EFTA00073972¶
Bureau of Prisons¶
Health Services Cosign/Review¶
Inmate Name: EPSTEIN, JEFFREY EDWARD¶
Date of Birth: 01/20/1953¶
Reg #: 76318-054¶
| Sex: | M |
| Provider: | Lab Result Receive |
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:¶
-
Explain purpose of session.
-
Explain confidentiality.
-
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¶
| b. | Unprotected or multiple sex partners | Page 143 of 148 |
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¶
-
Obtain informed consent (when applicable).
-
Risk Reduction Behaviors. Educational material given.
-
Patient Reactions/Comments.
-
Explain how the patient will be notified of the result.
The above information has been explained to me in a language I can understand.¶
| Signature of Inmate | Signature of Staff Counselor Jessibell Mueses |
| Date: 7/9/15 76318-054 | |
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¶
| 7-9-2019 |
| Date |
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¶
| 7-24-2019 |
| Date |
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¶