## Bureau of Prisons Health Services ### Vision Screens | Reg #: 76318-054 | | | | Inmate Name: EPSTEIN, JEFFREY EDWARD | | | | | |-----------------------------------|------------|------------------------------------------------------------|-----|--------------------------------------|----------|------|-----|--| | Vision Screen on 07/09/2019 12:52 | | | | | | | | | | Blindness: | | | | | | | | | | Distance Vision: | OD: 20/100 | | | OS: 20/70 | | OU: | | | | Near Vision: | OD: | | OS: | | | OU: | | | | With Corrective | | | | | | | | | | Distance Vision: | OD: | | OS: | | | OU: | | | | Near Vision: | OD: | | OS: | | | OU: | | | | Present Glasses - Distance | | | | Refraction - Distance | | | | | | Sphere | Cylinder | Axis | Add | Sphere | Cylinder | Axis | Add | | | R: | | | | R: | | | | | | L: | | | | L: | | | | | | Color Test: | | | | | | | | | | Tonometry: | R: | L: | | | | | | | | Comments:
Orig Entered: | | Needs evaluation with optometrist.
07/09/2019 12:54 EST | | MLP | | | | | Generated 08110/2019 11:02 by Bureau of Prisons - NVM Page 1 of 1 CONFIDENTIAL SDNY_00009458 ### Bureau of Prisons Health Services Immunizations | Begin Date: 07/07/2019
End Date:
08/10/2019 | | | | | | | | |-------------------------------------------------------------|----------------------------------------|---------------------------------|-----------|-----------------|-----|----------|--| | Reg #:
Inmate Name: EPSTEIN, JEFFREY EDWARD
76318-054 | | | | | | | | | immunization
Hepatitis A and B (TwinRx) | immunization Date | Administered
History Unknown | JLocation | Dosaae Drug Mfg | Lai | Axp Date | | | Measles/Mumps/Rubeila Series | Orig Entered: 07/09/2019 12:51 EST MM. | MLP
History Unknown | | | | | | | Orig Entered: 07/09/2019 12:51 EST
Smallpox Series | | . MLP
History Unknown | | | | | | | Tetanus | Orig Entered: 07/09/2019 12:51 EST | MLP
History Unknown | | | | | | | Varicella Series | Orig Entered: 07/09/2019 12:51 EST | MLP
History Unknown | | | | | | | Total: 5 | Orig Entered: 07/09/2019 12:51 EST | MLP | | | | | | Generated 09/10/201911:02 by RN/1OPADC Bureau of Prisons NYM Page loll CONFIDENTIAL SDNY_00009459 ## Bureau of Prisons Health Services ### Medical Duty Status | Reg #: 76318-054 | Inmate Name: EPSTEIN. JEFFREY EDWARD | | |---------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------|------------------------------------------------------| | Housing Status
confined to the living quarters except
meals | _treatments
pill line | Exp. Date: | | _bathroom privileges only
on complete bed rest:
cell on first floor _single cell X lower bunk
X cell:
other: | airborne infection isolation | Exp. Date:
Exp. Date:
10/09/2019
Exp. Date: | | Physical Limitation/Restriction
all sports
_upper body
weightlifting:
lower body
running _jogging
walking
cardiovascular exercise: | softball | Exp. Date:
Exp. Date:
Exp. Date: | | _football _basketball _handball
other: | stationary equipment | Exp. Date: | | May have the following equipment in his / her possession:
Equipment | End Date
Start Date | Return Dale | | C-Pap
PHILIPS RESPIRONICS SYSTEM ONE CPAP MACHINE.
