Epstein Secrets

- Medical Consent And Records Release I certify that the information I have provided above is true to the best of my knowledge. I hereby authorize the United States Marshals Service to request, review, and have access to all medical records of care provided to me during the time that I am in the custody of that agency, and to al

on III must be signed by the prisoner. If prisoner refuses to sign, note that in the signature block. All refusals should be immediately reported to the Office of Interagency Medical Services, Prisoner Services Division. The completed Form USM-552 is to be retained in the prisoner's files. Section I - USMS Prisoner Information I. Prison

purposes of providing me with appropriate medical care, adjudicating medical bills for health care services provided to me while in the custody of the United States Marshals Service, and for infectious disease clearances. Signature of Prisoner Date Signature of USMS Intake Officer Date Original--Prisoner File Copy to Distri

on III must be signed by the prisoner. If prisoner refuses to sign, note that in the signature block. All refusals should be immediately reported to the Office of Interagency Medical Services, Prisoner Services Division. The completed Form USM-552 is to be retained in the prisoner's files. Section I - USMS Prisoner Information I. Prison

Ill - Medical Consent And Records Release I certify that the information I have providedabove is true to the best of my kaowledgc. hereby authorize the United States Marshals Service to request review, and have access to all medical records of cam provided to mc during the lime dial I am St the custody of that agency. and to all

on III must be signed by the prisoner. If prisoner refuses to sign, note that in the signature block. All refusals should be immediately reported to the Office of Interagency Medical Services. Prisoner Services Division. The completed USM form 552 is to be retained in the prisoner's files. Section I - USMS Prisoner Information I. Prison