Epstein Secrets

care in last 33 days 72 Yes No U Papitil in-pabent HeepiW ED/ outpatient U •losp COA C Other. specify: J J Nursing hone/long teem care Hospice rickey Decedent's residence DAM AND HOUR Of MAIM: 08/10/2019 7:36 AM Unk INJURY: Date Time: AM PM AT WORK J YES U NO TYPE OF PLACE:Irk

tein. Mark Note Type: ID Event Department: Identifications Date77me: 08/11/2019 09:56 Entered By: Notes: Dr. S presented to our office with the Decedent's brother to watch the autopsy. He was given an observer form to complete and was swabbed before he went to observe the autopsy Note Type: Status M

r: O Recent hospitalizations or travel: if yes, where and when: O Dentist name/address): O Tattoos or scars (e.g., old surgery), describe: 0 Any Hospice care in last 30 days? If so, where: High blood pressure Heart problems Diabetes Seizures Lung problems Tuberculosis Tobacco use Brain infecti

No U '36 f t i C Hospital in.pstient I-Capita/ ED/ ail:patient Hasp WA Other, specify: U U U Nursing hcene/long wan ewe Hospice facility Decedent's residence DATE AND HOUR OF DEATH: 08/10/2019 7:36 AM Jnk INJURY: Cote Time: AN PM AT wOR< YES _ NO TYPE OF PLACE:IN:me, Stmet, etc./ L

last 93 days Yes ijb• No u NO U. 0 Hospital In-patient Hospital ED/outpatient Hoop DOA Other specify: u U U Nursing harnMong term care Hospice facity Decedents resktence DATE AND HOUR OF DEATH: 08/10/2019 7:36 AM u Unk INJURY: Date Time: AM PM AT WORK U YES U NO TYPE OF PIACE

Epstein, Mark Note Type: ID Even Department: Identifications Detonate: 08/1112019 09:58 Entered By: Notes: Dr. resented to our office with the Decedent's brother to watch the autopsy. He was given an observer form to complete an was swabbed before he went to observe the autopsy Note Type: Status Ma