case Management System (TICMS) #: 201901489 
April XX, 2020 
U.S. Immigration and Customs Enforcement 
Office of Professional Responsibility 
2019-ICLl-00051 4965 

DHS-ICE-19-0196, 19-0197-Q-000136
TABLE OF CONTENTS 
DETAILS OF REVIEW ............................................................................................................................ 2 
IMMIGRATION AND CRIMINAL HISTORY ...................................................................................... 2 
CHRONOLOGY OF EVENTS .......................................... ....................................................................... 3 
EXHIBITS ................................................................................................................................................. 25 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 4966 
llPage 

DHS-ICE-19-0196, 19-0197-Q-000137
(b)(5) 
21Page 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 4967 

DHS-ICE-19-0196, 19-0197-Q-000138
(b)(5) 
/\Mlf IC'AI\ 
pVERSIGHT 2019-ICLl-00051 4968 
' ' ' ' ' ' ' ' ' ' '' ,, 
,, 
:: 
" " " ,, ' " ' " ' " ' " ' :: " ' : 
"' ,, ,, 
(b)(5) 
" ,, IJ 11 ff !;L _________________ _ It 11 ., ,, ., It 
II II II 11 II II 
1, " 
, ii 
!! 
:: 
1! 
:: 
" :: 
" :: 
H 
s 
: 
: 
: 

DHS-ICE-19-0196, 19-0197-Q-000139
(b)(5) 
41Page 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 4969 

DHS-ICE-19-0196, 19-0197-Q-000140
b)(5) 
/\Mlf IC'AI\ 
pVERSIGHT 
SI Page 
2019-ICLl-00051 4970 
1)(5) 
I 
:: 
" " :: " 
" 
ff 
:: 
I! 
tf 
i 
: 
: 
! 
I 

DHS-ICE-19-0196, 19-0197-Q-000141
(b)(5) 
61Page 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 4971 

DHS-ICE-19-0196, 19-0197-Q-000142
b)(5) 
/\Mlf IC'AI\ 
pVERSIGHT 
71Page 
2019-ICLl-00051 4972 
" ,, 
" ,, 
,, 
" " " " " " " 6 :: " " " " :'l 
!I 
. 
: 
! 
! 
' 

DHS-ICE-19-0196, 19-0197-Q-000143
(b)(5) 
SI Page 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 4973 

DHS-ICE-19-0196, 19-0197-Q-000144
b)(5) 
/\Mlf IC'AI\ 
pVERSIGHT 
9IPage 
2019-ICLl-00051 497 4 

DHS-ICE-19-0196, 19-0197-Q-000145
(b)(5) 
lOIPage 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 4975 

DHS-ICE-19-0196, 19-0197-Q-000146
b)(5) 
/\MEf IC'AI\ 
pVERSIGHT 
lllPage 
2019-ICLl-00051 4976 
(b)(5) 
' !,-------------
:: 
:: " 
" " " " 
fl 
:: 
:: 
!! 
H 
~ : 
! . 
~ 

DHS-ICE-19-0196, 19-0197-Q-000147
b)(5) 
/\Mlf IC'AI\ 
pVERSIGHT 
,,. .,~. 
12 I P a g e 
2019-ICLl-00051 4977 
b)( 5) 
' ' ' ' ' " 
!! 
" 
II 
!! 
!! 
;; 
H 
' 

DHS-ICE-19-0196, 19-0197-Q-000148
(b)(5) 
Bl Page 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 4978 

DHS-ICE-19-0196, 19-0197-Q-000149
(b) (5) 
I 
/\Mlf IC'AI\ 
pVERSIGHT 
14 I P a g e 
2019-ICLl-00051 4979 
,, 
,, 
i ,, 
,, 
,, 
,, 
" ,, 
" ,, 
" i ,, 
" " 
1/ i 
1: ' 
b)(5) 
" 
!! 
:: 
:: 
:: " 
:: " 
:: " 
H 
if 
!! 
: 
" : 
= 

DHS-ICE-19-0196, 19-0197-Q-000150
(b)(5) 
lSIPage 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 4980 

DHS-ICE-19-0196, 19-0197-Q-000151
(b)(5) 
16 I P a g e 
/\Mlr 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 4981 

DHS-ICE-19-0196, 19-0197-Q-000152
(b)(5) 
17 I P a g e 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 4982 

DHS-ICE-19-0196, 19-0197-Q-000153
(b)(5) 
181Page 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 4983 

DHS-ICE-19-0196, 19-0197-Q-000154
b)(S) 
(b)(5) 
/\Mlf IC'AI\ 
pVERSIGHT 
)(5) 
2019-ICLl-00051 4984 

DHS-ICE-19-0196, 19-0197-Q-000155
l~(bX5) ====-il:::;,{_b)(S) _I b)(S) 
/\Mlf IC'AI\ 
pVERSIGHT 2019-ICLl-00051 4985 
20IPage 

DHS-ICE-19-0196, 19-0197-Q-000156
(b)(5) 
(b)(5) 
I 
b)(5) 
/\Mlf IC'AI\ 
pVERSIGHT 
21 I P a g e 
2019-ICLl-00051 4986 
b)(5) 
I' 
! 
' 
I 
' ' ' ' ' ' ' ' ' 
! 
I 

DHS-ICE-19-0196, 19-0197-Q-000157
~~-====-====:;I ,....,..,.,,1rb-)(5_) ____________________ 1V!L(b)-(5)------~-
b)(5) 
(b)(5) 
1~)(5) 
/\Mlf IC'AI\ 
pVERSIGHT 
22 I P a g e 
2019-ICLl-00051 4987 

DHS-ICE-19-0196, 19-0197-Q-000158
(b)(5) 
(b)(5) 
/\Mlf IC'AI\ 
pVERSIGHT 
---f_(5) _I 
23 I P a g e 
2019-ICLl-00051 4988 

DHS-ICE-19-0196, 19-0197-Q-000159
b)(5) 
/\MERICAi\ 
pVERSIGHT 
24 I P a g e 
2019-ICLl-00051 4989 

DHS-ICE-19-0196, 19-0197-Q-000160
EXHIBITS 
(b)(5) 
/\MERICAi\ 
pVERSIGHT 
251Page 
2019-ICLl-00051 4990 

DHS-ICE-19-0196, 19-0197-Q-000161
l
(b)(6); (b)(?)(C) 
From: _ 
Sent: 13 Mar 2020 18:57:26 +0000 
To: l<b)(6); (b)(7)(C) I 
Subject: AMAR DOR Report 
Attachments: AMAR DOR Report.docx, AutoRecovery save of AMAR Detainee Death Review 
Healthcare and Security Compliance Analysis FINAL (2) CC MEDICAL responses round 4.docx 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 4991 

DHS-ICE-19-0196, 19-0197-Q-000162
Detainee Death Review Report 
Mergensana Dabaevich AMAR 
Date ofDeath: November 18, 2018 
Alien File Number: 216 269 802 
Joint Integrity Case Management System (TICMS) #: 201901489 
March XX, 2020 
U.S. Immigration and Customs Enforcement 
Office of Professional Responsibility 
2019-ICLl-00051 4992 

DHS-ICE-19-0196, 19-0197-Q-000163
TABLE OF CONTENTS 
DETAILS OF REVIEW ............................................................................................................................ 2 
IMMIGRATION AND CRIMINAL HISTORY ...................................................................................... 2 
CHRONOLOGY OF EVENTS .......................................... ....................................................................... 3 
EXHIBITS ................................................................................................................................................. 23 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 4993 
llPage 

DHS-ICE-19-0196, 19-0197-Q-000164
(b)(5) 
21Page 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 4994 

DHS-ICE-19-0196, 19-0197-Q-000165
(b)(5) 
31Page 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 4995 

DHS-ICE-19-0196, 19-0197-Q-000166
(b)(5) 
41Page 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 4996 

DHS-ICE-19-0196, 19-0197-Q-000167
~b=)(S.,-) ---------------------7;,f=)(S=)========-I 
b)(S) 
/\Mlf IC'AI\ 
pVERSIGHT 
SI Page 
2019-ICLl-00051 4997 
,, 
" ,, 
,, 
'' 
I 

DHS-ICE-19-0196, 19-0197-Q-000168
b)(5) 
/\Mlf IC'AI\ 
pVERSIGHT 
b}(5 
61Page 
2019-ICLl-00051 4998 

DHS-ICE-19-0196, 19-0197-Q-000169
(b )(5) 
b) 
-
/\Mlf IC'AI\ 
pVERSIGHT 
71Page 
2019-ICLl-00051 4999 
r bXS) 
;--------
: 
' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' 

DHS-ICE-19-0196, 19-0197-Q-000170
(b)(5) 
(b )(5) 
b)(5) 
'(b"_' 
b)(5) 
/\Mlf IC'AI\ 
pVERSIGHT 2019-ICLl-00051 5000 
(b)(5) 
' ' ' , 
' ' 
' ' ' ' ' ' ' ' ' ., ' ' ' " ,, 
:: ' ' ,, ' " ' " ' " ' " ' " ' " ' " ' " ' " ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' 

DHS-ICE-19-0196, 19-0197-Q-000171
(b )(5) 
(b)(5) 
/\Mlf IC'AI\ 
pVERSIGHT 2019-ICLl-00051 5001 
(b)(5) 
' ' ' ' ' ' ' ' '' '' '' '' '' '' '' '' '' '' , , 
': ' ' ' ' ' ' ' ' ' 
I 
I 

DHS-ICE-19-0196, 19-0197-Q-000172
(b)(5) 
lOIPage 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5002 

DHS-ICE-19-0196, 19-0197-Q-000173
b)(5) 
b)(5) 
(b)(5) 
/\Mlf IC'AI\ 
pVERSIGHT 
lllPage 
2019-ICLl-00051 5003 
b)(5) 
! 
!! 
.. ,, 
,, 
,, 
,, 
,, 
,, 
,, 
" ,, 
,, 
" ,, 
,, 
,, 
,, 
,, 
" ,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
" ,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
" ,, 
,, 
,, 
,, 
.. 
" ,, 
,, 
" ,, 
:: 
,, 
,, 
,, 
,, 
,, 
" ,, 
,, 
" ,, 
" " ,, 
,, 
" ,, 
,, 
" ,, 
" " 

DHS-ICE-19-0196, 19-0197-Q-000174
b)(5) 
b)(5) 
(b)(5) 
/\Mlf IC'AI\ 
pVERSIGHT 
12 I P a g e 
2019-ICLl-00051 5004 
' ' ' ' ' ' 

DHS-ICE-19-0196, 19-0197-Q-000175
(b)(5) 
b)(5) 
/\Mlf IC'AI\ 
pVERSIGHT 
Bl Page 
2019-ICLl-00051 5005 

DHS-ICE-19-0196, 19-0197-Q-000176
~b)-=(5),-----------------------7 _/rX6); (b)(7)(C) 
/\Mlf IC'AI\ 
pVERSIGHT 2019-ICLl-00051 5006 
14 I P a g e 

DHS-ICE-19-0196, 19-0197-Q-000177
=~-------------------11(b)(5) -------- (b)(5) . ~ 
/\Mlf IC'AI\ 
pVERSIGHT 2019-ICLl-00051 5007 
15 I P a g e 
D 
I 
! 
i 
! 
I 
I 
I 
t 

DHS-ICE-19-0196, 19-0197-Q-000178
(b)(5) 
/\MERICAi\ 
pVERSIGHT 
16 I P a g e 
2019-ICLl-00051 5008 

DHS-ICE-19-0196, 19-0197-Q-000179
(b)(5) 
(b)(5) 
b)(5) 
/\Mlf IC'AI\ 
pVERSIGHT 
(b)(5) 
171Page 
2019-ICLl-00051 5009 

DHS-ICE-19-0196, 19-0197-Q-000180
b)(5) 
' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ,, 
,, 
,, 
" ,, 
''; ::: 
: : : 
"' ff t 
,, fi : ,, '
(b)(5) 
:: ! : 'l : : L _________________ _ ~ : : 
'' ,, 
,, 
'' '' '' 
:: '' 
'' '' '' ,, 
'' '' ,,
,, 
'' :: 
'/ 
~~-=--=--=--=--=--=--=--=--=--=--=--=--=----=-----=-----=--=--=-==-==---=---=---=---=---=--.=1_1__,i b)(5) 
b)(5) 
/\MEf IC'AI\ 
pVERSIGHT 
18 I P a g e 
2019-ICLl-00051 5010 

DHS-ICE-19-0196, 19-0197-Q-000181
(b)(5) 
/\Mlf IC'AI\ 
pVERSIGHT 2019-ICLl-00051 5011 
' ' ' ' ' ' ' ' ' 
(b)(5) 
f .-------- ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' 
. I 
I 
I 

DHS-ICE-19-0196, 19-0197-Q-000182
b)(5) 
/\Mlf IC'AI\ 
pVERSIGHT 2019-ICLl-00051 5012 
(b)(5 
, 
-
, 
20IPage 

DHS-ICE-19-0196, 19-0197-Q-000183
(b )(5) 
/\MERICAi\ 
pVERSIGHT 
21 I P a g e 
2019-ICLl-00051 5013 

DHS-ICE-19-0196, 19-0197-Q-000184
b)(5) 
/\MERICAi\ 
pVERSIGHT 
22 I P a g e 
2019-ICLl-00051 5014 
b)(5) 
' ' ' ' ' 
I 
I 
! 
I 
J 

DHS-ICE-19-0196, 19-0197-Q-000185
b)(5) 
/\MERICAi\ 
pVERSIGHT 
23 I P a g e 
2019-ICLl-00051 5015 
, 
, 
, 
' ' 
' ' ' ' ' ' 
' 
' ' ' ' ' ' 
(b)(5) 
IL_ _______ _ 

DHS-ICE-19-0196, 19-0197-Q-000186
EXHIBITS 
b)(5) 
/\MERICAi\ 
pVERSIGHT 
24 I P a g e 
2019-ICLl-00051 5016 

DHS-ICE-19-0196, 19-0197-Q-000187
DETAINEE DEATH REVIEW: Mergensana AMAR, A216269802 
Healthcare and Security Compliance Analysis 
Northwest Detention Center 
Tacoma, Washington 
(b)(5) 
SYNOPSIS 
(b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5017 
Page 1 

DHS-ICE-19-0196, 19-0197-Q-000188
(b)(5) 
[t 
11. ~1 ...... "'" .... , ... 
/\Mlr \. ,,,,,. 
pVERSIGHT 2019-ICLl-00051 5018 

DHS-ICE-19-0196, 19-0197-Q-000189
(b)(5) 
11. ~1 ...... "'" .... , ... 
/\M~ \. f\l'\i 
pVERSIGHT 2019-ICLl-00051 5019 

DHS-ICE-19-0196, 19-0197-Q-000190
(b)(5) 
11. ~1 ...... "'" .... , ... 
/\M~ \. f\l'\i 
pVERSIGHT 2019-ICLl-00051 5020 

DHS-ICE-19-0196, 19-0197-Q-000191
b)(5) 
(b)(5) 
(b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative ~c•rr cti11s 
/\Mlf IC'AI\ 
pVERSIGHT 
Page 5 
2019-ICLl-00051 5021 
' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' 
' ' ' ' , 
' ' ' ' 
. 
' ' ' . . 
' ' ' . 
' . 
' ' ' ' 
b)(5) 

DHS-ICE-19-0196, 19-0197-Q-000192
b)(5) 
' , ' ' ' , ' ' ' ' , ' ' , ..,...----------------'I// '/ / ,,., 
',,,"'' 
/ -===========------~/ (b)(5) 
(b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative. ~c•rr ct111s 
/\Mlf IC'AI\ 
pVERSIGHT 
Page 6 
2019-ICLl-00051 5022 
' ' ' ' ' \ '\ 
. ' 1\ \ 
" .. ' ' " " " " " " " " " " " " " " \ 

DHS-ICE-19-0196, 19-0197-Q-000193
(b)(5) 
b)(5) 
(b )(5) 
(b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative. l.2::::iilc•rr ct111s 
/\MEf IC'AI\ 
pVERSIGHT 
Page 7 
2019-ICLl-00051 5023 
b)(5) 
/ 
/ 
---
---
, 
, 
/'/, :/ 
' ' , 
' ' ' ' " " " " " " :: " 
" "' "' "' "• "' "' '" '" !f 
' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' 

DHS-ICE-19-0196, 19-0197-Q-000194
(b)(5) 
b)(5) 
(b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5024 
Page 8 

DHS-ICE-19-0196, 19-0197-Q-000195
l
b)(S) 
b)(5) 
L------------=--
(b)(5) 
' ' ' ' ' ' ' ' ' ' ' ' ' ' ,, 
" " " " ,, 
;; 
:: 
:: 
u " ' " ' " ' " ' " ' ,, " ' ,, "' ' 
"' ,,, 
,,, 
'" '" "' ,,, 
"' '" "' ,,, 
'" "' .,, ' 111 I 11I I Ill I 
Ill I 
111 I 
111 I 
Ill I 
lfl I 
Jtl I l1f I !ti I IJI I lfJ I 111 I 
111 I 
111 I 
,, ' 
"' ,, ' ,, ' "' ,, ' ,, ' ,, ' ,, ' ,, ' ,, ! l.P,...,../t:J>...-/---------------------------------1; 
(b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative. ~c•rr ct111s 
/\Mlf IC'AI\ 
pVERSIGHT 
f 
Page 9 
2019-ICLl-00051 5025 
b)(5) 

DHS-ICE-19-0196, 19-0197-Q-000196
b)(5) 
(b)(5) 
(b)(5) 
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative ~c•rr cti11s 
/\Mlf IC'AI\ 
pVERSIGHT 
Page 10 
2019-ICLl-00051 5026 
' ' ' 
! ,, 
,, 
,, 
,, 
'' '' '' '' '' '' '' '' 
b)(5) 
::'-------------' 
'' '' '' '' 
'I '' 
I I 
'' I 0 
' ' ' ' I ' ' ' : : 
: : 
' ' ! : 
; : 
; : 
' ' ' ' ' ' 
! 
: 
: 
' ' ' ' ' ' ' : 
' 

DHS-ICE-19-0196, 19-0197-Q-000197
(b)(S) 
,U/\CJ/ 
b)(S) 
(b)(S) 
(b)(S) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative ~c•rr cti11s 
/\Mlf IC'AI\ 
pVERSIGHT 
Page 11 
2019-ICLl-00051 5027 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
I 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
,, 
I I ,, 
< I ,, 
< I 
b)(S) 
' ' ' ' ' ' ' 
/.__ __________ ____, 
' ' ' ' ' ' ' ' 
! 
! 
I 
I 
f 
' I 
I 

DHS-ICE-19-0196, 19-0197-Q-000198
b)(5) 
j (b )(5) 
I 
{ 
b)(5) 
lDJ(:)J 
(b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative ~c•rr cti11s 
/\Mlf IC'AI\ 
pVERSIGHT 
Page 12 
2019-ICLl-00051 5028 
(b)(5) 
' ' ' ' ' . ' ' ' ' ' 
I 
' ' ' 
. . ' 
. 
I 

