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

19136788_UPDATE_20190811_193631.pdf Note Type: Status Management Department: Pathology DateTime: 08/11/2019 19:40 Entered By: Cms System Notes: NEW DC Note Type: Status Management Department: Mortuary Detonate?: 08/11/201918:11 Entered By: Notes: Check-Out Borough: Manhattan Note Type: FOS Tim

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

Status Management Department: Pathology Notes: 19136788_UPDATE_2019081 I _ 93631 .pdf Note Type: Status Management Department: Pathology Notes: NEW DC Note Type: Status Management Department: Mortuary Notes: Check-Out Borough: Manhattan Note Type: FOS Time out Department: Quality Assurance No

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

19136788_UPDATE_20190811_193631.pcif Note Type: Status Management Department' Pathology DateTime: 08/11/2019 19:40 Entered By: Cms System Notes: NEW DC Note Type: Status Management Department Mortuary Notes: Cheek-Out Borough: Manhattan Note Type: FOS Time out Department: Duality Assurance Not