BP-S358 .060
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.
7-24-2019
Date s Sign Date
CONFIDENTIAL NYM-NEW YORK MCC
3
1
SDNY 00009374
EFTA00139318
BP-S358.C60
SEP 05 MEDICAL TREATMENT REFUSAL COMM
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:
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.
7-10-2019
Date
Signature of Witness Paten Signature Date
NW-NEW YORK MCC
CONFIDENTIAL SDNY 00009375
EFTA00139319
BP-S358 060 MEDICAL TREATMENT REFUSAL C0FRkl
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:
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.
Counseled by
NYM--NEW YORK MCC as Sign Date i•
I
CONFIDENTIAL SDNY_00009376
EFTA00139320
BP-A0618 A&O DENTAL EXAMINATION
JUN 16 (Initial Clinical Dental Findings)
U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS
POF (Approval valid 18 months from examination date)
Ptescdbod by P6400 re en icer
MCC New York
Replaces BP.A0618 of JUN 10
CONFIDENTIAL SDNY_00009377
EFTA00139321
BP-A0618
JUN 16
U.S. DEPARTMENT OF JUSTICE A&O DENTAL EXAMINATION
(Initial Clinical Dental Findings)
FEDERAL BUREAU OF PRISONS
PM:
BWs:
Panorex: (Approval valid 18 months from examination date)
PeentName:
gip &kin eSirity
r Institution: /
MCC NEW YORK Number: I
7‘31(C-os-I Den' •
Date:
PDF Piesalbed by P6400 Signature Block/Stamp:
Replaces BP-A0616 c4JUN 10
CONFIDENTIAL SDNY_00009378
EFTA00139322
BP-5358 060 MEDICAL TREATMENT REFUSAL CDFRM 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:
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.
Counseled by 7-24-2019
Dale Pa as Sign
NYM--NEW YORK MCC Date
CONFIDENTIAL SDNY_00009379
EFTA00139323
Federal
Bureau of
Prisons U.S. Medical Center for Federal Prisons
••• Sensitive But Unclassified •••
Name EPSTEIN, JEFFREY
Reg # 76318-054
DOB 01/20/1953
Sex M Facility MCC New York
Order Unit E06-547U
Provider Collected 07/09/2019 13:34
Received 07/10/2019 10:44
Reported 07/10/2019 14:46
LIS ID 188191004
HIV
FLAG LEGEND L=Low L!=Low Critical H=High H!=High Critical A=Abnorrnal A! =Abnormal Critical
Page 3 of 3
CONFIDENTIAL SDNY_00009380
EFTA00139324
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 byl on 07/14/2019 18:12.
Bureau of Prisons - NYM
CONFIDENTIAL SDNY_00009381
EFTA00139325
BP-S358 C50 MEDICAL TREATMENT REFUSAL CDFRM
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:
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.
7-24-2019
Counseled by Date
NYM--NEW YORK MCC
CONFIDENTIAL SDNY_00009382
EFTA00139326
BP-A0618
JUN 18
U.S. DEPARTMENT OF JUSTICE A&O DENTAL EXAMINATION
(initial Clinical Dental Findings)
FEDERAL BUREAU OF PRISONS
•
Instructed how to obtain urgent and non-urgent dental care: Yes: i No:
Treatment Priorities: None: Non-urgent
non-urgent Urgent Referred to Sick Call:
Radiographs authorized:
PM: . Prophylaxis authorized: Yes I No
(Approval valid 18 months from examination date)
8Ws:
Panorex:
Patient Name:
s--c4 .
n 1--)C_M -Q t1 E Den'
ins FAc
T4Number. I
-7G 3 1 Sf- D.S-\ Institution: /
MCC NEW YORK Date:
7- zo -1 Q.
PDF Prescribed by P64C0 Replaces BP.A0618 ofJON 10
CONFIDENTIAL SDNY_00009383
EFTA00139327
Ell:14358.0W
SEP 05
U.S. DEPARTMENT OF JUSTICE MEDICAL TREATMENT REFUSAL CDFRM
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.
Counseled by 7-24-2019
Date
NYM-NEW YORK MCC
CONFIDENTIAL SDNY_00009384
EFTA00139328
BP-S358.C60 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:
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.
