EFTA00121357

# Bureau of Prisons
Health Services
Vision Screens

<table border="1"><tr><td colspan="4">Reg #: 76318-054</td><td colspan="5">Inmate Name: EPSTEIN, JEFFREY EDWARD</td></tr><tr><td colspan="10">Vision Screen on 07/09/2019 12:52</td></tr><tr><td colspan="10">Blindness:</td></tr><tr><td>Distance Vision:</td><td colspan="3">OD: 20/100</td><td colspan="3">OS: 20/70</td><td colspan="3">OU:</td></tr><tr><td>Near Vision:</td><td colspan="3">OD:</td><td colspan="3">OS:</td><td colspan="3">OU:</td></tr><tr><td colspan="10">With Corrective</td></tr><tr><td>Distance Vision:</td><td colspan="3">OD:</td><td colspan="3">OS:</td><td colspan="3">OU:</td></tr><tr><td>Near Vision:</td><td colspan="3">OD:</td><td colspan="3">OS:</td><td colspan="3">OU:</td></tr><tr><td colspan="4">Present Glasses - Distance</td><td colspan="6">Refraction - Distance</td></tr><tr><td>Sphere</td><td>Cylinder</td><td>Axis</td><td>Add</td><td>Sphere</td><td>Cylinder</td><td>Axis</td><td>Add</td><td></td><td></td></tr><tr><td>R:</td><td></td><td></td><td></td><td>R:</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>L:</td><td></td><td></td><td></td><td>L:</td><td></td><td></td><td></td><td></td><td></td></tr></table>

Color Test:

Tonometry: R: L:

Comments: Needs evaluation with optometrist.

| Orig Entered: | 07/09/2019 12:54 EST | MLP |

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Bureau of Prisons - NYM