EFTA00139053

# Bureau of Prisons Health Services Inmate Local Hospital

<table border="1"><tr><td>Reg #: 76318-054</td><td colspan="2">Inmate Name: EPSTEIN, JEFFREY EDWARD</td></tr><tr><td colspan="3">SENSITIVE BUT UNCLASSIFIED – This information is confidential and must be appropriately safeguarded.</td></tr><tr><td colspan="2">Transfer To:</td><td>Transfer Date: 08/10/2019</td></tr><tr><td colspan="3">Health Problems</td></tr><tr><td>Health Problem</td><td colspan="2">Status</td></tr><tr><td>Hyperlipidemia, unspecified HYPERTRIGLYCERIDEMIA</td><td colspan="2">Current</td></tr><tr><td>Sleep apnea</td><td colspan="2">Current</td></tr><tr><td>Essential(primary) hypertension BY HX.</td><td colspan="2">Current</td></tr><tr><td>Constipation, unspecified</td><td colspan="2">Current</td></tr><tr><td>Low back pain</td><td colspan="2">Current</td></tr><tr><td>Neuralgia and neuritis, unspecified</td><td colspan="2">Current</td></tr><tr><td>No Diagnosis</td><td colspan="2">Current</td></tr><tr><td>Prediabetes</td><td colspan="2">Current</td></tr><tr><td>Injury, unspecified R/O self inflicted injuries.</td><td colspan="2">Current</td></tr><tr><td>Body mass index(BMI)27.0-27.9, adult</td><td colspan="2">Current</td></tr></table>

Medications: All medications to be continued until evaluated by a physician unless otherwise indicated. Bolded drugs required for transport.

<table border="1"><tr><td>Docusate Sodium 100 MG Cap</td><td>Exp:08/11/2019</td><td>SIG:Take one capsule(100 MG)by mouth twice daily for30days</td></tr><tr><td>Docusate Sodium 100 MG Cap</td><td>Exp:01/22/2020</td><td>SIG:Take one capsule(100 MG)twice daily bymouth with plenty of water</td></tr></table>

Milk of Magnesia Susp (OTC) (473ML) 400MG/5ML Exp: 10/28/2019 SIG: shake well take 10ml by mouth twice daily AS NEEDED

<table><tr><td>Omega 3 (Vascepa) 1 GM Capsule</td><td>Exp: 01/13/2020</td><td>SIG: Take two capsules (2 GM) twice daily by mouth with food</td></tr></table>

OTCs: Listing of all known OTCs this inmate is currently taking.

None

## Pending Appointments

<table border="1"><tr><td>Date</td><td>Time</td><td>Activity</td><td>Provider</td></tr><tr><td>07/24/2019</td><td>00:00</td><td>Clinical Encounter</td><td>Optometrist</td></tr><tr><td>01/07/2020</td><td>00:00</td><td>Chronic Care Visit</td><td>Mid-Level Provider</td></tr><tr><td>07/01/2020</td><td>00:00</td><td>Chronic Care Visit</td><td>Physician 01</td></tr><tr><td>07/09/2020</td><td>00:00</td><td>PPD Administration</td><td>Nurse</td></tr></table>

## Pending Non-Medication Orders:

<table><thead><tr><th>Order</th><th>Order Date</th><th>Frequency</th><th>Duration</th><th>Details</th></tr></thead><tbody><tr><td>EKG</td><td>07/06/2019</td><td>One Time</td><td></td><td>66 y/o male</td></tr><tr><td>Fecal Occult Blood</td><td>07/06/2019</td><td>One Time</td><td></td><td>3 different stools</td></tr></tbody></table>

TB Clearance: Yes

Last PPD Date: 07/09/2019

Last Chest X-Ray Date:___

TB Treatment:___

TB Follow-up Recommended: No

| | |

| :--- | :--- |

| Induration: | 0mm |

| Results: | |

| Sx free for 30 days: | Yes |

## Sickle Cell:

Sickle Cell Trait/Disease: ___ No___

Generated 08/10/2019 07:00 by



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RN

Bureau of Prisons - NYM

EFTA00139054

# SENSITIVE BUT UNCLASSIFIED – This information is confidential and must be appropriately safeguarded.

## Limitations/Restrictions/Diets:
- Cell: lower bunk --- 10/09/2019
- Cleared for Food Service: Yes
- Other diet restrictions: FISH ALLERGIES. --- 07/30/2020

## Comments:

## Allergies
No Known Allergies

## Devices / Equipment
C-Pap

## Travel:
- Direct Travel: No
- Travel Restrictions: None

## UNIVERSAL PRECAUTIONS OBSERVED WHEN TRANSPORTING ANY INMATE:

**Transfer From Institution:** NEW YORK MCC
Address 1: 150 PARK ROW
Address 2:
City/State/Zip: NEW YORK, New York 10007

Name/Title of Person Completing Form: RN
Date: 08/10/2019

Inmate Name: EPSTEIN, JEFFREY EDWARD
Reg #: 76318-054
DOB: 01/20/1953
Sex: M

Generated 08/10/2019 07:00 by

RN



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Bureau of Prisons - NYM