Counseled by 7-10-2019
Date Patien Signature
Signature of Witness Date NYM-NEW YORK MCC Date
CONFIDENTIAL SDNY_00009385
EFTA00139329
BP-A0618
JUN 16
U.S. DEPARTMENT OF JUSTICE A&O DENTAL EXAMINATION
1
7-2-6 -19. r Number:
76 3 RP- US-1/4i (Initial Clinical Dental Findings)
FEDERAL BUREAU OF PRISONS
3-c.c.city £ Institution: /
MCC NEW YORK
POE non-urgent
Prophylaxis authorized: No
(Approval valid 18 months from examination date)
Date:
Prescribed by P8400 Replaces 8P-A0618 of JUN 10 /
CONFIDENTIAL SDNY_00009386
EFTA00139330
Bureau of Prisons
Health Services
Clinical Encounter
Inmate Name: EPSTEIN, JEFFREY EDWARD Reg 76318-054
Date of Birth: 01/20/1953 Sex: Facility: NYM
Encounter Date: 08/10/2019 07:25 Provider: Unit: Z04
Emergency Code - Resuscitation Event encounter performed at Special Housing Unit.
SUBJECTIVE:
Emergency Note Provider:
Team Members:
Provider Bak
Team/Code Leader
Code Events:
Tvoe Value Data
CPR Compressions 08/10/2019 06:35
EKG/Monitor Lifepak 08/10/2019 06:39
No shock advised
CPR Compressions 08/10/2019 06:40
Oxygen 15 L 08/10/2019 06:47
IV Access Peripheral IV 08/10/2019 06:48
18 g Left AC
Airway Endotracheal Tube
ET Tube 7.5 24CM to L Lip line Placed by Paramedics 08/10/2019 07:08
Medications Epinephrine 1mg IV 08/10/2019 07:10
Epinephrine 3 doses and Sodium bicarb 2 doses administered by paramedics
CPR Compressions 08/10/2019 07:11
Medications Sodium Bicarbonate 1 mEa/kg IV 08/10/2019 07:11
IV Fluids Normal Saline 0.9% 1000 ml 08/10/2019 07:12
Medications Epinephrine 1mg IV 08/10/2019 07:13
CPR Compressions 08/10/2019 07:14
Medications Sodium Bicarbonate 1 mEa/kg IV 08/10/2019 07:14
Medications Epinephrine 1mg IV 08/10/2019 07:16
CPR Compressions 08/10/2019 07:17
Comments:
Responded to a body alarm at 0635 for medical emergency on 9S, Upon arrival Inmate was received on the floor of his
cell unresponsive with CPR in progress by correctional officers, Inmate was Cold, with circumferential Bruising around the
neck and posterior mottling, Pupils Fixed and dilated, No Palpable pulses, Call place for EMS, CPR Continued, AED
Placed No shock advised, CPR Continued, inmate transported to HSU treatment room with CPR in progress, 18g hep lock
to L AC, O2 15 Lt ViA BVM, Pulse Check NO SHOCK advised. EMS and Paramedics arrived 0656, Placed on cardiac
monitor asystole Resumed CPR, Inmate was intubated by Medics, 3 Rounds of Epinephrine administered, Pulse Check
asystole, Inmate was transported to Local ER with CPR in progress.
OBJECTIVE:
Exam:
General
Appearance
Yes: Unconscious
Generated 08/1012019 08:10 by Bureau of Prisons - NYM Page 1 of 2
CONFIDENTIAL SDNY_00009387
EFTA00139331
Inmate Name: EPSTEIN. JEFFREY EDWARD
Date of Birth: 01/20/1953 Sex:
Encounter Date: 08/10/2019 07:25 Provider: M Rare: WHITF Reg #: 76318.054
Facility: NYM
Unit: Z04
Exam:
ASSESSMENT:
Cardiac Arrest
PLAN:
New Consultation Requests:
Consultation/Procedure Target Date Scheduled Target Date Priority Translator Language
Emergency Room 08/10/2019 08/10/2019 Emergent No
Subtype:
AMBULANCE
Reason for Request:
Cardiac arrest with CPR in progress
Copay Required:No
TelephoneNerbal Order: No
Completed b
Requested to be cosigned by
Cosign documentation will be displayed on the following page. Cosign Required: Yes
n 08/10/2019 08:10
Generated 0811012019 08:10 by Bureau of Prisons • NYM Page 2 of 2
CONFIDENTIAL SDNY_00009388
EFTA00139332
Bureau of Prisons
Health Services
Clinical Encounter
Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054
Date of Birth: 01/20/1953 Sex: • Facility: NYM
Encounter Date: 07/30/2019 15:58 Provider: Unit: 201
Chronic Care - Chronic Care Clinic encounter performed at Health Services.
