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

y: LCEJA(via Livescan) Note Type: Status Management Department: Other Deter/me: 08/11/2019 11:54 Entered By: Notes: Entered case to determine if Mortuary access was ready to be rescinded. Note Type: Status Management Department Identifications Date Time: 08/11/2019 11:02 Entered By: Cms System Not

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

ia Livescam Note Type: Status Management Department Other Clete Time: O8/11Ø91134 Entered By: Kan3em Wiggins Notes: Entered case to determine if Mortuary access was ready to be resdnded. Note Type: Status Management Department: Identifications getellmc O8/11201911Ø Entered By: Can System Notes: ID

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

By : LCEJA(vitt Uvescan) Note Type: Status Management Department: Other attennte:06I11/2019 11:54 EnteredDy: Notes: Entered case to determine If Mortuary access was ready to be rescinded. Note Type: Status Management Department: Identifications Datenme: 08/11/2019 11:02 Entered By: Cms System Note