DHS-ICE-19-0196, 19-0197-Q-000199
ltb\/6\· /b\/7\/C\ 
(b)(5) 
b)(5) 
(b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative ~c•rr cti11s 
/\Mlf IC'AI\ 
pVERSIGHT 
Page 13 
2019-ICLl-00051 5029 
, 
, 
, 
, 
, 
, 
, 
, 
, 
, , , , , , , , 
' / 
, , , , , , , , 
, 
, , :/ , 
b)(5) 

DHS-ICE-19-0196, 19-0197-Q-000200
b)(5) 
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5030 
Page 14 

DHS-ICE-19-0196, 19-0197-Q-000201
(b)(S) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative l.2::::iilc•rr cti11s 
/\MEf IC'AI\ 
pVERSIGHT 
Page 15 
2019-ICLl-00051 5031 
r bXS) 
' ~ ' ' ' ' ' ' ! 
! 
! 
/ 

DHS-ICE-19-0196, 19-0197-Q-000202
(b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5032 
Page 16 

DHS-ICE-19-0196, 19-0197-Q-000203
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative ~c•rr cti11s 
/\Mlf IC'AI\ 
pVERSIGHT 
Page 17 
2019-ICLl-00051 5033 
! 
! 
! 
! 
r)(5) 
I ____________, 
I 
J 

DHS-ICE-19-0196, 19-0197-Q-000204
(b)(5) 
b)(5) 
b)(5) 
(b )(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative ~c•rr cti11s 
/\Mlf IC'AI\ 
pVERSIGHT 2019-ICLl-00051 5034 
b)(5) 
,, 
--
, 
' 
' ' ' 
Page 18 

DHS-ICE-19-0196, 19-0197-Q-000205
(b )(5) 
\U}\v/ 
(b )(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative ~c•rr cti11s 
/\Mlf IC'AI\ 
pVERSIGHT 
(b)(5) 
,, 
" I 
Page 19 
2019-ICLl-00051 5035 

DHS-ICE-19-0196, 19-0197-Q-000206
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MEf I( 1\1\i 
pVERSIGHT 2019-ICLl-00051 5036 
Page 20 

DHS-ICE-19-0196, 19-0197-Q-000207
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5037 
Page 21 

DHS-ICE-19-0196, 19-0197-Q-000208
(b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5038 
Page 22 

DHS-ICE-19-0196, 19-0197-Q-000209
(b)(5) 
,- ,,~, 
(b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative ~c•rr cti11s 
/\Mlf IC'AI\ 
pVERSIGHT 2019-ICLl-00051 5039 
! 
I 
! 
' ' ' ' ' ' ' 
Page 23 

DHS-ICE-19-0196, 19-0197-Q-000210
(b )(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5040 
Page 24 

DHS-ICE-19-0196, 19-0197-Q-000211
(b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5041 
Page 25 

DHS-ICE-19-0196, 19-0197-Q-000212
(b)(S) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\Mlf I( 1\1\i 
pVERSIGHT 2019-ICLl-00051 5042 
Page 26 

DHS-ICE-19-0196, 19-0197-Q-000213
(b)(5) 
b)(5) 
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative ~c•rr cti11s 
/\Mlf IC'AI\ 
pVERSIGHT 
Page 27 
2019-ICLl-00051 5043 
' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' 
' ' ' ' 
(b)(5) 
:.__ ___________ __. 
" " ,, 
" " ·; ' ' ' ' ' ' ' ' ' ' " ,, 
" ,, 
,, 
" " ,, 
" ,, 
" " ,, 
,, 
" ,, 
! 
! 

DHS-ICE-19-0196, 19-0197-Q-000214
(b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5044 
Page 28 

DHS-ICE-19-0196, 19-0197-Q-000215
(b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5045 
Page 29 

DHS-ICE-19-0196, 19-0197-Q-000216
b)(S) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative ~c•rr cti11s 
/\Mlf IC'AI\ 
pVERSIGHT 
Page 30 
2019-ICLl-00051 5046 

DHS-ICE-19-0196, 19-0197-Q-000217
b)(5) 
rU/\v/ 
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative ~c•rr cti11s 
/\Mlf IC'AI\ 
pVERSIGHT 
Page 31 
2019-ICLl-00051 5047 
' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' I 
l JI 
/i-" 
:: " 
Ii 
!! 
! 
b)(5) 

DHS-ICE-19-0196, 19-0197-Q-000218
b)(5) 
(b)(5) 
(b)(5) 
b)(5) 
b)(5) 
rb)(5) 
responders were m H Segregat10n for approximately 12 minutes. 
(b)(5) 
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative ~c•rr cti11s 
/\Mlf IC'AI\ 
pVERSIGHT 2019-ICLl-00051 5048 
~· ! 
Page 32 
' ' ' 
,, : '
" ,, 
,, 
' ' ' ! ' ,, 
! I 
' ' ' 
'' I! 
b)(5) 
' ' ' :: " ... , -------------' 
"• :: : 
ff; 
:: : 
:: : 
' 'i ! 
,, 
! 
" " " j; " 
' 
'' '! 
! 
I 
' ' ' ' ' ' ' ' ' 
I 

DHS-ICE-19-0196, 19-0197-Q-000219
(b)(5) 
b)(5) 
/ -------------------------------- ~b)(5) ' ' ' ' ' ' ' 
, 
, 
, ...=;::::::=========================:::-'' 
(b)(5) ~ / 
b)(5) 
Kb)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative ~c•rr cti11s 
/\Mlf IC'AI\ 
pVERSIGHT 
Page 33 
2019-ICLl-00051 5049 
I 
, 
, 
, 

DHS-ICE-19-0196, 19-0197-Q-000220
b)(5) 
b)(5) 
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5050 
I 
Page 34 

DHS-ICE-19-0196, 19-0197-Q-000221
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5051 
J 
Page 35 

DHS-ICE-19-0196, 19-0197-Q-000222
b)(5) 
(b)(5) 
1~)(5) 
(b)(5) 
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative l.2::::iilc•rr cti11s 
/\MEf IC'AI\ 
pVERSIGHT 
Page 36 
2019-ICLl-00051 5052 
(b)(5) 
' ' ' ' ' ' ' ' ' ' ' ' ' ' : : 
: ,' 
' ' : ,' 
'' '' '' '' 
,,,/ 
~/ 

DHS-ICE-19-0196, 19-0197-Q-000223
b)(5) 
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\Mlf I( 1\1\i 
pVERSIGHT 2019-ICLl-00051 5053 
Page 37 

DHS-ICE-19-0196, 19-0197-Q-000224
lcbHG>· <b><7><C> 
CONCLUSIONS 
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5054 
Page 38 

DHS-ICE-19-0196, 19-0197-Q-000225
(b)(S) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5055 
Page 39 

DHS-ICE-19-0196, 19-0197-Q-000226
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5056 
Page 40 

DHS-ICE-19-0196, 19-0197-Q-000227
(b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5057 
Page 41 

DHS-ICE-19-0196, 19-0197-Q-000228
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5058 
Page 42 

DHS-ICE-19-0196, 19-0197-Q-000229
(b )(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5059 
Page 43 

DHS-ICE-19-0196, 19-0197-Q-000230
b)(5) 
• 
• 
• 
' ' ' ' ' ' , 
' ' 
(b)(5) 
' ' ' ' 
, ' ' 
' ' ' ' ' ' ' ' ' ' ' ' 
. i 
i 
I 
i 
! 
! 
! 
i 
(b)(5.,__ ____________________________ ...,..I 
J~)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative l.2::::iilc•rr cti11s 
/\MEf IC'AI\ 
pVERSIGHT 
Page 44 
2019-ICLl-00051 5060 

DHS-ICE-19-0196, 19-0197-Q-000231
.... r ,_)(S_)_______________________ ___.l--- ,,,,,. ~)I/XE) 
b)(S) 
(b )(5) 
(b)(S) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative ~c•rr cti11s 
/\Mlf IC'AI\ 
pVERSIGHT 2019-ICLl-00051 5061 
' , 
' ' , 
' , 
, 
Page 45 

DHS-ICE-19-0196, 19-0197-Q-000232
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5062 
Page 46 

DHS-ICE-19-0196, 19-0197-Q-000233
(b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5063 
Page 47 

DHS-ICE-19-0196, 19-0197-Q-000234
(b)(S) 
(b)(S) 
APPENDIX 2 
Hunger Strike Monitoring 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5064 
Page 48 

DHS-ICE-19-0196, 19-0197-Q-000235
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5065 
Page 49 

DHS-ICE-19-0196, 19-0197-Q-000236
(b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5066 
Page 50 

DHS-ICE-19-0196, 19-0197-Q-000237
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5067 
Page 51 

DHS-ICE-19-0196, 19-0197-Q-000238
b)(5) 
APPENDIX 3 
Significant Hospital Logbook Entries 
(b )(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5068 
Page 52 

DHS-ICE-19-0196, 19-0197-Q-000239
b)(S) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5069 
Page 53 

DHS-ICE-19-0196, 19-0197-Q-000240
November 19. 201s 
November 20 2018 
b)(S) 
November 21 2018 
b)(S) 
November 22 2018 
b)(S) 
November 23, 2018 
b)(S) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5070 
Page 54 

DHS-ICE-19-0196, 19-0197-Q-000241
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5071 
Page 55 

DHS-ICE-19-0196, 19-0197-Q-000242
From: 
Sent: 
To: 
Cc: 
Subject: 
Attachments: 
~b)(S) 
rb)(6); (b)(7)(C) 
20 Mar 2020 15:52:32 +0000 
(b)(6); (b)(7)(C) 
AMAR DOR Report 
AMAR DOR Report.docx 
My apologies for the delay. Attached is the AMAR DOR. There are still a few outstanding items that 
we're waiting for Creative Corrections to provide and I've identified those areas with a comment bubble. 
Creative Corrections is overnighting me their working papers so I should have them soon. 
Regards, 
rb)(6); (b)(7)(C) 
Section Chief 
Office of Professional Responsibility 
Immigration and Customs Enforcement 
950 L'Enfant Plaza, SW 
Washington, DC 20536 
Office: (202) 7 (b)(6); 
Cell: (202) 425- (b)(?)(C) 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 5072 

DHS-ICE-19-0196, 19-0197-Q-000243
Detainee Death Review Report 
Mergensana Dabaevich AMAR 
Date ofDeath: November 18, 2018 
Alien File Number: 216 269 802 
Joint Integrity Case Management System (TICMS) #: 201901489 
March XX, 2020 
U.S. Immigration and Customs Enforcement 
Office of Professional Responsibility 
2019-ICLl-00051 5073 

DHS-ICE-19-0196, 19-0197-Q-000244
TABLE OF CONTENTS 
DETAILS OF REVIEW ............................................................................................................................ 2 
IMMIGRATION AND CRIMINAL HISTORY ...................................................................................... 2 
CHRONOLOGY OF EVENTS .......................................... ....................................................................... 3 
EXHIBITS ................................................................................................................................................. 23 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 507 4 
llPage 

DHS-ICE-19-0196, 19-0197-Q-000245
(b)(5) 
21Page 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5075 

DHS-ICE-19-0196, 19-0197-Q-000246
(b)(5) 
31Page 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5076 

DHS-ICE-19-0196, 19-0197-Q-000247
(b)(5) 
41Page 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5077 

DHS-ICE-19-0196, 19-0197-Q-000248
b)(5) 
/\MEf IC'AI\ 
pVERSIGHT 
SI Page 
2019-ICLl-00051 5078 
' ' ' ' . ' ' . . ' 
. . . 
I 
I 

DHS-ICE-19-0196, 19-0197-Q-000249
r (b)(5) 
61Page 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5079 

DHS-ICE-19-0196, 19-0197-Q-000250
b)(5) 
/\Mlf IC'AI\ 
pVERSIGHT 
71Page 
2019-ICLl-00051 5080 
' ' ' ' ' ' ' 
b)(5) 
I~ 
! 
r-
-

DHS-ICE-19-0196, 19-0197-Q-000251
(b)(5) 
SI Page 
/\M~r 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5081 

DHS-ICE-19-0196, 19-0197-Q-000252
(b)(5) 
91Page 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5082 

DHS-ICE-19-0196, 19-0197-Q-000253
(b)(5) 
lOIPage 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5083 

DHS-ICE-19-0196, 19-0197-Q-000254
(b)(5) 
lllPage 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5084 

DHS-ICE-19-0196, 19-0197-Q-000255
(b)(5) 
12 I P a g e 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5085 

DHS-ICE-19-0196, 19-0197-Q-000256
(b)(5) 
Bl Page 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5086 

DHS-ICE-19-0196, 19-0197-Q-000257
(b)(5) 
14 I P a g e 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5087 

DHS-ICE-19-0196, 19-0197-Q-000258
(b)(5) 
lSIPage 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5088 

DHS-ICE-19-0196, 19-0197-Q-000259
b)(5) 
/\MEf IC'AI\ 
pVERSIGHT 
16 I P a g e 
2019-ICLl-00051 5089 
(b)(5) 
: : I 
''' '' '' 
I 
: 

DHS-ICE-19-0196, 19-0197-Q-000260
(b)(5) 
17 I P a g e 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5090 

DHS-ICE-19-0196, 19-0197-Q-000261
(b)(5) 
181Page 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5091 

DHS-ICE-19-0196, 19-0197-Q-000262
b)(5) 
/\Mlf IC'AI\ 
pVERSIGHT 
19 I P a g e 
2019-ICLl-00051 5092 

DHS-ICE-19-0196, 19-0197-Q-000263
(b)(5) 
20IPage 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5093 

DHS-ICE-19-0196, 19-0197-Q-000264
(b)(5) 
21 I P a g e 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5094 

DHS-ICE-19-0196, 19-0197-Q-000265
(b)(5) 
22 I P a g e 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5095 

DHS-ICE-19-0196, 19-0197-Q-000266
' 
b)(S) 
' 
' 
• (b)(S) 
• 
r)(S) 
/\MERICAi\ 
pVERSIGHT 
23 I P a g e 
2019-ICLl-00051 5096 
r(5) 
!! I 
;; 
!! 
:! 
f! 
:: 
" ii 
!! 
" 
!! 
:: 
" ff 
:: ,, 
:: ,, 
" , , 
,, 
:: , , 
:: ,, 
, , ,, 
:: 
If 
I 
I 

DHS-ICE-19-0196, 19-0197-Q-000267
EXHIBITS 
b)(S) 
/\MERICAi\ 
pVERSIGHT 
24 I P a g e 
2019-ICLl-00051 5097 

DHS-ICE-19-0196, 19-0197-Q-000268
From: l(b)(6); (b)(7)(C) 
Sent: 
To: 
11 Mac 2020 l 3·50·02 *f 000 
l(b)(6); (b)(7)(C) -
Subject: 
Hi (b)(6); 
(b)(7)(C) 
AMAR DOR 
I just uploaded the AMAR death certificate and autopsy to SharePoint so you can include in your report. 
Regards, 
rb)(6); (b)(7)(C) 
Section Chief 
Office of Professional Responsibility 
Immigration and Customs Enforcement 
950 L'Enfant Plaza, SW 
Washington, DC 20536 
Office: (202) 7 ~li~l(c) 
Cell: (202) 425-._____. 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 5098 

DHS-ICE-19-0196, 19-0197-Q-000269
From: 
l(b)(6); (b)(?)(C) 
Sent: 25 Se 2019 13:19:18 +0000 
To: b)(6); (b)(?)(C) 
Subject: 
Hey (b)(6); (b)(?)(C) 
Here's what Creative cited for the AMAR report pertaining to video cameras, not sure if it's the same 
citation asl\~1\~L, 
l. (b)(5) 
It's for-~-------------------------------' 
Regards, 
l(b)(6); (b)(?)(C) 
Acting Section Chief 
External Reviews and Analysis Unit 
Office of Professional Responsibility 
Immigration and Customs Enforcement 
950 L'Enfant Plaza, SW 
Washington, DC 20536 
Office: (202) 7 ~\i~\(C) 
Cell: {202} 425 .___ _ __, 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 5099 

DHS-ICE-19-0196, 19-0197-Q-000270
From: l(b)(6); (b)(7)(C) I 
Sent: 27 Feb 2020 00:08:05 +0000 
To: 
Cc: 
j<b)(6); (b)(7)(C) I 
Subject: AMAR Dental Refusal 
Attachments: AMAR Dental Refusal.pdf 
(b )(6); 
Hey, b 7 c I attached the progress note from the dentist noting the refusal and that AMAR signed a 
refusal form. I can't find the actual signed refusal form either. 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 5100 

DHS-ICE-19-0196, 19-0197-Q-000271
04/2412018 
Af\/r 
pVERSIGHT 
U.S. Immigration 
and Customs 
Enforcement 
AMAR,MERGENSANA A: 216269802 SwlO: 360005614 
Faclity Codo: CSO#/WA tblsing Area: B 
39 Y old Male,~· lD!ZJ/1916 
A<:coont - b )(7)/ El I 1623 E.J STI11:ET, Tl>IXMA, WM18421 
Appoirtmcnt Facility: Northwest Detention Center 
Appointment Provider: Dane L McCturg, DDS 
Reason for Appointment 
1. DEN:sc#15-myfilling broke)<'Slefday 
History of Present IUnoss 
tl!lali!!: Dental (Subjeai1e) 
Location cl Ewlualion Pavent evaluated in dinic 
"'8¥JU c1mendyin pain? No 
Patient Identification: 
Patient ldenbfication 
Patient p,ope~yidentified by2 sources including: Wist Band.ID Badge 
Interpretation J)(O\ided? Yes ~--~ 
lnterpmler Name_ or Number. l(b )(6); 
language RuSS1an · Chaperone Present? Yos 
Dental /!Gsislant"'Kb""')("" 6
-);""'---, 
Vital Signs 
0outof10 
96.8F 
60/min 
1~mmHg 
16/min 
169.61bs 
66.51n 
26.96 lnclex 
Examination 
General Emminatmn: 
Pain scale 
04fl4/2018 06:35:31 M1 
Temo 
04fl4/2018 06:35:31 M1 
~ 
04/24/201806:35:31 M1 
BP 
04fl4/2018 06:35:31 M1 
RR 
04fl4/2018 06:35:31 M1 
WI 
04fl4/2018 06:35:31 M1 
~ 
04/24/2018 06:35:31 M1 
BNI 
04/24/2018 06:35:31 M1 
b)(6); 
b)(7)(C) 
Problem focused e>am, med hxoompleted by patient re\iewed, NKDA Toolh #15 has gross caries e>tending Inl0 nerw, 
missing resloration. Toolh has p,..,;ous RCT. 1 PA taken v.ilh lead apron on palienL and re\i.....oo byJ)(O\ider. Periapical 
radloluoencynoo!d. No signs cl arute dislress or swelling noted. No mobility, dinical CIOY"1 fra<:lured on lingaul due to caries. 
Toolh is non response to <Xlld stimuli. Porrussion and palpation were 'ANL 
Assessments 
Toolh 15-RCT trealed. chrooc apical periodontitis. 
Treatment 
1. Others 
Notes: Discussed findings v,;lh patient. reoommend r..,;s,1 for eiaaaion 15. Pt refused and signed rellsal form because he wants to ha\e endo n~treal J>dlised pt to return to sic:kcall ~ S)fflptomS 'M)f'Sen. Reliewed 0-il. Pt-ert>alillld understanding. 
Procedure Codes 
D0140 LTD CRl'I.. EV/11.UATIOII -PROOI.EMFOCUS 
D0220 INTRl'CR-PERJPPICl'l 1 ALM70300 
D1330 CRl'I.. H'IGIENE INSTRUCTIOIIS 
Appointment Provi{b)( 5); (b)(?)(C) 
Bectronically signefb )(6 ); (b )(?)(C) 
Sign off status: Completed 
~ on 04/24/2018 06:52:00 (Pacific Daylight Timo) 
Northwest Detention Center 
1623 E. J STI1l:ET 
Tl>Cl:AAA. WA98421 
Tel: 253-TT~9 
2019-ICLl-00051 5101 
I 

