EFTA00073872

# Bureau of Prisons
Health Services
Clinical Encounter - Administrative Note

Inmate Name: EPSTEIN, JEFFREY EDWARD

Date of Birth: 01/20/1953

Race: WHITE

Sex:

Provider:

<table border="1"><tr><td>Reg #:</td><td>76318-054</td></tr><tr><td>Facility:</td><td>NYM</td></tr><tr><td>Unit:</td><td>E06</td></tr></table>

Note Date: 07/07/2019 00:17

Cosign Note - Intake Cosign encounter performed at Health Services.

Administrative Notes:

# ADMINISTRATIVE NOTE 1

MED CL:1

NO CCC APPT.

Provider:

<table><thead><tr><th>Details</th><th>Frequency</th><th>Due Date</th><th>Priority</th></tr></thead><tbody><tr><td>Lab Tests-H-Hemoglobin A1C</td><td>One Time</td><td>08/05/2019 00:00</td><td>Routine</td></tr><tr><td>Lab Tests-C-CBC w/diff</td><td></td><td></td><td></td></tr><tr><td>Lab Tests-L-Lipid Profile</td><td></td><td></td><td></td></tr><tr><td>Lab Tests-C-Comprehensive Metabolic Profile (CMP)</td><td></td><td></td><td></td></tr><tr><td>Lab Tests-U-Urinalysis w/Reflex to Microscopic</td><td></td><td></td><td></td></tr><tr><td colspan="4">Additional Information:</td></tr><tr><td colspan="4">66 y/o male, elevated BP</td></tr><tr><td colspan="4">Labs requested to be reviewed by: Beaudoin, Robert MD</td></tr><tr><td colspan="4">New Laboratory Requests:</td></tr><tr><td></td><td colspan="3">Withheld pursuant to exemption</td></tr><tr><td>Details</td><td>Frequency</td><td>Due Date</td><td>Priority</td></tr><tr><td>Chronic Care Clinics-Diabetic-CBC w/diff</td><td>(b)(6); (b)(7)(A); (b)(7)(C)</td><td>07/25/2019 00:00</td><td>Routine</td></tr><tr><td>Chronic Care Clinics-Diabetic-Lipid Profile</td><td></td><td></td><td></td></tr><tr><td>Chronic Care Clinics-Diabetic-Hemoglobin</td><td></td><td></td><td></td></tr><tr><td>Lab Tests-H-HIV 1/2</td><td></td><td></td><td></td></tr><tr><td>Lab Tests-RPR</td><td></td><td></td><td></td></tr><tr><td>Chronic Care Clinics-Diabetic-Comprehensive Metabolic Profile (CMP)</td><td></td><td></td><td></td></tr><tr><td colspan="4">New Radiology Request Orders:</td></tr><tr><td>Details</td><td>Frequency</td><td>End Date</td><td>Due Date</td></tr><tr><td>General Radiology-Chest-2 Views</td><td>One Time</td><td></td><td>07/25/2019</td></tr><tr><td colspan="4">Specific reason(s) for request (Complaints and findings):</td></tr></tbody></table>

66 YR OLD MALE WITH NO PMHX , REFERRED FOR ROUITNE CXR.

Cosign Required: No

Copay Required: No

Telephone/Verbal Order: No

Completed by on 07/07/2019 00:30

Generated 07/07/2019 00:30 by

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Bureau of Prisons - NYM