EFTA00134768¶
| BP-S358.060 | |
| SEP 05 |
CDFRM¶
MEDICAL TREATMENT REFUSAL¶
U.S. DEPARTMENT OF JUSTICE¶
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.¶
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.¶
Patient’s Signature¶
NYM—NEW YORK MCC¶
$DNY_00001025¶
| EFTA_00000234 | | :--- | :--- |¶
This is a simple Markdown document with no headings, paragraphs, or tables. It contains just one line of text: “EFTA_00000234”.¶
EFTA00134769¶
| BP-S358.060 | |
| SEP 05 |
MEDICAL TREATMENT REFUSAL¶
CDFRM¶