DHS-ICE-19-0196, 19-0197-Q-000272
l
(b)(6); (b)(?)(C) 
From: _ 
Sent: 28 Feb 2020 21:26:23 +0000 
To: l(b)(6); (b)(7)(C) I 
Subject: AMAR Detainee Death Review Healthcare and Security Compliance Analysis 
FINAL (2) CC Responses to round 1 questions 
Attachments: AMAR Detainee Death Review Healthcare and Security Compliance Analysis 
FINAL (2) CC Responses to round 1 questions.docx 
. (b)(6); 
H1 (b)(?)(C) 
I have a few more questions, I still haven't made it to October. Blah. 
The personal property is going to need to be addressed somehow. I've deleted my questions that I'm 
good with. I kept a few and didn't provide a comment because I still need to review it in depth a bit 
more. 
I'm teleworking Monday through Wednesday next week to knock out this report. 
Regards, 
ect1on 1e 
Office of Professional Responsibility 
Immigration and Customs Enforcement 
950 L'Enfant Plaza, SW 
Washington, DC 20536 
Office: (202) 7 (b)(6); 
Cell: (202) 425 (b)(?)(C) 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 5102 

DHS-ICE-19-0196, 19-0197-Q-000273
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5103 
Page 1 

DHS-ICE-19-0196, 19-0197-Q-000274
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5104 
Page 2 

DHS-ICE-19-0196, 19-0197-Q-000275
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5105 
Page 3 

DHS-ICE-19-0196, 19-0197-Q-000276
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5106 
Page 4 

DHS-ICE-19-0196, 19-0197-Q-000277
(b)(5) 
b)(5) 
(b )(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative ~c•rr cti11s 
/\Mlf IC'AI\ 
pVERSIGHT 
b)(5) 
Page 5 
2019-ICLl-00051 5107 

DHS-ICE-19-0196, 19-0197-Q-000278
~r-)(5_) __________________________ v; ~)(5) 
•' . ',l,.,,.(b..,.,.)(5"'")----------------------------,l.\\ 
~-----------------------------~~ \ 
December 23, 2017 ~\ \ 
l
.,...,..,.,,(b)(5,--) -----'-------------1\\ \ 
b)(5) 
• rb)(5) 
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative ~c•rr cti11s 
/\Mlf IC'AI\ 
pVERSIGHT 
Page 6 
2019-ICLl-00051 5108 
\\\ 
... I I \ 
... 
~ \ \ ,, ' . .. ' 
. '~ \ \ . \ . 
' .. ' . 
~ 
" 
.. . .. . .. \ •' .. 
.. 
. . . .. ' .... ' .. . 
I 
, 
n \ .. .. .. .. 
" " " .. .. .. 
.. .. .. 
\ 

DHS-ICE-19-0196, 19-0197-Q-000279
(b)(5) 
(b)(5) 
_D/\::l/ 
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative ~c•rr cti11s 
/\Mlf IC'AI\ 
pVERSIGHT 
Page 7 
2019-ICLl-00051 5109 
.. :: 
' ' ' ' ' ' " " " " " " " " :: I :: f 
' ' ' '' ,, 
/ ' ' ' 
' ' 
' 
~ '. '. ,, 
b)(5) 
,, 
,, /:'--------------' " ' ' ' ' " " :: " 
" " : 
. 
: 
! 

DHS-ICE-19-0196, 19-0197-Q-000280
b)(5) 
b)(5) 
(b)(5) 
b)(5) 
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative ~c•rr cti11s 
/\Mlf IC'AI\ 
pVERSIGHT 
Page 8 
2019-ICLl-00051 5110 
' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' I ' ' ' ' ' ' ' ' 
r ' ' ' ' ' ' ' ' ' ' ' ' 
(b)(5) 
I .___________ _. 
! 
! 
I 
' ' ' ' ' 
! 

DHS-ICE-19-0196, 19-0197-Q-000281
(b)(5) 
' ' ' ' , 
' 
! 
'' '' '' '' '' '' 
(b)(5) 
::'--------------' 
'' 
, '' ' 
'I' 
, ' I I 
I' 
'' '' 
I '' 0 
'' '' '' '' '' '' 
, '' ' I' '' '' '' 
I 
'r;;(b::-;-),;,(5') -----------========-----------------(! 
August 25, 2018 
(b)(5) 
(b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative ~c•rr cti11s 
/\Mlf IC'AI\ 
pVERSIGHT 
I 
Page 9 
2019-ICLl-00051 5111 

DHS-ICE-19-0196, 19-0197-Q-000282
k \H-.\· /h \I '\I I 
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5112 
D 
Page 10 

DHS-ICE-19-0196, 19-0197-Q-000283
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5113 
Page 11 

DHS-ICE-19-0196, 19-0197-Q-000284
I 
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5114 
u 
Page 12 

DHS-ICE-19-0196, 19-0197-Q-000285
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5115 
Page 13 

DHS-ICE-19-0196, 19-0197-Q-000286
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5116 
Page 14 

DHS-ICE-19-0196, 19-0197-Q-000287
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5117 
Page 15 

DHS-ICE-19-0196, 19-0197-Q-000288
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5118 
Page 16 

DHS-ICE-19-0196, 19-0197-Q-000289
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5119 
Page 17 

DHS-ICE-19-0196, 19-0197-Q-000290
[< 
I 
I 
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5120 
Page 18 

DHS-ICE-19-0196, 19-0197-Q-000291
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5121 
] 
Page 19 

DHS-ICE-19-0196, 19-0197-Q-000292
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5122 
Page 20 

DHS-ICE-19-0196, 19-0197-Q-000293
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5123 
Page 21 

DHS-ICE-19-0196, 19-0197-Q-000294
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5124 
Page 22 

DHS-ICE-19-0196, 19-0197-Q-000295
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5125 
D 
Page 23 

DHS-ICE-19-0196, 19-0197-Q-000296
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5126 
Page 24 

DHS-ICE-19-0196, 19-0197-Q-000297
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5127 
Page 25 

DHS-ICE-19-0196, 19-0197-Q-000298
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5128 
Page 26 

DHS-ICE-19-0196, 19-0197-Q-000299
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5129 
D 
] 
Page 27 

DHS-ICE-19-0196, 19-0197-Q-000300
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
Kb)(6); (b)(7)(C) 
pVERSIGHT 2019-ICLl-00051 5130 
I 
Page 28 

DHS-ICE-19-0196, 19-0197-Q-000301
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5131 
D 
Page 29 

DHS-ICE-19-0196, 19-0197-Q-000302
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5132 
D 
Page 30 

DHS-ICE-19-0196, 19-0197-Q-000303
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5133 
Page 31 

DHS-ICE-19-0196, 19-0197-Q-000304
l/b\/6\ /b\/7\/C\ 
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
I 
pVERSIGHT 2019-ICLl-00051 5134 
D 
D 
Page 32 

DHS-ICE-19-0196, 19-0197-Q-000305
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5135 
Page 33 

DHS-ICE-19-0196, 19-0197-Q-000306
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5136 
Page 34 

DHS-ICE-19-0196, 19-0197-Q-000307
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5137 
D 
Page 35 

DHS-ICE-19-0196, 19-0197-Q-000308
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5138 
Page 36 

DHS-ICE-19-0196, 19-0197-Q-000309
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5139 
D 
Page 37 

DHS-ICE-19-0196, 19-0197-Q-000310
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5140 
Page 38 

DHS-ICE-19-0196, 19-0197-Q-000311
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5141 
Page 39 

DHS-ICE-19-0196, 19-0197-Q-000312
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5142 
Page 40 

DHS-ICE-19-0196, 19-0197-Q-000313
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5143 
D 
D 
Page 41 

DHS-ICE-19-0196, 19-0197-Q-000314
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5144 
Page 42 

DHS-ICE-19-0196, 19-0197-Q-000315
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5145 
Page 43 

DHS-ICE-19-0196, 19-0197-Q-000316
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5146 
Page 44 

DHS-ICE-19-0196, 19-0197-Q-000317
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5147 
Page 45 

DHS-ICE-19-0196, 19-0197-Q-000318
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5148 
Page 46 

DHS-ICE-19-0196, 19-0197-Q-000319
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5149 
Page 47 

DHS-ICE-19-0196, 19-0197-Q-000320
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5150 
Page 48 

DHS-ICE-19-0196, 19-0197-Q-000321
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5151 
Page 49 

DHS-ICE-19-0196, 19-0197-Q-000322
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5152 
Page 50 

DHS-ICE-19-0196, 19-0197-Q-000323
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5153 
Page 51 

DHS-ICE-19-0196, 19-0197-Q-000324
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5154 
Page 52 

DHS-ICE-19-0196, 19-0197-Q-000325
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5155 
Page 53 

DHS-ICE-19-0196, 19-0197-Q-000326
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5156 
Page 54 

DHS-ICE-19-0196, 19-0197-Q-000327
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5157 
Page 55 

DHS-ICE-19-0196, 19-0197-Q-000328
From: 
Sent: 
To: 
Subject: 
FINAL (2) 
Attachments: 
FINAL (2).docx 
(b)(6); 
fh\17\fr\ 
26 Feb 2020 21:58:51 +0000 
fb)(6); (b)(?)(C) I 
AMAR Detainee Death Review Healthcare and Security Compliance Analysis 
AMAR Detainee Death Review Healthcare and Security Compliance Analysis 
I was really trying to get to October, but I failed. G 
Either way, seems like the security and medical comments/questions are neck and neck. We'll see how 
the rest of the week turns out. 
Regards, 
(b)(6); (b)(?)(C) 
ec 10n 1e 
Office of Professional Responsibility 
Immigration and Customs Enforcement 
950 L'Enfant Plaza, SW 
Washington, DC 20536 
Office: (202) 73 b)(6); 
Cell: (202) 425- b)(?)(C) 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 5158 

DHS-ICE-19-0196, 19-0197-Q-000329
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5159 
Page 1 

DHS-ICE-19-0196, 19-0197-Q-000330
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5160 
Page 2 

DHS-ICE-19-0196, 19-0197-Q-000331
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5161 
Page 3 

DHS-ICE-19-0196, 19-0197-Q-000332
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5162 
Page 4 

DHS-ICE-19-0196, 19-0197-Q-000333
(b)(5) 
(b)(5) 
(b)(5) 
rb)(5) 
(b)(5) 
(b )(5) 
b)(5) 
(b)(S) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative ~c•rr cti11s 
/\Mlf IC'AI\ 
pVERSIGHT 2019-ICLl-00051 5163 
/ (b}(5} 
' ' ' ' ' ' ' 
' ' 
i 
'' : : 
I J 
' ' 
'I 
I i ,.___________ ___, 
I 
' ' ' ' ' 
I 
' 
I / 
I 
Page 5 

DHS-ICE-19-0196, 19-0197-Q-000334
r 
'--------,.,0- .... •------------------------------------------------------------------------------------------------------------------_- _________________ ....,...._ 
v￾b)(5) 
(b )(5) 
l(b)(5) 
1~)(5) 
(b )(5) 
(b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative ~c•rr cti11s 
/\Mlf IC'AI\ 
pVERSIGHT 
Page 6 
2019-ICLl-00051 5164 
, 
, 
, 
, 
' ' ' ' ' ' ' ' ' ' ' ' ' 
, 
, 
' 
' ' , ,,...__________ _, , ' 
' ' ' , ' 
' ' , ' ' , ' ' , ' , ' , ' 
/ 
~ I 

DHS-ICE-19-0196, 19-0197-Q-000335
(b)(5) 
A ...... 1 llllf .... 6'1 0 
b)(5) 
], 
' ' ' ' ' ' ' ' ' ' 
(b)(5) 
i ! 
: :'--------------' 
' ' ,' : 
I i 
: : 
' 
l i 
: : 
: ; 
' : ' 
r~b-)(5_)_1/b-\/-5)---------------------~~ I 
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative ~c•rr cti11s 
/\Mlf IC'AI\ 
pVERSIGHT 
Page 7 
2019-ICLl-00051 5165 

DHS-ICE-19-0196, 19-0197-Q-000336
b)(5) 
, 
, 
, 
, 
, 
, 
, 
, 
'/ 
';::::=l(b)(S=)===========:::::::-'11 
A 22 2018 Ul!USt ' I 
(b )(5) 
(b)(5) 
t I /'--------------' (b)(5) , 
' ' ' ' ' ' ,, 
b)(5) 
b)(5) 
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C reative ~c•rr cti11s 
/\Mlf IC'AI\ 
pVERSIGHT 
,, 
: ' 
Page 8 
2019-ICLl-00051 5166 

DHS-ICE-19-0196, 19-0197-Q-000337
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5167 
Page 9 

DHS-ICE-19-0196, 19-0197-Q-000338
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5168 
D 
D 
Page 10 

DHS-ICE-19-0196, 19-0197-Q-000339
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5169 
Page 11 

DHS-ICE-19-0196, 19-0197-Q-000340
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MEf I( 1\1\i 
pVERSIGHT 2019-ICLl-00051 5170 
l(b)(6); (b)(7)(C) 
D 
D 
Page 12 

DHS-ICE-19-0196, 19-0197-Q-000341
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5171 
Page 13 

DHS-ICE-19-0196, 19-0197-Q-000342
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5172 
Page 14 

DHS-ICE-19-0196, 19-0197-Q-000343
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\Mlf I( 1\1\i 
pVERSIGHT 2019-ICLl-00051 5173 
Page 15 

DHS-ICE-19-0196, 19-0197-Q-000344
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 517 4 
Page 16 

DHS-ICE-19-0196, 19-0197-Q-000345
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5175 
Page 17 

DHS-ICE-19-0196, 19-0197-Q-000346
I 
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5176 
llb\16\· lb\17\IC\ I 
Page 18 

DHS-ICE-19-0196, 19-0197-Q-000347
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5177 
D 
Page 19 

DHS-ICE-19-0196, 19-0197-Q-000348
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5178 
Page 20 

DHS-ICE-19-0196, 19-0197-Q-000349
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5179 
Page 21 

DHS-ICE-19-0196, 19-0197-Q-000350
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
~b)(6); (b)(?)(C) I 
pVERSIGHT 2019-ICLl-00051 5180 
Page 22 

DHS-ICE-19-0196, 19-0197-Q-000351
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5181 
Page 23 

DHS-ICE-19-0196, 19-0197-Q-000352
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5182 
Page 24 

DHS-ICE-19-0196, 19-0197-Q-000353
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5183 
Page 25 

DHS-ICE-19-0196, 19-0197-Q-000354
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5184 
Page 26 

DHS-ICE-19-0196, 19-0197-Q-000355
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5185 
Page 27 

DHS-ICE-19-0196, 19-0197-Q-000356
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5186 
Page 28 

DHS-ICE-19-0196, 19-0197-Q-000357
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5187 
D 
D 
D 
Page 29 

DHS-ICE-19-0196, 19-0197-Q-000358
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5188 
D 
Page 30 

DHS-ICE-19-0196, 19-0197-Q-000359
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5189 
D 
Page 31 

DHS-ICE-19-0196, 19-0197-Q-000360
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5190 
D 
] 
Page 32 

DHS-ICE-19-0196, 19-0197-Q-000361
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5191 
Page 33 

DHS-ICE-19-0196, 19-0197-Q-000362
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5192 
Page 34 

DHS-ICE-19-0196, 19-0197-Q-000363
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5193 
Page 35 

DHS-ICE-19-0196, 19-0197-Q-000364
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5194 
llb\16\· I 
Page 36 

DHS-ICE-19-0196, 19-0197-Q-000365
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5195 
Page 37 

DHS-ICE-19-0196, 19-0197-Q-000366
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5196 
Page 38 

DHS-ICE-19-0196, 19-0197-Q-000367
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5197 
Page 39 

DHS-ICE-19-0196, 19-0197-Q-000368
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5198 
Page 40 

DHS-ICE-19-0196, 19-0197-Q-000369
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5199 
D 
Page 41 

DHS-ICE-19-0196, 19-0197-Q-000370
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5200 
Page 42 

DHS-ICE-19-0196, 19-0197-Q-000371
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5201 
Page 43 

DHS-ICE-19-0196, 19-0197-Q-000372
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5202 
Page 44 

DHS-ICE-19-0196, 19-0197-Q-000373
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5203 
Page 45 

DHS-ICE-19-0196, 19-0197-Q-000374
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5204 
Page 46 

DHS-ICE-19-0196, 19-0197-Q-000375
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5205 
Page 47 

DHS-ICE-19-0196, 19-0197-Q-000376
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5206 
Page 48 

DHS-ICE-19-0196, 19-0197-Q-000377
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5207 
Page 49 

DHS-ICE-19-0196, 19-0197-Q-000378
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5208 
Page 50 

DHS-ICE-19-0196, 19-0197-Q-000379
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5209 
Page 51 

DHS-ICE-19-0196, 19-0197-Q-000380
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5210 
Page 52 

DHS-ICE-19-0196, 19-0197-Q-000381
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5211 
Page 53 

DHS-ICE-19-0196, 19-0197-Q-000382
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5212 
Page 54 

DHS-ICE-19-0196, 19-0197-Q-000383
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5213 
Page 55 

DHS-ICE-19-0196, 19-0197-Q-000384
From: '~(b_)(6_)_; (b)_(7_)(C_) ___ ~ 
Sent: 17 Apr 202015:57:48 +0000 
To: !(b)(6); (b)(7)(C) I 
Subject: AMAR 
Attachments: AMAR Detainee Death Review Healthcare and Security Compliance Analysis 
FINAL Revised 04-17-20.docx 
b)(6); 
b)(7)(C) 
Here is the clean revision. I figured out the August 25 mystery, adding notes (per the format at the 
time) to explain. 
I know you join me in hoping this does it! 
b)(6); 
b)(7)(C) 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 5214 

DHS-ICE-19-0196, 19-0197-Q-000385
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5215 
Page 1 

DHS-ICE-19-0196, 19-0197-Q-000386
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5216 
Page 2 

DHS-ICE-19-0196, 19-0197-Q-000387
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5217 
Page 3 

DHS-ICE-19-0196, 19-0197-Q-000388
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5218 
Page 4 

DHS-ICE-19-0196, 19-0197-Q-000389
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5219 
Page 5 

DHS-ICE-19-0196, 19-0197-Q-000390
I .\// .. ll.-..\1 '\I I 
[ b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5220 
Page 6 

DHS-ICE-19-0196, 19-0197-Q-000391
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5221 
Page 7 

DHS-ICE-19-0196, 19-0197-Q-000392
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5222 
Page 8 

DHS-ICE-19-0196, 19-0197-Q-000393
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5223 
Page 9 

DHS-ICE-19-0196, 19-0197-Q-000394
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5224 
D 
Page 10 

