EFTA00059508

Bureau of Prisons
Health Services
See Amendment

Inmate Name: EPSTEIN, JEFFREY EDWARD
Date of Birth: 01/20/1953
Sex: M
Encounter Date: 07/26/2019 08:57

Reg #: 76318-054
Race: WHITE
Facility: NYM

Amendment made to this note by MD on 07/26/2019 08:58.

# Bureau of Prisons
Health Services
Clinical Encounter - Administrative Note

<table><thead><tr><th>Inmate Name:</th><td colspan="4">EPSTEIN, JEFFREY EDWARD</th><th>Reg #:</th><td>76318-054</td></tr></thead><tbody><tr><td>Date of Birth:</td><td>01/20/1953</td><td>Sex:</td><td>M</td><td>Race:WHITE</td><td>Facility:</td><td>NYM</td></tr><tr><td>Note Date:</td><td>07/24/2019 15:10</td><td>Provider:</td><td colspan="2"></td><td>Unit:</td><td>H01</td></tr></tbody></table>

Admin Note - General Administrative Note encounter performed at Health Services.

Administrative Notes:

Copay Required:No

ADMINISTRATIVE NOTE 1 Provider: MD

PATIENT WAS OFFERED TO HAVE AN OPTOMETRIST EVALUATION. HE REFUSED. REFUSAL FORM SIGNED.

Telephone/Verbal Order: No

Cosign Required: No

Completed by MD on 07/24/2019 15:17

Generated 07/24/2019 15:17 by

MD

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Bureau of Prisons - NYM