EFTA00073972

# Bureau of Prisons
Health Services
Cosign/Review

Inmate Name: EPSTEIN, JEFFREY EDWARD

Date of Birth: 01/20/1953



Reg #: 76318-054



<table><tr><td>Sex:</td><td>M</td></tr><tr><td>Provider:</td><td>Lab Result Receive</td></tr></table>

Encounter Date: 07/10/2019 16:58

Race: WHITE

Facility: NYM

Cosigned by

on 07/14/2019 18:12.

Page 142 of 148

Withheld pursuant to exemption

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

of the Freedom of Information and Privacy Act

Bureau of Prisons - NYM

EFTA00073973



BP-A0489
JUN 10


HIV COUNSELING DOCUMENTATION

U.S. DEPARTMENT OF JUSTICE
FEDERAL BUREAU OF PRISONS

## Directions:

Use the following criteria to counsel the patient who is tested for the HIV antibody. Check off each item as they are discussed. Write NA beside any item that is inappropriate to the situation. Thereverse side of this form will be utilized to document seronegative and inconclusive test result. Then file in the patient's record, documenting in progress notes that counseling was completed.

## PRETEST:

1. Explain purpose of session.

2. Explain confidentiality.

3. Explain HIV antibody test.

a. What HIV is

b. What the test is

___c. Test Procedure

d. Meaning of test results

e. Inability of detecting early infection (false negatives)

| | |

| :--- | :--- |

| \_\_\_ f. | Potential need for additional testing |

g. Significance of a positive test.

## 4. List risk factors/clinical signs: (check all that apply)

a. Injecting drug use, sharing drug or tattoo equipment

<table><tr><td>b.</td><td>Unprotected or multiple sex partners</td><td>Page 143 of 148</td></tr></table>

c. Treated for: sexually transmitted infections, hepatitis, or TB

d. Clinical s/s: fever or illness of withheld pursuant to exposition AIDS opportunistic infections.

e. Exposure: recent occupational or non-occupational exposure/incident.

Pregnant female

of the Freedom of Information and Privacy Act

5. Obtain informed consent (when applicable).

6. Risk Reduction Behaviors. Educational material given.

7. Patient Reactions/Comments.

8. Explain how the patient will be notified of the result.

The above information has been explained to me in a language I can understand.

<table border="1"><tr><td>Signature of Inmate</td><td>Signature of Staff Counselor Jessibell Mueses</td></tr><tr><td colspan="2">Date: 7/9/15 76318-054</td></tr></table>

Inmate Name:

Register No.:

Institution:

File in the Medical Record: Section 6.

Prescribed by P6190

Replaces BP-S489.061 of APR,

EFTA00073974

| | |
| :--- | :--- |
| BP-S358.060 | |
| SEP 05 | |

MEDICAL TREATMENT ■ EFUSAL

CDFRM

FEDERAL BUREAU OF PRISONS

U.S. DEPARTMENT OF JUSTICE

<table border="1"><tr><td>7-9-2019</td></tr><tr><td>Date</td></tr></table>

1, 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:

Rectal and genital examination

The following treatment(s) was/were recommended:

Rectal and genital examination

Page 144 of 148

Withheld pursuant to exemption

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

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:

Undetected and untreated medical condition.

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 expressed wishes and directions.









EFTA00073975

| | |
| :--- | :--- |
| BP-S358.060 | |
| SEP 05 | |

MEDICAL TREATMENT REFUSAL

CDFRM

U.S. DEPARTMENT OF JUSTICE

FEDERAL BUREAU OF PRISONS

<table border="1"><tr><td>7-24-2019</td></tr><tr><td>Date</td></tr></table>



I. JEFFREY EPSTEIN



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.

Page 145 of 148

Withheld pursuant to exemption

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

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 expressed wishes and directions.







NYM--NEW YORK MCC