DHS-ICE-19-0196, 19-0197-Q-000395
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5225 
Page 11 

DHS-ICE-19-0196, 19-0197-Q-000396
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5226 
D 
Page 12 

DHS-ICE-19-0196, 19-0197-Q-000397
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5227 
D 
Page 13 

DHS-ICE-19-0196, 19-0197-Q-000398
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5228 
Page 14 

DHS-ICE-19-0196, 19-0197-Q-000399
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5229 
Page 15 

DHS-ICE-19-0196, 19-0197-Q-000400
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5230 
Page 16 

DHS-ICE-19-0196, 19-0197-Q-000401
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5231 
Page 17 

DHS-ICE-19-0196, 19-0197-Q-000402
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5232 
Page 18 

DHS-ICE-19-0196, 19-0197-Q-000403
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5233 
Page 19 

DHS-ICE-19-0196, 19-0197-Q-000404
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
llb\16\· lb\17\IC\ 
pVERSIGHT 2019-ICLl-00051 5234 
I 
Page 20 

DHS-ICE-19-0196, 19-0197-Q-000405
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5235 
~h\/f\\· /h\/7\trl I 
Page 21 

DHS-ICE-19-0196, 19-0197-Q-000406
I 
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5236 
Page 22 

DHS-ICE-19-0196, 19-0197-Q-000407
I 
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5237 
□ 
Page 23 

DHS-ICE-19-0196, 19-0197-Q-000408
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5238 
D 
Page 24 

DHS-ICE-19-0196, 19-0197-Q-000409
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5239 
Page 25 

DHS-ICE-19-0196, 19-0197-Q-000410
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5240 
Page 26 

DHS-ICE-19-0196, 19-0197-Q-000411
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5241 
Page 27 

DHS-ICE-19-0196, 19-0197-Q-000412
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5242 
D 
D 
Page 28 

DHS-ICE-19-0196, 19-0197-Q-000413
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5243 
Kb)(6); (b)(?)(C) I 
Page 29 

DHS-ICE-19-0196, 19-0197-Q-000414
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5244 
] 
D 
D 
Page 30 

DHS-ICE-19-0196, 19-0197-Q-000415
I 
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5245 
D 
Page 31 

DHS-ICE-19-0196, 19-0197-Q-000416
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5246 
D 
Page 32 

DHS-ICE-19-0196, 19-0197-Q-000417
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5247 
Page 33 

DHS-ICE-19-0196, 19-0197-Q-000418
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5248 
Page 34 

DHS-ICE-19-0196, 19-0197-Q-000419
lf1.-. ,u_•,. I 
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5249 
D 
Page 35 

DHS-ICE-19-0196, 19-0197-Q-000420
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5250 
D 
Page 36 

DHS-ICE-19-0196, 19-0197-Q-000421
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5251 
Page 37 

DHS-ICE-19-0196, 19-0197-Q-000422
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5252 
Page 38 

DHS-ICE-19-0196, 19-0197-Q-000423
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5253 
Page 39 

DHS-ICE-19-0196, 19-0197-Q-000424
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5254 
rbl/6) /bl/7\/Cl I 
Page 40 

DHS-ICE-19-0196, 19-0197-Q-000425
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5255 
Page 41 

DHS-ICE-19-0196, 19-0197-Q-000426
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5256 
D 
Page 42 

DHS-ICE-19-0196, 19-0197-Q-000427
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5257 
Page 43 

DHS-ICE-19-0196, 19-0197-Q-000428
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5258 
Page 44 

DHS-ICE-19-0196, 19-0197-Q-000429
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5259 
Page 45 

DHS-ICE-19-0196, 19-0197-Q-000430
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5260 
Page 46 

DHS-ICE-19-0196, 19-0197-Q-000431
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5261 
Page 47 

DHS-ICE-19-0196, 19-0197-Q-000432
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5262 
Page 48 

DHS-ICE-19-0196, 19-0197-Q-000433
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5263 
Page 49 

DHS-ICE-19-0196, 19-0197-Q-000434
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5264 
Page 50 

DHS-ICE-19-0196, 19-0197-Q-000435
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5265 
Page 51 

DHS-ICE-19-0196, 19-0197-Q-000436
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5266 
Page 52 

DHS-ICE-19-0196, 19-0197-Q-000437
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5267 
Page 53 

DHS-ICE-19-0196, 19-0197-Q-000438
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5268 
Page 54 

DHS-ICE-19-0196, 19-0197-Q-000439
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5269 
Page 55 

DHS-ICE-19-0196, 19-0197-Q-000440
b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
C 're:ati,r,e I· -· i:11rii11Jeti1111:s 
/\MERK 1\1\i 
pVERSIGHT 2019-ICLl-00051 5270 
Page 56 

DHS-ICE-19-0196, 19-0197-Q-000441
~Im, ReglonaIDeteD1loa & Support~ . 
. Medleal Intake Packet L:A.LE eoa 1111 
Medleal Transfer Smu.ms1ry 
Departure Date: · . ~ .. \ ~ • ~ -==t￾Seadlng Fadlfi,t San LuJa ~Bl Defent{O?, & Support CaatBt 
1, General laf'onnatton1 
~- for Travel by Orou.ad TtaaspQ~m: ti! Yes □· No . 
. Cleared for Travel by~Trsnsporta1ion: ~ Yes O No . 
~for~ Cmtody=~ioal .. Me4k:al~~ y~ 0 . 
~yes,iypo □ ~~□ .~' .
2. 'I'liltamJipffi 8ldg Tpt(T§T) t PPD: . Date l'laeed Date Read Size In mm: 
=o Date: •N'l:A-· 
Jndetenntnate / Borderlfnl . 
. Symptom Screeplpg nr applleableli 
18 Ibo patlcaibeillg 1reated mr~- No- □ Yes. Date: 1 ~.C>'=f-fl-. SeleotQptiona: . . -. . 
t,J'CloaNclmrgenoraldeteotionpopuladoo · ~ . ~: Positive ~~~ . 
~ot clll!fCd ~genezal cletoadOJ! ~puJation · . Chest x-ray doge wlthl11 w:mu, O Being trealecUbr TB. ··. · · · · · • D · ' • fA- ·· · · • ,;.,;. ~abchodTB CaseMmJ!lpmaritdocumentat1.0J:>, _ ate: JVnc. . m,Screali""'6 
· · · · 0 N~ve. ~na1a1entyitm. . . 
· ~~-fo~~-~- ~(b.:....,,)(6~);...,..;(b~;(?~)(C=·)-~---t->~~-~-W~ . 
ote: Dams l1sied ~must be wilhin.onoyear of 1raDSfcr. ... . ·.. . . . _. . . . --- - ·-·--· .......... -· -· - .. -···. -----•··. -
. . 1------------1 · : Health ~uthorll;y -~~.CC:· . ~ • • . · .. .. . . , . •• .. •. - ♦ -
0Et!19 20fl . ' ' 
·-~It! .. : ., . " ..: ·. .. . 
. · .. ·. ~. -~~~~1D~~:~trilH~Jt11D(ap~rob~ ·. - 1JRGENT · '· • · · · .,_ 
. ' . . . ,: . ; . ,~~-- :_ . . ~:, ,•· . . . :. ' . ... . • ~t~ ~ . •. . ., ~ ~ '., . . - .. . .. , . . .... 
i 
. i 
-! 
·' 
.,_.,. :4..-.: . ·:: .: , :. )j;.'7imk>· .·· .. ~ .. --u11 .• :~ ·_. -~ . . . .. •·_··.;./•-· 
.... ~ ~: \ ...... - ~. •• • • ... ~:'.. • •• •• ••• • • • ~.. ■ • ' ... 
· · .s. Corrent ~~dona: ~As1All:(N(UDO,Doaap,i>IRctfoaa '° layman'• 1erins) · · ·. 
· ·. · .CMcJ;'qff~on&qut,vifforC.:.i,p~ ·: ·:. · _-· •'·• ·' · · · · · ..... . . . .. . . . . . . . ··-·. . .... ..... · .. ::-... ~ 
,__-- . . · /II V /V."""' · . 
. .. . . ./. . . . . ~ ··; .· ·: .. ' . '. . . - ~-;....._- _ _,,..4-....:....._-1---......:...---+------:.---------'--......;...~~-~- .• ·.· ~:· ·.· 
.v. . ... . . . ·••. . ~ . . . . . . . 
. · · · · Last J.rfrst Name . ·· . 
·. ·. AMAR,Mmt~SAN.A ·: ·: .. 
I • •' + 
·m # •. · ··DOA. ·cou ·· ICE/ODs 2162$802 Jl,/J/17. ·: · ·. ·. 
2019-ICLl-00051 5271 
.. •' . .. ,! 
:i 

DHS-ICE-19-0196, 19-0197-Q-000442
6. Bealtheani:roDO\V'!'Upi 
~lm Regloual Detention & Support ca.Jr 
Medleal Intake Paebt 
Mecllca1 Traufer Summary (coat.) 
Recoat(wkhhl6montb8)Teat~--,----------....,C..--------
RBceut (wifhla 6 ~) llosp~•-----=----+--,-----____;_ _____ _ 
Recommondodfutura LabWodc _· ------___,,;....-....,...i~.,----------
PendruiSpeotaity Appointmoat (s~ .... ·------:---r-:=--ir-k-r------'----------
1\ecommended SpeGlalty Appo~t{a):._- -----,---A-fff-f&----------
Raq~ Im~iate~·up:._· ____ -,,,c. _ __,f-lL.--------_.;..--
7. ~Ne~~~~tlGD!._.UU'IS1aD· 
. . . . · An there my medical. dental. or IIUJll1al condldon lbal mlricts the 1enQfh of time the patient can_ bo 011.nvol · . 8tatutl0Yes 0No. Reasoa(a) · 1eagthoftravel1bml: __________ _ 
·Does tho patient havo any l)Jeolal that oacoitlng ataft'Bhould bo aware on D Yes D No· . .1t so. whal? . · · • · . · · 
Equlpment~ t,y. • .Aulhorlt.Y Q Other Bqwpmart owned 1,yO.Mocltca1 Authorlcy □ Other · 
-Patient y,,IJI koop' · llt upon arrival at ~;.t1".ll? DY es D No_ .: ; · • · 
Is theie any med .equipment Nqqfmfto accompali)' 1he )Sltie?t dudllg tmel? D YGi D No 
· ·lfso. what' · · ♦ • ~ • • • ' 
. · ·.Atefl:8Y tprecauti~~during~ 0Yos0No· · · i . . . ~~DH4.td ~~-~fllll:~ . - . . ..... ,~~ -· I . . P1r4'dlUUOD8 .a.eeded·fpr the es,coitlngstaff.. . . . .. . . l 
. ~'~~~~~~~~~~)-~~~~~col~~ ::, ·• : ·1 
: 1·:::::~ ... ~~.~i~~ : . . . . . .; :.· . . . . . . . . . . • ··1·; .i . . . . . ·- .... ·A~. - --~ - -. ,,. :.-· .. ~. 
~°)·• • •• • . . ·_.. ·, . ~ •• - • • __ ,... :' • :-.11 .. : .,:N· ~-- :· . . . :-.. ~.-_.:··':-. 
· 9: ~e ~ ~_ciy: ~i:h cf ~cti~s fyr_~~ ~1~:Medlca1 ~.- :; :.-..~ .. ~_;_: :. . .. :· · ; · · · · · · · . :· ·□ Colll:tJ)unity Rcisourco lamm!ation, ifappllcab!e · : • . -.. 
. . . '. . . . :_:, ~-."~ . --~ :,'. · ........ : \.: ,-:_ :. : :·< .... _.:. ,.~~. ·: : .:_:/ . .. .· ";_ . : .. 
SendbigPapility P~"t o~~~~ ~cal ~i · · , · ' ·· · . . • • • -. • • .,, • • • • • • • ,, • •• • # • • • - - • • •• - • ' ...... •• ~ • 
~;(6i; (~)~;)(~; : ~ .. · .. _.·_:~,o -~~~~oi" .... · · ·, ·· : · · · : ~~ · -
.· '. (b)(6) 0,)(7)(C) : ·-'.~ :_:._. .:::•:: • _. . , . ' 
_ Printe4Namo.&T1tlo.: :. . . . ... .... ·. . . 
.. . . ~.--.--,,------' .. . . ·.-...... 
• : I • •. •• • :,• • •. • .. ;. •• 
-·· . · Lut lint Name · "· ~ ·. ·. · mi# · · ."-DOA Co . . DOB 
Ar✓- f '"4 CJw-. 
pVERSIGHT 2019-ICLl-00051 5272 

DHS-ICE-19-0196, 19-0197-Q-000443
Summary View for AMAR, MERGENSANA Page 1 of 5 
U.S. Immigration 
and Customs 
Enforcement 
AMAR, MERGENSANA 
A: 216269802 SubID: 360005614 
Facility Code: CSCNWW A Housing Area: H 
40 Y old Male DO~· 10,:,, t107° 
Account Nu.:iber~b)(?)(E) I 
1623 E. J STREET, TACOMA, WA-98421 
Appointment Facility: Northwest Detention Center 
10/27/2018 Appointment Provider: 1~(b-)(-
6
)_; (-b-)(?_>_<C_)------~ 
Reason for Appointment 
I. SRA 
History of Present Illness 
Patient Identification: 
Patient Identification 
Patient properly identified by 2 sources including: ID Badge,Picture, Verbally 
Chaperone Present? Yes 
Chaperone Name: GEO Medical Officer, observing directly 
What language do y_ou speak? Russian (b)(6); (b)(7)(C) 
Interpretation provided? Yes. Interpreter Name 
Name Use notesfielq(b)(6); __ I 
Language Russian 
Patient was referred by: medical 
Patient was referred for: found with a long( approx. 6 feet) handmade rope under mattress 
Record review conducted: Yes 
[x] No. [] Yes. -Has the detainee attempted suicide in last 24 hrs? Jf yes, stabilize - consider immediate transport to 
emergency department. 
Record ~eviewed. . . . b)(6); 
Pt. seen for the first time m MHU with h\t71rr, ho did Russian interpretation. He was put on suicide watch on 
10/26/2018 d b 6 . oximately 6-foot long handmade rope that was found under his mattress, potential for suicide. 
He was seen b_ U~7 \;r, sterday who place him on suicide watch. No self-harm behavior noted not suicidal ideation 
expressed per staff. Pt. was very cooperative, pleasant with fair eye contact. He reported good sleep and appetite. He denied 
hallucination, delusions, suicidal or homicidal ideations. When asked about why he made a rope, he replied " I had nothing 
to do". He was reminded that it is unsafe to be making a rope and hiding it under his mattress as it can be stolen by 
someone and can be used for suicide attempt as well as hurting someone. He expressed understanding. Pt. denied hx of 
psychiatric hospitalization, outpatient psychiatric treatment or counseling, drug or alcohol abuse, family hx of mental 
illness. He denied active mental health issues including hx of suicide attempts., depression or psychosis. Plan: I. 
Discontinue suicide watch. I. Place him on mental health observation with q IO minute irregular custody checks. 2. Follow￾up as scheduled. 
Current Medications 
Taking 
• Prenatal Vitamin Fixed Dose Tablet I , KOP: Yes, Drug Source: Pharmacy 
• Fiber 625 MG Tablet I tablet as needed Four times a day, KOP: Yes, Drug Source: Pharmacy 
• Acetaminophen 500 MG Tablet I tablets as needed QID PRN, stop date 12/30/2018, KOP: Yes, Drug Source: In House 
Pharmacy, Notes: Not required for travel 
• Pedialyte - Solution I BID, stop date 01/10/2019, KOP: Yes, Drug Source: In House Pharmacy 
• Fiber 625 MG Tablet 2 tablet as needed BID, stop date 04/15/2019, KOP: Yes, Drug Source: In House Pharmacy, Notes: 
Not required for travel 
• Boost Glucose Control - Liquid I BID, stop date I 1/16/2018, KOP: No, Drug Source: In House Pharmacy, Notes: Not 
required for travel, schedule for am and pm PL 
• Boost VHC - Liquid I along with a cup of water Daily Noon, stop date 11/16/2018, KOP: No, Drug Source: In House 
Pharmacy, Notes: Not required for travel, for the noon PL pass 
• Fiber 625 MG Tablet I tablet as needed QHS, stop date 11/08/2018, KOP: Yes, Drug Sou.rce: In House Pharmacy, Notes: 
~b)(6); (b)(7)(C) Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progress Note:r 
Note generated by eC/inica/Works EMRIPM Software (www.e._C_l_in-ic_a_l~-or_k_s_.c_o_m_) ___ _. 
2019-ICLl-00051 5273 
10/27/2018 
I. 12/3/2018 

DHS-ICE-19-0196, 19-0197-Q-000444
Summary View for AMAR, MERGENSANA Page 2 of 5 
Not required for travel 
• Acetamjnophen 500 MG Tablet I tablets as needed BID, stop date 11/24/2018, KOP: Yes, Drug Source: In House 
Pharmacy, Notes: Not required for travel 
Past Medical History 
Hunger strike 
Allergies 
High calorie boost: diarrhea: Side Effects 
Review of Systems 
Psychiatric: 
Anxiety denies. Auditory/visual hallucinations denies. Delusions denies. Depressed mood denies. Difficulty 
sleeping denies. Homicidal Thoughts denies. Inability to concentrate denies. Loss of appetite denies. Mental or 
Physical abuse denies. Stressors Immigration legal problems . Substance abuse denies. Suicidal thoughts denies. 
Examination 
Mental Health Evaluation: 
Suicide Risk Assessment 
Who referred patient? Medical Staff 
What led to referral and other Pertinent Information? Pt. was found with long handmade rope under mattress 
What was the concern/complaint that led to the refenal? Pt. was found with long handmade rope under mattress 
Is the referral information correct? Yes 
In the recent past, have you had thoughts of suicide? No 
Do you have cunent thoughts about killing yourself? No 
Do you have a desire and/or intent to die? No 
Do you have a plan to kill yourself? No 
Were other concerns expressed? No 
Impact of any pertinent physical conditions on mental health? No 
Is there anything that could keep you from harming yourself (family, etc) Yes 
Is there something that would change your plan? Has wife and 2 daughters ages 8 and JO 
Do you now or have you ever heal·d voices that other people don't hea.1·? No 
Do you now or have you ever felt others were trying to harm you for no logical or apparent reason? No 
Have you ever tried to kill yourself? No 
Have you ever been diagnosed with a mental illness or have you ever been hospitalized for psychiatric reasons? No 
Has any member of your family died in the last 3-5 years? No 
Has any member of your family or close friends killed themselves? No 
Detainee is currently: Married 
Does detainee have children? Yes 
Describe relationship(s) good 
Do you have outside support from family, friends, or religious groups? Yes 
Do you have a history of Alcohol or Substance Abuse/Dependence? No 
Do you drink alcohol? No 
Have you ever been convicted for driving under the influence of alcohol? No 
Ls detainee currently housed in Segregation or Isolation? Yes 
Is detainee currently intoxicated or in withdrawal from a substance? No 
Has detainee experienced any significant loss recently? No 
Do you have feelings of general hopelessness? No 
Are you currently in pain or do you have any medical issues that are not being addressed? No 
Will you engage or continue your mental health treatment here? N/A 
Do you have plans for you future? Yes 
Do you find support and hope through your religious customs/rituals? Not asked 
How hopeful are you on a scale of 0 - 10 (0=no hope and IO=fully expect positive resolution of problems) that you will 
resolve provlems associated with your current situation? Denied hopelessness 
Has psychotropic medication been helpful to you now or in the past in managing how you feel and deal with 
situations? N/A 
How long have you been in the US? 1 year 
Describe your work history Not asked 
r
b)(6); (b)(7)(C) 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progress Note: 10/27/2018 
Note generated by eC/inica/Works EMRIPM Software (www.------------~ 
/\MEf IC'AI\ 
P\LERSIGHT 
rb)(?)(E) 2019-ICLl-00051 5274 
12/3/2018 

