EFTA00139075

# Bureau of Prisons
Health Services
Dental Health History Screen

| Inmate Name: | EPSTEIN, JEFFREY EDWARD |
| :--- | :--- |
| Date of Birth: | 01/20/1953 |
| Encounter Date: | 07/26/2019 07:54 |

| Sex: M | Race: WHITE |
| :--- | :--- |
| Provider: | DDS |

| Reg #: | 76318-054 |
| :--- | :--- |
| Facility: | NYM |
| Unit: | H01 |

## ASSESSMENTS:

Health Problems as of Dental Health History Encounter date: 07/26/2019 07:54

## Health Problems

<table border="1"><tr><td>Health Problem</td><td>Status</td></tr><tr><td>Hyperlipidemia, unspecified HYPERTRIGLYCERIDEMIA</td><td>Current</td></tr><tr><td>Sleep apnea</td><td>Current</td></tr><tr><td>Constipation, unspecified</td><td>Current</td></tr><tr><td>Low back pain</td><td>Current</td></tr><tr><td>Neuralgia and neuritis, unspecified</td><td>Current</td></tr><tr><td>No Diagnosis</td><td>Current</td></tr><tr><td>Injury, unspecified R/O self inflicted injuries.</td><td>Current</td></tr></table>

Medical History as of Dental Health History Encounter date: 07/26/2019 07:54

**Allergies:** Denied

**Seizures:** Denied

**Diabetes:** Denied

<table><tr><td>Cardiovascular:</td><td>Denied</td></tr></table>

**CVA:**

Denied

**Hypertension:** Denied

**Respiratory:** Denied

| Sickle Cell Anemia: | Denied |

| :--- | :--- |

| Carcinoma/Lymphoma: | Denied |

| :--- | :--- |

When Tested: 2019

<table><thead><tr><th>Test Result:</th><th>Negative</th></tr></thead></table>

When Diagnosed AIDS:

**Hepatitis:** Denied

Generated 07/26/2019 07:59 by

DDS



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Bureau of Prisons - NYM

EFTA00139076

Other Infectious Diseases:

<table><thead><tr><th>Syphilis:</th><th>No</th></tr></thead></table>

<table><thead><tr><th>Syphilis Last Treatment:</th><th>N/A</th></tr></thead></table>

| Genital Warts: | No |

| :--- | :--- |

<table><tr><td>Chlamydia:</td><td>Yes</td></tr></table>

<table><tr><td>Gonorrhea:</td><td>No</td></tr></table>

| Herpes: | No |

| :--- | :--- |

Chicken Pox: Yes

Other: No

**Comments:** Chlamydia in 2015, treated Chicken pox in childhood

Other Health Issues:

Other Medical Conditions And Treatment: sleep apnea

Current Medical Conditions:

Other Current Treatments:

Pregnant: N/A

Dental Observations as of Dental Health History Encounter date: 07/26/2019 07:54

<table><tr><td>Alcohol:</td><td>No</td></tr></table>

Methamphetamine: No

Tobacco products: No

**Other drugs:** No

<table><tr><td>Sensitive teeth:</td><td>No</td></tr></table>

<table><tr><td>Bleeding gums:</td><td>Yes</td></tr></table>

<table><thead><tr><th>Food impaction:</th><th>Yes</th></tr></thead></table>

Pain around ear: No

**Toothache:** No

Wear partial dentures: No

Unusual sounds while eating: No

<table><thead><tr><th>Snoring:</th><th>Yes</th></tr></thead></table>

<table><tr><td>Blisters on lips or mouth:</td><td>No</td></tr></table>

Clenching or grinding: Yes

Burning tongue: No

| Swelling or lumps in mouth/throat: | No |

| :--- | :--- |

**Bad breath:** No

| Decayed teeth: | No |

| :--- | :--- |

| Loose teeth: | No |

| :--- | :--- |

Wear dentures: No

| None: | No |

| :--- | :--- |

Comments:

Generated 07/26/2019 07:59 by



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EFTA00139077

| Inmate Name: EPSTEIN, JEFFREY EDWARD | Sex: M | Race: WHITE | Reg #: 76318-054 |
| :--- | :--- | :--- | :--- |
| Date of Birth: 01/20/1953 | Provider: | DDS | Facility: NYM |
| Encounter Date: 07/26/2019 07:54 | | | Unit: H01 |

**Cardiac Condition Requiring Prophylaxis:** No

**Prosthetic joint(s):** No

**Radiation history of head or neck:** No

**Excessive bleeding:** No

**Bisphosphonates:** No

**Comments:**

**Medications as of Dental Health History Encounter date:** 07/26/2019 07:54

**Medications:**

Docusate Sodium 100 MG Cap Exp: 08/11/2019 SIG: Take one capsule (100 MG) by mouth twice daily for 30 days
Omega 3 (Vascepa) 1 GM Capsule Exp: 01/13/2020 SIG: Take two capsules (2 GM) twice daily by mouth with food

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

Instructed inmate how to obtain medical, dental, and mental health care.

Copay Required: No

Telephone/Verbal Order: No

Cosign Required: No

Completed by

DDS on 07/26/2019 07:59

Generated 07/26/2019 07:59 by

DDS

Bureau of Prisons - NYM



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