SERIAL ti: P1131281381ED. | 07/30/2019 | | | Work Restriction / Limitation:
Yes
Cleared for Food Service:
X No Restrictions | | | | Comments: N/A | | | | Health Services Staff | | 07/30/2019
Date | | EPSTEIN, JEFFREY EDWARD
Reg 4:
Inmate Name: | 76318.054
Quarters: | Z04 | ALL EXPIRATION DATES ARE AT 24:00 Generated 08/10/2019 11 02 by Bureau of Prisons • NYM Page 1 of ### Bureau of Prisons Health Services Medical Duty Status | Reg #: 76318-054 | Inmate Name: EPSTEIN, JEFFREY EDWARD | | |---------------------------------------------------------------------------------------------|-----------------------------------------------------------------------|----------------------------------------| | Housing Status
confined to the living quarters except
_
_
on complete bed rest: | _pill line
_meals
_treatments
___bathroom privileges only | Exp. Date:
Exp. Date: | | cell on first floor _single cell X lower bunk
X cell:
other: | airborne infection isolation | Exp. Date:
10/09/2019
Exp. Date: | | Physical Limitation/Restriction
all sports
weightlifting:
upper body | lower body | Exp. Date:
Exp. Date: | | running _jogging
cardiovascular exercise:
football | walking
softball
stationary equipment
handball
basketball | Exp. Date: | | other:
May have the following equipment in his / her possession: | | Exp. Date: | | Work Restriction / Limitation:
Yes
Cleared for Food Service:
X No Restrictions | | | | Comments: N/A | MLP | 07/09/2019 | | Health Services Staff
EPSTEIN, JEFFREY EDWARD
Inmate Name: | Reg #:
76318-054 | Date
Z04
Quarters: | ALL EXPIRATION DATES ARE AT 24:00 Generated 08/10/2019 11:02 by bureau of Prisons - NYM Page 1 of 1 ## Bureau of Prisons Health Services Medication Summary Historical | | Complex: NYM--NEW YORK MCC | | | Begin Date: 07/07/2019 | End Date: 08/10/2019 | |------------|--------------------------------------|------------------------------------------------------------|---------------------------------------------------------------------------------------------------|------------------------|-----------------------------------------| | Inmate: | | EPSTEIN. JEFFREY EDWARD | Reg #: | 76318-054 | Quarter:
Z04-206LAD | | | | | Medications listed reflect prescribed medications from the begin date to end date on this report. | | | | Allergies: | | Denied | | | | | | Active Prescriptions | | | | | | | Bisacodyl E.C. 5 MG TAB | | | | | | | | | Take one tablet (5 MG) by mouth at bedtime AS NEEDED for 10 days | | | | Rx#: | 121757-NYM | Doctor: | MLP | | | | | Start: 07/09/19 | Exp: 07/19/19 | D/C: 07/12/19 | | Pharmacy Dispensings: 10 TAB in 32 days | | | Docusate Sodium 100 MG Cap | | | | | | | | Take one capsule (100 MG) by mouth twice daily for 30 days | | | | | Rx#: | 121823-NYM | Doctor: | | | | | | Start: 07/12/19 | Exp: 08/11/19 | | | Pharmacy Dispensings: 60 CAP in 29 days | | | Docusate Sodium 100 MG Cap | | | | | | | | | Take one capsule (100 MG) twice daily by mouth with plenty of water | | | | Rx#: | 122084-NYM | Doctor: | | | | | | Start: 07/26/19 | Exp: 01/22/20 | | | Pharmacy DIspensIngs: 30 CAP in 15 days | | | | Milk of Magnesia Susp (OTC) (473ML) 400MG/5ML | | | | | | | shake well take 2 tablespoonful twice daily by mouth | | | | | Rx#: | 121835-NYM | Doctor: | | | | | | Start: 07/12/19 | Exp: 07/14/19 | | | Pharmacy Dispensings: 473 ML in 29 days | | | | Milk of Magnesia Susp (OTC) (473ML) 400MG/5ML | | | | | | | shake well take 10mi by mouth twice daily AS NEEDED | | | | | Rx#: | 122150-NYM | Doctor: | | | | | | Start: 07/30/19 | Exp: 10/28/19 | | | Pharmacy Dispensings: 473 ML in 11 days | | | | methylPREDNISolone 4 MG Tab ( 21 count Pack) | | | | | | Take the tablet by mouth as directed | | | | | | Rx#: | 121836-NYM | Doctor: | | | | | | Start: 07/12/19 | Exp: 07/18/19 | | | Pharmacy Dispensings: 21 tab in 29 days | | | | methylPREDNISolone 