DHS-ICE-19-0196, 19-0197-Q-000445
Summary View for AMAR, MERGENSANA 
Do you have any difficulty learning new things? No 
Do you have legal support for your current situation? Not asked 
Have you been involved in the work program? No 
Page 3 of 5 
Risk for Suicide: Low Risk: Mental Health Observation WITH 15 minute irregular custody checks Deemed Least 
restrictive environment given rish/protectivefactors assessed. 
Patient will be scheduled for follow-up with mental health provider: Tomorrow 
Risk Factors (Initial) 
I. Current thoughts of suicide: absent 
2. Current suicidal intent: absent 
3. Current suicidal plan: absent 
4. Feelings of hopelessness/ helplessness: absent 
5. Feeling like a burden to others: absent 
6. Fear for own safety: absent 
7. Recent significant loss: absent 
8. Social isolation: no 
9. Current physical pain: 0/10 
10. Sleep problems: absent 
11. Agitation (e.g., restlessness, irritability, anxious, increased psychomotor activity, etc): absent 
12. CuJTent Intoxication or in withdrawal from a substance: absent 
13. Adjustment to ICE detention (adequate/inadequate): present 
Describe: Adjustement to ICE detention is reported to be adequate 
14. Problem solving deficits (e.g., rash decision making, inadequate strategies to get needs met, impulsivity, etc.): 
absent 
15. Uncontrolled mental health symptoms: absent 
16. Non-compliance with mental health treatment: absent 
17. Chronic medical condition: absent 
18. History of self-injury or suicidal behavior: absent 
19. Family history of suicide: absent 
20. History of violent behavior: absent 
21. History of mental illness: absent 
22. History of inpatient psychiatric hospitalizations: absent 
23. History of childhood abuse (physical/sexual): absent 
Protective Factors 
25. Able to identify reasons for living: present 
26. Denial of suicidal ideations: present 
27. Fear of death: present 
28. Future orientation (e.g., plans for the future, etc.): present 
29. Adequate problem solving skills: present 
30. Religious beliefs against suicide: n/a 
31. Social support in detention center: n/a 
32. Supportive family relationships: present 
33. Willingness to engage in mental health treatment: n/a 
Protective Factors Comments: has wife and 2 daughters ages 8 and JO 
---OTHER RISK FACTORS: 
[x] No. []Yes.Do you have communication/stigma barriers to seeking MH care and alerting Custody of MH emergency 
in future? 
[] No. [x] Yes. Is detainee a male? (statistical risk factor) 
[x] No. []Yes.Are you single? (statistical risk factor) 
[ x] No. []Yes.Alcohol or Substance Use Disorder Hx 
[ x] No. []Yes.History oflmpairment in learning/ Special Education 
---OTHER PROTECTIVE FACTORS: 
[] No. [] Yes. Will you engage or continue your mental health treatment here? NI A 
[] No. []Yes.Do you find support and hope through your religious customs/rituals? NI A 
[] No. [x] Yes. Do you believe it is okay to ask for mental health and medical help? 
[] No. [x] Yes. Do you know how to access to clinical care for mental health and physical needs? 
[] No. [x] Yes. Do you know how to access to support services: Medical, ICE consultation, attorney consultation, Law 
Library? 
[] No. [x] Yes. Do you have children (statistical protective factor)? 
[] No. [x] Yes. Are you in a supportive marriage (statistical protective factor)? 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progress Note: (b)(5); (b)(?)(C) 10/27/2018 
Note generated by eC/inica/Works EMRIPM Software (www.""er,r,m""'1"'ca=rr.o"'r"'s"".-:::co"'"m;,;:;-,--------' 
/\r-. 
p~~~~T-&-----------------, - 2019-ICLl-00051 5275 I .. 12/3/2018 

DHS-ICE-19-0196, 19-0197-Q-000446
Summary View for AMAR, MERGENSANA Page 4 of 5 
[] No. [x] Yes. Do you feel hopeful you can work to resolve your problems/stressors? 
[] No. [] Yes. [x] NI A Has psychotropic medication been helpful to you now or in the past in managing mood, coping, 
etc? 
[] No. [ x] Yes. Do you normally get along well with your dormitory-mates 
[] No. [x] Yes. Do you normally feel safe in your dormitory? 
[] No. [x] Yes. Do you normally have an active daily routine in this facility? 
[x] No. []Yes.Do you normally have a voluntary job in this facility. 
Mental Status: 
APPEARANCE: adequately-groomed, well-nourished, dressed in clean suicide prevention smock . 
RELATEDNESS: friendly. 
ATTITUDE: cooperative. 
SPEECH/LANGUAGE: normal rate, rhythm, volume .. 
AFFECT: appropriate, full range. 
THOUGHT PROCESS: linear and goal directed . 
THOUGHT CONTENT: no delusional content . 
PERCEPTUAL DISORDERS: no perceptual disorder noted. 
PSYCHOMOTOR ACTIVITY: within normal range. 
KNOWLEDGE - INTELLECTUAL FUNCTION: No obvious impairment. 
DEGREE OF AWARENESS: within normal limits. 
ORIENTATION: person, place, time. 
CURRENT SUICIDAL POTENTIAL: low acute Si risk. 
CURRENT HOMICIDAL POTENTIAL: no to low acute risk. 
Assessments 
No Diagnosis. 
Preventive Medicine 
Due to the unpredictable nature of the immigration process including length of detention stay, the purpose of psychological 
intervention will be the stabilization of presenting symptoms, acute crisis intervention, and brief supportive/solution￾focused psychotherapy. Discussed following Plan with pt to address Mental Health (MH) issues. 
-Pt verbalized agreement with Plan: 
[x] No. [] Yes. Psychiatric Hospitalization required. Transported to Emergency Department for further evaluation 
[ x] No. [] Yes. Begin/ Continue Suicide Watch Prevention: I: I Watch deemed least restrictive environment given risks. 
[] No. [x] Yes. Begin Mental Health Observation with 10 IRREGULAR custody checks (See Special Needs for more Info) 
[x] No. [] Yes. Detainee released back to dormitory 
[ x] No. [] Yes. I.ssue 24 Hr Access Card with Special Needs to POD Officer and detainee 
[] No. [x] Yes. Low bunk, Low Tier Special Needs Issued. 
[] No. [x] Yes. Follow-up with me in [ I] days, [] I week after discharge, [] I mo after discharge, [] 2 mo after discharge 
[] No. [x] Yes. Psychiatry Referral 
[] No. [] Yes. Do not engage in any self-harm behavior; Continue to focus on short/long term goals, reasons for living, why 
suicide is against pt's belief system, resilient problem-solving skills - all to aid in reducing risk of suicide and ultimately to 
achieve pro-social, pro-individual / family goals. 
[] No. []Yes.] I.fat ANY time pt has any thought, intent or plan of suicide, pt must alert custody officer for emergent access 
to medical for further evaluation/tx. Pt agreed and denied communication and stigma barriers to alerting staff for 
emergencies. 
[] No. [ x] Yes. Engage Medical Sick Call process if symptoms worsen before next session and are NOT of an emergent 
nature 
[ x] No. []Yes.ROI for previous records 
[] No. [x] Yes. Tele Encounter to Medical Provider 
[x] No. [] Yes Referral to Chaplain 
[ x] No. []Yes.Engage in Sleep Hygiene Skills - Psychoeducation given, Handout provided in: English/ Spanish 
[ x] No. []Yes.Begin Breathing, Visualization, Progressive Muscle Relaxation Skills to aid mood/coping. Psychoeducation 
given, fnstruction handout provided in English/ Spanish/ Other 
[] No. [x] Yes. Seek out NWIRP, ICE, Law Library, and Detainee Handbook to aid in proactive problem-resolution to aid in 
coping 
[] No. [x] Yes. Utilize Jail Mail system (or paper kite process) to access facility support, resources, and other services - to 
r
b)(6); (b)(?)(C) ~ 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 Progress Note: R----------~ /27/2018 
Note generated by eC/inica/Works EMRIPM Software (www.eC_ . 
/\MEf IC'AI\ 
pVERSIGHT 
j(b)(?)(E) 
2019-ICI I-QQQ51 5276 
12/3/2018 

DHS-ICE-19-0196, 19-0197-Q-000447
I\ 
p 
Summary View for AMAR, MERGENSANA Page 5 of 5 
further proactive problem solving and healthy coping 
[] No. [ x] Yes. Begin/Continue daily routine: exercise, socialization, religious customs/rituals, pleasurable activities to aid 
in coping 
[] No. [x] Yes. Begin/Continue attention to hygiene: shower, teeth, grooming to aid in coping 
[] No. [x ] Yes. Begin/Continue eating/hydrating at each meal to further physical/mental health. 
[] No. [ x] Yes. Consider voluntary work program to aid in coping/mood mgt 
[ x] No. [] Yes. Engage in Stress Mgt Skills; Psychoeducation given, Instruction handout provided in English/ Spanish 
POST SESSION: Updated HSA, AHSAs, CD, MH Team, MHU Lead RN and GEO Staff on assessment and Plan. 
l
(b)(6); (b)(7)(C) 
Appointment Provider~-------------' 
rm 
r
b)(6); (b)(7)(C) I 
Electronically signed b._ _________ .... on 10/27/201810:46:12 (Pacific Daylight Time) 
Sign off status: Completed 
Northwest Detention Center 
1623 E. J STREET 
TACOMA, WA 98421 
Tel: 253-779-6049 
Fax: 
Patient: AMAR, MERGENSANA DOB: 10/23/1978 l
(b)(6); (b)(7)(C) I 
Progress Note:~- __________ _.10/27/2018 
Note generated by eC/inica/Works EMR/PM Software (www.eClinicalWorks.com) 
2019-ICLl-00051 5277 
I. 12/3/2018 

DHS-ICE-19-0196, 19-0197-Q-000448
From: 
rb)(6); (b)(7)(C) 
Sent: 
To: 
Cc: 
Subject: ~ICb_)CS_) ---~lis inviting you to collaborate on External Reviews & 
Analysis Unit 
Hello AFO CbJC6
J; CbJC?JccJ 
Please let me know if you have any issues accessing this library. There 
should be a folder titled AMAR DDR within which the documents should 
be uploaded. If you need access for other ERO employees, feel free to 
reach out to me directly. 
r)(6); (b)(7)(C) 
Go to External Reviews & Analysis Unit 
Follow this site to get updates in your newsfeed. 
$ Get the SharePoint mobile app! 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 5278 
'"' • CJ 

DHS-ICE-19-0196, 19-0197-Q-000449
From: 
rb)(6); (b)(7)(C) 
1 
Sent: 12 Dec 2018 09:26:14 -0800 
To: 
Cc: 
l(b)(6); (b)(7)(C) I 
Subject: l(b)(6); (b)(7)(C) Js inviting you to collaborate on External Reviews & 
Analysis Unit 
Here's the site that f._b>_<
6
_>; <_b>_<
7
_><c_> ___ _.lhared with you. 
Go to External Reviews & Analysis Unit 
Follow this site to get updates in your newsfeed. 
lJp Get the SharePoint mobile app! 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 5279 
'"' . a 

DHS-ICE-19-0196, 19-0197-Q-000450
From: l(b)(6); (b)(7)(C) 
Sent: 27 Nov 2018 19:28:16 +0000 
To: 
Cc: 
Subject: 
l(b}(6); (b)(7)(C) I 
Detainee Death Review - Mergensana AMAR 
Good afternoon, 
My office will be conducting a review of the death of detainee Mergensana AMAR, who died on 
November 24, 2017, at the St. Joseph's Hospital in Tacoma, WA. Our review will include an onsite visit 
at NWDC during which we'll interview security and medical staff who had contact with or knowledge of 
the detainee, as well as tour the areas of the facility where the detainee was held. I'd like to tentatively 
plan the onsite review for January 8-10, 2019 - can you please let me know if those dates work for your 
field office and the facility? Within the next week, I'll assign a team lead for the review who will send 
you a data request and provide instructions for uploading responsive records to our Sharepoint site. If 
you have any questions before then, please don't hesitate to reach out to me. 
Thank you in advance for your assistance. 
(b)(6); (b)(7)(C) nit Chief 
ICE O bee o Professional Responsibility 
External Reviews and Analysis Unit 
Office - (202) 732- (b)(6); 
Mobile - (202) 90 ~1<7)( 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 5280 

DHS-ICE-19-0196, 19-0197-Q-000451
From: l(b)(6); (b)(7)(C) I 
Sent: 7 May 2020 22:46:21 +0000 
To: Lucero, Enrique M;Johnson, Tae D;Davis, Mike P;Fenton, Jennifer M;Loiacono, 
Adam V b)(6); (b)(7)(C) (b)(6); (b)(7)(C) adilla, Kenneth;Pavlik-Keenan, Catrina M;kb)(6): I 
b)(6); (b)(7)(C) 
b)(6); (b)(7)(C) 
b)(6); (b)(7)(C) 
Cc: (b)(6); (b)(7)(C) 
b)(6); (b)(7)(C) 
Subject: Detainee Death Review - Mergensana Dabaevich AMAR 
Good evening, 
The ICE Office of Professional Responsibility, External Reviews and Analysis Unit, has completed the 
Detainee Death Review for Mergensana Dabaevich AMAR. AMAR, who was in U.S. ICE custody at the 
Northwest Detention Center in Tacoma, Washington, was pronounced dead on November 18, 2018. 
AMAR's cause of death was anoxic encephalopathy due to hanging. 
The memorandum announcing completion of the review, the final report, and the exhibits can be found 
HERE. 
If you have any questions or wish to further discuss the findings, please contact me. 
l(b)(6); (b)(7)(C) 
Unit Chief 
External Reviews and Analysis Unit 
Office of Professional Responsibility 
Immigration and Customs Enforcement 
(O) 202-732(b)(6); I (C) 202-42 (b)(6); 
/h\/7\tr'\ 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 5281 

DHS-ICE-19-0196, 19-0197-Q-000452
From: 
Sent: 
To: 
Cc: 
Subject: 
l(b)(6); (b)(?)(C) 
rb)(6). (b)(?)(C) 
1 
12 Mar 2020 22:37:35 +0000 
tb)(6); (b)(?)(C) 
FW: AMAR 
A h
. .1 
(b)(6); 
s st~~'-t 1s ema1 '""7"r' , I meant to copy you. I'm at a loss as to what to do to but am in touch 
with bout it. 
(b )(6); 
(b )(7)( 
From:fb)(6); (b)(?)(C) 
Sent: Thursday, March 12, 2020 6:30 PM 
To!(b)(6); (b)(?)(C) 
Subject: AMAR 
(b)(6); (b)(?)(C); (b)(S) 
b)(6); 
h\/7\lr'.\ 
~e.dhs.gov> 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 5282 

DHS-ICE-19-0196, 19-0197-Q-000453
From: 
Sent: 
To: 
Cc: 
Subject: 
Attachments: 
Hey￾fb)(6); (b)(7)(C) I 
5 Jul 2019 17:46:59 +0000 
b)(6); (b)(7)(C) 
FW: AMAR 
AMAR Mergensana Report - V4.docx 
With ~\)~\ir. eparture, can you take a look at this report? Let me know if you are missing any 
documents; (b)(~);__ eceived a file of loose papers and I might need to scan some in for you. 
l(b)(6); (b)(7)(C) 
(Acting) Unit Chief 
ERAU - OP ._-....L>.J.._ 
(OJ 202-732 ~)(~)tr (CJ 202-42 ~)(~lir. 
From (b)(6); (b)(7)(C) 
Sent: n 
To~)( ; ( 
Su ject: FW: AMAR 
:52AM 
FYI just in case this doesn't become mine 
Frol(b)(6); (b)(7)(C) 
Sent: Friday, July 5, 2019 11:30 AM 
~ice.dhs.gov> 
To:l(b)(6); (b)(7)(C) pice.dhs.gov> 
Subject: AMAR 
Sir: 
Made it to 27OCT18, highlighted portions are yet to be reviewed/shortened. I will have my ICE phone so 
feel free to email/call if needed. Good luck in ERAU, stay frosty! 
V/r, 
b)(6); (b)(7)(C) 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 5283 

DHS-ICE-19-0196, 19-0197-Q-000454
Detainee Death Review Report 
Mergensana AMAR 
Date of Death: December 19, 2017 
Alien File Number: 216 269 802 
Joint Integrity Case Management System (nCMS) #: 201901489 
May 23, 2019 
U.S. Immigration and Customs Enforcement 
Office of Professional Responsibility 
2019-ICLl-00051 5284 

DHS-ICE-19-0196, 19-0197-Q-000455
CONTENTS 
EXECUTIVE SUMMARY & FINDINGS ................................................................................................ 2 
DETAILS OF REVIEW ............................................................................................................................ 9 
IMMIGRATION AND CRIMINAL IIISTORY ...................................................................................... 9 
FACILITY INFORMATION .................................................................................................................. 11 
CHRONOLOGY OF EVENTS ............................................................................................................... 11 
APPENDIX ............................................................................................................................................... 33 
Table One ............................................................................................................................................... 33 
Table T,vo .............................................................................................................................................. 36 
EXHIBITS ................................................................................................................................................. 39 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 5285 
llPage 

DHS-ICE-19-0196, 19-0197-Q-000456
(EXECUTIVE SUMMARY & FINDINGS )__ ___________________________________ //lb)(S) 
b)(S) 
~------~ 
/\MEf IC'AI\ 
pVERSIGHT 2019-ICLl-00051 5286 
21Page 

DHS-ICE-19-0196, 19-0197-Q-000457
b)(5) 
/\MERICAi\ 
pVERSIGHT 
31Page 
2019-ICLl-00051 5287 

DHS-ICE-19-0196, 19-0197-Q-000458
(b)(5) 
(b)(5) 
b)(5) 
/\Mlf IC'AI\ 
pVERSIGHT 
41Page 
2019-ICLl-00051 5288 
' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' 
f"'' 

DHS-ICE-19-0196, 19-0197-Q-000459
(b)(5) 
SI Page 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5289 

DHS-ICE-19-0196, 19-0197-Q-000460
(b)(5) 
61Page 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5290 

DHS-ICE-19-0196, 19-0197-Q-000461
(b)(5) 
71Page 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5291 

DHS-ICE-19-0196, 19-0197-Q-000462
(b)(5) 
SI Page 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5292 

DHS-ICE-19-0196, 19-0197-Q-000463
(b)(5) 
91Page 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5293 

DHS-ICE-19-0196, 19-0197-Q-000464
(b)(5) 
lOIPage 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5294 

DHS-ICE-19-0196, 19-0197-Q-000465
(b)(5) 
lllPage 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5295 

