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

and/or Radio. Restraint Equipment Cage inventory conducted. equipMent accounted for. Metal Detector checks conducted. operative w/the exception of Rear Gate/Facilities/R&D. Roof Check completed. All secure. Temporary Chit Inventory: #1:2; #2:5; #3:5; #4:6; #5:5; #6:0; Hosp:O are PREA All All 758 73/5 12:00

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

and/or Radio. Restraint Equipment Cage inventory conducted. equipment accounted for. Metal Detector checks conducted. operative w/the exception of Rear Gate/Facilities/R&D. Roof Check completed. All secure. Temporary Chit Inventory: #1:2; #2:5; #3:5; #4:6; #5:5; #6:0; Hosp:0 are PREA All All 758 73/5 12:00

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

and/or Radio. Restraint Equipment Cage inventory conducted. equipment accounted for. Metal Detector checks conducted. operative w/the exception of Rear Gate/Facilities/R&D. Roof Check completed. All secure. Temporary Chit Inventory: #1:2; #2:5; #3:5; #4:6; #5:5; #6:0; Hosp:O are PREA All All 12:00 AM Institut