4 MG Tab ( 21 count Pack) | | | | | | Take the tablet by mouth as directed | | | | | | Rx#: | 122149-NYM | Doctor: | | | | | | Start: 07/30/19 | Exp: 08/05/19 | | | Pharmacy Dispensings: 21 tab in 11 days | | | | | | | | Bureau of Prisons - NYM Page 1 of 2 ## CONFIDENTIAL SDNY_00009462 | | Complex: NYM—NEW YORK MCC | | | Begin Date: 07/07/2019 | | End Date: 08/10/2019 | | | | |----------------------------------------------------------------------------------------------------------------|--------------------------------------|---------------------------------------------------------|--------|------------------------------------------|----------|----------------------|--|--|--| | Inmate: | | EPSTEIN, JEFFREY EDWARD | Reg #: | 76318-054 | Quarter: | 204-206LAD | | | | | | | | | | | | | | | | | Active Prescriptions | | | | | | | | | | | Omega 3 (Vascepa) 1 GM Capsule | | | | | | | | | | | | Take two capsules (2 GM) twice daily by mouth with food | | | | | | | | | Rx#: | 121885-NYM | Doctor: | | | | | | | | | | Start: 07/17/19 | Exp: 01/13/20 | | Pharmacy Dispensings: 180 Cap in 24 days | | | | | | | | Insulin Reg (10 ML) 100 UNITS/ML Inj | | | | | | | | | | daily '"pill linen' for 7 days "'pill linen'
Inject regular insulin subcutaneously per sliding scale: twice | | | | | | | | | | | Rx#: | 122148-NYM | Doctor: | | | | | | | | | | Start: 07/30/19 | Exp: 08/06/19
D/C: 07/31/19 | | Pharmacy Dispensings: 0 ML in 11 days | | | | | | | Insulin Reg (10 ML) 100 UNITS/ML lnj | | | | | | | | | | | Inject regular insulin subcutaneously per sliding scale: each morning for 7 days "'pill linen' "'pill linen' | | | | | | | | | | | Rx#: | 122160-NYM | Doctor: | | | | | | | | | | Start: 07/31/19 | Exp: 08/07/19 | | Pharmacy Dispensings: 0 ML in 10 days | | | | | | | | | | | | | | | | | ### Bureau of Prisons Health Services Dental Health History Screen | Inmate Name:
Date of Birth: | EPSTEIN, JEFFREY EDWARD
01/20/1953
Encounter Date: 07/26/2019 07:54 | | M
Sex:
Provider: | Race. | WHITE
DDS | Reg #:
Facility:
Unit: | 76318-054
NYM
H01 | | |--------------------------------|------------------------------------------------------------------------------|----------|------------------------|-------|------------------|------------------------------|-------------------------|--| | ASSESSMENTS: | | | | | | | | | | | Health Problems as of Dental Health History Encounter date: 07/26/2019 07:54 | | | | | | | | | Health Problems | | | | | | | | | | hen | | | Status | | | | | | | Hyperlipidemia, unspecified | HYPERTRIGLYCERIDEMIA | | Current | | | | | | | Sleep apnea | | | | | | Current | | | | Constipation, unspecified | | | | | | Current | | | | Low back pain | | | | | | Current | | | | | Neuralgia and neuritis, unspecified | | | | | Current | | | | No Diagnosis | | | | | | Current | | | | Injury, unspecified | R/O self inflicted injuries. | | | | | Current | | | | Medical History: | Medical History as of Dental Health History Encounter date | | | | 07/26/2019 07:54 | | | | | Allergies: | | Denied | | | | | | | | Seizures: | | Denied | | | | | | | | Diabetes: | | Denied | | | | | | | | Cardiovascular: | | Denied | | | | | | | | CVA: | | Denied | | | | | | | | Hypertension: | | Denied | | | | | | | | Respiratory: | | Denied | | | | | | | | Sickle Cell Anemia: | | Denied | | | | | | | | Carcinoma/Lymphoma: | | Denied | | | | | | | | HIV History: | | | | | | | | | | When Tested: | | 2019 | | | | | | | | Test Result: | | Negative | | | | | | | | When Diagnosed AIDS: | | | | | | | | | | Last CD4: | | | | | | | | | | Comments: | | | | | | | | | | Hepatitis: | | Denied | | | | | | | | Inmate Name:
Date of Birth: | EPSTEIN, JEFFREY EDWARD
01/20/1953
Encounter Date: 07/26/2019 07:54 | | Sex:
Provider: | M | Race: | WHITE
DDS | Reg #:
Facility:
Unit: | 76318-054
NYM
