EFTA00073854¶
Bureau of Prisons¶
Health Services Clinical Encounter - Administrative Note¶
Inmate Name: EPSTEIN, JEFFREY EDWARD¶
Reg #: 76318-054¶
Date of Birth: 01/20/1953¶
| Sex: | M | Race:WHITE |
| Provider: |
Note Date: 07/24/2019 15:10¶
| Facility: | NYM |
| Unit: | H01 |
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¶
Page 1 of 1¶
Bureau of Prisons - NYM¶