EFTA00140227

# 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

<table border="1"><tr><td colspan="2">Health Problems</td></tr><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

Medical History:

<table border="1"><tr><td>Allergies:</td><td>Denied</td></tr><tr><td>Seizures:</td><td>Denied</td></tr><tr><td>Diabetes:</td><td>Denied</td></tr><tr><td>Cardiovascular:</td><td>Denied</td></tr><tr><td>CVA:</td><td>Denied</td></tr><tr><td>Hypertension:</td><td>Denied</td></tr><tr><td>Respiratory:</td><td>Denied</td></tr><tr><td>Sickle Cell Anemia:</td><td>Denied</td></tr><tr><td>Carcinoma/Lymphoma:</td><td>Denied</td></tr><tr><td>HIV History:</td><td></td></tr><tr><td>When Tested:</td><td>2019</td></tr><tr><td>Test Result:</td><td>Negative</td></tr><tr><td>When Diagnosed AIDS:</td><td></td></tr><tr><td>Last CD4:</td><td></td></tr><tr><td>Comments:</td><td></td></tr><tr><td>Hepatitis:</td><td>Denied</td></tr></table>

Generated 07/26/2019 07:59 by

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DDS

Bureau of Prisons - NYM

EFTA00140228

<table><thead><tr><th>Inmate Name:</th><td colspan="5">EPSTEIN, JEFFREY EDWARD</th><th>Reg #:</th><td>76318-054</th></tr><tr><th>Date of Birth:</th><td colspan="2">01/20/1953</td><th>Sex: M</th><th colspan="2">Race: WHITE</th><th>Facility:</th><td>NYM</td></tr><tr><th>Encounter Date:</th><td colspan="2">07/26/2019 07:54</td><th>Provider:</th><th colspan="2"></th><th>Unit:</th><td>H01</td></tr></thead><tbody><tr><td colspan="9">Other Infectious Diseases:</td></tr><tr><td>&nbsp;&nbsp;Syphilis:</td><td></td><td>No</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>&nbsp;&nbsp;Syphilis Last Treatment:</td><td></td><td>N/A</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>&nbsp;&nbsp;Genital Warts:</td><td></td><td>No</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>&nbsp;&nbsp;Chlamydia:</td><td></td><td>Yes</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>&nbsp;&nbsp;Gonorrhea:</td><td></td><td>No</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>&nbsp;&nbsp;Herpes:</td><td></td><td>No</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>&nbsp;&nbsp;Chicken Pox:</td><td></td><td>Yes</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>&nbsp;&nbsp;Other:</td><td></td><td>No</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>&nbsp;&nbsp;Comments:</td><td colspan="2">Chlamydia in 2015, treated Chicken pox in childhood</td><td></td><td></td><td></td><td></td><td></td><td></td></tr></tbody></table>

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

Alcohol: No

Methamphetamine: No

Tobacco products: No

Other drugs: No

<table><thead><tr><th>Sensitive teeth:</th><th>No</th></tr></thead></table>

<Bleeding gums:</B> Yes

<table><tr><td>Food impaction:</td><td>Yes</td></tr></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>

Blisters on lips or mouth: No

Burning tongue: No

<table><tr><td>Clenching or grinding:</td><td>Yes</td></tr></table>

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

| :--- | :--- |

| Decayed teeth: | No |

| :--- | :--- |

| Loose teeth: | No |

| :--- | :--- |

Wear dentures: No

Bad breath: No

| None: | No |

| :--- | :--- |

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Bureau of Prisons - NYM

EFTA00140229

| 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

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.

<table><thead><tr><th>Copay Required: No</th><th>Cosign Required: No</th></tr></thead></table>

Telephone/Verbal Order: No

Completed by DDS on 07/26/2019 07:59

Generated 07/26/2019 07:59 by

DDS

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Bureau of Prisons - NYM