EFTA00139013¶
Bureau of Prisons¶
Health Services Clinical Encounter - Administrative Note¶
| Inmate Name: | EPSTEIN, JEFFREY EDWARD |
|---|---|
| Date of Birth: | 01/20/1953 |
| Note Date: | 07/24/2019 15:10 |
| Reg #: | 76318-054 | ||||
|---|---|---|---|---|---|
| Sex: M | Race: WHITE | Facility: NYM | |||
| Provider: MD | Unit: H01 |
Admin Note - General Administrative Note encounter performed at Health Services.¶
Administrative Notes:¶
ADMINISTRATIVE NOTE 1 Provider: MD¶
PATIENT WAS OFFERED TO HAVE AN OPTOMETRIST EVALUATION. HE REFUSED. REFUSAL FORM SIGNED.¶
Copay Required: No¶
Cosign Required: No¶
Telephone/Verbal Order: No¶
Completed by MD on 07/24/2019 15:17¶
Generated 07/24/2019 15:17 by¶
MD¶
Bureau of Prisons - NYM¶
Page 1 of 1 SDNY_00017377¶