| | |
| :--- | :--- |
| BP-S358.060 | |
| SEP 05 | |

MEDICAL TREATMENT REFUSAL

CDFRM

U.S. DEPARTMENT OF JUSTICE

FEDERAL BUREAU OF PRISONS

<table border="1"><tr><td>7-24-2019</td></tr><tr><td>Date</td></tr></table>

1, 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:

The following treatment(s) was/were recommended:

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:

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.



CONFIDENTIAL



NYM—NEW YORK MCC





SDNY_00009374
EFTA00139318


| | |
| :--- | :--- |
| BP-S358.060 | |
| SEP 05 | |

MEDICAL TREATMENT REFUSAL

CDFRM

U.S. DEPARTMENT OF JUSTICE

FEDERAL BUREAU OF PRISONS

<table border="1"><tr><td>7-10-2019</td></tr><tr><td>Date</td></tr></table>

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:

The following treatment(s) was/were recommended:

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:

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.

NYM-NEWYORK MCC

CONFIDENTIAL



SDNY_00009375
EFTA00139319


| | |
| :--- | :--- |
| BP-S358.060 | |
| SEP 05 | |

MEDICAL TREATMENT REFUSAL

U.S. DEPARTMENT OF JUSTICE

CDFRM

FEDERAL BUREAU OF PRISONS

<table><thead><tr><th>7-24-2019</th></tr><tr><th>Date</th></tr></thead></table>

1, 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:

The following treatment(s) was/were recommended:

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:

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.



CONFIDENTIAL



NYM--NEW YORK MCC





SDNY_00009376