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9 07:25 Sex: M Race: WHITE Provider. Reg #: 76318-0 Facility: NYM RN Unit: Z04 Emergency Code - Resuscitation Event encounter performed at Special Housing Unit. SUBJECTIVE: Emergency Note Provider: RN Team Members: Provider Balt RN Team/Code Leader Code Events: 1-Yea CPR Value, Compressions EKG/

ations, listed above, and still refuse recommended treatment. I hereby assume all responsibility for my physical and/or mental CO Won, and release the Buroau of Prisons and Its employees from any and all liability for respecting and f• owing my expressed wishes and directions. MD 7-24-2019 Counseled by Date Signature

/2019 07:25 Sex: M Race: WHITE Provider. Reg #: 76318-0 Facility: NYM Unit: Z04 Emergency Code - Resuscitation Event encounter performed at Special Housing Unit. SUBJECTIVE: Emergency Note Provider: Team Members: Provider Hs& Team/Code Leader Code Events: IYM CPR Value, Compressions EKG/Monitor Li

ations, listed above, and still refuse recommended treatment. I hereby assume all responsibility for my physical and/or mental CO Won, and release the Buroau of Prisons and Its employees from any and all liability for respecting and f• owing my expressed wishes and directions. 7-24-2019 Counseled by Date a** si .nature

9 07:25 Sex: M Race: WHITE Provider. Reg #: 76318-0 Facility: NYM RN Unit: Z04 Emergency Code - Resuscitation Event encounter performed at Special Housing Unit. SUBJECTIVE: Emergency Note Provider: RN Team Members: Provider RN Team/Code Leader Code Events: IYM CPR Value Compressions EKG/Monitor L

ations, listed above, and still refuse recommended treatment. I hereby assume all responsibility for my physical and/or mental CO 'Won, and release the Buroau of Prisons and Its employees from any and all liability for respecting and f• owing my expressed wishes and directions. 7-24-2019 Counseled by Dale a is Sign NYM