DHS-ICE-19-0196, 19-0197-Q-000466
(b)(5) 
12 I P a g e 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5296 

DHS-ICE-19-0196, 19-0197-Q-000467
(b)(5) 
Bl Page 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5297 

DHS-ICE-19-0196, 19-0197-Q-000468
(b)(5) 
14 I P a g e 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5298 

DHS-ICE-19-0196, 19-0197-Q-000469
October 26, 2018 
b)(S) 
(ti,\,.,, 
(b)(S) 
/\Mlf IC'AI\ 
pVERSIGHT 
15 I P a g e 
2019-ICLl-00051 5299 
(b)(S) 
' ' ! 
' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' 
~ 

DHS-ICE-19-0196, 19-0197-Q-000470
(b)(5); WIF Draft 
b)(5) 
/\MERICAi\ 
pVERSIGHT 
16 I P a g e 
2019-ICLl-00051 5300 

DHS-ICE-19-0196, 19-0197-Q-000471
b)(6); (b)(7)(C); WIF Draft 
b)(S) 
/\MERICAi\ 
pVERSIGHT 
17 I P a g e 
2019-ICLl-00051 5301 

DHS-ICE-19-0196, 19-0197-Q-000472
!WIF Draft; (b)(5) 
/\MERICAi\ 
pVERSIGHT 
181Page 
2019-ICLl-00051 5302 

DHS-ICE-19-0196, 19-0197-Q-000473
(b)(5); WIF Draft 
(b)(5) 
/\Mlf IC'AI\ 
pVERSIGHT 
191Page 
2019-ICLl-00051 5303 

DHS-ICE-19-0196, 19-0197-Q-000474
r,NIF Draft; (b)(5) 
1~)(5) 
/\MERICAi\ 
pVERSIGHT 
20IPage 
2019-ICLl-00051 5304 

DHS-ICE-19-0196, 19-0197-Q-000475
(b)(5); WIF Draft 
1~)(5) 
/\MERICAi\ 
pVERSIGHT 
21 I P a g e 
2019-ICLl-00051 5305 

DHS-ICE-19-0196, 19-0197-Q-000476
WI F Ora ft; (b )(5) 
b)(5) 
/\Mlf IC'AI\ 
pVERSIGHT 
p 
22 I P a g e 
2019-ICLl-00051 5306 

DHS-ICE-19-0196, 19-0197-Q-000477
(b)(5); WIF Draft 
(b)(5) 
/\Mlf IC'AI\ 
pVERSIGHT 
231Page 
2019-ICLl-00051 5307 

DHS-ICE-19-0196, 19-0197-Q-000478
WIF Draft; (b)(5) 
November 16, 2018 November 23, 2018 
(b)(S) 
b)(5) 
/\Mlf IC'AI\ 
pVERSIGHT 
(b )(5) 
24 I P a g e 
2019-ICLl-00051 5308 

DHS-ICE-19-0196, 19-0197-Q-000479
(b)(5) 
251Page 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5309 

DHS-ICE-19-0196, 19-0197-Q-000480
(b)(5) 
26 I P a g e 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5310 

DHS-ICE-19-0196, 19-0197-Q-000481
(b)(5) 
27 I P a g e 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5311 

DHS-ICE-19-0196, 19-0197-Q-000482
(b)(5) 
281Page 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5312 

DHS-ICE-19-0196, 19-0197-Q-000483
(b)(5) 
291Page 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5313 

DHS-ICE-19-0196, 19-0197-Q-000484
(b)(5) 
30IPage 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5314 

DHS-ICE-19-0196, 19-0197-Q-000485
(b)(5) 
31 I P a g e 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5315 

DHS-ICE-19-0196, 19-0197-Q-000486
From: 
Sent: 
l(b)(6), (b)(?)(C) I 
5 Jul 2019 15:52:07 +0000 
To: !(b)(6); (b)(?)(C) ! 
Subject: FW: AMAR 
Attachments: AMAR Mergensana Report - V4.docx 
FYI just in case this doesn't become mine 
l
(b )(6); (b )(?)(C) 
From:. , 
Sent: Friday, July 5, 2019 11:30 AM 
To: j(b)(6); (b)(?)(C) ~ice.dhs.gov> 
Subject: AMAR 
Sir: 
Made it to 27OCT18, highlighted portions are yet to be reviewed/shortened. I will have my ICE phone so 
feel free to email/call if needed. Good luck in ERAU, stay frosty! 
V/r, 
l(b)(6); (b)(?)(C) 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 5316 

DHS-ICE-19-0196, 19-0197-Q-000487
Detainee Death Review Report 
Mergensana AMAR 
Date of Death: December 19, 2017 
Alien File Number: 216 269 802 
Joint Integrity Case Management System (nCMS) #: 201901489 
May 23, 2019 
U.S. Immigration and Customs Enforcement 
Office of Professional Responsibility 
2019-ICLl-00051 5317 

DHS-ICE-19-0196, 19-0197-Q-000488
CONTENTS 
EXECUTIVE SUMMARY & FINDINGS ................................................................................................ 2 
DETAILS OF REVIEW ............................................................................................................................ 9 
IMMIGRATION AND CRIMINAL IIISTORY ...................................................................................... 9 
FACILITY INFORMATION .................................................................................................................. 11 
CHRONOLOGY OF EVENTS ............................................................................................................... 11 
APPENDIX ............................................................................................................................................... 33 
Table One ............................................................................................................................................... 33 
Table T,vo .............................................................................................................................................. 36 
EXHIBITS ................................................................................................................................................. 39 
/\MERICAi\ 
pVERSIGHT 2019-ICLl-00051 5318 
llPage 

DHS-ICE-19-0196, 19-0197-Q-000489
(EXECUTIVE SUMMARY & FINDINGS )__ __________________________________ //l(b)(S) 
b)(5) ~- ------~ 
/\MEf IC'AI\ 
pVERSIGHT 2019-ICLl-00051 5319 
21Page 

DHS-ICE-19-0196, 19-0197-Q-000490
(b)(5) 
31Page 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5320 

DHS-ICE-19-0196, 19-0197-Q-000491
b)(S) 
(b)(S) 
(b)(S) 
/\MEf IC'AI\ 
pVERSIGHT 
41Page 
2019-ICLl-00051 5321 
' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' 

DHS-ICE-19-0196, 19-0197-Q-000492
(b)(5) 
SI Page 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5322 

DHS-ICE-19-0196, 19-0197-Q-000493
(b)(5) 
61Page 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5323 

DHS-ICE-19-0196, 19-0197-Q-000494
(b)(5) 
71Page 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5324 

DHS-ICE-19-0196, 19-0197-Q-000495
(b)(5) 
SI Page 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5325 

DHS-ICE-19-0196, 19-0197-Q-000496
(b)(5) 
91Page 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5326 

DHS-ICE-19-0196, 19-0197-Q-000497
(b)(5) 
lOIPage 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5327 

DHS-ICE-19-0196, 19-0197-Q-000498
(b)(5) 
lllPage 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5328 

DHS-ICE-19-0196, 19-0197-Q-000499
(b)(5) 
12 I P a g e 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5329 

DHS-ICE-19-0196, 19-0197-Q-000500
(b)(5) 
Bl Page 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5330 

DHS-ICE-19-0196, 19-0197-Q-000501
(b)(5) 
14 I P a g e 
/\M~ 1.. 1\1\ 
pVERSIGHT 2019-ICLl-00051 5331 

DHS-ICE-19-0196, 19-0197-Q-000502
October 26, 2018 
b)(5) 
(b)(5); WIF Draft 
(b)(5) 
/\Mlf IC'AI\ 
pVERSIGHT 
(b)(5) 
15 I P a g e 
2019-ICLl-00051 5332 

DHS-ICE-19-0196, 19-0197-Q-000503
NIF Draft; (b)(S) 
b)(S) 
/\MERICAi\ 
pVERSIGHT 
16 I P a g e 
2019-ICLl-00051 5333 

DHS-ICE-19-0196, 19-0197-Q-000504
b)(5) 
November 2, 2018 
(b)(5) 
17 I P a g e 
/\MEf l /\I\ 
pVERSIGHT 2019-ICLl-00051 5334 

From: Daniel McGrath <daniel.mcgrath@americanoversight.org>
Sent: Friday, April 02, 2021 11:26 AM EDT
To: FOIA <foia@americanoversight.org>
Subject: FW: American Oversight v. ICE 2019-ICLI-00051 Eight Interim Release
Attachment(s): "'OPR March 2021 Release' of '2019-icli-00051'-6.pdf","'OPR March 2021 Release' of '2019-icli-00051'-
7.pdf","'OPR March 2021 Release' of '2019-icli-00051'-5.pdf"
From: "Flores, Angela M" <Angela.M.Flores@ice.dhs.gov>
Date: Friday, April 2, 2021 at 11:06 AM
To: "benton.peterson@usdoj.gov" <benton.peterson@usdoj.gov>, Daniel McGrath
<daniel.mcgrath@americanoversight.org>, "bgonzalezhorowitz@usa.doj.gov" <bgonzalezhorowitz@usa.doj.gov>
Cc: "Lanks, Christopher" <Christopher.Lanks@ice.dhs.gov>, ICEFOIALITIGATION <ICEFOIALITIGATION@ice.dhs.gov>
Subject: American Oversight v. ICE 2019-ICLI-00051 Eight Interim Release
EXTERNAL SENDER
Third and final.
Best regards,
Angela M Mendez Flores
Paralegal Specialist
DHS ICE FOIA OFFICE
Office: (202)732-3026
Angela.m.flores@ice.dhs.gov

Records Requested 
1. Detainee Records: 
\ Intake screening forms 
Medical screening forms 
l¥ Detention file 
Medical file 
Alien file 
Allsick-call requests and responses submitted 
All detainee request forms and responses submitted 
\ All grievances and responses submitted 
All housing records including segregation/special housing 
[~ Allincident statements concerning the detainee's death 
Telephone records 
Hospital and EMT records 
| All facility investigations concerning the detainee's death 
[~ All Local Law Enforcement investigations concerning the detainee's death 
[~ Autopsy report 
[~ Death certificate 
[~ Notification of detainee's death to his/her country of origin's Consulate 
Facility and ERO Records: 
I~ Post logs (Housing, Control, Medical, Transport, and Hospital) for following date(s): 
[~ Shift roster for following date(s): 
Video surveillance footage of detainee's housing unit and relevant facility locations 
for the following date(s): 
~ Any video footage relevant to the detainee's death, to include handheld, if applicable 
2019-ICLI-00051 5575 
DHS-ICE-19-0196, 19-0197-R-000001

[~ Names of detainee's cellmates 
¥ Name of detainee's Deportation Officer 
!~ Names ofall ERO personnel who had contact with detainee 
!~ Complete roster of medical staff at facility, with titles 
!~ Complete medical staffing plan 
3. Facility Policies: 
[~ Facility Medical Policies and Procedures 
I~ Facility Policy on Medical Emergencies 
!~ Local Operating Procedures for Medical Emergencies 
!~ Facility Policy on Incident Reporting 
4. Additional Documentation 
All responses to this request should be routed to: 
(AVA TAYV7VCY 
DHS ICE OPR ERAU. 
950 L’Enfant Plaza, SW 
Mail Stop 5501, Rooni(b)(6); 
KV7VC 
Washington, DC 20536 
2019-ICLI-00051 5576 
DHS-ICE-19-0196, 19-0197-R-000002

From: 'b)(6); (b)(7)(C) 
Sent: 25 Sep 2019 13:19:18 +0000 
To: ((b)(6); (b)(7)(C) 
Subject: AMAR DDR 
Hey ((b)(6); 
BVT 
Here’s what Creative cited for the AMAR report pertaining to video cameras, not sure if it’s the same 
citation as PADRON. 
1. Emergency Plans, Section (V)(D)(7) states, “At least one video camera shall be 
maintained in the control center for use in emergency situations, and the facility 
administrator shall ensure that it is maintained, tested and supplied as required in ‘K. 
Maintaining Audiovisual Recording Equipment and Records’ found in standard ‘2.15 
Use of Force and Restraints.”” 
It's for PBNDS 2016. 
Regards, 
\(b)( (7)(C) 
Acting Section Chief 
External Reviews and Analysis Unit 
Office of Professional Responsibility 
Immigration and Customs Enforcement 
950 L’Enfant Plaza, SW 
Washington, DC 20536 
_] Office: (202) 732{by6: 
] Cell: (202) 42406); 
2019-ICLI-00051 5577 
DHS-ICE-19-0196, 19-0197-R-000003

From: ((b)(6); (b)(7)(C) 
Sent: 10 Feb 2020 18:30:08 +0000 
To: 5)(6); (b)(7)(C) 
Subject: AMAR Draft 
Attachments: AMAR DDR Report - AMM Review 012720.docx 
Attached is the AMAR draft with my comments. Let me know if | can help further. 
Thanks, 
((b)(6). 
(bye) | (byi7vic) b | ICE OPR Inspections and Detention Oversight Division 
(b)(6); (b)(7)(C) e.dhs.gov | 202.732%bN@Ndesk | 202.816 ell 
2019-ICLI-00051 5578 
DHS-ICE-19-0196, 19-0197-R-000004

Detainee Death Review Report 
5)(5) 
(()(5) 
2019-ICLI-00051 5579 
DHS-ICE-19-0196, 19-0197-R-000005

DHS-ICE-19-0196, 19-0197-R-000006

MEMORANDUM FOR: Timothy S. Robbins 
Acting Executive Associate Director 
Office of Enforcement and Removal Operations 
THROUGH: Waldemar Rodriguez 
Associate Director 
Office of Professional Responsibility 
FROM: \(0)(6); (\(7(C) 
ACHE Assistant Director 
SUBJECT: Detainee Death Review Findings — Mergensana Amar 
EXECUTIVE SUMMARY AND FINDINGS 
(()(5) 
\()(5) 
2019-ICLI-00051 5581 
2|Page 
DHS-ICE-19-0196, 19-0197-R-000007

A()(5) 5)(5) 
3IPage 
2019-ICLI-00051 5582 
DHS-ICE-19-0196, 19-0197-R-000008

5)(5) ()(5) 
4|Page 
2019-ICLI-00051 5583 
DHS-ICE-19-0196, 19-0197-R-000009

5)(5) 
5IPage 
2019-ICLI-00051 5584 
DHS-ICE-19-0196, 19-0197-R-000010

5)(5) [oe 
2019-ICLI-00051 5585 
6IPage 
DHS-ICE-19-0196, 19-0197-R-000011

5)(5) ()(5) 
7IPage 
2019-ICLI-00051 5586 
DHS-ICE-19-0196, 19-0197-R-000012

5)(6); (b)(7)(C) 
B|Page 
DHS-ICE-19-0196, 19-0197-R-000013

(()(5) 5)(5) 
g|Page 
2019-ICLI-00051 5588 
DHS-ICE-19-0196, 19-0197-R-000014

|----{(b)(5) (()(5) 
10|Page 
2019-ICLI-00051 5589 
DHS-ICE-19-0196, 19-0197-R-000015

5)(5) 
2019-ICLI-00051 5590 
[Page 
DHS-ICE-19-0196, 19-0197-R-000016

August 17, 2018 (6)(5) 
5)(5) 
WP age 
2019-ICLI-00051 5591 
DHS-ICE-19-0196, 19-0197-R-000017

(6)(5) (()(5) 
2B|Page 
2019-ICLI-00051 5592 
DHS-ICE-19-0196, 19-0197-R-000018

5)(5) ()(5) 
14|Page 
2019-ICLI-00051 5593 
DHS-ICE-19-0196, 19-0197-R-000019

ore) 5)(5) 
15|Page 
2019-ICLI-00051 5594 
DHS-ICE-19-0196, 19-0197-R-000020

(()(5) \()(5) 
16|Page 
2019-ICLI-00051 5595 
DHS-ICE-19-0196, 19-0197-R-000021

-1(b)(5) (()(5) 
W7|Page 
2019-ICLI-00051 5596 
DHS-ICE-19-0196, 19-0197-R-000022

5)(5) --~((b)(5) 
WlPage 
2019-ICLI-00051 5597 
DHS-ICE-19-0196, 19-0197-R-000023

(()(5) (()(5) 
19|Page 
2019-ICLI-00051 5598 
DHS-ICE-19-0196, 19-0197-R-000024

(6)(5) 5)(5) 
2|Page 
2019-ICLI-00051 5599 
DHS-ICE-19-0196, 19-0197-R-000025

5)(5) ()(5) 
a|Page 
2019-ICLI-00051 5600 
DHS-ICE-19-0196, 19-0197-R-000026

5)(5) 
2019-ICLI-00051 5601 
WTF SES 
DHS-ICE-19-0196, 19-0197-R-000027

yO) (()(5) 
23|Page 
2019-ICLI-00051 5602 
DHS-ICE-19-0196, 19-0197-R-000028

5)(5) (()(5) 
2|Page 
2019-ICLI-00051 5603 
DHS-ICE-19-0196, 19-0197-R-000029

(()(5) ()(5) 
(()(5) 
2019-ICLI-00051 5604 
25|Page 
DHS-ICE-19-0196, 19-0197-R-000030

APPENDIX 
5)(5) 
26|Page 
2019-ICLI-00051 5605 
DHS-ICE-19-0196, 19-0197-R-000031

\()(5) 
2019-ICLI-00051 5606 
2Z\|Page 
DHS-ICE-19-0196, 19-0197-R-000032

(()(5) 
2019-ICLI-00051 5607 
2| Page 
DHS-ICE-19-0196, 19-0197-R-000033

5)(5) (()(5) 
WlPage 
2019-ICLI-00051 5608 
DHS-ICE-19-0196, 19-0197-R-000034

5)(5) 
2019-ICLI-00051 5609 
DHS-ICE-19-0196, 19-0197-R-000035

b)(5) 
1lPage 
DHS-ICE-19-0196, 19-0197-R-000036

EXHIBITS 
(()(5) 
32|Page 
2019-ICLI-00051 5611 
DHS-ICE-19-0196, 19-0197-R-000037

From: 'b)(6); (b)(7)(C) 
Sent: 17 Dec 2018 21:18:47 +0000 
To: \(b)(6); (b)(7)(C) 
Subject: AMAR Info for your meeting 
AMAR DDR Summary 
We conducted approximately 40 interviews as well as a facility tour and a review of tangible 
evidence/documents. It was a high op-tempo but the team did a great job. ERO and facility staff were 
cooperative and accommodating. The findings below are tentative as we still have outstanding 
document requests as well as telephonic interviews to conduct. 
5)(5) 
2019-ICLI-00051 5612 
DHS-ICE-19-0196, 19-0197-R-000038

5)(5) 
2019-ICLI-00051 5613 
DHS-ICE-19-0196, 19-0197-R-000039

From: ((b)(6); (b)(7)(C) 
Sent: 3 Apr 2019 13:40:26 +0000 
To: \(b)(6); (b)(7)(C) 
Ce: 
Subject: AMAR question 
Good morning |(b)(6); 
hV7VC) 
Do you have a certificate of death and/or autopsy report for the AMAR death at NWDC in November? 
Thanks! 
b)(6); (b)(7)(C) nit Chief 
ICE Office of Professional Responsibility 
Office of Detention Oversight (Acting) 
Office - (202) 732-{b)(6); 
Mobile — (202) 907-(b)(6); 
TON 
2019-ICLI-00051 5614 
DHS-ICE-19-0196, 19-0197-R-000040