H01 | |------------------------------------------------------------------|---------------------------------------------------------------------------|----|-------------------|---|-------|--------------|------------------------------|-------------------------| | Other Infectious Diseases: | | | | | | | | | | Syphilis: | | No | | | | | | | | Syphilis Last Treatment:
N/A | | | | | | | | | | Genital Wads:
No | | | | | | | | | | Chlamydia:
Yes | | | | | | | | | | Gonorrhea: | | No | | | | | | | | Herpes:
No | | | | | | | | | | Chicken Pox:
Yes | | | | | | | | | | Other: | | No | | | | | | | | Comments: Chlamydia in 2015, treated
Chicken pox in childhood | | | | | | | | | | Other Health Issues: | | | | | | | | | | | Other Medical Conditions And Treatment: sleep apnea | | | | | | | | | | | | | | | | | | Current Medical Conditions: Other Current Treatments: #### Pregnant: N/A #### Dental Observations as of Dental Health History Encounter date: 07/26/2019 07:54 | | History: | | |------------------------------------|----------|--| | Alcohol: | No | | | Methamphetamine: | No | | | Tobacco products: | No | | | Other drugs: | No | | | Sensitive teeth: | No | | | Bleeding gums: | Yes | | | Food impaction: | Yes | | | Pain around ear: | No | | | Toothache: | No | | | Wear partial dentures: | No | | | Unusual sounds while eating: | No | | | Snoring: | Yes | | | Blisters on lips or mouth: | No | | | Clenching or grinding: | Yes | | | Swelling or lumps in mouth/throat: | No | | | Burning tongue: | No | | | Bad breath: | No | | | Decayed teeth: | No | | | Loose teeth: | No | | | Wear dentures: | No | | | None: | No | | | Comments: | | | | | | | Generated 0712612019 07.59 by DOS Bureau of Prisons - NYM Page 2 of 3 ## CONFIDENTIAL SDNY_00009465 | Inmate Name:
Date of Birth: | EPSTEIN. JEFFREY EDWARD
01/20/1953
Encounter Date: 07/26/2019 07:54 | M
Sex:
Provider: | Race: | WHITE
DDS | Reg #:
Facility:
Unit: | 76318-054
NYM
H01 | | | |------------------------------------|---------------------------------------------------------------------------|------------------------|-------|--------------|------------------------------|-------------------------|--|--| | | Cardiac Condition Requiring Prophylaxis: No | | | | | | | | | Prosthetic joint(s): | | No | | | | | | | | Radiation history of head or neck: | | No | | | | | | | | Excessive bleeding: | | No | | | | | | | | Bisphosphonates: | | No | | | | | | | | Comments: | | | | | | | | | | | | | | | | | | | Medications as of Dental Health History Encounter date: 07/26/2019 07:54 Medications: Docusate Sodium 100 MG Cap Exp: 08/11/2019 SIG: Take one capsule (100 MG) by mouth twice daily for 30 days Omega 3 (Vascepa) 1 GM Capsule Exp: 01/13/2020 SIG: Take two capsules (2 GM) twice daily by mouth with food OTCs: Listing of all known OTCs this inmate is currently taking. Instructed inmate how to obtain medical, dental, and mental health care. | Copay Required:No | Cosign Required: No | | | | | | |---------------------------|-------------------------|--|--|--|--|--| | TelephoneNerbal Order: No | | | | | | | | Completed by | DDS on 07/26/2019 07:59 | | | | | | ### Bureau of Prisons Health Services Dental A&O Exam | Inmate Name:
Date of Birth: | | EPSTEIN, JEFFREY EDWARD
01/20/1953
Encounter Date: 07/26/2019 07:47 | Sex: M
Provider: | Race: WHITE
DDS | Reg #:
Facility:
Unit: | 76318-054
NYM
H01 | |-----------------------------------------------------------------------|----------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------|--------------------|------------------------------|-------------------------| | Reviewed Health Status:
Occlusion:
Oral Hygiene: Fair
CPITN: | Class I | Yes | | | | | | 3 | 2 | 3 | | | | | | 3 | 2
1 | 3
1 | | | | | | Comments: | | Hard and soft tissue examination performed and documented on BP618 form: Yes
Head & Neck/Soft Tissue within normal limits?
