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

t listed for each compound represents the lowest concentration of the compound that will be reported as being positive. If the compound is listed as None Detected, It Is not present above the Reporting Limit. Please refer to the Positive Findings section of the report for those compounds that were identified a

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

t listed for each compound represents the lowest concentration of the compound that will be reported as being positive. If the compound is listed as None Detected, it is not present above the Reporting LM'iit. Please refer to the Positive Findings section of the report for those compounds that were identified

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

t listed for each compound represents the lowest concentration of the compound that will be reported as being positive. If the compound Is listed as None Detected, it is not present above the Reporting Limit Please refer to the Positive Findings section of the report for those compounds that were identified as