Contour Normal:Yes

Increased AP Diameter:No

Asymmetrical Expansion:No

Lungs Clear: Yes

Wheezes: No

Crackles: No

Rhonchi: No

Rales: No

Accessory Muscle Use: No

Comments:

## Spine:

Deformity: No

Full ROM:Yes

Tenderness:No

Comments:

## Cardiovascular:

RRR: Yes

Normal S1/S2: Yes

Murmurs: No

Carotid Bruits: No

Arteries:	Right	Left
Radial:
Femoral:
Dorsalis Pedis:
Post. Tibialis:

Normal Contour:Yes

Scaphoid:No

Obese:No

Gravid:No

Hernias:No

Bruits:No

Masses:No

Scars:No

Tenderness:No

Organomegaly:No

Active Bowel Sounds:Yes

Comments:

## Extremities:

Nails Clubbing: No

Nails Cyanosis: No

Lower Extremity Edema - Right: None

Lower Extremity Edema - Left: None

Atrophy: No

Amputations: No

Other Deformities: No

Varicosities: No

Calf Tenderness: No

Pulse Deficit: No

Strength:	Right	Left
Arm:
Leg:
Full ROM:	Right	Left
Arm:	Yes	Yes
Leg:	Yes	Yes
Comments:

Generated 07/09/2019 13:03 by MLP Page 11 of 13 Bureau of Prisons - NYM CONFIDENTIAL SDNY_00009438 EFTA00139343 ## Reflexes: - **Biceps:** - **Patellar:** - **Brachioradialis:** - **Achilles:** **Sensation:** - Vibratory: Yes - Light Touch: Yes - Pin Prick: Yes **Comments:** ## GU: **Chaperoned By:** ## Rectum: Not Done **Comments:** Refused. ## Male Genitalia: Not Done **Comments:** Refused. ## Skin: - Normal: Yes - Rash: No - Redness: No - Abnormal Pigmentation: No - Abnormal Lesions/Growths: No **Comments:** ## Lymphatics: - Adenopathy: No **Comments:** ## Potential Items For Follow-up: **Item** - Travel Outside US - Other Infectious Disease History - Rectum Not Done - Male Genitalia Not Done - PPD Administration Not Performed **Comments:** - Patient has a history of constipation. Generated 07/09/2019 13:03 by MLP Bureau of Prisons - NYM Page 12 of 13 CONFIDENTIAL SDNY_00009439 EFTA00139344 | Inmate Name: EPSTEIN, JEFFREY EDWARD | Sex: M | Race: WHITE | Reg #: 76318-054 | | :--- | :--- | :--- | :--- | | Date of Birth: | | | Facility: NYM | | Encounter Date: 07/09/2019 12:35 | Provider: | MLP | Unit: H01 | Cleared For Food Services: Yes Health Problems Newly Identified During This Encounter: Health Problem Constipation, unspecified - Current - New Medication Orders: | Rx# | Medication | Order Date | Prescriber Order | | :--- | :--- | :--- | :--- | | | Bisacodyl E.C. Tablet | 07/09/2019 12:35 | 5 mg Orally at bedtime PRN x 10 day(s) | Indication: Constipation, unspecified Disposition: Follow-up at Sick Call as Needed Instructed inmate how to obtain medical, dental, and mental health care. Copay Required: No Cosign Required: Yes Telephone/Verbal Order: No Completed by . MLP on 07/09/2019 13:03 Requested to be cosigned by MD. Cosign documentation will be displayed on the following page. Generated 07/09/2019 13:03 by MLP Page 13 of 13 Bureau of Prisons - NYM CONFIDENTIAL SDNY_00009440 EFTA00139345 # Bureau of Prisons Health Services Cosign/Review | Inmate Name: | EPSTEIN, JEFFREY EDWARD | | :--- | :--- | | Date of Birth: | Sex: M | | Encounter Date: | 07/09/2019 12:35 | | Provider: | MLP | | Reg #: | 76318-054 | | :--- | :--- | | Race: | WHITE | | Facility: | NYM | Bureau of Prisons - NYM CONFIDENTIAL SDNY_00009441