moderate to advanced upper posterior gingival recession | No | | | | | Decayed: | Missing: | Filled: | | | | | | 0 | 1 | 14 | | | | | | Comments: | | Lower anterior crowding
Approved for hygiene appointment and radiographs:
Instructed inmate how to obtain routine and emergency dental care. Oral hygiene Instructions given: | | Yes | | Yes | | 07/26/2019 07:47. | | Dental A&O Screening Exam findings entered on EPSTEIN. JEFFREY EDWARD by | | | | DDS on | ### Bureau of Prisons Health Services Dental Soap/Admin Encounter | Inmate Name: | EPSTEIN, JEFFREY EDWARD | | | | Reg #: | 76318-054 | |----------------|----------------------------------|-----------|---|-------------|-----------|-----------| | Date of Birth: | 01/20/1953 | Sex: | M | Race: WHITE | Facility: | NYM | | | Encounter Date: 07/18/2019 13:48 | Provider: | | Dental Asst | Unit: | 205 | Screening encounter at Dental Clinic. Reason Not Done: Unavailable Comments: Patient has had several call outs for his Dental A & O screening but has not been escorted to the dental clinic. Cosign Required: No Completed by Dental Asst on 07/19/2019 13:49. ## CONFIDENTIAL SDNY_00009468 #### Federal Bureau of Prisons #### U.S. Medical Center for Federal Prisons 1900 W. Sunshine Street Springfield, MO 65807 417-874-1621 | | | | "' Sensitive But Unclassified 1" | | | |----------------------------------------------------------------------------------------------------------------------------------------------------------------------|---|---------------------|------------------------------------------------------------------------------------------------------------------------------------|--------|--| | Facility
Name EPSTEIN, JEFFREY
MCC New York
Order Unit E06-547U
Reg # 76318-054
Provider
MD
DOB
01/20/1953
M
Sex | | LIS ID
188191004 | Collected 07/09/2019 13:34
Received 07/10/2019 10:44
Reported 07/10/2019 14:46 | | | | | | | | | | | | | CHEMISTRY | | | | | Sodium | | 137 | 137-148 | mmol/L | | | Potassium | | 4.7 | 3.5-5.0 | mmoUL | | | Chloride | | 99 | 99-114 | mmol/L | | | CO2 | | 27 | 22-30 | mmoUL | | | BUN | | 17 | 7-22 | mg/dL | | | Creatinine | | 1.05 | 0.66-1.25 | mg/dL | | | eGFR (IDMS) | | >60 | | | | | GFR units measured as mUmin/1.73 mA2. If African American multiply by 1.210.
