EFTA00073854

# Bureau of Prisons
Health Services
Clinical Encounter - Administrative Note

Inmate Name: EPSTEIN, JEFFREY EDWARD



Reg #: 76318-054



Date of Birth: 01/20/1953

<table><tr><td>Sex:</td><td>M</td><td>Race:WHITE</td></tr><tr><td>Provider:</td><td></td><td></td></tr></table>

Note Date: 07/24/2019 15:10

<table border="1"><tr><td>Facility:</td><td>NYM</td></tr><tr><td>Unit:</td><td>H01</td></tr></table>

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

Administrative Notes:

ADMINISTRATIVE NOTE 1

Provider:

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

Copay Required: No

Cosign Required: No

Telephone/Verbal Order: No

Completed by

on 07/24/2019 15:17

Page 024 of 148

Withheld pursuant to exemption

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

of the Freedom of Information and Privacy Act

Generated 07/24/2019 15:17 by

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Bureau of Prisons - NYM