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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
8/10/2019 08:19 Notes: Call location MCC prison possible hanging Initial Call Recorded By: Canty, Shirley Printed: 08127/201946:10 EFTA00130107 DEPARTMENT OF HEALTH AND MENTAL HYGIENE OFFICE OF CHIEF MEDICAL EXAMINER Barbara A. Sampson, M.D.-Ph.D. Chief Medical Examiner 520 First Avenue, New York, New York 10016 Teleph
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
sion LO Lut sevised MAX& e..7r ii•eiteent L 2018 8504592 EPSTEJN, JEFFREY 08/10/2019 Tole 01/20/1953 M 421948243 07 27AM 0 M EFTA00063554 DEPARTMENT OF HEALTH AND MENTAL HYGIENE OFFICE OF CHIEF MEDICAL EXAMINER Barbara A. Sampson, M.D.-Ph.D. Chief Medical Examiner 520 First Av e New Y rk. New York 10016 Telephon
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
Shirley Canty Notes: Call location MCC prison possible hanging Initial Call Recorded By: Printed: 0812712019-16:10 EFTA00133127 EFTA00133128 DEPARTMENT OF HEALTH AND MENTAL HYGIENE OFFICE OF CHIEF MEDICAL EXAMINER Chief Medical Examiner 520 First Avenue, New York, New York 10016 Telephone: Official Website: www.nyc.
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