A calculated GFR <60 suggests chronic kidney disease if found over a 3 month period. | | | | | | | Calcium | | 9.8 | 8.5-10.9 | mg/dL | | | Glucose | | 102 | 70-110 | mg/dL | | | AST | H | 57 | 11-55 | U/L | | | ALT | | 62 | 11-66 | U/L | | | Alkaline Phosphatase | | 64 | 41-133 | U/L | | | Bilirubin, Total | | 1.1 | 0.2-1.3 | mg/dL | | | Total Protein | | 7.3 | 6.0-8.2 | g/dL | | | Albumin | | 4.4 | 3.6-5.1 | g/dL | | | Globulin | | 2.9 | 2.0-3.7 | g/dL | | | Alb/Glob Ratio | | 1.50 | 1.00-2.30 | | | | Anion Gap | | 10.2 | 9.0-19.0 | | | | BUN/Creat Ratio | | 16.1 | 5.0-30.0 | | | | Cholesterol | H | 216 | <200 | mg/dL | | | Trighicerides | H | 413 | 10-150 | mg/dL | | | | | | Calculation of LOL is not appropriate for samples with a triglyceride greater than 400 mg/dL. Therefore the LDL Is not calculated. | | | | HDL Cholesterol | L | 31 | 40-60 | mg/dL | | | Chol/HDL Ratio | H | 6.9 | 0.0-4.0 | | | | | | | | | | | HEMATOLOGY | | | | | | | | |-------------|-----------------------|-------------------------|----------------------------------|-------|--|--|--| | WBC | | 7.6 | 4.3-11.1 | K/uL | | | | | NRBC% | | 0.0 | | | | | | | RBC | | 5.42 | 4.46-5.78 | M/ut. | | | | | Hemoglobin | | 15.6 | 13.6-17.6 | g/dL | | | | | Hematocsit | | 47.8 | 40.2-51.4 | | | | | | MCV | | 88.2 | 82.5-96.5 | iL | | | | | MCH | | 28.8 | 27.1-34.9 | P9 | | | | | MCHC | L | 32.6 | 33.0-37.0 | g/dL | | | | | RDW-CV | | 12.8 | 12.0-14.0 | | | | | | Platelet | | 338 | 130-374 | K/uL | | | | | FLAG LEGEND | L=Low L!=Low Critical | H=High HI=High Critical | A=Abnormal Al =Abnormal Critical | | | | | Page 1 of 3 ## CONFIDENTIAL SDNY_00009469 | Federal
Bureau of
Prisons | U.S. Medical Center for Federal Prisons
1900 W. Sunshine Street
Springfield, MO 65807
417-874-1621 | ••• Sensitive But Unclassified ••• | | |------------------------------------------|-------------------------------------------------------------------------------------------------------------|------------------------------------|---------| | Name EPSTEIN, JEFFREY | Facility
MCC New York | Collected 07/09/2019 13:34 | | | Reg # 76318-054 | Order Unit E06-547U | Received 07/10/2019 10:44 | | | DOB
01/20/1953 | Provider
MD | Reported 07/10/2019 14:46 | | | M
Sex | | LIS ID
188191004 | | | | HEMATOLOGY | | | | MPV | 10.4 | 6.9-10.5 | fL | | Neutrophils % | 58.7 | | | | | Therapeutic decision making should be based on absolute values, rather than percentages | | | | Lymphocytes % | 25.0 | | | | Monocytes % | 11.1 | | ok | | Eosinophils % | 4.1 | | | | Basophils % | 0.8 | | | | Immature Granulocytes % | 0.3 | 0.0-5.0 | | | Neutrophils # | 4.4 | 1.9-6.7 | K/uL | | Lymphocytes # | 1.9 | 1.3-3.7 | K/uL | | Monocytes # | 0.8 | 0.3-1.1 | K/uL | | Eosinophils # | 0.3 | 0.0-0.5 | K/uL | | Basophils # | 0.1 | 0.0-0.1 | K/uL | | Immature Granulocytes # | 0.02 | 0.00-0.50 | 10^3/uL | | | HEMOGLOBIN A1C | | | | Hemoglobin A1C | H
6.3 | <5.7 | | | 5.7 - 6.4 Increased Risk
6.4 Diabetes | | | | | | SEROLOGY | | | | RPR | Non-Reactive | Non-Reactive | | Results may be affected in patients with severely advanced immunosuppression. FLAG LEGEND L=Low L!=Low Critical H=High Fil=High Critical A=Abnormal A! =Abnormal Critical Page 2 of 3 # CONFIDENTIAL SDNY_00009470 | U.S. Medical Center for Federal Prisons
itaE)Federal
p
Bureau of
1900 W. Sunshine Street
Prisons
Springfield, MO 65807
417.874-1621 | | | | | |----------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------|------------------------------------|--|--| | | | ••• Sensitive But Unclassified '•' | | | | Name EPSTEIN, JEFFREY | Facility
