EFTA00035180.pdf

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: EYE DOCTOR EVALUATION. The following treatment(s) was/were recommended: EYE DOCTOR EVALUATION. 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 INABILITY TO DIAGNOSE CURRENT OPTHALMOLOGIC DISEASES. • 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. Counseled by 7-24-2019 Date NYM-NEW YORK MCC EFTA00035180 BP-S358C80 MEDICAL TREATMENT REFUSAL CDFRM SEP 05 U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS 7-10-2019 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: 66 YR OLD MALE WITH NO PMHX , REFERRED FOR ROUITNE CXR. The following treatment(s) was/were recommended: CHEST X-RAY 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: WORSENING THE CONDITION IF THERE IS ANY FINDINGS 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. X-RAY 7-10-2019 Counseled by Date Patien Signature Date ( q, NYM-NEW YORK MCC Date EFTA00035181 BP -5358.060 MEDICAL TREATMENT REFUSAL CDFRM SEP 05 U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS 7-24-2019 Date 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: EYE DOCTOR EVALUATION. The following treatment(s) was/were recommended: EYE DOCTOR EVALUATION. 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: INABILITY TO DIAGNOSE CURRENT OPTHALMOLOGIC DISEASES. 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. Counseled by Dale 7-24-2019 Pa nt's Si Date NYM--NEW YORK MCC 4 EFTA00035182 BP -A0618 JUN 15 U.S. DEPARTMENT OF JUSTICE A&O DENTAL EXAMINATION (Initial Clinical Dental Findings) FEDERAL BUREAU OF PRISONS Occlusion: • AA 1 2 1 4 5 6 7 8 9 1011 1213 14 15 18 rg O 32 31 30 2D 28 27 2825 24 23 22 21 20 19 • 18 17 21 CC mmomel;;' Oral Hygiene: Good Fair , oar CP:TN: 3 3 3 2- 3 Head 8 Neck / Soft Tissue: D: M: I F: I Li Classification: CL Pain Scale: /10 Dental Prostheses at Intake: Yes No Type: Age: Condition: ComnAl I i7 aC r: Ft , ri V )72 .5 i Vet" r- ccess. cy-) ekt Sen)-e - L.7-se-e- C—Niell Or Cat.SajA c 0.1050-M 4 Intra-oral Photos Taken: Yes 0 Radiographs Taken: (Document findings on A8O encounter) Yes 9 • Instructed how to obtain urgent and non-urgent dental care: Yes: 1 No: Treatment Priorities: None: Non-urgent non-urgent Urgent Referred to Sick Cali: Radiographs authorized: PM: Prophylaxis authorize& Yes i No (Approval valid 18 months from examination date) BWs: Panoreic irnt Name: kmf skin, i -0 -4-li - -e_v S l>DS -Number. t -- 7 (, 3 lc= Us-Li institution: / MCC NEW YORK Date: 7- 26 -/ 9. Signature Biock/Stamp: 'DS. PDF Prescribed by P6400 het uentalOfficer MCC New York Replaces BP-A0618 of JUN 10 EFTA00035183 I 1 2 3 4 5 0 7 8 0 1011 1213 14 15 16 mr- 0 32 31 30 2D 28 27 26 25 24 23 22 21 20 10 18 17 BP -A0618 JUN 18 U.S. DEPARTMENT OF JUSTICE A&O DENTAL EXAMINATION (initial Clinical Dental Findings) FEDERAL BUREAU OF PRISONS Oodusion: Oral Hygiene: Good Fair Poor 3 2- 3 3 2- Head & Neck / Soft Tissue: D fa F: Classification: CL_ Pain Scale: /10. Dental Prostheses at Intake: Yes No Type: Ag e: Condition: Cot _to rii R Ce SS / 14,04- 1 0-4c1 zt= ..g),:ii ilitca OO DICX Sen.)-e- a pc caolim 0.10scAle4 Intra-oral Photos Taken: . Yes 0 Radiographs Taken: (Document fi ndings on A&O encounter) yes O • Instructed how to obtain urgent and non -urgent dental care: Yes: I No: Treatrnent Priorities: None: Non -urgent non -urgent Urgent Referred to Sick can: Radiographs authorized: PM: - Prophylaxis 811 (Approval read 18 Yes V No examination date) k months flan BWs: Panorer Patient Name: n ' -3-e_Institution:c-rity/ E Dent' ' bps ft, r Number: 76 3 I S r- OS-LI MCC NEW YORK Date: 7- 2-6 -I 9. • Stamp: DS. PDF Prescribed by P64C0 let L)ental Umcer MCC New York Replaces BP-A0618 of JUN 10 EFTA00035184 OP -S358.060 MEDICAL TREATMENT REFUSAL COFRM SEP 05 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: EYE DOCTOR EVALUATION. The following treatment(s) was/were recommended: EYE DOCTOR EVALUATION. 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: INABILITY TO DIAGNOSE CURRENT OPTHALMOLOGIC DISEASES. 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. 7-24-2019 S Date NYM-NEW YORK MCC Dale EFTA00035185 Federal Bureau of Prisons U.S. Medical Center for Federal Prisons 1900 W. Sunshine Street Springfield, MO 65807 417-874-1621 "' Sensitive But Unclassified "" Name EPSTEIN, JEFFREY Reg # 76318-054 DOB 01/20/1953 Sex M Facility MCC New York Order Unlit Provider MD Collected 07/09/2019 13:34 Received 07/10/2019 10:44 Reported 07/10/201914:46 LIS ID 188191004 HIV HIV 1/2 Negative Screening test - See confirmatory testing for Reactive results Negative FLAG LEGEND L=Low L!=Low Critical H=High H!=High Critical A=Abnormal A! =Abnormal Critical Page 3 of 3 EFTA00035186 Bureau of Prisons Health Services Cosign/Review Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Race: WHITE Encounter Date: 07/10/2019 16:58 Provider: Lab Result Receive Facility: NYM Cosigned by on 07/14/2019 18:12. Bureau of Pris