From: (()(6); (b)(7)(C) 
Sent: 3 Apr 2019 14:43:56 +0000 
To: ((5)(6), (b)(7)(C) 
Subject: AMAR summary 
Attachments: AMAR Exec Summary.docx 
See attached. Let me know if you have questions. It’s long ©). 
(6)(6); (b\(7(C)_ JUnit Chief 
ICE Office of Professional Responsibility 
Office of Detention Oversight (Acting) 
Office - (202) 73. 
Mobile — (202) 90 
2019-ICLI-00051 5615 
DHS-ICE-19-0196, 19-0197-R-000041

OPR Response: 
Executive Summary 
Detainee Mergensana AMAR — Tacoma, WA 
Death of a Detainee in ICE Custody 
Summary: 
On November 24, 2018, Mergensana AMAR, a 40-year-old citizen of Russia, died while in the custody of 
U.S. Immigration and Customs Enforcement (ICE), at the Saint Joseph’s Hospital (SJH) in Tacoma, WA. 
The medical staff pronounced AMAR deceased on November 24, 2018, at 6:05 p.m. PST. Medical staff 
identified the preliminary cause of death as asphyxia caused by hanging from the neck. 
Timeline of Events: 
On December 2, 2017, AMAR applied for entry into the United States via the pedestrian lanes at the San 
Ysidro, CA Port Entry. AMAR presented his valid Russian passport to the primary inspection Customs & 
Border Protection Officer (CBPO) and requested asylum. U.S. Customs and Border Protection (CBP) 
determined AMAR to be inadmissible and served him a Notice and Order of Expedited Removal, Form I￾860 charging inadmissibility pursuant to section 212(a)(7)(A)(i)(I) of the Immigration and Naturalization 
Act (INA), as amended, as an immigrant without immigrant visa. 
On December 6, 2017, CBP transferred AMAR to ERO San Diego custody at the San Luis Regional 
Detention Center. 
On December 19, 2017, ERO San Diego transferred AMAR to ERO Seattle at the Northwest Detention 
Center (NWDC) in Tacoma, WA, to await a credible fear interview with United States Citizenship and 
Immigration Services (USCIS) Asylum office in San Francisco, CA. Upon arrival to NWDC, AMAR 
received a timely intake medical screening during which no current or past medical or mental health 
problems were identified. AMAR was placed in general population housing. 
On December 23, 2017, AMAR received an initial physical examination, and no current or past medical 
or mental health problems were identified. 
No significant medical events occurred from December 24, 2017 to August 16, 2018. 
On January 3, 2018, a USCIS San Francisco Asylum Pre-Screening Officer (APSO) conducted a 
telephonic credible fear interview with AMAR in Tukwila, WA. The following day, the APSO rendered 
a positive credible fear determination in AMAR’s case and served him a Notice to Appear, Form 1-862, 
alleging inadmissibility pursuant to section 212(a)(7)(A)(i)(I) of the INA, as amended, as an immigrant 
without immigrant visa. 
On February 1, 2018, an immigration judge (IJ) in Tacoma, WA determined the court had no jurisdiction 
in a custody hearing due to AMAR being an arriving alien. 
On February 7, 2018, ERO Seattle served AMAR a Parole Advisal and Scheduling Notification. 
a On February 26, 2018, ERO Seattle denied AMAR parole due to posing risk of flight. 
On August 7, 2018, an IJ in Salt Lake City, UT, appearing via video teleconferencing, denied AMAR’s 
application for asylum, withholding under INA § 241(b)(3), and withholding of removal under the 
2019-ICLI-00051 5616 
DHS-ICE-19-0196, 19-0197-R-000042

Convention Against Torture (CAT), and ordered AMAR removed to Russia. AMAR reserved appeal, 
which was due by September 6, 2018. 
On August 16, 2018, an RN conducted a mental health wellness check on AMAR after he complained of 
feeling depressed. The RN consulted with a facility psychologist who determined AMAR’s complaints 
did not require a mental health appointment. 
On August 22, 2018, AMAR declared himself to be on hunger strike and medical staff began monitoring 
his meals. AMAR was placed in the Restricted Housing Unit (RHU) on medical observation for the 
hunger strike. RHU is used for Medical Housing Unit (MHU) overflow. 
On August 25, 2018, AMAR declined his ninth consecutive meal and Immigration Health Services Corps 
(IHSC) initiated hunger strike protocols. AMAR was moved to the MHU for hunger strike monitoring. 
AMAR remained in the MHU until October 15, 2018. 
From August 25 to September 6, 2018, AMAR declined to have medical staff assess him, refused all 
medications, and refused to eat. He was periodically observed drinking water from the sink while 
washing his face and brushing his teeth. 
On September 6, 2018, IHSC obtained an order to permit involuntary medical monitoring and hydration 
from a judge with the United States District Court for the Western District of Washington. When 
presented with the order, Amar began drinking Pedialyte and allowing medical monitoring. A physician 
noted a decrease in the detainee’s blood pressure, and a 21lbs weight loss since the beginning of his 
hunger strike. 
On September 14, 2018, AMAR began drinking Boost nutritional shakes and continued to consume 
Pedialyte, and occasionally ate pieces of fruit. 
On September 19, 2018, ERO Seattle scheduled AMAR for an escorted commercial removal with his 
valid Russian passport for October 24, 2018. 
By September 26, 2018, AMAR regularly consumed liquid nutritional supplements, ate fruit and took 
vitamins. Although he was effectively no longer on hunger strike, medical staff decided to keep him on 
hunger strike status in the MHU. Medical staff stated that as long as AMAR believed his hunger strike 
was taken seriously, he continued to consume items and drink water. 
On October 1, 2018, AMAR filed an untimely notice of appeal with the Board of Immigration Appeals 
(BIA). ERO Seattle cancelled AMAR’s scheduled removal. 
On October 16, 2018, AMAR consumed a full meal and IHSC declared an official end to hunger strike 
protocols. AMAR was moved to administrative segregation on this date at his request but continued to 
skip meals. Medical staff made nutritional supplements and Pedialyte available to AMAR three times 
daily to promote weight gain. Medical staff conducted a daily segregation round and three shift rounds 
while he was in administrative segregation. 
On October 26, 2018, officers found a long rope made of bedding material hidden under AMAR’s 
mattress. Although AMAR denied any suicidal ideations, medical staff re-admitted him to the MHU on 
one-to-one suicide watch as a precaution. 
2019-ICLI-00051 5617 
DHS-ICE-19-0196, 19-0197-R-000043

On October 27, 2018, a psychiatrist evaluated AMAR and determined he had no suicidal ideation, 
homicidal ideation, or auditory verbal hallucination. AMAR remained on constant-watch. Medical and 
security documentation indicates he refused most meals but ate fruit and drank nutritional supplements. 
On October 28, 2018, AMAR was transferred from the MHU to the RHU, but remained on 10-minute 
mental health observation checks, and daily mental health rounds. 
On November 2, 2018, the BIA dismissed AMAR’s appeal as having been filed untimely. 
On November 4, 2018, an officer discovered torn bedsheets in AMAR’s cell during a routine cell search. 
The officer documented the discovery in an Evidence/Search Report. Because the report was routed 
directly to administrative staff per standard facility procedure, neither the lieutenant responsible for the 
RHU nor medical staff were made aware of the torn sheets. 
On November 5, 2018, after two mental health professionals evaluated AMAR, medical staff determined 
the detainee was stable enough to be removed from mental health observation and return to general 
population housing. AMAR requested to remain in the RHU on protective custody (PC) status, and the 
facility agreed to let him remain in the RHU. AMAR remained in the RHU on PC status until November 
15, 2018. While housed in the MHU, officers conducted regular 30-minute security checks, and nurses 
completed all required segregation rounds. 
On November 7, 2018, an officer conducted a routine search of AMAR’s cell and found nothing 
noteworthy. This was the last documented search of AMAR’s cell before his death. 
On November 8, 2018, ERO Seattle re-scheduled AMAR’s removal to Russia for November 28, 2018. 
On November 12, 2018, AMAR began regularly eating facility provided meals and consumed a complete 
lunch and dinner. 
On November 13, 2018, a mental health provider conducted a weekly segregation round during which 
AMAR denied any mental health concerns. 
On November 14, 2018, AMAR also expressed his desire to leave administrative segregation and return 
to general population. AMAR also refused linen exchange on this date. 
On November 15, 2018, attendees of the facility’s weekly administrative meeting (Warden, Associate 
Warden, Major, RHU Lieutenant, ERO personnel, and IHSC personnel) agreed AMAR would be moved 
to general population later that day after ERO met with him to let him know he lost his immigration 
appeal. A Deportation Officer (DO) met with AMAR to deliver the news at approximately 1:40 p.m. 
Officers did not notice any unusual behavior from AMAR following the meeting with the DO. 
e Before his move from the RHU to general population housing, at approximately 3:06 p.m., an 
RHU officer discovered AMAR hanging from a noose made of bed sheets in his cell during a 
routine security check. The officer immediately called central control to activate the Incident 
Management System (IMS). Officers responded to AMAR’s cell within approximately one 
minute. The officers entered the cell, lifted AMAR to relieve the tension from his neck, and then 
a used life knife to cut the noose before placing him on the floor. 
2019-ICLI-00051 5618 
DHS-ICE-19-0196, 19-0197-R-000044

At approximately 3:08 p.m., medical staff arrived on the scene and began administering 
cardiopulmonary resuscitation (CPR) to AMAR. 
At approximately 3:10 p.m., medical staff instructed officers to contact emergency medical 
service (EMS). Security staff called 911 at approximately 3:11 p.m. 
At approximately 3:16 p.m., EMS from Tacoma Fire and Rescue arrived on scene and took over 
the administration of CPR. EMS records state that AMAR was unconscious, unresponsive, 
pulseless, and not breathing. Officers notified ERO Seattle that an IMS was called after AMAR 
was discovered attempting self-harm. 
At approximately 3:29 p.m., EMS reported that AMAR had a pulse. 
At approximately 3:34 p.m., EMS departed NWDC and transported AMAR to Saint Joseph’s 
Hospital in Tacoma, WA. 
At approximately 3:52 p.m., AMAR arrived at Saint Joseph’s Hospital. 
At approximately 5:15 p.m., a physician at Saint Joseph’s Hospital admitted AMAR to the 
intensive care unit (ICU) after determining the detainee was not breathing on his own and had no 
apparent brain activity. 
From November 16-24, 2018, AMAR remained hospitalized. 
On November 17, 2018, after tests showed AMAR had no brain activity, the hospital’s Ethics 
Committee recommended AMAR be considered a do not resuscitate (DNR) case in the event of 
sudden cardiac arrest. 
On November 18, 2018, after tests showed AMAR had no blood flow to his brain, and all testing 
indicated brain death, the hospital declared AMAR brain dead at 2:45 p.m. The hospital notified 
ICE that they intended to turn off life support unless next-of-kin could be located and granted 
ERO Seattle additional time to locate next of kin. 
On November 21, 2018, after finding contact information for AMAR’s parents in Russia, ERO 
facilitated communications between the Russian embassy, AMAR’s parents, and the hospital 
regarding his prognosis and plan for withdrawal of care. 
On the afternoon of November 24, 2018, AMAR’s parents decided to remove him from life 
support. Life support was removed at approximately 6:00 p.m. 
At approximately 6:05 p.m., hospital staff pronounced AMAR’s cardiac death. 
At approximately 6:30 p.m., IHSC notified ERO Seattle of AMAR's passing. 
On November 25, 2018, at approximately 10:51 a.m., ERO Seattle contacted the Russian 
consulate, and provided notification of AMAR’s death. 
2019-ICLI-00051 5619 
DHS-ICE-19-0196, 19-0197-R-000045

Preliminary Findings: 
The ICE Office of Professional Responsibility (OPR) External Reviews and Analysis Unit (ERAU) 
reviewed NWDC’s compliance with the ICE PBNDS 2011, as revised in 2016, with regard to AMAR’s 
medical care, safety and security, and found NWDC did not fully comply with the following standards: 
e Terminal Illness, Advanced Directives and Death, section (V)(F), Disposition of Property, 
which states, “Facilities shall turn over the property of the decedent to ICE/ERO within one week 
for processing and disposition. Unless property of a decedent is being held as part of an 
investigation into the circumstances of death, that property should be returned to the decedent’s 
next of kin, if known, within two weeks. 
« AMAR’s property had not yet been returned to his family at the time of ERAU’s visit, 
December 11-13, 2018. 
e Special Management Units, section (V)(A)(2), which states, “A written order shall be completed 
and approved by the facility administrator or designee before a detainee is placed in administrative 
segregation, except when exigent circumstances make such documentation impracticable. In such 
cases, an order shall be prepared as soon as possible. A. Prior to a detainee’s actual placement in 
administrative segregation, the facility administrator or designee shall complete the administrative 
segregation order (Form I-885 or equivalent), detailing the reasons for placing a detainee in 
administrative segregation. b. In an emergency, the detainee’s placement in administrative 
segregation may precede the paperwork, which the facility administrator or designee shall prepare 
as soon as possible after the detainee’s placement.” 
e Although AMAR was assigned to administrative segregation on October 28, 2018, an order 
was not prepared until the following day. 
e Special Management Units, section (V)(R)(2)(c), which states, “Extreme detainee behavior, such 
as destroying clothing or bedding or harmful behavior to self or others, must be documented, made 
part of the detainee’s file with the facility, and reported to the Field Office Director to implement 
necessary efforts to protect and care for the detainee. 
e There is no documentation that the Field Office Director was notified when AMAR 
destroyed his bedsheet on November 4, 2018. 
e Emergency Plans, section (D)(7), which states, “At least one video camera shall be maintained in 
the control center for use in emergency situations, and the facility administrator shall ensure that it 
is maintained, tested and supplied as required in “K. Maintaining Audiovisual Recording 
Equipment and Records” found in standard “2.15 Use of Force and Restraints.” 
e Although NWDC has five handheld cameras available for use in emergency situations, 
three camera batteries failed during the emergency response. 
e Emergency Plans, section (D)(18)(e), which states, “The post-emergency part of the plan shall 
include the following action items: “assessing damage and necessary repair; collecting written 
reports.” 
e Reports were not collected from three officers who responded to the emergency. 
2019-ICLI-00051 5620 
DHS-ICE-19-0196, 19-0197-R-000046

Emergency Plans, section (D)(18)(h), which states, “The post-emergency part of the plan shall 
include the following action items: “conducting general review and critique of emergency 
operations and management, with a follow-up agenda including, but not limited to: 1) monitoring 
the facility climate, and 2) revising the contingency plan.” 
e Although facility leadership reviewed video footage of emergency response timely, an 
official after-action review was not yet completed at the time of ERAU’s review. 
Funds and Personal Property, section (V)(G)(1), which states, “For recordkeeping and 
accounting purposes, use of the G-589 Property Receipt form or its equivalent is mandatory to 
inventory any funds removed from a detainee’s possession, and a separate G-589 form or its 
equivalent is required for each kind of currency and negotiable instrument. Removal and inventory 
of detainee funds shall be conducted by at least two officers and in the presence of the detainee. 
Separate documentation should be made for each kind of currency and negotiable instrument and 
should include detainee identification information and a description of the amount and type of 
currency or other negotiable instrument inventoried. Officers should then deposit the funds with a 
copy of the documentation in the drop safe or similarly secured depository.” 
e AMAR’s property inventory lists 21 foreign coins but does not describe the type and 
amount of the currency. 
2019-ICLI-00051 5621 
DHS-ICE-19-0196, 19-0197-R-000047

From: (b)(6); (b)\(7)(C) 
Sent: 8 Jun 2020 12:43:31 +0000 
To: ((b)(6); (b)(7)(C) 
Ce: 
Subject: AMAR Working Papers 
Good morning, I hope all is well on your end! I know you are super busy, as a reminder please 
upload your AMAR working papers here when you have a moment. 
Let me know if you have any questions. 
Vir, 
\()(6); (b)(7)(C) 
Inspections and Compliance Specialist 
Office of Professional Responsibility 
External Reviews and Analysis Unit 
Immigration and Customs Enforcement 
Office: (202) 732{>)6._ 
Cell: (202) 893-+(b)(6); 
()(7)(C) 
2019-ICLI-00051 5622 
DHS-ICE-19-0196, 19-0197-R-000048

From: (b)(6); (b)(7)(C)_ |(CTR) 
Sent: 12 Mar 2020 23:14:34 +0000 
To: ((b)(6); (b)(7)(C) 
Ce: 
Subject: AMAR 
Attachments: AutoRecovery save of AMAR Detainee Death Review Healthcare and Security 
Compliance Analysis FINAL CC MEDICAL responses round 3.docx, AutoRecovery save of AMAR Detainee 
Death Review Healthcare and Security Compliance Analysis FINAL (2) CC MEDICAL responses round 
4.docx 
Hey{b\(6): 
Attached are versions of the report with {(b)6), 5 responses to your most recent rounds of questions. As 
discussed on the phone, your consolidation into a version with open security questions and any follow 
up to medical questions, should greatly expedite our provision of answers. |(b)(6);Wwill jump on remaining 
medical questions and | will answer security questions to the extent | can. er will have to be punted 
tobe). 
Note | copied®)6).__ Jan ssure they know we are working together to get this done! 
b)(6); 
b\7(C) 
2019-ICLI-00051 5623 
DHS-ICE-19-0196, 19-0197-R-000049

5)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
° 
February 11, 2019 
= 
« teative. 
Cerrections 
2019-ICLI-00051 5624 
Page 1 
DHS-ICE-19-0196, 19-0197-R-000050

5)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
Page 2 
February 11, 2019 
| i, 
2019-ICLI-00051 5625 
DHS-ICE-19-0196, 19-0197-R-000051

b)(7)(C); (b)(5); (b)(6) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 3 
Healthcare and Security Compliance Analysis 
February 11, 2019 
= . 
| ee 
2019-ICLI-00051 5626 
DHS-ICE-19-0196, 19-0197-R-000052

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 4 
Healthcare and Security Compliance Analysis 
February 11, 2019 
= . 
| ee 
2019-ICLI-00051 5627 
DHS-ICE-19-0196, 19-0197-R-000053

(()(5) 
\()(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 5 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5628 
DHS-ICE-19-0196, 19-0197-R-000054

5)(5); (b)(6); (b)(7)(C) ()(5) 
edited. 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
Page 6 
2019-ICLI-00051 5629 
DHS-ICE-19-0196, 19-0197-R-000055

5)(6); (b)(7)(C); (b)(5) (()(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5630 
Page 7 
DHS-ICE-19-0196, 19-0197-R-000056

\()(6); (b)(7)(C); (b)(5) 5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 8 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5631 
DHS-ICE-19-0196, 19-0197-R-000057

\()(6); (b)(7)(C); (b)(5) (5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5632 
Page 9 
DHS-ICE-19-0196, 19-0197-R-000058

(()(6); (b)(7)(C); (b)(5) 
\()(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 10 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5633 
DHS-ICE-19-0196, 19-0197-R-000059

b)(6); (BTC); (DVS b)(6); (b)(7)(C); (b)(5) ((b)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 11 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5634 
DHS-ICE-19-0196, 19-0197-R-000060