SUBJECTIVE:
COMPLAINT 1 Provider:
CONFIDENTIAL SDNY_00009389
EFTA00139333
Inmate Name: EPSTEIN, JEFFREY EDWARD
Date of Birth: 01/20/1953 Sex:
Encounter Date: 07/30/2019 15:58 Provider:
Generated 07/30/2019 16:12 by Bureau of Prisons • NYM Page 2 of 2 M Race: WHITE Reg #: 76318-054
Facility: NYM
Unit: 201
CONFIDENTIAL SDNY_00009390
EFTA00139334
Bureau of Prisons
Health Services
Clinical Encounter
Inmate Name: EPSTEIN, JEFFREY EDWARD Reg ft 76318-054
Date of Birth: 01/20/1953 Sex: M Race: WHITE Facility: NYM
Encounter Date: 07/30/2019 11:12 Provider: Unit: 201
Generated 07/302019 14A5 by Bureau of Prisons NYM Page 7 of 3
CONFIDENTIAL SDNY_00009391
EFTA00139335
Inmate Name: EPSTEIN, JEFFREY EDWARD
Date of Birth: 01/20/1953
Encounter Date: 07/30/2019 11:12 Sex:
Provider: M Race: WHITE Reg #: 76318-054
NYM
Unit: 201
CONFIDENTIAL SDNY_00009392
EFTA00139336
Inmate Name: EPSTEIN, JEFFREY EDWARD
Date of Birth: 01/20/1953
Encounter Date: 07/30/2019 11:12
Generated 07/30/2019 14:05 by Bureau of Prisons • NYM Page 3 of 3 Sex:
Provider M Race: WHITE Reg #: 76318-054
Facility: NYM
Unit: 201
CONFIDENTIAL SDNY_00009393
EFTA00139337
Bureau of Prisons
Health Services
Clinical Encounter
Inmate Name: EPSTEIN. JEFFREY EDWARD
Date of Birth: 01/20/1953
Encounter Date: 07/30/2019 11:12 Sex: M Race: WHITE
Provider: Reg #: 76318-054
Facility: NYM
Unit: Z01
CONFIDENTIAL SDNY_00009394
EFTA00139338
Inmate Name: EPSTEIN, JEFFREY EDWARD
Date of Birth: 01/20/1953
Encounter Date: 07/30/2019 11:12 Sex: M Race: WHITE
Provider:Reg #: 76318-054
Facility: NYM
Unit: ZO1
CONFIDENTIAL SDNY 00009395
EFTA00139339
Inmate Name: EPSTEIN. JEFFREY EDWARD
Date of Birth: 01/20/1953 Sex:
Encounter Date: 07/30/2019 11:12 Provider:
Generated 07/30/2019 14.05 by M Race: WHITE Reg 8: 76318-054
Facility: NYM
Unit: 201
Bureau of Prisons • NYM Page 3 of 3
CONFIDENTIAL SDNY_00009396
EFTA00139340
Bureau of Prisons
Health Services
See Amendment
Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054
Date of Birth: 01/20/1953 Sex: M Race: WHITE
Encounter Date: 07/30/2019 15:58 Facility: NYM
Amendment made to this note by on 07/30/2019 16:12.
Bureau of Prisons - NYM
CONFIDENTIAL SDNY_00009397
EFTA00139341
📷 Images in this document (24 detected; 6 largest described)
AI-generated factual descriptions of embedded images (llava:13b). These are searchable across the corpus.
[Image 1] The image shows a document titled "Bureau of Prisons" with the heading "Clinical Encounter." The document appears to be a medical record or report, listing various medical procedures and medications administered to an individual. The visible fields include the patient's name, date of the encounter, and the name of the healthcare provider. The document includes sections for "Subjective," "Objective
[Image 2] The image shows a document that appears to be a medical treatment refusal form from the US Department of Justice. The form is titled "MEDICAL TREATMENT REFUSAL" and is dated 08/19/2019. It includes sections for the inmate's name, the name of the medical facility, and the name of the medical staff member. There is a checkbox for "I refuse medical treatment" and a section for the reason for the refu
[Image 3] The image shows a document titled "MEDICAL TREATMENT REFUSAL" from the Federal Bureau of Prisons. The document is a form with various fields filled out, including the name of the inmate, the date, and the reason for the refusal. The form includes a section for the medical staff to provide a brief explanation of the refusal, which is redacted in the image. The document is signed by a medical staff
[Image 4] The image shows a document that appears to be a medical treatment form from the U.S. Department of Justice, Medical Treatment Facility. The form includes sections for patient information, diagnosis, treatment, and a section for the attending physician's signature. The form is partially obscured by a red "CONFIDENTIAL" stamp, indicating that the information is sensitive and not to be shared without
[Image 5] The image shows a document that appears to be a medical treatment recommendation letter from the U.S. Department of Justice Medical Treatment Request. The letter is addressed to a specific individual and includes a date and a signature at the bottom. It mentions a specific treatment recommendation for a medical condition. The document is a formal letter with a header and footer, and it includes a
[Image 6] The image shows a document that appears to be a medical treatment record or a form related to medical treatment. It is a scanned document with visible text and fields to be filled out. The document is titled "Department of Justice Medical Treatment Refusal Form." It includes sections for the patient's name, date of birth, and medical treatment information. There is a checkbox for "Refusal of Medic