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

/19/201910:57 Entered By: Notes: Request No: 1905197( ) Note Type: Status Management Department: Pathology DateTime: 08117201911:16 Entered By: Edrs Service Notes: 19138788_UPDATE_20190817_111227.pdf Note Type: Status Management Department: Pathology Date Time: 08/17/201911:15 Entered By: Cms System

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

19 09:36 Entered By: Men Naka no match to records. Delta:me: 08/122019 17:14 Entered By: Nicholas Schultz Dater/me:08/1112019 19:40 Entered By: Edrs Service Datertme: 08/11/2019 19:40 Entered By: Cms System DateTime: 08/11/2019 18:11 Entered By: Sneyder Desousa Cotentin: 08/11/2019 17:41 Entered By:

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

om 07/23/2019. These were entered into the CMS record. Note Type: Status Management Department: Pathology Dafertme: 08/11/2019 19:40 Entered By: Edrs Service Notes: 19136788_UPDATE_20190811_193631.pcif Note Type: Status Management Department' Pathology DateTime: 08/11/2019 19:40 Entered By: Cms System