EFTA00139322¶
| BP-S358 060 | |
| SEP 05 |
MEDICAL TREATMENT REFUSAL¶
CDFRM¶
U.S. DEPARTMENT OF JUSTICE¶
FEDERAL BUREAU OF PRISONS¶
| 7-24-2019 |
|---|
| Date |
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—NEW YORK MCC¶
CONFIDENTIAL¶
SDNY_00009379¶