MCC New York | Collected 07/09/2019 13:34 | | | | Reg # 76318-054 | Order Unit E06-547U | Received 07/10/2019 10:44 | | | | DOB
01/20/1953 | Provider
MD | Reported 07/10/2019 14:46 | | | | Sex
M | | LIS ID
188191004 | | | | | | | | | | | HIV | | | | | HIV 1/2 | Negative | Negative | | | | Screening lest - See confirmatory testing for Reactive results | | | | | FLAG LEGEND L=Low LI=Low Critical H=High H!=High Critical A=Abnonnal A! =Abnormal Critical Page 3 of 3 ## CONFIDENTIAL SCINY_00009471 ## Bureau of Prisons Health Services Cosign/Review | Facility:
NYM
Provider:
Lab Result Receive
Encounter Date: 07/10/2019 16:58 | Inmate Name:
Date of Birth: | EPSTEIN, JEFFREY EDWARD
01/20/1953 | Sex: | M | Reg #:
Race: | 76318-054
WHITE | |-----------------------------------------------------------------------------------------|--------------------------------|---------------------------------------|------|---|-----------------|--------------------| |-----------------------------------------------------------------------------------------|--------------------------------|---------------------------------------|------|---|-----------------|--------------------| Cosigned by on 07/141201918:12. Bureau of Prisons NYM I #### U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS 7-24-2019 Date I, JEFFREY EPSTEIN 76318-054 refuse treatment recommended by the Federal Bureau of Prisons Medical staff for the following condition(s): DESCRIBE CONDITION IN LAYMAN'S TERMINOLOGY: EYE DOCTOR EVALUATION. The following treatment(s) was/were recommended: EYE DOCTOR EVALUATION. Federal Bureau of Prisons Medical staff members have carefully explained to me that the following possible consequences and/or complications may result because of my refusal to accept treatment: INABILITY TO DIAGNOSE CURRENT OPTHALMOLOGIC DISEASES. I understand the possible consequences and/or complications, listed above, and still refuse recommended treatment. I hereby assume all responsibility for my physical and/or mental condition, and release the Bureau of Prisons and its employees from any and all liability for respecting and following my | | ions. | | | | |----------------------|-------------------|-------------------|------|--| | Counseled by | 7-24-2019
Date | | Date | | | Signature ofVVitne s | Date | NYM--NEW YORK MCC | | | ## CONFIDENTIAL SDNY_00009473 EFTA00033858 1 #### BP-A0618 A&O DENTAL EXAMINATION JUN 16 (Initial Clinical Dental Findings) U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS #### Occlusion: • MN x 1 2 3 4 5 0 7 8 0 1011 12 13 14 15 18 WI - 32 31 30 2D 28 27 28 25 24 23 22 21 20 ID 18 17 7 054 Oral Hygiene: Good Fair E 00r CP:TN: 3 3 3 2- 3 Head & Neck / Soft Tissue: cAk, p Classification: CL -7— Pain Scale: /10 Dental Prostheses at Intake: Yes No Type: Age: Condition: Comrant .1O :44 0.* 75 / V41 r ie. 02 SS/ on 017Serum Lat-ste--r C+N. AC1or catsliAc 0.10w Intra-oral Photos Taken: Yes 0 Radiographs Taken: (Document findings on ASO encounter) Yes 9 Instructed how to obtain urgent and non-urgent dental care: Yes: I No: Treatment Priorities: None: Non-urgent non-urgent Urgent Referred to Sick Call: Radiographs authorized: PM: Prophylaxis authorized: Yes i No (Approval valid 18 months from examination date) BWs: Panorer Patient Name: s—terni . - ) C-C1PW-v E - - • -1 9. DS Fiegsti: Number , 76 3 ISE; ock-\ Institution: / MCC NEW YORK a e: --7- z6 gnature Block/Stamp: IDS. ief DentalOfficer MCC New York PDF Mescal:it'd by PeAci0 Replaces BP-A0618 of JUN 10 ## CONFIDENTIAL SDNY_00009474