5)(6); ()(5) (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 12, 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5635 
DHS-ICE-19-0196, 19-0197-R-000061

\()(5) 
(()(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 13 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5636 
DHS-ICE-19-0196, 19-0197-R-000062

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 14 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5637 
DHS-ICE-19-0196, 19-0197-R-000063

(()(5) 5)(7)(C); (b)(5); (b)(6) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 15, 
Healthcare and Security Compliance Analysis 
| 
February 11, 2019 
So ee 
2019-ICLI-00051 5638 
DHS-ICE-19-0196, 19-0197-R-000064

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 16 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5639 
DHS-ICE-19-0196, 19-0197-R-000065

\()(5) 
5)(6); (b)(7)(C); (b)(5) 
FEE 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 17 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5640 
DHS-ICE-19-0196, 19-0197-R-000066

5)(6); (b)(7)(C); (b)(5) Ac, {IMEL: pid BN Mati 
/ (6) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 18 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5641 
DHS-ICE-19-0196, 19-0197-R-000067

5)(6); (()(5) (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 19 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| 
| 
— - 
So ee 
2019-ICLI-00051 5642 
DHS-ICE-19-0196, 19-0197-R-000068

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 20 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| a. 
| ee 
2019-ICLI-00051 5643 
DHS-ICE-19-0196, 19-0197-R-000069

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| ee 
2019-ICLI-00051 5644 
Page 21 
DHS-ICE-19-0196, 19-0197-R-000070

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5645 
Page 22 
DHS-ICE-19-0196, 19-0197-R-000071

(()(5) 
\()(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 23 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5646 
DHS-ICE-19-0196, 19-0197-R-000072

\()(5) \()(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 24 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5647 
DHS-ICE-19-0196, 19-0197-R-000073

5)(6); (b)(7)(C); (b)(5) (()(5) 
TEE sesesesEesesesEesesesesesesesesesesesesee?7 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 25 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5648 
DHS-ICE-19-0196, 19-0197-R-000074

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
° 
February 11, 2019 
= 
« teative. 
Cerrections 
2019-ICLI-00051 5649 
Page 26 
DHS-ICE-19-0196, 19-0197-R-000075

(()(6); (b)(7)(C); (b)(5) (6)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 27 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5650 
DHS-ICE-19-0196, 19-0197-R-000076

(()(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| ee 
2019-ICLI-00051 5651 
Page 28 
DHS-ICE-19-0196, 19-0197-R-000077

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| ee 
2019-ICLI-00051 5652 
Page 29 
DHS-ICE-19-0196, 19-0197-R-000078

(()(6); (b)(7)(C); (b)(5) 
a 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| _, 
| ee 
2019-ICLI-00051 5653 
Page 30 
DHS-ICE-19-0196, 19-0197-R-000079

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 31 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| a. 
| ee 
2019-ICLI-00051 5654 
DHS-ICE-19-0196, 19-0197-R-000080

()(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 32 
Healthcare and Security Compliance Analysis 
February 11, 2019 
= . 
| ee 
2019-ICLI-00051 5655 
DHS-ICE-19-0196, 19-0197-R-000081

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
° 
February 11, 2019 
= 
« teative. 
Cerrections 
2019-ICLI-00051 5656 
Page 33 
DHS-ICE-19-0196, 19-0197-R-000082

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 34 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| ee 
2019-ICLI-00051 5657 
DHS-ICE-19-0196, 19-0197-R-000083

(()(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 35 
Healthcare and Security Compliance Analysis 
February 11, 2019 
= . 
| ee 
2019-ICLI-00051 5658 
DHS-ICE-19-0196, 19-0197-R-000084

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 36 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| a. 
| ee 
2019-ICLI-00051 5659 
DHS-ICE-19-0196, 19-0197-R-000085

5)(6); (b)(7)(C); (b)(5); (b)(7)(E) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 37 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5660 
DHS-ICE-19-0196, 19-0197-R-000086

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 38 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5661 
DHS-ICE-19-0196, 19-0197-R-000087

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| 
| ee 
2019-ICLI-00051 5662 
Page 39 
DHS-ICE-19-0196, 19-0197-R-000088

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 40 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| ee 
2019-ICLI-00051 5663 
DHS-ICE-19-0196, 19-0197-R-000089

5)(7)(C); (b)(5); (b)(6) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 41 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| a. 
| ee 
2019-ICLI-00051 5664 
DHS-ICE-19-0196, 19-0197-R-000090

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| ee 
2019-ICLI-00051 5665, 
Page 42 
DHS-ICE-19-0196, 19-0197-R-000091

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| a. 
| ee 
2019-ICLI-00051 5666 
Page 43 
DHS-ICE-19-0196, 19-0197-R-000092

(()(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 44 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5667 
DHS-ICE-19-0196, 19-0197-R-000093

(()(6); (b)(7)(C); (b)(5) 
5)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5668 
Page 45 
DHS-ICE-19-0196, 19-0197-R-000094

\()(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 46 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| ee 
2019-ICLI-00051 5669 
DHS-ICE-19-0196, 19-0197-R-000095

5)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
"= 
| ee 
2019-ICLI-00051 5670 
Page 47 
DHS-ICE-19-0196, 19-0197-R-000096

5)(5) 
\()(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| ee 
2019-ICLI-00051 5671 
Page 48 
DHS-ICE-19-0196, 19-0197-R-000097

5)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
° 
February 11, 2019 
= 
| ee 
2019-ICLI-00051 5672 
Page 49 
DHS-ICE-19-0196, 19-0197-R-000098

(()(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| a. 
| ee 
2019-ICLI-00051 5673 
Page 50 
DHS-ICE-19-0196, 19-0197-R-000099

5)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| in, 
| ee 
2019-ICLI-00051 5674 
Page 51 
DHS-ICE-19-0196, 19-0197-R-000100

\()(5) 
5)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
° 
February 11, 2019 
= 
« teative. 
Cerrections 
2019-ICLI-00051 5675 
Page 52 
DHS-ICE-19-0196, 19-0197-R-000101

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 53 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| a. 
| ee 
2019-ICLI-00051 5676 
DHS-ICE-19-0196, 19-0197-R-000102

(()(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
° 
February 11, 2019 
= 
| ee 
2019-ICLI-00051 5677 
Page 54 
DHS-ICE-19-0196, 19-0197-R-000103

5)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| a. 
| ee 
2019-ICLI-00051 5678 
Page 55 
DHS-ICE-19-0196, 19-0197-R-000104

DETAINEE DEATH REVIEW: Mergensana AMAR, A216269802 
Healthcare and Security Compliance Analysis 
Northwest Detention Center 
Tacoma, Washington 
(()(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
« reative 
Liga@corrections 
2019-ICLI-00051 5679 
Page 1 
DHS-ICE-19-0196, 19-0197-R-000105

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| ee 
2019-ICLI-00051 5680 
Page 2 
DHS-ICE-19-0196, 19-0197-R-000106

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| ee 
2019-ICLI-00051 5681 
Page 3 
DHS-ICE-19-0196, 19-0197-R-000107

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 4 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| a. 
| ee 
2019-ICLI-00051 5682 
DHS-ICE-19-0196, 19-0197-R-000108

()(6); (b)(7)(C); (b)(5) 
5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 5 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5683 
DHS-ICE-19-0196, 19-0197-R-000109

(()(6); (b)(7)(C); (b)(5) 
5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 6 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5684 
DHS-ICE-19-0196, 19-0197-R-000110

(()(5) 
5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 7 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5685 
DHS-ICE-19-0196, 19-0197-R-000111

5)(7)(C); (b)(5); (b)(6) ()(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 8 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| 
| 
— - 
So ee 
2019-ICLI-00051 5686 
DHS-ICE-19-0196, 19-0197-R-000112

5y(8) (oye) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 9 
Healthcare and Security Compliance Analysis 
February 11, 2019 
iS 
2019-ICLI-00051 5687 
DHS-ICE-19-0196, 19-0197-R-000113

(()(5) (()(5) 
FEES 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 10 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5688 
DHS-ICE-19-0196, 19-0197-R-000114

5)(5); (b)(6); (b)(7)(C) ()() 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 11 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5689 
DHS-ICE-19-0196, 19-0197-R-000115

5)(6); (b)(7)(C); (b)(5) (()(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 12 
Healthcare and Security Compliance Analysis 
| 
February 11, 2019 
So ee 
2019-ICLI-00051 5690 
DHS-ICE-19-0196, 19-0197-R-000116

5)(6); (b)(7)(C); (b)(5) (()(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 13 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5691 
DHS-ICE-19-0196, 19-0197-R-000117

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 14 
Healthcare and Security Compliance Analysis 
February 11, 2019 
= . 
| ee 
2019-ICLI-00051 5692 
DHS-ICE-19-0196, 19-0197-R-000118

(()(6); (b)(7)(C); (b)(5) (()(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 15, 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5693 
DHS-ICE-19-0196, 19-0197-R-000119

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
° 
February 11, 2019 
= 
« teative. 
Cerrections 
2019-ICLI-00051 5694 
Page 16 
DHS-ICE-19-0196, 19-0197-R-000120

(()(5) \()(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 17 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5695 
DHS-ICE-19-0196, 19-0197-R-000121

\()(7)(C); (b)(6); (b)(5) ()(7)(C), (b)(5); (b)(6) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
Page 18 
2019-ICLI-00051 5696 
DHS-ICE-19-0196, 19-0197-R-000122

(()(5) (()(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 19 
Healthcare and Security Compliance Analysis 
| 
February 11, 2019 
So ee 
2019-ICLI-00051 5697 
DHS-ICE-19-0196, 19-0197-R-000123

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| ee 
2019-ICLI-00051 5698 
Page 20 
DHS-ICE-19-0196, 19-0197-R-000124

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5699 
Page 21 
DHS-ICE-19-0196, 19-0197-R-000125

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 22 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| ee 
2019-ICLI-00051 5700 
DHS-ICE-19-0196, 19-0197-R-000126

(()(6); (b)(7)(C); (b)(5) \()(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 23 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5701 
DHS-ICE-19-0196, 19-0197-R-000127

\()(6); (b)(7)(C); (b)(5) \()(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 24 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5702 
DHS-ICE-19-0196, 19-0197-R-000128

(()(5) 
(()(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 25 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5703 
DHS-ICE-19-0196, 19-0197-R-000129

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
° 
February 11, 2019 
= 
| ee 
2019-ICLI-00051 5704 
Page 26 
DHS-ICE-19-0196, 19-0197-R-000130

()(6); (b)(7)(C); (b)(5) 5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 27 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5705 
DHS-ICE-19-0196, 19-0197-R-000131

5)(6); (()(5) (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 28 
Healthcare and Security Compliance Analysis 
| 
February 11, 2019 
So ee 
2019-ICLI-00051 5706 
DHS-ICE-19-0196, 19-0197-R-000132

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
° 
February 11, 2019 
= 
| ee 
2019-ICLI-00051 5707 
Page 29 
DHS-ICE-19-0196, 19-0197-R-000133

(()(5) 
(()(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 30 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5708 
DHS-ICE-19-0196, 19-0197-R-000134

(()(5); (b)(6); (b)(7)(C) (()(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 31 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5709 
DHS-ICE-19-0196, 19-0197-R-000135

5)(6); (b)(7)(C); (b)(5) (()(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5710 
Page 32, 
DHS-ICE-19-0196, 19-0197-R-000136

BY(G): (YT), (ONE) ADe 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 33 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5711 
DHS-ICE-19-0196, 19-0197-R-000137

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5712 
Page 34 
fore) 
DHS-ICE-19-0196, 19-0197-R-000138

()(7)(C); (b)(5); (b)(6) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 35 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5713 
DHS-ICE-19-0196, 19-0197-R-000139

()(5) 
(()(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 36 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5714 
DHS-ICE-19-0196, 19-0197-R-000140

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 37 
Healthcare and Security Compliance Analysis 
February 11, 2019 
= . 
| ee 
2019-ICLI-00051 5715 
DHS-ICE-19-0196, 19-0197-R-000141

(()(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5716 
Page 38 
DHS-ICE-19-0196, 19-0197-R-000142

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5717 
Page 39 
DHS-ICE-19-0196, 19-0197-R-000143

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| ee 
2019-ICLI-00051 5718 
Page 40 
DHS-ICE-19-0196, 19-0197-R-000144

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 41 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| a, . 
| ee 
2019-ICLI-00051 5719 
DHS-ICE-19-0196, 19-0197-R-000145

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 42 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| a. 
| ee 
2019-ICLI-00051 5720 
DHS-ICE-19-0196, 19-0197-R-000146

5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5721 
Page 43 
DHS-ICE-19-0196, 19-0197-R-000147

\()(6); (b)(7)(C); (b)(5) 
()(6); (b)(7)(C); (b)(5) 
‘| 
mNmNnNB99EoaRR9no————O 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 44 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5722 
DHS-ICE-19-0196, 19-0197-R-000148

5)(6); (b)(7)(C); (b)(5) APNE): (OC): (YS) 
\()(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5723 
Page 45, 
DHS-ICE-19-0196, 19-0197-R-000149

(()(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 46 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5724 
DHS-ICE-19-0196, 19-0197-R-000150

(()(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 47 
Healthcare and Security Compliance Analysis 
February 11, 2019 
2019-ICLI-00051 5725 
DHS-ICE-19-0196, 19-0197-R-000151

5)(6); (b)(7)(C); (b)(5) 
5)(6); (b)(7)(C); (b)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 48 
Healthcare and Security Compliance Analysis 
February 11, 2019 
= . 
| ee 
2019-ICLI-00051 5726 
DHS-ICE-19-0196, 19-0197-R-000152

5)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| a, . 
| ee 
2019-ICLI-00051 5727 
Page 49 
DHS-ICE-19-0196, 19-0197-R-000153

\()(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
SS 
| ee 
2019-ICLI-00051 5728 
Page 50 
DHS-ICE-19-0196, 19-0197-R-000154

(()(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| a. 
| ee 
2019-ICLI-00051 5729 
Page 51 
DHS-ICE-19-0196, 19-0197-R-000155

(()(5) 
5)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR Page 52 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| ee 
2019-ICLI-00051 5730 
DHS-ICE-19-0196, 19-0197-R-000156

(5)(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| ee 
2019-ICLI-00051 5731 
Page 53 
DHS-ICE-19-0196, 19-0197-R-000157

(()(5) 
DETAINEE DEATH REVIEW: Mergensana AMAR 
Healthcare and Security Compliance Analysis 
February 11, 2019 
| ee 
2019-ICLI-00051 5732 
Page 54 
DHS-ICE-19-0196, 19-0197-R-000158

DETAINEE DEATH REVIEW: Mergensana AMAR Page 55 
Healthcare and Security Compliance Analysis 
° 
February 11, 2019 
= 
| ee 
2019-ICLI-00051 5733 
DHS-ICE-19-0196, 19-0197-R-000159

From: en); YC) 
Sent: 19 Mar 2020 19:41:05 +0000 
To: BN), (OTC) 
Subject: DDR AMAR 
How’s AMAR coming along? Do you plan to have it completed by this week? 
{(o)(6): 
oy(7(C) 
2019-ICLI-00051 5734 
DHS-ICE-19-0196, 19-0197-R-000160

From: (()(6), (b)(7)(C) 
Sent: 20 Sep 2019 18:55:15 +0000 
To: 
Subject: DDR for AMAR 
Attachments: AMAR Mergensana Report - Draft Final.docx 
5)(6); (b)(7)(C) 
Hello there and welcome back! I hope you both enjoyed your vacations. 
Attached please find my first attempt at the DDR Report for Amar. 
I mimicked the format from the new DDR template on the SharePoint site. 
Standing by for edits/changes. 
Vir, 
5)(6); (b)(7)(C) 
Management and Program Analyst 
External Reviews and Analysis Unit 
Office of Professional Responsibility 
Immigration and Customs Enforcement 
Office: (202) 732{08) . 
Cell: (202) 893-[b)6) J 
2019-ICLI-00051 5735 
DHS-ICE-19-0196, 19-0197-R-000161

Page 5736 
Withheld pursuant to exemption 
WIF Draft ; (b)(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-R-000162

Page 5737 
Withheld pursuant to exemption 
WIF Draft ; (b)(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-R-000163

Page 5738 
Withheld pursuant to exemption 
WIF Draft ; (b)(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-R-000164

Page 5739 
Withheld pursuant to exemption 
WIF Draft ; (b)(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-R-000165

Page 5740 
Withheld pursuant to exemption 
WIF Draft ; (b)(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-R-000166

Page 5741 
Withheld pursuant to exemption 
WIF Draft ; (b)(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-R-000167

Page 5742 
Withheld pursuant to exemption 
WIF Draft ; (b)(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-R-000168

Page 5743 
Withheld pursuant to exemption 
WIF Draft ; (b)(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-R-000169

Page 5744 
Withheld pursuant to exemption 
WIF Draft ; (b)(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-R-000170

Page 5745 
Withheld pursuant to exemption 
WIF Draft ; (b)(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-R-000171

Page 5746 
Withheld pursuant to exemption 
WIF Draft ; (b)(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-R-000172

Page 5747 
Withheld pursuant to exemption 
WIF Draft ; (b)(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-R-000173

Page 5748 
Withheld pursuant to exemption 
WIF Draft ; (b)(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-R-000174

Page 5749 
Withheld pursuant to exemption 
WIF Draft ; (b)(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-R-000175

Page 5750 
Withheld pursuant to exemption 
WIF Draft ; (b)(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-R-000176

Page 5751 
Withheld pursuant to exemption 
WIF Draft ; (b)(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-R-000177

Page 5752 
Withheld pursuant to exemption 
WIF Draft ; (b)(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-R-000178

Page 5753 
Withheld pursuant to exemption 
WIF Draft ; (b)(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-R-000179

Page 5754 
Withheld pursuant to exemption 
WIF Draft ; (b)(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-R-000180

Page 5755 
Withheld pursuant to exemption 
WIF Draft ; (b)(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-R-000181

Page 5756 
Withheld pursuant to exemption 
WIF Draft ; (b)(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-R-000182

Page 5757 
Withheld pursuant to exemption 
WIF Draft ; (b)(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-R-000183

Page 5758 
Withheld pursuant to exemption 
WIF Draft ; (b)(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-R-000184

Page 5759 
Withheld pursuant to exemption 
WIF Draft ; (b)(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-R-000185

Page 5760 
Withheld pursuant to exemption 
WIF Draft ; (b)(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-R-000186

Page 5761 
Withheld pursuant to exemption 
WIF Draft ; (b)(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-R-000187

Page 5762 
Withheld pursuant to exemption 
WIF Draft ; (b)(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-R-000188

Page 5763 
Withheld pursuant to exemption 
WIF Draft ; (b)(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-R-000189

Page 5764 
Withheld pursuant to exemption 
WIF Draft ; (b)(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-R-000190

Page 5765 
Withheld pursuant to exemption 
WIF Draft ; (b)(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-R-000191

Page 5766 
Withheld pursuant to exemption 
WIF Draft ; (b)(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-R-000192

Page 5767 
Withheld pursuant to exemption 
WIF Draft ; (b)(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-R-000193

Page 5768 
Withheld pursuant to exemption 
WIF Draft ; (b)(5) 
of the Freedom of Information and Privacy Act 
DHS-ICE-19-0196, 19-0197-R-000194